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Article ; Online: Portable Monitoring for the Diagnosis of OSA.

Cooksey, Jessica A / Balachandran, Jay S

2016 Volume 149, Issue 4, Page(s) 1074–1081

Abstract: In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to ... ...

Abstract	In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to the development of algorithms that bypass the sleep laboratory in favor of portable monitoring studies and in-home initiation of positive airway pressure therapy. For appropriately selected outpatients, evidence is accumulating that portable monitors are a reasonable substitute for in-laboratory polysomnography. In the inpatient setting, in which SDB is both highly prevalent and associated with adverse outcomes in certain populations, the literature is evolving on the use of portable monitors to expedite diagnosis and treatment of SDB. This review discusses society guidelines and recent research in the growing field of portable monitoring.
MeSH term(s)	Algorithms ; Ambulatory Care ; Continuous Positive Airway Pressure/methods ; Humans ; Monitoring, Ambulatory/methods ; Polysomnography/methods ; Practice Guidelines as Topic ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/therapy
Language	English
Publishing date	2016-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.15-1076
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Article ; Online: Update in pulmonary, sleep, and critical care medicine: evidence published in 2013.

Balachandran, Jay S / Hall, Jesse B

Annals of internal medicine

2014 Volume 160, Issue 9, Page(s) 621–626

Language	English
Publishing date	2014-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M14-0209
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Article ; Online: In the clinic. Obstructive sleep apnea.

Balachandran, Jay S / Patel, Sanjay R

Annals of internal medicine

2014 Volume 161, Issue 9, Page(s) ITC1–15; quiz ITC16

Abstract: ... editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education ...

Abstract	This issue provides a clinical overview of Obstructive Sleep Apnea focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.
MeSH term(s)	Continuous Positive Airway Pressure ; Diagnosis, Differential ; Humans ; Polysomnography ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/therapy
Language	English
Publishing date	2014-11-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/0003-4819-161-9-201411040-01005
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Article ; Online: Obesity Hypoventilation Syndrome Epidemiology and Diagnosis.

Balachandran, Jay S / Masa, Juan Fernando / Mokhlesi, Babak

Sleep medicine clinics

2014 Volume 9, Issue 3, Page(s) 341–347

Language	English
Publishing date	2014-09-19
Publishing country	United States
Document type	Journal Article
ISSN	1556-4088
ISSN (online)	1556-4088
DOI	10.1016/j.jsmc.2014.05.007
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Article ; Online: Obstructive sleep apnea and the risk for cardiovascular disease.

Kohli, Puja / Balachandran, Jay S / Malhotra, Atul

Current atherosclerosis reports

2011 Volume 13, Issue 2, Page(s) 138–146

Abstract: Obstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. It is estimated that more than one quarter of the population is at risk for OSA, with increased prevalence noted in populations with hypertension, ... ...

Abstract	Obstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. It is estimated that more than one quarter of the population is at risk for OSA, with increased prevalence noted in populations with hypertension, coronary artery disease, stroke, and atrial fibrillation. A number of epidemiologic and mechanistic studies have recently generated interest in the role of OSA in the pathophysiology of cardiovascular disease, a link that continues to require extensive investigation. This chapter reviews these epidemiologic studies, the current understanding of the mechanisms by which OSA may contribute to the progression of cardiovascular diseases, and the effects of OSA treatment on cardiovascular disease outcomes.
MeSH term(s)	Adult ; Age Distribution ; Aged ; Behavior Therapy/methods ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/therapy ; Combined Modality Therapy ; Comorbidity ; Coronary Disease/epidemiology ; Coronary Disease/prevention & control ; Coronary Disease/therapy ; Female ; Humans ; Male ; Middle Aged ; Mouth Protectors ; Positive-Pressure Respiration/methods ; Prevalence ; Prognosis ; Risk Assessment ; Severity of Illness Index ; Sex Distribution ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/epidemiology ; Sleep Apnea, Obstructive/therapy ; Survival Analysis
Language	English
Publishing date	2011-01-21
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2057369-8
ISSN	1534-6242 ; 1523-3804
ISSN (online)	1534-6242
ISSN	1523-3804
DOI	10.1007/s11883-011-0161-8
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Article ; Online: Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

Guralnick, Amy S / Balachandran, Jay S / Szutenbach, Shane / Adley, Kevin / Emami, Leila / Mohammadi, Meelad / Farnan, Jeanne M / Arora, Vineet M / Mokhlesi, Babak

Thorax

2017 Volume 72, Issue 12, Page(s) 1132–1139

Abstract: Background: Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread ... ...

Abstract	Background: Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Methods: Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. Results: A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. Conclusions: In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. Trial registration number: ClinicalTrials.gov Identifier: NCT02553694.
Language	English
Publishing date	2017-12
Publishing country	England
Document type	Journal Article
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thoraxjnl-2017-210106
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Article ; Online: A brief survey of patients' first impression after CPAP titration predicts future CPAP adherence: a pilot study.

Balachandran, Jay S / Yu, Xiaohong / Wroblewski, Kristen / Mokhlesi, Babak

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2013 Volume 9, Issue 3, Page(s) 199–205

Abstract: Background: CPAP adherence patterns are often established very early in the course of therapy. Our objective was to quantify patients' perception of CPAP therapy using a 6-item questionnaire administered in the morning following CPAP titration. We ... ...

Abstract	Background: CPAP adherence patterns are often established very early in the course of therapy. Our objective was to quantify patients' perception of CPAP therapy using a 6-item questionnaire administered in the morning following CPAP titration. We hypothesized that questionnaire responses would independently predict CPAP adherence during the first 30 days of therapy. Methods: We retrospectively reviewed the CPAP perception questionnaires of 403 CPAP-naïve adults who underwent in-laboratory titration and who had daily CPAP adherence data available for the first 30 days of therapy. Responses to the CPAP perception questionnaire were analyzed for their association with mean CPAP adherence and with changes in daily CPAP adherence over 30 days. Results: Patients were aged 52 ± 14 years, 53% were women, 54% were African American, the mean body mass index (BMI) was 36.3 ± 9.1 kg/m(2), and most patients had moderate-severe OSA. Four of 6 items from the CPAP perception questionnaire- regarding difficulty tolerating CPAP, discomfort with CPAP pressure, likelihood of wearing CPAP, and perceived health benefit-were significantly correlated with mean 30-day CPAP adherence, and a composite score from these 4 questions was found to be internally consistent. Stepwise linear regression modeling demonstrated that 3 variables were significant and independent predictors of reduced mean CPAP adherence: worse score on the 4-item questionnaire, African American race, and non-sleep specialist ordering polysomnogram and CPAP therapy. Furthermore, a worse score on the 4-item CPAP perception questionnaire was consistently associated with decreased mean daily CPAP adherence over the first 30 days of therapy. Conclusions: In this pilot study, responses to a 4-item CPAP perception questionnaire administered to patients immediately following CPAP titration independently predicted mean CPAP adherence during the first 30 days. Further prospective validation of this questionnaire in different patient populations is warranted.
MeSH term(s)	Continuous Positive Airway Pressure/psychology ; Female ; Humans ; Male ; Middle Aged ; Patient Compliance/psychology ; Pilot Projects ; Retrospective Studies ; Sleep Apnea, Obstructive/psychology ; Sleep Apnea, Obstructive/therapy ; Surveys and Questionnaires
Language	English
Publishing date	2013-03-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.2476
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Article ; Online: Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline.

American journal of respiratory and critical care medicine

2019 Volume 200, Issue 3, Page(s) e6–e24

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Obesity Hypoventilation Syndrome/diagnosis ; Obesity Hypoventilation Syndrome/therapy ; United States
Language	English
Publishing date	2019-08-12
Publishing country	United States
Document type	Journal Article ; Practice Guideline ; Research Support, Non-U.S. Gov't
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201905-1071ST
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Article ; Online: Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep.

Grossman, Mila N / Anderson, Samantha L / Worku, Aelaf / Marsack, William / Desai, Nimit / Tuvilleja, Ambrosio / Ramos, Jacqueline / Francisco, Mary Ann / Lafond, Cynthia / Balachandran, Jay S / Mokhlesi, Babak / Farnan, Jeanne M / Meltzer, David O / Arora, Vineet M

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2017 Volume 13, Issue 2, Page(s) 301–306

Abstract: Study objectives: Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with ... ...

Abstract	Study objectives: Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives. Methods: Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects. Results: Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003]. Conclusion: Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.
Language	English
Publishing date	2017-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.6468
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Article ; Online: Risk of sleep apnea in hospitalized older patients.

Shear, Talia C / Balachandran, Jay S / Mokhlesi, Babak / Spampinato, Lisa M / Knutson, Kristen L / Meltzer, David O / Arora, Vineet M

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2014 Volume 10, Issue 10, Page(s) 1061–1066

Abstract: Background/objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality.: Design: Prospective cohort ... ...

Abstract	Background/objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. Design: Prospective cohort study. Setting: General medicine ward in academic medical center. Participants: 424 hospitalized adult patients ≥ 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). Main measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and efficiency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). Key results: Two of every 5 inpatients ≥ 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ∼ 5 h and mean sleep efficiency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ∼ 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These findings remained significant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ∼ 5.5% less sleep efficiency per night (-5.50 [-9.96, -1.05], p = 0.015). In multivariate analysis, patients at high risk for OSA also had lower self-reported sleep quality on KSQI (-0.101 [-0.164, -0.037], p = 0.002). Conclusion: Two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality. Commentary: A commentary on this article appears in this issue on page 1067.
MeSH term(s)	Aged ; Chicago/epidemiology ; Cohort Studies ; Female ; Geriatric Assessment/methods ; Geriatric Assessment/statistics & numerical data ; Humans ; Male ; Polysomnography/methods ; Prevalence ; Prospective Studies ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Risk Factors ; Sleep Apnea Syndromes/epidemiology ; Surveys and Questionnaires
Language	English
Publishing date	2014-10-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.4098
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