Twenty patients with obstructive sleep apnea (OSA) underwent complete polysomnography and simultaneous upper airway pressure monitoring with a custom-made, soft silicone-covered catheter measuring 2.3 mm in diameter. The catheter had four solid-state microtip pressure sensors positioned in the posterior nasopharynx, immediately caudal to the tip of the uvula, at the level of the hyoid bone, and in the midesophagus. The level(s) of airway collapse was determined by changes in the pressure patterns between transducers. In 14 of the 20 patients, airway collapse was confined or initiated at the oropharyngeal region. The obstruction extended to the base of tongue in 7 and to the entire collapsible upper airway in 2 patients. Four patients had collapse at the base of the tongue and 2 had collapse at the hypopharynx. The site of airway collapse remained fairly constant through various sleep stages and positions. Uvulopalatopharyngoplasty (UPPP) and postoperative polysomnography were performed in 4 patients (2 with hypopharyngeal, 1 with base of tongue, and 1 with oropharyngeal airway collapse). Two patients had a favorable response to UPPP.

Study objectives:To examine the real-world effectiveness of benzodiazepine receptor agonists (BzRAs) by quantifying response and remission rates in a clinical sample receiving chronic BzRA treatment for insomnia. Methods: Participants were outpatients (N = 193; 72% female; 55.2 ± 11.1 year) who had an insomnia diagnosis per medical records, and who were taking a therapeutic dose of BzRA for their insomnia. Endpoints were nocturnal sleep disturbance and Insomnia Severity Index (ISI) scores. A reduction meeting the criterion for the minimally important difference in ISI scores (change ≥ 6) constituted "response"; "remission" was inferred when symptoms fell below the clinical cutoff (ISI < 11). Results: Most participants (71%) used BzRAs at least 5 nights per week. Mean ISI scores were significantly lower (t = 22.31; p < .01) while on BzRAs than when untreated, but remained in the clinical range (mean = 11.0; standard deviation = 5.7). Although 76.7% responded to treatment, only 47.7% remitted. The majority (68.9%) of participants had a sleep-onset latency > 30 minutes and/or wake-time after sleep onset > 60 minutes while on BzRAs. After controlling for gender and insomnia severity when untreated, odds of insomnia persistence despite BzRA use were 2 times higher in patients with comorbid medical [odds ratio (OR) = 2.39; 95% confidence interval (CI) = 1.20% to 4.77%; p < .05] and psychiatric disorders (OR = 2.24; 95% CI = 1.21% to 4.13%; p < .05). Conclusions: This is the first study to distinguish between response and remission in insomnia patients taking BzRAs. Findings suggest that while many insomnia patients respond to chronic BzRA treatment, most do not remit. Remission rates are particularly low for comorbid insomnia, the most prevalent phenotype of the disorder.

Introduction Sleep restriction and sleep disorders are common causes of excessive daytime sleepiness (EDS). Medical disorders (MD) can also cause EDS, but previous studies have used non-standardized measures, selected samples, or have examined EDS in singular disorders. This study describes the relative degree of EDS associated with medical disorders to provide comparative data across a range of common medical conditions in a large unselected community-based sample. Methods Responses of 2612 individuals (aged 18-65) were assessed after excluding those with suspected sleep disordered breathing, narcolepsy, and shift workers. Participants across a range of medical disorders were evaluated using the Epworth Sleepiness Scale (ESS) and patient reports of nocturnal sleep. Results Sixty-seven percent of the sample reported a MD. The prevalence of EDS (ESS ≥ 10) was 31.4% in individuals with MD and increased as a function of number of MD (0 MD = 29.4%, 1 MD = 28.4%, 2 MD = 31.0%, 3 MD = 35.3%, 4 MD = 38.4%). Disorders which were independent predictors of EDS were ulcers OR = 2.21 (95% CI = 1.35 - 3.61), migraines OR = 1.36 (95% CI = 1.08 – 1.72), and depression OR = 1.46 (95% CI = 1.16 – 1.83) after controlling for other conditions, age, gender, time in bed, caffeine, smoking and alcohol use. Participants with ulcers had the highest prevalence of sleepiness, 50.0%, as well as the highest level of problems falling asleep (40.8%) and awakenings during the night (62.5%). Conclusions Individuals with ulcers, migraines, and depression have independent and clinically significant levels of EDS relative to other common MD.

Introduction Drowsy driving is a common occupational hazard for night shift workers (NSWs). While sleep loss is commonly identified as the primary culprit of drowsy driving, another critical factor to consider is circadian phase. However, the role of circadian phase in driving safety has not been well characterized in NSWs. This study examined if dim light melatonin offset (DLMOff, i.e. the cessation of melatonin secretion) is also a relevant phase marker of susceptibility to four different subtypes of risky on-the-road driving behaviors. Methods On-the-road driving was monitored over 8 weeks via a mobile application that tracked risky driving behaviors using accelerometer and GPS data from cell phones (N=15; 3052 total driving events recorded). Risky driving behaviors included: 1) frequency of hard-braking events, 2) frequency of aggressive-acceleration events, 3) duration of excessive-speeding, and 4) duration of phone-usage. At week 2, participants spent 24 hours in-lab where hourly saliva samples were collected and assayed for melatonin, and DLMOff was calculated. Phase angle of driving events relative to DLMOff was used as the predictor in nested mixed-effects regressions, with risky driving behaviors as the outcome variables. Results The most common occurrences of risky driving were phone-usage and hard-braking. On average, NSWs had 46.7% and 42.0% of driving events with at least one occurrence of phone-usage and hard-braking, respectively. Rates of aggressive-acceleration and speeding were 24.4% and 20.4%. Positive phase angles (i.e. driving after DLMOff) were associated with reduced rates of hard-braking and aggressive-acceleration, but not of phone-usage and excessive-speeding. Specifically, rates of hard-braking and aggressive-acceleration decreased by 4.5% (p&lt;.01) and 3.4% (p=.05) every two hours following DLMOff, respectively. Conclusion The study suggests DLMOff appears to be an important variable for predicting accident risk in NSWs. If replicated, circadian phase should be considered in recommendations to increase occupational health and safety of NSWs. Support Support for this study was provided to PC by NHLBI (K23HL138166).

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