What Works for One May Not Work for Another: A New Warning for Modafinil.

Narcolepsy is a clinical syndrome of hypothalamic disorder characterized by several sleep-wake disorders. The most common features include daytime sleepiness associated with hallucinations (hypnagogic and hypnopompic hallucinations) at the transition time of sleep-wake time, cataplexy or sudden loss of muscle tone, and sleep paralysis. We present a case of a patient affected with both narcolepsy and postural orthostatic tachycardia syndrome (POTS).

Correction: What Works for One May Not Work for Another: A New Warning for Modafinil.

[This corrects the article DOI: 10.7759/cureus.27287.

Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration.

Objectives: Obstructive sleep apnea (OSA) is a common disease, often treated using continuous positive airway pressure (CPAP) therapy. In many cases, patients fail a CPAP titration study due to inadequate control of the apnea-hypopnea index (AHI, events/hour) or due to treatment-emergent central sleep apnea (TE-CSA). We report our experience using a mode of non-invasive ventilation for alternative treatment of these patients.

Diagnosed or prescribed only? A national analysis of initial evaluation and management of insomnia among older adult Medicare beneficiaries.

Study Objectives: To describe initial insomnia-related encounters among a national sample of Medicare beneficiaries, and to identify older adults at risk for potentially inappropriate prescription insomnia medication usage.

Methods: Our data source was a random 5% sample of Medicare administrative claims data (2006-2013). Insomnia was operationalized as International Classification of Disease, Ninth Revision, Clinical Modification diagnostic codes.

Enhancing motor learning in people with stroke via memory reactivation during sleep.

Purpose: Investigate the use of repetitive delivery of task-related auditory cues, known as targeted memory reactivation (TMR), throughout a 1-hour daytime nap to enhance motor learning in individuals with chronic stroke.

Research Method: Participants with a history of stroke at least 6 months prior were recruited to perform a novel overhand throwing task to randomly appearing target locations using the nonparetic upper extremity immediately before and after a 1-hour daytime nap. Half of the participants received TMR during the nap.

CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease.

Study Objectives: To examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on health care utilization among a nationally representative and sample of older adults with multiple morbidities and pre-existing cardiovascular disease and subsequently diagnosed with obstructive sleep apnea in the United States.

Methods: Our data source was a random 5% sample of Medicare administrative claims data. All participants (n = 1,921) were of age ≥ 65 years, diagnosed with cardiovascular disease and obstructive sleep apnea, and subsequently began treatment with CPAP between 2009-2013.

Improving sleep medicine education among health professions trainees.

Study Objectives: Despite increasing recognition of its importance, sleep medicine education remains limited during medical training. We sought to assess the baseline knowledge of a group of health professions trainees and to determine whether an educational sleep medicine "boot camp" led to improvement in sleep medicine knowledge.

Methods: Participants attended a 2-day introduction to sleep medicine course designed for new sleep medicine fellows in July 2017 and 2018.

Use of average volume-assured pressure support as a therapeutic option in patients with central sleep apnea syndrome.

Purpose: Central sleep apnea (CSA) syndrome commonly occurs with other medical conditions such as congestive heart failure, opiate use, and brainstem disorders. Various treatment modalities have been used with varied effectiveness in an attempt to improve ventilation and reduce the apnea-hypopnea index (AHI) in patients with CSA. This study evaluated whether or not a bilevel positive airway pressure mode of noninvasive ventilation, average volume-assured pressure support (AVAPS) is effective in treating CSA.

CPAP adherence is associated with reduced risk for stroke among older adult Medicare beneficiaries with obstructive sleep apnea.

Study Objectives: To examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk of stroke among a nationally representative sample of older adults with obstructive sleep apnea.

Methods: We performed a retrospective cohort study among Medicare beneficiaries aged ≥ 65 years who were newly diagnosed with obstructive sleep apnea and had initiated CPAP (2009-2013). Monthly indicators of CPAP adherence included charges for machines, masks, or supplies and were summed over a 25-month follow-up to create a CPAP adherence variable.

CPAP adherence reduces cardiovascular risk among older adults with obstructive sleep apnea.

Study Objectives: To examine (1) the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk for cardiovascular (CVD) events among a nationally representative sample of older adults with obstructive sleep apnea (OSA), and (2) the heterogeneity of this effect across subgroups defined by race, sex, and socioeconomic status.

Methods: We conducted a retrospective cohort study among Medicare beneficiaries aged ≥ 65 years with OSA (2009-2013). Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable.

Which older adults receive sleep medicine specialty care? Predictors of being seen by a board-certified sleep medicine provider.

Study Objectives: The aim of this study was to characterize older adult Medicare beneficiaries seen by board-certified sleep medicine providers (BCSMPs) and identify predictors of being seen by a BCSMP.

Methods: Our data source was a random 5% sample of Medicare administrative claims data (2006-2013). BCSMPs were identified using a cross-matching procedure based on national provider identifiers available within the Medicare database and assigned based on the first sleep disorder diagnosis received.

Lower socioeconomic status and co-morbid conditions are associated with reduced continuous positive airway pressure adherence among older adult medicare beneficiaries with obstructive sleep apnea.

Study Objectives: To examine rates of adherence to continuous positive airway pressure (CPAP) therapy among a representative sample of older adult Medicare beneficiaries with obstructive sleep apnea (OSA), and to identify demographic and health-related factors associated with CPAP adherence.

Methods: Using a 5% sample of Medicare claims data, we utilized Medicare policy and CPAP machine charges as a proxy for CPAP adherence. A cumulative logit model was used to identify demographic, medical, and psychiatric predictors of CPAP adherence status.

Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.

Background: COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established.

Methods: We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained.

Sensorimotor performance is improved by targeted memory reactivation during a daytime nap in healthy older adults.

Sensorimotor consolidation occurs during sleep. However, the benefit of sleep-based consolidation decreases with age due to decreased sleep quality and quantity. This study aimed to enhance sensorimotor performance through repetitive delivery of task-based auditory cues during sleep, known as targeted memory reactivation (TMR).

Practice patterns of board-certified sleep medicine providers: a national analysis among older adult Medicare beneficiaries.

Study Objectives: To examine the proportion of Medicare beneficiaries with sleep disorders who were evaluated by board-certified sleep medicine providers (BCSMPs).

Methods: Using a random 5% sample of Medicare administrative claims data (2007-2011), BCSMPs were identified by employing a novel cross-matching approach based on National Provider Identifiers available within the Medicare database. Sleep disorders were included based partially on the International Classification of Sleep Disorders, Third Edition (insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm sleep-wake disorders, parasomnias, and restless legs syndrome), and operationalized as International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes.

Older adult US Medicare beneficiaries with untreated obstructive sleep apnea are heavier users of health care than matched control patients.

Study Objectives: To examine the effect of untreated obstructive sleep apnea (OSA) on health care utilization (HCU) and costs among a nationally representative sample of Medicare beneficiaries.

Methods: Our data source was a random 5% sample of Medicare administrative claims data for years 2006-2013. OSA was operationalized as (1) receipt of one or more International Classification of Disease, Version 9, Clinical Modification diagnostic codes for OSA in combination with (2) initiation of OSA treatment with either continuous positive airway pressure or oral appliance (OA) therapy.

Economic aspects of insomnia medication treatment among Medicare beneficiaries.

Study Objectives: To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.

Methods: Using a random 5% sample of Medicare administrative data (2006-2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals.

Use of targeted memory reactivation enhances skill performance during a nap and enhances declarative memory during wake in healthy young adults.

Sleep is an important component of motor memory consolidation and learning, providing a critical tool to enhance training and rehabilitation. Following initial skill acquisition, memory consolidation is largely a result of non-rapid eye movement sleep over either a full night or a nap. Targeted memory reactivation is one method used to enhance this critical process, which involves the pairing of an external cue with task performance at the time of initial motor skill acquisition, followed by replay of the same cue during sleep.

The Impact of Treatments for OSA on Monetized Health Economic Outcomes: A Systematic Review.

Objective: To review systematically the published literature regarding the impact of treatment for OSA on monetized health economic outcomes.

Methods: Customized structured searches were performed in PubMed, Embase (Embase.com), and the Cochrane Central Register of Controlled Trials (Wiley) databases.

Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.

Study Objectives: To examine the impact of untreated insomnia on health care utilization (HCU) among a nationally representative sample of Medicare beneficiaries.

Methods: Our data source was a random 5% sample of Medicare administrative data for years 2006-2013. Insomnia was operationalized as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on International Classification of Disease, Version 9, Clinical Modification codes or at least one prescription fill for an insomnia-related medication in Part D prescription drug files in each year.

Trends in Insomnia Diagnosis and Treatment Among Medicare Beneficiaries, 2006-2013.

Objective: Insomnia is an important clinical problem affecting the elderly. We examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period.

Methods: This was a time-series analysis of Medicare administrative data for years 2006-2013.

Poor Sleep Quality in Patients With Amyotrophic Lateral Sclerosis at the Time of Diagnosis.

Objectives: Patients with amyotrophic lateral sclerosis (ALS) have poor sleep quality, but little is known about which factors affect sleep at time of diagnosis.

Methods: Patients with newly diagnosed ALS were administered the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Beck Depression Inventory-Revised, and ALS Functional Rating Scale and were compared with controls.

Results: Forty-three patients, age 63.

The utility of current criteria for split-night polysomnography for predicting CPAP eligibility.

Introduction: Traditionally, evaluation of obstructive sleep apnea (OSA) has consisted of a diagnostic polysomnogram (PSG), followed by a continuous positive pressure (CPAP) titration. However, to reduce costs, many third-party payers mandate performance of split-night studies (SPL), combining diagnostic and CPAP titration testing. We ascertained the utility of performing SPL for diagnosis and treatment of OSA.

Sleep, Sleep Disorders, and Circadian Health following Mild Traumatic Brain Injury in Adults: Review and Research Agenda.

A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). Although many questions remain unanswered, the preponderance of evidence suggests that sleep and circadian disorders can result from mTBI. Among those with mTBI, sleep disturbances and clinical sleep and circadian disorders contribute to the morbidity and long-term sequelae across domains of functional outcomes and quality of life.

Inflammation and asthma control in children with comorbid obstructive sleep apnea.

Objectives: A bi-directional relationship exists between asthma and obstructive sleep apnea (OSA) in which presence of one is associated with increased prevalence and severity of the other. Our objective was to determine whether OSA accounted for differences in airway and systemic inflammation in asthmatic children and whether inflammation was associated with asthma control. We hypothesized that greater severity of SDB would correlate with increased upper airway and systemic inflammation and result in reduced asthma control.