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Accepted Papers

Scientific Investigations

Effect of CPAP on Cardiac Function in Minimally Symptomatic Patients with OSA: Results from a Subset of the MOSAIC Randomized Trial. 967-973.
Sonya Craig, MRCP1; Ilias Kylintireas, MD2; Malcolm Kohler, MD3; Debby Nicoll, PhD1; Daniel J. Bratton, PhD3,4; Andrew J. Nunn, MSc4; Paul Leeson, PhD, MRCP5; Stefan Neubauer, MD2; John R. Stradling, MD, FRCP1


Current Knowledge/Study Rationale: The effect of CPAP therapy on cardiac function in patients with minimally symptomatic OSA is unknown. We used three methods (echocardiography, cardiac MR and BNP measurements) to assess cardiac function at baseline and after six months in patients randomized to CPAP or standard care.

Study Impact: There was no improvement in cardiac function in any of the three measurements although baseline cardiac dysfunction was mild. This would suggest that conventional cardiovascular reduction methods such as antihypertensive therapy or smoking cessation would be more beneficial in this group of patients.

Echocardiographic Findings in Healthy Elderly People with Unrecognized Sleep Disordered Breathing. 975-980.
Emilia Sforza, MD, PhD1; Mouhamed Sabri, MD2; Antoine DaCosta, MD2; Karl Isaaz, MD2; Jean Claude Barthélémy, MD, PhD1; Frédéric Roche, MD, PhD1


Current Knowledge/Study Rationale: Middle-aged patients with sleep disordered breathing (SDB) are known to frequently suffer from left atrial and ventricular dysfunction related to the hemodynamic changes and arousals from sleep occurring during respiratory events. Limited and controversial data are available in elderly, where the coexistence of cardiac dysfunction and SDB may be explained by the effect of aging in itself. In this study, the impact of SDB on cardiac function in healthy elderly subjects is investigated.

Study Impact: The study demonstrates that in a large population of healthy elderly, a slight association between SDB versus left atrial and ventricular function existed, with subjects with an apnea-hypopnea index exceeding 30 having more significant cardiac dysfunction. Understanding the prevalence of cardiac dysfunction in elderly with severe SDB is important for timely recognition of these high-risk subjects, to whom appropriate treatment should be proposed.

Efficacy of Bilevel-auto Treatment in Patients with Obstructive Sleep Apnea Not Responsive to or Intolerant of Continuous Positive Airway Pressure Ventilation. 981-985.
Annalisa Carlucci, MD1; Piero Ceriana, MD1; Marco Mancini, MD1; Serena Cirio, RRT1; Paola Pierucci, MD2; Nadia D'Artavilla Lupo, MD3; Felice Gadaleta, MD3; Elisa Morrone, PhD, Pst3; Francesco Fanfulla, MD3


Current Knowledge/Study Rationale: CPAP is the gold standard treatment for patients with OSA. However, a small group of patients are not tolerant or not responders to CPAP therapy. The aim of this study was to evaluate in these particular patients the efficacy and tolerance of the Bi-PAP auto, a new ventilator device that is able automatically adjust expiratory and inspiratory pressure level.

Study Impact: The present study demonstrates that Bi-PAP auto enables optimal control of respiratory events during sleep in these patients offering a therapeutic alternative to patients not-compliant or notresponders to CPAP treatment.

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism. 987-993.
Motoo Yamauchi, MD, PhD1; Yukio Fujita, MD1; Makiko Kumamoto, MD, PhD1; Masanori Yoshikawa, MD, PhD1; Yoshinobu Ohnishi, MD, PhD2; Hiroshi Nakano, MD, PhD3; Kingman P. Strohl, MD4; Hiroshi Kimura, MD, PhD1


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) that is predominant during REM sleep is well recognized as a result of muscle atonia; however, NREM-predominant OSA is encountered and its mechanisms are unexplored.

Study Impact: The phenotype of NREM-predominant OSA is present in 17.9% of patients and is correlated with the decrease in estimated minute ventilation during transition from wakefulness to sleep. In clinical practice, although REM-predominant OSA represents the state-related decline in muscle activation, NREM-predominant OSA has different implications related to the dynamics of respiratory control.

Article Is Eligible For CME Credits A Comparison of Sleep Difficulties among Iraq/Afghanistan Theater Veterans with and without Mental Health Diagnoses. 995-1005.
Christi S. Ulmer, PhD1,2; Elizabeth Van Voorhees, PhD1,2; Anne E. Germain, PhD3; Corrine I. Voils, PhD1,4; Jean C. Beckham, PhD1,2,5; the VA Mid-Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup5


Current Knowledge/Study Rationale: Prior research has focused on relationships between sleep and mental health symptoms in previously deployed veterans and military personnel. However, little research has examined sleep in terms of the presence or absence of a mental health disorder, diagnosed using structured clinical diagnostic interviews.

Study Impact: This is the first study, to our knowledge, to reveal significantly impaired sleep among previously deployed veterans and military personnel who are known to not meet diagnostic criteria for a mental health disorder. Since prospective research suggests that sleep disturbance precedes the development of certain psychiatric disorders and health conditions, and that sleep disturbance may play a role in suicidality, improving sleep in this population may be an opportunity for primary prevention.

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children. 1007-1010.
Leon Joseph, MB ChB; Shmuel Goldberg, MD; Michal Shitrit; Elie Picard, MD


Current Knowledge/Study Rationale: High-flow nasal cannula (HFNC) therapy is used as respiratory support in many respiratory acute diseases and creates positive airway pressure. CPAP is the recommended first-line treatment for obstructive sleep apnea (OSA) not due to adenotonsillar hypertrophy but has very variable compliance.

Study Impact: We demonstrated significant improvement in polysomnography when using HFNC to treat OSA. This pilot study should pave the way for randomized studies of the use of HFNC as an alternative to CPAP.

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy. 1011-1020.
Yu-Lun Lo, MD1,2; Yung-Lun Ni, MD1,3; Tsai-Yu Wang, MD1; Ting-Yu Lin, MD1; Hsueh-Yu Li, MD4; David P. White, MD, PhD5; Jr-Rung Lin, PhD6; Han-Pin Kuo, MD, PhD1


Current Knowledge/Study Rationale: Drug-induced sleep endos-copy (DISE) were performed under different sedative conditions and might affect upper airway obstructions. We aimed to evaluate the affects of sedation depth and obstructive sleep apnea severity on different upper airway obstruction patterns.

Study Impact: Under DISE, sedation depth affected velopharynx and oropharynx obstruction severity, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse; however, OSA severity was associated with velopharynx and oropharynx obstruction severity as well as arytenoid prolapse. Bispectral index guided DISE offers an objective and reproducible method to evaluate upper airway collapsibility.

Article Is Eligible For CME Credits Chronotype and Improved Sleep Efficiency Independently Predict Depressive Symptom Reduction after Group Cognitive Behavioral Therapy for Insomnia. 1021-1027.
Bei Bei, PhD1,2,3; Jason C. Ong, PhD4,5; Shantha M.W. Rajaratnam, PhD1; Rachel Manber, PhD4


Current Knowledge/Study Rationale: Prevalence of depressive symptoms is high among individuals with insomnia, and cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve both sleep and depressive symptoms. Factors associated with depressive symptom reduction after CBT-I have not been well examined and could provide clinically relevant information on how to enhance the benefits of CBT-I.

Study Impact: In a large outpatient insomnia sample, stronger evening preference and less improvement in sleep efficiency independently predicted less reduction in depressive symptom severity following CBT-I. Empirically, this suggested evening preference and insomnia symptoms have distinct relationships with mood; clinically, this raises the possibility that the effect of CBT-I on depressive symptoms could be enhanced by assessing and addressing circadian factors.

Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women. 1029-1038.
Cass Edwards, BSc1,2,3; Sutapa Mukherjee, MB, PhD2; Laila Simpson, PhD2,4,5; Lyle J. Palmer, PhD6; Osvaldo P. Almeida, MD7; David R. Hillman, MB1,2,3,5


Current Knowledge/Study Rationale: Depressive symptoms are common in patients with obstructive sleep apnea.

Study Impact: This paper examines the nature of this relationship and the influence on it of gender and of effective treatment of obstructive sleep apnea in a large cohort of such patients.

Body Fat Composition: A Predictive Factor for Sleep Related Breathing Disorder in Obese Children. 1039-1045.
Rajeev Bhatia, MD1; Daniel J. Lesser, MD1; Flavia G.S.A. Oliveira, PhD2; Winston H. Tran, MS2; Thomas G. Keens, MD1; Michael C.K. Khoo, PhD2; Sally L. Davidson Ward, MD1


Current Knowledge/Study Rationale: In adults, studies have shown a strong correlation between body fat composition (utilizing DEXA scans) and OSA. Similar studies utilizing DEXA scans to assess body fat composition as a predictor of pediatric SRBD are lacking.

Study Impact: This study showed that total body fat mass and trunk fat mass, as measured on DEXA scanning, as well as BMI, were associated with total arousal index and desaturation index in obese children. BMI also correlated with DEXA parameters in these children. However, both relationships were influenced by age.

Review Articles

Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis. 1047-1056.
Yan Wang, MD1; Hao Mei, PhD2; Yan-Rui Jiang, MD1; Wan-Qi Sun, MD1; Yuan-Jin Song, MD1; Shi-Jian Liu, PhD3; Fan Jiang, MD, PhD1

Special Articles

Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions. 1057-1062.
Timothy I. Morgenthaler, MD1; Janet B. Croft, PhD2; Leslie C. Dort, MSc, DDS3; Lauren D. Loeding, MPH4; Janet M. Mullington, PhD5; Sherene M. Thomas, PhD4

Case Reports

Hypocretin Deficiency Associated with Narcolepsy Type 1 and Central Hypoventilation Syndrome in Neurosarcoidosis of the Hypothalamus. 1063-1065.
Mary Catherine Mayo, MD1; Jane C. Deng, MD, MS2; Jeffrey Albores, MD2; Michelle Zeidler, MD, MS2; Ronald M. Harper, PhD3; Alon Y. Avidan, MD, MPH1

Board Review Corner

How the CPAP Download Unexpectedly Helped a Young Man with a Sleeping Problem. 1066-1068.
Virginia Skiba, MD; Christopher Drake, PhD

Letters to the Editor

Obstructive Sleep Apnea is Not Associated with an Increased Risk of Osteoporosis: a Systematic Review and Meta-Analysis. 1069-1070.
Sikarin Upala, MD, MS1,2; Anawin Sanguankeo, MD1,2; Soontharee Congrete, MD1
Obstructive Sleep Apnea and Osteoporosis Risk. 1071-1072.
Marlene Chakhtoura, MD1; Mona Nasrallah, MD2; Hassan Chami, MD, MSc3,4
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