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Commentary

Weighing in on a Heavy Subject. 195-196.
Richard D. Simon, MD, FAASM

Scientific Investigations

The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea. 197-204.
Sara S. Johnson, PhD1; Patricia H. Castle, PhD1; Deborah Van Marter, MPH1; Anne Roc, PhD2; David Neubauer, MD3; Sanford Auerbach, MD4,5; Emma DeAguiar, BA1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Despite the increasing prevalence and harmful sequelae of obstructive sleep apnea (OSA), 80% to 90% of adults with OSA remain undiagnosed. There is therefore an urgent need to promote performance change related to its identification and management.

Study Impact: CME activities that included behavior change messages increased the likelihood that physicians would initiate a discussion about sleep problems, administer measures of excessive sleepiness and OSA, recommend sleep studies, or refer to a sleep specialist. The integration of CME and behavior change messages designed for clinicians in all stages of readiness to implement recommended practices for the identification and optimal management of OSA is a promising approach to increasing the extent to which those guidelines are adopted.

Sleep Pattern in Charcot-Marie-Tooth Disease Type 2: Report of Family Case Series. 205-211.
Cynthia C. Souza, BSc1; Camila Hirotsu, PhD2; Eduardo L.A. Neves, MD, PhD1; Lidiane C.L. Santos, Msci1; Iandra M.P.F. Costa, Msci1; Catarina A. Garcez, Msci1; Paula S. Nunes, PhD1; Adriano A.S. Araujo, PhD1,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep has been shown to be detrimental for quality of life and may play an important role in the neuropathies. Charcot-Marie-Tooth disease (CMT) is the most common genetic cause of neuropathy, in which sleep has been rarely characterized.

Study Impact: This is the first study which evaluated sleep in a large family affected by CMT2, showing poor sleep quality and fragmented sleep without sleep-breathing or periodic-moviment disorders. This study revealed that Sleep Medicine can contribute to the field of Neuro-muscular Medicine, suggesting that improvement of sleep quality may help delay the progression of CMT2.

Article Is Eligible For CME Credits Postoperative CPAP Use Impacts Long-Term Weight Loss Following Bariatric Surgery. 213-217.
Jacob Collen, MD1,3; Christopher J. Lettieri, MD2,3; Arn Eliasson, MD3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Obstructive sleep apnea is common among bariatric surgical candidates and often persists following weight loss. Adherence with continuous positive airway pressure (CPAP) therapy at follow-up is poor and may impact long-term clinical outcomes.

Study Impact: Long-term use of CPAP is dismal among bariatric surgery patients. Weight-loss outcomes are significantly worsened in patients who do not use CPAP postoperatively.

Sleep Disorders in Adult Sickle Cell Patients. 219-223.
Sunil Sharma, MD1; Jimmy T. Efird, PhD, MSc2,3; Charles Knupp, MD4; Renuka Kadali, MD4; Darla Liles, MD4; Kristin Shiue, BA2,3; Peter Boettger, PA4; Stuart F. Quan, MD5

BRIEF SUMMARY

Current Knowledge/Study Rationale: High prevalence of sleep apnea has been reported in children with sickle cell disease, however, data on adult sickle cell patients is lacking. With increasing number of sickle cell patients reaching adulthood, we investigated prevalence and characteristics of sleep disorders in adult sickle cell patients.

Study Impact: The study adds to our existing knowledge and suggests high prevalence of sleep disorders in adult sickle cell patients. The study also suggests that Epworth Sleepiness Scale and overnight pulse-oximetry may be cost effective screening tools for detecting sleep disordered breathing in this population.

Poor Sleep Quality is Independently Associated with Physical Disability in Older Adults. 225-232.
Meng-Yueh Chien, PT, PhD1; Hsi-Chung Chen, MD, PhD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep disturbance has been a prevalent health problem in older adults. However, the relationship between sleep disturbance and physical disability in older adults is yet to be fully elucidated.

Study Impact: Subjective poor sleep quality was independently associated with physical disability. Older adults with poor sleep quality deserve clinical attention regarding physical disability.

Article Is Eligible For CME Credits Common Sleep Disorders Increase Risk of Motor Vehicle Crashes and Adverse Health Outcomes in Firefighters. 233-240.
Laura K. Barger, PhD1,2; Shantha M.W. Rajaratnam, PhD1,2,3; Wei Wang, PhD1,2,4; Conor S. O'Brien, BA1; Jason P. Sullivan, BS1; Salim Qadri, BS1; Steven W. Lockley, PhD1,2; Charles A. Czeisler, PhD, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Heart attacks and motor vehicle crashes are the leading causes of death in US firefighters. We examined whether high risk of a sleep disorder was associated with motor vehicle crashes, cardiovascular disease, and other adverse mental and physical health outcomes in a nationwide cohort of firefighters.

Study Impact: Sleep disorders were found to be highly prevalent in firefighters, and were associated with substantially increased risk of motor vehicle crashes and cardiometabolic diseases. This study provides the rationale for further research evaluating the effectiveness of occupational sleep disorders management programs to identify individuals who are vulnerable to adverse safety and health consequences.

The Zurich 3-Step Concept for the Management of Behavioral Sleep Disorders in Children: A Before-and-After Study. 241-249.
Helene Werner, PhD1,2; Peter Hunkeler, MD1; Caroline Benz, MD1; Luciano Molinari, PhD1; Caroline Guyer, MD1; Fabienne Häfliger, MSc1; Reto Huber, PhD1,3; Oskar G. Jenni, MD1,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: The Zurich 3-step concept combines basic notions of the two-process model of sleep regulation (introducing a regular rhythm and adjusting bedtime to sleep need) with behavioral strategies to resolve learned maladaptive sleep habits for the management of behavioral sleep disorders in children. In this study, significant effects from before to after the intervention were found for objectively und subjectively measured sleep-wake variables and for child behavioral problems.

Study Impact: Our study may enrich the literature on interventions in sleep-disordered children by describing how aspects of the two-process model of sleep regulation may be integrated into a clinical intervention concept.

Sleep Patterns, Sleep Instability, and Health Related Quality of Life in Parents of Ventilator-Assisted Children. 251-258.
Lisa J. Meltzer, PhD1; Maria M. Sanchez-Ortuno, PhD2; Jack D. Edinger, PhD1; Kristin T. Avis, PhD3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Parental caregivers of children with chronic illnesses are known to have shorter sleep duration and poorer quality sleep, as well as poorer health related quality of life (HRQOL). However, objective sleep patterns, night-to-night variability in sleep, and the relationship between sleep and HRQOL have not been previously examined in this population.

Study Impact: This study has shown that in families with ventilator-assisted children, parent sleep is not only shorter, but more variable. Further, the instability in sleep patterns was significantly related to multiple aspects of HRQOL. Because of the high demands places on parental caregivers in terms of medical care for their children, increased support, including nursing and/or respite care, is needed to improve the quantity and quality of parent sleep.

Review Articles

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management. 259-270.
Rohit Budhiraja, MD1; Tauseef A. Siddiqi, MD2; Stuart F. Quan, MD2,3

Case Reports

Trichotillomania and Non-Epileptic Seizures as Sleep-Related Dissociative Phenomena. 271-273.
Melina Angulo-Franco, MD; Alejandra Bush-Martínez, MD; Alejandro Nenclares-Portocarrero, MD; Alejandro Jiménez-Genchi, MD, MS

Special Section

Measurement of Quality to Improve Care in Sleep Medicine. 279-291.
Timothy I. Morgenthaler, MD1; Amy J. Aronsky, DO2; Kelly A. Carden, MD3; Ronald D. Chervin, MD4; Sherene M. Thomas, PhD5; Nathaniel F. Watson, MD6
Quality Measures for the Care of Adult Patients with Restless Legs Syndrome. 293-310.
Lynn Marie Trotti, MD, MS1; Cathy A. Goldstein, MD2; Christopher G. Harrod, MS3; Brian B. Koo, MD4; Denise Sharon, MD, PhD5; Rochelle Zak, MD6; Ronald D. Chervin, MD, MS2
Quality Measures for the Care of Patients with Insomnia. 311-334.
Jack D. Edinger, PhD1,2; Daniel J. Buysse, MD3; Ludmila Deriy, PhD4; Anne Germain, PhD3; Daniel S. Lewin, PhD5; Jason C. Ong, PhD6; Timothy I. Morgenthaler, MD7
Quality Measures for the Care of Patients with Narcolepsy. 335-355.
Lois E. Krahn, MD1; Shelley Hershner, MD2; Lauren D. Loeding, MPH3; Kiran P. Maski, MD4; Daniel I. Rifkin, MD5; Bernardo Selim, MD6; Nathaniel F. Watson, MD, MSc7
Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea. 357-383.
R. Nisha Aurora, MD1; Nancy A. Collop, MD2; Ofer Jacobowitz, MD, PhD3; Sherene M. Thomas, PhD4; Stuart F. Quan, MD5,6,7; Amy J. Aronsky, DO8
Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea. 385-404.
Sanjeev V. Kothare, MD1; Carol L. Rosen, MD2; Robin M. Lloyd, MD3; Shalini Paruthi, MD4; Sherene M. Thomas, PhD5; Matthew M. Troester, DO6; Kelly A. Carden, MD7
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