Journal of Clinical Sleep Medicine最新文献

{"title":"Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis.","authors":"Mohanad AlGaeed, Tarrant McPherson, Ikjae Lee, Michelle Feese, Inmaculada Aban, Gary Cutter, Henry J Kaminski, Elias G Karroum","doi":"10.5664/jcsm.11386","DOIUrl":"10.5664/jcsm.11386","url":null,"abstract":"<p><strong>Study objectives: </strong>Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire.</p><p><strong>Methods: </strong>The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semiannual basis to survey participants with MG. Patients aged ≥ 18 years, living in the United States, and answering \"yes\" to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG-quality of life-15 revised, MG-activities of daily living instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS. Multivariable logistic regression models explored the association between RLS and MG variables of interest.</p><p><strong>Results: </strong>A total of 630 eligible participants with MG (age: 62.8 ± 13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-activities of daily living, MG-quality of life-15 revised, and depression scores. History of \"thymic tumor with thymectomy\" and \"continuous positive airway pressure therapy\" were also independent predictors of RLS.</p><p><strong>Conclusions: </strong>RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS.</p><p><strong>Citation: </strong>AlGaeed M, McPherson T, Lee I, et al. Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis. <i>J Clin Sleep Med</i>. 2025;21(2):269-276.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"269-276"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new perspective after facing the crucible of a Food and Drug Administration class 1 recall.","authors":"Colleen G Lance, Kathryn Hansen","doi":"10.5664/jcsm.11408","DOIUrl":"10.5664/jcsm.11408","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"447-448"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series report of 3 patients with borderline personality disorder who received eye movement desensitization and reprocessing therapy.","authors":"Behnoush Sabayan, Parviz Dabaghi, Mohammad Reza Ghasemzadeh, Naser Goodarzi, Amir Mohsen Rahnejat, Kianoosh Gholami","doi":"10.5664/jcsm.11428","DOIUrl":"10.5664/jcsm.11428","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"449"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of microsleeps to estimate sleepiness at the wheel and near-miss accidents in obstructive sleep apnea.","authors":"Pasquale Tondo, Caterina Pronzato, Irene Risi, Carlo Perretti, Luigi De Gennaro, Maria R Bonsignore, Alberto Malovini, Francesco Fanfulla","doi":"10.5664/jcsm.11376","DOIUrl":"10.5664/jcsm.11376","url":null,"abstract":"<p><strong>Study objectives: </strong>Obstructive sleep apnea is considered a risk factor for sleepiness at the wheel and near-miss accidents (NMA). To date, there are subjective and objective methods such as the Maintenance of Wakefulness Test (MWT) to investigate sleepiness. However, these methods have limitations. Therefore, a new analysis of the MWT was introduced based on the identification of microsleeps (MS). So, we tested MS analysis to improve the discriminative ability of MWT in recognizing individuals at risk for sleepiness at the wheel and NMA in a population with obstructive sleep apnea.</p><p><strong>Methods: </strong>The study was conducted on 100 naïve patients with suspected obstructive sleep apnea referred to our Sleep Medicine Unit. All patients performed a full standard polysomnography and MWT. The MWT was analyzed according to standard criteria, and the presence of MS episodes, the mean MS latency, and the MS density (the mean absolute or relative number of MS) were assessed.</p><p><strong>Results: </strong>MS were observed in 100% of alert or sleepy patients and 47% of the fully alert patients (<i>P</i> < .0001). Almost 90% of patients reporting NMA showed episodes of MS during MWT. The occurrence of NMA was related to excessive daytime sleepiness, MS latency, and MS density (<i>P</i> < .001). The discriminative power for the NMA of MS density measures was higher than that derived from latency analysis, particularly in patients without excessive daytime sleepiness and with a simultaneous mean sleep latency > 33 minutes.</p><p><strong>Conclusions: </strong>MS analysis provides objective evidence of sleepiness and, therefore, could improve the discriminative ability of the MWT in recognizing individuals at high risk for accidents.</p><p><strong>Citation: </strong>Tondo P, Pronzato C, Risi I, et al. The role of microsleeps to estimate sleepiness at the wheel and near-miss accidents in obstructive sleep apnea. <i>J Clin Sleep Med.</i> 2025;21(2):287-295.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"287-295"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of automated pediatric sleep stage classification using U-Sleep: a convolutional neural network.","authors":"Ajay Kevat, Rylan Steinkey, Sadasivam Suresh, Warren R Ruehland, Jasneek Chawla, Philip I Terrill, Andrew Collaro, Kartik Iyer","doi":"10.5664/jcsm.11362","DOIUrl":"10.5664/jcsm.11362","url":null,"abstract":"<p><strong>Study objectives: </strong>U-Sleep is a publicly available automated sleep stager, but has not been independently validated using pediatric data. We aimed to (1) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and (2) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3,114 polysomnograms from a tertiary center.</p><p><strong>Methods: </strong>Agreement between U-Sleep and \"gold\" 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon 2 1-sided test. Multivariable regression and generalized additive modeling were used on the clinical dataset to estimate the effects of age, comorbidities, and polysomnographic findings on U-Sleep performance.</p><p><strong>Results: </strong>The median (interquartile range) Cohen's kappa agreement of U-Sleep and individual trained humans relative to \"gold\" scoring for 5-stage sleep staging in the concordance dataset were similar, kappa = 0.79 (0.19) vs 0.78 (0.13), respectively, and satisfied statistical equivalence (2 1-sided test <i>P</i> < .01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa = 0.69 (0.22). Modeling indicated lower performance for children < 2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction = 0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction = 0.1).</p><p><strong>Conclusions: </strong>While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children < 2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.</p><p><strong>Citation: </strong>Kevat A, Steinkey R, Suresh S, et al. Evaluation of automated pediatric sleep stage classification using U-Sleep: a convolutional neural network. <i>J Clin Sleep Med</i>. 2025;21(2):277-285.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"277-285"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arousal burden is highest in supine sleeping position and during light sleep.","authors":"Minna Pitkänen, Juho Huovinen, Marika Rissanen, Henna Pitkänen, Samu Kainulainen, Thomas Penzel, Francesco Fanfulla, Ulla Anttalainen, Tarja Saaresranta, Ludger Grote, Jan Hedner, Richard Staats, Brett Duce, Juha Töyräs, Arie Oksenberg, Timo Leppänen","doi":"10.5664/jcsm.11398","DOIUrl":"10.5664/jcsm.11398","url":null,"abstract":"<p><strong>Study objectives: </strong>Arousal burden (AB) is defined as the cumulative duration of arousals during sleep divided by the total sleep time. However, in-depth analysis of AB related to sleep characteristics is lacking. Based on previous studies addressing the arousal index, we hypothesized that the AB would peak in the supine sleeping position and during non-rapid eye movement stage 1 and show high variability between scorers.</p><p><strong>Methods: </strong>Nine expert scorers analyzed polysomnography recordings of 50 participants, the majority with an increased risk for obstructive sleep apnea. AB was calculated in different sleeping positions and sleep stages. A generalized estimating equation was used to test the association between AB and sleeping positions, sleep stages, and scorers. The correlation between AB and arousal index was tested with Spearman's rank-order correlation.</p><p><strong>Results: </strong>AB significantly differed between sleeping positions (<i>P</i> < .001). The median AB in the supine sleeping position was 47-62% higher than in the left and right positions. The AB significantly differed between the sleep stages (<i>P</i> < .001); the median AB was more than 200% higher during non-rapid eye movement stage 1 than during other sleep stages. In addition, the AB differed significantly between scorers (<i>P</i> < .001) and correlated strongly with arousal index (<i>r =</i> .935, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>AB depends on the sleeping position, sleep stage, and scorer, as hypothesized. AB behaved similarly to the arousal index, but the high variability in the ABs between scorers indicates a potential limitation caused by subjective manual scoring. Thus, the development of more accurate techniques for scoring arousals is required before AB can be reliably used.</p><p><strong>Citation: </strong>Pitkänen M, Huovinen J, Rissanen M, et al. Arousal burden is highest in supine sleeping position and during light sleep. <i>J Clin Sleep Med.</i> 2025;21(2):337-344.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"337-344"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REM sleep-related bradyarrhythmia syndrome.","authors":"Karolina Perez, Misty Shah, Aadhavi Sridharan, Stuart F Quan, Talal Moukabary, Imran Patel, Salma I Patel","doi":"10.5664/jcsm.11406","DOIUrl":"10.5664/jcsm.11406","url":null,"abstract":"<p><p>Rapid eye movement sleep-related bradyarrhythmia syndrome is a rare condition marked by abnormal sinus arrest or atrioventricular conduction disturbance blocks during rapid eye movement sleep unassociated with sleep-disordered breathing. We present a case of a young male without a cardiovascular history exhibiting pauses of up to 9.7 seconds during polysomnography. Initially referred for suspected obstructive sleep apnea due to nocturnal awakenings with shortness of breath, confusion, and dizziness. Polysomnography results were unremarkable apart from electrocardiogram findings revealing prolonged sinus pauses related to rapid eye movement sleep. Evaluation via extended 14-day patch monitor revealed an overall normal sinus rhythm with the lowest heart rate recorded at 14 beats per minute and 412 pauses exceeding 2 seconds, with the longest pause lasting 12.5 seconds during nocturnal hours. A permanent pacemaker was considered, but after shared decision making with the patient, the decision was to continue monitoring without any intervention.</p><p><strong>Citation: </strong>Perez K, Shah M, Sridharan A, et al. REM sleep-related bradyarrhythmia syndrome. <i>J Clin Sleep Med</i>. 2025;21(2):435-438.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"435-438"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program.","authors":"Alexander Sweetman, R Doug McEvoy, Michael S Frommer, Robert Adams, Ching Li Chai-Coetzer, Sallie Newell, Vivienne Moxham-Hall, Sally Redman","doi":"10.5664/jcsm.11374","DOIUrl":"10.5664/jcsm.11374","url":null,"abstract":"<p><strong>Study objectives: </strong>Insomnia is a highly prevalent and debilitating disorder. Cognitive behavioral therapy for insomnia (CBTi) is the recommended \"first line\" treatment, but is accessed by a minority of people with insomnia. This paper describes a system-level implementation program to improve access to CBTi in Australia to inform CBTi implementation in other locations.</p><p><strong>Methods: </strong>From 2019-2023, we conducted a program of work to promote sustained change in access to CBTi in Australia. Three distinct phases included (1) scoping and mapping barriers to CBTi access, (2) analysis and synthesis of barriers and facilitators to devise change goals, and (3) structured promotion and coordination of change. We used a system-level approach, knowledge brokerage, and codesign, and drew on qualitative, quantitative, and implementation science methods.</p><p><strong>Results: </strong>We identified barriers to CBTi access from the perspectives of people with insomnia, primary care clinicians, and the health system. A stakeholder advisory committee was convened to codesign change goals, identify modifiable barriers, devise program logic, and drive change strategies. We commenced a program to promote system-level change in CBTi access via: improved awareness and education of insomnia among primary care clinicians, self-guided interventions, and advocating to Government for additional CBTi funding mechanisms.</p><p><strong>Conclusions: </strong>This implementation program made significant progress toward improving access to CBTi in Australia. Ongoing work is required to continue this program, as long-term system-level change requires significant and sustained time, effort, and resources from multiple stakeholders. This program may be used to inform CBTi implementation activities in other locations.</p><p><strong>Citation: </strong>Sweetman A, McEvoy RD, Frommer MS, et al. Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program. <i>J Clin Sleep Med</i>. 2025;21(2):325-335.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"325-335"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responses to questions about Sunrise in the review on OSA wearables by Chiang et al.","authors":"Jean-Benoit Martinot, Nhat-Nam Le-Dong","doi":"10.5664/jcsm.11458","DOIUrl":"10.5664/jcsm.11458","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"451-452"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel.","authors":"Vaishnavi Kundel, Anjali Ahn, Michael Arzt, Jerryll Asin, Ali Azarbarzin, Nancy Collop, Aneesa Das, James C Fang, Rami Khayat, Thomas Penzel, Jean-Louis Pépin, Sunil Sharma, Maria V Suurna, Sudha Tallavajhula, Atul Malhotra","doi":"10.5664/jcsm.11424","DOIUrl":"10.5664/jcsm.11424","url":null,"abstract":"<p><p>Central sleep apnea (CSA) is commonly encountered among patients with sleep-disordered breathing; however, its clinical consequences are less well-characterized. The senior author (A.M.) therefore convened an expert panel to discuss the common presentations of CSA, as well as challenges and knowledge gaps in the diagnosis and management of CSA. The panel identified several key research priorities essential for advancing our understanding of the disorder. Within the diagnostic realm, panel members discussed the utility of multinight assessments and importance of the development and validation of novel metrics and automated assessments for differentiating central vs obstructive hypopneas, such that their impact on clinical outcomes and management may be better evaluated. The panel also discussed the current therapeutic landscape for the management of CSA and agreed that therapies should primarily aim to alleviate sleep-related symptoms, after optimizing treatment to address the underlying cause. Most importantly, the panel concluded that there is a need to further investigate the clinical consequences of CSA, as well as the implications of therapy on clinical outcomes, particularly among those who are asymptomatic. Future research should focus on endo-phenotyping central events for a better mechanistic understanding of the disease, validating novel diagnostic methods for implementation in routine clinical practice, as well as the use of combination therapy and comparative effectiveness trials in elucidating the most efficacious interventions for managing CSA.</p><p><strong>Citation: </strong>Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. <i>J Clin Sleep Med.</i> 2025;21(2):405-416.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"405-416"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}