Impact of the sleep apnea management group clinic on positive airway pressure adherence.

Background: Positive airway pressure (PAP) adherence is critical for managing obstructive sleep apnea (OSA). We postulate that group-based Sleep Apnea Management (SAM) clinic, which harnesses the benefits of providing mutual support as well as facilitates access to system-based resources and education, will confer improvements in PAP adherence.

Methods: Data from SAM clinic attendees from January 2017 to June 2018 were retrospectively analyzed.

The clinical problem of the lethality of insomnia: a new empirical exploration from a clinical trial.

Moul DE. The clinical problem of the lethality of insomnia: a new empirical exploration from a clinical trial. .

Sleep disturbance predicts future health status after stroke.

Study Objectives: We evaluated factors associated with the presence of sleep disturbance in patients with stroke and whether sleep disturbance predicted change in other patient-reported domains of health over time.

Methods: Observational cohort study of 2,190 patients with stroke seen in a cerebrovascular clinic February 17, 2015 to July 5, 2017 who completed patient-reported outcome measures (PROMs) at ≥ 1 visit, including the Patient Health Questionnaire-9 depression screen, Quality of Life in Neurological Disorders (NeuroQoL) cognitive function and Patient-Reported Outcomes Information Measurement System (PROMIS) sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. Separate multivariable models were constructed with PROMIS sleep disturbance as the dependent variable.

Sleep-related symptoms in patients with mild stroke.

Study Objectives: Treatable sleep-related conditions are frequent in stroke patients, although their prevalence across stroke types and ideal method for screening is not clear. The objectives of this study were to evaluate the prevalence of sleep disturbance across different stroke types and identify approaches to the collection of sleep-related measures in clinical practice.

Methods: We performed an observational cohort study of 2,213 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or transient ischemic attack seen in a cerebrovascular clinic February 17, 2015 through July 5, 2017 who completed at least one of the following sleep-related questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance, Insomnia Severity Index (ISI), Sleep Apnea Probability Scale (SAPS), and sleep duration.

Effect of Positive Airway Pressure Therapy on Drowsy Driving in a Large Clinic-Based Obstructive Sleep Apnea Cohort.

Study Objectives: Drowsy driving related to obstructive sleep apnea (OSA) represents an important public health problem with limited data on the effect of positive airway pressure (PAP) therapy. We hypothesize that PAP therapy will reduce self-reported drowsy driving in a large clinic-based OSA cohort.

Methods: Drowsy driving (self-reported near-accidents/accidents) incidents from baseline to after PAP therapy (stratified by adherence) were compared in a cohort of 2,059 patients with OSA who initiated PAP therapy from January 1, 2010 to December 31, 2014.

The Epworth Sleepiness Scale: Validation of One-Dimensional Factor Structure in a Large Clinical Sample.

Study Objectives: The Epworth Sleepiness Scale (ESS) is used by clinicians and researchers to determine level of daytime sleepiness. The number of factors included in the scale has been debated. Our study objective was to clarify the dimensionality of the ESS using a large clinical sample.

Depression score changes in response to sleep disordered breathing treatment with positive airway pressure in a large clinic-based cohort.

Objective: The clinical-population impact of positive airway pressure (PAP) on depressive symptoms in sleep disordered breathing (SDB) awaits clear documentation. We hypothesized that depressive symptoms improve in response to PAP treatment in a large clinical setting, and that lower socio-economic status poses barriers to full therapeutic response.

Method: We performed a retrospective cohort study of SDB patients attending a tertiary ambulatory sleep center between January 1, 2010 and December 31, 2015.

Impact of Sleep-Disordered Breathing Treatment on Quality of Life Measures in a Large Clinic-Based Cohort.

Study Objectives: This study aims to report the effect of positive airway pressure (PAP) therapy on quality of life (QoL) measures in the clinical sleep-disordered breathing (SDB) population.

Methods: We examined general QoL measures assessed by European Quality of Life-5D (EQ-5D) and sleep-specific QoL by examining Functional Outcomes of Sleep Questionnaire (FOSQ) scores before and after PAP therapy retrospectively in a clinical SDB population using paired and two-sample tests. Age and socioeconomic status (SES) effect modification on pre-PAP QoL measures were investigated utilizing the interaction terms.

"Go! to Sleep": A Web-Based Therapy for Insomnia.

Background: Insomnia is a common complaint of individuals presenting to healthcare providers and is associated with decreased quality of life and higher healthcare utilization. In-person cognitive behavioral therapy (CBT) is an effective treatment for insomnia but is hindered by cost and limited access to treatment. Initial research suggests that Web-based CBT may mitigate these obstacles.

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients.

Study Objectives: We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN).

Methods: Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements.

A pilot study: portable out-of-center sleep testing as an early sleep apnea screening tool in acute ischemic stroke.

Introduction: Prompt diagnosis of obstructive sleep apnea (OSA) after acute ischemic stroke (AIS) is critical for optimal clinical outcomes, but in-laboratory conventional polysomnograms (PSG) are not routinely practical. Though portable out-of-center type III cardiopulmonary sleep studies (out-of-center cardiopulmonary sleep testing [OCST]) are widely available, these studies have not been validated in patients who have recently suffered from AIS. We hypothesized that OCST in patients with AIS would yield similar results when compared to conventional PSG.

Neck Circumference-Height Ratio as a Predictor of Sleep Related Breathing Disorder in Children and Adults.

Study Objectives: While neck circumference (NC) is a useful predictor of obstructive sleep apnea (OSA) in adults, childhood OSA is difficult to predict clinically. We utilized the neck circumference-height ratio (NHR) to normalize NC in growing children. Our study aimed to determine if (1) NC is a reproducible clinical measurement; (2) NHR predicts OSA in children; (3) this metric translates to adults.

Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort.

Background: Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort.

Methods: Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits.

Effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea.

Previous studies suggest that treatment for obstructive sleep apnea (OSA) in patients with epilepsy can improve seizure control. We investigated the effect of positive airway pressure (PAP) therapy on seizures in adults with epilepsy referred to the Cleveland Clinic for polysomnography (PSG) from 1997 to 2010. Seizure outcome at baseline and 1 year later was compared in patients with no OSA (apnea-hypopnea index [AHI] <5), patients with PAP-treated OSA, and patients with untreated OSA.

Sleep apnea and epilepsy: who's at risk?

Obstructive sleep apnea (OSA) is highly prevalent, affecting 25% of men and 10% of women. Treatment reduces seizures in some patients. Awareness of the comorbidity of sleep disturbances in epilepsy has been increasing.

Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans.

Objective: Pharmacological and cognitive-behavioral treatments targeting insomnia and nightmares have been shown to be effective in the treatment of military veterans with sleep complaints comorbid with symptoms of stress-related disorders, including Post-Traumatic Stress Disorder (PTSD), but the two approaches have not been directly compared. This randomized controlled trial compared the effects of prazosin vs. a behavioral sleep intervention (BSI), targeting nightmares and insomnia against a placebo pill control condition on sleep and daytime symptoms.

Development of short forms from the PROMIS™ sleep disturbance and Sleep-Related Impairment item banks.

This article reports on the development of short forms from the Patient-Reported Outcomes Measurement Information System (PROMIS™) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) item banks. Results from post-hoc computerized adaptive testing (CAT) simulations, item discrimination parameters, item means, and clinical judgments were used to select the best-performing 8 items for SD and SRI. The final 8-item short forms provided less test information than the corresponding full banks, but correlated strongly with the longer forms.

Efficacy of brief behavioral treatment for chronic insomnia in older adults.

Background: Chronic insomnia is a common health problem with substantial consequences in older adults. Cognitive behavioral treatments are efficacious but not widely available. The aim of this study was to test the efficacy of brief behavioral treatment for insomnia (BBTI) vs an information control (IC) condition.

Pathologies of awakenings: the clinical problem of insomnia considered from multiple theory levels.

Limit cycle-based mid-level theories that rationalize effective clinical treatments for chronic insomnia have empirical support from whole-organism studies of sleep physiology, but their relation to network-level and cellular neurobiologies remains obscure. The neurobiology of pharmacological treatments for insomnia has been increasingly understood, but has not been fully integrated with psychological theories or electroencephalographic descriptions of sleep. Better clinical diagnostic and treatment frameworks will require both greater conceptual clarity as to what an "awakening" is descriptively and detailed investigations to relate fundamental neuroscience to clinical technologies can be both accessible and diagnostically useful to clinicians.

Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments.

Study Objectives: To develop an archive of self-report questions assessing sleep disturbance and sleep-related impairments (SRI), to develop item banks from this archive, and to validate and calibrate the item banks using classic validation techniques and item response theory analyses in a sample of clinical and community participants.

Design: Cross-sectional self-report study.

Setting: Academic medical center and participant homes.

Night-to-night sleep variability in older adults with and without chronic insomnia.

Objectives: (1) To quantify night-to-night variability in sleep behaviors and sleep measures among older chronic insomnia (CI) subjects and non-insomnia (NI) controls; (2) to investigate systematic temporal patterns of sleep behaviors and sleep measures across nights; and (3) to examine clinical correlates of sleep variability.

Methods: Sixty-one older adults with CI (71.4years old, 67% F) and 31 older adults with NI (70.

Psychometric evaluation of the Insomnia Symptom Questionnaire: a self-report measure to identify chronic insomnia.

Study Objectives: The objective was to psychometrically evaluate the Insomnia Symptom Questionnaire (ISQ), a self-report instrument designed to establish a clinically relevant case definition of insomnia consistent with widely used insomnia classification criteria, using methods from classical test theory and item response theory (IRT).

Methods: The ISQ was evaluated using IRT algorithms in a cohort of 362 pre-, peri- and post-menopausal women recruited for the SWAN (Study of Women's Health Across the Nation) Sleep Study. This yielded a dichotomous outcome consistent with the presence/absence of insomnia.

EEG spectral analysis in primary insomnia: NREM period effects and sex differences.

Study Objectives: To compare NREM EEG power in primary insomnia (PI) and good sleeper controls (GSC), examining both sex and NREM period effects; to examine relationships between EEG power, clinical characteristics, and self-reports of sleep.

Design: Overnight polysomnographic study.

Setting: Sleep laboratory.