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Accepted Papers


Big-Data or Slim-Data: Predictive Analytics Will Rule with World. 159-160.
Daniel Combs, MD1,2; Safal Shetty, MD2,3; Sairam Parthasarathy, MD2,3

Scientific Investigations

Clinical Prediction Models for Sleep Apnea: The Importance of Medical History over Symptoms. 161-168.
Berk Ustun, MS1; M. Brandon Westover, MD, PhD2; Cynthia Rudin, PhD3; Matt T. Bianchi, MD, PhD2,4


Current Knowledge/Study Rationale: Most screening tools for OSA rely on a combination of medical history components as well as self-reported symptoms. The relative contributions of each of these two categories to the predictive utility is not well understood.

Study Impact: The current results suggest that self-reported symptoms contribute little information beyond that which is contained in the medical history. As medical history components may be extractable from electronic records, future screening tools may be amenable to scalable automation.

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence. 169-176.
Joseph M. Dzierzewski, PhD1,2; Douglas M. Wallace, MD3,4; William K. Wohlgemuth, PhD3


Current Knowledge/Study Rationale: Untreated sleep apnea is associated with many negative consequences. Although many studies have examined predictors of CPAP use, few have examined CPAP adherence employing an integrative model including biomedical and psychological domains.

Study Impact: An integrative, biopsychological model revealed that self-efficacy beliefs modify the relationship between prescribed CPAP pressure and CPAP adherence. Efforts to promote CPAP adherence should consider self-efficacy beliefs as an important modifiable predictor.

Improvement of Cognitive and Psychomotor Performance in Patients with Mild to Moderate Obstructive Sleep Apnea Treated with Mandibular Advancement Device: A Prospective 1-Year Study. 177-186.
Tea Galic, DMD1; Josko Bozic, MD2; Renata Pecotic, MD, PhD3,4; Natalija Ivkovic, MSc, RN3; Maja Valic, MD, PhD3,4; Zoran Dogas, MD, PhD3,4


Current Knowledge/Study Rationale: The mandibular advancement device (MAD) is an approved, effective modality of treatment in patients with mild to moderate obstructive sleep apnea (OSA). However, the effect of MAD treatment on cognitive and psychomotor performance has not been sufficiently established. The aim of this study was to assess the effect of MAD treatment on cognitive and psychomotor performance and subjective measures, excessive daytime sleepiness, and quality of life.

Study Impact: This study demonstrates that MAD therapy in patients with mild to moderate OSA is associated with improvement in cognitive and psychomotor performance. Furthermore, there was considerable improvement of well-being following MAD therapy.

Lifestyle Factors and Risk of Restless Legs Syndrome: Prospective Cohort Study. 187-194.
Salma Batool-Anwar, MD, MPH1; Yanping Li, PhD2,4; Katerina De Vito, MSc2; Atul Malhotra, MD5; John Winkelman, MD, PhD3; Xiang Gao, MD, PhD2,4,6


Current Knowledge/Study Rationale: Lifestyle factors have been postulated to have an effect on the risk and severity of RLS. Since current treatment for RLS largely depends on pharmacologic interventions, we prospectively examined the associations between lifestyle factors and the risk of developing RLS.

Study Impact: The results of this study suggest that certain lifestyle factors are associated with the risk of developing RLS. The study underscore the importance of behavioral modification in treating RLS.

Derived Arterial Stiffness is Increased in Patients with Obstructive Sleep Apnea and Periodic Limb Movements during Sleep. 195-202.
Panagis Drakatos, MD1; Sean Higgins1; Martino F. Pengo, MD1,2; Brian D. Kent, MD1; Rex Muza, MD1; Kiriakos Karkoulias, MD, PhD3; Guy Leschziner, MRCP, PhD1,4; Adrian Williams, MBBS, FRCP1,4


Current Knowledge/Study Rationale: Periodic limb movements during sleep are a relatively common finding in sleep studies and even though not yet established, increasing evidence supports their possible effect on the development of cardiovascular disease. Several markers of large artery stiffness have been linked to cardiovascular disease and have been found to be increased in patients with obstructive sleep apnea.

Study Impact: An easily derived marker of the large artery stiffness, produced from the oximetry and accessible to the most sleep centers, was found increased in patients with significant periodic limb movements during sleep and comparable to patients with moderate/ severe obstructive sleep apnea patients and higher in patients with a combination of these two conditions. The SIDVP could potentially serve as an easily derived and widely available in clinical practice marker of large arteries stiffness and further research on the effect of periodic limb movements during sleep on cardiovascular disease through increased arterial stiffness should be undertaken.

Influence of Day Length and Physical Activity on Sleep Patterns in Older Icelandic Men and Women. 203-213.
Robert J. Brychta, PhD1; Nanna Yr Arnardottir, MSc2,3; Erlingur Johannsson, PhD4; Elizabeth C. Wright, PhD1; Gudny Eiriksdottir, MSc3; Vilmundur Gudnason, MD, PhD3,5; Catherine R. Marinac, BA1; Megan Davis, MPsy1; Annemarie Koster, PhD6; Paolo Caserotti, PhD7; Thorarinn Sveinsson, PhD2; Tamara Harris, MD8; Kong Y. Chen, PhD1


Current Knowledge/Study Rationale: Both physical activity and changes in day length are thought to influence sleep patterns, but the combined effect on older adults is not well understood. We sought to identify seasonal patterns of sleep and physical activity in a large group of community-dwelling, older Icelandic adults using objective actigraphy-based measurements.

Study Impact: We found that while day length and activity both had a significant influence on the pattern of sleep timing, the actual within-individual differences of the repeaters were rather subtle between periods of longer and shorter day-lengths. We conclude that the limited variation in sleep patterns and quality in response to significant changes in daylight may be due to long-term adaptation in this group of older Icelandic adults.

Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments. 215-223.
Jennifer M. Mundt, MS1; Earl C. Crew, MS1; Kendra Krietsch, MS1; Alicia J. Roth, MA1; Karlyn Vatthauer, MS1; Michael E. Robinson, PhD1; Roland Staud, MD2; Richard B. Berry, MD3; Christina S. McCrae, PhD4


Current Knowledge/Study Rationale: Individuals with comorbid chronic pain and insomnia often have sleep that is more fragmented than those with only insomnia. This study was undertaken to examine the concordance of different sleep assessment methods in a comorbid population and to determine the utility of actigraphy as a treatment outcome measure.

Study Impact: In contrast to previous findings in primary insomnia, actigraphy—which typically underestimates wake time—estimated a longer sleep onset latency than polysomnography. As in prior insomnia treatment studies, sleep diaries were the most sensitive measure of intervention effects, but actigraphy was sensitive to most treatment-related changes detected by diaries and may be a useful, complementary outcome measure in this population.

Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. 225-233.
Michael Tvilling Madsen, MD1,2; Melissa Voigt Hansen, PhD1,2; Lærke Toftegård Andersen, MD1,2; Ida Hageman, MD3; Lars Simon Rasmussen, DMSc Professor4; Susanne Bokmand, MD2; Jacob Rosenberg, DMSc Professor1; Ismail Gögenur, DMSc Professor1


Current Knowledge/Study Rationale: Sleep disturbances are severe and overlooked problems in patients with breast cancer. Melatonin can potentially alleviate these sleep disturbances; hence this study was undertaken to investigate this issue.

Study Impact: Melatonin was shown to improve objectively determined sleep as measured via actigraphy, which has never before been shown in patients with breast cancer.

The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. 235-245.
Melanie A. Hom, MS1; Ian H. Stanley, BA1; Megan L. Rogers, BA1; Mirela Tzoneva, BS1; Rebecca A. Bernert, PhD2; Thomas E. Joiner, PhD1


Current Knowledge/Study Rationale: Insomnia has been demonstrated to be a robust predictor of depression onset, and distinct yet related lines of inquiry from basic affective neuroscience research have established a relationship between sleep and emotion. Despite this, little is known about explicit emotion regulation difficulties as a possible explanatory factor in the association between sleep problems and depression symptoms, including among firefighters—a sample at elevated risk for insomnia, nightmares, and depression.

Study Impact: Difficulties in emotion regulation, particularly lack of access to emotion regulation strategies, may in part explain the link between sleep disturbances and depression among firefighters. Emotion dysregulation may be an important therapeutic target for reducing depression risk for firefighters and related groups experiencing insomnia and nightmares.

A Novel Application of a Biopsychosocial Theory in the Understanding of Disturbed Sleep before and after Kidney Transplantation. 247-256.
Jacob M. Williams, PhD1; Christina S. McCrae, PhD2; James R. Rodrigue, PhD3,4; Pamela R. Patton, PA, MSP5


Current Knowledge/Study Rationale: This study was conducted in order to explore the biopsychosocial factors contributing to sleep disturbance among patients before and after kidney transplantation. Prior research indicates that sleep problems are extremely common among individuals with end stage renal disease both before and after kidney transplantation but has not provided an explanatory model for these sleep problems.

Study Impact: This study confirms the high rates of sleep problems found in prior research and identifies biopsychosocial factors which may contribute to sleep disturbance, particularly insomnia. These results provide evidence for specific factors which may be useful targets in the treatment of insomnia in these populations.

Article Is Eligible For CME Credits Further Evidence for the JuSt Program as Treatment for Insomnia in Adolescents: Results from a 1-Year Follow-Up Study. 257-262.
Karolin Roeser, Dr. Dipl.-Psych1; Barbara Schwerdtle, D. Dipl.-Psych1; Andrea Kübler, Prof. Dipl.-Psych, Dipl.-Biol1; Angelika A. Schlarb, Prof. Dipl.-Psych2


Current Knowledge/Study Rationale: Insomnia in adolescence adversely affects young people's mental and physical health. The present study evaluated a multimodal group therapy by which insomnia in adolescents can be treated effectively and economically.

Study Impact: The intervention reduced symptoms of insomnia and improvements were stable for a 12 months follow-up history. Thus, the JuSt treatment constitutes an effective and economic intervention that can be implemented by clinical psychologists and psychotherapists.

Review Articles

Article Is Eligible For CME Credits Measuring Sleep Efficiency: What Should the Denominator Be?. 263-266.
David L. Reed, PhD1; William P. Sacco, PhD2

Case Reports

Central Apneas and REM Sleep Behavior Disorder as an Initial Presentation of Multiple System Atrophy. 267-270.
Aldara Garcia-Sanchez, MBBS; Isabel Fernandez-Navarro, MD; Francisco Garcia-Rio, MD

Sleep Medicine Pearls

A 62-year-old Man with Facial and Finger Twitching. 272-275.
Stuart J. McCarter, BA; Erik K. St. Louis, MD

Letters to the Editor

Error in Calculation of Predictive Values in Paper on Screening for Sleep Bruxism. 277.
Karen G. Raphael, PhD
The Real Role of Sensitivity, Specificity and Predictive Values in the Clinical Assessment. 279-280.
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
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