Journal of Clinical Sleep Medicine最新文献

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.

Citation: Perez K, Shah M, Sridharan A, et al. REM sleep-related bradyarrhythmia syndrome. J Clin Sleep Med. 2025;21(2):435-438.

Study objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Citation: Sweetman A, McEvoy RD, Frommer MS, et al. Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program. J Clin Sleep Med. 2025;21(2):325-335.

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.

Citation: Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med. 2025;21(2):405-416.

Study objectives: Catathrenia has been classified as a sleep-related breathing disorder variant in the third edition of the International Classification of Sleep Disorders, but its validity remains unverified. We analyzed the clinical descriptive variables and polysomnographic findings of catathrenia and discussed the similarities to and differences from those of obstructive sleep apnea, non-rapid eye movement parasomnias, and sleep bruxism (SB).

Methods: A retrospective analysis was conducted on 47 patients diagnosed with nocturnal groaning through polysomnography. We examined sex, body mass index, age at symptom onset, weekly symptom frequency, and presence/absence of comorbidities, including obstructive sleep apnea, periodic limb movement disorder, non-rapid eye movement parasomnia, and SB. The groaning event index was calculated according to sleep position and sleep stage.

Results: The distribution of patients with catathrenia did not show sex differences (male/female = 20:27), body mass index was 20.6 ± 3.0 kg/m², and age of onset was 18.2 ± 7.4 years. The groaning event index was higher in stages N1 and R than in stage N3 and in the supine position than in the lateral position. There were no cases complicated with non-rapid eye movement parasomnia, but the complication of SB was observed in 30% of the participants, and SB events appeared immediately before or during the interictal period of the groaning event episodes in these cases.

Conclusions: Given the clinical background, posture- and sleep stage-dependent appearance of groaning events, and the relatively high complication rate of SB, catathrenia pathogenesis may be heterogeneous or comprise elements of different sleep disorders.

Citation: Takei Y, Nakayama H, Inoue Y. Characteristics of clinical descriptive variables and polysomnographic findings of catathrenia. J Clin Sleep Med. 2025;21(2):377-381.

Study objectives: Sleep disturbances lead to negative health outcomes and caregiver burden, particularly in community settings. This study aimed to investigate a predictive model for sleep efficiency and its associated features in older adults living with dementia in their own homes.

Methods: This was an exploratory, observational study. A total of 69 older adults diagnosed with dementia were included in this study. Data were collected via actigraphy for sleep and physical activity for 14 days, a sweat patch for cytokines for 2-3 days, and a survey of diseases, medications, psychological and behavioral symptoms, functional status, and demographics at baseline. Using 730 days of actigraphy, sweat patches, and baseline data, the best prediction model for sleep efficiency was selected and further investigated to explore its associated top 10 features using machine learning analysis.

Results: The CatBoost model was selected as the best predictive model for sleep efficiency. In order of importance, the most important features were sleep regularity, number of medications, dementia medication, daytime activity count, instrumental activities of daily living, neuropsychiatric inventory, hypnotics, occupation, tumor necrosis factor-alpha, and waking hour lux.

Conclusions: This study established the best sleep efficiency predictive model among community-dwelling older adults with dementia and its associated features using machine learning and various sources, such as the Internet of Things. This study highlights the importance of individualized sleep interventions for community-dwelling older adults with dementia based on associated features.

Citation: Lee JY, Yang E, Cho AY, Choi Y, Lee S, Lee KH. Sleep efficiency in community-dwelling persons living with dementia: exploratory analysis using machine learning. J Clin Sleep Med. 2025;21(2):393-400.

Radiotherapy for head and neck cancer can trigger or worsen obstructive sleep apnea (OSA) due to factors such as neurological impairment, muscle atrophy, edema, and xerostomia. We present a case in which a patient developed severe OSA 3 months after undergoing radiochemotherapy and neck dissection for squamous cell carcinoma of the right lingual tonsil with regional metastasis. Polysomnography confirmed severe OSA. Unfortunately, the patient did not adhere to the recommended treatment. The symptoms persisted for 6 months but then, unexpectedly, resolved completely. A follow-up polysomnography conducted 1 year after radiotherapy showed no evidence of OSA. This case suggests that a recent diagnosis of OSA following head and neck radiotherapy may not be permanent and should not necessarily lead to a lifelong prognosis of sleep-related breathing disorders.

Citation: Palma VM, Silva POT, Formigoni GGS, Sennes LU, Cahali MB. Transient radiation-induced severe obstructive sleep apnea. J Clin Sleep Med. 2025;21(2):427-429.

Study objectives: Sleep-disordered breathing is prevalent in children with sickle cell disease (SCD) and is associated with worse outcomes. This study aimed to compare the outcomes of polysomnography (PSG) performed for pediatric patients with SCD at 3 US centers.

Methods: We included patients with SCD aged 0-21 years who underwent PSG at 3 American Academy of Sleep Medicine-accredited centers, the University of Alabama at Birmingham, the University of Florida, and Duke University Hospital, between 2012 and 2022. Descriptive statistics were used as appropriate to compare the baseline characters and PSG outcomes among the different centers.

Results: A total of 210 children with SCD from the 3 centers were included, with comparable sex, SCD genotypes, hemoglobin, hematocrit levels, and chronic transfusion. Children from the different centers exhibited variations in age (P < .001), body mass index (P < .05), mean corpuscular volume (P < .05), and hydroxyurea usage (P < .05) at the time of the PSG. Overall, the 3 centers showed significantly different PSG outcomes. Patients from the University of Florida had worse obstructive sleep apnea, oxygenation, and periodic leg movement events, together with lower hydroxyurea usage, and those from Duke University Hospital showed higher hypoventilation and arousal indices.

Conclusions: This multicenter study underscores variations in PSG outcomes among pediatric SCD patients at different centers in the southeastern United States. These findings emphasize the need for standardized approaches to screen for sleep-disordered breathing, refer to PSG, and interpret the results in children with SCD. These conclusions may apply to other genetic disorders associated with an increased risk of sleep-disordered breathing.

Citation: Alishlash AS, Nourani AR, Lebensburger J, Rothman JA, Ali-Dinar T, Ezmigna D. Multicenter comparative study of polysomnography outcomes in children with the monogenic disorder sickle cell disease. J Clin Sleep Med. 2025;21(2):297-304.