Non-REM sleep with hypertonia in Parkinsonian Spectrum Disorders: A pilot investigation.

Introduction: From an ongoing multicenter effort toward differentiation of Parkinsonian spectrum disorders (PSD) from other types of neurodegenerative disorders, the sleep biomarker non-rapid-eye-movement sleep with hypertonia (NRH) emerged.

Methods: This study included in the PSD group patients with dementia with Lewy bodies/Parkinson disease dementia (DLB/PDD = 16), Parkinson disease (PD = 16), and progressive supranuclear palsy (PSP = 13). The non-PSD group included patients with Alzheimer disease dementia (AD = 24), mild cognitive impairment (MCI = 35), and a control group with normal cognition (CG = 61).

Criteria for oral appliance and/or supine avoidance therapy selection based on outcome optimization and cost-effectiveness.

Aim: Produce empirical support for further enhancements to a therapy selection protocol for obstructive sleep apnea (OSA) patients intolerant of positive airway pressure.

Methods: A retrospective analysis was conducted in 101 men and 69 women patients. Two-night home sleep apnea studies were conducted at baseline and with a trial oral appliance.

A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea.

Objective: Evaluate the concordance between overall and positional oxygen desaturation indices (ODI) and apnea-hypopnea indices (AHI) according to two different definitions for positional obstructive sleep apnea (POSA).

Methods: A total of 184 in-home polysomnograms were edited to simulate Level III home sleep apnea tests (HSAT) with the auto-scored AHI and ODI based on recording time. POSA was determined using 132 records with an AHI≥5 and at least 20 mins of recording time in both supine and non-supine positions.

Head Position During Sleep: Potential Implications for Patients with Neurodegenerative Disease.

Background: The characterization of sleep in those with neurodegenerative disease (NDD) is essential in understanding the potential neurobiological mechanisms that underlie the connection between sleep disruption and NDD manifestations and progression.

Objective: Explore the inter-relationships between NDD and age, sex, diagnosis of obstructive sleep apnea, snoring, and duration of sleep time with the head in the supine and non-supine positions.

Methods: A case-control design was used to evaluate differences in sleep position obtained from multi-night, in-home Sleep Profiler recordings in 45 patients with diagnosed NDD (24 with mild cognitive impairment, 15 with Alzheimer's disease, and 6 with Lewy Body, Parkinson's, or other dementias) and 120 age-sex matched controls with normal cognition (NC).

The Accuracy, Night-to-Night Variability, and Stability of Frontopolar Sleep Electroencephalography Biomarkers.

Study Objectives: To assess the validity of sleep architecture and sleep continuity biomarkers obtained from a portable, multichannel forehead electroencephalography (EEG) recorder.

Methods: Forty-seven subjects simultaneously underwent polysomnography (PSG) while wearing a multichannel frontopolar EEG recording device (Sleep Profiler). The PSG recordings independently staged by 5 registered polysomnographic technologists were compared for agreement with the autoscored sleep EEG before and after expert review.

Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea.

Study Objectives: A majority of patients diagnosed with obstructive sleep apnea are position dependent whereby they are at least twice as severe when sleeping supine (POSA). This study evaluated the accuracy and efficacy of a neck-worn device designed to limit supine sleep. The study included nightly measurements of snoring, sleep/wake, time supine, and the frequency and duration of feedback to monitor compliance.

Capability of a neck worn device to measure sleep/wake, airway position, and differentiate benign snoring from obstructive sleep apnea.

To evaluate the accuracy of a neck-worn device in measuring sleep/wake, detecting supine airway position, and using loud snoring to screen for obstructive sleep apnea. Study A included 20 subjects who wore the neck-device during polysomnography (PSG), with 31 records obtained from diagnostic and split-night studies. Study B included 24 community-based snorers studied in-home for up to three-nights with obstructive sleep apnea (OSA) severity measured with a validated Level III recorder.

Retrospective cross-validation of automated sleep staging using electroocular recording in patients with and without sleep disordered breathing.

Background: Alterations of sleep duration and architecture have been associated with increased morbidity and mortality, and specifically linked to chronic cardiovascular disease and psychiatric disorders, such as type 2 diabetes or depression. Measurement of sleep quality to assist in the diagnosis or treatment of these diseases is not routinely performed due to the complexity and cost of conventional methods. The objective of this study is to cross-validate the accuracy of an automated algorithm that stages sleep from the EEG signal acquired with sensors that can be self-applied by patients.

Patients with positional versus nonpositional obstructive sleep apnea: a retrospective study of risk factors associated with apnea-hypopnea severity.

Objective: The aim of this study was to investigate the differences in and risk factors for positional and nonpositional obstructive sleep apnea (OSA).

Study Design: One hundred twenty-three nonpositional (supine apnea-hypopnea index [AHI] < 2 times the lateral AHI), 218 positional (supine AHI ≥ 2 times the lateral AHI), and 109 age-, gender-, and BMI-matched patients with positional OSA performed 2 nights of sleep study. Gender, age, BMI, and percentage of time in supine position, and percentage of time snoring louder than 40 dB were evaluated as risk factors.

Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients.

Objective: The aim of the study was to investigate treatment outcome of mandibular advancement devices (MADs) for positional and nonpositional obstructive sleep apnea (OSA).

Study Design: Forty-two positional (supine apnea-hypopnea index [AHI] > or = 2 times lateral AHI) and 30 nonpositional (supine AHI < 2 times lateral AHI) OSA patients performed 2-nights of sleep study before and after insertion of MADs.

Results: The decreases in apnea severity based on a reduction in the overall and supine AHI values after MADs therapy were significantly greater for the positional OSA than nonpositional OSA group.

Validation of forehead venous pressure as a measure of respiratory effort for the diagnosis of sleep apnea.

Objectives: The aim of the study was to validate the measurement of Forehead Venous Pressure derived from a single site on the forehead as an alternative to esophageal manometry and respiratory effort bands in the differential diagnosis of sleep apnea.

Methods: Fourteen subjects underwent a laboratory polysomnography concurrently with ARES Unicorder at Walter Reed Army Medical Center. Two-hundred respiratory events were selected by a scorer boarded in sleep medicine and classified into six event categories used in the differential diagnosis of sleep disordered breathing.

Assessment of the test-retest reliability of laboratory polysomnography.

Statement Of The Problem: When conducting a treatment intervention study, it is assumed that a level of reliability can be obtained from the measurement tool such that the outcome can be reasonably assessed.

Purpose Of Study: Investigate the reliability of laboratory polysomnography, the gold standard for assessment of treatment outcomes for obstructive sleep apnea, at a 1-month interval.

Materials And Methods: In a clinical trial of 118 patients recruited to assess the effects of a pharmaceutical treatment intervention, a subset of 20 patients designated as placebo controls completed two polysomnography studies, one at baseline and one at least one month later.

Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients.

Obstructive sleep apnea is a commonly undiagnosed chronic disease. While dentists represent an important resource for identifying people at risk for primary snoring and sleep apnea, less than 50% of dentists are capable of identifying the common signs and symptoms of sleep disordered breathing. The aim of this study is to assess the prevalence of probable obstructive sleep apnea/sleep disordered breathing and symptoms associated with this condition in a population of dental patients using a validated questionnaire and software that could be administered in a dental office.

In-home evaluation of efficacy and titration of a mandibular advancement device for obstructive sleep apnea.

There is increasing evidence that mandibular advancement devices (MADs) can be an effective treatment for some patients with obstructive sleep apnea, a highly prevalent chronic disease. In this study, the objectives were to objectively assess the effectiveness of MAD therapy using a limited channel recorder, and to develop a model for identifying patients who may be appropriate for MAD therapy as the initial treatment option. Thirty patients were prospectively recruited and studied at two independent dentist offices and the participants' homes.

Description and validation of the apnea risk evaluation system: a novel method to diagnose sleep apnea-hypopnea in the home.

Study Objectives: To evaluate the accuracy and practicality of the Apnea Risk Evaluation System (ARES; Advanced Brain Monitoring; Carlsbad, CA), a limited-channel system for diagnosing sleep apnea/hypopnea in the home.

Design: Prospective randomized study with blinded analysis.

Settings: Two independent, community-based, sleep-disorders centers and the participants' homes.