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Accepted Papers


Joy in the Practice of Sleep Medicine. 829-832.
Timothy I. Morgenthaler, M.D., F.A.A.S.M.
The Case of Simultaneous Submission: “Flying too Close to the Sun”. 833.
Stuart F. Quan, M.D., F.A.A.S.M.

Scientific Investigations

Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use. 835-843.
Harneet K. Walia, M.D.1; Hong Li, M.S.2; Michael Rueschman, M.P.H.3; Deepak L. Bhatt, M.D., M.P.H.7; Sanjay R. Patel, M.D., M.S.3,4; Stuart F. Quan, M.D., F.A.A.S.M.3; Daniel J. Gottlieb, M.D., M.P.H., F.A.A.S.M.3,5; Naresh M. Punjabi, M.D., Ph.D., F.A.A.S.M.6; Susan Redline, M.D., M.P.H.3,4; Reena Mehra, M.D., M.S., F.A.A.S.M.1


Current Knowledge/Study Rationale: There are limited data regarding the severity of obstructive sleep apnea (OSA) and elevated blood pressure (BP) in patients with cardiovascular disease. Given the limited existing data, we examined the association between OSA severity and BP resistant to an intensive antihypertensive regimen in a group of individuals with high cardiovascular risk or established cardiovascular disease recruited from cardiology specialty clinics.

Study Impact: In this study of individuals at high cardiovascular risk or established cardiovascular disease, we observed a strong association of severe untreated OSA and resistant elevated BP despite treatment with an aggressive antihypertensive medication regimen even after consideration of well-recognized hypertension risk factors. Strategies to treat OSA in this subgroup should be strongly considered, as improved control in BP could lead to decreased cardiovascular morbidity and mortality.

Article Is Eligible For CME Credits Sleep Disordered Breathing and Chronic Respiratory Failure in Patients with Chronic Pain on Long Term Opioid Therapy. 847-852.
Anand R. Rose, M.D.1,2; Peter G. Catcheside, Ph.D.1,2; R. Doug McEvoy, M.D.1,2; Denzil Paul, MBiotech1,2; Dilip Kapur, M.B.Ch.B.3; Emily Peak, B.Behav.Sc.1,2; Andrew Vakulin, Ph.D.1,2,4; Nicholas A. Antic, M.B.B.S., Ph.D.1,2


Current Knowledge/Study Rationale: The use of opioid medication for chronic pain has been increasing. The main aim of this study was to assess how many patients on opiates had sleep disordered breathing and the type of SDB in patients on oral opioids for chronic pain.

Study Impact: Patients on long-term opioids frequently have severe SDB which in part is central in origin. PVT was markedly impaired. Half of the patients studied have evidence of chronic ventilatory failure.

A Novel Adaptive Servoventilation (ASVAuto) for the Treatment of Central Sleep Apnea Associated with Chronic Use of Opioids. 855-861.
Michelle Cao, D.O., F.A.A.S.M.1; Chia-Yu Cardell1; Leslee Willes, M.S.2; June Mendoza3; Adam Benjafield, Ph.D.3; Clete Kushida, M.D., Ph.D., F.A.A.S.M.1


Current Knowledge/Study Rationale: Opioid medications have become one of the most highly prescribed medications for the treatment of chronic non-terminal pain and are associated with serious adverse effects such as sleep disordered breathing, respiratory depression, and death. The purpose of this study was to determine the effectiveness of the minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure versus bilevel with back-up respiratory rate (bilevel-ST) in treating central sleep apnea induced by chronic use of opioid medications on patients who may frequently vary their opioid intake depending on daily severity of pain.

Study Impact: Results showed that ASVAuto was significantly more effective than bilevel-ST for the treatment of central sleep apnea induced by chronic opioid use. Clinicians should consider the ASVAuto as a primary treatment modality in this particular group of patients. Further studies are needed to clarify long-term effectiveness of therapy in improving morbidity and mortality.

Assessment of a Neck-Based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea. 863-871.
Daniel J. Levendowski, M.B.A.; Sean Seagraves, B.S; Djordje Popovic, M.D.; Philip R. Westbrook, M.D.


Current Knowledge/Study Rationale: Obstructive sleep apnea is now quite easy to diagnose but remains difficult to treat when both efficacy and compliance are considered. In this prospective study, we evaluated the impact of 4 weeks of neck-based vibro-tactile positional therapy on respiratory and sleep architecture measures, subjective symptoms, and compliance in patients with mild, moderate, and severe positional obstructive sleep apnea (POSA).

Study Impact: We found position therapy significantly reduced sleep disordered breathing and significantly improved sleep quality and moderately reduced symptoms across all OSA severity groups. The prevalence of POSA was relatively consistent across all patients who had an overall AHI < 60 events/hour.

Complete Blood Count Alterations after Six Months of Continuous Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea. 873-878.
Sinem Nedime Sökücü, M.D.1; Cengiz Özdemir, M.D.1; Levent Dalar, M.D.1; Levent Karasulu, M.D.1; Şenay Aydın, M.D.1; Sedat Altın, M.D.2


Current Knowledge/Study Rationale: Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk. These markers increase in patients with OSA. The effect of CPAP treatment on these parameters was evaluated.

Study Impact: Our data suggest that complete blood count parameters such as MPV, PDW, and RDW changed significantly after CPAP therapy in patients with OSA. A complete blood count is simple to perform and can be useful in the follow up of CPAP therapy.

Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population. 879-885.
Natasha Garg, M.D.2; Andrew J. Rolle, M.P.H.4; Todd A. Lee, Pharm.D., Ph.D.3; Bharati Prasad, M.D., M.S.1,2


Current Knowledge/Study Rationale: This study was done to examine the feasibility and accuracy of home-based diagnostic testing in urban populations at risk for sleep apnea.

Study Impact: This study extends our knowledge of the applicability of home-based diagnostic testing for sleep apnea to urban underserved populations. The cost-effectiveness of this strategy needs to be further examined.

The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring. 887-892.
Sushanth Bhat, M.D.1; Neola Gushway-Henry, M.D.1; Peter G. Polos, M.D., Ph.D.1; Vincent A. DeBari, Ph.D.2; Sandeep Riar, M.D.3; Divya Gupta, M.D., F.A.A.S.M.1; Liudmila Lysenko, M.D.4; Disha Patel, M.D.1; Justin Pi, M.D.5; Sudhansu Chokroverty, M.D., F.A.A.S.M.1


Current Knowledge/Study Rationale: This study addresses questions raised by a previously published case report that suggests that a chin-strap alone may be an alternative to CPAP in the treatment of OSA. We systematically analyzed the effects of chinstrap use on sleep disordered breathing based on severity of OSA in REM sleep and in supine sleep, and also addressed the question of whether the use of a chinstrap alone improves snoring.

Study Impact: The study results suggest that a chinstrap alone is an ineffective treatment for sleep disordered breathing, even in patients with mild OSA, and does not improve snoring. It also does not improve the AHI in REM sleep or supine sleep.

Effect of Sensory Stimuli on Restless Legs Syndrome: A Randomized Crossover Study. 893-896.
Anouk D. Rozeman, M.D.1; Truus Ottolini1; Diana C. Grootendorst, Ph.D.2; Oscar J.M. Vogels, M.D., Ph.D.3; Roselyne M. Rijsman, M.D., Ph.D.1


Current Knowledge/Study Rationale: Clinical experience shows that a variety of sensory stimuli may relieve RLS symptoms, though systematic evaluations of these phenomena are lacking. We performed a randomized crossover study to evaluate the effect of external sensory stimulation on restless legs syndrome symptoms.

Study Impact: External sensory input tends to reduce leg discomfort in patients suffering from restless legs syndrome. This potential benefit could open new ways towards a better pathophysiological understanding and non-pharmacological treatments.

Drug Testing in Children with Excessive Daytime Sleepiness During Multiple Sleep Latency Testing. 897-901.
Eliot S. Katz, M.D.1; Kiran Maski, M.D.2; Amanda J. Jenkins, Ph.D.3


Current Knowledge/Study Rationale: Caffeine is widely available in beverages used by children, and consumption increases with age. Caffeine temporarily enhances alertness, but also has adverse effects on sleep quality, and may contribute to excessive daytime sleepiness. Study Impact: Children presenting with excessive daytime sleepiness are ingesting considerable amounts of caffeinated beverages that may adversely affect sleep. In addition, many of these children deny caffeine usage, and physicians frequently omit explicit documentation of caffeine intake during clinic visits.

Do Respiratory Cycle-Related EEG Changes or Arousals from Sleep Predict Neurobehavioral Deficits and Response to Adenotonsillectomy in Children?. 903-911.
Ronald D. Chervin, M.D., M.S., F.A.A.S.M.1; Susan L. Garetz, M.D.2; Deborah L. Ruzicka, R.N., Ph.D.1; Elise K. Hodges, Ph.D.3; Bruno J. Giordani, Ph.D.3; James E. Dillon, M.D.4; Barbara T. Felt, M.D.5; Timothy F. Hoban, M.D., F.A.A.S.M.6; Kenneth E. Guire, M.S.7; Louise M. O'Brien, Ph.D.8; Joseph W. Burns, Ph.D.9


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) in children is associated with neurobehavioral morbidity, but common polysomnographic measures of OSA presence or severity do not predict which children experience such morbidity or improvement in these areas after adenotonsillectomy. This study was performed to assess whether sleep fragmentation—in the form of standardly scored arousals or respiratory cycle-related EEG changes (RCREC) believed to reflect inspiratory microarousals—might improve predictive utility of sleep studies.

Study Impact: Cognition, behavior, sleepiness, and mental health generally improved 6 months after adenotonsillectomy, but rates of arousals and magnitude of RCREC at baseline did not consistently predict outcomes. These measures of sleep fragmentation do not appear to explain the neurobehavioral morbidity of pediatric OSA, or to improve the prognostic utility of polysomnography for these outcomes.

Feasibility of Comprehensive, Unattended Ambulatory Polysomnography in School-Aged Children. 913-918.
Carole L. Marcus, M.B.B.Ch., F.A.A.S.M.1; Joel Traylor1; Sarah N. Biggs, Ph.D.2; Robin S. Roberts, M.Sc.3; Gillian M. Nixon, M.D.2,4; Indra Narang, M.D.5; Rakesh Bhattacharjee, M.D.6; Margot J. Davey, M.B.B.S.2,4; Rosemary S.C. Horne, Ph.D.2; Maureen Cheshire5; K. Jeremy Gibbons, B.Sc.5; Joanne Dix, B.Sc.N.3; Elizabeth Asztalos, M.D.7; Lex W. Doyle, M.D.8; Gillian F. Opie, M.B.B.S., M.D.9; Judy D'ilario3; Lorrie Costantini, B.A.3; Ruth Bradford1; Barbara Schmidt, M.D.3,10


Current Knowledge/Study Rationale: Ambulatory sleep studies are frequently performed in adults. However, there have been few studies evaluating the feasibility of performing comprehensive, unattended, ambulatory polysomnography in children.

Study Impact: This large, international study has shown that comprehensive, unattended, ambulatory polysomnography is feasible, technically adequate and well-tolerated in school-aged children. However, further study is needed before these results can be translated into the clinical setting.

Assessing and Predicting the Likelihood of Interventions during Routine Annual Follow-up Visits for Management of Obstructive Sleep. 919-924.
Srikant Nannapaneni, M.B.B.S., M.P.H.1; Timothy I. Morgenthaler, M.D., F.A.A.S.M.1,2; Kannan Ramar, M.B.B.S., M.D., F.A.A.S.M.1,2


Current Knowledge/Study Rationale: Though patients with obstructive sleep apnea (OSA) on positive airway pressure (PAP) are routinely advised annual follow-up visits to assess ongoing effectiveness and address problems related to PAP use, there is no available data to support the value of this practice, particularly in an era of decreasing costs of care and improving patient access with appropriate resource utilization.

Study Impact: Our study found that in the absence of subjective symptoms, OSA patients on CPAP are less likely to need an intervention during their annual follow-up face-to-face visit. Our findings suggest an opportunity for future studies to investigate screening tools that would assess predictive factors prospectively to determine the need for and timing of face-to-face follow-up visits for this patient population.

Case Reports

Adult NREM Parasomnia Associated with Lancinating Throat Pain. 925-926.
Jitka Bušková, M.D., Ph.D.; Karel Šonka, Prof, D.Sc.

Review Articles

Article Is Eligible For CME Credits Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports. 927-935.
Francesca Ingravallo, Ph.D.1; Francesca Poli, Ph.D.1; Emma V. Gilmore, B.A.1; Fabio Pizza, Ph.D.2,3; Luca Vignatelli, Ph.D.4; Carlos H. Schenck, M.D.5; Giuseppe Plazzi, M.D.2,3
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August 15, 2014
Volume 10, Issue 08

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