Pub Date : 2019-08-01DOI: 10.1093/med/9780190671099.003.0012
Silvia Neme-Mercante, Zahreddin Alsheikhtaha, N. Foldvary-Schaefer
Sleep-related hypermotor epilepsy, previously known as nocturnal frontal lobe epilepsy, is a focal epilepsy with seizures arising from sleep, typically involving activation of ventromesial frontal, insular, or frontoparietal networks. The etiology may be genetic or due to structural pathology but in most cases is unknown. Seizures are characterized by hypermotor activity with violent proximal limb movements or tonic-dystonic posturing, usually short in duration and often in clusters during non–rapid-eye-movement (NREM) sleep and sleep/wake transitions. The differentiation of seizures from physiologically arousals or pathological arousals (NREM parasomnias) is often challenging, and misdiagnosis is common. Video electroencephalography-polysomnography recording typical events is often required to confirm the diagnosis.
{"title":"Like Clockwork","authors":"Silvia Neme-Mercante, Zahreddin Alsheikhtaha, N. Foldvary-Schaefer","doi":"10.1093/med/9780190671099.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780190671099.003.0012","url":null,"abstract":"Sleep-related hypermotor epilepsy, previously known as nocturnal frontal lobe epilepsy, is a focal epilepsy with seizures arising from sleep, typically involving activation of ventromesial frontal, insular, or frontoparietal networks. The etiology may be genetic or due to structural pathology but in most cases is unknown. Seizures are characterized by hypermotor activity with violent proximal limb movements or tonic-dystonic posturing, usually short in duration and often in clusters during non–rapid-eye-movement (NREM) sleep and sleep/wake transitions. The differentiation of seizures from physiologically arousals or pathological arousals (NREM parasomnias) is often challenging, and misdiagnosis is common. Video electroencephalography-polysomnography recording typical events is often required to confirm the diagnosis.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"2020 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80916393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0008
Frank M. Ralls, M. Grigg-Damberger
This chapter reviews the evaluation and treatment of a 7-year-old girl with Down syndrome who had difficulty tolerating positive airway pressure (PAP) therapy. Children with Down syndrome are at high risk for symptomatic residual obstructive sleep apnea after AT. Treating children, especially those with developmental delays, behavior problems, and/or anxiety, with PAP requires patience, flexibility, and ingenuity. PAP therapy can be particularly challenging in children with tactile aversion. Gradual exposure to the mask and machine (operant conditioning) can facilitate habituation. PAP practice sessions should start with an enjoyable calming activity so the child begins to associate PAP with pleasant positive experiences. Maternal education about the indications for, risks or, and benefits of PAP to treat sleep apnea in children was the best predictor of mean hours used per night.
{"title":"No Easy Way Down","authors":"Frank M. Ralls, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0008","url":null,"abstract":"This chapter reviews the evaluation and treatment of a 7-year-old girl with Down syndrome who had difficulty tolerating positive airway pressure (PAP) therapy. Children with Down syndrome are at high risk for symptomatic residual obstructive sleep apnea after AT. Treating children, especially those with developmental delays, behavior problems, and/or anxiety, with PAP requires patience, flexibility, and ingenuity. PAP therapy can be particularly challenging in children with tactile aversion. Gradual exposure to the mask and machine (operant conditioning) can facilitate habituation. PAP practice sessions should start with an enjoyable calming activity so the child begins to associate PAP with pleasant positive experiences. Maternal education about the indications for, risks or, and benefits of PAP to treat sleep apnea in children was the best predictor of mean hours used per night.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82926172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0002
N. Foldvary-Schaefer, M. Grigg-Damberger, R. Mehra
This chapter provides an overview of sleep testing performed inside or outside the sleep laboratory. The chapter reviews the classification of sleep studies and methodology of in-lab polysomnography and home sleep apnea testing. Specifically, the indications for and relative contraindications and limitations of both procedures are discussed. Positive airway pressure (PAP) titration procedures are reviewed and the PAP-NAP, an abbreviated daytime study for patients with sleep apnea and PAP intolerance or hesitancy, is described. The authors also discuss the methodology of, indications for, and interpretation of the multiple sleep latency test and the maintenance of wakefulness test, which are daytime studies performed to evaluate excessive daytime sleepiness. Finally, the role of actigraphy in the evaluation of sleep disorders is discussed.
{"title":"Introduction to Sleep Testing","authors":"N. Foldvary-Schaefer, M. Grigg-Damberger, R. Mehra","doi":"10.1093/MED/9780190671099.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0002","url":null,"abstract":"This chapter provides an overview of sleep testing performed inside or outside the sleep laboratory. The chapter reviews the classification of sleep studies and methodology of in-lab polysomnography and home sleep apnea testing. Specifically, the indications for and relative contraindications and limitations of both procedures are discussed. Positive airway pressure (PAP) titration procedures are reviewed and the PAP-NAP, an abbreviated daytime study for patients with sleep apnea and PAP intolerance or hesitancy, is described. The authors also discuss the methodology of, indications for, and interpretation of the multiple sleep latency test and the maintenance of wakefulness test, which are daytime studies performed to evaluate excessive daytime sleepiness. Finally, the role of actigraphy in the evaluation of sleep disorders is discussed.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77651879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0024
M. Horan, Sally Ibrahim, Petra Olivieri
The patient presented in this chapter had uncontrolled obstructive sleep apnea (OSA) and was intolerant of positive airway pressure (PAP). Previous conservative and surgical interventions failed. The patient was successfully treated with maxillomandibular advancement (MMA) surgery. Although many patients benefit from first-line therapy with PAP for OSA, some are intolerant of PAP and require discussion of alternative treatments. Maxillofacial surgical approaches are an option for the treatment of OSA in patients whose craniofacial anatomy is anatomically appropriate. With MMA, patients can achieve significant improvement and in many cases can achieve cure of OSA. Multiple studies support the benefits of MMA in those who are candidates for this treatment.
{"title":"On the Cutting Edge","authors":"M. Horan, Sally Ibrahim, Petra Olivieri","doi":"10.1093/MED/9780190671099.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0024","url":null,"abstract":"The patient presented in this chapter had uncontrolled obstructive sleep apnea (OSA) and was intolerant of positive airway pressure (PAP). Previous conservative and surgical interventions failed. The patient was successfully treated with maxillomandibular advancement (MMA) surgery. Although many patients benefit from first-line therapy with PAP for OSA, some are intolerant of PAP and require discussion of alternative treatments. Maxillofacial surgical approaches are an option for the treatment of OSA in patients whose craniofacial anatomy is anatomically appropriate. With MMA, patients can achieve significant improvement and in many cases can achieve cure of OSA. Multiple studies support the benefits of MMA in those who are candidates for this treatment.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80825903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0011
V. Krishnan
Distant travels can affect sleep in many ways. Jet lag disorder is a specific circadian sleep disorder characterized by misalignment of the inherent circadian rhythm and the external environment caused by rapid travel across multiple time zones. Travel fatigue due to repetitive long-distance travels may affect a traveler’s daytime function and mood. Airplane travel and high-altitude locations may contribute to travel-related fatigue. The sleep environment—including the comfort of the bed, the ambient light, sounds, temperature, and air quality—can all interfere with optimal sleep. Changes in daytime eating, drinking, and activity levels can also impose stresses on sleep. Countermeasures for each of these conditions can help ensure a more restful journey. Duration of travel, distance of journey, time for preparation, and time for post-travel recovery will all influence the recommendations to mitigate jet lag disorder symptoms.
{"title":"A Journey Through Time and Sleep","authors":"V. Krishnan","doi":"10.1093/MED/9780190671099.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0011","url":null,"abstract":"Distant travels can affect sleep in many ways. Jet lag disorder is a specific circadian sleep disorder characterized by misalignment of the inherent circadian rhythm and the external environment caused by rapid travel across multiple time zones. Travel fatigue due to repetitive long-distance travels may affect a traveler’s daytime function and mood. Airplane travel and high-altitude locations may contribute to travel-related fatigue. The sleep environment—including the comfort of the bed, the ambient light, sounds, temperature, and air quality—can all interfere with optimal sleep. Changes in daytime eating, drinking, and activity levels can also impose stresses on sleep. Countermeasures for each of these conditions can help ensure a more restful journey. Duration of travel, distance of journey, time for preparation, and time for post-travel recovery will all influence the recommendations to mitigate jet lag disorder symptoms.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82086001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0032
Mohammed Alzoubaidi, B. Mokhlesi
This chapter outlines the growing evidence that obstructive sleep apnea during rapid-eye-movement sleep (REM-related OSA) is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. The authors also review the clinical implications of the duration of nightly continuous positive airway pressure (CPAP) use that is needed to effectively treat REM-related OSA. Current CPAP adherence guidelines of 4 hours/night potentially leave the majority of REM-related OSA untreated. Thus, the optimal duration of positive airway pressure therapy to effectively treat REM OSA requires clarification. Clinicians should encourage patients with REM-related OSA to increase CPAP usage to include the early morning hours, before awakening. Further research is needed to establish whether patients with significant REM-related OSA but an overall normal Apnea–Hypopnea Index would benefit from treatment.
{"title":"A Case of Sleepiness and Turbulent Dreams","authors":"Mohammed Alzoubaidi, B. Mokhlesi","doi":"10.1093/MED/9780190671099.003.0032","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0032","url":null,"abstract":"This chapter outlines the growing evidence that obstructive sleep apnea during rapid-eye-movement sleep (REM-related OSA) is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. The authors also review the clinical implications of the duration of nightly continuous positive airway pressure (CPAP) use that is needed to effectively treat REM-related OSA. Current CPAP adherence guidelines of 4 hours/night potentially leave the majority of REM-related OSA untreated. Thus, the optimal duration of positive airway pressure therapy to effectively treat REM OSA requires clarification. Clinicians should encourage patients with REM-related OSA to increase CPAP usage to include the early morning hours, before awakening. Further research is needed to establish whether patients with significant REM-related OSA but an overall normal Apnea–Hypopnea Index would benefit from treatment.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91320368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0018
R. Hiensch, N. Shah
Delayed sleep/wake phase disorder (DSWPD) is the most common circadian rhythm disorder. It is characterized by persistently delayed sleep onset and wake times relative to conventional norms. Individuals usually present in young adulthood with symptoms of sleep-onset insomnia, sleep inertia, and excessive daytime sleepiness due to sleep deprivation when societal commitments require significantly earlier than desired sleep and wake times. Sleep quality itself is normal. The diagnosis can usually be made by history and sleep diaries. The exact cause of DSWPD is unknown, but genetics, abnormal circadian physiology, and perpetuating behaviors all contribute. Treatment consists of morning phototherapy and evening melatonin at times individualized to the patient’s circadian rhythm. Strict adherence to standard sleep hygiene practices increases the chance of success.
{"title":"Whoever Wanted to Catch a Worm, Anyway?","authors":"R. Hiensch, N. Shah","doi":"10.1093/MED/9780190671099.003.0018","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0018","url":null,"abstract":"Delayed sleep/wake phase disorder (DSWPD) is the most common circadian rhythm disorder. It is characterized by persistently delayed sleep onset and wake times relative to conventional norms. Individuals usually present in young adulthood with symptoms of sleep-onset insomnia, sleep inertia, and excessive daytime sleepiness due to sleep deprivation when societal commitments require significantly earlier than desired sleep and wake times. Sleep quality itself is normal. The diagnosis can usually be made by history and sleep diaries. The exact cause of DSWPD is unknown, but genetics, abnormal circadian physiology, and perpetuating behaviors all contribute. Treatment consists of morning phototherapy and evening melatonin at times individualized to the patient’s circadian rhythm. Strict adherence to standard sleep hygiene practices increases the chance of success.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87079256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0026
M. Grigg-Damberger
A small-vessel left paramedian pontine ischemic infarction on awakening from sleep in a 74-year-old woman with hypercholesterolemia triggered an evaluation for untreated severe obstructive sleep apnea (OSA). This case illustrates how the clinical presentation of OSA is different in older and younger adults. Older adults with OSA are more likely to report not feeling well rested in the morning, to have higher scores on the Epworth Sleepiness Scale, and to have greater frequency of nocturia. It is important to consider untreated OSA in patients who have ischemic stroke on awakening from sleep. Most strokes occur between 6 a.m. and noon, but strokes during sleep warrant consideration of untreated OSA. OSA is highly prevalent in patients after stroke or transient ischemic attack. OSA is associated with poorer outcomes after ischemic strokes.
{"title":"“Wakeup” to Reality!","authors":"M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0026","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0026","url":null,"abstract":"A small-vessel left paramedian pontine ischemic infarction on awakening from sleep in a 74-year-old woman with hypercholesterolemia triggered an evaluation for untreated severe obstructive sleep apnea (OSA). This case illustrates how the clinical presentation of OSA is different in older and younger adults. Older adults with OSA are more likely to report not feeling well rested in the morning, to have higher scores on the Epworth Sleepiness Scale, and to have greater frequency of nocturia. It is important to consider untreated OSA in patients who have ischemic stroke on awakening from sleep. Most strokes occur between 6 a.m. and noon, but strokes during sleep warrant consideration of untreated OSA. OSA is highly prevalent in patients after stroke or transient ischemic attack. OSA is associated with poorer outcomes after ischemic strokes.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79133378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0046
A. Hoy, N. Foldvary-Schaefer, M. Grigg-Damberger
Diagnosing multiple system atrophy (MSA) is a complex, interdisciplinary process due to the variation in symptom presentation. Diagnosing MSA requires following the case history; the early signs and symptoms are characteristic in many diseases while additional symptoms may seem unrelated or comorbid with other disorders. This case focuses on an individual diagnosed with Parkinson disease whose wife notices him gasping with a high-pitched sound during the night. A sleep study with audio/video recording determines this to be an inspiratory stridor, which confirms a diagnosis of MSA. Inspiratory stridor is due to either dystonia of the thyroarytenoid muscles or paralysis of the posterior cricoarytenoid muscles. Inspiratory stridor during sleep in an adult with parkinsonian symptoms warrants consideration of MSA, not Parkinson disease. Almost all patients with MSA have rapid-eye-movement (REM) sleep behavior disorder. A third of patients with MSA have inspiratory stridor, which typically occurs primarily in sleep. Inspiratory gasps awake and asleep are common in patients with MSA.
{"title":"He Sounds Like a Crow and Leaps from the Bed","authors":"A. Hoy, N. Foldvary-Schaefer, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0046","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0046","url":null,"abstract":"Diagnosing multiple system atrophy (MSA) is a complex, interdisciplinary process due to the variation in symptom presentation. Diagnosing MSA requires following the case history; the early signs and symptoms are characteristic in many diseases while additional symptoms may seem unrelated or comorbid with other disorders. This case focuses on an individual diagnosed with Parkinson disease whose wife notices him gasping with a high-pitched sound during the night. A sleep study with audio/video recording determines this to be an inspiratory stridor, which confirms a diagnosis of MSA. Inspiratory stridor is due to either dystonia of the thyroarytenoid muscles or paralysis of the posterior cricoarytenoid muscles. Inspiratory stridor during sleep in an adult with parkinsonian symptoms warrants consideration of MSA, not Parkinson disease. Almost all patients with MSA have rapid-eye-movement (REM) sleep behavior disorder. A third of patients with MSA have inspiratory stridor, which typically occurs primarily in sleep. Inspiratory gasps awake and asleep are common in patients with MSA.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87510122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0013
Harneet K. Walia, M. Mansukhani, Madeleine Grigg-Damberger
Insufficient sleep syndrome is highly prevalent and an important sleep problem. It occurs when an individual persistently fails to obtain the amount of sleep required to maintain normal levels of alertness and wakefulness. The patient’s ability to initiate and maintain sleep is unimpaired or above average. This chapter outlines the relevant literature linking sleep deprivation and adverse wide-ranging consequences and plausible mechanisms linking them. One of the most striking of these consequences is drowsy driving, which many times is caused by sleep deprivation. Insufficient sleep is an important cause of motor vehicle crashes and carries a high socioeconomic burden. Dissemination and implementation research strategies are needed to inform public health policy initiatives to address insufficient sleep syndrome and drowsy driving.
{"title":"Turn Up the Volume","authors":"Harneet K. Walia, M. Mansukhani, Madeleine Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0013","url":null,"abstract":"Insufficient sleep syndrome is highly prevalent and an important sleep problem. It occurs when an individual persistently fails to obtain the amount of sleep required to maintain normal levels of alertness and wakefulness. The patient’s ability to initiate and maintain sleep is unimpaired or above average. This chapter outlines the relevant literature linking sleep deprivation and adverse wide-ranging consequences and plausible mechanisms linking them. One of the most striking of these consequences is drowsy driving, which many times is caused by sleep deprivation. Insufficient sleep is an important cause of motor vehicle crashes and carries a high socioeconomic burden. Dissemination and implementation research strategies are needed to inform public health policy initiatives to address insufficient sleep syndrome and drowsy driving.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76969409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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