Earn CME
Accepted Papers


Justice Antonin Scalia—The Wrong Message. 639-640.
Nancy A. Collop, MD, FAASM


Can You Hear Me Now?. 641-642.
Amir Sharafkhaneh, MD, PhD1,2; Max Hirshkowitz, PhD3
Ramelteon for Idiopathic REM Sleep Behavior Disorder: Implications for Pathophysiology and Future Treatment Trials. 643-645.
Erik K. St. Louis, MD, MS; Stuart J. McCarter, BA; Bradley F. Boeve, MD

Scientific Investigations

Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students. 647-652.
Carol Chu, MS1; Melanie A. Hom, MS1; Megan L. Rogers, BA1; Fallon B. Ringer, BS1; Jennifer L. Hames, PhD1,4; Sooyeon Suh, PhD2,3; Thomas E. Joiner, PhD1


Current Knowledge/Study Rationale: Rates of suicide are particularly high in South Korea. There is no research examining the role of insomnia, a significant risk factor for suicide, in the theoretical context of the interpersonal theory of suicide in this population.

Study Impact: This study informs suicide prevention efforts among individuals suffering from insomnia in South Korea and globally. Treatment of thwarted belongingness may be indicated for individuals simultaneously presenting with severe insomnia and suicidal symptoms.

Lowest Oxyhemoglobin Saturation May Be an Independent Factor Influencing Auditory Function in Severe Obstructive Sleep Apnea. 653-658.
Young Joon Seo, MD, PhD1,*; Sang Yoo Park, MD, PhD1,*; Hyo Jin Chung, MD2; Chang-Hoon Kim, MD, PhD2,3; Jeung-Gweon Lee, MD, PhD2; Sung Huhn Kim, MD, PhD2; Hyung-Ju Cho, MD, PhD2,3


Current Knowledge/Study Rationale: To verify our hypothesis that a correlation exists between the level of hypoxia induced by severe OSAS and the level of auditory dysfunction using polysomnography (PSG), We found that the sole variable that remained significant in parameters of PSG was lowest oxyhemoglobin saturation (total; p = 0.046). Oxyhemoglobin saturation, especially the lowest oxyhemoglobin saturation level, showed lower thresholds in the hearing impairment group than in the control group (p = 0.039 at NREM stage; p = 0.029 at REM stage; p = 0.001 at total sleep stage).

Study Impact: With this study, we recommend that lowest oxyhemoglobin saturation in PSG is the only variable correlated with the hearing threshold could be predictive of possible hearing alternation in patients with severe OSAS. Considering that severe OSAS might be a trigger for hearing loss, attention should be given to hearing evaluations in high-risk patients (e.g., obese middle-aged or elderly male) with OSAS screening.

Examining the Frequency of Stimulant Misuse among Patients with Primary Disorders of Hypersomnolence: A Retrospective Cohort Study. 659-662.
William G. Mantyh, MD1; R. Robert Auger, MD2,3; Timothy I. Morgenthaler, MD1,2,4; Michael H. Silber, MBChB2,5; Wendy R. Moore, BSN, RN, NE-BC2


Current Knowledge/Study Rationale: Although pharmacotherapy with modafinil and the traditional stimulants is considered the mainstay of treatment for narcolepsy and idiopathic hypersomnia, physicians are often uncomfortable with their long-term prescription because of concerns regarding misuse.

Study Impact: The goal of this study was to assess the frequency of stimulant misuse within this patient population. As there was no evidence of such, providers should not withhold pharmacotherapy because of a fear of patient medication misuse.

Psoriasis and Sleep Apnea: A Danish Nationwide Cohort Study. 663-671.
Alexander Egeberg, MD, PhD1,2; Usman Khalid, MD1; Gunnar Hilmar Gislason, MD, PhD1; Lotus Mallbris, MD, PhD3; Lone Skov, MD, PhD, DMSci2; Peter Riis Hansen, MD, PhD, DMSci1


Current Knowledge/Study Rationale: Psoriasis and sleep apnea are inflammatory diseases associated with significant cardiovascular morbidity and mortality, but information on their potential bidirectional association are lacking.

Study Impact: Patients with psoriasis or psoriatic arthritis have a disease severity increased risk of sleep apnea, and patients with sleep apnea have increased risk of psoriasis and psoriatic arthritis.

Article Is Eligible For CME Credits The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus. 673-680.
Teresa Arora, PhD1; Mimi Z. Chen, MBChB, MRCP, PhD2; Ashley R. Cooper, PhD3,4; Rob C. Andrews, MBChB, FRCP, PhD2; Shahrad Taheri, PhD, MBBS, FRCP1,5,6,7


Current Knowledge/Study Rationale: Sleep loss has been attributed to diabetes onset and progression, but little is known about the chronic effect of weekday sleep debt, which is common in contemporary society, upon diabetes outcomes in those with a recent diagnosis. Our study was performed to assess the long-term impact of weekday sleep debt upon multiple common, yet modifiable, diabetes outcomes (obesity, insulin sensitivity and central adiposity) in newly diagnosed type 2 diabetes mellitus patients.

Study Impact: Our findings highlight the importance of improving sleep in those with a new diagnosis of type 2 diabetes mellitus. Avoiding accumulation of sleep debt on weekdays may be a key component for minimizing adverse outcomes associated with diabetes mellitus (obesity, insulin resistance, and excess central adiposity), which could be incorporated into the future clinical management of this patient population.

Overnight Motor Skill Learning Outcomes in Obstructive Sleep Apnea: Effect of Continuous Positive Airway Pressure. 681-688.
Shane Landry, BSc Hons1; Denise M. O'Driscoll, PhD2,3,4; Garun S. Hamilton, MBBS, FRACP, PhD3,4; Russell Conduit, PhD5


Current Knowledge/Study Rationale: Compared to healthy controls, patients with obstructive sleep apnea (OSA) do not demonstrate typical overnight gains in the consolidation of motor skill learning. It is not currently known if this impairment can be rectified by successful treatment.

Study Impact: The findings of this study demonstrate a consistently impaired aspect of learning and memory in patients with OSA that appears to improve with successful CPAP treatment.

An Open-Labeled Trial of Ramelteon in Idiopathic Rapid Eye Movement Sleep Behavior Disorder. 689-693.
Yuichi Esaki, MD, PhD1; Tsuyoshi Kitajima, MD, PhD1; Shigefumi Koike, MD, PhD2; Hiroshige Fujishiro, MD, PhD3; Yasuyo Iwata, MT2; Akiko Tsuchiya, MD, PhD1; Marina Hirose, MD, PhD1; Nakao Iwata, MD, PhD1


Current Knowledge/Study Rationale: Clonazepam is a first-line treatment for rapid eye movement sleep behavior disorder (RBD). However, clonazepam is not always effective for treating RBD symptoms, and produces numerous side effects. Recently the melatonin receptor agonist ramelteon has been documented as being effective in two patients with secondary RBD. This study investigated the effect of ramelteon on patients with idiopathic RBD.

Study Impact: Ramelteon treatment did not have a clear effect on symptoms of idiopathic RBD. However, ramelteon had high tolerability for elderly individuals with RBD, with minor side effects, and there were some individual cases in which RBD symptoms were improved after ramelteon treatment. Ramelteon might be useful for patients with RBD who are unable to take clonazepam or are resistant to clonazepam treatment.

Comparison of Sleep Problems in Individuals with Spinal Cord Injury and Multiple Sclerosis. 695-701.
Donald J. Fogelberg, PhD1; Abbey J. Hughes, PhD1,2; Michael V. Vitiello, PhD3; Jeanne M. Hoffman, PhD1; Dagmar Amtmann, PhD1


Current Knowledge/Study Rationale: Individuals with neurological conditions such as spinal cord injury (SCI) and multiple sclerosis (MS) are at increased risk for developing sleep problems. However, as SCI and MS typically involve disparate disease courses and etiologies, it is plausible that sleep problem profiles may differ between these groups. The current study sought to compare SCI and MS groups on global and subscale scores of the MOS-SS, a validated, self-report measure of sleep.

Study Impact: Our findings show that although SCI and MS groups report similar overall levels of sleep problems, individuals with SCI report achieving significantly fewer hours of sleep and greater levels of sleep disruption. Results suggest that interventions aimed at increasing sleep duration may be more helpful for individuals with SCI, and that fatigue and daytime somnolence management interventions may be more appropriate for individuals with MS.

A Pre-Screening Questionnaire to Predict Non-24-Hour Sleep-Wake Rhythm Disorder (N24HSWD) among the Blind. 703-710.
Erin E. Flynn-Evans, PhD1,2,3; Steven W. Lockley, PhD1,2


Current Knowledge/Study Rationale: Non-24-hour sleep-wake rhythm disorder (N24HSWD) is prevalent among individuals who are totally blind, but diagnosis of this disorder is challenging due to the high prevalence of other sleep disorders experienced by blind individuals. Accurate diagnosis of N24HSWD requires evaluation of circadian phase markers, such as urinary melatonin sampled over several weeks; therefore it is desirable to have a screening tool in order to identify blind patients at the highest risk for N24HSWD.

Study Impact: We developed the first screening tool to discriminate blind individuals at risk for N24HSWD from those unlikely to have the disorder. Our tool provides clinicians with a cost-effective way to pre-screen blind patients with sleep complaints for N24HSWD.

Sleep/Wake Patterns and Parental Perceptions of Sleep in Children Born Preterm. 711-717.
Sarah N. Biggs, PhD1; Lisa J. Meltzer, PhD2; Ignacio E. Tapia, MD, MS3; Joel Traylor, RPsgT3; Gillian M. Nixon, MD1,4; Rosemary S.C. Horne, PhD1; Lex W. Doyle, MD5; Elizabeth Asztalos, MD6; Jodi A. Mindell, PhD3,7; Carole L. Marcus, MBBCh3


Current Knowledge/Study Rationale: Sleep disorders, short sleep duration and irregularity of sleep/wake schedules have detrimental effects on daytime functioning. Children born preterm are at increased risk of some sleep disorders, however whether they are also at risk of maladaptive sleep behaviors remains unknown.

Study Impact: Short sleep duration is common in children born preterm with up to 38% of this cross-cultural cohort sleeping less than recommended. Timing of bed and wake times were culturally specific; however, short sleep duration and irregular sleep schedules were not.

Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos. 719-726.
Amit Chopra, MBBS1; Molly Jung, MPH2; Robert C. Kaplan, PhD2; David W. Appel, MD3; Elizabeth A. Dinces, MD3; Sumitrajit Dhar, PhD4; Phyllis C. Zee, MD, PhD4; Franklyn Gonzalez, MS5; David J. Lee, PhD6; Alberto R. Ramos, MD, MPSH6; Howard J. Hoffman, MA7; Susan Redline, MD, MPH8; Karen J. Cruickshanks, PhD9; Neomi A. Shah, MD, MPH10


Current Knowledge/Study Rationale: Sleep apnea may be associated with hearing impairment via vascular insufficiency of cochlea. Few studies have examined the relationship between sleep apnea SA and hearing impairment, but results have been inconsistent.

Study Impact: This is a large population-based study, which showed a strong and independent association between sleep apnea and hearing impairment. Further studies are needed to elucidate the mechanism linking SA with HI, and to assess the effect of SA therapy on HI.

Objective Sleep Assessments in Patients with Postural Tachycardia Syndrome using Overnight Polysomnograms. 727-733.
Kanika Bagai, MD, MSCI1,2; Amanda C. Peltier, MD, MSCI1,2; Beth A. Malow, MD, MS2; André Diedrich, MD, PhD1,3,4,6; Cyndya A. Shibao, MD, MSCI1,3; Bonnie K. Black, RN, CNP1,3; Sachin Y. Paranjape, BS1,3; Carlos Orozco, BS1; Italo Biaggioni, MD1,3,5; David Robertson, MD1,2,3,5; Satish R. Raj, MD, MSCI1,3,5,7


Current Knowledge/Study Rationale: This study was conducted to enhance our understanding of the sleep disturbances reported by patients with POTS.

Study Impact: Better understanding of the sleep quality of POTS patients with objective measures could lead to better management of sleep disturbances for these patients, with a resultant improvement in quality of life.

Accuracy of Automatic Polysomnography Scoring Using Frontal Electrodes. 735-746.
Magdy Younes, MD1,2; Mark Younes, BMu2; Eleni Giannouli, MD1


Current Knowledge/Study Rationale: It is currently not known whether the accuracy of automatic scoring of sleep using frontal electroencephalography electrodes is comparable to that obtained when using the standard central electrodes. Michele Sleep Scoring System (MSS) is a well validated automatic scoring system that was developed using central electrodes, but has not been validated if frontal electrodes were used instead.

Study Impact: This study has shown that results of MSS when using frontal electrodes are comparable to those when using central electrodes. This makes it possible to obtain reliable scoring from frontal electrodes, which can be easily applied by the patient at home, thereby making it less complicated and expensive to obtain information about sleep in home studies.

Review Articles

Sleep Characteristics in Children with Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analyses. 747-756.
Amparo Díaz-Román, MPsy; Eva Hita-Yáñez, PsyD; Gualberto Buela-Casal, PsyD

Special Articles

Article Is Eligible For CME Credits Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: “The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses”. 757-761.
R. Nisha Aurora, MD, MHS1; Sabin R. Bista, MD2; Kenneth R. Casey, MD, MPH3; Susmita Chowdhuri, MD4; David A. Kristo, MD5; Jorge M. Mallea, MD6; Kannan Ramar, MD7; James A. Rowley, MD8; Rochelle S. Zak, MD9; Jonathan L. Heald, MA10

Case Reports

A Case of Recurrent Insomnia: Extending the Spectrum of Autoimmune Encephalitis. 763-765.
Priyanka Sabharwal, MD, PhD1; Mandana Mahmoudi, MD2; Nisida Berberi, MD1; Blanca A. Vasquez, MD1; Daniel Friedman, MD1; Sanjeev V. Kothare, MD1
Sleep Disordered Breathing Mimicking Myasthenia Crisis in a Patient with Myasthenia Gravis. 767-769.
Yi-Chun Lai, MD, MA1; Jung-Yueh Chen, MD2; Huey-Dong Wu, MD3; Chih-Chao Yang, MD4; Chin-Hsien Lin, MD, PhD4; Pei-Lin Lee, MD, PhD5,6,7

Sleep Medicine Pearls

Pulseless Electrical Activity during Polysomnography. 771-773.
Safal Shetty, MD1,2; Tam Le, MD1,2; Sairam Parthasarathy, MD1,2
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