Journal of Clinical Sleep Medicine最新文献

{"title":"Positional therapy: is it ready for prime time?","authors":"Shalini Manchanda, Ninotchka Liban Sigua","doi":"10.5664/jcsm.11510","DOIUrl":"10.5664/jcsm.11510","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"221-222"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective crossover trial of positional and CPAP therapy for the treatment of mild-to-moderate positional obstructive sleep apnea.","authors":"Malcolm R Wilson, Robert Carroll, Stephen Kinder, Alexander Ryan, Craig A Hukins, Brett Duce, Claire M Ellender","doi":"10.5664/jcsm.11378","DOIUrl":"10.5664/jcsm.11378","url":null,"abstract":"<p><strong>Study objectives: </strong>We evaluated the efficacy of vibrotactile positional therapy (PT) compared to standard continuous positive airway pressure (CPAP) therapy in mild-to-moderate positional obstructive sleep apnea.</p><p><strong>Methods: </strong>We conducted a prospective crossover randomized controlled trial of adult patients with treatment-naïve, symptomatic, mild-to-moderate positional obstructive sleep apnea, defined as ≥ 5 total apnea-hypopnea index < 30 with supine-to-nonsupine apnea-hypopnea index ratio ≥ 2. Participants were randomized to in-laboratory treatment initiation polysomnography with either PT or CPAP on sequential nights before an 8-week trial of each therapy. The primary end point was symptomatic improvement (Epworth Sleepiness Scale; ΔESS). Secondary end points included patient preference, usage, sleep architecture, and quality of life measures.</p><p><strong>Results: </strong>A total of 52 participants were enrolled and completed both arms of the study. Participants were symptomatic with a median ESS score of 12 (interquartile range, 10-14). Treatment resulted in a significant (<i>P</i> < .001) symptomatic improvement with both PT and CPAP (ΔESS 4; interquartile range, 6-11) without a significant difference between treatment arms (<i>P =</i> .782). PT was effective at restricting supine sleep and demonstrated improved sleep efficiency compared with CPAP, although no better than baseline. Both therapies were effective at reducing apnea-hypopnea index, although CPAP demonstrated superior apnea-hypopnea index reduction. There were otherwise no clinically significant differences in sleep architecture, usage, or secondary outcomes including overall patient preference.</p><p><strong>Conclusions: </strong>In this cohort, treatment with PT or CPAP resulted in clinically significant symptomatic improvement (ΔESS) that was not significantly different between treatment arms. No real difference was seen in other secondary outcome measures. This study provides further evidence to support the use of PT as an alternative first-line therapy with CPAP in appropriately selected patients with positional obstructive sleep apnea.</p><p><strong>Clinical trial registration: </strong>Registry: Australian New Zealand Clinical Trials Registry; Name: Prospective crossover trial of Positional and Continuous positive airway pressure Therapy for the treatment of mild-to-moderate positional obstructive sleep apnea; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377221&isReview=true; Identifier: ACTRN12619000475145.</p><p><strong>Citation: </strong>Wilson MR, Carroll R, Kinder S, et al. Prospective crossover trial of positional and CPAP therapy for the treatment of mild-to-moderate positional obstructive sleep apnea. <i>J Clin Sleep Med.</i> 2025;21(2):305-313.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"305-313"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central sleep apnea: realignment required.","authors":"Winfried Randerath, Esther Irene Schwarz","doi":"10.5664/jcsm.11476","DOIUrl":"10.5664/jcsm.11476","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"227-228"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the hidden risks of CPAP device innovations and the necessity of patient-centric testing.","authors":"Gimbada Benny Mwenge, Giuseppe Liistro, Charlotte Smetcoren, Charlotte Debaille","doi":"10.5664/jcsm.11384","DOIUrl":"10.5664/jcsm.11384","url":null,"abstract":"<p><p>A 72-year-old patient had a severe sleep apnea syndrome well controlled for many years through continuous positive airway pressure therapy. When switching to a newer device with upgraded functions, therapy completely failed. A video recording performed by the patient's wife showed high-frequency mask movements suggesting inability to maintain a therapeutic pressure with high-frequency pressure fluctuations, confirmed afterwards during full night polysomnography and in a bench study. Continuous positive airway pressure therapy manufacturers may put on the market new devices with supposedly better algorithms that in fact may have escaped serious premarketing evaluation and that may jeopardize the efficacy of a well proven treatment. We suggest that better evaluations are necessary before marketing therapeutic devices, and that postmarketing assessment of unanticipated side effects should become the norm.</p><p><strong>Citation: </strong>Mwenge GB, Liistro G, Smetcoren C, Debaille C. Unveiling the hidden risks of CPAP device innovations and the necessity of patient-centric testing. <i>J Clin Sleep Med</i>. 2025;21(2):421-425.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"421-425"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public engagement with consumer sleep technology for obstructive sleep apnea screening: implications for equity, access, and practice.","authors":"Nicholas R Lenze, Ruby J Kazemi, Allison K Ikeda, Punithavathy Vijayakumar, Cathy A Goldstein, Jeffrey J Stanley, Michael J Brenner, Paul T Hoff","doi":"10.5664/jcsm.11418","DOIUrl":"10.5664/jcsm.11418","url":null,"abstract":"<p><strong>Study objectives: </strong>To characterize public practices and perspectives on the use of consumer sleep technology (CST) and evaluate perspectives on using CST as a screening tool for obstructive sleep apnea.</p><p><strong>Methods: </strong>We designed a survey instrument incorporating content from validated instruments (STOP-Bang and the Epworth Sleepiness Scale) and hypothesis-generated questions. Survey development involved multidisciplinary collaboration among 3 board-certified sleep medicine experts, researchers, and consumers. The survey was disseminated across a national sample of adults living in the United States via an online platform.</p><p><strong>Results: </strong>Among 897 respondents, the mean (standard deviation) age was 47.5 (16.9) years; 73.1% were female, 81.8% were White, and 505 respondents (56.3%) reported having tracked sleep using CST. Factors associated with decreased odds of CST use included household income < $30,000 (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.28-0.79; <i>P</i> = .004), Medicaid insurance (OR 0.43, 95% CI 0.26-0.69; <i>P</i> = .001), Medicare insurance (OR 0.59, 95% CI 0.41-0.84; <i>P</i> = .004), and lack of a primary care physician (OR 0.55, 95% CI 0.33-0.91; <i>P</i> = .021). Most respondents (91.1%) agreed or strongly agreed that screening for obstructive sleep apnea would be a useful feature of CST, but respondents reporting an education of high school diploma or less (OR 0.48, 95% CI 0.29-0.79; <i>P</i> = .004) were less likely to agree with this statement.</p><p><strong>Conclusions: </strong>Attitudes toward and use of CST differed based on demographic and socioeconomic factors. Further study is needed to understand and address barriers to CST adoption and to characterize implications for equitable access to care for sleep disorders.</p><p><strong>Citation: </strong>Lenze NR, Kazemi RJ, Ikeda AK, et al. Public engagement with consumer sleep technology for obstructive sleep apnea screening: implications for equity, access, and practice. <i>J Clin Sleep Med</i>. 2025;21(2):345-353.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"345-353"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for permanent sleep telehealth: an American Academy of Sleep Medicine position statement.","authors":"Kunwar Praveen Vohra, Karin G Johnson, Ashtaad Dalal, Sally Ibrahim, Vidya Krishnan, Fariha Abbasi-Feinberg, Alexandre Rocha Abreu, Anuja Bandyopadhyay, Indira Gurubhagavatula, David Kuhlmann, Jennifer L Martin, Eric J Olson, Susheel P Patil, Anita V Shelgikar, Lynn Marie Trotti, Emerson M Wickwire, James A Rowley, Vishesh K Kapur","doi":"10.5664/jcsm.11438","DOIUrl":"10.5664/jcsm.11438","url":null,"abstract":"<p><p>Telehealth use greatly expanded under the Centers for Medicare and Medicaid Services waivers at the start of the COVID-19 pandemic; however, the uncertainty and limitations of continued coverage risks loss of this momentum. Permanent coverage with adequate reimbursement is essential for the long-term acceptance and expansion of telehealth services. Telehealth supports both the current and future need for sleep health management by expanding patient access, increasing clinician efficiency, improving patient safety, and addressing health care equity. Sleep medicine is an ideal field for telehealth due to limited provider access, safety concerns with sleepy patients, availability of remote patient monitoring for treatment management, and the minimal need for repeated physical examinations. Telehealth is noninferior for delivery of cognitive behavioral therapy for insomnia and can enhance obstructive sleep apnea treatment adherence. It is the position of the American Academy of Sleep Medicine that telehealth is an essential tool for the provision of high-quality, patient-centered care for patients with sleep disorders. We encourage all stakeholders including legislators, policymakers, clinicians, and patients to work together to address payment models, interstate care, technology access, prescribing practices, and ongoing research to ensure that sleep telehealth services are permanently available and accessible for all patients seeking sleep medicine care.</p><p><strong>Citation: </strong>Vohra KP, Johnson KG, Dalal A, et al. Recommendations for permanent sleep telehealth: an American Academy of Sleep Medicine position statement. <i>J Clin Sleep Med</i>. 2025;21(2):401-404.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"401-404"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-diagnostic chest-worn patch to detect obstructive sleep apnea and cardiac arrhythmias.","authors":"Cathy Goldstein, Hamid Ghanbari, Surina Sharma, Nancy Collop, Zak Loring, Colleen Walsh, Brennan Torstrick, Emily Herreshoff, Mark Pollock, David S Frankel, Ilene M Rosen","doi":"10.5664/jcsm.11522","DOIUrl":"https://doi.org/10.5664/jcsm.11522","url":null,"abstract":"<p><strong>Study objectives: </strong>Evaluate the performance of the SANSA device to simultaneously assess obstructive sleep apnea (OSA) and cardiac arrhythmias.</p><p><strong>Methods: </strong>Participants suspected or known to have OSA underwent polysomnography (PSG) while wearing SANSA. SANSA's algorithm was trained using 86 records and tested on 67 to evaluate training bias. SANSA performance was evaluated against ground truth PSG scored by the consensus of three technologists. PSG scoring from individual testing sites was also evaluated against consensus. Diagnostic performance was evaluated using standard apnea-hypopnea index (AHI) cutoffs. AHI and total sleep time (TST) agreement was analyzed using correlation and Bland-Altman plots. ECG was reviewed for presence of significant arrhythmias (frequent premature atrial/ventricular complexes and atrial fibrillation).</p><p><strong>Results: </strong>SANSA's sensitivity and specificity to detect OSA ranged from 91-97% and 78-97%, respectively, across all severity levels. SANSA TST correlation with Consensus PSG TST was 0.83 with a mean difference of 3.8 minutes (limits of agreement: -91.1 to 98.7). Significant arrhythmias were detected in 32% of participants. These participants had a greater AHI (27.5 versus 15.8, P=0.003) and spent nearly twice as long at reduced oxygenation levels (47.5 versus 20.5 minutes under 88% SpO₂, P = 0.009).</p><p><strong>Conclusions: </strong>SANSA is a promising tool for comprehensive OSA evaluation, offering the unique advantage of concurrent arrhythmia detection. This dual functionality may improve patient outcomes through early diagnosis and management of both conditions.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061418","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":"Images: Pharmacological treatment of pediatric insomnia: a successful trial of doxepin.","authors":"Xinhang Tu, Christine A Matarese, Robin Lloyd, Channing Sorensen, Scott T Schmidt, Julie M Baughn","doi":"10.5664/jcsm.11500","DOIUrl":"https://doi.org/10.5664/jcsm.11500","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054093","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":"Clinical significance criteria in the ICSD and DSM sleep disorder classifications: a content overlap analysis using the Jaccard index.","authors":"Christophe Gauld, Vincent P Martin, Clélia Quilès, Pierre-Alexis Geoffroy, Julien Coelho, Pierre Philip, Régis Lopez, Jean-Arthur Micoulaud-Franchi","doi":"10.5664/jcsm.11570","DOIUrl":"https://doi.org/10.5664/jcsm.11570","url":null,"abstract":"<p><strong>Study objectives: </strong>Both the <i>International Classification of Sleep Disorders</i> (ICSD) and the sleep-wake disorders section of the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (DSM) emphasize the importance of clinical judgment in distinguishing the normal from the pathological in sleep medicine. The fourth edition of the DSM (DSM-IV, 1994) introduced the clinical significance criterion (CSC) to standardize this judgment and enhance diagnostic reliability.</p><p><strong>Methods: </strong>This review conducts a theoretical and historical content analysis of CSC presence, frequency, and formulation in the diagnostic criteria of sleep disorders. Three steps were undertaken: i) selecting main sleep disorder classifications and main disorders within them, ii) systematically extracting CSC-related content, and iii) analyzing the evolution of CSC presence through quantification (Jaccard index) and visualization (radar plots).</p><p><strong>Results: </strong>The fifth edition, text revision of the DSM (DSM-5-TR) includes CSC in five of nine main sleep disorders, compared to two in the third edition, text revision of the ICSD (ICSD-3-TR) (circadian rhythm sleep-wake disorder and nightmare disorder). The overlap between DSM-5-TR and ICSD-3-TR is moderate (Jaccard index = 0.40). The overlap between DSM versions is higher (0.53). Conversely, ICSD revisions exhibit minimal similarity (0.16). Radar plots reveal a gradual increase in CSC use within ICSD versions.</p><p><strong>Conclusions: </strong>These results highlight the variable application of CSC in sleep disorder classifications. Universal CSC inclusion may not be essential, but systematic discussion of its potential use can help refine diagnostic criteria. This refinement is important for accurately diagnosing sleep disorders and better differentiating the normal from the pathological, a major challenge in sleep medicine.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043280","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":"Hand dominance shift during sleep in sexsomnia: a clue to pathophysiology?","authors":"Alon Y Avidan, Rosa Hasan, Varun Badami, Carlos H Schenck","doi":"10.5664/jcsm.11554","DOIUrl":"10.5664/jcsm.11554","url":null,"abstract":"<p><strong>Study objectives: </strong>To elucidate whether awake handedness in sexsomnia is retained during sleep to uncover potential clues about the underlying neurophysiologic mechanisms.</p><p><strong>Methods: </strong>Participants' and observers' self-reported handedness during sexsomnia events.</p><p><strong>Results: </strong>Case 1: A 22 y/o right-handed female with an eight-year history of nocturnal sleep-related masturbatory behavior (SMB) involving the left hand (LH) exclusively. Case 2: A 30 y/o ambidextrous male with SMB involving both hands, but most prominently the LH. Case 3: A 33 y/o right-handed female with exclusively LH SMB in the setting of acute multiple sclerosis exacerbation with cervical spinal cord and brainstem involvement. Case 4: A 44 y/o right-handed (RH) male with bilateral dream enactment behavior (DEB) and LH-predominant SMB noted by the bed partner (BP). Case 5: A 59 y/o RH female with a history of multiple system atrophy (MSA) and REM sleep behavior disorder (RBD) developed a new SMB, noted by the BP involving exclusively the LH. Case 6: A 37y/o RH man with inappropriate sexual behaviors involving the non-dominant LH without retention of memory for the events. Case 7: A 17 y/o RH male with polysomnographic evidence of genital manipulation using both hands but predominantly involving the non-dominant hand.</p><p><strong>Conclusions: </strong>We speculate that sexsomnias originate from CPG in the brainstem and spinal cord, as opposed to the cerebral cortex. The lack of involvement of cerebral motor control is further substantiated by amnesia for sexsomnia events. The implications of this data provide fundamental new clues about the mechanism of sexsomnias with critical forensic implications.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015301","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}