Sleep_Disorders RSS : Gourt

Sleeping on the Job: How Innovative Employers Encourage Nap ...

Office naptime is zonking workplaces across the country, according to an article on business newssite INC.com. The story notes that NASA has teamed up with the National Space Biomedical Research Institute and the Perelman School of Medicine at the University of Pennsylvania to teach astronauts how to nap better during long missions.

Dawn of A New Sleep Drug?

Several pharmaceutical companies are working on new approaches to treat insomnia, reports the Wall Street Journal. Studies show that cognitive behavioral therapy for insomnia, known as CBT-I, can be as effective as medication for treating chronic insomnia. CBT-I typically includes "sleep restriction," or limiting the amount of time patients spend in bed when they're unable to sleep, and "stimulus...

Can Too Little Sleep Make you Gain Weight?

Although a new study doesn't prove that sleeplessness causes people to pack on extra pounds, or exactly how the relationship between sleep and body weight might work, they do show that "sleep should be a priority," said Michael Grandner, PhD, of the Center for Sleep and Respiratory Neurobiology. "If you're making your diet a priority and trying to be healthy, don't forget that getting healthy...

From Z's To A's

Sleep’s function has long been a mystery, but many researchers have gathered evidence that it is important for learning and memory. Two new studies confirm that sleep plays a central role in solidifying memories and preparing the brain for new learning. Tickling a few neurons located at the top of the fruit fly brain triggers the insects to sleep, researchers at Washington University in St. Louis...

Sleepy Wife May Take It Out on Hubby

After a bad night’s sleep women — but not men — tend to have more negative interactions with their spouses, a new study shows. Grace Pien, MD, MSCE, DASBM, suspects that women may just be more sensitive to sleep problems. “They are more conscious about how their sleep is affecting them,” said Pien, an assistant professor of Medicine. “And that may translate into their interactions with their...

Is FAA Asleep to Night's Real Risks?

Since March, authorities have disclosed a rash of incidents in which a controller is believed to have dozed off on the midnight shift. The toll for any type of employee who works night shifts or rotating shifts - there are about 15 million such workers in the U.S. - can be heavy. "Basically everything in our body, every chemical, every hormone, every physiological process, is on a 24-hour cycle,"...

Sleep Well and Look 20 Years Younger: Pennsylvania Hospital Expert Shares Secrets with Oprah

Ronald Kotler, MD, medical director of the Pennsylvania Hospital Sleep Disorders Center appeared on yesterday's Oprah with Bob Greene, Oprah’s trainer, and his “Dream Team” of experts discussing how proper exercise, skin care, nutrition and sleep can help you look 20 years younger. Dr. Kotler offers his expertise on how proper sleep habits and hygiene are essential to good health. He counseled...

Professor Recommends Nine Hours of Sleep Nightly

The Daily Pennsylvanian reports on research findings by psychology professor David Dinges, PhD, recommending nine hours of sleep each night for the average healthy person.

A New Treatment for Sleep Apnea

The Wall Street Journal reports that snoring and waking up at night are common nighttime annoyances, but for many, they are signs of a major health problem: sleep apnea. A number of companies are marketing nasal devices to treat the disorder. Scientists say the nonprescription devices haven't been adequately studied, but two new studies found a prescription device effective in some patients. "I...

How Little Sleep Can You Get Away With?

We all know that we don’t get enough sleep. But, the New York Times Magazine asks, how much sleep do we really need? Enter David Dinges, PhD, the head of the Sleep and Chronobiology Laboratory and professor of Psychiatry, who has the distinction of depriving more people of sleep than perhaps anyone in the world. Not every sleeper is the same, his research has shown: Dinges has found that some...

To Sleep, Perchance Not to Crash a Plane

In continuing coverage, the a NYTimes.com blog discusses shift work sleep challenges, in respect to air traffic controllers. The article suggests that perhaps, the F.A.A., in addition to its recent change requiring more than one air-traffic controller on duty overnight, should rethink the way it schedules its employees. And don’t bother asking the controllers if they’re tired. As Dr. Dinges makes...

Air Traffic Controllers' Schedules Impact Sleep

ABC's Good Morning America and World News Tonight delve into the issues surrounding sleepy air traffic controllers. "When we're constantly having to adjust to different work schedules, our body is always playing catchup," says Phil Gehrman, PhD, CSBM, clinical director of Behavioral Sleep Medicine in Psychiatry. Air traffic controllers work in dimly lit conditions with little stimulation, yet...

Sleep Experts Chat about Insomnia

Every week, the ABC News Medical Unit holds an online Twitter chat about a selected health topic, hosted by correspondent Dr. Richard Besser. On April 12, 2011, Philip Gehrman, PhD, CBSM, Clinical Director, Behavioral Sleep Medicine Program at Penn Medicine, joined the discussion about sleep. "Don't toss and turn," said Dr. Gehrman. "If you can't fall back to sleep in a little while get up until...

Free Online Help for Children's Sleep Problems

About 25 percent of parents believe their child has a sleep disturbance, typically difficulty falling asleep or staying asleep through the night. There's now a new tool that can help put parents at ease. "So much of it is about creating regularity. Many kids thrive on consistency and predictability," said Philip Gehrman, PhD, assistant professor of Psychology in Psychiatry. "When your kids wake...

How to Stay Awake After an All-Nighter: Coffee and Other Tips

WebMD.com reports that a night of sleep deprivation affects your brain -- how quickly you can react, how well you can pay attention, how you sort information or remember it. Studies have shown that after an all-nighter, you may be functioning at a similar level as someone who is legally drunk. “You would think you would be the most impaired the longer you’re awake, but that is not the case,” says...

The Emerging Role of Hypocretin (Orexin-A) in the Developing Central Nervous System

Seeking Useful Biomarkers for the Quality and Effectiveness of Sleep

Insomnia Research Is Coming of Age

Maturation of Heart Rate and Blood Pressure Variability during Sleep in Term-Born Infants

Study Objectives:Abnormal blood pressure control is implicated in the sudden infant death syndrome (SIDS). However, no data exist on normal development of blood pressure control during infancy. This study assessed maturation of autonomic control of blood pressure and heart rate during sleep within the first 6 months of life.Participants:Term infants (n = 31) were studied longitudinally at 2-4 weeks, 2-3 months, and 5-6 months postnatal age.Interventions:Infants underwent daytime polysomnography at each age studied. Blood pressure and heart rate were recorded during quiet (QS) and active (AS) sleep in undisturbed baseline and head-up tilt conditions.Measurements and Results:Autonomic control was assessed using spectral indices of blood pressure and heart rate variability (BPV and HRV) in ranges of low frequency (LF, reflecting sympathetic + parasympathetic activity) and high frequency (HF, parasympathetic activity), total power (LF+HF), and LF/HF ratio (sympathovagal balance).With increasing postnatal age and predominantly during QS, HRV-LF, HRV-HF, and HRV total power increased, while HRV-LF/HF decreased. BPV-LF/HF also decreased with postnatal age. All changes were evident in both baseline and head-up tilt conditions. BPV-LF and BPV total power during tilts were markedly reduced in QS versus AS at each age.Conclusions:In sleeping infants, sympathetic vascular modulation of the circulation decreases with age, while parasympathetic control of heart rate is strengthened. These normative data will aid in the early identification of conditions where autonomic function is impaired, such as in SIDS.Citation:Yiallourou SR; Sands SA; Walker AM; Horne RSC. Maturation of heart rate and blood pressure variability during sleep in term-born infants. SLEEP 2012;35(2):177-186.

CSF Levels of Hypocretin-1 (Orexin-A) Peak during Early Infancy in Humans

Study Objectives:Hypocretin (orexin) is a unique neuropeptide involved in the consolidation of wakefulness and sleep. Although hypocretin-1 levels in the cerebrospinal fluid (CSF) are stable after infancy, how levels change in preterm and term human infants is unknown.Design, Patients, and Setting:Hypocretin-1 levels were measured in CSF samples, obtained from 284 preterm (25-37 gestational weeks) and full-term infants in the first 4 months of life and 35 older children (ages 0.5-13 years), in a tertiary hospital.Measurements and Results:Detailed clinical and laboratory data were collected for each of the 319 participants. Based on that data, 108 neurologically intact children were selected (95 infants [43 preterm and 52 term] and 13 older children). CSF hypocretin-1 was measured by direct radioimmunoassay. Hypocretin-1 levels at the first weeks of the 3rd embryonic trimester (gestational age [GA] 28-34 weeks) were 314 ± 65 pg/mL (n = 17). The levels linearly increased during the third trimester and early infancy (r = 0.6), peaking in infants of 2-4 months ages (476 ± 72 pg/mL; n = 16) and decreasing thereafter; hypocretin levels in 2- to 4-month-old infants were significantly higher than those in children 0.5-13 years old (353 ± 78 pg/mL, n = 13; P = 0.0001).Conclusions:The present findings indicate that in human infants, CSF hypocretin-1 increases during the third embryonic trimester and is highest at 4 months of life. Thereafter, and consistent with previously published results, hypocretin levels are lower and stable until the geriatric age. This pattern may reflect the role of hypocretin in the dramatic process of sleep and wakefulness consolidation that occurs during early infancy.Citation:Aran A; Shors I; Lin L; Mignot E; Schimmel MS. CSF levels of hypocretin-1 (orexin-A) peak during early infancy in humans. SLEEP 2012;35(2):187-191.

An Adaptive-Duration Version of the PVT Accurately Tracks Changes in Psychomotor Vigilance Induced by Sleep Restriction

Study Objectives:The Psychomotor Vigilance Test (PVT) is a widely used assay of behavioral alertness sensitive to the effects of sleep loss and circadian misalignment. The standard 10-minute duration of the PVT is often considered impractical for operational or clinical environments. Therefore, we developed and validated an adaptive-duration version of the PVT (PVT-A) that stops sampling once it has gathered enough information to correctly classify PVT performance.Design:Repeated-measures experiments involving 10-minute PVT assessments every 2 hours across both acute total sleep deprivation (TSD) and 5 days of chronic partial sleep deprivation (PSD).Setting:Controlled laboratory environment.Participants:Seventy-four healthy subjects (34 women), aged 22 to 45 years.Interventions:A TSD experiment involving 33 hours awake (n = 31 subjects), and a PSD experiment involving 5 nights of 4 hours time in bed (n = 43 subjects).Measurements and Results:The PVT-A algorithm was trained with 527 TSD test bouts and validated with 880 PSD test bouts. Based on our primary outcome measure “number of lapses (response times ≥ 500 ms) plus false starts (premature responses or response times < 100 ms),” 10-minute PVT performance was classified into high (≤ 5 lapses and false starts), medium (> 5 and ≤ 16 lapses and false starts), or low (> 16 lapses and false starts). The decision threshold for PVT-A termination was set so that at least 95% of training data-set tests were classified correctly and no test was classified incorrectly across 2 performance categories (i.e., high as low or low as high), resulting in an average test duration of 6.0 minutes (SD 2.4 min). In the validation data set, 95.7% of test bouts were correctly classified, and there were no incorrect classifications across 2 categories. Agreement corrected for chance was excellent (κ = 0.92). Across the 3 performance categories, sensitivity averaged 93.7% (range 87.2%-100%), and specificity averaged 96.8% (range 91.6%-99.9%). Test duration averaged 6.4 minutes (SD 1.7 min), with a minimum of 27 seconds.Conclusions:We developed and validated a highly accurate, sensitive, and specific adaptive-duration version of the 10-minute PVT. Test duration of the adaptive PVT averaged less than 6.5 minutes, with 60 tests (4.3%) terminating after less than 2 minutes, increasing the practicability of the test in operational and clinical settings. The adaptive-duration strategy may be superior to a simple reduction of PVT duration in which the fixed test duration may be too short to identify subjects with moderate impairment (showing deficits only later during the test) but unnecessarily long for those who are either fully alert or severely impaired.Citation:Basner M; Dinges DF. An adaptive-duration version of the PVT accurately tracks changes in psychomotor vigilance induced by sleep restriction. SLEEP 2012;35(2):193-202.

Respiratory Cycle-Related EEG Changes: Response to CPAP

Study Objectives:Respiratory cycle-related EEG changes (RCREC) quantify statistically significant synchrony between respiratory cycles and EEG spectral power, vary to some extent with work of breathing, and may help to predict sleepiness in patients with obstructive sleep apnea. This study was designed to assess the acute response of RCREC to relief of upper airway obstruction by positive airway pressure (PAP).Design:Comparison of RCREC between baseline diagnostic polysomnograms and PAP titration studies.Setting:Accredited academic sleep disorders center.Patients:Fifty adults referred for suspected sleep disordered breathing.Interventions:For each recording, the RCREC in specific physiologic EEG frequency ranges were computed as previously described for the last 3 h of sleep not occupied by apneic events.Results:The sample included 27 women; mean age was 47 ± 11 (SD) years; and median respiratory disturbance index at baseline was 24 (inter-quartile range 15-43). Decrements in RCREC, from baseline to PAP titration, reached 43%, 24%, 14%, 22%, and 31% for delta (P = 0.0004), theta (P = 0.01), alpha (P = 0.10), sigma (P = 0.08), and beta (P = 0.01) EEG frequency ranges, respectively. Within each specific sleep stage, these reductions from baseline to PAP studies in synchrony between EEG power and respiratory cycles still reached significance (P < 0.05) for one or more EEG frequency ranges and for all frequency ranges during REM sleep.Conclusions:RCREC tends to diminish acutely with alleviation of upper airway obstruction by PAP. These data in combination with previous observations support the hypothesis that RCREC reflect numerous, subtle, brief, but consequential inspiratory microarousals.Citation:Chervin RD; Shelgikar AV; Burns JW. Respiratory cycle-related EEG changes: response to CPAP. SLEEP 2012;35(2):203-209.

Switch-Task Performance in Rats Is Disturbed by 12 h of Sleep Deprivation But Not by 12 h of Sleep Fragmentation

Study Objectives:Task-switching is an executive function involving the prefrontal cortex. Switching temporarily attenuates the speed and/or accuracy of performance, phenomena referred to as switch costs. In accordance with the idea that prefrontal function is particularly sensitive to sleep loss, switch-costs increase during prolonged waking in humans. It has been difficult to investigate the underlying neurobiological mechanisms because of the lack of a suitable animal model. Here, we introduce the first switch-task for rats and report the effects of sleep deprivation and inactivation of the medial prefrontal cortex.Design:Rats were trained to repeatedly switch between 2 stimulus-response associations, indicated by the presentation of a visual or an auditory stimulus. These stimulus-response associations were offered in blocks, and performance was compared for the first and fifth trials of each block. Performance was tested after exposure to 12 h of total sleep deprivation, sleep fragmentation, and their respective movement control conditions. Finally, it was tested after pharmacological inactivation of the medial prefrontal cortex.Settings:Controlled laboratory settings.Participants:15 male Wistar rats.Measurements & Results:Both accuracy and latency showed switch-costs at baseline. Twelve hours of total sleep deprivation, but not sleep fragmentation, impaired accuracy selectively on the switch-trials. Inactivation of the medial prefrontal cortex by local neuronal inactivation resulted in an overall decrease in accuracy.Conclusions:We developed and validated a switch-task that is sensitive to sleep deprivation. This introduces the possibility for in-depth investigations on the neurobiological mechanisms underlying executive impairments after sleep disturbance in a rat model.Citation:Leenaars CHC; Joosten RNJMA; Zwart A; Sandberg H; Ruimschotel E; Hanegraaf MAJ; Dematteis M; Feenstra MGP; van Someren EJW. Switch-task performance in rats is disturbed by 12 h of sleep deprivation but not by 12 h of sleep fragmentation. SLEEP 2012;35(2):211-221.

Free Recall of Word Lists under Total Sleep Deprivation and after Recovery Sleep

Study Objectives:One task that has been used to assess memory effects of prior total sleep deprivation (TSD) is the immediate free recall of word lists; however, results have been mixed. A possible explanation for this is task impurity, since recall of words from different serial positions reflects use of distinct types of memory (last words: short-term memory; first and intermediate words: episodic memory). Here we studied the effects of 2 nights of TSD on immediate free recall of semantically unrelated word lists considering the serial position curve.Design:Random allocation to a 2-night TSD protocol followed by one night of recovery sleep or to a control group.Setting:Study conducted under continuous behavioral monitoring.Participants:24 young, healthy male volunteers.Intervention:2 nights of total sleep deprivation (TSD) and one night of recovery sleep.Measurements and Results:Participants were shown five 15 unrelated word-lists at baseline, after one and 2 nights of TSD, and after one night of recovery sleep. We also investigated the development of recall strategies (learning) and susceptibility to interference from previous lists. No free recall impairment occurred during TSD, irrespective of serial position. Interference was unchanged. Both groups developed recall strategies, but task learning occurred earlier in controls and was evident in the TSD group only after sleep recovery.Conclusion:Prior TSD spared episodic memory, short-term phonological memory, and interference, allowed the development of recall strategies, but may have decreased the advantage of using these strategies, which returned to normal after recovery sleep.Citation:Zanini GAV; Tufik S; Andersen ML; da Silva RCM; Bueno OFA; Rodrigues CC; Pompéia S. Free recall of word lists under total sleep deprivation and after recovery sleep. SLEEP 2012;35(2):223-230.

Glucose Tolerance in Patients with Narcolepsy

Study Objectives:Obesity is a common feature of narcolepsy. In addition, an increased occurrence of non-insulin dependent diabetes has been reported. So far, it is not known whether glucose metabolism in narcolepsy is disturbed due to, or independently of obesity.Design:Case-control study.Setting:Sleep medicine clinic at a research institute.Patients:We studied 17 patients with narcolepsy/cataplexy compared to 17 healthy controls matched for age, sex, and body mass index (BMI).Interventions:A 75-g oral glucose tolerance test was performed.Measurements:Glucose tolerance was determined by computing plasma glucose curve following oral glucose challenge for 240 minutes; insulin sensitivity and insulin secretion by homeostasis model assessment and minimal model analysis.Results:Standard outcome measures and indices of the oral glucose tolerance test did not differ between the patient group and the group of control subjects.Conclusions:In this study, no clinically relevant pathologic findings in the glucose metabolism of narcoleptic patients compared to weight matched controls were found. Thus, narcolepsy is unlikely to be a risk factor per se for impaired glucose tolerance or diabetes.Citation:Beitinger PA; Fulda S; Dalal MA; Wehrle R; Keckeis M; Wetter TC; Han F; Pollmächer T; Schuld A. Glucose tolerance in patients with narcolepsy. SLEEP 2012;35(2):231-236.

The Longitudinal Relationship between Fatigue and Sleep in Breast Cancer Patients Undergoing Chemotherapy

Study Objective:Fatigue and sleep disturbances are two of the most common and distressing symptoms of cancer patients. A relationship between the two symptoms was reported in symptom cluster studies; however, only subjective measurements of sleep were examined and most studies were cross-sectional. In this study of women with breast cancer undergoing chemotherapy, we explored the longitudinal relationship between fatigue and sleep measured both subjectively and objectively.Design:Prospective study. Data were collected at 7 time points: before (baseline) and during the 3 weeks of cycle 1 and cycle 4 chemotherapy.Participants:Ninety-seven women with newly diagnosed stage I-III breast cancer who were scheduled to receive at least four 3-week cycles of chemotherapy.Measurement and Results:Objective sleep parameters were measured with an Actillume actigraph (Ambulatory Monitoring Inc.). Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Fatigue was assessed with the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Fatigue became worse during both cycles of chemotherapy (P-values < 0.01). Subjective sleep quality was poor at baseline and remained unchanged throughout treatment. Objective nighttime and daytime total sleep time increased compared to baseline during the treatment administration week of both cycles; daytime total wake time decreased during the treatment week of both cycles and during the last 2 week of cycle 4. Mixed model results revealed that fatigue was positively associated with total PSQI scores and with objective measures of total nap time, and negatively associated with total wake time during the day (all P-values < 0.01).Conclusion:Fatigue was significantly associated with subjective reports of poor sleep and objective measures of daytime sleepiness, but not with nocturnal sleep as measured with actigraphy. This relationship between fatigue and sleep warrants further studies to explore their possible common underlying etiology.Citation:Liu L; Rissling M; Natarajan L; Fiorentino L; Mills PJ; Dimsdale JE; Sadler GR; Parker BA; Ancoli-Israel S. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. SLEEP 2012;35(2):237-245.

Sleep in Spousal Alzheimer Caregivers: A Longitudinal Study with a Focus on the Effects of Major Patient Transitions on Sleep

Study Objectives:Findings on sleep disturbances in family dementia caregivers are conflicting. We studied the longitudinal effects of dementia caregiving and major transitions in the caregiving situation on caregivers' sleep and the effect of moderating variables.Design and Setting:Community-based longitudinal study with assessments about once a year for up to three years.Participants:A sample of 109 elderly spousal Alzheimer caregivers and 48 non-caregiving age- and gender-matched controls.Measurements and Results:Random regression models with fixed and time-variant effects for covariates known to affect sleep were used to evaluate changes in the Pittsburgh Sleep Quality Index (PSQI) and in four actigraphy measures over time in relation to caregiving status and transitions (i.e., nursing home placement or death of the Alzheimer disease spouse). Multivariate-adjusted sleep characteristics did not significantly differ between caregivers and non-caregivers over time. Spousal death increased caregivers' nighttime wake after sleep onset (WASO) by 23 min (P = 0.002) and daytime total sleep time (TST) by 29 min (P = 0.003), while nighttime sleep percent decreased by 3.2% (P = 0.009) and nighttime TST did not change. Placement of the spouse had no significant effect on caregivers' sleep. Older age, male gender, role overload, depressive symptoms, and proinflammatory cytokines variously emerged as significant moderators of the relationships between caregiving and transitions with poor subjective and objective sleep.Conclusions:Alzheimer caregivers and non-caregiving controls had similar trajectories of sleep. However, there may be subgroups of caregivers who are vulnerable to develop sleep disturbances, including those whose spouses have died.Citation:von Känel R; Mausbach BT; Ancoli-Israel S; Dimsdale JE; Mills PJ; Patterson TL; Ziegler MG; Roepke SK; Chattillion EA; Allison M; Grant I. Sleep in spousal alzheimer caregivers: a longitudinal study with a focus on the effects of major patient transitions on sleep. SLEEP 2012;35(2):247-255.

Daily Sleep and Fatigue Characteristics in Nulliparous Women during the Third Trimester of Pregnancy

Objectives:To examine the association among nighttime sleep and daytime napping behaviors, depressive symptoms, and perception of fatigue in pregnant women.Design:A prospective descriptive study with within-subject design.Setting:A university-affiliated hospital and participants' home environments.Participants:Thirty-eight third trimester nulliparous women completed sleep and depressive symptom questionnaires, wore a wrist actigraphy monitor for 7 consecutive days, and kept a concurrent diary reporting naps and rating their level of fatigue using a 0-10 visual analogue scale each morning, midday, afternoon, and evening. A generalized estimating equation regression model was applied to evaluate the time-dependent association.Interventions:N/A.Measurements and Results:Mean duration of total nighttime sleep by actigraphy was 386.3 ± 60.7 min, with 11 (28.9%) women having an average total nighttime sleep < 6 h. Nineteen women (50%) napped > 3 days, and only 2 women did not nap over the entire week. Antecedent night sleep duration had a significant inverse association with morning (P = 0.022) and afternoon fatigue (P = 0.009) of the subsequent day. Self-reported naps were significantly associated with midday fatigue (P = 0.003). More depressive symptoms predicted more severe fatigue throughout the day.Conclusions:Results suggest that interventions designed to increase sleep duration and decrease depressive symptoms have the potential to prevent, ameliorate, or reduce fatigue in pregnant women. Depressive symptoms during pregnancy likely share some psychological and behavioral tendencies with fatigue and/or sleep disturbance which may complicate the evaluation of intervention effect.Citation:Tsai SY; Lin JW; Kuo LT; Thomas KA. Daily sleep and fatigue characteristics in nulliparous women during the third trimester of pregnancy. SLEEP 2012;35(2):257-262.

The Supraglottic Effect of a Reduction in Expiratory Mask Pressure During Continuous Positive Airway Pressure

Study Objectives:Patients with obstructive sleep apnea may have difficulty exhaling against positive pressure, hence limiting their acceptance of continuous positive airway pressure (CPAP). C-Flex is designed to improve comfort by reducing pressure in the mask during expiration proportionally to expiratory airflow (3 settings correspond to increasing pressure changes). When patients use CPAP, nasal resistance determines how much higher supraglottic pressure is than mask pressure. We hypothesized that increased nasal resistance results in increased expiratory supraglottic pressure swings that could be mitigated by the effects of C-Flex on mask pressure.Design:Cohort study.Setting:Sleep center.Participants:Seventeen patients with obstructive sleep apnea/hypopnea syndrome and a mechanical model of the upper airway.Interventions:In patients on fixed CPAP, CPAP with different C-Flex levels was applied multiple times during the night. In the model, 2 different respiratory patterns and resistances were tested.Measurements and Results:Airflow, expiratory mask, and supraglottic pressures were measured on CPAP and on C-Flex. Swings in pressure during expiration were determined. On CPAP, higher nasal resistance produced greater expiratory pressure swings in the supraglottis in the patients and in the model, as expected. C-Flex 3 produced expiratory drops in mask pressure (range −0.03 to −2.49 cm H2O) but mitigated the expira-tory pressure rise in the supraglottis only during a sinusoidal respiratory pattern in the model.Conclusions:Expiratory changes in mask pressure induced by C-Flex did not uniformly transmit to the supraglottis in either patients with obstructive sleep apnea on CPAP or in a mechanical model of the upper airway with fixed resistance. Data suggest that the observed lack of expiratory drop in supraglottic pressure swings is related to dynamics of the C-Flex algorithm.Citation:Masdeu MJ; Patel AV; Seelall V; Rapoport DM; Ayappa I. The supraglottic effect of a reduction in expiratory mask pressure during continuous positive airway pressure. SLEEP 2012;35(2):263-272.

Effects of a 3-Hour Sleep Delay on Sleep Homeostasis in Alcohol Dependent Adults

Objectives:This study evaluated slow wave activity homeostatic response to a mild sleep challenge in alcohol-dependent adults compared to healthy controls.Design:Participants maintained a 23:00-06:00 schedule for 5 days verified by actigraphy and diary, followed by 3 nights in the lab: adaptation, baseline, and a sleep delay night with an 02:00-09:00 schedule.Setting:Sleep ' Chronophysiology laboratory.Participants:48 alcohol-dependent adults (39 men, 9 women) who were abstinent for at least 3 weeks and 16 healthy control adults (13 men, 3 women), 21-55 years of age participated in study.Interventions:N/A.Measurements and Results:Slow wave EEG activity (SWA) in consecutive NREM periods was compared between baseline and sleep delay nights and between AD and HC groups, using age and sex as statistical covariates. The AD group showed a blunted SWA response to sleep delay with significantly lower SWA power than the HC group. Exponential regression analyses confirmed lower asymptotic SWA with a slower decay rate over NREM sleep time in the AD group. Results were similar for raw SWA and %SWA on the delay night expressed relative to baseline SWA.Conclusions:Alcohol dependence is associated with impaired SWA regulation and a blunted response to a mild homeostatic sleep challenge.Citation:Armitage R; Hoffmann R; Conroy DA; Arnedt JT; Brower KJ. Effects of a 3-hour sleep delay on sleep homeostasis in alcohol dependent adults. SLEEP 2012;35(2):273-278.

A Closed Literature-Based Discovery Technique Finds a Mechanistic Link Between Hypogonadism and Diminished Sleep Quality in Aging Men

Study Objectives:Sleep quality commonly diminishes with age, and, further, aging men often exhibit a wider range of sleep pathologies than women. We used a freely available, web-based discovery technique (Semantic MEDLINE) supported by semantic relationships to automatically extract information from MEDLINE titles and abstracts.Design:We assumed that testosterone is associated with sleep (the A-C relationship in the paradigm) and looked for a mechanism to explain this association (B explanatory link) as a potential or partial mechanism underpinning the etiology of eroded sleep quality in aging men.Measurements and Results:Review of full-text papers in critical nodes discovered in this manner resulted in the proposal that testosterone enhances sleep by inhibiting cortisol. Using this discovery method, we posit, and could confirm as a novel hypothesis, cortisol as part of a mechanistic link elucidating the observed correlation between decreased testosterone in aging men and diminished sleep quality.Conclusions:This approach is publically available and useful not only in this manner but also to generate from the literature alternative explanatory models for observed experimental results.Citation:Miller CM; Rindflesch TC; Fiszman M; Hristovski D; Shin D; Rosemblat G; Zhang H; Strohl KP. A closed literature-based discovery technique finds a mechanistic link between hypogonadism and diminished sleep quality in aging men. SLEEP 2012;35(2):279-285.

The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring

Study Objectives:To present an expert consensus, standardized, patient-informed sleep diary.Methods and Results: Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference 1 were collected and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a Core sleep diary, and those deemed optional were retained for an expanded diary. Secondly, optional items would be available in other versions. A draft of the Core and optional versions along with a feedback questionnaire were sent to members of the Pittsburgh Assessment Conference. The feedback from the group was integrated and the diary drafts were subjected to 6 focus groups composed of good sleepers, people with insomnia, and people with sleep apnea. The data were summarized into themes and changes to the drafts were made in response to the focus groups. The resultant draft was evaluated by another focus group and subjected to lexile analyses. The lexile analyses suggested that the Core diary instructions are at a sixth-grade reading level and the Core diary was written at a third-grade reading level. Conclusions:The Consensus Sleep Diary was the result of collaborations with insomnia experts and potential users. The adoption of a standard sleep diary for insomnia will facilitate comparisons across studies and advance the field. The proposed diary is intended as a living document which still needs to be tested, refined, and validated.Citation: Carney CE; Buysse DJ; Ancoli-Israel S; Edinger JD; Krystal AD; Lichstein KL; Morin CM. The consensus sleep diary: standardizing prospective sleep self-monitoring. SLEEP 2012;35(2):287–302.

The effects of heated humidifier in continuous positive airway pressure titration

Abstract Background Previous studies have shown that routine heated humidifier (HH) do not provide any benefit during continuous positive airway pressure (CPAP) titration if there are no significant naso-pharyngeal symptoms. In clinical practice, nasal diseases and upper airway symptoms are very common. This study investigates the effects of HH during CPAP titration in subjects with or without naso-pharyngeal symptoms. Methods Fifty-two patients who received polysomnography with CPAP titration were randomly assigned to HH and non-HH groups. Their nasal cavity, pharynx, and naso-pharynx were evaluated before CPAP titration, and a questionnaire on subjective sensation, including naso-pharyngeal symptoms, willingness to further use CPAP, and sleep improvement, was used. Objective (e.g., leak, apnea–hypopnea index (AHI) reduction, and optimal CPAP pressure level) and subjective data were analyzed between the two groups. Results In subjective sensation, the HH group did not have any benefit in further willingness to use CPAP and in sleep improvement, but had improved naso-pharyngeal symptoms (p = 0.043). There were no significant differences in leak, AHI reduction, and optimal CPAP pressure, even in patients with significant naso-pharyngeal symptoms. Conclusion Routine use of HH is not necessary during CPAP titration regardless of naso-pharyngeal symptoms. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0661-yAuthors Chung-Chieh Yu, Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of ChinaCheng-Ming Luo, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of ChinaYu-Chih Liu, Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of ChinaHuang-Pin Wu, Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Insomnia symptoms influence CPAP compliance

Abstract Purpose The aim of this study is to determine parameters which influence 6-month compliance of continuous positive airway pressure therapy (CPAP) in patients with obstructive sleep apnea syndrome (OSAS). Methods This prospective study investigated 73 patients (24 females) with OSAS and medical indication for CPAP therapy: age 55.1 ± 11.5 years, body mass index (BMI) 30.8 ± 5.0 kg/m2, Apnea–Hypopnea Index (AHI) 39.2 ± 26.7/h, Oxygen Desaturation Index (ODI) 33.2 ± 25.4/h, minimum O2 saturation 78.9 ± 7.6%. The influence of baseline parameters (demographic and polysomnographic data, sleeping medication intakes, BMI, psychometrics [Epworth Sleepiness Scale, Regensburg Insomnia Scale, Vigilance test and Beck Depression Inventory]) on 6-month compliance was evaluated with a correlation and a linear regression analysis. Results The baseline value of the Regensburg Insomnia Scale (RIS) predicts 6-month CPAP compliance (r = −0.376, R 2 = 0.14, p < 0.001), although no other baseline parameter correlates. Patients with a compliance of <4 h/night show higher RIS scores, i.e., more insomnia symptoms (17.6 ± 8.8) compared to those with ≥4 h/night (12.6 ± 6.9; p < 0.05). Conclusions Insomnia symptoms prior to the beginning of CPAP treatment show a negative influence on CPAP compliance. Further studies should clarify, if a treatment of insomnia symptoms leads to a benefit in compliance. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0655-9Authors Christoph Pieh, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyMagdalena Bach, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyRoland Popp, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyCecilia Jara, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyTatjana Crönlein, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyGöran Hajak, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, GermanyPeter Geisler, Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Role of leptin as antioxidant in obstructive sleep apnea: an in vitro study using electron paramagnetic resonance method

Abstract Introduction As in obstructive sleep apnea (OSA), the chronic cycles of hypoxia and reoxygenation are thought to be conducive of oxidative stress (OS) with generation of reactive oxygen species, identifying effective mechanisms of protection against oxidant-mediated tissue damage becomes of outmost importance. Leptin’s role had been recently extended into that of participant to OS; while its exact role in this process is yet to be defined, elevated leptin levels correlate significantly with several indices of OSA disease severity such as nocturnal hypoxemia, possibly acting as a counteractive mechanism against the chronic intermittent hypoxia-related OS and serving as a marker of future risk of atherosclerotic disease. We therefore investigated leptin’s antioxidant mechanism on superoxide (O2−•) anions using spectrophotometry and electron paramagnetic resonance (EPR). Methods The O2−• was generated by oxidation of xanthine (XAN) by xanthine oxidase (XO) in the presence of spin trap 5-diethoxyphosphoryl-5-methyl-1-pyrroline N-oxide with various concentrations of leptin (0.001, 0.01, 0.1, and 1 mg/ml) and without leptin. Signal intensity between 3,440 and 3,540 G was expressed as standard means ± SD. The activity of leptin on XO was determined by monitoring the conversion of XAN to uric acid at 293 nm using a Beckman DU 800 UV–visible spectrophotometer. Results Leptin added to aqueous solutions at 0.1 and 1 mg/ml concentrations was associated with a statistically significant decrease in the EPR signal due to leptin’s direct scavenging activity towards the O2−•. Conclusion Leptin is an antioxidant agent of possible use as a marker of OS and future risk of atherosclerotic disease in OSA. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0656-8Authors Madalina Macrea, Salem VA Medical Center, affiliate of the University of Virginia School of Medicine, Charlottesville, VA, USAThomas Martin, Salem VA Medical Center, affiliate of the University of Virginia School of Medicine, Charlottesville, VA, USALeon Zagrean, Physiology Department, “Carol Davila” School of Medicine, Bucharest, RomaniaZhenquan Jia, Department of Biology, University of North Carolina at Greensboro, Greensboro, NC 27410, USAHara Misra, Edward Via Virginia College of Osteopathic Medicine, Virginia Tech Corporate Research, Blacksburg, VA, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

A case–control study of craniofacial features of children with obstructed sleep apnea

Abstract Objective This study aims to analyze differences in the skeletal, dental, and soft tissue components of craniofacial structure predisposing to the pediatric obstructive sleep apnea, by a comparison of the cephalograms between children with obstructive sleep apnea (OSA) and controls. Materials and methods The study enrolled a total of 30 children who were composed of the following two groups: 15 OSA patients and 15 controls. The two groups were strictly matched by age and sex. Lateral head radiographs were obtained and then cephalometric measurements were compared between the two. Fifty-six measurements were determined to study various skeletal, soft tissue, and airway structure. Results Marked differences were demonstrated in terms of SNB, PG-NB, lower facial height, H-C3Me, and adenoid (A) and tonsil (T/P). The SNB angle (75.82 ± 4.30) in case group was smaller than in the control (78.71 ± 2.61; p = 0.035), the PG/NB value in case group (1.32 ± 0.84 mm) was higher than that in the control (0.62 ± 0.60 mm; p = 0.015). The anterior lower facial height was 65.12 ± 5.91 mm in case group (p = 0.048), while the anterior lower facial height in control was 61.51 ± 3.22 mm. The position of hyoid was lower in case group (5.30 ± 3.67 mm) compared with the control one (2.64 ± 2.58 mm; p = 0.029). Furthermore, the patients with OSA had larger As and T/Ps than the controls. Conclusions The case group differed from the control group in the length of mandible, anterior lower facial height, position of hyoid and the chin, and the size of the As and T/Ps. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0636-4Authors Jinrong Deng, 3rd dental centre, School and Hospital of Stomatology, Peking University, Beijing, ChinaXuemei Gao, Department of Orthodontics, School and Hospital of Stomatology, Peking University, 22 Zhongguancun Nandajie, Haidian District, Beijing 100181, China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy

Abstract Purpose Auto-CPAP devices (APAP) are controlled, e.g., by the respiratory flow and pressure to adjust the treatment pressure to the variable obstruction in sleep apnea syndromes. By obstruction of the upper airway during inspiration, a pressure difference between the lower airways and the mask can be measured. In case of an opening of the pharynx at the end of the obstruction, the pressure decreases immediately. This brief negative pressure, the so-called obstructive pressure peak (OPP) can be used to identify obstruction or open airways with the algorithm of an APAP device. Useless pressure increases, e.g., after central apneas without obstruction may be avoided. We therefore investigated the association of the OPP signal with respiratory events during APAP therapy. Methods In this pilot study, 13 patients with obstructive sleep apnea syndrome were evaluated. Attended automatic CPAP titration (SOMNObalance, Fa Weinmann Hamburg/Germany) was performed. The OPP signal was recorded synchronously in parallel with the polysomnographic data. If the OPP signal was within a time range of ±5 s of the resumption of normal breathing, it was assigned to the event. Results A total of 480 sleep-related breathing disorders events were studied. The most common were the mixed apneas associated with more than 90% of all cases with an OPP signal, followed by obstructive sleep apneas (66.7%) and central apneas (38%). The difference in OPP frequency distribution between central apneas and obstructive apneas was significant with p < 0.001. Conclusions The analysis of the pressure characteristics of APAP treatment with the registration of OPP allows a further differentiation in obstructed and not obstructed upper airways. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s11325-012-0657-7Authors K. H. Ruhle, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, GermanyU. Domanski, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, GermanyG. Nilius, Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091 Hagen, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Central apnea after adenotonsillectomy in childhood: case report

Central apnea after adenotonsillectomy in childhood: case report Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s11325-011-0634-6Authors Leila Azevedo de Almeida, Department of Neuroscience and Behavioral Sciences—Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, BrazilAlan Luiz Eckeli, Department of Neuroscience and Behavioral Sciences—Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, BrazilWilma Terezinha Anselmo Lima, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo, Av. Bandeirantes, 3900, CEP: 14048-900 Ribeirão Preto, SP, BrazilEdgard Camilo de Oliveira Filho, Cardiology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, BrazilHeidi Haueisen Sander, Department of Neuroscience and Behavioral Sciences—Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, BrazilRegina Maria França Fernandes, Department of Neuroscience and Behavioral Sciences—Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, BrazilFabiana Cardoso Pereira Valera, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo, Av. Bandeirantes, 3900, CEP: 14048-900 Ribeirão Preto, SP, Brazil Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury

Abstract Objectives We hypothesized that obstructive sleep apnea (OSA) has a dose-dependent impact on mortality in those with ischemic heart disease or previous myocardial injury. Methods We performed a retrospective cohort study of 281 consecutive OSA patients with a history of myocardial injury as determined by elevated troponin levels or with known existing ischemic heart disease. We compared survival between those with severe OSA [apnea–hypopnea index (AHI) ≥30] and those with mild to moderate OSA (AHI >5 and <30). Results Of the 281 patients (mean age 65 years, mean BMI 34, 98% male, 58% with diabetes), 151 patients had mild-moderate OSA and 130 had severe OSA. During a mean follow-up of 4.1 years, there were significantly greater deaths in the severe OSA group compared to the mild-moderate OSA group [53 deaths (41%) vs. 44 deaths (29%), respectively, p = 0.04]. The adjusted hazard ratio for mortality with severe OSA was 1.72 (95% confidence interval 1.01–2.91, p = 0.04). Conclusions The severity of obstructive sleep apnea is associated with increased risk of death, and risk stratification based on OSA severity is relevant even in the diseased cardiac patient. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-012-0653-yAuthors Christine H. Won, UCSF Sleep Disorders Center, University of California, San Francisco, CA, USAHyung J. Chun, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USASuparna M. Chandra, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USAPriscilla S. Sarinas, VA Palo Alto Healthcare System, Palo Alto, CA, USARajinder K. Chitkara, VA Palo Alto Healthcare System, Palo Alto, CA, USAPaul A. Heidenreich, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Effects of exercise and nutritional intake on sleep architecture in adolescents

Abstract Purpose Few studies have evaluated the relationship between sleep architecture and body mass index (BMI), nutrition, and physical activity in children. This study determined the relationship between sleep architecture and diet and exercise. Methods Three hundred nineteen Caucasian and Hispanic children aged 10 to 17 years participated in the follow-up assessment of the Tucson Children’s Assessment of Sleep Apnea study. The children and parents completed several questionnaires on dietary habits, amount of physical activity, and sleep habits. Subjects also underwent a home polysomnogram to characterize their sleep. Results Significant bivariate correlations were noted between stage II sleep percentage and the following: BMI (r = 0.246, p < 0.01), estimated total recreational energy expenditure (r = 0.205, p < 0.01), vigorous activity (r = 0.130, p = 0.009), and total estimated activity (r = 0.148, p = 0.009). In girls, significant correlations were noted between stage II percentage sleep and BMI score (r = 0.279, p < 0.01). Also in girls, significant negative correlation was noted between rapid eye movement (REM) sleep percentage and total fat intake (r = −0.168, p = 0.039). In boys, significant correlations were again seen between stage II percentage sleep and the following: BMI score (r = 0.218, p = 0.005), estimated total recreational energy expenditure (r = 0.265, p = 0.001), vigorous activity (r = 0.209, p = 0.008), and total estimated activity (r = 0.206, p = 0.010). When controlling for BMI percentile and age, significant bivariate correlation was also noted between REM sleep percentage and total fat intake (r = 0.176, p = 0.034) in boys. Conclusions BMI and exercise were associated with increases in stage II sleep. In girls, total fat intake was associated with a reduction in REM sleep, while in boys (after controlling for BMI percentile and age), total fat intake correlated with REM sleep. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-012-0658-6Authors Karim M. Awad, Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USAAmy A. Drescher, Arizona Respiratory Center, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USAAtul Malhotra, Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USAStuart F. Quan, Division of Sleep Medicine, Harvard Medical School, 401 Park Drive, 2nd Floor East, Boston, MA 02215, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

On “Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia” (Sleep Breath 2011 doi 10.1007/s11325-011-0608-8)

On “Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia” (Sleep Breath 2011 doi 10.1007/s11325-011-0608-8) Content Type Journal ArticleCategory Letter to the EditorsPages 1-2DOI 10.1007/s11325-012-0649-7Authors Raffaele Ferri, Sleep Research Centre, Department of Neurology I.C., Oasi Institute on Mental Retardation and Brain Aging (IRCCS), Via C. Ruggero 73, 94018 Troina, ItalyViola Gschliesser, Department of Neurology, Innsbruck Medical University, Innsbruck, AustriaBirgit Frauscher, Department of Neurology, Innsbruck Medical University, Innsbruck, AustriaWerner Poewe, Department of Neurology, Innsbruck Medical University, Innsbruck, AustriaBirgit Högl, Department of Neurology, Innsbruck Medical University, Innsbruck, Austria Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Assessment of the impact on compliance of a new CPAP system in obstructive sleep apnea

Abstract Background Despite the efficacy of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA), compliance with therapy remains suboptimal. The aim of this study was to determine whether the use of S9TM increased compliance in established CPAP users. Methods Subjects with OSA (50) were recruited into the study. When subjects entered the study, 28 days of respective compliance data were downloaded from the patient's usual CPAP device. Subjects trialled the S9 CPAP for 28 days. Subjects then resumed use of their usual CPAP for 28 days. Compliance data from the patient's usual CPAP pre- and post-trialling S9 were compared with data from the S9 CPAP. Results Patients were significantly more compliant when using the S9 than their usual CPAP device both pre- and post-S9 based on average daily usage. CPAP pre-S9 = 6.58 ± 1.95 (mean hours ± SD), S9 = 7.08 ± 1.18 h and CPAP post-S9 = 6.71 ± 1.72 h. The difference between CPAP pre-S9 and S9 was 0.5 h (p = 0.003). The difference between S9 and CPAP post-S9 was 0.35 h (p = 0.01). There was no significant difference between CPAP pre-S9 and CPAP post-S9 (p = 0.34). Patients also completed questionnaires comparing the S9 system to their usual device. Subjective feedback showed a strong preference for the S9. Conclusions Participants were significantly more compliant when using the S9 than their usual CPAP device both pre- and post-S9 use. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-012-0651-0Authors Alison J. Wimms, ResMed Science Centre, ResMed Ltd, 1 Elizabeth Macarthur Drive, Bella Vista 2153, Sydney, AustraliaGlenn N. Richards, ResMed Science Centre, ResMed Ltd, 1 Elizabeth Macarthur Drive, Bella Vista 2153, Sydney, AustraliaAdam V. Benjafield, ResMed Science Centre, ResMed Ltd, 1 Elizabeth Macarthur Drive, Bella Vista 2153, Sydney, Australia Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Relationship of obstructive sleep apnea syndrome with the 5-HT2A receptor gene in Brazilian patients

Abstract Background Serotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Polymorphisms in the 5-HT2A receptor gene can alter its transcription, affecting the number of receptors in the serotoninergic system, contributing to obstructive sleep apnea syndrome (OSAS). Objective The aim of this study was to determine the prevalence of the 102T-C and -1438G-A polymorphisms in the 5-HTR2A gene in Brazilian patients with and without OSAS. Subjects and methods A cross-sectional study performed at the Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School, FAMERP. One hundred patients were examined as index cases and 100 persons as controls, of both genders to both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed both polymorphisms were amplified by PCR-RFLP. Results There was a significant prevalence of the male gender in index cases compared with the control group gender (p < 0.0001). There was no significant genotypic difference in the 102T-C polymorphism between the case and control groups (p = 1.000). The AA genotype of the -1438G-A polymorphism was more prevalent in the patients with OSAS compared with the controls (OR, 2.3; CI 95% 1.20–4.38; p = 0.01). Conclusions There was no difference in the prevalence of the 102T-C polymorphism between patients with OSAS and the control group. Serotoninergic system dysfunction appeared to be related to OSAS. The -1438G-A polymorphism and OSAS are related in this studied Brazilian population. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0645-yAuthors Thiago Bittencourt Ottoni de Carvalho, Department of Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School (FAMERP), Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo 15090-000, BrazilMarcela Suman, Department of Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School (FAMERP), Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo 15090-000, BrazilFernando Drimel Molina, Department of Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School (FAMERP), Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo 15090-000, BrazilVânia Belintani Piatto, Department of Morphology, São José do Rio Preto Medical School (FAMERP), Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo 15090-000, BrazilJosé Victor Maniglia, Department of Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School (FAMERP), Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, São Paulo 15090-000, Brazil Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Screening of snoring with an MP3 recorder

Abstract Purpose Snoring patients seeking medical assistance represent a wide range of clinical and sleep study findings from nonsleepy nonapneic snoring to severe obstructive sleep apnea syndrome. The prevalence of snoring is high and it significantly impacts quality of life. Its objective diagnosis usually requires a sleep study. We developed a system to analyze snoring sounds with a Moving Picture Experts Group Layer-3 Audio (MP3) recorder device and present its value in the screening of snoring. Methods We recorded snoring sounds during in-lab polysomnography (PSG) in 200 consecutive patients referred for a suspicion of obstructive sleep apnea. Snoring was recorded during the PSG with two microphones: one attached to the throat and the other to the ceiling; an MP3 device was attached to the patient’s collar. Snoring was confirmed when the MP3 acoustic signal exceeded twice the median value of the acoustic signal for the entire recording. Results of the MP3 snoring recording were compared to the snoring recordings from the PSG. Results MP3 recording proved technically successful for 87% of the patients. The Pearson correlation between PSG snoring and MP3 snoring was highly significant at 0.77 (p < 0.001). The MP3 recording device underestimated the snoring time by a mean ± SD of 32 ± 55 min. Conclusions The recording of snoring with an MP3 device provides reliable information about the patient’s snoring. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-012-0652-zAuthors Hanna-Riikka Kreivi, Sleep Unit, Division of Pulmonary Medicine, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 372, 00029 HUS Helsinki, FinlandTapani Salmi, Department of Clinical Neurophysiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 HUS Helsinki, FinlandPaula Maasilta, Sleep Unit, Division of Pulmonary Medicine, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 372, 00029 HUS Helsinki, FinlandAdel Bachour, Sleep Unit, Division of Pulmonary Medicine, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 372, 00029 HUS Helsinki, Finland Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Multiple sleep bruxism data collected using a self-contained EMG detector/analyzer system in asymptomatic healthy subjects

Abstract Purpose Small, self-contained electromyographic (EMG) detector/analyzer (D/A) devices have become available for the detection of jaw muscle activity events above threshold. These devices claim to be less intrusive to the subjects sleep so it is less prone to induce disturbed sleep. The objective of this study was to evaluate for night-to-night variability and examine for a systematic alteration on the first night in EMG levels. Methods Ten asymptomatic healthy volunteers (mean age, 26.8 ± 3.78) were recorded for six sequential nights in their home environment using EMG D/A system. The device yields a nightly EMG level above threshold score on a 0–4 level. Because the data are categorical and nonparametric, the data of the ten subjects across six nights were submitted to a Friedman repeated measures ANOVA. The significant level was set as alpha equal to 0.05. Results The median and mode values of the subjects were tabulated and analyzed and we did not find a significant difference in EMG D/A level across the six nights (p = 0.287, Kendall's coefficient of concordance = 0.124, Friedman two-way repeated measures ANOVA). The data did show clear and substantial night-to-night variability. Conclusion Substantial night-to-night variability in masseter EMG activity levels was clearly observed in our subjects. There was no evidence of a suppressed or elevated first-night effect-like variability on masseter muscle EMG level seen in these subjects using a small portable self-contained EMG detector/analyzer. These data suggest that recordings should be at least 5–6-nights duration to establish a reasonable measure of an individual's average nightly masseter EMG level. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s11325-011-0602-1Authors Hajime Minakuchi, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 JapanChiyomi Sakaguchi, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 JapanEmilio S. Hara, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 JapanKenji Maekawa, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 JapanYoshizo Matsuka, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 JapanGlenn T. Clark, Division of Diagnostic Science, School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089-0641, USATakuo Kuboki, Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ward, Okayama, 700-8525 Japan Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study

Abstract Purpose This study aims: (1) to identify patients with multiple sclerosis (MS) who are at high risk for obstructive sleep apnea (OSA) by utilizing the STOP-BANG questionnaire and (2) to evaluate the relationship between OSA risk as determined by the STOP-BANG questionnaire and self-reported sleepiness and fatigue using the Epworth Sleepiness Scale (ESS) and the Fatigue Severity Scale (FSS), respectively. Methods A total of 120 consecutive patients presenting to the UC Davis Neurology MS Clinic were invited to participate in an anonymous survey. The exclusion criteria were: age <18 years, indefinite MS diagnosis, or incomplete survey. Results There were 103 subjects included in our study: 42% of subjects (n = 43) met the criteria for high-risk OSA, 69% of subjects (n = 71) screened high for fatigue (FSS ≥ 4), but only 24 subjects (23%) screened high for excessive daytime sleepiness (ESS > 10). In males, 44% of the variation in ESS scores and 63% in FSS scores were explained by the STOP-BANG components. However, only 17% of the variation in ESS scores and 15% of the variation in FSS scores was explained by the STOP-BANG components in females. Conclusions Over 40% of MS patients were identified as high risk for OSA based on the STOP-BANG questionnaire. The STOP-BANG questionnaire offers clinicians an efficient and objective tool for improving detection of OSA risk in MS patients. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s11325-011-0642-6Authors Robert A. Dias, Department of Pulmonary, Critical Care and Sleep Medicine, PSSB Bldg Rm 3400 4150 V Street, Sacramento, CA 95817, USAKimberly A. Hardin, Department of Pulmonary, Critical Care and Sleep Medicine, PSSB Bldg Rm 3400 4150 V Street, Sacramento, CA 95817, USAHeather Rose, School of Education, UC Davis, One Shields Ave, Davis, CA 95616, USAMark A. Agius, Department of Neurology, UC Davis Medical Center, Suite 0100, 4860 Y Street, Sacramento, CA, USAMichelle L. Apperson, Department of Neurology, UC Davis Medical Center, Suite 0100, 4860 Y Street, Sacramento, CA, USASteven D. Brass, Department of Neurology, UC Davis Medical Center, Suite 0100, 4860 Y Street, Sacramento, CA, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Multiple heart pauses during sleep in a patient with obstructive sleep apnoea syndrome

Multiple heart pauses during sleep in a patient with obstructive sleep apnoea syndrome Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s11325-012-0648-8Authors Athanasia Pataka, Respiratory Failure Unit, G. Papanikolaou Hospital, Exohi 57010, Thessaloniki, GreeceEuphemia Daskalopoulou, Sleep Laboratory, Department of Internal Medicine, “St. Paul” General Hospital, Thessaloniki, GreeceStefanos Papastefanou, Department of Cardiology, “St. Paul” General Hospital, Thessaloniki, GreeceChousein Baltatzi, Sleep Laboratory, Department of Internal Medicine, “St. Paul” General Hospital, Thessaloniki, GreecePetros Aggelopulos, Department of Clinical Neurophysiology, Psychiatric Hospital Thessaloniki, Thessaloniki, GreeceEmmanuel Vlachogiannis, Sleep Laboratory, Department of Internal Medicine, “St. Paul” General Hospital, Thessaloniki, Greece Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?

Abstract Purpose Success rates of non-ventilation therapies for sleep disordered breathing (SDB) remain hardly acceptable. Drug-induced sleep endoscopy (DISE) tends to show the level and mechanism of obstruction and helps to specify therapy individually. Therefore, increasing success rates are expected. The objective of this study is to detect whether locations of treatment recommendations given after DISE are different to those made after clinical basic ENT (ear, nose, throat) examination (CBE). Methods This study included patients with obstructive sleep apnea (OSA) and primary snoring who wish or require an alternative therapy to the gold standard, continuous positive airway pressure (CPAP). After CBE, a theoretical treatment recommendation was given comprising surgery (possible surgical target: soft palate, tonsils, tongue base, epiglottis) and mandibular advancement splints (MAS) or both. A second ENT specialist conducted a DISE and independently recommended a second therapy concept without knowing the first one. A third person compared both theoretical locations of treatment recommendations (CBE vs. DISE). Results A total of 97 patients (eight female and 89 male, age 30–85 years, AHI 1.9–88.6/h, body mass index [BMI] 20.3–36.3 kg/m²) received two therapy recommendations. Regarding surgical options only, 63.9% of the examined patients got a different recommendation in at least one of four levels. If MAS was included, a change was found in 78.4% of the patients. Subdivided into each type of intervention, the following changes were found in the therapy concept: 24.7% (n = 24/97) soft palate, 12.4% (n = 12/97) tonsils, 33.0% (n = 32/97) tongue base, 27.8% (n = 27/97) epiglottis, 38.1% (n = 37/97) MAS. Conclusions DISE shows a relevant influence on the location of treatment recommendation. Thus, a change in success rates of non-CPAP therapy in OSA and snoring appears possible. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-012-0647-9Authors Corlette Eichler, Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyJ. Ulrich Sommer, Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyBoris A. Stuck, Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyKarl Hörmann, Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyJoachim T. Maurer, Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Fatigue and sleep disorders in multiple sclerosis: is obstructive sleep apnea a link?

Fatigue and sleep disorders in multiple sclerosis: is obstructive sleep apnea a link? Content Type Journal ArticlePages 1-2DOI 10.1007/s11325-011-0643-5Authors Friedemann Paul, NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, GermanyChristian Veauthier, Department of Neurology, Hanse-Klinikum Stralsund, Stralsund, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Gender and age influence the effects of slow-wave sleep on respiration in patients with obstructive sleep apnea

Abstract Introduction Obstructive sleep apnea (OSA) is influenced by sleep architecture with rapid eye movement (REM) sleep having the most adverse influence, especially in women. There is little data defining the influence of slow-wave sleep (SWS) on OSA. We wished to study the influence of SWS on OSA and identify differences attributable to gender and/or age, if any. Methods Retrospective study of polysomnography (PSG) records of adult patients referred for diagnostic PSG. Records were excluded if they underwent split night or positive airway pressure titration studies, had <180 min of total sleep time (TST) and/or <40% sleep efficiency, or had SWS <5 min and/or <1% of TST. The apnea–hypopnea index (AHI) recorded during SWS was compared with that measured during other non-rapid eye movement (NREM) sleep and during REM sleep. The REM–SWS difference in AHI was measured, and compared between genders. Results Records from 239 patients were included. The mean AHI in all subjects was 17.7 ± 22.6. The SWS AHI was 6.8 ± 18.9, compared to the REM AHI of 24.9 ± 25.8, and NREM AHI of 15.8 ± 22.8. Females had significantly higher SWS by percentage, and lower NREM AHI (P < 0.0001) and SWS AHI (P = 0.03). Among patients with OSA (AHI ≥5), the difference between REM AHI and SWS AHI was greater in women than in men (34.2 ± 27.4 vs. 21.6 ± 26.0, P = 0.006). Conclusions The upper airway appears to be less susceptible to OSA during SWS than during REM and other NREM sleep. This may be related to phase-specific influences on both dynamic upper airway control as well as loop gain. Gender and age appear to modify this effect. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-011-0644-4Authors Shyam Subramanian, University Hospitals Sleep Center, Case Western Reserve University, 1100 Euclid Avenue, Cleveland, OH 44106, USASean Hesselbacher, Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USAAmarbir Mattewal, Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USASalim Surani, Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Elevated incidence of sleep apnoea in acromegaly—correlation to disease activity

Abstract Purpose An elevated prevalence of sleep apnoea (SA) in patients with acromegaly has been suggested. Methods We performed polysomnographies in 52 patients with acromegaly (25 m, 27 f, age 51 years, range 19-82 years). Patients were defined having SA if they had more than five apnoeas or hypopnoeas per hour (respiratory disturbance index = RDI). The type of SA was divided into obstructive (OSA), central (CSA) or mixed (OSA+CSA). Seventeen patients had newly diagnosed disease, and 18 patients were treated with somatostatin analogues. Results Twenty-three patients had controlled disease activity (mean GH levels <1 μg/l during a 3-h profile and normalised IGF-1 levels). Twelve had active acromegaly despite medical treatment. Thirty patients (58%) had SA. Twenty-five of those had OSA, three had CSA, and two had mixed. Of the patients with active disease, 66% had SA, compared to 48% in the cured group. Significantly more patients with hypertension (n = 18) than without hypertension (n = 12, p = 0.041) had SA. Basal glucose was not significantly different between patients with (100 mg/dl, range 75–207 mg/dl) and without SA (92 mg/dl, range 74–120 mg/dl), but HbA1c was significantly higher in patients with SA (5.9% (4.9–9.0%) vs. 5.4% (4.3–6.1%), p = 0.001). A positive correlation between RDI and BMI (p = 0.04), RDI and age (p = 0.013) and RDI and disease activity (p = 0.014) was seen. No major correlation could be found between RDI and the duration of disease activity nor between RDI and GH levels. Conclusion RDI correlates positively with disease activity but not with the duration of the disease. The parameters of the metabolic syndrome are positively associated to the degree of SA in acromegalic patients. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0641-7Authors J. Roemmler, Medizinische Klinik - Innenstadt der universität München, LM-University of Munich, Ziemssenstr. 1, 80336 München, GermanyB. Gutt, Department of Endocrinology, Klinikum Schwabing, Klinikum München GmbH, Munich, GermanyR. Fischer, Medizinische Klinik - Innenstadt der universität München, LM-University of Munich, Ziemssenstr. 1, 80336 München, GermanyS. Vay, Medizinische Klinik - Innenstadt der universität München, LM-University of Munich, Ziemssenstr. 1, 80336 München, GermanyA. Wiesmeth, Academic Teaching Hospital Bogenhausen, Technical University of Munich, Munich, GermanyM. Bidlingmaier, Medizinische Klinik - Innenstadt der universität München, LM-University of Munich, Ziemssenstr. 1, 80336 München, GermanyJ. Schopohl, Medizinische Klinik - Innenstadt der universität München, LM-University of Munich, Ziemssenstr. 1, 80336 München, GermanyM. Angstwurm, Department of Internal Medicine (Endocrinology)—Innenstadt, LM-University of Munich, Ziemssenstr. 1, 80336 Munich, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

BN Mallick, SR Pandi-Perumal, RW McCarley, AR. Morrison (eds): Rapid Eye Movement Sleep: Regulation and Function (Hardback)

BN Mallick, SR Pandi-Perumal, RW McCarley, AR. Morrison (eds): Rapid Eye Movement Sleep: Regulation and Function (Hardback) Content Type Journal ArticleCategory Book ReviewPages 1-2DOI 10.1007/s11325-011-0637-3Authors Kingman P. Strohl, Case Western Reserve University, Cleveland, OH, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

The actual role of sodium cromoglycate in the treatment of asthma—a critical review

Abstract Introduction Despite international consensus and clearly written guidelines urging wider use of corticosteroids or combinations of inhaled short- and long-acting β-agonists (SABA and LABA) and corticosteroids in persistent asthma, prescribing patterns and compliance rates fall far short of recommendations. Objectives The failure to use steroids more aggressively is due, in part, to their side effects, even with inhaled forms of the drug. There is a role for expanded use of sodium cromolyn in asthma. Its potent anti-inflammatory effects, lack of side effects, and acceptable dosing and method of delivery, as well as its special role in exercise-induced asthma, make it a very suitable choice in the initial therapy for control of asthma. Conclusion Compared to SABA and LABA, cromoglycates alone are unsuspicious of being used to enhance physical performance. Content Type Journal ArticleCategory ReviewPages 1-6DOI 10.1007/s11325-011-0639-1Authors Nikolaus C. Netzer, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Paracelsus Medical University, Salzburg, AustriaT. Küpper, Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, GermanyHans W. Voss, Clin Research Inc., Cologne, GermanyArn H. Eliasson, Pulmonary Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Restless legs syndrome: relationship between prevalence and latitude

Abstract Purpose Restless legs syndrome (RLS) has a broad worldwide prevalence between 0.01% and 18.3%. While differences in RLS definitions and data ascertainment methods account for some variability, other factors likely contribute. The circadian nature of RLS and the fact that RLS symptoms track with endogenous melatonin levels suggest that light or ultraviolet radiation (UVR) may be related to RLS expression. As the amount of UVR decreases with latitude, we considered the potential effect of geography on RLS prevalence with the thought being that RLS prevalence rises with increasing latitude. Methods RLS epidemiologic studies were sought via Pubmed search in the period between January 1, 1992 and November 15, 2010. Prevalence was mapped for each country or specific region studied and examined by continent. Pearson’s correlational testing was carried out for RLS prevalence and latitude of the region studied. Results Global RLS prevalence ranges from 0.01% in Africa, 0.7% to 12.5% in Asia, 2.0% to 18.9% in the Americas, and 3.2% to 18.3% in Europe. Mapping RLS prevalence by country or region in both the Americas and in Europe suggests increasing RLS frequency with greater northern latitude. RLS prevalence is positively correlated with northern latitude in both North America and Europe with correlation coefficients of r = 0.77 (0.15, 0.96; p = 0.02) and r = 0.74 (0.44, 0.89; p = 0.0002), respectively. In Europe, lower latitudinal countries like Greece and Turkey had RLS prevalence (per 1,000 persons) of 38 and 34, respectively, middle latitudinal countries like France and England of 108 and 86, respectively, and high latitudinal countries like Norway and Iceland of 143 and 183, respectively. Conclusions RLS epidemiology indicates an increase in RLS frequency in northern latitudinal countries as a function of distance from the equator, an effect most evident in Europe. This suggests that factors that track with latitude like UVR may be involved in the expression of RLS. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0640-8Authors Brian B. Koo, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Sleep-related epilepsy in a Long-Evans hooded rat model of depression

Abstract Introduction Neonatal treatment with clomipramine (CLI) has been shown to have reliable behavioral and biological changes that mimic major symptomatic and biochemical changes found in depression. This paper further explores a common feature of depression, the comorbidity of seizure activity and depressive behaviors in this mode. Methods Rat pups were neonatally treated with 40 mg/kg/day of CLI from postnatal day 8 through 21. In adulthood, they were instrumented with electroencephalographic (EEG) and electromyographic (EMG) electrodes for 24 h of polysomnogram (PSG) recordings. PSG data were analyzed for: (1) sleep-wake cycle; (2) spectral power; and (3) epileptiform activity, including NREM-to-REM transition (NRT) bursts. Results Neonatal treatment with CLI reliably produces enhanced levels of REM (p < 0.01) and reduced sexual activity (p < 0.05). Theta power was enhanced during NREM sleep in the CLI group (p = 0.02). CLI-treated animals experienced increased frequency at the NRT (p < 0.01), as well as additional epileptiform activity of continuous (CTS; p < 0.05) and petite-continuous (P-CTS; p < 0.01) types, across the sleep–wake cycle. There is a strong temporal correlation with increased REM sleep duration, increased frequency of NRT bursts, and increased theta power during NREM sleep in CLI-treated animals. Discussion Neonatal CLI-treated animals experienced significantly more epileptiform activity as a whole, in addition to comorbid features of depression in adulthood. Neonatal exposure to CLI will not only produce depressive phenotype but may also enhance risk for epilepsy in some individuals. This warrants further investigation into currently acceptable medicinal use in humans. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s11325-011-0630-xAuthors Angela L. McDowell, Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USAKingman P. Strohl, Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USAPingfu Feng, Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Functional gastrointestinal disorders among adolescents with poor sleep: a school-based study in Shanghai, China

Abstract Purpose This study aimed to determine whether functional gastrointestinal disorders are more common among adolescents with self-reported poor sleep. Methods Junior middle school and senior high school students (n = 1,362) were recruited from schools in Shanghai. Students completed two questionnaires: the questionnaire for irritable bowel syndrome (IBS) in adolescents and the Pittsburgh Sleep Quality Index. Results The prevalence of poor sleep was 34.29% [95% confidence interval (CI) = 31.77–36.81] and there was no significant difference between genders (P = 0.991). The tendency towards poor sleep increased with age, with age group yielding a significant effect (P = 0.001). In junior middle school and senior high school students, the propensity towards poor sleep was 30.10% (95% CI = 27.08–33.12%) and 42.11% (95% CI = 37.67–46.55%), respectively. Among students with poor sleep, the prevalence of IBS was 19.70% (95% CI = 16.09–23.31). After adjusting for age, sex, night pain, and psychological factors, IBS was significantly more common in students with poor sleep (odds ratio = 1.92; 95% CI = 1.07–2.58). Conclusion We conclude that IBS is prevalent in students with poor sleep. Poor sleep was independently associated with IBS among adolescents in Shanghai China. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-011-0635-5Authors Hui-Qing Zhou, Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092 ChinaMin Yao, Department of Paediatrics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 ChinaGuang-Yu Chen, Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092 ChinaXiao-Dong Ding, Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092 ChinaYan-Ping Chen, Department of Paediatrics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 ChinaDing-Guo Li, Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092 China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Cromoglycate, reproterol, or both—what’s best for exercise-induced asthma?

Abstract Objective International guidelines recommend short- (SABA) or long-acting b-agonists for the prevention of bronchoconstriction after exercise (EIB) in patients with exercise-induced asthma (EIA). However, other drugs are still in discussion for the prevention of EIB. We investigated the efficacy of a combination of inhaled sodium cromoglycate and the β-mimetic drug reproterol versus inhaled reproterol alone and both versus inhaled placebo in subjects with exercise-induced asthma (EIA). Methods The study aimed to prove the preventive effect of a combination of 1-mg reproterol and 2-mg disodium cromoglycate (DSCG) and its single components vs. placebo, measuring the decrease of FEV1 after a standardized treadmill test in 11 patients with recorded EIA. The study medication was twice as high as those of drugs which are commercially available (e.g., Allergospasmin®, Aarane®). Results The results revealed that the combination of reproterol and DSCG was significantly effective against a decrease of FEV1 after a standardized exercise challenge test (ECT) compared to placebo. The short-acting b-agonist reproterol alone had almost the same effectiveness as the combination of reproterol and DNCG. The difference between the combination with DNCG and reproterol alone was less than 10% and insignificant (p 0.48). DNCG alone did not show a difference in the effectiveness compared to placebo. Conclusion Prevention of EIA with the combination of reproterol and DSCG or with reproterol only is effective. An exclusive recommendation in favor of the combination cannot be given due to the low difference in the effectiveness versus reproterol alone. Due to the limited number of subjects and some probands showing protection under DSCG, it cannot be completely excluded that there is some preventive power of DSCG in individual cases. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0638-2Authors T. Küpper, Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, GermanyK. Goebbels, Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, GermanyL. N. Kennes, Institute of Medical Statistics, RWTH Aachen University, Aachen, GermanyN. C. Netzer, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Science Program of the Paracelsus Medical University Salzburg, Ghersburgstr. 9, 83043 Bad Aibling, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Modeling the effects of obstructive sleep apnea and hypertension in Vietnam veterans with PTSD

Abstract Purpose The present work aimed to extend models suggesting that obstructive sleep apnea (OSA) is associated with worse cognitive performance in community-dwelling older adults. We hypothesized that in addition to indices of OSA severity, hypertension is associated with worse cognitive performance in such adults. Methods The PTSD Apnea Clinical Study recruited 120 community-dwelling, male veterans diagnosed with PTSD, ages 55 and older. The Rey Auditory Verbal Learning Test (RAVLT) and Color-Word Interference Test (CWIT) were measures of auditory verbal memory and executive function, respectively. Apnea–hypopnea index (AHI), minimum and mean pulse oximeter oxygen saturation (min SpO2, mean SpO2) indicators were determined during standard overnight polysomnography. Multivariate linear regression and receiver operating characteristic (ROC) curve analyses were performed. Results In regression models, AHI (β = −4.099; p < 0.01) and hypertension (β = −4.500; p < 0.05) predicted RAVLT; hypertension alone (β = 9.146; p < 0.01) predicted CWIT. ROC analyses selected min SpO2 cut-points of 85% for RAVLT (κ = 0.27; χ² = 8.23, p < 0.01) and 80% for CWIT (κ = 0.25; χ² = 12.65, p < 0.01). Min SpO2 cut-points and hypertension were significant when added simultaneously in a regression model for RAVLT (min SpO2, β = 4.452; p < 0.05; hypertension, β = −4.332; p < 0.05), and in separate models for CWIT (min SpO2, β = −8.286; p < 0.05; hypertension, β = −8.993; p < 0.01). Conclusions OSA severity and presence of self-reported hypertension are associated with poor auditory verbal memory and executive function in older adults. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0632-8Authors Lisa M. Kinoshita, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAJerome A. Yesavage, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAArt Noda, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USABooil Jo, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USABeatriz Hernandez, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USAJoy Taylor, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAJamie M. Zeitzer, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USALeah Friedman, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USAJ. Kaci Fairchild, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAJauhtai Cheng, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAWare Kuschner, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USARuth O’Hara, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USAJon-Erik C. Holty, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USABlake K. Scanlon, Department of Veterans Affairs, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Acute pulmonary embolism in patients with obstructive sleep apnoea: does it affect the severity of sleep-disordered breathing?

Abstract Background Acute pulmonary embolism (PE) may result in an increase in central venous pressure, which may contribute to pharyngeal narrowing by fluid accumulation in nuchal and peripharyngeal soft tissues and therefore affect obstructive sleep apnoea (OSA). Purpose This study aimed to clarify the impact of acute PE on the severity of sleep-disordered breathing in OSA patients. Methods Polysomnography (PSG) was performed in 15 OSA patients shortly after acute PE and again after 3 months of sufficient anticoagulation therapy. OSA remained untreated meanwhile. Results Acute PE did not significantly affect the apnoea-hypopnoea index (AHI). Conclusion The diagnosis of OSA is representative in acute PE, as the transient increase of central venous pressure seems not to affect the AHI once the patients are clinical stable for PSG. Content Type Journal ArticlePages 1-3DOI 10.1007/s11325-011-0633-7Authors Thomas M. Berghaus, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, GermanyChristian Faul, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, GermanyFabian Unterer, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, GermanyChristian Thilo, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, GermanyWolfgang von Scheidt, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, GermanyMartin Schwaiblmair, Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Augsburg, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive sleep apnea and kidney disease: is there any direct link?

Abstract Background Obstructive sleep apnea (OSA) is a common and underrecognized disorder affecting at least 2% and 4% of women and men, respectively. Chronic kidney disease (CKD), on the other hand, affects around 13% of US adults. Both of these conditions share some risk factors such as age, obesity, and smoking and are associated with increased cardiovascular morbidity and mortality. By itself OSA may play a role in the development of arterial hypertension, metabolic syndrome, type 2 diabetes mellitus, and dyslipidemia with potential impact on CKD development and/or progression. But the data regarding OSA and CKD are relatively scant. Discussion Moreover, several studies had shown possible harmful effects on kidney function independent from conventional risk factors. CKD is associated with excessive fluid volume, with potential shift during recumbency towards the neck area with increased upper airway resistance. Thus, OSA and CKD may be the results of each other and when present together may impose much greater cardiovascular risk than either disease alone. Content Type Journal ArticleCategory ReviewPages 1-8DOI 10.1007/s11325-011-0624-8Authors Aibek E. Mirrakhimov, Kyrgyz State Medical Academy named after I.K. Akhunbaev, Akhunbaev street 92, Bishkek, 720020 Kyrgyzstan Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education

Abstract Background Continuous positive airway pressure (CPAP) therapy is the most effective treatment in obstructive sleep apnea syndrome (OSAS) although it is known that adherence to therapy is limited. The aims of this study were to evaluate the effect of visual education on CPAP adherence and to identify the factors affecting adherence. Methods Out of 133 consecutive newly diagnosed moderate-to-severe OSAS patients, 66 were informed about OSAS and CPAP therapy and received visual education by videotape (video group), whereas only information was given to 67 of them (control group). The patients were followed up in the 1st, 3rd, and 6th months. Results After 6-month follow-up, adherence rate to CPAP therapy was 71.2% in the video group and 56.7% in the control group (p = 0.08). OSAS symptoms, such as witnessed apnea, morning headache, night sweating, dry mouth, and Epworth sleepiness score (ESS), were ameliorated more significantly in the video group (p < 0.05). In order to assess predictors of adherence, 85 patients using CPAP effectively were compared to 48 nonadherent patients; significant improvement in OSAS symptoms and ESS was observed in the adherent patients (p < 0.05). ESS was negatively correlated with the duration of CPAP use (r = −0.524, p < 0.0001). Adverse effects such as mask intolerance, choking, noise, and nasal congestion were related to poorer adherence (p < 0.01). Conclusions It is shown that adherence rate to CPAP therapy might be improved by visual education although the difference was not significant. Besides, patients with better adherence to CPAP treatment report the greatest improvement in OSAS symptoms and daytime sleepiness, and adverse effects are significantly related to poorer adherence. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-011-0631-9Authors Ozen K. Basoglu, Department of Chest Diseases, Ege University Medical School, 35100 Bornova, Izmir, TurkeyMeltem Midilli, Department of Chest Diseases, Ege University Medical School, 35100 Bornova, Izmir, TurkeyRasit Midilli, Department of Ear, Nose and Throat, Ege University Medical School, Izmir, TurkeyCem Bilgen, Department of Ear, Nose and Throat, Ege University Medical School, Izmir, Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Cognitive behavioral therapy for institutionalized elders complaining of sleep disturbance in Alexandria, Egypt

Abstract Background Behavioral interventions such as cognitive behavioral therapy (CBT) are among the most widely used nonpharmacologic alternatives for the treatment of insomnia. Purpose The aim of this study was to determine the prevalence of insomnia, factors affecting it, and the impact of a cognitive behavioral therapy for institutionalized elders complaining of sleep disturbance in Alexandria, Egypt. Methods This study was done through two phases. A cross-sectional design was used in the first phase to detect the prevalence of sleep problems and their correlates among the elderly, then pretest–posttest design was used to apply an intervention program to the elders who suffered from insomnia. A pre-designed structured interview questionnaire was presented to the participants. The main outcome measure was sleep quality, as measured by the Pittsburgh Sleep Quality Index. Results The study included a total of 210 elders (97 males and 113 females), with a mean age of 72.2 ± 5.3 years, about two thirds of them were poor sleepers (63.3%). The results show that after carrying out the behavioral therapy for the elders, the percentage of poor sleepers decreased from 63.3% to 46.2%. Two variables (educational level and female sex) proved to be statistically significantly related to the improvement in sleep quality. Conclusions A goal of this intervention program was considerably achieved. Importantly, the intervention appears to improve sleep quality among the elders. Data from this study re-enforce the continuing need for more sleep educational programs that are intended to attract the attention of elders especially those institutionalized. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-011-0629-3Authors Heba M. El Kady, Geriatric Health, High Institute of Public Health, Alexandria University, Alexandria, EgyptHala K. Ibrahim, Public Health Nursing, Family Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Avenue, El Hadara, Alexandria, EgyptSherine G. Mohamed, Health Education and Behavioral sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

“Age is associated with self-reported sleep bruxism, independently of tooth loss.” A critical commentary

“Age is associated with self-reported sleep bruxism, independently of tooth loss.” A critical commentary Content Type Journal ArticleCategory Editorial (invited)Pages 1-2DOI 10.1007/s11325-011-0628-4Authors Ephraim Winocur, Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, 69978 Israel Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Age is associated with self-reported sleep bruxism, independently of tooth loss

Abstract Purpose The aim of this study was to investigate whether the association between self-reported sleep bruxism (SB) and age is modified by the presence of tooth loss. Methods A cross-sectional study was done involving 1,930 residents, ranging from 18 to 89 years of age, who underwent health checkups at the rural health center in Japan. The data collection included oral examinations and self-administrated questionnaires. Results The prevalence of self-reported SB was 8% (n = 152). It was higher in the groups ranging from 30 to 39 and 40 to 49 years of age in comparison to the groups composed of individuals older than 60 years of age. In the crude analyses, the prevalence of self-reported SB was associated with tooth loss, male, smoking, snoring, sleep talking and a history of childhood teeth grinding. A multiple logistic regression confirmed a significant relationship between self-reported SB and the groups of 30–39 years of age (OR: 2.78, P = 0.003) and 40–49 years of age (OR: 2.31, P = 0.005). Snoring (OR: 2.58, P = 0.001) and known (OR: 8.09, P < 0.001) or unknown (OR: 3.03 P < 0.001%) childhood teeth grinding also showed to be related to self-reported SB. Conclusions The present study demonstrates that self-reported SB is associated with age, independently of tooth loss. The associations between SB and age will await further physiological investigations. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0625-7Authors Takafumi Kato, Department of Oral Anatomy and Neurobiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka, 565-0871 JapanAna M. Velly, Faculty of Dentistry, McGill University, Montreal, QC, CanadaTakashi Nakane, Department of Oral Hygiene, Matsumoto Dental University, Nagano, JapanYuji Masuda, Department of Oral and Maxillofacial Biology, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, JapanShigeru Maki, Department of Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

SR Pandi-Perumal, Jaime M. Monti and Andrew A. Monjan (eds): Geriatric sleep medicine

SR Pandi-Perumal, Jaime M. Monti and Andrew A. Monjan (eds): Geriatric sleep medicine Content Type Journal ArticleCategory Book ReviewPages 1-1DOI 10.1007/s11325-011-0619-5Authors Nikolaus C. Netzer, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis

Abstract Purpose This study was made to evaluate the effect of automatic continuous positive airway pressure (auto-CPAP) versus fixed continuous positive airway pressure (fixed CPAP) in reducing the apnea–hypopnea index (AHI) and the mean therapy pressure, improving subjective sleepiness, sleep architecture, patient compliance, and preference in patients with obstructive sleep apnea. Methods We searched the electronic databases MEDLINE, EMBASE, the Cochrane Library, and Google Scholar. Randomized controlled trials comparing auto-CPAP with fixed CPAP were reviewed. Continuous variables were presented as mean difference (MD), and dichotomous data as odds ratio (OR), both with 95% confidence intervals (CI). Results We identified 19 studies consisting of 845 patients. Compared to fixed CPAP, the use of auto-CPAP reduced mean therapy pressure (MD −1.64; 95% CI −2.46 to −0.82), improved patient compliance (MD 0.23; 95% CI 0.06 to 0.39), increased the percentage of total sleep time (TST) in slow wave sleep (MD 5.11; 95% CI 1.34 to 8.88), and decreased the percentage of TST in stage 2 sleep (MD −4.75; 95% CI −9.38 to −0.11). Moreover, more patients preferred auto-CPAP therapy (OR 3.65; 95% CI 1.27 to 10.53). There were nonsignificant trends towards better outcomes with auto-CPAP for AHI and Epworth Sleepiness Scale (MD −0.43; 95% CI −1.10 to 0.23, and MD −0.24; 95% CI −0.74 to 0.25, respectively), though these are of questionable clinical significance. Conclusions There are some aspects of clinical care, such as a mild improvement in compliance, patient preference, and sleep architecture that appear to favor the use of auto-CPAP compared to fixed CPAP. The clinical relevance of these findings requires further study. Content Type Journal ArticleCategory ReviewPages 1-10DOI 10.1007/s11325-011-0626-6Authors Ting Xu, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 ChinaTaoping Li, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 ChinaDongning Wei, Department of Neurology of the 309th Hospital of PLA, Beijing, 100091 ChinaYuan Feng, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 ChinaLewu Xian, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 ChinaHaiqing Wu, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 ChinaJian Xu, Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515 China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive sleep apnea syndrome and anthropometric obesity indexes

Abstract Background The purpose of this study is to investigate whether the general body adiposity or regional adiposity was a risk factor in the evolution of obstructive sleep apnea syndrome (OSAS) by examining the relationships between the anthropometric obesity indexes such as waist (WC) and neck circumference index (NC), body mass index (BMI), and OSAS in Turkish adult population, and to access the possible differences by gender. Methods The data related to polysomnographic, demographic, and anthropometric indexes of the 499 subjects were examined retrospectively. The patients whose apnea–hypopnea index was ≥5 were determined as OSAS group. Results The avarage BMI, WC, and NC of the OSAS group (n = 431) were statistically higher than the control group (p < 0.001). According to logistic regression analysis, BMI, WC, and NC enlargement were observed as significant risk factors for OSAS development. Risk coefficients were determined 5.53 for NC, 4.48 for WC, and 2.22 for BMI. Cutoff point values for anthropometric obesity indexes as OSAS determiner were recorded as below: BMI for male >27.77 kg/m2 and female >28.93 kg/m2, NC index for male >40 cm and female >36 cm, and WC index for male >105 cm and female >101 cm. Conclusions BMI, WC, and NC enlargement were determined as significant risk factors for OSAS development. This was an initial study to determine the cutoff points of which increase the OSAS risk in BMI, WC, and NC index in Turkish adult population. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-011-0623-9Authors Akın Cem Soylu, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, TurkeyEnder Levent, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, TurkeyNesrin Sarıman, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, TurkeyŞirin Yurtlu, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, TurkeySümeyye Alparslan, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, TurkeyAttila Saygı, Faculty of Medicine, Department of Pulmonary Diseases, Maltepe University, Istanbul, Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Clinical and polysomnographic data of positional sleep apnea and its predictors

Abstract Introduction In Asian population, facial structure may contribute to the primary pathophysiology of obstructive sleep apnea (OSA). We hypothesized that sleep position may have more effect on OSA in Asians compared to the Western population. If this hypothesis is accurate, positional therapy will have a major impact on treatment of OSA among Asians. Patients/methods We reviewed 263 polysomnographic studies from our laboratory from January 1, 2010 to June 30, 2010. Criteria for positional and non-positional OSA were (1) supine respiratory disturbance index (RDI)/non-supine RDI ≥2 and total RDI ≥5 and (2) supine RDI/non-supine RDI <2 and total RDI ≥5, respectively. We aimed to determine the difference in baseline characteristics, polysomnographic findings, and predictors for positional OSA. Results We found 144 patients diagnosed with OSA (RDI ≥5), and 96 patients met the criteria for positional OSA (67%), in which in almost half of these patients (47%), RDI was normalized (RDI < 5) in non-supine position. Snoring frequency were significantly lower among positional OSA and OSA was less severe indicated by lower RDI and arousal index, higher mean and nadir oxygen saturation, and higher %NREM3. We also found that low snoring frequency (less than 20% of total sleep time) was a significant predictor for positional OSA (odd ratio of 3.27; p = 0.011), contrarily to low mean oxygen saturation (<95%) which was found to be a negative predictor (odd ratio of 0.31; p = 0.009). Among OSA patients, low RDI (<15) was a significant predictor for normalization of RDI in non-supine position (odd ratio of 8.77; p = < 0.001), contrarily to low mean oxygen saturation (<95%) which was also found to be a negative predictor (odd ratio of 0.13; p = 0.001). Conclusion Positional OSA is very prevalent and noted in almost 70% of our patients. Low snoring frequency was noted to be a positive predictor for positional OSA, contrarily to low mean oxygen saturation which was found to be a negative predictor. These findings are encouraging that positional therapy can be very beneficial as the treatment modality for OSA among Asians. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s11325-011-0627-5Authors Busarakum Teerapraipruk, Department of Otolaryngology and Opthalmology, Naresuan University, Phitsanulok, ThailandNaricha Chirakalwasan, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, 1873 King Rama IV Road, Bangkok, Thailand 10330Rosalind Simon, Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, MalaysiaPrakobkiat Hirunwiwatkul, Department of Otolaryngology, Chulalongkorn University, Bangkok, ThailandNattapong Jaimchariyatam, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, 1873 King Rama IV Road, Bangkok, Thailand 10330Tayard Desudchit, Division of Pediatric Neurology, Department of Pediatrics, Chulalongkorn University, Bangkok, ThailandNatamon Charakorn, Department of Otolaryngology, Chulalongkorn University, Bangkok, ThailandChaisiri Wanlapakorn, Department of Medicine, Chulalongkorn University, Bangkok, Thailand Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Relationship between sleep quality and depression among elderly nursing home residents in Turkey

Abstract Objectives Epidemiological studies indicate that more than half of the elderly population suffers from chronic sleep disturbances. Therefore, this descriptive study was conducted to examine sleep quality, excessive daytime sleepiness, daytime napping, and depression among a population of nursing home residents. Methods The study’s sample included 73 elderly people living in a nursing home in Turkey. Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and a sleep diary were used. Results The participants’ mean age was 74.0 years (standard deviation (SD) = 6.7). Forty-four of the individuals had a poor sleep quality prevalence of 60.3%; and the mean global PSQI score was 6.6 (SD = 3.6). Their mean ESS score was 5.9 (SD = 4.6) and 14 participants (19.2%) had daytime sleepiness. The mean daytime napping duration was 1.0 h (SD = 1.3) according to the participants’ sleep diaries. The study found that 60.3% of the participants were depressed, furthermore the mean depression score was 15.9 (SD = 7.0). There was a significant correlation between the PSQI subscores; subjective sleep quality, the sleep latency, and sleep disturbances scores and depression scores. Also, daytime napping frequency and daytime napping duration, according to the sleep diary, were correlated positively with depression scores. Conclusions The current study’s results confirm the previously reported high prevalence of poor sleep quality and depression in this nursing home population. Clinicians need to assess patients appropriately to identify high prevalence of sleep problems and depression in nursing home patients and initiate appropriate referrals and interventions. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0601-2Authors Fatma Özlem Orhan, Department of Psychiatry, Kahramanmaras Sutcuimam University Faculty of Medicine, 46100 Kahramanmaras, TurkeyDeniz Tuncel, Department of Neurology, Kahramanmaras Sutcuimam University Faculty of Medicine, 46100 Kahramanmaras, TurkeyFiliz Taş, Kahramanmaras Sutcuimam University, Higher Vocational School of Health Services, 46100 Kahramanmaras, TurkeyNermin Demirci, Kahramanmaras Sutcuimam University, Higher Vocational School of Health Services, 46100 Kahramanmaras, TurkeyAli Özer, Department of Public Health, Malatya Inonu University Faculty of Medicine, Malatya, TurkeyMehmet Fatih Karaaslan, Department of Psychiatry, Kahramanmaras Sutcuimam University Faculty of Medicine, 46100 Kahramanmaras, Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Tongue position controller as an alternative treatment for obstructive sleep apnea

Tongue position controller as an alternative treatment for obstructive sleep apnea Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s11325-011-0617-7Authors Satoru Tsuiki, Neuropsychiatric Research Institute, Tokyo, JapanShiroh Isono, Department of Anesthesiology, Graduate School, Chiba University, Chiba, JapanOsamu Minamino, Techno Sai Inc. Ltd, Saitama, JapanKeiko Maeda, Neuropsychiatric Research Institute, Tokyo, JapanMina Kobayashi, Neuropsychiatric Research Institute, Tokyo, JapanTaeko Sasai, Neuropsychiatric Research Institute, Tokyo, JapanYasuro Takahashi, Neuropsychiatric Research Institute, Tokyo, JapanYuichi Inoue, Neuropsychiatric Research Institute, Tokyo, Japan Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Got CPAP? Use it in the hospital!

Got CPAP? Use it in the hospital! Content Type Journal ArticleCategory Editorial (invited)Pages 1-2DOI 10.1007/s11325-011-0618-6Authors Leon Rosenthal, Sleep Medicine Associates of Texas, Dallas, TX, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Frequency of provision of CPAP in the inpatient setting: an observational study

Abstract Background Little is known about the rates of provision of CPAP in inpatient settings. A single prior “data mining” study using diagnostic and procedural codes concluded that 6% of people with sleep apnea receive CPAP when in the hospital. The purpose of this study is to reexamine the frequency with which people who have an established diagnosis of sleep apnea receive therapy for it when they are admitted to the hospital for other reasons. Methods A retrospective cohort study of 195 people with an existing diagnosis of obstructive sleep apnea admitted to a tertiary medical center from March 2009–July 2009. A logistic regression analysis was used to determine relative risk for provision of CPAP therapy controlling for the following variables: admission diagnosis, unit of admission (medical/surgical/psychiatric/pediatrics), length of stay, comorbidities, and patient characteristics (age/ race/ gender). Results Twenty-six percent of people with an established diagnosis of OSA received CPAP therapy during their hospitalization. In an additional 10%, therapy was offered but not implemented. Of the variables considered, only admission diagnosis of obesity (n = 3) was associated with an increased likelihood of receiving CPAP. Conclusions This rate of provision of CPAP to hospitalized patients, while low at 26%, is much higher than a previous study on this topic that estimated frequency of use of CPAP strictly linking diagnostic codes for OSA and procedural codes for CPAP. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s11325-011-0621-yAuthors Adam J. Sorscher, Dartmouth Medical School, Hanover, NH, USAEvan M. Caruso, Cornell University, Ithaca, NY, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Sleep quality and asthma control and quality of life in non-severe and severe asthma

Abstract Purpose The effect of sleep quality on asthma control independent from common comorbidities like gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) is unknown. This study examined the association between sleep quality and asthma control and quality of life after accounting for OSA and GERD in non-severe (NSA) and severe (SA) asthma. Methods Cross-sectional data from 60 normal controls, 143 with NSA, and 79 with SA participating in the Severe Asthma Research Program was examined. Those who reported using positive airway pressure therapy or were at high risk for OSA were excluded. Results Both SA and NSA had poorer sleep quality than controls, with SA reporting the worst sleep quality. All asthmatics with GERD and 92% of those without GERD had poor sleep quality (p = 0.02). The majority (88–100%) of NSA and SA participants who did not report nighttime asthma disturbances still reported having poor sleep quality. In both NSA and SA, poor sleep quality was associated with worse asthma control and quality of life after controlling for GERD and other covariates. Conclusions These results suggest that poor sleep quality is associated with poor asthma control and quality of life among asthmatics and cannot be explained by comorbid GERD and nighttime asthma disturbances. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11325-011-0616-8Authors Faith S. Luyster, University of Pittsburgh School of Nursing, Pittsburgh, PA, USAMihaela Teodorescu, University of Wisconsin School of Medicine, Madison, WI, USAEugene Bleecker, Wake Forest University School of Medicine, Winston-Salem, NC, USAWilliam Busse, University of Wisconsin School of Medicine, Madison, WI, USAWilliam Calhoun, University of Texas Medical Branch at Galveston, Galveston, TX, USAMario Castro, Washington University School of Medicine, St. Louis, St. Louis, MO, USAKian Fan Chung, Imperial College London School of Medicine, London, UKSerpil Erzurum, The Cleveland Clinic, Cleveland, OH, USAElliot Israel, Brigham and Women’s Hospital, Boston, MA, USAPatrick J. Strollo, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USASally E. Wenzel, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Longitudinal analyses of polysomnographic variables, serum androgens, and parameters of glucose metabolism in obese adolescents with polycystic ovarian syndrome

Abstract Purpose The prevalence of obstructive sleep apnea syndrome (OSAS) is clearly increased in adults with polycystic ovarian syndrome (PCOS), whereas OSAS does not seem to be frequent in adolescents with PCOS, pointing towards the fact that some patients with PCOS develop OSAS in the further course of the disease. We therefore aimed to analyze the changes of polysomnographic variables in obese adolescents with PCOS in a longitudinal analysis. Methods Fifteen adolescents with PCOS (age 15.3 years ± 1.2, BMI 32.9 kg/m2 ± 6.4, SDS-BMI 2.5 ± 0.8) underwent overnight 12-channel polysomnography at baseline and after a mean duration of 28 ± 6 months (age 17.8 years ± 1.1, BMI 32.7 kg/m2 ± 7.0, SDS-BMI 2.1 ± 0.9). After performing the initial polysomnography, we treated hyperandrogenemia and insulin resistance in the study group. We determined parameters of body weight/body composition, parameters of glucose metabolism, and serum androgens in all patients at baseline and follow-up. At follow-up, we compared the polysomnographic variables of the study group to those of healthy female adults. Results The polysomnographic variables, the parameters of body weight/body composition, and the parameters of glucose metabolism in the study group did not change significantly during the observation period. The serum levels of total testosterone and sex hormone binding globulin increased significantly, whereas free androgen index decreased significantly. At follow-up, the polysomnographic variables of the study group did not differ from those of healthy female adults. Conclusions OSAS does not seem to develop in adolescents with PCOS being treated for hyperandrogenism and insulin resistance. The pathogenesis of OSAS in PCOS needs to be examined in larger controlled studies. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s11325-011-0620-zAuthors Gideon de Sousa, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, GermanyBernhard Schlüter, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, GermanyThomas Menke, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, GermanyEckardt Trowitzsch, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, GermanyWerner Andler, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, GermanyThomas Reinehr, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Late-onset, insidious course and invasive treatment of congenital central hypoventilation syndrome in a case with the Phox2B mutation: case report

Late-onset, insidious course and invasive treatment of congenital central hypoventilation syndrome in a case with the Phox2B mutation: case report Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s11325-011-0614-xAuthors Lia Rita Azeredo Bittencourt, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilMario Pedrazzoli, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilFabiana Yagihara, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilGabriela Pontes Luz, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilSilvério Garbuio, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilGustavo Antonio Moreira, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, BrazilJoão Aléssio J. Perfeito, Disciplina de Cirurgia de Tórax, Departamento de Cirurgia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 04024-002 São Paulo, São Paulo, BrazilSergio Tufik, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002 São Paulo, São Paulo, Brazil Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Prediction formulas for nasal continuous positive airway pressure in patients with obstructive sleep apnea syndrome

Prediction formulas for nasal continuous positive airway pressure in patients with obstructive sleep apnea syndrome Content Type Journal ArticleCategory Editorial (invited)Pages 1-3DOI 10.1007/s11325-011-0613-yAuthors Sophia E. Schiza, Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, GreeceIzolde Bouloukaki, Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive sleep apnea and the metabolic syndrome

Obstructive sleep apnea and the metabolic syndrome Content Type Journal ArticleCategory Letter to the EditorsPages 1-2DOI 10.1007/s11325-011-0615-9Authors Zhen-hua Gao, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No.23 PingJiang road, HeXi district, Tianjin, 30021 People’s Republic of ChinaRu-yu Yuan, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No.23 PingJiang road, HeXi district, Tianjin, 30021 People’s Republic of ChinaKang-yin Chen, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No.23 PingJiang road, HeXi district, Tianjin, 30021 People’s Republic of ChinaGuang-ping Li, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No.23 PingJiang road, HeXi district, Tianjin, 30021 People’s Republic of China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Determination of new prediction formula for nasal continuous positive airway pressure in Turkish patients with obstructive sleep apnea syndrome

Abstract Background Race/ethnicity may play an important role in determining body size, severity of obstructive sleep apnea syndrome (OSAS), and effective continuous positive airway pressure (CPAP) (Peff). Turkey is composed of different ethnic groups. Therefore, the aims of this study were to determine new prediction formula for CPAP (Ppred) in Turkish OSAS patients, validate performance of this formula, and compare with Caucasian and Asian formulas. Methods Peff of 250 newly diagnosed moderate-to-severe OSAS patients were calculated by in-laboratory manual titration. Correlation and multiple linear regression analysis were used to model effects of ten anthropometric and polysomnographic variables such as neck circumference (NC) and oxygen desaturation index (ODI) on Peff. New formula was validated in different 130 OSAS patients and compared with previous formulas. Results The final prediction formula was \textPpred = ( 0.148 ×\textNC ) + ( 0.038 ×\textODI ) . When Peff of control group was assessed, it was observed that mean Peff was 8.39 ± 2.00 cmH2O and Ppred was 8.23 ± 1.22 cmH2O. Ppred was within ±3 cmH2O of Peff in 96.2% patients. Besides, Peff was significantly correlated with new formula, and prediction formulas developed for Caucasian and Asian populations (r = 0.651, p < 0.001, r = 0.648, p < 0.001, and r = 0.622, p < 0.001, respectively). Conclusions It is shown that level of CPAP can be successfully predicted from our prediction formula, using NC and ODI and validated in Turkish OSAS patients. New equation correlates with other formulas developed for Caucasian and Asian populations. Our simple formula including ODI, marker of intermittent hypoxia, may be used easily in different populations. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0612-zAuthors Ozen K. Basoglu, Department of Chest Diseases, Sleep Laboratory, Ege University School of Medicine, 35100 Bornova, Izmir, TurkeyMehmet Sezai Tasbakan, Department of Chest Diseases, Sleep Laboratory, Ege University School of Medicine, 35100 Bornova, Izmir, Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Sleep apnea, heart failure, and sleep position

Sleep apnea, heart failure, and sleep position Content Type Journal ArticleCategory Letter to the EditorsPages 1-3DOI 10.1007/s11325-011-0611-0Authors Ozcan Ozeke, Department of Cardiology, Acibadem Hospital, Hosnudiye Caddesi, 26100 Eskisehir, TurkeyCagatay Ertan, Department of Cardiology, Acibadem Hospital, Hosnudiye Caddesi, 26100 Eskisehir, TurkeyAhmet Duran Demir, Department of Cardiology, Acibadem Hospital, Hosnudiye Caddesi, 26100 Eskisehir, Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Three-dimensional reconstruction of soft palate modeling from subject-specific magnetic resonance imaging data

Abstract Purpose The objectives of this study were to extract a computational three-dimensional (3D) soft palate model from a set of magnetic resonance imaging (MRI) data and to identify an approach that generates a patient-specific model in a computerized visual platform. Methods Multiple MRI slices of the head and neck region of a young, non-overweight Caucasian male volunteer were taken in the supine position with a passive oral appliance in place. The DICOM (Digital Imaging and Communications) MRI slices were registered into a high-resolution volumetric data set for manually segmentation to generate a surface mesh and, with additional editing, a volume mesh. For biomechanical dynamic simulation and for physical simulation of the anatomical structures, the volume mesh format and multiple landmarks of each muscle were imported into ArtiSynth, a 3D biomechanical modeling toolkit. Results The segmented soft palate complex consisted of five groups of muscles: levator veli palatini, tensor veli palatini, palatoglossus, palatopharyngeous and musculus uvulae. The palatine tonsil between the pharyngopalatine and glossopalatine arches was included in the segmentation. Conclusions The same procedure was used to build up a generic reference model of the dentition, tongue, mandible and airway from a mixture of medical records (CT and dental casts) of the same subject. This manual segmentation method eliminated the common errors that occur from an automatic segmentation although it was more time-consuming. It remains a fundamental process for analyzing the dynamic interaction between anatomical components in the oral, pharyngeal, and laryngeal areas. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0610-1Authors Hui Chen, Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3Sidney Fels, Department of Electrical and Computer Engineering, University of British Columbia, 2356 Main Mall, Vancouver, BC, Canada V6T 1Z4Tricia Pang, Department of Electrical and Computer Engineering, University of British Columbia, 2356 Main Mall, Vancouver, BC, Canada V6T 1Z4Ling Tsou, Department of Electrical and Computer Engineering, University of British Columbia, 2356 Main Mall, Vancouver, BC, Canada V6T 1Z4Fernanda Riberiro de Almeida, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3Alan A. Lowe, Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Polysomnography in stable COPD under non-invasive ventilation to reduce patient–ventilator asynchrony and morning breathlessness

Abstract Background Stable severe chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure treated by nocturnal bi-level positive pressure non-invasive ventilation (NIV) may experience severe morning deventilation dyspnea. We hypothesised that in these patients, progressive hyperinflation, resulting from inappropriate ventilator settings, leads to patient–ventilator asynchrony (PVA) with a high rate of unrewarded inspiratory efforts and morning discomfort. Methods Polysomnography (PSG), diaphragm electromyogram and transcutaneous capnography (PtcCO2) under NIV during two consecutive nights using baseline ventilator settings on the first night, then, during the second night, adjustment of ventilator parameters under PSG with assessment of impact of settings changes on sleep, patient–ventilator synchronisation, morning arterial blood gases and morning dyspnea. Results Eight patients (61 ± 8 years, FEV1 30 ± 8% predicted, residual volume 210 ± 30% predicted) were included. In all patients, pressure support was decreased during setting adjustments, as well as tidal volume, while respiratory rate increased without any deleterious effect on nocturnal PtcCO2 or morning PaCO2. PVA index, initially high (40 ± 30%) during the baseline night, decreased significantly after adjusting ventilator settings (p = 0.0009), as well as subjective perception of PVA leaks, and morning dyspnea while quality of sleep improved. Conclusion The subgroup of COPD patients treated by home NIV, who present marked deventilation dyspnea and unrewarded efforts may benefit from adjustment of ventilator settings under PSG or polygraphy. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s11325-011-0605-yAuthors Dan Adler, Division of Pulmonary Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, SwitzerlandStephen Perrig, Sleep laboratory, Department of Psychiatry, Geneva University Hospitals, 1211 Geneva 14, SwitzerlandHiromitsu Takahashi, Division of Pulmonary Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, SwitzerlandFabrice Espa, Sleep laboratory, Department of Psychiatry, Geneva University Hospitals, 1211 Geneva 14, SwitzerlandDaniel Rodenstein, Division of Pulmonary Diseases, Clinique St Luc, Catholic University of Louvain, Brussels, BelgiumJean Louis Pépin, Sleep laboratory and HP2 Laboratory INSERM U 1042, University Hospital, Grenoble, FranceJean-Paul Janssens, Division of Pulmonary Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia

Abstract Objective It is a matter of debate whether patients with primary insomnia require a polysomnographic examination in order to exclude specific sleep disorders such as sleep apnea syndrome (SAS) or periodic limb movements (PLM). Using a prospective design, we investigated the prevalence of organic sleep disorders by means of polysomnography (PSG) in a series of patients who were previously diagnosed with primary insomnia. This diagnosis was based on a clinical exam and an ambulatory monitoring device or previous PSG. Methods Seventy-seven women and 16 men (mean age 55.12 ± 13.21 years) who were admitted for cognitive behavioral therapy for insomnia were evaluated by PSG including cardiorespiratory parameters and tibialis EMG. Among them, 50 patients had undergone a clinical exam by a sleep specialist; in 18 patients, actigraphy or portable monitoring had been performed to exclude SAS or PLM; 25 patients had undergone PSG in another sleep lab previously. Results In 32 patients (34% of the sample), a PSG revealed a specific sleep disorder (SAS 16; PLMD 11; both 5), resulting in therapeutic consequences for 21 patients (SAS 10; PLMD 9; both 2). SAS and PLM patients were older and SAS patients had a higher body mass index than insomnia patients without additional findings. Conclusion Indications for a PSG should be handled less restrictively in the diagnostic workup of older insomnia patients since they have a higher risk of comorbid sleep disorders even in the absence of the clinical signs of SAS or PLM. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s11325-011-0608-8Authors Tatjana Crönlein, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyPeter Geisler, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyBerthold Langguth, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyPeter Eichhammer, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyCecilia Jara, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyChristoph Pieh, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyJürgen Zulley, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, GermanyGöran Hajak, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers.

Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers. Sleep Med. 2012 Jan 31; Authors: Kaditis A, Kheirandish-Gozal L, Gozal D Abstract There is currently no consensus on the best method of managing of obstructive sleep apnea (OSA) in childhood. In the present paper, an algorithm for the diagnosis and treatment of the disorder is proposed. Sleep apnea is suspected when parents report relevant symptoms or when there are abnormalities that predispose to OSA such as adenotonsillar hypertrophy, obesity, craniofacial anomalies, or neuromuscular disorders. OSA-associated morbidity including elevated blood pressure, daytime sleepiness or learning problems, growth failure, and enuresis should be recognized. Severity of intermittent upper airway obstruction during sleep can be determined objectively by polysomnography or, if polysomnography is not available, by nocturnal pulse oximetry. Risk factors predicting persistence of OSA in adolescence (male gender, development of obesity) need to be identified. Children with moderate-to-severe OSA, or with mild OSA, but accompanied by morbidity, or by risk factors predicting persistence of the disorder should have priority for treatment. An individualized and multifaceted therapeutic approach which addresses in a step-by-step fashion all abnormalities that contribute to upper airway obstruction during sleep is necessary. PMID: 22300748 [PubMed - as supplied by publisher]