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Scientific Investigations

F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease. 369-375.
Patrizia Congiu, MD, PhD1; Maria Livia Fantini, MD, PhD, MSc2; Giulia Milioli, MD, PhD3; Paolo Tacconi, MD4; Michela Figorilli, MD1; Gioia Gioi, MD1; Bruno Pereira, PhD5; Francesco Marrosu, MD4; Liborio Parrino, MD3; Monica Puligheddu, MD, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Currently, the diagnosis of RLS/WED is based on clinical criteria and exclusion of secondary causes and mimicking conditions; there are no instrumental tools able to distinguish between subjects affected by RLS/WED and other conditions characterized by leg discomfort, especially at night. The aim of this study is to evaluate the sensibility and the specificity of some F-wave parameters, easily obtainable during routine nerve conduction study, in the diagnosis of primary RLS/WED.

Study Impact: The introduction of these parameters may represent a new diagnostic instrumental tool that is easy to perform and that may contribute to a correct diagnosis of primary RLS/WED and therefore to the most appropriate therapy.

Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population. 377-384.
Shibin Wang, PhD1,2; Bo Li, PhD1; Yanhua Wu, PhD1; Gabor S. Ungvari, MD, PhD3,4; Chee H. Ng, MD5; Yingli Fu, PhD1; Changgui Kou, PhD1; Yaqin Yu, PhD1; Hong-Qiang Sun, MD, PhD6; Yu-Tao Xiang, MD, PhD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Habitual short and long sleep durations are usually associated with poor health outcomes. The patterns of sleep duration and its correlates have been rarely examined in China.

Study Impact: Short and long sleep durations are significantly associated with a number of demographic and clinical characteristics in Chinese adults. Given the high prevalence of short sleep, professionals should pay more attention to sleep patterns in general health care.

Sleep Quality in an Adult American Indian Community Sample. 385-391.
Cindy L. Ehlers, PhD; Derek N. Wills, BS; Philip Lau, MA; David A. Gilder, MD

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although several large epidemiological studies have found that sleep insufficiency is more common among American Indians/Alaska Natives (AI/AN), what other aspects of sleep quality and what other comorbid conditions influence sleep in AI/AN is not clear.

Study Impact: This study shows that short sleep duration (< 6 h/night) was associated with the degree of AI ancestry but not cultural identification or body mass index. Substance use disorders, anxiety, and affective disorders influenced sleep as quantified by the Pittsburgh Sleep Quality Index.

Circulating Anti-Coatomer Protein Complex Subunit Epsilon (COPE) Autoantibodies as a Potential Biomarker for Cardiovascular and Cerebrovascular Events in Patients with Obstructive Sleep Apnea. 393-400.
Takuma Matsumura, MD1; Jiro Terada, MD, PhD1; Taku Kinoshita, MD1; Yoriko Sakurai, MD, PhD1; Misuzu Yahaba, MD, PhD1; Ryogo Ema, MD1; Atsuko Amata, MD1,2; Seiichiro Sakao, MD, PhD1; Kengo Nagashima, PhD3; Koichiro Tatsumi, MD, PhD1; Takaki Hiwasa, PhD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Moderate to severe OSA is an independent risk factor for arteriosclerosis-related disease; however, the development of severe atherosclerosis-related diseases such as cardiovascular and cerebrovascular events cannot yet be predicted in patients with OSA. The objective of this study was to evaluate whether COPE-Ab levels had an association with cardiovascular and cerebrovascular events in patients with OSA.

Study Impact: This study demonstrates that significant differences in COPE-Ab levels are observed when patients are stratified by OSA severity. An elevated COPE-Ab level is significantly predictive of CVD and/or stroke in patients with OSA; therefore, patients with higher COPE-Ab levels may require more careful and intensive treatment.

A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities. 401-410.
Tonya M. Palermo, PhD1,2; Sarah Beals-Erickson, PhD2; Maggie Bromberg, PhD2; Emily Law, PhD1,2; Maida Chen, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Insomnia is highly prevalent in the adolescent population and frequently occurs in the context of other medical and psychiatric concerns (e.g., chronic pain, depression). Efficacy of cognitive behavioral therapy for insomnia (CBT-I) has been established in adults with comorbid conditions; however, there are limited data on the efficacy of CBT-I in adolescents with co-occurring health or psychiatric conditions, which we aimed to examine in this pilot trial.

Study Impact: CBT-I is feasible to implement with adolescents with co-occurring medical and psychiatric conditions and is associated with improvements in insomnia, sleep quality and habits, psychological symptoms, and health-related quality of life. Our preliminary findings support the need for future randomized controlled trials of CBT-I in this population.

Performance of Remotely Controlled Mandibular Protrusion Sleep Studies for Prediction of Oral Appliance Treatment Response. 411-417.
Kate Sutherland, PhD1,2; Joachim Ngiam, BDS (Hons), MSD, MPhil1; Peter A. Cistulli, MD, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Oral appliance treatment response varies between individuals and development of methods to pre-identify treatment responders has been an ongoing challenge. A commercially available RCMP device has become available for use during sleep studies for this purpose; we wished to assess this methodology in our own laboratory setting for accuracy in prediction of oral appliance treatment outcome.

Study Impact: This study presents predictive accuracy of the RCMP methodology in an independent site to the original validation study. This study provides further information about the performance of this technique in another center and supports the application of this methodology in the clinical setting.

Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy. 419-425.
Kiran Maski, MD1,2; Erin Steinhart, BS, MA2; David Williams, PhD1,2; Thomas Scammell, MD1,4; Julie Flygare, JD5; Kimberly McCleary, BA6; Monica Gow, BA7

BRIEF SUMMARY

Current Knowledge/Study Rationale: It is unclear what patient factors contribute to the problem of diagnostic delays for narcolepsy. Furthermore, health care providers and researchers tend to focus on assessments of core narcolepsy symptoms to determine treatment efficacy but it is not clear if these are the symptoms of most importance to patients for daily functioning.

Study Impact: This phenomenological study provides novel data on narcolepsy disease experience that informs these gaps in the literature. Specifically, symptom onset before 18 y of age contributes to delayed diagnosis but not to reports of comorbid depression. Study results are informative for health care providers and narcolepsy patient advocates to improve diagnostic delays and care of patients with narcolepsy. Results may also inform the development of future patient-reported outcome tools.

Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population. 427-432.
Adeline Tan, MBBS1; Jason D.C. Yin, MSc2; Linda W.L. Tan, MPH2; Rob M. van Dam, PhD2,3; Yan Yi Cheung, BSc3,4; Chi-Hang Lee, MD3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: There has been an alarming increase in the prevalence of obstructive sleep apnea (OSA) in recent population-based studies. However, the majority of these subjects remain undiagnosed. Most screening tools developed to predict OSA have been validated mainly in referral populations where the prevalence of OSA is high. The Berlin questionnaire was initially developed as a tool to identify patients who are likely to have OSA in the primary care setting.

Study Impact: Our findings show that the Berlin questionnaire can be used as a screening tool in the general population in view of its good sensitivity and high negative predictive value in ruling out severe OSA. However, the positive predictive value is low. Subjects from a population-based cohort who are classified as high risk on the questionnaire can be prioritized to undergo further testing to confirm the presence of OSA.

Ambulatory Blood Pressure Monitoring in Chinese Patients with Obstructive Sleep Apnea. 433-439.
Yan Ma, MD1; Shuchen Sun, MD2,3; Chung-Kang Peng, PhD1; Yeming Fang, MD4; Robert J. Thomas, MD5

BRIEF SUMMARY

Current Knowledge/Study Rationale: Chinese populations have a higher incidence of sleep-disordered breathing (SDB) than Caucasians because of a narrow cranial base and flat midface structure. We aimed to evaluate the BP profile in Chinese patients, in whom the OSA-BMI correlation is weaker.

Study Impact: OSA and its severity are associated with pathological blood pressure patterns, and this association presents even when BMI is at worst mildly elevated. Hypertension pathology in OSA is underestimated unless 24-h BP is measured.

Intravenous Immunoglobulin Therapy in Pediatric Narcolepsy: A Nonrandomized, Open-Label, Controlled, Longitudinal Observational Study. 441-453.
Michel Lecendreux, MD1,2; Johanna Berthier, Medical Student3; Jennifer Corny, PharmD4; Olivier Bourdon, MD, PhD4,5; Claire Dossier, MD6; Christophe Delclaux, MD, PhD1,7

BRIEF SUMMARY

Current Knowledge/Study Rationale: Pediatric narcolepsy is a chronic, debilitating condition with no available disease-modifying therapies. Because the disease is thought to result from autoimmune destruction of hypocretin neurons, intravenous immunoglobulin therapy may offer potential benefit, especially in patients with early-onset disease.

Study Impact: This report represents the most extensive evaluation to date of the treatment of narcolepsy in children <18 y of age with IVIg (1 g/kg in 3 monthly infusions plus standard care, n=22) compared with standard care alone (n=30), both in terms of numbers of patients evaluated (n=52) and the length of follow-up (3.9 y). Although, symptoms of narcolepsy were not significantly reduced by intravenous immunoglobulin compared with standard care alone, improvement was more rapid with intravenous immunoglobulin in a subset of patients with high baseline symptoms.

VAMONOS (Veterans Affairs' Metabolism, Obstructed and Non-Obstructed Sleep) Study: Effects of CPAP Therapy on Glucose Metabolism in Patients with Obstructive Sleep Apnea. 455-466.
Octavian C. Ioachimescu, MD, PhD1,2; Jeremy Anthony, MD3; Tina Constantin, MD1,2; Mary-Margaret Ciavatta, PAC1; Kandace McCarver, PAC1; Mary Ellen Sweeney, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: The effects of sustained CPAP therapy on glucose metabolism in patients with OSA are still unclear. We aimed to assess trends in hemoglobin A1c, fasting blood glucose, and other metabolic parameters in a large cohort of consecutive patients seen in sleep clinics, in relationship to body weight fluctuations, medication changes, and adherence to CPAP therapy.

Study Impact: We found that patients with OSA treated with CPAP tend to gain more weight, in a “dose”-response relationship, yet the glucose metabolism is improved with better therapeutic adherence. Even with a median follow-up of less than 1 y, we found that incident diabetes mellitus and impaired fasting glucose are significantly curtailed by superior adherence to CPAP therapy.

Special Articles

Article Is Eligible For CME Credits Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. 479-504.
Vishesh K. Kapur, MD, MPH1; Dennis H. Auckley, MD2; Susmita Chowdhuri, MD3; David C. Kuhlmann, MD4; Reena Mehra, MD, MS5; Kannan Ramar, MBBS, MD6; Christopher G. Harrod, MS7
Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients. 505-510.
Anita Valanju Shelgikar, MD, FAASM1; Sharon Aronovich, DMD2; Jeffrey J. Stanley, MD1,3

Case Reports

Cyclic Alternating Pattern Associated with Catathrenia and Bruxism in a 10-Year-Old Patient. 511-512.
Brian Villafuerte-Trisolini, MD1; Fiorella Adrianzén-Álvarez, MD1; Kevin R. Duque, MD1; Jimmy Palacios-García, MD1,2,3; Darwin Vizcarra-Escobar, MD1,2,4

Sleep Medicine Pearls

A Four-Year-Old Boy with Unusually Severe Obstructive Sleep Apnea. 513-516.
Taomei Li, MS; Guangyao Zhou, MD; Linghui Yang, MS; Lu Tan, MD; Rong Ren, MD; Yuanfeng Sun, MS; Yun Li, MD; Xiangdong Tang, MD, PhD

Emerging Technologies

Validation of Contact-Free Sleep Monitoring Device with Comparison to Polysomnography. 517-522.
Asher Tal, MD1; Zvika Shinar, PhD2; David Shaki, MD1; Shlomi Codish, MD3; Aviv Goldbart, MD1
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