Journal of Clinical Sleep Medicine最新文献

{"title":"Cognitive behavioral therapy for insomnia is associated with reduced sleep apnea severity but not its endotype traits in those with comorbid insomnia and sleep apnea.","authors":"Elliot J Brooker, Shane A Landry, Pedro R Genta, Gabriel T Abdelmessih, Bradley A Edwards, Sean P A Drummond","doi":"10.5664/jcsm.11636","DOIUrl":"10.5664/jcsm.11636","url":null,"abstract":"<p><strong>Study objectives: </strong>Cognitive behavioral therapy for insomnia (CBT-I) improves obstructive sleep apnea (OSA) severity in comorbid insomnia and sleep apnea, though the mechanisms underlying this change are unstudied. CBT-I, which promotes sleep continuity and reduces hyperarousal, may improve OSA by raising the respiratory arousal threshold. We aimed to investigate the effect of CBT-I on OSA severity and its impact on the arousal threshold and other endotype traits.</p><p><strong>Methods: </strong>In this single-arm trial, 25 patients with comorbid insomnia and sleep apnea (13 females and 12 males, mean age [standard deviation] = 53.7 [8.7] years) completed a 7-week individual CBT-I program. Patients met diagnostic criteria for insomnia and demonstrated an apnea-hypopnea index (AHI) ≥ 10 events/h (mean AHI [standard deviation] <i>=</i> 35.2 [16.4] events/h). Overnight polysomnography before and after CBT-I measured OSA severity, sleep architecture, and the 4 OSA endotypes (ie, collapsibility, muscle compensation, loop gain, and arousal threshold).</p><p><strong>Results: </strong>There was a 7.7 ± 10.2 events/h reduction in the AHI from baseline to posttreatment (<i>P</i> = .001) but no change in any of the OSA endotype traits studied (all <i>P</i> > .05). Secondary analyses showed a relationship whereby increases in stage N3 sleep were associated with decreases in AHI (<i>r</i>² = .19, <i>P</i> = .03). Significant improvements were also found in insomnia severity and sleep diary-based sleep efficiency, sleep onset latency, and wake after sleep onset at posttreatment (all <i>P</i> < .001).</p><p><strong>Conclusions: </strong>CBT-I is beneficial in improving insomnia symptoms and we provide further support CBT-I improves OSA severity. Despite no change in the OSA endotype traits, the improvement in the AHI may be associated with increased amounts of stage N3 sleep. These results underscore the importance of managing insomnia in comorbid insomnia and sleep apnea.</p><p><strong>Clinical trial registration: </strong>Registry: Australian New Zealand Clinical Trial Registry; Name: Project COMISA (Comorbid Insomnia and obstructive Sleep Apnea): A study investigating the effect of cognitive behavioral therapy for insomnia (CBT-I) on obstructive sleep apnea severity and cognitive functioning in patients experiencing COMISA; URL: http://www.anzctr.org.au/; Identifier: ACTRN12622000226707.</p><p><strong>Citation: </strong>Brooker EJ, Landry SA, Genta PR, Abdelmessih GT, Edwards BA, Drummond SPA. Cognitive behavioral therapy for insomnia is associated with reduced sleep apnea severity but not its endotype traits in those with comorbid insomnia and sleep apnea. <i>J Clin Sleep Med.</i> 2025;21(6):1041-1051.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1041-1051"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617746","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":"Evaluation of vestibular evoked myogenic potentials responses in patients with severe obstructive sleep apnea before and after continuous positive airway pressure therapy.","authors":"İbrahim Arslan, Mesut Güneş, Ömer Tarık Selçuk, Hülya Eyigör","doi":"10.5664/jcsm.11772","DOIUrl":"https://doi.org/10.5664/jcsm.11772","url":null,"abstract":"<p><strong>Study objectives: </strong>To investigate the diagnostic role of vestibular evoked myogenic potential (VEMP) in detecting potential damage to the otolithic organs and brainstem in patients with obstructive sleep apnea syndrome (OSAS) and evaluate the effect of continuous positive airway pressure (CPAP) therapy on the vestibular system through VEMP measurements.</p><p><strong>Methods: </strong>This single-center, prospective study included 51 patients with severe OSAS (102 ears) and 20 controls without OSAS (40 ears). Cervical and ocular VEMP tests were administered to both groups. For patients with OSAS, VEMP tests were repeated after three-month CPAP therapy. Pre- and post-treatment VEMP data were compared between the groups.</p><p><strong>Results: </strong>Patients with OSAS had significantly lower response rates of both ocular and cervical VEMP compared to controls (p=0.003 and p=0.027, respectively). In ocular VEMP, prolonged p1 and n1 latencies, shortened p1-n1 interpeak latencies, and decreased amplitudes were observed (p<0.0001 for all). In cervical VEMP, prolonged n1 and p1-n1 interpeak latencies and reduced amplitudes were noted (p<0.0001 for all), while no significant changes were observed in p1 latency. Significant post-treatment improvements were detected in ocular VEMP parameters, including n1 latency, p1-n1 latency, and amplitudes (p<0.0001, p=0.001, and p=0.001, respectively). Similarly, significant post-treatment improvements were observed in cervical VEMP parameters, namely n1 latency, p1-n1 latency, and amplitudes (p<0.0001, p<0.0001, and p=0.003, respectively). There was no significant change in p1 latency.</p><p><strong>Conclusions: </strong>Subclinical abnormalities in otolithic organs and the brainstem in severe OSAS could be detected early using non-invasive VEMP testing. VEMP tests also revealed that a three-month CPAP therapy ameliorated these vestibular system abnormalities.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144266","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":"Respiratory center function in patients under adaptive servoventilation: etiology and outcome.","authors":"Isabel Martinez-Gonzalez Posada, Ramon Fernandez Alvarez, Andres Ortiz Reyes, Marina Acebo Castro, Ines Ruiz Alvarez, Pablo Lozano Cuesta, Claudia Madrid Carvajal, Maria Vazquez López, Marta Garcia Clemente, Gemma Rubinos Cuadrado","doi":"10.5664/jcsm.11764","DOIUrl":"https://doi.org/10.5664/jcsm.11764","url":null,"abstract":"<p><strong>Study objectives: </strong>Central sleep apnea (CSA) is a sleep disorder characterized by instability in the respiratory center's (RC) function, leading to an excessive ventilatory response. The most effective treatment for these patients is adaptive servo-ventilation (ASV). We hypothesize that individuals with CSA may exhibit hyperresponsiveness of the RC, and ASV treatment could normalize its function. We aimed to measure the ventilatory response to hypercapnia (VRH) and its relationship with the outcomes following ASV treatment.</p><p><strong>Methods: </strong>A prospective study with repeated measurements was conducted on subjects with CSA treated with ASV. A VHR test was performed using p0.1/pEtCO₂ determinations: a first determination at the time of inclusion and a second one after at least six months of ASV treatment. We used the Pearson correlation test and the comparison of means (t-test) for independent and paired variables for statistical analysis. A p0.1/pEtCO₂ value of 0.43 cmH₂O/mmHg was considered a reference value.</p><p><strong>Results: </strong>We analyzed 46 subjects, 82% male. AHI 47/h (23), central AHI 27/h (12). The initial p0.1/pEtCO₂ was 0.48 (0.24) cmH₂O/mmHg, significantly higher than the reference value (p=0.02). After ASV treatment, 63% of subjects normalized p0.1/pEtCO₂ and decreased to 0.37 (0.23) cmH₂O/mmHg, which was significantly lower than the initial value (p=0.015) and comparable to the reference value (p=0.26). CSA secondary to opioid use has a substantially lower p0.1/pEtCO₂: 0.27 cmH₂O/mmHg SD 0.11 (p=0,021).</p><p><strong>Conclusions: </strong>VRH in patients with CSA and ASV treatment, could differentiate phenotypes and impact on therapeutic decisions.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144269","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":"Prescribing controlled substances in sleep medicine clinics: an overview of legal issues and best safety practices.","authors":"Bhanu Prakash Kolla, Michael H Silber, David R Rushlow, Kannan Ramar, Meghna P Mansukhani","doi":"10.5664/jcsm.11770","DOIUrl":"https://doi.org/10.5664/jcsm.11770","url":null,"abstract":"<p><strong>Study objectives: </strong>This review describes the legal and regulatory landscape surrounding controlled substance prescribing in sleep medicine, focusing on the Controlled Substance Act (CSA), Drug Enforcement Agency (DEA), and best practices. It explores abuse and dependence risks associated with these medications and addresses telemedicine and e-prescribing considerations.</p><p><strong>Methods: </strong>We synthesized information from the CSA, DEA, Centers for Disease Control and Prevention, Federation of State Medical Boards, peer-reviewed medical literature, and professional organizational position statements regarding controlled substances in sleep medicine.</p><p><strong>Results: </strong>Managing controlled substances in sleep medicine necessitates careful consideration of DEA scheduling, regulatory requirements, and potential risks. Opioids pose a risk of dependence or abuse, but the lower doses used in sleep medicine may mitigate this risk. There is less evidence available regarding the abuse potential of stimulants. Hypnotics and benzodiazepines require cautious prescribing due to the potential for long-term use by patients and possibility of dose escalation. Oxybates are subject to strict Risk Evaluation and Mitigation Strategy programs. Best practices include comprehensive patient evaluations, thorough risk assessments, Prescription Drug Monitoring Program checks, and transparent patient communication. Telemedicine prescribing is governed by strict regulatory statutes, with temporary exceptions currently in place.</p><p><strong>Conclusions: </strong>Controlled substances are vital for managing various sleep disorders. Balancing patient access to effective medications while minimizing abuse and diversion is crucial. Further research is needed to refine risk assessment tools and develop standardized protocols, particularly for non-opioids. The evolving role of telemedicine and e-prescriptions requires ongoing evaluation and adaptation of practices to ensure patient safety and regulatory compliance.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121224","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":"Mechanisms associated with obstructive sleep apnea in achondroplasia.","authors":"G Dave Singh","doi":"10.5664/jcsm.11778","DOIUrl":"https://doi.org/10.5664/jcsm.11778","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121218","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":"Sleep research, quality and implementation priorities in the Veterans Health Administration: a white paper.","authors":"Q Afifa Shamim-Uzzaman, Michelle R Zeidler, Eilis A Boudreau, Susmita Chowdhuri, Lucas M Donovan, Ali El-Solh, Amado X Freire, Daniel J Gottlieb, Ripu D Jindal, Sean Hesselbacher, Brian Koo, Samuel Kuna, Miranda M Lim, Sherwin Mina, Carl Stepnowsky, Sadeka Tamanna, Lauren Tobias, Christi Ulmer, Klar Yaggi, Salim Surani, Charles Atwood, Kathleen Sarmiento, Octavian C Ioachimescu","doi":"10.5664/jcsm.11734","DOIUrl":"https://doi.org/10.5664/jcsm.11734","url":null,"abstract":"<p><p>The Veterans Administration (VA) seeks to improve the quality of life and long-term health outcomes for Veterans facing unique sleep challenges related to their military service. The prevalence and burden of sleep disorders among military service members and Veterans are alarmingly high, often worsened by inadequate sleep environments, insufficient sleep, shift work, and exposure to trauma. VA's National Sleep Medicine Program Office (SMPO) has outlined key priorities for enhancing sleep medicine research and quality improvement. These recommendations reflect the consensus within the Sleep Research and Quality Improvement Subcommittee of the Field Advisory Board for the SMPO. These priorities include advancing sleep science at basic, clinical, and population levels; promoting sleep health through personalized treatment strategies tailored to Veterans; increasing funding for sleep research; establishing a network of VA sleep research centers to conduct high-quality, multi-center, collaborative studies; developing a veteran-specific portfolio of sleep research and innovations; and optimizing the dissemination of diagnostic tools and therapies through quality improvement initiatives. VA aims to achieve these goals through a series of strategic objectives and milestones that consider importance, timeline, effort, and cost. Specific topics of interest are highlighted and investigators are encouraged to address knowledge gaps in these areas. This white paper seeks to strengthen sleep research within VA by developing a comprehensive pipeline of researchers and systematically evaluating strategies to improve sleep health care for Veterans. The ultimate goal is to generate actionable insights that could potentially influence broader sleep-related clinical guidelines and policies within and beyond the VA healthcare system.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081676","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":"Pediatric sleep movements: a review of methodologies, normative data, disease associations and research gaps.","authors":"Mimi Lu, Dominic A Fitzgerald, Mark B Norman, Colin E Sullivan, Karen A Waters","doi":"10.5664/jcsm.11748","DOIUrl":"https://doi.org/10.5664/jcsm.11748","url":null,"abstract":"<p><p>Restless sleep is a common complaint among children, yet its quantification and clinical significance remain poorly defined. Polysomnography (PSG), the standard diagnostic tool for sleep disorders, often fails to fully explain restlessness, even when other conditions are excluded. Measuring body movement indices, proposed as an objective marker of sleep restlessness but lacking a standardized methodology, currently has limited clinical application. Recent efforts by the International Restless Legs Syndrome Study Group (IRLSSG) have led to consensus diagnostic criteria for restless sleep disorder (RSD) that incorporate both subjective and objective measures. We review various methodologies used to quantify body movements during sleep, including PSG with video recordings, actigraphy and less invasive 'contactless' device. Key discrepancies in measurement techniques and normative data reporting are identified. To advance the inclusion of this disorder into the clinical setting, we collated and compared studies providing normative values for sleep movements across different populations and explore their relevance to other disorders. Providing a historical perspective on how measurements sleep movement has evolved, shows how technological advancements have influenced current approaches. In this context, the consequences of restless sleep and its potential impact on neurocognitive and behavioral outcomes are then discussed. We conclude by highlighting key knowledge gaps and proposing future research directions.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081674","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":"Comorbid sleep disorders among individuals with spinal cord injury.","authors":"Abdulghani Sankari, Ahmad Aldwaikat, Moustafa Habra, Anan Salloum, Salam Zeineddine, Nishtha Pandya, Jennifer L Martin, M Safwan Badr","doi":"10.5664/jcsm.11752","DOIUrl":"10.5664/jcsm.11752","url":null,"abstract":"<p><strong>Study objectives: </strong>To determine the rate of sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). and its types (central and obstructive, and combined (COSA) and to assess the response to treatment using positive airway pressure (PAP) (defined as an apnea-hypopnea index (AHI) of less than 5 events per hour on initial PAP titration) in individuals with SCI.</p><p><strong>Methods: </strong>Individuals with SCI who underwent a full night of diagnostic polysomnography (PSG) from to 2010-2024 to determine the type of SDB and its severity using the AHI and central apnea index (CAI). The inclusion criteria were individuals with chronic SCI at low cervical or thoracic (at C4-T6 levels). who are not mechanically ventilated or had tracheostomies. \"Central sleep apnea (CSA)\" is diagnosed with an AHI of 5+ events/h and a CAI of at least 50% of the AHI. \"Obstructive sleep apnea (OSA) only\" is identified by an AHI of 5+ events/h and a CAI of less than 5 events/h. COSA is characterized by an AHI of 5+ events/h, with a CAI over 5 events/h but under 50% of the total AHI. The positive response to PAP therapy was based on the AHI level of less than 5 events/h after initiating PAP treatment and based on remote monitoring data.</p><p><strong>Results: </strong>Among the 81 individuals who met the inclusion criteria, 12 patients (15%) were diagnosed with COSA, 4 patients (5%) presented with CSA only, 56 patients (69%) had OSA, and 8 patients (10%) exhibited no SDB. In a subset of participants (N=51) hypopneas were classified as obstructive or central events based on American Academy of Sleep Medicine (AASM) definition and revealed that approximately one-third (32%) had central or COSA, 63% had OSA, and 6% did not have SDB on PSG. A total of 35 (47%) individuals diagnosed with SDB underwent PAP titration and were prescribed PAP. Twenty (27%) individuals received PAP treatment, and only 17 (23%) continued their use for the initial three months. Only 11 patients (15%) demonstrated responsiveness to PAP on day 90 (AHI<5 during therapy).</p><p><strong>Conclusions: </strong>SDB is extremely common in individuals with SCI. The efficacy of PAP therapy is suboptimal, and adherence rates decline significantly over time.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030585","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":"Treatment-emergent central sleep apnea after initiation of hypoglossal nerve stimulator.","authors":"Jonathan Tam, Farnaz Abbasmoradi, Lourdes M DelRosso","doi":"10.5664/jcsm.11728","DOIUrl":"https://doi.org/10.5664/jcsm.11728","url":null,"abstract":"<p><p>Treatment emergent central sleep apnea occurs when primary obstructive sleep apnea improves with positive airway pressure treatment, but central events emerge or persist. While documented with positive airway pressure and other treatment modalities, emergence of central sleep apnea has rarely been reported with hypoglossal nerve stimulation. In this case report, we present two patients who developed central apnea during hypoglossal nerve stimulator titration with emergence of central events at higher voltages. Central apneas resolved in both patients at follow-up when maintained at stable voltages; however, in one patient, central apnea recurred upon trialing higher voltages. These cases demonstrate that treatment emergent sleep apnea can also be considered as a potential consequence of treatment of obstructive sleep apnea with hypoglossal nerve stimulator.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038690","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":"Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey.","authors":"M Melanie Lyons, Dennis H Auckley, Babak Mokhlesi, Jean G Charchaflieh, John V Myers, Meltem Yilmaz, Lisa M Williams, Meena S Khan, Elizabeth B Card, Brian J Gelfand, Michael A Pilla, Theodore O Loftsgard, Amy M Sawyer, Lea Ann Matura, Melissa A Carlucci, Ashima S Sahni, Kathleen M Glaser, Dana E Al Ghussain, Guy N Brock, Nitin Y Bhatt, Ulysses J Magalang, Ilene M Rosen, Bhargavi Gali","doi":"10.5664/jcsm.11528","DOIUrl":"10.5664/jcsm.11528","url":null,"abstract":"<p><strong>Study objectives: </strong>Physicians-in-training (residents, fellows) and advanced practice providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period.</p><p><strong>Methods: </strong>Electronic-mail surveys were sent to physicians-in-training and APPs, in 5 categories of practice (anesthesiology, internal medicine, family medicine, obstetrics/gynecology/gynecologic oncology, and surgery) at 9 major institutions. Cochran-Mantel-Haenszel tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-<i>P</i> values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from Cochran-Mantel-Haenszel tests.</p><p><strong>Results: </strong>We received 2,236/6,724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-<i>P</i> < .001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-<i>P</i> < .001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-<i>P</i> < .001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-<i>P</i> < .001) as anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in surgery (48%) and obstetrics/gynecology/gynecologic oncology (46%) reported not routinely asking. Differences also existed by physician postgraduate year clinical training (FDR-adjusted-<i>P</i> = .005) with those with higher postgraduate year reporting they asked about OSA more often.</p><p><strong>Conclusions: </strong>Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.</p><p><strong>Citation: </strong>Lyons MM, Auckley DH, Mokhlesi B, et al. Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey. <i>J Clin Sleep Med</i>. 2025;21(5):765-773.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"765-773"},"PeriodicalIF":3.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915697","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}