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Accepted Papers


AASM Scoring Manual Version 2.2 Updates: New Chapters for Scoring Infant Sleep Staging and Home Sleep Apnea Testing. 1253-1254.
Richard B. Berry, MD1; Charlene E. Gamaldo, MD2; Susan M. Harding, MD3; Rita Brooks, MEd, RST, RPSGT4; Robin M. Lloyd, MD5; Bradley V. Vaughn, MD6; Carole L. Marcus, MBBCh7


Sleep Disorders in Indigenous Communities: Time to Close the Gap. 1255-1256.
Garun Hamilton, MBBS, FRACP, PhD1,2; Simon Joosten, MBBS, BMedSc, FRACP1,2

Scientific Investigations

Narcolepsy Type 1 and Idiopathic Generalized Epilepsy: Diagnostic and Therapeutic Challenges in Dual Cases. 1257-1262.
Simone Baiardi, MD1; Stefano Vandi, RPSGT1,2; Fabio Pizza, MD, PhD1,2; Lara Alvisi, R.EEG.T1,2; Lucia Toscani, MD3; Elena Zambrelli, MD4; Paolo Tinuper, MD1,2; Geert Mayer, MD5; Giuseppe Plazzi, MD, PhD1,2


Current Knowledge/Study Rationale: Misdiagnosis of NT1 as generalized epilepsy is not rare, especially in children and young adults close to disease onset. The prevalence of dual cases of NT1 and generalized epilepsy is unknown; although probably rare they represent diagnostic and therapeutic challenges.

Study Impact: A comprehensive neurologic and hypnologic interviews as well as electrophysiological studies (namely, EEG, nocturnal polysomnography, MSLT, videopolygraphy) are mandatory for the differential diagnosis and to disclose dual cases. Sodium oxybate in combination with antiepileptic drugs is safe and effective in treating cataplexy and excessive daytime sleepiness in comorbid NT1 and generalized epilepsy.

Sleep Disorders in Aboriginal and Torres Strait Islander People and Residents of Regional and Remote Australia. 1263-1271.
Cindy E. Woods, PhD1,2; Karen McPherson, RM3; Erik Tikoft, BNg3; Kim Usher, PhD2; Fariborz Hosseini, MBBS3; Janine Ferns, BSci4; Hubertus Jersmann, MBBS3,5; Ral Antic, MBBS3,5,6; Graeme Paul Maguire, PhD1,3,7


Current Knowledge/Study Rationale: There are currently no published data relating to the nature of sleep related breathing disorders affecting Aboriginal and Torres Strait Islander adults. Addressing these knowledge gaps is particularly relevant as access to diagnostic and treatment services for sleep related breathing disorders for Indigenous Australians is likely to be influenced by their lifestyle and cultural and geographic factors, all of which can impede access to health care and the ability to comply with management plans.

Study Impact: Our data from northern and central Australia have demonstrated that Aboriginal and Torres Strait Islander peoples have a reduced rate of use of diagnostic sleep services and there are significant difficulties in ensuring follow-up and thus, by extension, the implementation and refinement of treatment. Education regarding the health risks of untreated OSA and the benefits of treatment is essential, as is support for patients and local health care providers to persevere through the difficult adjustment period when commencing continuous positive airway pressure treatment therapy.

Long-Term Follow-up Investigation of Isolated Rapid Eye Movement Sleep Without Atonia Without Rapid Eye Movement Sleep Behavior Disorder: A Pilot Study. 1273-1279.
Ambra Stefani, MD; David Gabelia, MD; Birgit Högl, MD; Thomas Mitterling, MD; Philipp Mahlknecht, MD, PhD; Heike Stockner, MD; Werner Poewe, MD; Birgit Frauscher, MD


Current Knowledge/Study Rationale: Isolated rapid eye movement (REM) sleep without atonia (RWA) might be an even earlier stage of synuclein-mediated neurodegeneration than REM sleep behavior disorder (RBD). To date, no data on isolated RWA progression over time are available.

Study Impact: This is the first long-term follow-up study in subjects with isolated RWA. We provide first evidence for neurodegeneration in isolated RWA, as shown by a progression of RWA over time, a positivity in neurodegenerative biomarkers, and a reported conversion rate to RBD in isolated RWA subjects.

Article Is Eligible For CME Credits Psychosocial Characteristics of Children with Central Disorders of Hypersomnolence Versus Matched Healthy Children. 1281-1288.
Kristin T. Avis, PhD, CBSM1; Jiabin Shen, PhD2; Patrick Weaver, BS2; David C. Schwebel, PhD2


Current Knowledge/Study Rationale: Hypersomnolence may impact children's daytime functioning and quality of life.

Study Impact: Pediatric central disorders of hypersomnolence influences academic functioning, quality of life, and wellness compared to healthy controls matched on age, race/ethnicity, gender, and estimated household income.

The Barcelona Sleepiness Index: A New Instrument to Assess Excessive Daytime Sleepiness in Sleep Disordered Breathing. 1289-1298.
Marc Guaita, DMD1,6; Manel Salamero, MD, PhD1,2,6,10; Isabel Vilaseca, MD, PhD1,3,7,10; Alex Iranzo, MD, PhD1,4,6,8; Josep M. Montserrat, MD, PhD1,5,7,10; Carles Gaig, MD, PhD1,4,8; Cristina Embid, MD, PhD1,5,7; Montserrat Romero, BSc1,6; Mònica Serradell, BSc1,9; Carme León, RN1,5; Joan de Pablo, MD, PhD1,2,6,10; Joan Santamaria, MD, PhD1,4,6,8,10


Current Knowledge/Study Rationale: Subjective sleepiness scales have weak correlations with objective measures of sleepiness and disease severity in patients with sleep disordered breathing. A new questionnaire developed using focus group techniques and validated with different objective sleepiness measures could be useful in clinical practice.

Study Impact: The Barcelona Sleepiness Index is a brief questionnaire of just two items, which correlates well with objective sleepiness measures, oxyhemoglobin desaturation and is sensitive to change with therapy. This instrument could be helpful in the evaluation of sleepiness, both during routine clinical interviews as well as a screening method in epidemiological studies.

Sleep Apnea in Patients with and without a Right-to-Left Shunt. 1299-1304.
Mohammad Khalid Mojadidi, MD1; Pooya Isaac Bokhoor, MD1; Rubine Gevorgyan, MD1; Nabil Noureddin, MD1; W. Cameron MacLellan, MD1; Eugenia Wen, MD2; Ravi Aysola, MD2; Jonathan M. Tobis, MD1


Current Knowledge/Study Rationale: Right-to-left shunt (RLS) occurs more frequently in patients with sleep apnea, and may be involved in the pathophysiology of sleep apnea. In this observational study, we determined the prevalence of RLS among patients with sleep apnea and compared clinical characteristics and the results of sleep studies of patients with and without RLS.

Study Impact: Patients with OSA and RLS have hypoxemia out of proportion to the observed respiratory disturbance, highlighting the likely role of RLS in the resultant nocturnal desaturation. Such observational studies support the hypothesis that the presence of a RLS from a PFO may exacerbate sleep apnea symptoms

Article Is Eligible For CME Credits Relationship between Clinical and Polysomnography Measures Corrected for CPAP Use. 1305-1312.
Erin M. Kirkham, MD, MPH1; Susan R. Heckbert, MD, PhD3; Edward M. Weaver, MD, MPH1,2


Current Knowledge/Study Rationale: For patients treated with continuous positive airway pressure (CPAP), some investigators have theorized that the discordance between patient-centered outcomes and polysomnography outcomes are due in part to the variability in CPAP use. We aim to test the hypothesis that patient-reported outcomes of CPAP treatment have stronger correlations with AHI when it is corrected for mean nightly CPAP use.

Study Impact: While the correlations between polysomnography measures and patient-reported outcomes improve after correcting AHI for CPAP use, the correlations remain weak. The use of weighted average formulas strengthen AHI as a surrogate measure and should be used whenever measuring AHI outcomes with CPAP, but patient-centered outcomes such as symptoms and quality of life should also be measured directly.

Predictors of Obstructive Sleep Apnea on Polysomnography after a Technically Inadequate or Normal Home Sleep Test. 1313-1318.
Michelle R. Zeidler, MD, MS1,2; Vicente Santiago, MD3; Joseph M. Dzierzewski2,4; Michael N. Mitchell, PhD4; Silverio Santiago, MD1; Jennifer L. Martin, PhD2,4


Current Knowledge/Study Rationale: Home sleep tests are becoming the first line diagnostic tool for identifying patients with OSA. As a result, understanding patient factors associated with PSG diagnosis of OSA among those not diagnosed with HST will facilitate improved triage and allocation of resources in health care systems.

Study Impact: This study suggests that older patients are more likely to require PSG if OSA is not diagnosed with HST. Cost-effectiveness research is needed to evaluate the utility of HSTs in subgroups of patients who are more likely to require a PSG.

Comparative Capabilities of Clinical Assessment, Diagnostic Criteria, and Polysomnography in Detecting Sleep Bruxism. 1319-1325.
Marcelo Palinkas, DDS, MSc, PhD1; Graziela De Luca Canto, DDS, MSc, PhD2,3; Laíse Angélica Mendes Rodrigues, DDS, MSc, PhD1; César Bataglion, DDS, MSc, PhD4; Selma Siéssere, DDS, MSc, PhD1; Marisa Semprini, DDS, MSc, PhD1; Simone Cecilio Hallak Regalo, DDS, MSc, PhD1


Current Knowledge/Study Rationale: Although PSG is considered the gold standard tool for SB diagnosis, the relative complexity of PSG and the inherent costs associated with this have spurred the quest for alternative diagnostic methods.

Study Impact: There is an acknowledged gap in the literature regarding diagnosis of SB, which is multifactorial in etiology and poses clinical challenges. Although a single set of simple criteria cannot capture the complexity of such a sleep movement disorder, it may be reasonable to combine the criteria evaluated in this study into a clinical algorithm that could form the basis for new diagnostic system combining intelligent methodologies and clinical insights. Future research is needed to clarify this topic and better provide tools with acceptable diagnostic test accuracy.

Review Articles

Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies. 1327-1334.
Luca Guarda-Nardini, MD, DDS1; Daniele Manfredini, DDS, PhD1; Marta Mion, MD2; Gary Heir, DMD3; Rosario Marchese-Ragona, MD, PhD2

Special Articles

Confronting Drowsy Driving: The American Academy of Sleep Medicine Perspective. 1335-1336.
Nathaniel F. Watson, MD, MS1; Timothy Morgenthaler, MD2; Ronald Chervin, MD3; Kelly Carden, MD4; Douglas Kirsch, MD5; David Kristo, MD6; Raman Malhotra, MD7,8; Jennifer Martin, PhD9; Kannan Ramar, MD10; Ilene Rosen, MD11,12; Terri Weaver, PhD, RN13; Merrill Wise, MD14

Case Reports

Excessive Dynamic Airway Collapse of the Lower Airway: A Cause for Persistent Sleep Disordered Breathing after Tracheostomy. 1337-1339.
Raj C. Dedhia, MD, MS1,2; Vishesh K. Kapur, MD, MPH1; Edward M. Weaver, MD, MPH2,3
Hypersomnolence in Wilson Disease. 1341-1343.
Valerie C. Amann, MD1,2; Neal K. Maru, MD3; Vivek Jain, MD4

Letters to the Editor

Vitamin D and Sleep Apnea: Beyond a Simple Association. 1345.
Daniela Leite de Oliveira, BsC; Camila Hirotsu, PhD; Sergio Tufik, MD, PhD; Monica Levy Andersen, PhD
Association between 25-Hydroxyvitamin D and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. 1347.
Sikarin Upala, MD, MS1,2; Anawin Sanguankeo, MD1,2
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