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Editorials

Thanks to Dr. Quan and the Next Chapter for JCSM. 5.
Nancy A. Collop, MD, FAASM
Sleep Duration: A Consensus Conference. 7-8.
Nathaniel F. Watson, MD, MSc

Scientific Investigations

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress. 11-22.
Gilbert Seda, MD, PhD1; Maria M. Sanchez-Ortuno, PhD2,5; Carolyn H. Welsh, MD3,6; Ann C. Halbower, MD4; Jack D. Edinger, PhD5,7

BRIEF SUMMARY

Current Knowledge/Study Rationale: Imagery rehearsal therapy (IRT) and prazosin are both used for treatment of nightmares in posttraumatic stress. The main aim of this study was a comparative meta-analysis of each treatment on nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms.

Study Impact: IRT and prazosin had similar effects for nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms; however, adding cognitive-behavior therapy for insomnia to IRT enhanced its effects for improving sleep quality as well as posttraumatic stress disorder symptoms.

Article Is Eligible For CME Credits Factors Associated with Referrals for Obstructive Sleep Apnea Evaluation among Community Physicians. 23-26.
Natasha J. Williams, EdD1; João V. Nunes, MD2; Ferdinand Zizi, MBA1; Kola Okuyemi, MD3; Collins O. Airhihenbuwa, PhD4; Gbenga Ogedegbe, MD1; Girardin Jean-Louis, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Despite the serious negative consequences of obstructive sleep apnea (OSA), most patients remain undiagnosed and untreated. It is plausible that community physicians play a crucial role in the detection and referral for OSA evaluation. The present study sought to examine the knowledge and attitudes of community physicians toward OSA and the implications for OSA evaluation.

Study Impact: Our findings show that the likelihood of receiving a referral for OSA evaluation is influenced by whether the patients inquired about OSA. This suggests that multilevel interventions that target community physicians and focus on increasing patient health literacy may be useful in increasing OSA awareness.

Article Is Eligible For CME Credits Diagnostic Capability of Biological Markers in Assessment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. 27-36.
Graziela De Luca Canto, DDS, MSc, PhD1,2; Camila Pachêco-Pereira, DDS2; Secil Aydinoz, MD3,4; Paul W. Major, DDS, MSc, FRCD(C)2; Carlos Flores-Mir, DDS, DSc, FRCD(C)2; David Gozal, MD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: The purpose of this systematic review was to evaluate the diagnostic properties of markers in biological samples, such as in exhaled breath condensate, blood, saliva, and urine, and compare their predictive characteristics to the gold standard in the diagnosis of OSA—nocturnal PSG.

Study Impact: A substantial number of studies have been published in the literature in the quest for diagnostic biomarkers of OSA in both children and adults; however, most of the explored approaches do not identify definitive biomarkers, and only a small number of candidates appears promising and merits further research.

Obstructive Sleep Apnea Pretreatment and Posttreatment in Symptomatic Children with Congenital Craniofacial Malformations. 37-43.
Marta Moraleda-Cibrián, MD1,2; Sean P. Edwards, DDS, MD, FRCD(C)2; Steven J. Kasten, MD, MHPE3; Steven R. Buchman, MD3; Mary Berger, MS3; Louise M. O'Brien, PhD, MS1,2,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: The presence of craniofacial anomalies in children is frequently associated with symptoms of sleep-disordered breathing yet, objective data regarding the presence of obstructive sleep apnea (OSA) in this population is lacking. The purpose of this study was to investigate the frequency of OSA and the impact of treatment in symptomatic children with CFM.

Study Impact: The vast majority of symptomatic children with CFM have objective evidence of OSA. Nonetheless, despite treatment, residual OSA is common is this population. We suggest that a posttreatment polysomnogram should be considered in symptomatic children with CFM.

Patterns and Predictors of Sleep Quality Before, During, and After Hospitalization in Older Adults. 45-51.
Joseph M. Dzierzewski, PhD1,2; Michael Mitchell, PhD2; Juan Carlos Rodriguez, MD1,2,3; Constance H. Fung, MD, MSHS1,2; Stella Jouldjian, MSW, MPH2; Cathy A. Alessi, MD1,2; Jennifer L. Martin, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Health factors are suspected to play a role in sleep changes with the aging process. However, little is known regarding the impact of acute health changes and hospitalization on sleep in older adults.

Study Impact: Sleep quality does not appear to significantly change throughout the hospitalization process; however, slight alterations in clinical cutoffs used to demarcate poor sleep can lead to drastic changes in classification status. Caution is suggested for clinicians working with hospitalized elders using questionnaires to identify patients with poor sleep.

Short Time to First Void Is Associated with Lower Whole-Night Sleep Quality in Nocturia Patients. 53-55.
Donald L. Bliwise, PhD1; Tove Holm-Larsen, PhD2; Sandra Goble, PhD3; Jens Peter Nørgaard, MD3

BRIEF SUMMARY

Current Knowledge/Study Rationale: This study sought to determine to what extent poor sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), was related to a commonly used measure in studies of nocturia, the time to first void.

Study Impact: The data presented here indicate that time to first void is a good proxy for many aspects of sleep assessed by the PSQI, including sleep quality, depth, duration and even daytime sleepiness. The overall magnitude of effects were relatively small, but the ease of collecting this self-reported measure related to nocturnal voiding suggests that it could have value in future studies.

Restless Legs Syndrome in Non-Dialysis Renal Patients: Is It Really That Common?. 57-60.
Jesús Calviño, MD1; Secundino Cigarrán, MD, PhD2; Luis M. Lopez, MD3; Agustin Martinez, MD3; Maria-Jesús Sobrido, MD, PhD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: The frequency of restless legs syndrome (RLS) among patients with chronic kidney disease (CKD) is debated and may be overestimated due to co-morbidities and RLS mimics, such as vascular disease, arthritis and peripheral neuropathy. Most investigations of RLS in renal disease have studied dialysis patients. The aim of our study was to address this issue in non dialysis CKD.

Study Impact: The results of our study suggest that the prevalence of RLS in CKD may be similar to that in the general population. Expert neurological evaluation is essential for the confirmation of RLS, while self-administered questionnaires based on the consensus diagnostic criteria can lead to overestimation of the frequency of RLS among patients with kidney diseases.

Academic Performance among Adolescents with Behaviorally Induced Insufficient Sleep Syndrome. 61-68.
Yu Jin Lee, MD, PhD1; Juhyun Park, MA1; Soohyun Kim, MA1; Seong-Jin Cho, MD, PhD2; Seog Ju Kim, MD, PhD1,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although previous studies have reported an association between academic performance and short sleep duration in adolescence, the independent association between behaviorally induced insufficient sleep syndrome (BISS) and academic performance among adolescents has not been addressed. The present study investigated academic performance among adolescents with BISS and attempted to identify independent predictors of academic performance among BISS-related factors.

Study Impact: The current study reports that BISS among adolescents is associated with poor academic performance, suggesting that harsh sleep restrictions to allot extra time for studying could hamper academic performance. In addition, the current study suggests that sleep debt, as represented by weekend oversleep, is the most important factor associated with poor academic performance among adolescents with BISS.

Review Articles

Sleep Disturbances among Medical Students: A Global Perspective. 69-74.
Muhammad Chanchal Azad, MBBS, MSc1; Kristin Fraser, MD2; Nahid Rumana, MS, MD, PhD3; Ahmad Faris Abdullah, MD, MMed1; Nahid Shahana, MMed, Mphil4; Patrick J. Hanly, MD2,3; Tanvir Chowdhury Turin, MD, PhD5,6

BRIEF SUMMARY

Current Knowledge/Study Rationale: Medical students carry a large academic load which could potentially contribute to poor sleep quality above and beyond that already experienced by modern society. So, it is important to know whether they have a sleep problem, the extent of the problem, and also whether their sleep disturbance has any effect on academic performance or quality of life. This review aims to summarize, organize, and clarify the current literature on sleep problems among undergraduate medical students around the world.

Study Impact: This review documented the magnitude of sleep problem, sleep awareness, factors associated with poor sleep among medical students and the impact of sleep problem on medical students' academic performance and mental health. The findings of this review will make the medical educators and planners aware to take necessary steps for the improvement of medical students' quality of life.

Case Reports

Obstructive Sleep Apnea Syndrome in a Pubescent Boy of Short Stature Was Improved with an Orthodontic Mandibular Advancement Oral Appliance: A Case Report. 75-76.
Shin Ito, DDS, PhD1; Hironao Otake, MD, PhD2; Satoru Tsuiki, DDS, PhD3; Etsuko Miyao, DDS, PhD4; Akiko Noda, PhD5

Sleep Medicine Pearls

A 14-Year-Old Girl with Excessive Daytime Sleepiness and Facial Twitching. 77-78.
Lourdes M. DelRosso, MD1; Kristina E. Patrick, MS2; Romy Hoque, MD3

Letter to the Editor

Can Psychomotor Vigilance Task Improve the Diagnosis of Excessive Daytime Sleepiness in Stroke Patients?. 79.
Renata Carvalho Cremaschi, MD1,2; Sérgio Tufik, MD, PhD1; Fernando Morgadinho Coelho, MD, PhD1,2
Underrecognition of Sleep Disorders in Patients with Multiple Sclerosis. 81.
Tiffany J. Braley, MD, MS1,2; Benjamin M. Segal, MD2; Ronald D. Chervin, MD, MS1

Obituaries

In Memoriam: Dr. William C. Kohler. 83.
W. McDowell Anderson
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