Earn CME
Accepted Papers


Expediting Peer Review: Just Say No. 941.
Stuart F. Quan, M.D., F.A.A.S.M.

Scientific Investigations

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea. 943-949.
Kate Sutherland, Ph.D.1,2; Craig L. Phillips, Ph.D.1,2; Amanda Davies, B.Sc.(Hons)1,2; Vasanth K. Srinivasan, M.D.Sc.3; Oyku Dalci, Ph.D.3; Brendon J. Yee, M.D., Ph.D.1,4; M. Ali Darendeliler, Ph.D.3; Ronald R. Grunstein, M.D., Ph.D.1,4; Peter A. Cistulli, M.D., Ph.D.1,2


Current Knowledge/Study Rationale: CPAP pressure has been shown to predict oral appliance treatment response in Japanese male OSA patients and could be a simple and useful clinical predictor for some OSA patients. We sought to assess the relationship between CPAP pressure and oral appliance treatment response in a predominantly Caucasian population.

Study Impact: We confirm a relationship between lower CPAP pressure and oral appliance treatment response, although not as strong as in the Japanese population and requiring a higher CPAP pressure cutoff value for best predictive utility. CPAP pressure requirement, in conjunction with patient characteristics of age and OSA severity, may be useful in indicating oral appliance treatment response in Caucasian OSA populations.

Alternative Scoring Models of STOP-Bang Questionnaire Improve Specificity To Detect Undiagnosed Obstructive Sleep Apnea. 951-958.
Frances Chung, M.B.B.S.; Yiliang Yang, M.D.; Russell Brown, M.D.; Pu Liao, M.D.


Current Knowledge/Study Rationale: The STOP-Bang questionnaire is a validated screening tool with a high sensitivity. Its moderate specificity may yield a high false-positive rate. The specific combinations of predicting factors in the STOP-Bang questionnaire may improve its specificity.

Study Impact: This study shows that the specific constellations of predictive factors improved the specificity of STOP-Bang questionnaire. For patients with a STOP score ≥ 2, male gender, and BMI > 35 kg/m2 were more predictive of obstructive sleep apnea than age ≥ 50 and neck circumference > 40 cm.

Prevalence and Clinical Significance of Supine-Dependent Obstructive Sleep Apnea in Patients Using Oral Appliance Therapy. 959-964.
Marijke Dieltjens, M.B.S.1,2,4; Marc J. Braem, D.D.S., Ph.D.1,4; Paul H. Van de Heyning, M.D., Ph.D.2,4; Kristien Wouters, Ph.D.3; Olivier M. Vanderveken, M.D., Ph.D.2,4


Current Knowledge/Study Rationale: Body position during sleep is known to not only affect the severity of obstructive sleep apnea (OSA), but also the therapeutic outcome of oral appliance therapy with a mandibular advancement device (OAm). The prevalence of supine-dependent OSA (sdOSA) in a general population is relatively high. The prevalence of sdOSA under OAm therapy is currently unknown.

Study Impact: The results of this study show that the prevalence of sdOSA before and under OAm therapy is relatively high. In addition, one-third of patients shifted from non-sdOSA to sdOSA under OAm therapy.

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects. 965-971.
Emilia Sforza, M.D., Ph.D.; Magali Saint Martin, M.Sc.; Jean Claude Barthelemy, M.D., Ph.D.; Frédéric Roche, M.D., Ph.D.


Current Knowledge/Study Rationale: An association between hyper-tension and short and poor sleep has been reported in middle-aged insomniac patients. Contradictory results have been obtained in elderly with insomnia. We assess the relationship between sleep duration and sleep quality and blood pressure values and hypertension in a large group of elderly without insomnia complaints.

Study Impact: In the elderly without insomnia, no association was found between sleep duration and sleep quality and hypertension and blood pressure values. These results argue against a true relationship between hypertension and sleep perception in older subjects.

Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study. 973-977.
Keiko Maeda, Ph.D.1,2,3; Satoru Tsuiki, Ph.D.1,2,3; Seiichi Nakata, Ph.D.4,5; Kenji Suzuki, Ph.D.4; Eiki Itoh, Ph.D.1,2,3; Yuichi Inoue, Ph.D.1,2,3


Current Knowledge/Study Rationale: The persistence of obstructive sleep apnea (OSA) after adenotonsillectomy (AT) in children may be associated with the maxillofacial morphology, as in adult OSA patients. Therefore, we evaluated the relationship between the severity of residual OSA and the maxillofacial morphology by using lateral upright cephalography.

Study Impact: A significant negative association between maxillomandibular size and post-treatment AHI suggests that OSA likely remains after AT when pediatric OSA is associated with a smaller mandible. Therefore, an approach to encourage mandibular growth (e.g., orthodontic treatment) could be considered.

Evaluation of a New Pediatric Positive Airway Pressure Mask. 979-984.
Clete A. Kushida, M.D., Ph.D., F.A.A.S.M.1; Ann C. Halbower, M.D.2; Meir H. Kryger, M.D., F.A.A.S.M.3; Rafael Pelayo, M.D., F.A.A.S.M.1; Valerie Assalone, R.N.3; Chia-Yu Cardell, RPSGT1; Stephanie Huston, B.S.2; Leslee Willes, M.S.4; Alison J. Wimms, M.Sc.5; June Mendoza, B.S.5


Current Knowledge/Study Rationale:There are limited choices for children with sleep related breathing disorders who require use of continuous positive airway pressure (CPAP). The current study tests a new CPAP mask specifically designed and constructed for children.

Study Impact: This study provides a suitable choice for children with sleep related breathing disorders compared to other CPAP masks.

Mallampati Score and Pediatric Obstructive Sleep Apnea. 985-990.
Harsha Vardhan Madan Kumar, M.D.1; James W. Schroeder, M.D.2; Zhang Gang, Ph.D.3; Stephen H. Sheldon, D.O., F.A.A.S.M.4


Current Knowledge/Study Rationale: History and physical exam are not sufficient to make the diagnosis of pediatric obstructive sleep apnea. Polysomnography (PSG) is the gold standard used to confirm this diagnosis and is therefore recommended in certain clinical situations. However, PSG is an expensive test and access to pediatric sleep labs is limited.

Study Impact: Mallampati score and tonsillar size are independent predictors for the presence of and the severity of pediatric OSA and may be used to help prioritize sleep studies for earlier diagnosis and management of pediatric OSA.

Average Heart Rates of Hispanic and Caucasian Adolescents during Sleep: Longitudinal Analysis from the TuCASA Cohort. 991-995.
Kristen Hedger-Archbold, Ph.D.1; Seth T. Sorensen, M.A.2; James L. Goodwin, Ph.D.3; Stuart F. Quan, M.D., F.A.A.S.M.3,4


Current Knowledge/Study Rationale: Little is known about heart rate patterns during sleep for adolescents and how these patterns may change over a 5-year period. We aimed to describe and determine the relationships between age, sex, body mass index (BMI), physical activity and ethnicity on nocturnal heart rate patterns in a cohort of healthy adolescents.

Study Impact: No significant differences were found between obese vs. non-obese, Caucasian vs. Hispanic adolescents in nocturnal heart rates, although female adolescents had significantly faster heart rates than males at all time points. Levels of physical activity and fitness may be an important contributor to the observed sex differences in nocturnal heart rate and should be investigated in future work.

Article Is Eligible For CME Credits Stress-Related Sleep Vulnerability and Maladaptive Sleep Beliefs Predict Insomnia at Long-Term Follow-Up. 997-1001.
Chien-Ming Yang, Ph.D.1,2; Chih-Ying Hung, M.S.1; Hsin-Chien Lee, M.D.3,4


Current Knowledge/Study Rationale: Vulnerability to stress-related sleep disturbances and maladaptive sleep beliefs has been proposed to predispose the development of insomnia. The current study aims to confirm the predisposing roles of these factors with a longitudinal survey study.

Study Impact: The findings that both vulnerability to stress-related sleep disturbances and maladaptive sleep beliefs are predisposing factors for insomnia provide a direction to identify individuals with higher risk for insomnia. Preventive strategies can then be applied to reduce their risk of developing chronic insomnia.

Sleep Measures Predict Next-Day Symptoms in Women with Irritable Bowel Syndrome. 1003-1009.
Diana Taibi Buchanan, Ph.D.; Kevin Cain, Ph.D.; Margaret Heitkemper, Ph.D.; Robert Burr, M.S.E.E., Ph.D.; Michael V. Vitiello, Ph.D.; Jasmine Zia, M.D.; Monica Jarrett, Ph.D.


Current Knowledge/Study Rationale: Self-reported sleep quality predicts next-day symptoms in IBS, but it is not known whether the same is true of objectively measured sleep. Furthermore, studies show that GI symptoms or pain do not necessarily predict sleep disturbance, but little evidence on this relationship is available in persons with IBS.

Study Impact: This study shows that objective as well as subjective sleep outcomes predict next-day IBS symptoms, but that daytime IBS symptoms do not predict subsequent nighttime sleep quality. Clarifying the relationship between sleep quality and IBS symptoms is important for understanding underlying mechanisms of IBS and identifying potential treatment targets in persons with IBS.

Article Is Eligible For CME Credits Dual Cases of Type 1 Narcolepsy with Schizophrenia and Other Psychotic Disorders. 1011-1018.
Francesca Canellas, M.D., Ph.D.1; Ling Lin, M.D., Ph.D.2; Maria Rosa Julià, Ph.D.3; Antonio Clemente, Ph.D.3; Cristofol Vives-Bauza, Ph.D.4; Hanna M. Ollila, Ph.D.2; Seung Chul Hong, M.D., Ph.D.5; Susana M. Arboleya, M.D.1,6; Mali A. Einen2; Juliette Faraco, Ph.D.2; Marcelo Fernandez-Vina, Ph.D.7; Emmanuel Mignot, M.D., Ph.D., F.A.A.S.M.2


Current Knowledge/Study Rationale: Rare cases of narcolepsy with psychosis have been reported but never systematically studied regarding clinical features, treatment outcomes, or potential autoimmune markers. We carefully examined a cohort of dual cases to define characteristics of hallucinations and delusions, compared to simple narcolepsy, and searched for antibodies directed against targets known to be involved in other forms of psychosis.

Study Impact: Our study will improve diagnosis and treatment of these complex cases, and provides a specialized questionnaire for clinical use. We found no evidence of antibody-mediated autoimmunity or new HLA associations, but based on our study of clinical history, we make recommendations on how to proceed.

Psychomotor Vigilance Task Demonstrates Impaired Vigilance in Disorders with Excessive Daytime Sleepiness. 1019-1024.
Janine Thomann, M.Sc.1; Christian R. Baumann, M.D.1; Hans-Peter Landolt, Ph.D.2,3; Esther Werth, Ph.D.1


Current Knowledge/Study Rationale: The Psychomotor Vigilance Task (PVT) is one of the leading assays of vigilant attention in sleep research and highly sensitive to the effects of sleep loss. Even though PVT is widely used in sleep deprivation studies, little is known about PVT performance in patients suffering from sleep-wake disorders.

Study Impact: Performance on the PVT shows different patterns in patients with sleep-wake disorders and in controls. Our study suggests that PVT has a potential to be of clinical relevance because it provides extra information in the diagnostic process to distinguish between healthy controls and patients with sleepiness.

The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis. 1025-1031.
Steven D. Brass, M.D., M.P.H., M.B.A.1; Chin-Shang Li, Ph.D.2; Sanford Auerbach, M.D., F.A.A.S.M.3


Current Knowledge/Study Rationale: Sleep disorders in Multiple Sclerosis patients are reportedly common but the epidemiological data on prevalence is limited to small sample sizes. The rationale for this study was to report on a large population level the prevalence of restless legs syndrome, insomnia, and the risk of obstructive sleep apnea in subjects with Multiple Sclerosis patients using validated screening questionnaires.

Study Impact: Greater than 70% of MS subjects in this large population based survey screened positive for one or more sleep disorders. The vast majority of these sleep disorders are potentially undiagnosed and untreated. Physicians treating patients with Multiple Sclerosis need to be diligent in the screening, evaluation and management of sleep disorders in this population as untreated sleep disorders may impact the fatigue and quality of life of the individual.

Case Reports

Upper Airway Obstruction during Noninvasive Ventilation Induced by the Use of an Oronasal Mask. 1033-1035.
Bart Vrijsen, P.T., M.Sc.; Bertien Buyse, M.D., Ph.D.; Catharina Belge, M.D., Ph.D.; Dries Testelmans, M.D., Ph.D.
Restless Legs Syndrome as a First Manifestation of a Cerebral Infarct. 1037-1038.
Elisabeth Ruppert, M.D.1,2,3; Ulker Kilic-Huck, M.D.1,2,3; Valérie Wolff, M.D.3,4; Laurent Tatu, M.D., Ph.D.5,6; Marion Ghobadi, M.D.1,2,3; Marc Bataillard, M.D.1,2,3,4; Patrice Bourgin, M.D., Ph.D.1,2,3
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September 15, 2014
Volume 10, Issue 09

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