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Accepted Papers


Free Insomnia in Primary Care: Misreported, Mishandled, and Just Plain Missed. 937-939.
Michael A. Grandner, PhD, MTR, CBSM, FAASM1,2; Subhajit Chakravorty, MD3,4

Scientific Investigations

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea. 941-947.
Patrick Koo, MD, ScM; Eric J. Gartman, MD; Jigme M. Sethi, MD; Eyad Kawar, MD; F. Dennis McCool, MD


Current Knowledge/Study Rationale: Sleep-disordered breathing (SDB) may be worsened by reductions in end-expiratory lung volume (EELV). However, there are few reports examining change in EELV following sleep onset and during stage R (REM sleep). Previous studies incorporated invasive means to study lung volume changes. These methods may have interfered with sleep or induced change in EELV. The current study investigated whether noninvasive measures of chest wall motion using magnetometry could be used to measure change in EELV during sleep and if changes were related to indices of SDB.

Study Impact: Measurements of change in EELV with magnetometry can be used during sleep and provide a precise, noninvasive, continuous alternative to more invasive methods used to measure change in EELV. The significant reduction in EELV during stage R sleep compared to non-stage R sleep may be one mechanism accounting for the predominance of SDB during stage R sleep noted in some individuals.

Article Is Eligible For CME Credits Validated Measures of Insomnia, Function, Sleepiness, and Nasal Obstruction in a CPAP Alternatives Clinic Population. 949-957.
Austin S. Lam, BS1; Nancy A. Collop, MD2,3; Donald L. Bliwise, PhD2,4; Raj C. Dedhia, MD, MS2,5


Current Knowledge/Study Rationale: CPAP alternatives clinics specialize in the treatment of patients in whom CPAP therapy fails or is declined. Because CPAP nonadherence is highly prevalent and contributes to significantly decreased quality of life and overall health, this study was undertaken to examine and describe the characteristics of patients who are CPAP nonadherent who actively seek treatment and present to a CPAP alternatives clinic.

Study Impact: This study demonstrates that patients who present to a CPAP alternatives clinic have moderate to severe, untreated OSA and exhibit significant insomnia, nasal obstruction, and functional impairment. This highlights the importance of encouraging patients such as these to seek CPAP alternatives clinics for both symptomatic improvement and avoidance of OSA sequelae.

Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity. 959-966.
Ming Zheng, MD1,2; Xiangdong Wang, MD1,2; Siqi Ge, MS3; Ying Gu1; Xiu Ding1; Yuhuan Zhang4; Jingying Ye, MD4; Luo Zhang, PhD1,2,5


Current Knowledge/Study Rationale: Several studies have suggested that rhinitis contributes to the pathogenesis of obstructive sleep apnea. However, to date, few studies have investigated the prevalence of AR and NAR in patients with OSA.

Study Impact: The presence or severity of AR or NAR does not influence the severity of OSA; however, rhinitis may significantly disturb sleep in patients with OSA. As rhinitis may lead to significant changes in sleep patterns in patients with OSA, AR and NAR may be considered as symptoms potentiating, rather than risk-potentiating factors in the pathophysiology of OSA.

Self-Reported Sleep Quality, Duration, and Health-Related Quality of Life in Older Chinese: Evidence From a Rural Town in Suzhou, China. 967-974.
Chen-Wei Pan, MD, PhD1; Xiaoling Cong, Bsc2; Hui-Jun Zhou, MD, MSc, PhD3; Jing Li, PhD4; Hong-Peng Sun, PhD1; Yong Xu, MSc1; Pei Wang, MSc, PhD5,6


Current Knowledge/Study Rationale: To date, only two studies have assessed the sleep-HRQOL relationships in an older population. More investigations are needed to understand the nature of this association. The current study is aimed to explore the cross-sectional associations of sleep quality and duration with HRQOL in older Chinese based on data from a large community-based survey.

Study Impact: We found that self-reported poor sleep quality and extreme sleep durations were associated with worse HRQOL among older community-dwelling Chinese. Given the ever-growing aging population in China, sleep quality/duration thus should be taken into consideration as important factors when inquiring about HRQOL of older Chinese.

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome. 975-980.
David G. Ingram, MD1; Amanda G. Ruiz, BA2; Dexiang Gao, PhD3; Norman R. Friedman, MD2


Current Knowledge/Study Rationale: Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA), and adenotonsillectomy is the first-line therapy. To date, outcomes data are limited to small case series, and the current study is the largest study to date examining polysomnographic outcomes.

Study Impact: The outcome data are reliable because there was not a lengthy delay from the diagnosis of OSA to surgical intervention and subsequent postoperative polysomnographic assessment. Our results demonstrate that despite these children having significant improvements in OSA severity following surgery, approximately 50% have residual disease that is moderate/severe.

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea. 981-989.
Stephen Hawkins, MD1,2; Stephanie Huston, BS1; Kristen Campbell, BS3; Ann Halbower, MD1,2


Current Knowledge/Study Rationale: Pediatric obstructive sleep apnea is associated with significant morbidity but the efficacy of CPAP treatment is limited by poor adherence. Inadequate evidence exists to support the use of HFNC for OSA treatment, although its use is widespread for treatment of a variety of conditions such as neonatal respiratory distress and chronic obstructive pulmonary disease.

Study Impact: We provide much-needed data that demonstrate improved respiration with the use of HFNC in children with OSA and CPAP intolerance. This adds to a scant evidence base that provides justification to payers while emphasizing that HFNC for pediatric OSA needs to be a topic of further rigorous study, especially compared to CPAP.

Article Is Eligible For CME Credits Free Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment. 991-999.
Christi S. Ulmer, PhD, CBSM1,2; Hayden B. Bosworth, PhD1,3; Jean C. Beckham, PhD2,4; Anne Germain, PhD5; Amy S. Jeffreys, MStat1; David Edelman, MD1,6; Stephanie Macy, BS1; Angela Kirby, MA4; Corrine I. Voils, PhD7,8


Current Knowledge/Study Rationale: Prior research has not examined primary care provider (PCP) perspectives on treatment within the Veterans Affairs (VA) health care system. This study was conducted to expand the existing literature with data from the VA health care setting.

Study Impact: Despite increased availability of cognitive behavioral therapy for insomnia within the VA, this study reveals the need for additional systems-level changes. Specifically, PCP education and practice standards are needed to increase patient access to evidence-based insomnia treatments.

Free Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal. 1001-1008.
Liese Exelmans, MA1; Jan Van den Bulck, DSc, PhD2


Current Knowledge/Study Rationale: Whether regular television viewing has much effect on sleep is debated. New viewing patterns, such as binge viewing, in which consumers watch an excessive amount of television in one sitting, have, however, not been studied. There is also a lack of understanding of the underlying mechanism of the association between technology use and sleep.

Study Impact: The current study shows binge viewing is prevalent among young adults and is the first to demonstrate a link with poorer sleep quality, more fatigue, and increased insomnia. Importantly, the mechanism explaining this relationship appears to be increased cognitive arousal, resulting from binge viewing. Although this has been explained by viewers' higher level of engagement with the television show, future research should verify this hypothesis.

Emerging Technologies

Evaluation of Continuous Negative External Pressure (cNEP) for the Treatment of Obstructive Sleep Apnea: A Pilot Study. 1009-1012.
Jerrold A. Kram, MD, FAASM1; Robyn V. Woidtke, MSN, RN1; Kenneth B. Klein, MD2; Richard M. Rose, MD3

Case Reports

A Case of “Abnormally Abnormal” Hypoxic Ventilatory Responses: A Novel NPARM PHOX 2B Gene Mutation. 1013-1015.
Stefan A. Unger, PhD, MRCPCH1,2; Maude Guillot, MBChB1; Donald S. Urquhart, MD, FRCPCH1,2
Parental Fitness Questioned on the Grounds of Narcolepsy: Presentation of Two Cases. 1017-1018.
Laura Barbero, MD1; Annamaria Govi, MD1; Fabio Pizza, MD, PhD2,3; Giuseppe Plazzi, MD2,3; Francesca Ingravallo, MD, PhD1,3

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