Journal of Clinical Sleep Medicine最新文献

Study objectives: Socioeconomic disparities are known to have a significant impact on health outcomes including those related to obstructive sleep apnea. More recently, a metric known as area deprivation index (ADI), which combines 17 social determinants of health, has been used to better quantify this impact. We aim to examine the relationship between socioeconomic disparities and continuous positive airway pressure (CPAP) adherence among adults with obstructive sleep apnea using ADI.

Methods: A retrospective study of patients with diagnosis of obstructive sleep apnea and prescribed CPAP from October-December 2022 was performed. Patients were divided into more- or less-socioeconomically disadvantaged groups based on ADI, as well as social vulnerability index, which captures high school diploma rates. Thirty-day, 6-month, and 12-month CPAP adherence and follow-up rates were collected and compared across ADI/social vulnerability index quartiles.

Results: A total of 536 patients met inclusion criteria. Patients from the most deprived areas (highest ADI) had significantly lower CPAP adherence than those from least deprived areas at all timepoints (P < .05). Patients from areas with lower high school diploma rates had lower CPAP adherence (P < .05).

Conclusions: Socioeconomic disparities appear to have a significant impact on CPAP adherence. People from areas that are more deprived and with lower high school diploma rates have lower therapy adherence rates. Patients within these groups may benefit from additional resources and/or closer follow up to improve adherence with treatment.

Citation: Shing SR, Molin N, DeKloe J, et al. Impact of socioeconomic disparities on CPAP adherence. J Clin Sleep Med. 2025;21(12):2091-2099.

Study objectives: Patients with atrial fibrillation have elevated risk of obstructive sleep apnea (OSA). A peripheral arterial tonometry-based device, the Watch-PAT (WP) has been increasingly used as a home OSA test. We conducted a multisetting evaluation of WP in OSA diagnosis by comparing results from in-laboratory polysomnography (PSG), in-laboratory WP, and home WP in patients with atrial fibrillation.

Methods: Patients with atrial fibrillation underwent an in-laboratory PSG with concurrent in-laboratory WP and 2 consecutive nights of home WP. OSA was categorized into no OSA, mild, moderate, and severe OSA by apnea-hypopnea index (< 5, ≥ 5 to < 15, ≥ 15 to < 29, ≥ 30 events/h). The primary outcome was OSA severity agreement between in-laboratory PSG vs home WP. Secondary outcomes included the agreement between in-laboratory PSG vs in-laboratory WP, as well as in-laboratory WP vs home WP. Night-to-night variability of consecutive nights of home WP was also evaluated. Results were expressed by Cohen's kappa (κ) for apnea-hypopnea index scoring rules 1a and 1b.

Results: A total of 27 patients were included for analysis. There was slight and fair agreement between in-laboratory PSG and home WP (κ = 0.15, 0.40 for score rule 1a and 1b, respectively), substantial agreement between in-laboratory PSG vs in-laboratory WP (κ = 0.63, 0.71), moderate agreement between in-laboratory WP and home WP (κ = 0.59, 0.59), and almost perfect agreement between first night home WP and second night home WP (κ = 0.87, 0.89).

Conclusions: We demonstrate overall slight to fair agreement between home WP vs in-laboratory PSG, suggesting inadequate performance against the standard reference test. This should be considered when interpreting the results of home WP. Other evaluations demonstrated moderate agreement for in-laboratory WP and home WP in the classification of OSA severity, substantial agreement between in-laboratory PSG and in-laboratory WP, and almost perfect agreement in the comparison of both home WP.

Citation: Stafford PL, Roth R, Ferguson J, et al. Multisetting evaluation of Watch-PAT in obstructive sleep apnea diagnosis in patients with atrial fibrillation. J Clin Sleep Med. 2025;21(12):2139-2154.

Restless legs syndrome, also called Willis-Ekbom disease, is a neurological disorder marked by a strong, uncontrollable urge to move the legs, often paired with unpleasant or uncomfortable sensations. To address gaps and variations in care in this patient population, the American Academy of Sleep Medicine Quality Measures Task Force performed quality measure maintenance on the quality measures for the care of adult patients with restless legs syndrome (originally developed in 2015). The Quality Measures Task Force conducted a comprehensive review of current medical literature, including updated clinical practice guidelines, systematic literature reviews, existing quality measures for restless legs syndrome, and performance data to identify ongoing gaps and variations in care since the implementation of the original quality measure set and to inform potential revisions.

Citation: Lloyd RM, Crawford T'A, Donald R, et al. Quality measures for care of patients with restless legs syndrome: 2025 update after measure maintenance. J Clin Sleep Med. 2025;21(12):2205-2211.

Study objectives: Insomnia is prevalent among stroke survivors in the chronic stage of stroke. However, effective interventions remain limited. This study examined the effects of nurse-led, face-to-face, and web-based brief behavioral therapy for insomnia (BBTI) compared with sleep hygiene education on sleep outcomes in stroke survivors.

Methods: A total of 45 stroke survivors were recruited from an outpatient clinic in Java, Indonesia, and randomly assigned (1:1:1) to either a face-to-face BBTI, web-based BBTI, or sleep hygiene education group. Both BBTI interventions followed a standardized 4-week protocol delivered in person or through an online platform. The primary outcome was insomnia severity, measured using the Indonesian version of the Insomnia Severity Index. Secondary outcomes included sleep onset latency, wake after sleep onset, sleep efficiency, excessive daytime sleepiness, anxiety, depression, and fatigue. Data were analyzed using generalized estimating equations.

Results: The Indonesian version of the Insomnia Severity Index scores were significantly lower in the BBTI groups than in the sleep hygiene education group. After 1 month, insomnia remission (Indonesian version of the Insomnia Severity Index score < 8) was achieved in 93.3% of the web-based BBTI group and 86.7% of the face-to-face BBTI group. These values were significantly higher than the 33.3% remission rate observed in the sleep hygiene education group (P < .001). Improvements were observed in sleep onset latency, wake after sleep onset, and sleep efficiency. The BBTI groups reported reduced daytime sleepiness, although no significant changes in depression, anxiety, or fatigue were observed.

Conclusions: Nurse-led BBTI, whether in the face-to-face or web-based format, effectively reduces insomnia severity and improves sleep outcomes in stroke survivors, highlighting nurses' essential role in delivering sleep interventions.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Nurse-led BBTI for Improving Insomnia Severity; URL: https://clinicaltrials.gov/study/NCT05310136; Identifier: NCT05310136.

Citation: Hasan F, Prasetya EC, Gordon CJ, et al. Effects of nurse-led, web-based brief behavioral therapy on insomnia severity in patients in the chronic stage of stroke recovery: a preliminary randomized controlled trial. J Clin Sleep Med. 2025;21(12):2031-2040.

Study objectives: Obstructive sleep apnea-related hypoxemia, measured by hypoxic burden (HB), is associated with chronic kidney disease (CKD). Obstructive sleep apnea-related autonomic response may also be associated with CKD. This study examined whether individuals with high HB and varying autonomic responses to obstructive sleep apnea have a different risk of CKD progression compared to those with low HB.

Methods: Polysomnography data from the multicenter Canadian Sleep and Circadian Network cohort were analyzed. HB was defined as the area under event-related oxygen desaturation curves during sleep. Autonomic responses were assessed using "vasoconstriction burden" (area under photoplethysmography declines, reflecting vascular reactivity) and heart rate response to events (reflecting cardiac autonomic response). Estimated glomerular filtration rate and urine albumin:creatinine ratio were used to identify participants at risk of CKD progression. This risk was compared across individuals with high HB (≥ median) and varying levels of autonomic responses relative to those with low HB.

Results: Data from 421 participants were analyzed. The odds ratio of CKD progression was higher in those with high vs low HB. Compared to the low HB group, individuals with high HB and low vasoconstriction burden (lowest quartile) were at increased risk of CKD progression (odds ratio [95% confidence interval] = 2.49 [1.23, 5.05]), whereas the risk was not significantly elevated in those with the high vasoconstriction burden (highest quartile). In contrast, within high HB, both high (highest quartile) and low heart rate response (lowest quartile) groups were at increased risk of CKD progression compared to those with low HB.

Conclusions: Autonomic response to respiratory events improves risk stratification for CKD progression in obstructive sleep apnea. Vasoconstriction burden and heart rate response show distinct associations with this risk.

Citation: Hajipour M, Beaudin AE, Hicks JB, et al. Autonomic responses to respiratory events and risk of chronic kidney disease in obstructive sleep apnea. J Clin Sleep Med. 2025;21(12):2041-2050.

Study objectives: Individuals with isolated rapid eye movement sleep behavior disorder (iRBD) are at high risk of neurodegenerative parkinsonian disorders or dementia (NPD). Determining which characteristics predict greatest risk could improve clinical care. Our objectives were to utilize electronic health record data to apply prodromal Parkinson's disease research diagnostic criteria to outpatients with iRBD and determine their utility for identifying patients with iRBD at high vs low risk for NPD diagnosis.

Methods: This was a retrospective cohort study at a tertiary care center in western Pennsylvania. Diagnosis of iRBD was confirmed with expert manual chart review. Prodromal risk markers and signs and symptoms were determined with diagnostic codes. Multivariable Cox proportional hazards models examined a range of covariates as predictors of time to NPD diagnosis.

Results: Of 448 patients with iRBD, 82 (18.30%) were diagnosed with NPD. Forty-nine (10.93%) had > 80% prodromal Parkinson's disease probability. There was no difference in time to NPD among those who met vs did not meet > 80% probability (log-rank P = .49). In a Cox model that included all assessed criteria features, risk of diagnosis was associated with male sex (hazard ratio = 2.06, 95% confidence interval = 1.04-1.10), older baseline age (hazard ratio = 1.07, 95% confidence interval = 1.05-1.10), and cognitive dysfunction diagnostic code (hazard ratio = 2.83, 95% confidence interval = 1.79-4.46). Time to NPD diagnosis among patients with predicted high vs low risk was significantly different (log-rank test P = .012).

Conclusions: In outpatients with iRBD, a model combining individual Parkinson's disease risk factors and prodromal features accurately identifies individuals at high risk for NPD diagnosis. Results demonstrate the potential of electronic health record data to translate research on prodromal Parkinson's disease to the clinic.

Citation: Chahine LM, Newman A, Boyce RD, Brooks MM. Prodromal features and risk of neurodegenerative disorders diagnosis in outpatients with REM sleep behavior disorder. J Clin Sleep Med. 2025;21(11):1857-1869.

Study objectives: Obstructive sleep apnea is a prevalent disorder associated with significant health risks, often managed with continuous positive airway pressure. However, continuous positive airway pressure adherence remains suboptimal, prompting interest in surgical alternatives. Traditional uvulopalatopharyngoplasty (UPPP), introduced in 1981, has demonstrated limited success and notable side effects, leading to skepticism regarding its utility in obstructive sleep apnea treatment. However, advancements in patient selection and surgical technique have led to the development of modified UPPP procedures, including expansion sphincter pharyngoplasty, barbed reposition pharyngoplasty, and the Australian modified UPPP.

Methods: In this narrative review, we focus on the evolution of the palatal surgery field over the past 2 decades.

Results: Recent randomized controlled trials and observational cohort studies have shown that modified UPPP variants can significantly reduce apnea-hypopnea index, improve symptoms, and even offer potential cardiovascular benefits. These reconstructive approaches have demonstrated consistently improved success rates, enhanced patient-reported outcomes, and reduced postoperative morbidity compared to traditional excisional UPPP.

Conclusions: While controversies persist regarding patient selection, long-term durability, and the role of palate surgery in the era of hypoglossal nerve stimulation, emerging evidence supports modified UPPP as a viable alternative for appropriately selected patients with obstructive sleep apnea. This review underscores the evolution of palatal surgery, highlighting its role in a personalized, multimodal approach to obstructive sleep apnea management, particularly for continuous positive airway pressure-intolerant patients seeking durable and effective treatment.

Citation: Kaffenberger TM, Soose RJ, Woodson BT, et al. Modified uvulopalatopharyngoplasty in modern obstructive sleep apnea treatment: a narrative review. J Clin Sleep Med. 2025;21(11):1979-1991.