Drowsy Driving Considerations in Non-Commercial Drivers for the Sleep Physician
The sleep physician faces many challenges in the assessment of drowsy driving. The following article reviews current clinical evaluation methods and legal considerations at the state level in the United States.Citation:Bhat A, Marciarille AM, Stevens D, Ingram DG. Drowsy driving considerations in non-commercial drivers for the sleep physician.J Clin Sleep Med. 2019;15(7):1069–1071. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

What Are the Effects of Physical Activity on Sleep Quality and Low Back Pain in Older Adults?
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Steroids: A Wake-Up Call in TBI Induced Hypersomnolence
Hypersomnolence is one of the more common symptoms reported after mild traumatic brain injury (TBI) and often one of the most difficult to treat. This case series presents a cohort of patients with TBI related hypersomnolence associated with a de novo autoimmune process that successfully resolved with pulse dose corticosteroid treatment. When associated with an autoimmune inflammatory process, corticosteroids may serve to stabilize the blood brain barrier leading to the successful and sustained resolution of TBI induced sleepiness.Citation:Oks M, Kothare SV. Steroids: a wake-up call in TBI induced hypersomnolence.J Clin Sl...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Sleep Validity of a Non-Contact Bedside Movement and Respiration-Sensing Device
Conclusions:Similar limitations in detecting wake after sleep onset (WASO) were found for the S+ as have been previously reported for actigraphy and other commercial sleep tracking devices. S+ WBSO detection was higher than actigraphy, and S+V2 algorithm further improved WASO accuracy. Researchers and clinicians should remain aware of the potential for algorithm updates to impact validity.Commentary:A commentary on this article appears in this issue on page 935.Citation:Schade MM, Bauer CE, Murray BR, Gahan L, Doheny EP, Kilroy H, Zaffaroni A, Montgomery-Downs HE. Sleep validity of a non-contact bedside movement and respir...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

The Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Metabolic Peptides Regulating Appetite, Food Intake, Energy Homeostasis, and Systemic Inflammation: A Literature Review
Conclusions:There is significant controversy in the literature regarding the impact of SDB and PAP therapy on these metabolic peptides. This could be due to the lack of randomized clinical trials and the variability of the methodology used in these studies. Further research is needed to assess the impact of SDB and PAP therapy on the levels of these peptides and whether this impact is also related to body mass index and body fat composition.Citation:Mashaqi S, Badr MS. The impact of obstructive sleep apnea and positive airway pressure therapy on metabolic peptides regulating appetite, food intake, energy homeostasis, and s...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Information on Bedtimes and Wake Times Improves the Relation Between Self-Reported and Objective Assessments of Sleep in Adults
Study Objectives:To investigate the correlation between self-reported and objective measures of total sleep time (TST) in adults and examine whether sex, race/ethnicity, and weight status influence this association.Methods:Participants were individuals who screened for sleep intervention studies, providing> 7 days of wrist actigraphy sleep data (TSTobj) and reporting sleep duration (TSTPSQI) using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (n = 53 men, 60 women; 59% minority/Hispanics; age 30.9± 9.7 years; body mass index 26.2± 3.2 kg/m2). In addition, TSTbed/wake was calculated as the differe...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Sleep in ADCY5-Related Dyskinesia: Prolonged Awakenings Caused by Abnormal Movements
Conclusions:In this series of patients withADCY5-related dyskinesia, nocturnal paroxysmal dyskinesia were not associated with drowsiness or delayed sleep onset, but emerged during nighttime awakenings with subsequent delayed sleep, whereas sleep architecture was normal.Citation:Méneret A, Roze E, Maranci JB, Dodet P, Doummar D, Riant F, Tranchant C, Fraix V, Anheim M, Ekmen A, McGovern E, Vidailhet M, Arnulf I, Leu-Semenescu S. Sleep inADCY5-related dyskinesia: prolonged awakenings caused by abnormal movements.J Clin Sleep Med. 2019;15(7):1021–1029. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Association Between Periodic Limb Movements in Sleep and Cerebrovascular Changes in Children With Sickle Cell Disease
Conclusions:The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.Citation:Lin J, Morrone K, Manwani D, Chernin R, Silver EJ, Shifteh K, Sin S, Arens R, Graw-Panzer K. Association between periodic limb movements in sleep and cerebrovascular changes in children with sickle cell disease.J Clin Sleep Med. 2019;15(7):1011–1019. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Improving Daytime Functioning, Work Performance, and Quality of Life in Postmenopausal Women With Insomnia: Comparing Cognitive Behavioral Therapy for Insomnia, Sleep Restriction Therapy, and Sleep Hygiene Education
Conclusions:CBTI and SRT are efficacious options for postmenopausal women with chronic insomnia. Both interventions improve daytime function, quality of life, and work performance, although CBTI produces superior results including the added benefit of improved emotional health.Clinical Trial Registration:Registry: ClinicalTrials.gov; Title: Behavioral Treatment of Menopausal Insomnia; Sleep and Daytime Outcomes; Identifier: NCT01933295; URL:https://clinicaltrials.gov/ct2/show/record/NCT01933295Citation:Kalmbach DA, Cheng P, Arnedt JT, Cuamatzi-Castelan A, Atkinson RL, Fellman-Couture C, Roehrs T, Drake CL. Improving daytim...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Use of a Transformed ECG Signal to Detect Respiratory Effort During Apnea
Study Objectives:To evaluate the ability of a transformed electrocardiography (ECG) signal recorded using standard electrode placement to detect inspiratory bursts from underlying surface chest wall electromyography (EMG) activity and the utility of the transformed signal for apnea classification compared to uncalibrated respiratory inductance plethysmography (RIP).Methods:Part 1: 250 consecutive adult studies without regard to respiratory events were retrospectively reviewed. The ECG signal was transformed with high pass filtering and viewed with increased sensitivity and channel clipping to determine the fraction of stud...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

The Feasibility and Utility of Level III Portable Sleep Studies in the Pediatric Inpatient Setting
Study Objectives:Sleep-disordered breathing (SDB) may significantly impact the course of medical illness in hospitalized children. Polysomnography (PSG) is the gold standard for establishing diagnosis of SDB, but its availability is limited. The aim of this study was to explore the feasibility and utility of level III portable sleep studies in hospitalized children with SDB.Methods:A retrospective study was conducted at a tertiary hospital over the preceding 2 years in hospitalized children
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Effects of Medical Therapy on Mild Obstructive Sleep Apnea in Adult Patients
Conclusions:Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA.Clinical Trial Registration:Registry: ClinicalTrials.gov; Title: Montelukast and Nasa ICS for Treatment of Mild Obstructive Sleep Apnea in Adults; Identifier: NCT01089647; URL:https://clinicaltrials.gov/ct2/show/record/NCT01089647Citation:Smith DF, Sarber KM, Spiceland CP, Ishman SL, Aug...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Physical Activity in Overlap Syndrome of COPD and Obstructive Sleep Apnea: Relationship With Markers of Systemic Inflammation
Conclusions:Persons with OVS have significantly lower levels of PA and higher levels of inflammatory biomarkers, compared to COPD alone. Lower PA is significantly associated with higher IL-6 levels in OVS.Citation:Fitzgibbons CM, Goldstein RL, Gottlieb DJ, Moy ML. Physical activity in overlap syndrome of COPD and obstructive sleep apnea: relationship with markers of systemic inflammation.J Clin Sleep Med. 2019;15(7):973–978. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Associations Between the Apnea-Hypopnea Index During REM and NREM Sleep and Cognitive Functioning in a Cohort of Middle-Aged Adults
Conclusions:Sleep state-specific (REM, NREM) OSA may be differentially associated with varying dimensions of cognitive deficits in middle-aged to older adults, and such associations are likely to be modified by genetic factors, include APOE polymorphisms.Citation:Devita M, Peppard PE, Mesas AE, Mondini S, Rusconi ML, Barnet JH, Hagen EW. Associations between the apnea-hypopnea index during REM and NREM sleep and cognitive functioning in a cohort of middle-aged adults.J Clin Sleep Med. 2019;15(7):965–971. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Nondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension
Study Objectives:Systemic hypertension is highly prevalent in obstructive sleep apnea (OSA) but there are limited data on OSA prevalence in cohorts with hypertension comparing dippers and nondippers. We investigated this relationship in a clinic-based cohort of patients with hypertension who were not screened for any pretest possibility of OSA.Methods:A total of 100 patients with hypertension aged (mean± SD) 58± 10 years, body mass index 30.5± 6.1 kg/m2, and Epworth Sleepiness Scale score 6± 4 were included. All underwent overnight attended sleep studies and 24-hour ambulatory blood pressure mon...
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

NightBalance Sleep Position Treatment Device Versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea
Study Objectives:Compare treatment efficacy and objective adherence between the NightBalance sleep position treatment (SPT) device and auto-adjusting positive airway pressure (APAP) in patients with exclusive positional obstructive sleep apnea (ePOSA) defined as a supine apnea-hypopnea index (sAHI)≥ 2 times the nonsupine AHI (nsAHI) and a nsAHI
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Male Patients on Peritoneal Dialysis Have a Higher Risk of Sleep Apnea
Conclusions:Patients on PD should receive regular SA assessments and that an increased awareness and a higher index of suspicion for SA should be maintained in these patients, especially male patients.Citation:Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chang MY, Wu CF, Sung JM, Chiou YY, Lin SH. Male patients on peritoneal dialysis have a higher risk of sleep apnea.J Clin Sleep Med. 2019;15(7):937–945. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Non-Contact Sleep Monitoring: Are We There Yet?
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - July 13, 2019 Category: Sleep Medicine Source Type: research

Patient With a New Parasomnia
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

The Respiratory Signature: A Novel Concept to Leverage Continuous Positive Airway Pressure Therapy as an Early Warning System for Exacerbations of Common Diseases such as Heart Failure
Each night millions of patients use continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA). To facilitate monitoring of treatment success, modern CPAP machines routinely record and analyze the respiratory signal in near real-time and submit some of these data to the manufacturer's centralized cloud server. Some of the conditions frequently associated with OSA such as heart failure or chronic obstructive pulmonary disease result in characteristic changes of the respiratory signal (“signatures”), especially during exacerbations. Thus, this infrastructure could be leveraged to detect cha...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities
Conclusions:Children with DD had better PAP adherence expressed as percentage of nights used than TD children. Hours of usage on nights used at 3 and 6 months were similar between groups and improved over time. Higher income and titration at or before 6 months were predictive of adherence in all children. These findings indicate that children with DD can successfully wear PAP.Citation:Kang EK, Xanthopoulos MS, Kim JY, Arevalo C, Shults J, Beck SE, Marcus CL, Tapia IE. Adherence to positive airway pressure for the treatment of obstructive sleep apnea in children with developmental disabilities.J Clin Sleep Med. 2019;15(6):9...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

The Effect of Upper Airway Surgery on Loop Gain in Obstructive Sleep Apnea
Study Objectives:Controversy exists as to whether elevated loop gain is a cause or consequence of obstructive sleep apnea (OSA). Upper airway surgery is commonly performed in Asian patients with OSA who have failed positive airway pressure therapy and who are thought to have anatomical predisposition to OSA. We hypothesized that high loop gain would decrease following surgical treatment of OSA due to reduced sleep apnea severity.Methods:Polysomnography was performed preoperatively and postoperatively to assess OSA severity in 30 Chinese participants who underwent upper airway surgery. Loop gain was calculated using a valid...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
Conclusions:Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.Citation:Bengtsson C, Jonsson L, Holmström M, Hellgren J, Franklin K, Gíslason T, Holm M, Johannessen A, Jõgi R, Schlünssen V, Janson C, Lindberg E. Incident chronic rhinosinusitis is associated with impaired sleep quality: results of the RHINE study.J Clin Sleep Med. 2019;15(6):899–905. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Prevalence, Effect on Functional Outcome, and Treatment of Sleep-Disordered Breathing in Patients With Subacute Stroke
Study Objectives:We aimed to elucidate the prevalence of sleep-disordered breathing (SDB), effect of SDB severity on the functional outcome, and feasibility of continuous positive airway pressure (CPAP) therapy in patients with subacute stroke.Methods:We recruited 433 consecutive patients (mean age: 66.5 years, 271 men) admitted to our rehabilitation wards for subacute stroke (8 to 90 days after onset) from August 2011–November 2013, who had undergone at least one successful sleep study within 4 weeks after admission to the wards. We investigated the prevalence of SDB, defined as a respiratory event index (REI)≥ 5...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

The Risk of Hospitalization for Motor Vehicle Accident Injury in Narcolepsy and the Benefits of Stimulant Use: A Nationwide Cohort Study in Taiwan
Study Objectives:To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy.Methods:This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810&ndash...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Prescription Patterns of Sedative Hypnotic Medications in the Military Health System
Conclusions:ADSM had a 2% to 3% higher adjusted prevalence of sedative hypnotic medications than non-ADSM. The use of sedative hypnotics in the young ADSM population highlights the need for military-appropriate sleep practices and novel interventions to mitigate sleep disturbances and chronic sleep disorders in this population.Citation:Thelus Jean R, Hou Y, Masterson J, Kress A, Mysliwiec V. Prescription patterns of sedative hypnotic medications in the Military Health System.J Clin Sleep Med. 2019;15(6):873–879. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Toddler Bedtime Routines and Associations With Nighttime Sleep Duration and Maternal and Household Factors
Conclusions:Maternal depressive symptoms, food insecurity, and household insecurity (factors associated with low socioeconomic status) may be associated with a negative sleep environment and poor toddler sleep quality, potentially because of decreased implementation of bedtime routines.Commentary:A commentary on this article appears in this issue on page 821.Citation:Covington LB, Rogers VE, Armstrong B, Storr CL, Black MM. Toddler bedtime routines and associations with nighttime sleep duration, and maternal and household factors.J Clin Sleep Med. 2019;15(6):865–871. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Delayed Sleep Time in African Americans and Depression in a Community-Based Population
Study Objectives:Studies have shown racial differences in circadian rhythm in African Americans when compared to non-Hispanic whites, and an association between circadian dyssynchrony and depression. We hypothesized that the prevalence of delayed sleep time is greater in African Americans when compared to whites and that delayed sleep time is associated with depression.Methods:We analyzed data from the Sleep Heart Health Study (SHHS), a large community-based sample. Delayed sleep time was defined as self-reported weeknight bedtime after midnight. Depression was defined based on participant's response to the question,&ldquo...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Anthropometric Measures and Prediction of Maternal Sleep-Disordered Breathing
Conclusions:Modeling neck circumference while allowing for differences by Mallampati class showed a nearly threefold increase in the risk of SDB with increasing neck circumference in women with Mallampati class 1. Other potential sites of airway obstruction need to be investigated in future research.Citation:Bourjeily G, Chambers A, Salameh M, Bublitz MH, Kaur A, Coppa A, Risica P, Lambert-Messerlian G. Anthropometric measures and prediction of maternal sleep-disordered breathing.J Clin Sleep Med. 2019;15(6):849–856. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Effect of CPAP Treatment of Sleep Apnea on Clinical Prognosis After Ischemic Stroke: An Observational Study
Study Objectives:To evaluate continuous positive airway pressure (CPAP) treatment in patients with moderate to severe sleep-disordered breathing (SDB) after an ischemic stroke.Methods:We identified patients included in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) who underwent polysomnography after an ischemic stroke. We compared patients without significant SDB (apnea-hypopnea index [AHI]
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Air Pollutants Are Associated With Obstructive Sleep Apnea Severity in Non-Rapid Eye Movement Sleep
Conclusions:An adjustment for continuous positive airway treatment dose by season is not warranted. Protection for air pollutant-vulnerable groups should be provided. The exact mechanism of the associations between apnea-hypopnea index and air conditions only in non-rapid eye movement sleep must be clarified.Citation:Cheng WJ, Liang SJ, Huang CS, Lin CL, Pien LC, Hang LW. Air pollutants are associated with obstructive sleep apnea severity in non-rapid eye movement sleep.J Clin Sleep Med. 2019;15(6):831–837. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Moderate to Severe Obstructive Sleep Apnea in Military Personnel Is Not Associated With Decreased Exercise Capacity
Study Objectives:Studies of older and less active patients with obstructive sleep apnea (OSA) have reported decreased exercise capacity as measured by peak oxygen uptake (VO2 max) during cardiopulmonary exercise testing (CPET). We looked to determine whether VO2 max was decreased in younger patients with OSA who regularly exercise as would be encountered in the military.Methods:We evaluated military personnel who had undergone pulmonary function testing (PFT), CPET, and polysomnography (PSG) as part of the larger STAMPEDE III study for comprehensive evaluation of exertional dyspnea. For analysis, patients were classified i...
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Sleep Routines in Children
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

OSA, Exercise, and the Military
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Time to Show Leadership on the Daylight Saving Time Debate
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - June 15, 2019 Category: Sleep Medicine Source Type: research

Response to Dr. Hunasikatti
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Predictors of Obstructive Sleep Apnea on Home Sleep Apnea Test After a Negative Attended Polysomnography: Not So Fast
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

The Treatment of Narcolepsy With Amphetamine-Based Stimulant Medications: A Call for Better Understanding
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Public Awareness, Medical Integration, and Innovation in Sleep Medicine
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Consumer Sleep Technologies, Clinical Guidelines, and Evidence-Based Medicine: This is Not a Zero-Sum Game
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

The Importance of Evidence-Based Medicine and Clinical Guidelines: Meaningful and Clinically Actionable Information Cannot be Compromised for the Convenience of Consumer Sleep Data
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Sudden Improvement in PAP Download Indices Without Treatment Change
(Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Rapid Eye Movement Sleep Percentage and Duration in Posttraumatic Stress Disorder Vary Dynamically and Inversely With Indices of Sympathetic Activation During Sleep and Sleep Fragmentation
Posttraumatic stress disorder (PTSD) is associated with activation of the brain fear circuitry. Studies of sleep in PTSD provide a unique window into the relation or connection of sleep physiology and autonomic activation. Serial level 3 home sleep apnea tests (HSATs) (10 HSATs over 1 month) in a patient who was medication free, had PTSD, and had refused positive airway pressure therapy, revealed both percentage of rapid eye movement (REM) sleep (mean± standard deviation [SD]: 19.88%± 10.11%; range 1.94% to 35.01%) and REM sleep duration (minutes) (mean± SD: 73.08± 48.24; range 3.49– 151.5...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Iatrogenic Nontraumatic CPAP-Induced Pneumocephalus in a Patient With Meningitis
We describe a case of a patient who presented with meningitis due to an atypical organism that usually resides in the oral cavity, and who developed nontraumatic pneumocephalus in the hospital due to CPAP therapy. The underlying cause, a cerebrospinal fluid leak, was likely the mediator for both pathologies. In the setting of the increasing prevalence of obstructive sleep apnea, physicians can benefit from being aware of this atypical presentation of meningitis and atypical complication of CPAP therapy.Citation:Charokopos A, Card ME, Manes RP, Shaw A. Iatrogenic nontraumatic CPAP-induced pneumocephalus in a patient with me...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Acute Drug-Induced Symptoms of Restless Legs Syndrome in an Emergency Department
We describe a case of an abrupt presentation of restless legs syndrome symptoms induced by infusion of metoclopramide during treatment of a migraine attack in settings of an emergency department. The patient shortly after infusion of metoclopramide started to experience rapid movements of the legs, claiming that it was the only way to relieve extremely unpleasant sensations in her legs. The symptoms subsided after saline infusion and did not appear again.Citation:Sieminski M, Zemojtel L. Acute drug-induced symptoms of restless legs syndrome in an emergency department.J Clin Sleep Med. 2019;15(5):779–780. (Source: Jou...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

The Effect of Patient-Facing Applications on Positive Airway Pressure Therapy Adherence: A Systematic Review
Conclusions:PFA use was associated with improved adherence to PAP therapy. Although this conclusion is based on only two small trials and predominantly observational studies and therefore should be tested in large prospective trials, the PAFs are inexpensive, do not draw on health care resources, and show promise in improving PAP therapy for OSA.Citation:Shaughnessy GF, Morgenthaler TI. The effect of patient-facing applications on positive airway pressure therapy adherence: a systematic review.J Clin Sleep Med. 2019;15(5):769–777. (Source: Journal of Clinical Sleep Medicine : JCSM)
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans
Conclusions:Combining IR with CBT-I conferred no advantage overall. Further research is essential to examine the possibly greater benefit of adding IR to CBT-I for some subgroups of veterans with PTSD.Clinical Trial Registration:Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy (CBT) for Nightmares in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans; Identifier: NCT00691626; URL:https://clinicaltrials.gov/ct2/show/NCT00691626Citation:Harb GC, Cook JM, Phelps AJ, Gehrman PR, Forbes D, Localio R, Harpaz-Rotem I, Gur RC, Ross RJ. Randomized controlled trial of imagery rehearsal for posttra...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes
Study Objectives:Self-reported sleepiness is common in patients with obstructive sleep apnea (OSA) and is being increasingly recognized as an effect modifier of the association between OSA and cardiovascular outcomes. However, data on whether sleepiness modifies the association between OSA and glycemic outcomes are lacking. The current study sought to characterize the association between glycemic control and sleepiness in people with OSA and type 2 diabetes.Methods:Adults with non-insulin requiring type 2 diabetes and undiagnosed moderate to severe OSA were recruited from the community. Demographic data, Epworth Sleepiness...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Improvement of Parasomnias After Treatment of Restless Leg Syndrome/Periodic Limb Movement Disorder in Children
Study Objectives:Previous studies have shown that non-rapid eye movement (NREM) sleep parasomnias commonly coexist with restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) in children, leading to speculation that RLS/PLMD may precipitate or worsen parasomnias. However, there are limited data about the effect of the treatment of RLS/PLMD on parasomnias in children. Hence, we performed this study to determine whether the treatment of RLS/PLMD with oral iron therapy is associated with improvement of parasomnias in children.Methods:A retrospective database was created for children with RLS/PLMD who were tre...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients
Study Objectives:Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously.Methods:A consecutive series of pediatric patients referred to the University of Illino...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research