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Accepted Papers

Scientific Investigations

Relationship between Physical Function and Sleep Quality in African Americans. 1323-1329.
Roland J. Thorpe, PhD1; Alyssa A. Gamaldo, PhD2; Rachel E. Salas, MD3; Charlene E. Gamaldo, MD3; Keith E. Whitfield, PhD4


Current Knowledge/Study Rationale: There is a burgeoning body of research examining the relationship between sleep and functional outcomes particularly among older adults. However, there is a paucity of work focusing on sleep and physical functioning in older African Americans.

Study Impact: Sleep quality is an important correlate of difficulties of ADL among older African Americans regardless of gender. Understanding this relationship in this understudied population is important given that the number of older African Americans is expected to continue to grow over the next three decades in the United States.

Article Is Eligible For CME Credits Obstructive Sleep Apnea Increases the Perioperative Risk of Cardiac Valve Replacement Surgery: A Prospective Single-Center Study. 1331-1337.
Ning Ding, PhD1; Bu-Qing Ni, PhD2; Hong Wang, PhD1; Wen-Xiao Ding, PhD1; Rong Xue, MD1; Wei Lin, MD3; Zhang Kai, MD4; Shi-Jiang Zhang, PhD2; Xi-Long Zhang, PhD1


Current Knowledge/Study Rationale: We have previously reported a high prevalence of sleep apnea (SA) among rheumatic valvular heart disease (RVHD) patients undergoing cardiac valve replacement (CVR) surgery; however, whether the presence of SA increases the perioperative risk of CVR is not well established. We explored the potential association of obstructive SA (OSA) and central SA (CSA) with perioperative events of CVR surgery in RVHD patients.

Study Impact: RVHD patients with SA have an increased incidence of perioperative complications. OSA was independently associated with overall worsening of postoperative recovery (longer duration of ICU stay), respiratory insufficiency (longer duration of mechanical ventilation), and higher rate of postoperative pacemaker use; while CSA was not associated with postoperative events.

Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy. 1339-1346.
Raquel P. Hirata, MSc1; Fabiola Schorr, MD1; Fabiane Kayamori, SLP1; Henrique Takachi Moriya, PhD2; Salvatore Romano, MSc3; Giuseppe Insalaco, MD3; Eloisa M. Gebrim, MD4; Luis Vicente Franco de Oliveira, PhD5; Pedro R. Genta, MD1; Geraldo Lorenzi-Filho, MD1


Current Knowledge/Study Rationale: There is a growing interest to develop simple methods to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Negative expiratory pressure (NEP) evaluates upper airway collapsibility and can be easily performed during wakefulness.

Study Impact: We showed that NEP applied with a nasal mask in the supine position is associated with the anatomical component of upper airway collapsibility and performs similarly to the laborious method of Pcrit in patients under investigation for OSA. This tool may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.

Article Is Eligible For CME Credits Minimizing Interrater Variability in Staging Sleep by Use of Computer-Derived Features. 1347-1356.
Magdy Younes, MD1,2,3; Patrick J. Hanly, MD2


Current Knowledge/Study Rationale: Inter-scorer variability in scoring polysomnograms results primarily from difficulty in determining whether: (1) an electroencephalogram pattern of wakefulness spans > 15 sec in transitional epochs, (2) spindles or K complexes are present, and (3) duration of delta waves exceeds 6 sec in a 30-sec epoch. We hypothesized that providing digitally derived information about these variables to the scorers may reduce inter-scorer variability.

Study Impact: Percent agreement between scorers improved dramatically after their scores were independently modified using digitally obtained information about sleep depth, delta duration, spindles, and K complexes. Provision of such information during scoring can greatly reduce interrater variability in sleep staging by eliminating the guesswork in scoring epochs with equivocal features.

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients. 1357-1364.
Harneet K. Walia, MD, FAASM1; Sandra D. Griffith, PhD2; Nicolas R. Thompson, MS2; Douglas E. Moul, MD, MPH1; Nancy Foldvary-Schaefer, DO, MS1; Reena Mehra, MD, MS, FCCP, FAASM1


Current Knowledge/Study Rationale: There exists a strong association between sleep-disordered breathing and hypertension, particularly resistant hypertension, and these are associated with impaired quality of life. There is a need for a greater understanding of patient-reported outcomes responsiveness to positive airway pressure therapy in individuals suffering from both conditions

Study Impact: This study provides a novel longitudinal measurement on improvement in daytime sleepiness, depressive symptoms, and fatigue in patients with sleep-disordered breathing and hypertension/ resistant hypertension. Caucasians and younger patients derived greater benefit, thus informing clinicians of expected patient reported outcomes response to positive airway pressure therapy.

Relationship of Fluid Accumulation in the Neck to Sleep Structure in Men during Daytime Sleep. 1365-1371.
Azadeh Yadollahi, PhD1,2; Daniel Vena, MSc2; Owen D. Lyons, MBBCh1,3,4; T. Douglas Bradley, MD1,3,4


Current Knowledge/Study Rationale: While it is known that age and sleep apnea severity worsen sleep structure, our previous studies show a strong association between total body water and sleep structure. We hypothesized that fluid accumulation in the neck is a significant contributor to the sleep structure.

Study Impact: This is the first study to show that compared to sleep apnea severity or age, fluid accumulation in the neck had a stronger contribution to impair sleep structure and reduce slow wave sleep.

Temporal Stability of the Ford Insomnia Response to Stress Test (FIRST). 1373-1378.
Denise C. Jarrin, PhD1,2; Ivy Y. Chen, BS1,2; Hans Ivers, PhD1,2; Christopher L. Drake, PhD3; Charles M. Morin, PhD1,2


Current Knowledge/Study Rationale: The use of the Ford Insomnia Response to Stress Test (FIRST) has grown in the field; however, data on its temporal stability are scarce and based on relatively short-term test-retest intervals in small samples. The current psychometric study aimed to investigate the temporal stability of the FIRST over two 6-mo intervals in a population-based sample of adults with and without insomnia.

Study Impact: Such information is important when assessing the psychometric properties of the FIRST (i.e. high FIRST scores). This is the first step in its future use to identify and predict long-term risk and outcomes in individuals with sleep reactivity.

The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome. 1379-1388.
Juan F. Masa, MD, PhD1,17; Jaime Corral, MD1,17; Auxiliadora Romero, MD11; Candela Caballero, MD11; Joaquin Terán-Santos, MD, PhD2,17; Maria L. Alonso-Álvarez, MD, PhD2,17; Teresa Gomez-Garcia, MD3; Mónica González, MD, PhD4; Soledad López-Martínez, MD5; Pilar De Lucas, MD, PhD5; José M. Marin, MD, PhD6,17; Sergi Marti, MD, PhD7,17; Trinidad Díaz-Cambriles, MD8,17; Eusebi Chiner, MD, PhD9; Miguel Merchan, MStat1; Carlos Egea, MD, PhD10,17; Ana Obeso, MD, MSc18; Babak Mokhlesi, MD, MSc19


Current Knowledge/Study Rationale: Supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS) treated with noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), in order to improve residual hypoxemia during daytime and/or sleep and as a palliative treatment in OHS patients who reject NIV or CPAP therapies. However, there is paucity of data regarding its efficacy and safety.

Study Impact: Oxygen therapy added to NIV, CPAP, or lifestyle modification during 2 mo produced mixed results that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring.

Flumazenil for the Treatment of Refractory Hypersomnolence: Clinical Experience with 153 Patients. 1389-1394.
Lynn Marie Trotti, MD, MSc1; Prabhjyot Saini, MSc1,2; Catherine Koola, MPH2; Vincent LaBarbera, MD1; Donald L. Bliwise, PhD1; David B. Rye, MD, PhD1


Current Knowledge/Study Rationale: Hypersomnolence can be treated with a variety of wake-promoting medications. However, a subgroup of patients have persistent, severe sleepiness despite use of standard therapies.

Study Impact: This large case series suggests that sublingual and transdermal flumazenil may be beneficial for some patients with treatment-refractory sleepiness. A prospective, controlled study of flumazenil is needed to confirm these observations.

The Use of Melatonin by Children: Parents' Perspectives. 1395-1401.
Amy Y. Waldron, BPharm(Hons); M. Joy Spark, PhD; Christina M. Dennis, Grad Dip Clin Pharm


Current Knowledge/Study Rationale: Sleep disorders in children can be stressful for both the child and their family and holistic care for children requires an understanding of parents' perceptions of alternative treatments. This study was undertaken to investigate parents' perspectives of melatonin use by their children.

Study Impact: Prescribers are provided with an insight into parents' perception that melatonin treatment has transformed both their child's and their lives. Knowing that parents and health care professionals can have different priorities and perceptions could improve the quality of care offered to families with children with sleep disturbances.

Effects of Rotigotine on REM Sleep Behavior Disorder in Parkinson Disease. 1403-1409.
Yan Wang, MD1; Yuechang Yang, MD1; Huijuan Wu, MD, PhD2; Danmei Lan, MD1; Ying Chen, PhD2; Zhongxin Zhao, MD, PhD1


Current Knowledge/Study Rationale: REM sleep behavior disorder (RBD) is a common manifestation of Parkinson disease (PD). No published trails have investigated the efficacy of nonergolinic dopamine agonist rotigotine on RBD symptoms.

Study Impact: In PD, rotigotine can improve the frequency and severity of abnormal motor behaviors, improve the quality of sleep of patients. Rotigotine could be used as an alternative to clonazepam for RBD patients with PD.

Review Articles

The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review. 1411-1421.
Chloé Kastoer, MD1,4; Marijke Dieltjens, MSc, PhD1,2,4; Eline Oorts, MD1; Evert Hamans, MD, PhD4; Marc J. Braem, DDS, PhD2,4; Paul H. Van de Heyning, MD, PhD1,3,4; Olivier M. Vanderveken, MD, PhD1,3,4

Case Reports

Sleep Apnea in Hurler Syndrome: Looking Beyond the Upper Airway. 1423-1424.
Sumera Shaikh Solaiman, MD1; Daniel Scott Rifkin, MD2; Harish Rao, MD3

Sleep Medicine Pearls

Rhythmic Electroencephalogram Activity during Polysomnography. 1426-1428.
Safal Shetty, MD1,2,3; Faraz Jaffer, MD2; Sairam Parthasarathy, MD1,2,3


In Memoriam: Thomas E. Meade, DDS, 1941–2016. 1429.
Wolfgang Schmidt-Nowara, MD
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