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Scientific Investigations

Article Is Eligible For CME Credits Free Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy. 863-870.
Galit Levi Dunietz, PhD1; Lynda D. Lisabeth, PhD2; Kerby Shedden, PhD3; Q. Afifa Shamim-Uzzaman, MD1; Alexandra S. Bullough, MBChB4; Mark C. Chames, MD5; Marc F. Bowden1; Louise M. O'Brien, PhD1,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: Restless legs syndrome (RLS) affects up to one-third of pregnant women, yet data on its associated maternal sleep-wake disturbances—which are predictors of adverse pregnancy outcomes—are scarce. This study examined the frequency of RLS and its association with sleep-wake disturbances in a large sample of pregnant women.

Study Impact: Results from this large cohort of pregnant women suggest that RLS is strongly associated with poor sleep quality, excessive daytime sleepiness, and poor daytime function, which are common symptoms frequently attributed to pregnancy. Screening and identification of RLS in pregnancy may alleviate the burden of symptoms in the majority of cases.

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy. 871-880.
John E. Remmers, MD1,2; Zbigniew Topor, PhD1,2; Joshua Grosse, MMath2; Nikola Vranjes, DDS3; Erin V. Mosca, PhD2; Rollin Brant, PhD4; Sabina Bruehlmann, PhD2; Shouresh Charkhandeh, DDS2,3; Seyed Abdolali Zareian Jahromi, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Oral appliances that protrude the mandible are a potentially important therapy for the treatment of obstructive sleep apnea. However, only 50% to 70% of individuals with sleep apnea experience a satisfactory therapeutic response to the therapy. Hence, we need a test that prospectively identifies therapeutic responders.

Study Impact: The current study describes a feedback-controlled mandibular positioner for use at home and demonstrates that it prospectively identifies individuals with obstructive sleep apnea who will respond to oral appliance therapy. Additionally, the feedback-controlled mandibular positioner test provides a mandibular position that is efficacious in almost all responders.

A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms. 881-888.
Teresa Shirlaw, MSc (Hons), RPSGT; Kevin Hanssen, MSc, RPSGT; Brett Duce, BSc (Hons), RPSGT; Craig Hukins, MBBS, FRACP

BRIEF SUMMARY

Current Knowledge/Study Rationale: Aerophagia is a known side effect of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea. Currently there is no evidence for the use of autotitrating positive airway pressure (APAP) in reducing the symptoms of aerophagia in affected patients.

Study Impact: This study showed that using APAP reduces the symptoms of aerophagia but does not increase compliance with therapy. APAP is a viable alternative to CPAP in patients experiencing aerophagia.

Later School Start Times: What Informs Parent Support or Opposition?. 889-897.
Galit Levi Dunietz, PhD, MPH1; Amilcar Matos-Moreno, MPH2; Dianne C. Singer, MPH2; Matthew M. Davis, MD, MAPP2,3,4; Louise M. O'Brien, PhD, MS1; Ronald D. Chervin, MD, MS1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Despite recent evidence that links later school start times with improved sleep health among adolescents, most middle and high schools have current start times before 8:30 am. This study identifies potential facilitators and barriers to parental support for school start times at 8:30 am or later.

Study Impact: Results from this nationally representative survey of United States parents of adolescents suggest that education about medical recommendations in support of later school start times, anticipated effect on health, and performance benefits might improve support for adoption of recommended school start times. Efforts to publicize the positive experiences of communities that have made this transition, with regard to previously feared family scheduling and transportation challenges, may also prove helpful.

Self-Reported Sleep Duration and Self-Rated Health in Young Adults. 899-904.
Lovro Štefan, MEd1; Dora Juranko, MEd2; Rebeka Prosoli, MEd1; Renata Barić, PhD1; Goran Sporiš, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep duration represents a key factor for physical and mental health, especially in young adults. Evidence suggests that only short sleep is known to affect poor self-rated health in young adults.

Study Impact: Our study shows that young adults reporting both short (< 7 hours) and long (> 10 hours) sleep duration have higher odds of having poor self-rated health. Special interventions and policies that leverage sleep duration might serve as an avenue for health promotion in young adults.

Article Is Eligible For CME Credits Free Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study. 905-910.
Łukasz Mokros, MD, PhD1; Wojciech Kuczyński, MD2; Łukasz Franczak2; Piotr Białasiewicz, MD, PhD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Obesity and other interrelated comorbidities of obstructive sleep apnea (OSA) makes it difficult to reveal associations between clinical variables. Although OSA is known to influence blood pressure, this effect is rarely investigated independently of obesity, especially in non-hypertensive patients.

Study Impact: The effect on morning diastolic blood pressure of a 1 kg/m2 increment of body mass index seems to be similar to the effect of a 1 event/h increment of apnea-hypopnea index. Therefore, we suggest that elevated morning diastolic blood pressure may be one of the symptoms related to OSA that warrants specific diagnostics.

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?. 911-921.
Megan R. Crawford, PhD1,2; Diana A. Chirinos, PhD3; Toni Iurcotta, BA4; Jack D. Edinger, PhD5; James K. Wyatt, PhD2; Rachel Manber, PhD6; Jason C. Ong, PhD2,7

BRIEF SUMMARY

Current Knowledge/Study Rationale: Current management of insomnia disorder relies primarily on diagnostic boundaries; however, there might be merit in a symptom-based approach. This study used sophisticated, data-driven statistical models to elucidate possible symptom cluster profiles in a sample of patients with insomnia disorder.

Study Impact: The results may offer a clinical guide for those who present to sleep clinics with insomnia, which may lead to a more patient-centered approach and enhanced patient care.

Case Reports

A Case of Recurrent Hypersomnia With Autonomic Dysfunction. 923-924.
Mandana Mahmoudi, MD, PhD, MPH1; Daniel Friedman, MD2; Martina Vendrame, MD, PhD3; Sanjeev V. Kothare, MD2
Three-Generation Family With Congenital Central Hypoventilation Syndrome and Novel PHOX2B Gene Non-Polyalanine Repeat Mutation. 925-927.
Ajay S. Kasi, MD1; Taryn J. Jurgensen, BA1; Stephanie Yen, MD2; Sheila S. Kun, RN, MS1; Thomas G. Keens, MD1,2; Iris A. Perez, MD1,2

Sleep Medicine Pearls

A Turbulent Night. 929-930.
Matt T. Bianchi, MD, PhD

Letters to the Editor

Free Why Should We Care About Selenium in Obstructive Sleep Apnea?. 931-932.
Rachel Gimenes Albuquerque, BSc; Camila Hirotsu, PhD; Sergio Tufik, MD, PhD; Monica Levy Andersen, PhD

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