Associations between self-reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders.

AIM: To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. METHODS: Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia-specific questions were included. Patients responding "often" or "always" to parasomnia-specific questions were considered "symptom-positive," whereas a "few times" or "never" were considered "symptom-negative" (controls). RESULTS: The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder. CONCLUSION: Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.

Utility of home sleep apnea testing in high-risk veterans.

PURPOSE: Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. METHODS: A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. RESULTS: Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were observed between groups with regard to rates of positive studies, study integrity indicators, or predictors of OSA. Veterans, on average, had 30 min less recording time compared to those in the general clinic sample (p < .01). However, these differences did not impact the amount of the record that was deemed valid nor were veterans more likely to have wakefulness after sleep onset. Predictors of OSA for both groups included advancing age, and increased measures of adiposity (neck circumference and BMI). Mean AHI and respiratory disturbance index (RDI) were statistically similar for both groups and were similar for sleep stage and position. CONCLUSIONS: Home sleep apnea testing for the diagnosis of OSA appears to yield similar results for VAMC patients deemed at high risk for OSA as it does with general sleep clinic patients.

A pilot validation study for the NOX T3(TM) portable monitor for the detection of OSA.

PURPOSE: The aim of the current pilot study is to compare the diagnostic accuracy of the NOX T3(TM) (T3) portable sleep monitor (PM) to that of simultaneously recorded in-lab polysomnogram (PSG). METHODS: A total of 40 participants were recruited following face-to-face evaluation at a sleep disorders clinic. Each participant wore both PSG and PM equipment simultaneously during their in-lab PSG. PSG records were manually scored using the American Academy of Sleep Medicine (AASM) criteria, and PM records were double-scored using the device's autoscore algorithm as well as manual scoring. RESULTS: The final sample consisted of 32 participants (56% male, 50% black) with a mean ESS, BMI, and apnea-hypopnea index (AHI) of 10.4, 32.8, and 16.3, respectively. Three participants (7.5%) were excluded for poor PM signal quality. Mean AHI derived from the T3's autoscore algorithm was similar to that from manual scoring (19.6 ± 18.9 vs. 18.6 ± 19.1, respectively). Autoscore-derived T3 AHI and PSG-derived AHI were strongly related (r = .93). The T3 (autoscored AHI) demonstrated a high degree of sensitivity for the presence of obstructive sleep apnea syndrome (OSA; 100%) and acceptable specificity for the exclusion of OSA using an AHI cutoff of ≥5 events/h (70%). The unit (autoscored) had a high degree of both sensitivity (92%) and specificity (85%) when the presence of OSA was defined more conservatively (AHI > 15 events/h). For OSA defined as an AHI of ≥5, the T3 (autoscored) correctly identified 88% of positive cases and 100% of negative cases. CONCLUSIONS: In this small, clinic-based sample, the T3 demonstrated very good measurement agreement compared to PSG and a high degree of sensitivity for detecting even mild OSA. False positives appeared to be due to respiratory effort-related arousals (RERAs) being autoscored as obstructive apneas and may be due to inherent discrepancy in flow measurement sensitivity between PSG and portable monitors.

Changes in sleep duration, timing, and quality as children transition to kindergarten.

Sleep can be seen as a biologically driven behavior shaped by cultural context. A "poor fit" occurs when contextual demands for the timing and duration sleep periods are incompatible with the underlying biology. Such contextual factors are well-known for adults, yet little is known of the contextual factors that shape young children's sleep health and to what degree such factors impact sleep duration, timing, and quality. This study attempted to identify how the transition to kindergarten was associated with changes in sleep timing, duration, and quality for children enrolled in preschool prior to attending kindergarten vs. those who were not. Wrist actigraphy in 38 5-year-old children was collected at three longitudinal points before and after the start of kindergarten. Our data suggested that the transition to kindergarten was associated with a reduction in weekday sleep (mostly due to lost napping) and an advance in the weekday nocturnal sleep period that was most pronounced for children not enrolled in preschool prior to kindergarten. These sleep changes paralleled objective and caregiver-reported data of increased sleep pressure that lasted well into the first month of kindergarten.

Automatic Detection of Chronic Insomnia from Polysomnographic and Clinical Variables Using Machine Learning.

Insomnia is defined subjectively by the presence and frequency of specific clinical symptoms and an association with distress. Although sleep study data has shown some weak associations, no objective test can currently be used to predict insomnia. The purpose of this study was to use previously reported and relatively crafted insomnia-related polysomnographic variables in machine learning models to classify groups with and without insomnia. Demographics, diagnosed depression, Epworth Sleepiness Scale (ESS), and features derived from electroencephalography (EEG), arousals, and sleep stages from 3,407 sleep clinic patients (2,617 without insomnia and 790 insomnia patients based on responses to a set of questions) were included in this analysis. The number of features were reduced using pair-wise correlation and recursive feature elimination. Predictive value of three machine learning models (logistic regression, neural network, and support vector machine) was investigated, and the best performance was achieved with logistic regression, yielding a balanced accuracy of 71%. The most important features in predicting insomnia were depression, age, sex, duration of longest arousal, ESS score, and EEG power in theta and sigma bands across all sleep stages. Results indicate potential of machine learning-based screening for insomnia using clinical variables and EEG.

The cortisol awakening response (CAR) in 2- to 4-year-old children: effects of acute nighttime sleep restriction, wake time, and daytime napping.

The cortisol awakening response (CAR) is presumed critically important for healthy adaptation. The current literature, however, is hampered by systematic measurement difficulties relative to awakening, especially with young children. While reports suggest the CAR is smaller in children than adults, well-controlled research in early childhood is scarce. We examined whether robust CARs exist in 2- to 4-year-old children and if sleep restriction, wake timing, and napping influence the CAR (n = 7). During a 25-day in-home protocol, researchers collected four salivary cortisol samples (0, 15, 30, 45 min post-wake) following five polysomnographic sleep recordings on nonconsecutive days after 4 hr (morning nap), 7 hr (afternoon nap), 10 hr (evening nap), 13 hr (baseline night), and 16 hr (sleep restriction night) of wakefulness (20 samples/child). The CAR was robust after nighttime sleep, diminished after sleep restriction, and smaller but distinct after morning and afternoon (not evening) naps. Cortisol remained elevated 45 min after morning and afternoon naps. .

Comparison of the macro and microstructure of sleep in a sample of sleep clinic hypersomnia cases.

The purpose of this study was to elucidate the differentiating or grouping EEG characteristics in various hypersomnias (type 1 and type 2 narcolepsy (N-1 and N-2) and idiopathic hypersomnia (IH) compared to an age-matched snoring reference group (SR). Polysomnogram sleep EEG was decomposed into a 4-frequency state model. The IH group had higher sleep efficiency (SE; 92.3% vs. 85.8%; sp < 0.05), lower WASO (IH = 35.4 vs. N-1 = 65.5 min; p < 0.01), but similar (i.e. high) arousal indices as N-1 (~33/h). N-1 and N-2 had earlier REM latency than IH and SR (N-1 = 64.8, N-2 = 76.3 vs. IH/SR = 118 min, p < 0.05). N-1 and N-2 showed an increase in MF1 segments (characteristic of stage 1 and REM) across the night as well as distinct oscillations every 2 h, but MF1 segment timing was advanced by 30 min compared to the SR group (p < 0.05). This suggests the presence of circadian organization to sleep that is timed earlier or of increased pressure and/or lability. MF1 demonstrated a mixed phenotype in IH, with an early 1st oscillation (like N-1 and N-2), 2nd oscillation that overlapped with the SR group, and a surge prior to wake (higher than all groups). This phenotype may reflect a heterogeneous group of individuals, with some having more narcolepsy-like characteristics (i.e. REM) than others. LF domain (delta surrogate) was enhanced in IH and N-1 and more rapidly dissipated compared to N-2 and SR (p < 0.05). This suggests an intact homeostatic sleep pattern that is of higher need/reduced efficiency whereas rapid dissipation may be an underlying mechanism for sleep disruption.

The SinuSonic: reducing nasal congestion with acoustic vibration and oscillating expiratory pressure.

INTRODUCTION: Nasal congestion is common, burdensome, and costly. Current treatments are limited by partial/temporary relief and untoward side-effects. The goal of this study was to evaluate the performance of a novel, non-pharmacologic nasal device designed to reduce nasal congestion via simultaneous administration of acoustic vibration and gentle oscillating expiratory pressure. MATERIALS AND METHODS: Patients were recruited from a tertiary care sleep clinic and all reported moderate-to-severe nasal congestion for >2 weeks (N=14; 64% female; 71% Caucasian). Visual analog scale (VAS) (10 items) quantifying nasal congestion and ease-of-breathing were administered before and after SinuSonic application for 2-5 mins. Global and clinical impressions of change were assessed post-administration. RESULTS: Wilcoxon signed-rank tests indicated that post-test ranks were statistically improved from pre-test ranks for both VAS measures (congestion p=0.002; ease-of-breathing p=0.003). A binomial test indicated that the proportion of patients with ≥ minimal improvement on clinical and global impressions of change was higher than expected (100% vs expected 75%, p=0.018). CONCLUSION: Overall, outcomes were encouraging from this small pilot study with effect sizes in the moderate to large range and no reports of discomfort. It is probable that this device will provide acute, and possibly chronic, relief of nasal congestion with minimal side-effects.

Demographic and nap-related variance of the MSLT: results from 2,498 suspected hypersomnia patients: Clinical MSLT variance.

OBJECTIVE: The purpose of this study was to enhance our understanding of clinical trends in sleep and rapid eye movement (REM) propensity on the multiple sleep latency test (MSLT). Demographic variables of interest included early childhood/advanced age, gender, race, and REM-suppressant use. METHODS: Nocturnal sleep studies and 5-nap MSLTs were retrieved from a large repository of deidentified studies from various US sleep clinics between 2007 and 2015. Studies were signal processed, human-edited, and underwent rigorous quality assurance for inclusion. RESULTS: The final sample consisted of N = 2498 MSLTs (24.2% Black; 34.2% Men; Age 4-89). In adults (age ≥ 21), sleep propensity modestly decreased across nap (90% at nap 1 to 80% at nap 5; p < 0.001). Children ≤12 years were least likely to fall asleep on any nap (∼55% at nap 5). REM propensity troughed at nap 4 (13%) and varied with age. Advanced age (≥60 years; OR: 0.28, p < 0.001), REM-suppressant use (OR:0.52, p < 0.001), and female sex (men OR: 1.48, p = 0.012) was associated with a decreased proportion of ≥2 REMs in adjusted logistic models. Children often demonstrated only 1 REM and generally had long sleep latencies, yielding a low proportion of MSLTs consistent with narcolepsy (11.0% vs. 19.2% and 16.8% in those between 13-20 and 21-59, respectively; p = 0.003). CONCLUSIONS: MSLT outcomes vary greatly across age, gender, and use of psychotropic medication. Demographic variance should be considered when interpreting MSLT results. Robust age effect question the appropriateness of the MSLT as currently designed and implemented for children and older adults.

Underutilization of the MSLT in sleepy patients with a short onset REM period (SOREMP) in the sleep clinic.

OBJECTIVE/BACKGROUND: A nocturnal sleep onset REM period (defined as REM onset latency ≤ 15 min; SOREMP) occurs rarely and research has shown that the phenomenon is specific for type 1 and 2 narcolepsy. However, little is known about the meaningfulness of the phenotype in general sleep clinic patients because those that exhibit the phenomenon often present with few traditional narcolepsy symptoms. As such, this study aimed to (1) evaluate the rate of eventual MSLT testing for those with a SOREMP on routine PSG when the phenomenon occurred in the absence of potential explanatory factors and (2) quantify the stability of the SOREMP phenotype. PATIENTS/METHODS: This was a retrospective analysis of a large repository of de-identified PSG and MSLT test results from 2008 to 2015. Patient records were retrieved from a repository of studies completed at a variety of sleep laboratories across the USA. A total of 118,046 baseline polysomnograms were evaluated for a PSG SOREMP (occurred in 0.7% of the sample). Patients were excluded if they indicated working either shift or night work at the time of the SOREMP or if their self-reported habitual weekday time in bed was less than 7 h. A final sample of 391 cases with a SOREMP were sequestered and previous or consecutive studies were searched for each individual. RESULTS: The vast majority of patients (n = 347/391; 89%) with a PSG SOREMP never received MSLT testing. Patients that were evaluated by MSLT (n = 44; 11%) were typically very sleepy and 82% ended up with a diagnosis of narcolepsy or had MSLTs consistent with current narcolepsy criteria (ie, including the nocturnal SOREMP). Only seven of the 140 patients (n = 5%) that with OSA that first underwent one or more PAP titrations were subsequently seen for an MSLT. Compared to those that eventually received an MSLT, patients that did not receive MSLT testing were older (52 vs. 41 years, p < 0.001), more likely to have moderate to severe OSA (AHI ≥ 15; 39% vs. 16%, p < 0.001), and were generally less likely to report severe sleepiness (ESS ≥ 16; 25% vs. 55%, p < 0.001) and vehicle or workplace accidents or injuries. However, 12% of those that never received an MSLT reported such extreme sleepiness that they endorsed a near-miss car accident due to sleepiness, almost twice as prevalent than that found in a random sample of matched moderate-to-severe OSA patients (p < 0.01). Overall, the reliability of the SOREMP phenotype was low at 9.8%, but was much higher for those diagnosed with type 2 narcolepsy (31%) compared to those without narcolepsy (IH or normal MSLTs; 0%; p < 0.01) or where narcolepsy status was unknown because an MSLT was not conducted (7%; p < 0.01). CONCLUSIONS: The MSLT has been historically underutilized for those exhibiting a SOREMP on diagnostic PSG, a potential marker of narcolepsy. This is presumably because patients with a PSG SOREMP reported variable levels of sleepiness (although some severe) and many had some degree of OSA, which may either be a partial factor in symptomology or even obscure true narcolepsy. Some patients with a PSG SOREMP were very sleepy and most, when an MSLT was conducted, received a diagnosis of type 2 narcolepsy despite few presenting with some of the associated features of narcolepsy. Well-controlled longitudinal studies with high quality data on cataplexy and hypocretin status are needed to understand where the PSG SOREMP phenomenon falls on the hypersomnolence spectrum and to establish which comorbidities share variance with and/or potentially mask narcolepsy. However because untreated narcolepsy can have high social, functional, and financial burden, until such studies are done, physicians should consider a narcolepsy workup when a SOREMP is observed (especially if multiple are seen) as well as close follow-up for symptom resolution when, for example, a patient is treated for sleep apnea.

Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing.

STUDY OBJECTIVES: To evaluate sex differences in predictors of obstructive sleep apnea (OSA) as per outcomes from home sleep apnea testing. DESIGN: This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. SETTING AND PATIENTS: A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. INTERVENTIONS: Not applicable. MEASUREMENTS AND RESULTS: Predictors of OSA (apnea hypopnea index4%≥5) were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (P<0.001) even after controlling for measures of adiposity and medical conditions. Females over the age of 45 years were much more likely to have OSA compared to their younger counterparts (78.7% vs 42.5%, respectively; odds ratio: 5.0) versus males (88.1% vs 68.8%, respectively; odds ratio: 3.4). Snoring, although more frequently reported by males, was similarly predictive of OSA for both sexes. Witnessed apneas and measures of adiposity were better predictors of OSA for males than females. Insomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (P<0.001), even after controlling for age, measures of adiposity, and other medical conditions. Diabetes, heart disease, stroke, and sleepiness did not contribute unique variance in OSA in adjusted models. CONCLUSION: This study found that males and females report different symptoms upon clinical evaluation for suspected sleep apnea, with some of the "classic" OSA features to be more common in and robustly predictive for males. The finding that advancing age uniquely and robustly predicted OSA in females reinforces our understanding that age-related changes in sex hormones play a role in the development and/or manifestation of sleep disordered breathing. Need exists for sex-specific prediction models and quantification of menopausal status in OSA screening tools.

Event-related potentials indicate that reality monitoring differs from external source monitoring.

This experiment investigated differences in event-related potentials (ERPs) observed in 2 types of source monitoring decisions. Participants discriminated between self-generated, heard, and new words (reality monitoring) in one condition; in another they discriminated between words heard in a male or female voice and new items (external source monitoring). The data support the source monitoring framework, which argues that reality monitoring discriminations differ from external source monitoring discriminations. Analysis revealed better overall source accuracy during reality monitoring than during external source monitoring. In the external source monitoring task, an early old-new ERP difference was observed at parietal electrodes followed by frontal old-new effect that persisted longer, replicating previous ERP results. However, early ERP amplitude differences between sources were observed at parietal electrode sites during reality monitoring, suggesting that self-generated items activate more differentiated information during remembering. Furthermore, there were no frontal old-new ERP differences during reality monitoring, suggesting that different decision processes are used in these types of source monitoring decisions.

Prevalence and Clinical Correlates of a Short Onset REM Period (SOREMP) during Routine PSG.

STUDY OBJECTIVES: The objectives of this study were to quantify the (1) sensitivity and specificity of nocturnal PSG SOREMP (REM latency ≤ 15 min) for narcolepsy in those being evaluated for hypersomnolence and (2) prevalence and predictors of SOREMP during baseline PSG for patients being evaluated for various sleep disorders. DESIGN: This was a retrospective analysis of a large repository of de-identified PSG and MSLT test results from 2007 to 2013. SETTING AND PATIENTS: Patient records were retrieved from a repository of studies completed at a variety of sleep laboratories across the USA. Included in the analyses were 79,651 general sleep clinic patients (without an MSLT; 48% male; 72% Caucasian) and an additional 3,059 patients (31.3% male; 72% Caucasian) being evaluated for hypersomnolence (with a consecutive MSLT). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: For patients being evaluated for hypersomnolence, the prevalence of PSG SOREMP increased in a dose-response fashion with the number of REM onsets that occurred on a consecutive MSLT (0.5% for no MSLT SOREMPs to > 33.0% for those with 5 MSLT SOREMPs). Overall, having a PSG SOREMP was highly specific (99.5%; 95% CI: 99.1-99.7%) but not sensitive (6.7%; 95% CI: 4.7-9.2%) for narcolepsy. The prevalence of PSG SOREMP for patients in the general sleep clinic sample (i.e., not being evaluated by a consecutive MSLT) was 0.8% and was much higher in those that work night/swing shift. In adjusted models, African American race contributed to the most variance in PSG SOREMP. CONCLUSIONS: A short onset rapid eye movement (REM) latency occurs rarely in general sleep clinic samples (< 1.0%), but is highly specific for the diagnosis of narcolepsy. Although rare, the prevalence of the phenomenon is much higher than the estimated prevalence of narcolepsy and may provide a critical opportunity for practitioners to identify narcolepsy in sleep clinic patients. These data also suggest that the utility of polysomnography (PSG) short onset REM peroid (SOREMP) for the diagnosis of narcolepsy may be altered by a history of shift/night work and/ or other factors that may allow for a rebound of REM sleep (e.g., undergoing a positive airway pressure titration), supporting published guidelines that other sleep disorders and insufficient and/or poorly timed sleep should be ruled out and/or adequately controlled for prior to conducting sleep testing. Further research is needed to understand racial differences in PSG SOREMP and narcolepsy. This study was limited in that data on cataplexy (with exception to that in final diagnosis) and habitual sleep duration were not available.

Who is getting tested for obstructive sleep apnea using a portable recording system? Test results from 193,221 patients.

STUDY OBJECTIVES: To address some of the questions about "who" has been tested for OSA (in terms of pretest risk and study outcomes) using a leading national portable recorder (PR; "home sleep test"). DESIGN: This was a retrospective analysis of a large repository of de-identified test results and pretest OSA risk from 2009 to 2013. SETTING AND PATIENTS: A total of 244,602 patients were referred for testing from a variety of clinical practices across North America. A total of 193,221 studies were included in the final analyses. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: The final sample was predominately male (59%), middle-aged (53.5 ± 14.2 years), obese (BMI >30; 54%), with a large neck circumference (males = 16.9 ± 1.2 in; females = 15.0 ± 1.3 in) and a mild degree of reported sleepiness (ESS 8.7±5.3). Approximately 50% of the sample endorsed a history of hypertension. The majority of patients (89.6%) were at a high risk for OSA as assessed by the ARES screening questionnaire. Of this group, 79.9% had an AHI ≥5 (MAHI = 18.2 ± 18.1) and 98% had an RDI ≥5 (MRDI = 28.0 ± 19.6). The majority of patients (~60%) that screened at no apparent risk for OSA indeed had AHIs <5 events/h. Those with a high pretest risk for OSA but low test outcomes (AHI <5) were twice as likely to be female and approximately 20% to 30% more likely to report a history of insomnia, lung disease, and/or stroke. CONCLUSIONS: The majority of PR has been conducted on patients with a high degree of suspicion for OSA. These data suggest that PR has been used in patients with a high pretest probability of OSA. Patients with a history of insomnia, stroke, and/ or lung disease may especially benefit by a comprehensive evaluation by a physician trained in sleep medicine, especially if PR results are negative for OSA. Future studies should evaluate the utility of gender-appropriate screening measures. Although questionnaire-based screening is helpful in determining OSA risk, it is imperative that it be used in conjunction with clinical decision-making.

Maximizing positive airway pressure adherence in adults: a common-sense approach.

Positive airway pressure (PAP) therapy is considered the most efficacious treatment of obstructive sleep apnea (OSA), especially moderate to severe OSA, and remains the most commonly prescribed. Yet suboptimal adherence presents a challenge to sleep-medicine clinicians. The purpose of the current review is to highlight the efficacy of published interventions to improve PAP adherence and to suggest a patient-centered clinical approach to enhancing PAP usage.

Time in Bed is Associated with Decreased Physical Activity and Higher BMI in Women Seeking Weight Loss Treatment.

Short sleep duration is associated with obesity risk. Despite calls to incorporate strategies to enhance sleep within the context of behavioral weight loss (BWL) treatment, little is known regarding the association between sleep and body mass index (BMI) among individuals presenting for BWL. Moreover, most research has focused on eating pathways linking sleep and BMI, and have not explored how sleep may impact engagement in physical activity. The purpose of the present study was to determine whether, in a sample of women seeking treatment for weight loss, there was an association between reported time in bed (TIB), higher BMI, lower physical activity, and less favorable dietary composition. Prior to randomization, 318 women completed measures of TIB, eating, and activity; weight and height were measured. Findings demonstrated that report of '6 hours or less' TIB/night was associated with higher BMI and lower reported physical activity compared to the referent (>7 to ≤ 8 hours/night). It was not associated with the number of reported calories consumed each day or with the percent of calories consumed from fat, carbohydrates or protein. Better understanding the role of sleep within the context of BWL treatment in women seems warranted.

Sleep and obesity in children and adolescents.

The purpose of this review is to provide a comprehensive update of epidemiologic studies that have assessed the association between sleep and obesity risk. Data suggest that short sleep is associated with an increased risk for being or becoming overweight/obese or having increased body fat. Late bedtimes are also a risk factor for overweight/obesity. Findings also suggest that changes in eating pathways may lead to increased body fat. Future experimental studies are needed to enhance our understanding of the underlying mechanisms through which sleep may play a role in the development and maintenance of childhood obesity.