Sleep Medicine

Obstructive sleep apnea

Sullivan CE, Berthon-Jones M, Issa FQ et al. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981 April 18; 1(8225):862-5. First description of CPAP in the treatment of OSA. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6112294

Iber C, O'Brien C, Schluter J, et al.  Single night studies in obstructive sleep apnea.  Sleep 1991;14:383-5. Contrary to the accompanying editorial, this study first documented the effectiveness of split-night studies for the evaluation of OSA and helped establish split-night studies as the standard of care. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1759089. 

Portable monitoring vs. In-lab polysomnography: This remains a controversial issue. The following articles include guidelines from the AASM as well as recent studies suggesting a more streamlined approach to diagnosis and treatment achieves outcomes similar to laboratory testing in patients with a high pre-test probability of moderate to severe OSA.

Collop NA, Anderson WM, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.  J Clin Sleep Med. 2007; 3:737-47.. The use of portable monitors is likely to increase in the U.S. now that it is reimbursed by Medicare.  The task force recommends use of unattended portable monitoring studies be limited to patients with a high likelihood of moderate to severe OSA and at minimum record airflow, respiratory effort, and oxygen saturation. The evaluation should be supervised by a board-certified or eligible sleep physician.
http://www.ncbi.nlm.nih.gov/pubmed/18198809?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Mulgrew AT, Fox N, Ayas NT, et al. Diagnosis and initial management of obstructive sleep apnea without polysomnography.  Ann Intern Med 2007;146:157-166.  Randomized validation study concluded that for patients with a high clinical probability of OSA (based on clinical features and overnight oximetry alone), PSG confers no advantage over ambulatory auto-titrating CPAP for the initial diagnosis and management of OSA.  http://www.ncbi.nlm.nih.gov/pubmed/17283346?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Antic NA, Buchan C, Esterman A, et al. A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea.  Am J Respir Crit Care Med 2009; 179:501-8. Study of 195 patients with high likelihood of moderate to severe OSA based on clinical features and home oximetry alone had outcomes with ambulatory auto-titrating CPAP similar to those achieved with laboratory PSG. The study was novel in that management was supervised by nurses with a mean of 8.3 years of experience in sleep CPAP therapy rather than physicians. Sleep physicians were consulted 15% of the time in the nurse-led arm. PSG revealed periodic limb movement in 5.3% and central apnea index > 5/hr in 2.1% of patients. http://www.ncbi.nlm.nih.gov/pubmed/19136368?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Impact of treatment on CV outcomes

Haentjens P, Van Meerhaeghe A, Moscariello A, et al.  The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials.  Arch Intern Med. 2007; 167:757-64.  In this meta-analysis of data from 12 randomized controlled trials, the pooled estimate of the effect of the CPAP intervention on 24-hour mean arterial blood pressure was a net decrease of 1.69 mm Hg (95% confidence interval, -2.69 to -0.69), with greater treatment-related reductions among patients with a more severe OSA and a better adherence to CPAP therapy.
http://www.ncbi.nlm.nih.gov/pubmed/17452537?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnea with or without treatment with continuous positive airway pressure:  an observational study. Lancet 2005; 365: 1046-53.  The best of a growing number of observational studies indicating that non-adherence to CPAP therapy is associated with increased cardiovascular morbidity and mortality. Patients adherent to CPAP for severe sleep apnea had cardiovascular morbidity and mortality similar to that in a weight- and age-matched control group. However, this type of study design, however, has been criticized for being prone to a “healthy user” bias.
http://www.ncbi.nlm.nih.gov/pubmed/15781100?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165:1217-39.  This article reviews the epidemiologic studies identifying a high prevalence of undiagnosed OSA in the general population, as well as the association between OSA and increased likelihood of hypertension, cardiovascular disease, and stroke. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11991871&query_hl=1&itool=pubmed_DocSum

Central sleep apnea

Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure.  N Engl J Med 2005; 353:2025-33.  The oft-cited, randomized CANPAP study of 258 patients found use of CPAP in patients with CHF and Cheyne-Stokes Respirations did not improve mortality. Some believe the lack of benefit compared to previous studies is due to advances in CHF treatment with beta blockers.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16282177&query_hl=13&itool=pubmed_docsum

Obesity Hypoventilation Syndrome

 Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008; 5:218-25. Reviews the clinical presentation, pathophysiology, morbidity, mortality, and currently available treatment of obesity hypoventilation syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/18250215?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Sleep Deprivation                                                                                                                  

Landrigan CP, Rothschild JM, Cronin JW, et al.  Effect of reducing interns' work hours on serious medical errors in intensive care units.  N Engl J Med. 2004; 351:1838-48.  Prospective, randomized study determined that interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit. http://www.ncbi.nlm.nih.gov/pubmed/15509817?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 Insomnia

Passarella S, Duong MT.  Diagnosis and treatment of insomnia.  Reviews the diagnostic criteria for insomnia as well as non-pharmacologic and pharmacologic treatment.  Am J Health Syst Pharm. 2008; 65:927-34.
http://www.ncbi.nlm.nih.gov/pubmed/18463341?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Morgenthaler T, Kramer M, Alessi C, et al.  Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report.  A comprehensive literature review since 1999 that grades the evidence for various non-pharmacological treatments of insomnia.
http://www.ncbi.nlm.nih.gov/pubmed/17162987?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Parasomnias

Schenck CH, Mahowald MW.  REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 2002; 25:120-38.  Comprehensive update of work accomplished since the first clinical description of REM sleep behavior disorder in 1986. http://www.ncbi.nlm.nih.gov/pubmed/11902423?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Mahowald MW.  Parasomnias. Med Clin North Am 2004; 88:669-78.  This article reviews the most common parasomnias: disorders of arousal, the REM behavior disorder (RBD), and nocturnal seizures.   http://www.ncbi.nlm.nih.gov/pubmed/15087210?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Circadian Rhythm Disorders

Lu BS, Zee PC. Circadian rhythm sleep disorders. Chest 2006; 130:1915-23.  This review focuses on the clinical approach to the diagnosis and management of the various circadian rhythm sleep disorders, including delayed sleep phase disorder, advanced sleep phase disorder, non-entrained type, irregular sleep-wake rhythm, shift work sleep disorder and jet lag disorder. http://www.ncbi.nlm.nih.gov/pubmed/17167016?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Restless Legs Syndrome

Earley, CJ.  Restless legs syndrome.  N Engl J Med 2003; 348:2103-9. The review offers a concise summary of the evaluation and management of RLS. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12761367