Publications by authors named "Lynn M Trotti"

Article Synopsis
  • Telehealth utilization surged during the COVID-19 pandemic, but its future is uncertain without permanent coverage and adequate reimbursement, which are crucial for its long-term viability and acceptance.
  • Telehealth enhances sleep health management by improving patient access, clinician efficiency, and safety, while addressing healthcare equity, making it particularly suitable for the field of sleep medicine.
  • The American Academy of Sleep Medicine advocates for telehealth as a vital component of high-quality care for sleep disorders and urges collaboration among stakeholders to strengthen its availability and accessibility.
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Introduction: This guideline establishes clinical practice recommendations for Treatment of Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) in adults and pediatric patients.

Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations.

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Introduction: This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD).

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of pharmacological or nonpharmacological treatment to no treatment to improve patient-important outcomes.

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Article Synopsis
  • Unstructured and structured data in electronic health records (EHR) can provide valuable insights for research, but extracting this information can be challenging; researchers introduced an automated model to identify patients with Alzheimer's Disease, related dementias (ADRD), and mild cognitive impairment (MCI).
  • The study involved a sample of 3,626 outpatient adults, using medical notes and diagnoses from chart reviews to develop a logistic regression model that predicts MCI/ADRD diagnoses with high performance metrics.
  • The model demonstrated impressive accuracy (99.88%) and other metrics (like AUROC of 0.98), showing that automated EHR phenotyping could effectively facilitate large-scale research on MCI/ADRD.
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Article Synopsis
  • The study aimed to compare the effectiveness of modafinil versus amphetamine-dextroamphetamine in treating narcolepsy type 2 and idiopathic hypersomnia through a randomized, blinded trial involving 44 adults over 12 weeks.
  • Results showed that while modafinil improved sleepiness levels (5.0 points on the Epworth scale) more than amphetamine-dextroamphetamine (4.4 points), the latter was noninferior in several secondary measures of symptoms and disease severity.
  • Adverse effects were more prevalent with modafinil, including higher rates of anxiety, while amphetamine-dextroamphetamine showed less dropouts due to adverse events, suggesting implications for treatment choices in these disorders.
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Idiopathic hypersomnia (IH) is a sleep disorder characterized by highly disruptive symptoms. Like narcolepsy type 1, a well-characterized sleep disorder, individuals with IH suffer from excessive daytime sleepiness, though there is little overlap in metabolic or neural biomarkers across these two disorders. This lack of common pathophysiology, combined with the clear overlap in symptoms presents an ideal paradigm for better understanding the impact of IH on an individual's functional activity and organization, and potentially, the underlying pathophysiology.

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Article Synopsis
  • Atrial fibrillation (AF) is often undetected due to its asymptomatic nature, presenting a significant risk for stroke and heart failure, making early prediction and management essential.
  • The study focused on analyzing 18,782 single-lead ECG recordings from 13,609 patients undergoing polysomnography (PSG) to identify individuals at high risk for developing AF, using both hand-crafted features and deep learning methods for prediction.
  • By employing advanced feature extraction techniques, the researchers aimed to enhance AF detection using PSG data, ultimately improving patient outcomes through early intervention.
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Background: Optimal measurement tools for problematic sleep inertia, common in some central disorders of hypersomnolence (CDH), have not yet been determined. We evaluated the performance of the Sleep Inertia Questionnaire (SIQ) in CDH, and how well it distinguished hypersomnolent groups from controls, and IH (idiopathic hypersomnia) from narcolepsy type 1 (NT1).

Methods: This prospective, bi-centric study included 63 control, 84 IH, 16 NT1, 18 narcolepsy type 2 (NT2), and 88 subjective excessive daytime sleepiness (sEDS) participants, using ICSD-3 criteria.

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Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity.

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Article Synopsis
  • Atrial fibrillation (AF) is often unnoticed but poses significant risks for stroke and heart failure, making early detection and management vital, especially since many AF patients also suffer from obstructive sleep apnea (OSA).
  • The study analyzed over 18,000 ECG recordings from patients at Massachusetts General Hospital to find indicators of AF by leveraging data from standard sleep assessments that included ECG monitoring.
  • A deep learning approach was used to enhance the prediction model, extracting features from the ECG data to forecast individuals who are at high risk of developing AF in the future.
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Study Objectives: An estimated 3% of the population has clinically significant restless legs syndrome. Given the limited pharmacological options in the arsenal, there is a need for a therapeutic agent with a better side effect profile.

Methods: Twelve treatment naive adults (10 women and 2 men with a median age of 41.

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Unlabelled: Restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) have been variably implicated in risk for cardiovascular disease (CVD), but there is lack of consensus on these relationships. We sought to assess subclinical CVD measures and RLS/PLMS in a large cohort to further evaluate these associations. The Emory Center for Health Discovery and Well Being cohort is composed of employed adults, with subclinical CVD measures including endothelial function (flow-mediated vasodilation), microvascular function (reactive hyperemia index, RHI), arterial stiffness (pulse wave velocity and augmentation index), and carotid intima-media thickness (cIMT).

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Introduction: There remains an urgent need to identify preclinical pathophysiological mechanisms of Alzheimer's disease (AD) development in high-risk, racially diverse populations. We explored the relationship between cerebrospinal fluid (CSF) markers of vascular injury and neuroinflammation with AD biomarkers in middle-aged Black/African American (B/AA) and non-Hispanic White (NHW) participants.

Methods: Adults (45-65 years) with a parental history of AD were enrolled (n = 82).

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Unlabelled: The period of the year from spring to fall, when clocks in most parts of the United States are set one hour ahead of standard time, is called daylight saving time, and its beginning and ending dates and times are set by federal law. The human biological clock is regulated by the timing of light and darkness, which then dictates sleep and wake rhythms. In daily life, the timing of exposure to light is generally linked to the social clock.

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Although many people suffer from sleep disorders, most are undiagnosed, leading to impairments in health. The existing polysomnography method is not easily accessible; it's costly, burdensome to patients, and requires specialized facilities and personnel. Here, we report an at-home portable system that includes wireless sleep sensors and wearable electronics with embedded machine learning.

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Purpose Of Review: To provide a brief overview of current objective measures of hypersomnolence, discuss proposed measure modifications, and review emerging measures.

Recent Findings: There is potential to optimize current tools using novel metrics. High-density and quantitative EEG-based measures may provide discriminative informative.

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GABA receptor-positive modulators are well-known to induce sedation, sleep, and general anesthesia. Conversely, GABA receptor negative allosteric modulators (GABARNAMs) can increase arousal and induce seizures. Motivated by our studies with patients with hypersomnia, and our discovery that two GABARNAMs can restore the Excitation/Inhibition (E/I) balance in vitro and arousal in vivo, we chose to screen 11 compounds that have been reported to modulate arousal, to see if they shared a GABA-related mechanism.

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Unlabelled: Obstructive sleep apnea (OSA) remains a highly prevalent disorder that can lead to multiple adverse outcomes when undiagnosed and/or when left untreated. There continue to be gaps and variations in the provision of care for the adult patient population with OSA, which emphasizes the importance of the measure maintenance initiative for The Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea (originally developed in 2015). The American Academy of Sleep Medicine (AASM) convened the Quality Measures Task Force in 2018 to review the current medical literature, other existing quality measures focused on the same patient population, and any performance data or data in the medical literature that show gaps or variations in care, to inform potential revisions to the quality measure set.

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Unlabelled: This position statement provides guidance for age and weight considerations for using continuous positive airway pressure therapy in pediatric populations. The American Academy of Sleep Medicine commissioned a task force of experts in pediatric sleep medicine to review the medical literature and develop a position statement based on a thorough review of these studies and their clinical expertise. The American Academy of Sleep Medicine Board of Directors approved the final position statement.

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Background: The association between restless legs syndrome (RLS) and Parkinson's disease (PD) remains controversial, with epidemiologic and descriptive evidence suggesting some potential overlap while mechanistic/genetic studies suggesting relative independence of the conditions.

Objective: To examine a known, objectively measured endophenotype for RLS, periodic leg movements (PLMS) in sleep, in patients with PD and relate that objective finding to restless legs symptoms.

Methods: We performed polysomnography for one (n = 8) or two (n = 67) consecutive nights in 75 PD patients and examined the association of PLMS with restless legs symptoms.

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