Journal of Clinical Sleep Medicine最新文献

A patient previously diagnosed with moderate obstructive sleep apnea and treated with continuous positive airway pressure was seen for her yearly routine follow-up. A continuous positive airway pressure adherence report of the previous year revealed periodic usage with almost stable monthly fluctuation between proper and poor adherence. The patient declared consistent usage when sleeping. The patient's sleep habits, such as usual bedtime and start of continuous positive airway pressure treatment, had not changed during the monthly variations. What disorder can explain this continuous positive airway pressure adherence pattern?

Citation: Peeters A, Horckmans S, Testelmans D, Buyse B, Kalkanis A. Images: a disorder-specific CPAP adherence pattern. J Clin Sleep Med. 2025;21(11): 2011-2013.

The field of artificial intelligence (AI) is rapidly expanding and has the potential to significantly impact the practice of sleep medicine. Sleep practitioners may be able to augment the efficiency and effectiveness of care delivery to patients by incorporating AI into clinical practice. However, AI must be implemented in a responsible manner, with a full appreciation of the technology's current limitations and evolving nature. Specifically, the tenets of data privacy, fairness and transparency, infrastructure, and medical-legal issues must be considered. Many of these issues are evolving and will continue to impact AI implementation in new ways. Enhancements in technology will provide new AI options for clinicians and patients. Evolving case law will influence the legal risks that clinicians, hospitals, and sleep centers will face. Creation of new policies within the United States and internationally will provide frameworks and safeguards for data privacy and AI use. Sleep clinicians and researchers should remain updated and knowledgeable in these areas. As AI continues to develop and advance in the sleep medicine field, it must be a partner to, and not a replacement for, clinician (ie, human) oversight. It is the position of the American Academy of Sleep Medicine that responsible AI integration into sleep medicine has the potential to enhance clinical care and research but requires careful consideration to overcome clinical validation challenges, ensure ongoing accuracy after implementation, and incorporate clinically relevant and user-friendly tools into practice, while also upholding standards of safety, appropriateness, and transparency.

Citation: Oks M, Sachdeva R, Davenport MA, et al. Artificial intelligence in sleep medicine: an updated American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2025;21(11):1953-1955.

Study objectives: To evaluate the efficacy and safety of intraoral negative air pressure (iNAP) devices in patients with obstructive sleep apnea.

Methods: A systematic search without language restrictions was conducted in the Ovid Medline, Embase, and Scopus databases to identify all original studies on the effects of iNAP devices in adult patients with obstructive sleep apnea who reported the apnea-hypopnea index. The final update was made on December 7, 2024. The risk of bias assessment tool for nonrandomized studies was applied for quality assessment. Review Manager was used to conduct statistical analysis.

Results: Of the 72 originally retrieved articles, 9 studies were included that involved a total of 445 individuals. Meta-analysis of the pooled data showed that, following iNAP treatment, the participants had a significant improvement in mean apnea-hypopnea index with a mean difference of 12.4 (95% confidence interval, 7.5-17.3), minimum oxygen saturation with mean difference of -3.6 (95% confidence interval, -5.3 to -1.8), Epworth sleepiness scale with mean difference of 2.64 (95% confidence interval, 0.23-5.05) and oxygen desaturation index with mean difference of 10.8 (95% confidence interval, 7.2-14.3). Participants also had a trend of improvement in the percentages of time spent with oxygen saturation ≥ 90% after treatment but did not reach statistical significance. The most common adverse events related to the device were oral tissue discomfort and irritation. No serious adverse events were reported.

Conclusions: Treatment with iNAP devices significantly improved apnea-hypopnea index and oxygen desaturation index. iNAP may be a suitable treatment option for selected patients with obstructive sleep apnea.

Citation: Puvatanond C, Kasemsuk N, Banhiran W. The efficacy and safety of an intraoral negative air pressure device in patients with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2025;21(11):1969-1977.

Study objectives: Mandibular distraction osteogenesis (MDO) is recommended for children with craniofacial microsomia (CFM) and obstructive sleep apnea (OSA). However, its efficacy remains limited, with success rates of 36.4-60%. The role of adenoid hypertrophy (AH) in persistent OSA post-MDO has not been been fully investigated. This study aimed to evaluate the role of AH in influencing MDO outcomes and to explore its contribution to the pathophysiology and treatment of OSA in patients with CFM.

Methods: A retrospective analysis was conducted on 72 patients with CFM undergoing MDO. Preoperative adenoid size was assessed using adenoid/nasopharyngeal ratios from cranial computed tomography scans. Polysomnographic data, including preoperative and postoperative obstructive apnea-hypopnea index, were analyzed. Patients were classified into effective and ineffective groups based on postoperative OSA improvement. Statistical correlations between adenoid/nasopharyngeal ratios, OSA severity, Pruzansky-Kaban classification and treatment outcomes were examined.

Results: AH prevalence among patients with CFM with OSA was 61.1%. Adenoid/nasopharyngeal ratios correlated with postoperative obstructive apnea-hypopnea index (r = .261, P = .027), but not with preoperative obstructive apnea-hypopnea index. The ineffective group had higher adenoid/nasopharyngeal ratios than the effective group (0.69 ± 0.13 vs 0.64 ± 0.12). Overall, the MDO effectiveness rate was 47.22%, with greater improvement observed in patients with severe OSA. No significant association was found between the Pruzansky-Kaban classification and either OSA severity or MDO treatment outcomes.

Conclusions: AH plays a significant role in persistent OSA post-MDO, particularly in mild to moderate cases. Routine preoperative assessment of AH, combined with targeted interventions such as adenoidectomy when indicated, may improve treatment outcomes. These findings underscore the importance of addressing both skeletal and soft tissue factors in the comprehensive management of OSA in patients with CFM.

Citation: Liang Y, Cheng W, Shu K, et al. The role of adenoid hypertrophy in obstructive sleep apnea outcomes post-mandibular distraction osteogenesis in patients with craniofacial microsomia. J Clin Sleep Med. 2025;21(11):1839-1845.

Study objectives: To evaluate the short-term effect of zolpidem on continuous positive airway pressure (CPAP) acclimatization in patients with obstructive sleep apnea compared with placebo.

Methods: This randomized, double-blind, placebo-controlled crossover trial enrolled CPAP-naive patients with obstructive sleep apnea who had an indication for CPAP therapy. Participants were randomly assigned to receive either zolpidem 10 mg or an identical placebo capsule, administered 30 minutes before bedtime for 1 week. In the second week, they crossed over to the alternate treatment. A 24-hour washout period separated the 2 treatment phases.

Results: Twenty-eight participants (mean age, 54.5 ± 13.7 years; 57.1% male) completed the study. The mean CPAP usage per night did not differ significantly between zolpidem and placebo (mean difference, 0.18; 95% confidence interval, -0.39 to 0.75). The percentage of nights with CPAP use ≥ 4 hours also showed no significant difference (mean difference, 2.60; 95% confidence interval, -5.65 to 10.87). Treatment sequence did not affect CPAP adherence (P = .87). Subgroup analyses by sex, disease severity, and arousal index revealed no significant impact of zolpidem on adherence. No serious adverse events were reported, and the most common minor adverse event was dizziness (7.14%).

Conclusions: Short-term zolpidem use did not improve CPAP adherence during the acclimatization period. These findings underscore the importance of employing multiple acclimatization strategies rather than relying on routine zolpidem use. Larger-scale studies with extended follow-up are warranted to confirm these results.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Zolpidem on CPAP Acclimatization in OSA; URL: https://clinicaltrials.gov/study/NCT06084130; Identifier: NCT06084130.

Citation: Pisalnoradej P, Banhiran W, Kasemsuk N. The effect of zolpidem on CPAP acclimatization in patients with OSA: a crossover, randomized, double-blinded, placebo-controlled trial. J Clin Sleep Med. 2025;21(11):1831-1837.

Study objectives: Obstructive sleep apnea (OSA) is a common comorbidity in type 2 diabetes and has been associated with poor glycemic control, but few data exist in youth-onset type 2 diabetes. We evaluated the prevalence of OSA and its associations with metabolic control and cardiovascular risk in young adults with pediatric type 2 diabetes.

Methods: OSA presence and severity was assessed by polysomnography in 114 participants in the TODAY study (Treatment Options for type 2 Diabetes in Adolescents and Youth) (mean age 23.5 years, diabetes duration 10 years, body mass index 35.3 kg/m²). Glycated hemoglobin, β-cell function, and diabetes-related complications were collected in the TODAY cohort. Adjusted regression models evaluated relationships between OSA and outcomes.

Results: The prevalence of OSA in TODAY was 38.6%. OSA was not associated with glycated hemoglobin, loss of metabolic control, or diabetes-related complications in this cohort.

Conclusions: Despite nearly 10 years of poorly controlled diabetes, young adults with youth-onset type 2 diabetes had a moderate prevalence of OSA. Severity of OSA was not associated with loss of glycemic control or diabetes-related complications in the TODAY cohort. The prevalence of OSA was lower than that reported in adults with prediabetes/early type 2 diabetes.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY); URL: https://clinicaltrials.gov/study/NCT00081328; Identifier: NCT00081328.

Citation: Levitt Katz LE, El ghormli LK, Nadeau KJ, et al. Obstructive sleep apnea, glycemic control, and cardiovascular risk in young adults with youth-onset type 2 diabetes: results from the TODAY study. J Clin Sleep Med. 2025;21(11):1925-1933.

Study objectives: Poor sleep quality is prevalent among postpartum females and can impair maternal and family health. Nonpharmacological interventions are preferred approaches over pharmaceutical methods for improving postpartum sleep, though their comparative effects remain unclear. This study aimed to systematically compare and rank the effects of various nonpharmacological interventions on maternal sleep quality at different postpartum stages.

Methods: A systematic review and network meta-analysis was conducted. Electronic databases were systematically searched from their inception to July 2024. Randomized controlled trials of nonpharmacological interventions for postpartum sleep were included. Random-effects network meta-analyses were adopted.

Results: In total, 19 randomized controlled trials involving 1,826 participants examined 13 nonpharmacological interventions for postpartum sleep quality. Foot reflexology demonstrated the largest effect size (standardized mean difference [SMD] = -3.5), followed by progressive muscle relaxation (SMD = -3.2) and massage (SMD = -2.0), compared to usual care during the first 3 months postpartum. Cognitive behavioral therapy for insomnia (SMD = -1.7) and light-dark therapy (SMD = -1.3) are effective during 4-12 months postpartum.

Conclusions: Nonpharmacological interventions effectively improve postpartum sleep, with foot reflexology being the most effective in the early postpartum period and cognitive behavioral therapy for insomnia optimal for 4-12 months. Health professionals can incorporate these promising interventions into postpartum sleep care. Future research evaluating the direct comparisons of nonpharmacological interventions for postpartum sleep is warranted.

Citation: Nguyen CTT, Chiu H-Y, Lin-Lewry M, Bei B, Tsai S-Y, Kuo S-Y. Comparative effectiveness of nonpharmacological interventions on postpartum maternal sleep quality: a systematic review and network meta-analysis. J Clin Sleep Med. 2025;21(11):1957-1967.

Study objectives: Evaluate nocturnal polysomnography sleep stage stability features in an adult, sample of clinical patients with hypersomnolence disorder (HD) against healthy sleeper controls (HSCs). Explore differences in sleep stage stability features across HD who displayed objective criteria for idiopathic hypersomnia (IH) (HD/IH+) and those who did not (HD/IH-).

Methods: Sixty unmedicated clinical patients with HD (average age = 28.6 ± 8.6 years; percentage female = 78.3%) and 29 HSCs underwent ad libitum nocturnal polysomnography and daytime Multiple Sleep Latency Tests. Sleep stage stability features included number of stage bouts, median stage bout duration, number of transitions between stages, and survival analysis of stage bouts. Regression and Cox proportional hazards models compared HD against HSC. Analysis of covariance, log-rank tests, and pairwise comparisons explored differences between HSC, HD/IH+ (n = 14), and HD/IH-. All analyses accounted for age, sex, body mass index, and depressive symptom severity.

Results: HD displayed longer non-rapid eye movement (NREM) stage 2 sleep bouts (P = .02) and increased survival of NREM stage 2 sleep (P < .0001) and rapid eye movement (REM) (P < .0001) bouts, relative to HSC, with fewer NREM stage 3 sleep bouts (P = .02) that were comparable in duration and survival. Many phenotypic similarities were observed between HD/IH+ and HD/IH-, though HD/IH+ displayed significantly increased NREM stage 2 sleep survival (P = .03), longer sleep duration (P = .004), and greater sleep continuity (P = .003).

Conclusions: Our findings demonstrate enhanced NREM stage 2 sleep and REM stability in adult clinical patients with unexplained hypersomnolence. Follow-up studies are necessary to determine the role of distinct sleep stage stability features as valid, reliable and specific signatures of unexplained hypersomnolence. These results may also be useful for future nosological frameworks that consider unexplained hypersomnolence along a continuum of severity that includes both HD and IH.

Citation: Cook JD, Rumble ME, Vascan AM, et al. Nocturnal sleep stage stability features in unexplained hypersomnolence. J Clin Sleep Med. 2025;21(11): 1911-1924.

Study objectives: We compared the performance of a comprehensive automated polysomnogram analysis algorithm-CAISR (Complete Artificial Intelligence Sleep Report)-to a multiexpert gold-standard panel, crowdsourced scorers, and experienced technicians for sleep staging and detecting arousals, respiratory events, and limb movements.

Methods: A benchmark dataset of 57 polysomnogram records (Inter-Scorer Reliability dataset) with 200 30-second epochs scored per American Academy of Sleep Medicine guidelines was used. Annotations were obtained from (1) the American Academy of Sleep Medicine multiexpert gold-standard panel, (2) American Academy of Sleep Medicine Inter-Scorer Reliability (ISR) platform users ("crowd," averaging 6,818 raters per epoch), (3) 3 experienced technicians, and (4) CAISR. Agreement was assessed via Cohen's kappa (κ) and percent agreement.

Results: Across tasks, CAISR achieved performance comparable to that of experienced technicians but did not match consensus-level agreement between the multiexpert gold standard and the crowd. For sleep staging, CAISR's agreement with multiexpert gold standard was 82.1% (κ = 0.70), comparable to experienced technicians but below the crowd (κ = 0.88). Arousal detection showed 87.81% agreement (κ = 0.45), respiratory event detection 83.18% agreement (κ = 0.34), and limb movement detection 94.89% agreement (κ = 0.11), each aligning with performance equivalent to experienced technicians but trailing crowd agreement (κ = 0.83, 0.78, and 0.86 for detection of arousal, respiratory events, and limb movements, respectively).

Conclusions: CAISR achieves experienced technician-level accuracy for polysomnogram scoring tasks but does not surpass the consensus-level agreement of a multiexpert gold standard or the crowd. These findings highlight the potential of automated scoring to match experienced technician-level performance while emphasizing the value of multirater consensus.

Citation: Tripathi A, Nasiri S, Ganglberger W, et al. Automated analysis of the American Academy of Sleep Medicine Inter-Scorer Reliability gold-standard polysomnogram dataset. J Clin Sleep Med. 2025;21(11):1821-1829.