The Future of Sleep Measurements
This article provides an overview of the current use, limitations, and future directions of the variety of subjective and objective sleep assessments available. This article argues for various ways and sources of collecting, combining, and using data to enlighten clinical practice and the sleep research of the future. It highlights the prospects of digital management platforms to store and present the data, and the importance of codesign when developing such platforms and other new instruments. It also discusses the abundance of opportunities that data science and machine learning open for the analysis of data. (Source: Sl...
Source: Sleep Medicine Clinics - July 5, 2021 Category: Sleep Medicine Authors: Erna Sif Arnardottir, Anna Sigridur Islind, Mar ía Óskarsdóttir Source Type: research

Daylight Saving Time
The original rationale for the adoption of daylight saving time (DST) was to conserve energy; however, the effects of DST on energy consumption are questionable or negligible. Conversely, there is substantial evidence that DST transitions have the cumulative effect on sleep deprivation with its adverse health effects. In light of current evidence, the European Commission in 2018 decided that biannual clock change in Europe would be abolished. Current indirect evidence supports the adoption of perennial standard time, which aligns best with the human circadian system and has the potential to produce benefits for public heal...
Source: Sleep Medicine Clinics - July 2, 2021 Category: Sleep Medicine Authors: Barbara Gnidovec Stra žišar, Lea Stražišar Source Type: research

Telemedicine in Sleep-Disordered Breathing
Interest in telemedicine has increased exponentially. There is a growing body of published evidence on the use of telemedicine for patients using continuous positive airway pressure. Telemedicine-ready devices can support the transmission on use time, apnea –hypopnea index, and leakage. This approach enables early activation of troubleshooting. Automated, personalized feedback for patients and patient access to their own data provide unprecedented opportunities for integrating comanagement approaches, multiactor interactions, and patient empowerment. Telemedicine is likely cost effective, but requires better evidence...
Source: Sleep Medicine Clinics - July 2, 2021 Category: Sleep Medicine Authors: Johan Verbraecken Source Type: research

Sleep and Cardiovascular Risk
Sleep is essential for healthy being and healthy functioning of human body as a whole, as well as each organ and system. Sleep disorders, such as sleep-disordered breathing, insomnia, sleep fragmentation, and sleep deprivation are associated with the deterioration in human body functioning and increased cardiovascular risks. However, owing to the complex regulation and heterogeneous state sleep per se can be associated with cardiovascular dysfunction in susceptible subjects. The understanding of sleep as a multidimensional concept is important for better prevention and treatment of cardiovascular diseases. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 25, 2021 Category: Sleep Medicine Authors: Lyudmila Korostovtseva, Mikhail Bochkarev, Yurii Sviryaev Source Type: research

Future Treatment of Sleep Disorders
Sleep disorders are categorized in line with traditional taxonomy. This conventional approach allows adequate management of many patients. Failure of treatment, however, may be due to nonspecificity of symptoms, coincidental association between symptoms and pathophysiological endotype, as well as co-occurrence of different pathologic mechanisms affecting sleep. Complex phenotypes often do not respond well to standard therapeutic interventions. In these cases, the clinical workup should aim at identifying treatable traits that will likely improve under targeted therapy. The challenge for sleep medicine is to further develop...
Source: Sleep Medicine Clinics - June 25, 2021 Category: Sleep Medicine Authors: Dirk Pevernagie Source Type: research

Insomnia Burden and Future Perspectives
This article discusses the role of insomnia in modern societies, newer complicating factors, and its overall social and public health burden. Acute insomnia and sleep difficulties during pandemic and confinement are reviewed. The article also focuses on newer developments accumulating in the field of insomnia and possible future trends. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 25, 2021 Category: Sleep Medicine Authors: Samson G. Khachatryan Source Type: research

Sleep in Neurologic Disorders
Sleep is a complex brain state with fundamental relevance for cognitive functions, synaptic plasticity, brain resilience, and autonomic balance. Sleep pathologies may interfere with cerebral circuit organization, leading to negative consequences and favoring the development of neurologic disorders. Conversely, the latter can interfere with sleep functions. Accordingly, assessment of sleep quality is always recommended in the diagnosis of patients with neurologic disorders and during neurorehabilitation programs. This review investigates the complex interplay between sleep and brain pathologies, focusing on diseases in whic...
Source: Sleep Medicine Clinics - June 19, 2021 Category: Sleep Medicine Authors: Carlotta Mutti, Francesco Rausa, Liborio Parrino Source Type: research

Sleepiness Behind the Wheel and the Implementation of European Driving Regulations
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and t...
Source: Sleep Medicine Clinics - June 19, 2021 Category: Sleep Medicine Authors: Walter T. McNicholas Source Type: research

Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services —Longitudinal Data from the Swedish Sleep Apnea Registry
The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorder...
Source: Sleep Medicine Clinics - May 31, 2021 Category: Sleep Medicine Authors: Ludger Grote, Jenny Theorell-Hagl öw, Martin Ulander, Jan Hedner Source Type: research

Prolonged effects of the COVID-19 pandemic on sleep medicine services - longitudinal data from the Swedish Sleep Apnea Registry (SESAR)
In conclusion, the ongoing COVID-19 pandemic has lead to a substantial reduction of sleep medicine services and the long-term concequences may be considerable. Novel clinical techniques such as telemedicine support may facilitate the recovery of sleep medicine services. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment. This includes OSA patients who potentially may be on high risk for severe COVID-19. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 31, 2021 Category: Sleep Medicine Authors: Ludger Grote, Jenny Theorell-Hagl öw, Martin Ulander, Jan Hedner Source Type: research

Periodic Leg Movements During Sleep
Periodic leg movements during sleep (PLMS) are a frequent finding in nocturnal sleep registrations that include tibialis anterior electromyographic signals. Different PLMS scoring rules exist and can have a major impact on PLMS frequency, which tends to be underappreciated. There is no consistent evidence that frequent PLMS are a causal risk factor for clinically significant outcomes. Several critical open questions are identified that need to be addressed, including but not limited to the consideration of the full range of all sleep-related leg movement activity. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Authors: Stephany Fulda Source Type: research

Sleep and Epilepsy, Clinical Spectrum and Updated Review
Electroencephalogram (EEG) recording is essential in the evaluation of complex movement and behaviors during sleep, but in particular for differentiating epileptic versus nonepileptic events. In general, epileptiform discharges occur with greater density in the first few nonerapid eye movement cycles, and approximately 12% to 20% of seizures occur exclusively at night. This review examines the epilepsy types and syndromes whose presentation is strongly influenced by the sleep state, with an appraisal about the role that sleep plays in facilitating seizures, while deleaneatign EEG findings and clinical manifestation. The re...
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Authors: Ting Wu, Alon Y. Avidan, Jerome Engel Source Type: research

Restless Sleep Disorder
Restless sleep disorder is (RSD) a condition characterized by frequent large movements during sleep associated with daytime impairment. RSD has been studied in children aged 6 to 18  years. Polysomnography is necessary for the diagnosis of RSD. The current diagnostic criteria include more than 5 large movements per hour of sleep documented by PSG. The pathophysiology is not known yet, but iron deficiency and sleep instability and increased sympathetic activation are suspected to play a role. Iron supplementation is the only treatment option studied so far. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Authors: Lourdes M. DelRosso, Rosalia Silvestri, Raffaele Ferri Source Type: research

Preface
Traditionally, sleep was considered a period of brain inactivity characterized by an overall reduction of the main neural functions. However, this concept changed following the discovery of rapid eye movement (REM) sleep in the middle of the last century. During REM sleep, the brain is active while the rest of the body is paralyzed: sleep is not a uniform state, but a dual state of REM and non-REM sleep. As sleep deepens, muscle tone gradually decreases, becoming markedly diminished during REM sleep. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Authors: Diego Garcia-Borreguero Source Type: research

Movement Disorders in Sleep
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Authors: Diego Garcia-Borreguero Source Type: research

Copyright
ELSEVIER (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Source Type: research

Forthcoming Issues
Sleep Medicine: Current Challenges and its Future (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Source Type: research

Contributors
TEOFILO LEE-CHIONG, Jr., MD (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Source Type: research

Contents
Diego Garcia-Borreguero (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - May 11, 2021 Category: Sleep Medicine Source Type: research

Restless Legs Syndrome - Clinical Features
Restless legs syndrome (RLS) is one of the most common neurologic conditions, with an estimated prevalence in European and North American heritage populations of about 2% to 5%. Because RLS diagnosis is essentially clinical, a careful evaluation of the symptoms is mandatory. It is important to exclude RLS mimics and evaluate factors that could exacerbate RLS symptoms. It is mandatory to evaluate systemic iron parameters, because the initial treatment depends on this result. Other complementary tests could help support the diagnosis or exclude mimics. The decision about when and how to treat should be carefully tailored to ...
Source: Sleep Medicine Clinics - April 23, 2021 Category: Sleep Medicine Authors: Celia Garcia-Malo, Sofia Romero-Peralta, Irene Cano-Pumarega Source Type: research

Restless Legs Syndrome- Clinical Features
Restless legs syndrome (RLS) is one of the most common neurologic conditions, with an estimated prevalence in European and North American heritage populations of about 2% to 5%. Because RLS diagnosis is essentially clinical, a careful evaluation of the symptoms is mandatory. It is important to exclude RLS mimics and evaluate factors that could exacerbate RLS symptoms. It is mandatory to evaluate systemic iron parameters, because the initial treatment depends on this result. Other complementary tests could help support the diagnosis or exclude mimics. The decision about when and how to treat should be carefully tailored to ...
Source: Sleep Medicine Clinics - April 23, 2021 Category: Sleep Medicine Authors: Celia Garcia-Malo, Sofia Romero-Peralta, Irene Cano-Pumarega Source Type: research

Restless Legs Syndrome. Clinical Features
Restless legs syndrome (RLS) is one of the most common neurologic conditions, with an estimated prevalence in European and North American heritage populations of about 2% to 5%. Because RLS diagnosis is essentially clinical, a careful evaluation of the symptoms is mandatory. It is important to exclude RLS mimics and evaluate factors that could exacerbate RLS symptoms. It is mandatory to evaluate systemic iron parameters, because the initial treatment depends on this result. Other complementary tests could help support the diagnosis or exclude mimics. The decision about when and how to treat should be carefully tailored to ...
Source: Sleep Medicine Clinics - April 23, 2021 Category: Sleep Medicine Authors: Celia Garcia-Malo, Sofia Romero-Peralta, Irene Cano-Pumarega Source Type: research

The Clinical Evaluation of Sleep-Related Movement Disorders
This article is a comprehensive review of the clinical evaluation of sleep-related movement disorders. In this review, the authors present a practical approach to help clinicians identify the “pattern recognition” of movement and behavior disorders during sleep, with the process of translating a particular movement that occurs when asleep, with clinically classifying disorders, and with obtaining an etiologic diagnosis. The aim is not to provide an exhaustive review of the literature , but to concentrate on the most important symptoms, so the clinical approach can be improved and the best choices can be made du...
Source: Sleep Medicine Clinics - April 17, 2021 Category: Sleep Medicine Authors: Samantha S. Anguizola E, Laura M. Botta P, Andrea Castro-Villaca ñas, Diego García-Borreguero Source Type: research

Sleep Bruxism
The vision of adult sleep bruxism (SB) has changed over time. Thus, among the most important concomitant factors of SB noted are the pathophysiological aspect, namely sleep arousal, obstructive sleep apnea, gastroesophageal pH/gastroesophageal reflux disease, and the use or abuse of certain substances. The aim of this article was to review the main clinically relevant pathophysiological SB-associated factors and a proposal for a diagnostic process. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 17, 2021 Category: Sleep Medicine Authors: Thomas Bornhardt, Veronica Iturriaga Source Type: research

Restless Legs Syndrome: Challenges to Treatment
For a long time, dopaminergic treatment (DT) was the medication for restless legs syndrome. Although DT is effective and safe over the short-term, complications develop over longer periods, including augmentation, tolerance, and impulse control disorders. Nowadays, it is recommended that first-line treatment should be alpha-2 ligands, which are more effective in the absence of previous DT. As a second-line treatment, opioids, such as oxycodone extended-release with naloxone, are approved in Europe. Brain iron should be monitored before and during treatment and corrected if necessary. Two new promising non-DTs are being dev...
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Laura Botta, Samantha Anguizola, Andrea Castro-Villaca ñas, Diego Garcia-Borreguero Source Type: research

The Long-Term Psychiatric and Cardiovascular Morbidity and Mortality of Restless Legs Syndrome and Periodic Limb Movements of Sleep
This article summarizes the literature investigating the potential consequences of both RLS and PLMS. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Benjamin Wipper, John W. Winkelman Source Type: research

Sleep-Related Rhythmic Movement Disorder
Sleep-related rhythmic movements disorder (SRRMD), typically considered a benign pediatric sleep disorder, comprise a group of movement disorders that occur predominantly early in childhood with an average age of onset of 9  months of age. Although it usually resolves spontaneously as the child ages, it can persist into adulthood. In this article, the authors review the identification, diagnosis, and management of SRRMD in children and adults. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Lourdes M. DelRosso, Irene Cano-Pumarega, Samantha Anguizola Source Type: research

Fragmentary Hypnic Myoclonus and Other Isolated Motor Phenomena of Sleep
Excessive fragmentary hypnic myoclonus, hypnic jerks, hypnagogic foot tremor, alternating leg muscle activation, and sleep-related cramps are less known sleep-related motor disorders (SRMDs). These manifestations are frequently missed or misinterpreted polygraphic findings that can be frequently confused with the more frequent SRMDs. These symptoms can present as isolated motor symptoms but can be also the cause of otherwise cryptogenic insomnias and somnolence. Expanding the knowledge on these isolated symptoms and defining their polygraphic and clinical features are essential for their identification. However, clear cut-...
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Luca Baldelli, Federica Provini Source Type: research

Propriospinal Myoclonus
Propriospinal myoclonus (PSM) consists of paroxysmal and sudden jerks involving axial flexion trunk and hip muscles, conditioning sudden myoclonias of the trunk and arms/limbs, both spontaneous and triggered by sensory stimulations, emerging in relaxed wakefulness typically during the transition between wake and sleep. Generally, PSM originates from a thoracic myelomere and spreads caudally and rostrally, provoking flexion and/or extension movements, leading to jumps or trunk jerks. They appear triggered by the lying-down position and disappear when the subject stands up. The main consequences are the difficulties in sleep...
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Marco Zucconi, Francesca Casoni, Andrea Galbiati Source Type: research

Sleep Disorders in Parkinson Disease
Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization, polysomnographic description, pathophysiologic understanding, and treatment took place. Parkinson disease encompasses the whole spectrum of sleep medicine: every category of sleep disorder can be observed in these patients. Video polysomnography frequently is indicated, sometimes followed by multiple sleep latency/maintenance of wakefulness tests. Additional studies may include actigraphy, cardiorespiratory polygraphy, and dim light melatonin assessment. T...
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Ambra Stefani, Birgit H ögl Source Type: research

The Isolated Form of Rapid Eye Movement Sleep Behavior Disorder
The diagnosis of rapid eye movement (REM) sleep behavior disorder (SBD) requires videopolysomnography detection of excessive electromyographic activity during REM sleep, which is time consuming and difficult. An easier, faster, reliable, and reproducible methodology is needed for its diagnosis. The isolated form of RBD represents an early manifestation of the synucleinopathies Parkinson disease and dementia with Lewy bodies. There is a need to find neuroprotective drugs capable of preventing parkinsonism and dementia onset in isolated RBD. Clonazepam and melatonin ameliorate the RBD symptoms, but therapeutic alternatives a...
Source: Sleep Medicine Clinics - April 15, 2021 Category: Sleep Medicine Authors: Alex Iranzo, Lina Agudelo Ramos, Sabela Novo Source Type: research

Pediatric Restless Legs Syndrome
Early-onset restless legs syndrome has a relatively high prevalence in pediatrics, is highly familial, and is often preceded by a diagnosis of periodic limb movement disorder or childhood insomnia. Diagnostic criteria are derived but not equal to those of the adult syndrome and are adapted according to children ’s age and linguistic competence. Diagnosis requires parents or caregivers to participate; video-polysomnographic nocturnal recording, although not mandatory, may help confirm dubious cases. The syndrome severely impacts children’s sleep and cognitive-behavioral abilities. Iron supplementation i s curren...
Source: Sleep Medicine Clinics - April 9, 2021 Category: Sleep Medicine Authors: Rosalia Silvestri, Lourdes DelRosso Source Type: research

Akathisia and Restless Legs Syndrome
This article proposes that it involves an increased presynaptic dopaminergic transmission in the ventral striatum and concomitant strong activation of postsynaptic dopamine D1 receptors, which form complexes (heteromers) with dopamine D3 and adenosine A1 receptors. It also proposes that in DRBA-induced akathisia, increased dopamine release depends on inactivation of autoreceptors, whereas in RLS it depends on a brain iron deficiency –induced down-regulation of striatal presynaptic A1 receptors. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 9, 2021 Category: Sleep Medicine Authors: Sergi Ferr é, Xavier Guitart, César Quiroz, William Rea, Celia García-Malo, Diego García-Borreguero, Richard P. Allen, Christopher J. Earley Source Type: research

Piecing Together the Puzzle of Adherence in Sleep Medicine
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Authors: Jessie P. Bakker Source Type: research

Copyright
ELSEVIER (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Source Type: research

Forthcoming Issues
Movement Disorders in Sleep (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Source Type: research

Contributors
JESSIE P. BAKKER, MS, PhD (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Source Type: research

Contents
Jessie P. Bakker (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Source Type: research

Piecing Together the Puzzle of Adherence in Sleep Medicine
This issue of Sleep Medicine Clinics focuses primarily on our current understanding and future directions regarding adherence to therapy for sleep disorders, as described by experts in the field. The title, “Piecing Together the Puzzle of Adherence,” nods to how much we have learned to date while acknowledging that adherence remains a complex and puzzling behavioral phenomenon. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 12, 2021 Category: Sleep Medicine Authors: Jessie P. Bakker Tags: Preface Source Type: research

Adherence to Cognitive Behavior Therapy for Insomnia
This article discusses information extracted from 53 studies that have measured adherence to cognitive behavior therapy for insomnia. There has been an increase in more complex and less biased methods for assessing adherence that move beyond simply asking the patients whether they have adhered to the intervention or not. There is a need for a consensus around how to measure adherence, if clinicians want to arrive at an estimate of optimal adherence. Heterogeneity of studies, particularly in the way adherence is operationalized, prohibited conclusions about the relationship between adherence and outcome, as well as about pr...
Source: Sleep Medicine Clinics - December 27, 2020 Category: Sleep Medicine Authors: Sommer Agnew, Annie Valli ères, Ailie Hamilton, Stephanie McCrory, Marek Nikolic, Simon D. Kyle, Leanne Fleming, Megan R. Crawford Source Type: research

Using the Remote Monitoring Framework to Promote Adherence to Continuous Positive Airway Pressure
The ability to remotely monitor positive airway pressure therapy adherence and efficacy provides a unique opportunity for the field of sleep medicine to quickly and efficiently improve patient adherence. Smaller randomized studies and larger-scale retrospective evaluations show that telemedicine interventions leveraging these data can increase average usage and efficiency of care. However, more evidence on the impact of these programs on longer-term adherence and improving patient-reported outcomes is needed. Combining data from remote monitoring with clinical information in electronic health records may prove to be invalu...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Brendan T. Keenan, Richard J. Schwab Source Type: research

Considering the Role of Adherence in New and Emerging Sleep Treatments
There are several novel and emerging treatments for obstructive sleep apnea (OSA), including new devices and pharmacotherapies. Long-term efficacy and adherence data for these interventions in the sleep context are lacking. Future studies exploring the long-term adherence and efficacy in novel and emerging treatments of OSA are required to fully understand the place of these treatments in treatment hierarchies. Such research also should aim to evaluate the use of these novel therapies in real-world clinical settings, because many of the studies performed to date have been done under closely monitored research populations a...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Simon A. Joosten, Shane A. Landry, Ai-Ming Wong, Bradley A. Edwards Source Type: research

Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults
This article reviews studies published on behavioral interventions aimed at improving the uptake and ma intenance of PAP treatment (January 2016–February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 19, 2020 Category: Sleep Medicine Authors: Angela L. D ’Rozario, Yael Galgut, Megan Crawford, Delwyn J. Bartlett Source Type: research

Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure?
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibilit...
Source: Sleep Medicine Clinics - December 14, 2020 Category: Sleep Medicine Authors: Amy M. Sawyer, Douglas M. Wallace, Luis F. Buenaver, Alexa J. Watach, Amy Blase, Bruno Saconi, Sanjay R. Patel, Samuel T. Kuna, Naresh M. Punjabi Source Type: research

Adherence to Sleep Therapies in Children and Adolescents
Improved recognition of obstructive sleep apnea (OSA) in children has led many to identify effective strategies to treat pediatric OSA. Positive airway pressure (PAP) therapy in children, which has been shown to resolve OSA, is highly contingent on adequate adherence. In pediatrics, adherence is complex, related largely to the influence of age. Consequently, reported adherence rates in children are often lower than adults. Notwithstanding, studies have identified significant risk factors, some modifiable, and several intervention strategies that may improve pediatric adherence. Close follow-up, including use of cloud-based...
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Rakesh Bhattacharjee Source Type: research

Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome
This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Jeremy Wearn, Bimaje Akpa, Babak Mokhlesi Source Type: research

Socioeconomic Disparities in Positive Airway Pressure Adherence
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future direct...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Earl Charles Crew, William K. Wohlgemuth, Amy M. Sawyer, Natasha J. Williams, Douglas M. Wallace Source Type: research

What Do We Know About Adherence to Oral Appliances?
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1  year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effe...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Kate Sutherland, Oyku Dalci, Peter A. Cistulli Source Type: research

Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implem...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Martha E. Billings, Sachin R. Pendharkar Source Type: research

The Impact of Device Modifications and Pressure Delivery on Adherence
This article reviews the evidence to date examining whether adherence to positive airway pressure (PAP) therapy is affected by any device modifications to pressure delivery. To date there is no robust evidence from systematic reviews and meta-analyses indicating that any modification to standard fixed-pressure PAP makes a clinically significant difference to patient adherence to therapy. The main modifications are reviewed in this article and whether improving pressure could drive adherence, in turn improving patient outcomes, is discussed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Roo Killick, Nathaniel S. Marshall Source Type: research