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Accepted Papers

Scientific Investigations

Urine Toxicology Screen in Multiple Sleep Latency Test: The Correlation of Positive Tetrahydrocannabinol, Drug Negative Patients, and Narcolepsy. 93-99.
Samuel Dzodzomenyo, MD1,2; Adrienne Stolfi, MSPH2; Deborah Splaingard, MA3; Elizabeth Earley, MPH3; Oluwole Onadeko, MD4; Mark Splaingard, MD3


Current Knowledge/Study Rationale: We hypothesized that symptoms consistent with narcolepsy including excessive daytime sleepiness, cataplexy, sleep paralysis or hypnagogic/hypnopompic hallucinations might be reported by some pediatric patients who use marijuana. We also hypothesized that THC use/withdrawal might be associated with a decreased mean sleep onset latency and an increased number of sleep onset REM periods on multiple sleep latency testing (MSLT) consistent with narcolepsy.

Study Impact: Ten percent of all pediatric patients ≥ 13 years who presented with excessive daytime sleepiness without cataplexy and also had a multiple sleep latency test consistent with narcolepsy were found to have a urine drug screen (+) for THC. Drug screening is important in interpreting MSLT findings for children ≥ 13 years.

Article Is Eligible For CME Credits Asthma, Allergic Rhinitis, and Sleep Problems in Urban Children. 101-110.
Daphne Koinis-Mitchell, PhD; Sheryl J. Kopel, MSc; Julie Boergers, PhD; Kara Ramos, BS; Monique LeBourgeois, PhD; Elizabeth L. McQuaid, PhD; Cynthia A. Esteban, MSN, MPH; Ronald Seifer, PhD; Gregory K. Fritz, MD; Robert B. Klein, MD


Current Knowledge/Study Rationale: Urban minority children are disproportionately affected by both asthma and allergic rhinitis, which in turn may increase sleep problems and negatively affect sleep behaviors and patterns. Study results highlight the role of asthma and AR control in potentially improving children's sleep and how specific groups may be more at risk for poor sleep problems.

Study Impact: By understanding associations between asthma, AR, sleep hygiene, and overall sleep problems in specific groups at risk for poor asthma morbidity and poor sleep, interventions can be better tailored to address asthma and sleep in a multifaceted way. Focused questions targeted on children's missed sleep may prioritize where to enhance educational and treatment strategies with urban families who have children with asthma and AR.

Article Is Eligible For CME Credits The Prevalence and Management of Poor Sleep Quality in a Secondary Care Mental Health Population. 111-116.
Michelle O'Sullivan, MSc1,2; Masuma Rahim, PsychD1,2; Christopher Hall, PsychD3


Current Knowledge/Study Rationale: Comorbid sleep problems are common in those with mental illness. There is a dearth of evidence regarding the prevalence of insomnia among those in contact with secondary mental health services, as well as limited understanding of the interventions provided.

Study Impact: There is a lack of knowledge related to insomnia among clinical staff and an absence of effective, evidence-based intervention for those who present with comorbid sleep difficulties. There is a need for formal assessment and treatment pathways for those with comorbid sleep problems.

Associations of Heart Failure with Sleep Quality: The Rotterdam Study. 117-121.
Lisette A. Zuurbier, MSc1; Annemarie I. Luik, MSc, MA1; Maarten J.G. Leening, MSc, MD1,2; Albert Hofman, MD, PhD1; Rosanne Freak-Poli, PhD1,3; Oscar H. Franco, MD, PhD1; Bruno H. Stricker, MB, PhD1,4,5; Henning Tiemeier, MD, PhD1,6,7


Current Knowledge/Study Rationale: With increasing age, the prevalence of heart failure and sleep disturbances increases. How sleep quality changes over time in patients with cardiac dysfunction, prevalent or new-onset heart failure is unclear.

Study Impact: Clinical heart failure, but not echocardiographic indicators of cardiac dysfunction, increases the risk of poor sleep quality in the general population. In this population-based study no cross-sectional associations were observed. These findings suggest that clinical manifestations of heart failure negatively affect sleep.

Sleep-Wake Time Perception Varies by Direct or Indirect Query. 123-129.
Yvonne Alameddine, BA1; Jeffrey M. Ellenbogen, MD2; Matt T. Bianchi, MD, PhD1,3


Current Knowledge/Study Rationale: Self reporting sleep-wake times is fundamental to the diagnosis and management of insomnia patients. However, much uncertainty exists in regard to mismatch between subjective and objective measures of sleep in this population. We tested the hypothesis that subjective reports might differ, within individuals, according to the nature of the time query.

Study Impact: Sleep-wake time responses depended on whether the query was direct or indirect. The results highlight an additional dimension of uncertainty when assessing sleep patterns by clinical history. This is particularly relevant for patients with insomnia, in whom objective measures are not routinely obtained.

Usage of Positional Therapy in Adults with Obstructive Sleep Apnea. 131-137.
Grietje E. de Vries, MSc1,2; Aarnoud Hoekema, MD, PhD3; Michiel H.J. Doff, DMD, PhD3; Huib A.M. Kerstjens, MD, PhD1,2; Petra M. Meijer, NP1,4; Johannes H. van der Hoeven, MD, PhD5; Peter J. Wijkstra, MD, PhD1,2,4


Current Knowledge/Study Rationale: To our knowledge this is the largest study to date to assess effectiveness and long-term compliance of positional therapy as a primary treatment option in patients with different severities of positional OSA. Furthermore, in this study both a commercial fabricated waistband and self-made constructions mimicking the tennis ball technique were assessed.

Study Impact: After reading this article, readers should be able to know the short-term effectiveness of and long-term compliance with positional therapy. Positional therapy is an effective method to treat patients with positional OSA on the short-term. Long-term compliance is low especially in patients with moderate OSA at baseline. More comfortable devices such as vibrating devices might be more useful to treat positional OSA.

Sleep Position Trainer versus Tennis Ball Technique in Positional Obstructive Sleep Apnea Syndrome. 139-147.
Michiel M. Eijsvogel, MSc1; Rinse Ubbink, MSc2; Janita Dekker, MSc2; Eline Oppersma, MSc2; Frans H. de Jongh, PhD1,3,4; Job van der Palen, PhD5,6; Marjolein G. Brusse-Keizer, PhD5


Current Knowledge/Study Rationale: Standard positional therapy, with the tennis ball technique, in patients with positional obstructive sleep apnea prevents supine position and is an effective therapy (as long as it is used) but the compliance is low. New small easy to wear, in supine position vibrating devices, can perhaps be as effective and improve compliance; our study is the first randomized controlled trial comparing such a new device with standard therapy.

Study Impact: The main results of this study are twofold: both therapies are highly and equally effective in patients with mild positional obstructive sleep apnea who still use their therapy at one month, but a substantially better, objectively measured compliance, was observed in favor of the sleep position trainer. Long-term compliance studies are now needed.

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift. 149-156.
Laura H. White, MBChB1,3; Owen D. Lyons, MBBCh1,3; Azadeh Yadollahi, PhD1,2; Clodagh M. Ryan, MB1,3,4; T. Douglas Bradley, MD1,3,4


Current Knowledge/Study Rationale: Overnight rostral fluid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. Intra-individual night-tonight variability in OSA severity may relate to night-to-night variations in overnight rostral fluid shift.

Study Impact: This study found that intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fluid volume and overnight rostral fluid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep.

Screening of Obstructive Sleep Apnea during Pregnancy: Differences in Predictive Values of Questionnaires across Trimesters. 157-163.
Visasiri Tantrakul, MD1,2; Piyaporn Sirijanchune, MD2,4; Panyu Panburana, MD3; Janejira Pengjam1; Worakot Suwansathit, BN1; Viboon Boonsarngsuk, MD2; Christian Guilleminault, MD, BiolD5


Current Knowledge/Study Rationale: During pregnancy physiological changes occur continuously until delivery. Prevalence of sleep disordered breathing increased from first trimester to third trimester. Symptoms of sleep disordered breathing changes as pregnancy progressed. Therefore, performances of OSA screening questionnaires might be different in each trimester.

Study Impact: Our study suggests that screening questionnaires in high-risk pregnancy, particularly the Berlin questionnaire, are poorly predictive of OSA during the first trimester. The most appropriate time to use Berlin and Stop-Bang questionnaires is during the second and third trimesters. Significant predictors varied according to each trimester. Serial monitoring and screening for OSA throughout the course of pregnancy may be needed.

Review Articles

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review. 165-175.
Madhulika A. Gupta, MD, FAASM; Fiona C. Simpson, HBSc

Sleep Medicine Pearls

Management of Obstructive Sleep Apnea in a Developmentally Delayed Pediatric Patient with Aggressive Behavior and Pierre Robin Sequence. 181-183.
Holly J. Skinner, DO1; Russell B. Walther, DDS, MD2; M. Franklin Dolwick, DMD, PhD2; Richard B. Berry, MD1; Mary H. Wagner, MD3
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