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Sleep Apnea Syndromes: HELP
Articles by Nancy A. Collop
Based on 33 articles published since 2010
(Why 33 articles?)

Between 2010 and 2020, Nancy Collop wrote the following 33 articles about Sleep Apnea Syndromes.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea. 2016

Chung, Frances / Memtsoudis, Stavros G / Ramachandran, Satya Krishna / Nagappa, Mahesh / Opperer, Mathias / Cozowicz, Crispiana / Patrawala, Sara / Lam, David / Kumar, Anjana / Joshi, Girish P / Fleetham, John / Ayas, Najib / Collop, Nancy / Doufas, Anthony G / Eikermann, Matthias / Englesakis, Marina / Gali, Bhargavi / Gay, Peter / Hernandez, Adrian V / Kaw, Roop / Kezirian, Eric J / Malhotra, Atul / Mokhlesi, Babak / Parthasarathy, Sairam / Stierer, Tracey / Wappler, Frank / Hillman, David R / Auckley, Dennis. ·From the *Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesiology, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York; ‡Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; §Department of Anesthesiology and Perioperative Medicine, University Hospital, St. Joseph's Hospital and Victoria Hospital, London Health Sciences Centre and St. Joseph's Health care, Western University, London, Ontario, Canada; ‖Paracelsus Medical University, Department of Anesthesiology, Perioperative Medicine and Intensive Care, Salzburg, Austria; ¶Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College New York, New York; #Department of Anesthesia, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria; **Department of Medicine, University of California San Diego, San Diego, California; ††Sparrow Hospital, Lansing, Michigan; ‡‡Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Texas; §§Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada; ‖‖University of British Columbia, Vancouver, BC, Canada; ¶¶Department of Medicine, Emory University, Atlanta, Georgia; ##Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California; ***Department of Anesthesia, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts; †††Library and Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada; ‡‡‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; §§§Department of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota; ‖‖‖School of Medicine, Universidad Peruana de Ciencias Apl ·Anesth Analg · Pubmed #27442772.

ABSTRACT: The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

2 Editorial Justice Antonin Scalia-The Wrong Message. 2016

Collop, Nancy A. ·The Emory Clinic Sleep Disorders Center, Atlanta, GA; Editor-In-Chief, Journal of Clinical Sleep Medicine. ·J Clin Sleep Med · Pubmed #27092697.

ABSTRACT: -- No abstract --

3 Editorial Point: Should board certification be required for sleep test interpretation? Yes. 2013

Fleishman, Sam A / Collop, Nancy A / Aronsky, Amy J / McCann, Kathleen M. ·American Academy of Sleep Medicine, Fayetteville, NC; Sleep Center, Cape Fear Valley Health System, Atlanta, GA. Electronic address: safleishman@capfearvalley.com. · American Academy of Sleep Medicine, Fayetteville, NC; Emory University, Hamilton, NJ. · American Academy of Sleep Medicine, Fayetteville, NC; Comprehensive Sleep Associates, Darien, IL. · American Academy of Sleep Medicine, Fayetteville, NC. ·Chest · Pubmed #23880672.

ABSTRACT: -- No abstract --

4 Editorial I don't sleep because I can't breathe. 2013

Collop, Nancy. · ·Sleep Med · Pubmed #23746824.

ABSTRACT: -- No abstract --

5 Editorial Home sleep testing: appropriate screening is the key. 2012

Collop, Nancy. · ·Sleep · Pubmed #23115391.

ABSTRACT: -- No abstract --

6 Editorial Home sleep testing: it is not about the test. 2010

Collop, Nancy A. · ·Chest · Pubmed #20682524.

ABSTRACT: -- No abstract --

7 Review Surgical Treatment of OSA on Cardiovascular Outcomes: A Systematic Review. 2017

Halle, Tyler R / Oh, Melissa S / Collop, Nancy A / Quyyumi, Arshed A / Bliwise, Donald L / Dedhia, Raj C. ·Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA. · Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA. · Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. · Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA; Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA. Electronic address: raj.dedhia@emory.edu. ·Chest · Pubmed #28923761.

ABSTRACT: BACKGROUND: OSA is an increasingly prevalent clinical problem with significant effects on quality of life and cardiovascular risk. Surgical therapy represents an important treatment for those unable to use positive airway pressure. This systematic review examines the available cardiovascular risk reduction data for the surgical treatment of OSA. METHODS: A comprehensive literature search was performed. Articles were included if they met the following criteria: (1) the sample population consisted of adults (age ≥ 18 years); (2) OSA was diagnosed according to a sleep study; (3) surgical intervention was performed for OSA; and (4) one or more physical or biochemical cardiovascular and/or cerebrovascular variables was measured preoperatively and at ≥ 14 days postoperatively. RESULTS: Thirty-three articles were included. The majority of studies were case series and cohort studies (42% and 44%, respectively), with wide-ranging follow-up periods (4 weeks-9 years) and sample sizes (range, 6-10,339; median, 34). The following classes of surgical intervention were examined: pharyngeal surgery (n = 23), tracheostomy (n = 6), maxillomandibular advancement (n = 3), and hypoglossal nerve stimulation (n = 1). In total, 19 outcome measures were assessed. Tracheostomy was most consistently associated with improvement in cardiovascular end points. Pharyngeal surgeries (eg, uvulopalatopharyngoplasty) were variably associated with improvement in cardiovascular end points. CONCLUSIONS: The published literature examining cardiovascular end points following surgical treatment of OSA is limited and generally of poor quality. However, available data from mainly small and observational studies suggest that surgical treatment of OSA may provide improvement in some cardiovascular end points. Larger, randomized, and prospective trials with more rigorous study designs are needed. TRIAL REGISTRY: PROSPERO International Prospective Register of Systemic Reviews (PROSPERO 42016040120).

8 Review Legal and Regulatory Aspects of Sleep Disorders. 2017

Venkateshiah, Saiprakash B / Hoque, Romy / DelRosso, Lourdes M / Collop, Nancy A. ·Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA 30322, USA. · Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA. · Department of Pediatrics, University of California San Francisco, 747 52nd street, Oakland, CA 94609, USA; Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609, USA. · Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA. Electronic address: nancy.collop@emory.edu. ·Sleep Med Clin · Pubmed #28159093.

ABSTRACT: Sleep disorders may interact with the law, making awareness important. Insufficient sleep and obstructive sleep apnea (OSA) are prevalent and associated with excessive sleepiness. Patients with excessive sleepiness may have civil or criminal liability if they fall asleep and cause a motor vehicle accident. Awareness of screening and treatment of OSA is increasing in certain industries. Parasomnia associated sleep-related violence represents a challenge to clinicians, who may be called on to consider parasomnia as a contributing, mitigating, or exculpatory factor in criminal proceedings. Improving access to sleep medicine care is an important aspect in reducing the consequences of sleep disorders.

9 Review Commercial Motor Vehicle Driver Obstructive Sleep Apnea Screening and Treatment in the United States: An Update and Recommendation Overview. 2016

Colvin, Loretta J / Collop, Nancy A. ·Maryville University and Clayton Sleep Institue, St. Louis, MO. · Emory Sleep Center, Emory University, Atlanta, GA. ·J Clin Sleep Med · Pubmed #26094916.

ABSTRACT: ABSTRACT: No regulatory mandate exists in the United States (U.S.) for comprehensive obstructive sleep apnea (OSA) risk assessment and stratification for commercial motor vehicle (CMV) drivers. Current Federal Motor Carrier Safety Administration (FMCSA) requirements are outdated and depend largely on subjective report, a less reliable strategy in an occupational setting. Without FMCSA standards, sleep specialists, occupational medical examiners and employers rely on a collection of medical consensus recommendations to establish standards of care. These recommendations advise OSA risk assessment through a combination of focused medical history, physical examination, questionnaires, and accident history, which increase OSA detection compared to current FMCSA standards. For those diagnosed with OSA, consensus-based risk stratification helps identify CMV drivers who may benefit from OSA treatment and establish minimum standards for assessing treatment efficacy and adherence. Unfortunately no consolidated recommendation exists; rather, publications span medical and governmental literature in a patchwork fashion that no longer fully reflect current practice due to subsequent advances in OSA diagnosis, treatment, and technology. Based on searches of medical literature, internet materials, and reference lists from existing publications, an overview and discussion of key published recommendations regarding OSA assessment and treatment in CMV operators is provided. Suggestions for incorporating these recommendations into clinical sleep medicine practice in the U.S. are presented. The challenge for sleep specialists is maintaining the delicate balance between recommendations impacting standard of care and associated medico-legal impact with stakeholder interests from medical, regulatory, industry and public perspectives while providing high quality and efficient care.

10 Review Perioperative Assessment and Management for Sleep Apnea in the Ambulatory Surgical Patient. 2015

Stierer, Tracey L / Collop, Nancy A. ·Department of Anesthesiology and Critical Care Medicine and Department of Otolaryngology, Head and Neck Surgery (Dr Stierer), Johns Hopkins Medicine, Baltimore, MD. Electronic address: tstiere@jhmi.edu. · Department of Medicine, Emory University School of Medicine, Atlanta, GA. ·Chest · Pubmed #25856723.

ABSTRACT: The overwhelming majority of surgical procedures performed in the United States are done on an outpatient basis. Patients with complicated medical problems are routinely scheduled for ambulatory procedures that have become progressively more complex. Appropriate patient selection is paramount to ensuring optimal perioperative outcomes, and the patient with known or suspected OSA presents unique challenges to the anesthesia care team regarding airway management, pain control, and postoperative monitoring requirements. Currently, a relative paucity of high-quality evidence exists on which to base guidelines or recommendations for the anesthetic care of these patients. It is generally agreed that early identification of those at risk for OSA allows for planning and implementation of strategies to help to reduce the risk of adverse perioperative events. Although various national societies have published consensus statements aimed at guiding the perioperative management of the patient at risk for OSA, more studies are needed to define the optimal approach to the perioperative care of this population.

11 Review Maximizing positive airway pressure adherence in adults: a common-sense approach. 2013

Wickwire, Emerson M / Lettieri, Christopher J / Cairns, Alyssa A / Collop, Nancy A. ·Pulmonary Disease and Critical Care Associates, Columbia, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: emerson@ewickwire.com. · Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD. · Pulmonary Disease and Critical Care Associates, Columbia, MD. · Departments of Medicine and Neurology, Emory University, Atlanta, GA. ·Chest · Pubmed #23918114.

ABSTRACT: Positive airway pressure (PAP) therapy is considered the most efficacious treatment of obstructive sleep apnea (OSA), especially moderate to severe OSA, and remains the most commonly prescribed. Yet suboptimal adherence presents a challenge to sleep-medicine clinicians. The purpose of the current review is to highlight the efficacy of published interventions to improve PAP adherence and to suggest a patient-centered clinical approach to enhancing PAP usage.

12 Review An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement. 2013

Strohl, Kingman P / Brown, Daniel B / Collop, Nancy / George, Charles / Grunstein, Ronald / Han, Fang / Kline, Lawrence / Malhotra, Atul / Pack, Alan / Phillips, Barbara / Rodenstein, Daniel / Schwab, Richard / Weaver, Terri / Wilson, Kevin / Anonymous260760. · ·Am J Respir Crit Care Med · Pubmed #23725615.

ABSTRACT: BACKGROUND: Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. METHODS: A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. RESULTS: A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. DISCUSSION: The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available.

13 Review Latest advances in sleep medicine: obstructive sleep apnea. 2012

Simon, Sibyl / Collop, Nancy. ·Division of Sleep Medicine, Emory University, Atlanta, GA. · Division of Sleep Medicine, Emory University, Atlanta, GA. Electronic address: nancy.collop@emory.edu. ·Chest · Pubmed #23208337.

ABSTRACT: This article is a review of the pertinent scientific data regarding obstructive sleep apnea (OSA) as presented in the medical literature. Attention regarding the diagnosis of OSA focused on the debate regarding home testing as compared with in-laboratory polysomnography (PSG), with a surprising result of possibly more cost benefit from PSG. New advances abound in the treatment of OSA, including those directed at preventing pharyngeal collapsibility. Multiple studies reviewed the comparative effects of oral appliances in conjunction with CPAP, with little difference between the two noted, especially for mild OSA. Finally, a number of studies evaluated both risks of OSA and outcomes from the use of CPAP, including functional outcomes, direct cardiac benefits, and overall cardiac mortality.

14 Review Sleep-disordered breathing. 2012

Ioachimescu, Octavian C / Collop, Nancy A. ·Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, 1670 Clairmont Rd, Decatur, GA, USA. oioac@yahoo.com ·Neurol Clin · Pubmed #23099131.

ABSTRACT: Obesity is a critical factor in the development of sleep-disordered breathing (SDB). Snoring is the most frequent nocturnal symptom suggesting a diagnosis of SDB. Other common nighttime symptoms include snorting, gasping, choking, coughing, and witnessed apneas. The most frequent diurnal symptom in SDB is excessive daytime sleepiness. Patients suspected of having SDB should undergo a full night of in-laboratory polysomnography or in-home oligosomnography. SDB includes a spectrum of disorders; the most common are obstructive sleep apnea and central sleep apnea.

15 Review Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. 2011

Collop, Nancy A / Tracy, Sharon L / Kapur, Vishesh / Mehra, Reena / Kuhlmann, David / Fleishman, Sam A / Ojile, Joseph M. ·Emory Sleep Center, Atlanta, GA, USA. ·J Clin Sleep Med · Pubmed #22003351.

ABSTRACT: Guidance is needed to help clinicians decide which out-of-center (OOC) testing devices are appropriate for diagnosing obstructive sleep apnea (OSA). A new classification system that details the type of signals measured by these devices is presented. This proposed system categorizes OOC devices based on measurements of Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters.Criteria for evaluating the devices are also presented, which were generated from chosen pre-test and post-test probabilities. These criteria state that in patients with a high pretest probability of having OSA, the OOC testing device has a positive likelihood ratio (LR+) of 5 or greater coinciding with an in-lab-polysomnography (PSG)-generated apnea hypopnea index (AHI) ≥ 5, and an adequate sensitivity (at least 0.825).Since oximetry is a mandatory signal for scoring AHI using PSG, devices that do not incorporate oximetry were excluded. English peer-reviewed literature on FDA-approved devices utilizing more than 1 signal was reviewed according to the above criteria for 6 questions. These questions specifically addressed the adequacy of different respiratory and effort sensors and combinations thereof to diagnose OSA. In summary, the literature is currently inadequate to state with confidence that a thermistor alone without any effort sensor is adequate to diagnose OSA; if a thermal sensing device is used as the only measure of respiration, 2 effort belts are required as part of the montage and piezoelectric belts are acceptable in this context; nasal pressure can be an adequate measurement of respiration with no effort measure with the caveat that this may be device specific; nasal pressure may be used in combination with either 2 piezoelectric or respiratory inductance plethysmographic (RIP) belts (but not 1 piezoelectric belt); and there is insufficient evidence to state that both nasal pressure and thermistor are required to adequately diagnose OSA. With respect to alternative devices for diagnosing OSA, the data indicate that peripheral arterial tonometry (PAT) devices are adequate for the proposed use; the device based on cardiac signals shows promise, but more study is required as it has not been tested in the home setting; for the device based on end-tidal CO(2) (ETCO(2)), it appears to be adequate for a hospital population; and for devices utilizing acoustic signals, the data are insufficient to determine whether the use of acoustic signals with other signals as a substitute for airflow is adequate to diagnose OSA.Standardized research is needed on OOC devices that report LR+ at the appropriate AHI (≥ 5) and scored according to the recommended definitions, while using appropriate research reporting and methodology to minimize bias.

16 Review Insomnia and sleep-related breathing disorders. 2010

Wickwire, Emerson M / Collop, Nancy A. ·Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, 10710 Charter Dr, Ste 310, Columbia, MD 21044, USA. ewickwire@pulmdocs.com ·Chest · Pubmed #20525657.

ABSTRACT: Insomnia disorder and obstructive sleep apnea are the two most common sleep disorders among adults. Historically, these conditions have been conceptualized as orthogonal, or insomnia has been considered a symptom of sleep apnea. Insomnia researchers have sought to exclude participants at risk for sleep-related breathing disorders (SRBD), and vice versa. In recent years, however, there has been a growing recognition of co-occurring insomnia disorder and SRBD and interest in the prevalence, consequences, and treatment of the two conditions when they co-occur. Although plagued by inconsistent diagnostic criteria and operational definitions, evidence from clinical and research samples consistently suggests high rates of comorbidity between the two disorders. More important, insomnia disorder and SRBD have additive negative effects. To date, only a few studies have explored the combined or sequential treatment of the conditions. Results support the importance of an integrated, interdisciplinary approach to sleep medicine. This article reviews the empirical literature to date and provides clinical recommendations as well as suggestions for future research.

17 Clinical Trial Solriamfetol for the Treatment of Excessive Sleepiness in OSA: A Placebo-Controlled Randomized Withdrawal Study. 2019

Strollo, Patrick J / Hedner, Jan / Collop, Nancy / Lorch, Daniel G / Chen, Dan / Carter, Lawrence P / Lu, Yuan / Lee, Lawrence / Black, Jed / Pépin, Jean-Louis / Redline, Susan / Anonymous1661017. ·From the University of Pittsburgh/Veterans Administration Pittsburgh Health System, Pittsburgh, PA. Electronic address: strollopj@upmc.edu. · Sahlgrenska University Hospital, Gothenberg University, Gothenberg, Sweden. · Emory Sleep Center, Emory University, Atlanta, GA. · PAB Clinical Research/Florida Sleep Disorder Center, Brandon, FL. · Jazz Pharmaceuticals plc, Palo Alto, CA. · Jazz Pharmaceuticals plc, Palo Alto, CA; University of Arkansas for Medical Sciences, Little Rock, AR. · Jazz Pharmaceuticals plc, Palo Alto, CA; Stanford University Center for Sleep Sciences and Medicine, Redwood City, CA. · INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France. · Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. ·Chest · Pubmed #30471270.

ABSTRACT: BACKGROUND: Excessive sleepiness (ES) is a common symptom of OSA, which often persists despite primary OSA therapy. This phase III randomized withdrawal trial evaluated solriamfetol (JZP-110) for the treatment of ES in adults with OSA. METHODS: After 2 weeks of clinical titration (n = 174) and 2 weeks of stable dose administration (n = 148), participants who reported improvement on the Patient Global Impression of Change (PGI-C) and had numerical improvements on the Maintenance of Wakefulness Test (MWT) and Epworth Sleepiness Scale (ESS) were randomly assigned to placebo (n = 62) or solriamfetol (n = 62) for 2 additional weeks. Coprimary end points were change from weeks 4 to 6 in MWT and ESS. RESULTS: In the modified intention-to-treat population (n = 122), MWT mean sleep latencies and ESS scores improved from baseline to week 4 (from 12.3-13.1 to 29.0-31.7 minutes and from 15.3-16.0 to 5.9-6.4, respectively). From weeks 4 to 6, participants treated with solriamfetol maintained improvements (least squares [LS] mean [SE] changes of -1.0 [1.4] minutes on MWT and -0.1 [0.7] on ESS), whereas participants treated with placebo worsened (LS mean [SE] change of -12.1 [1.3] minutes on MWT and 4.5 [0.7] on ESS); LS mean differences between treatments were 11.2 minutes (95% CI, 7.8-14.6) and -4.6 (95% CI, -6.4 to -2.8) on MWT and ESS, respectively. Fewer participants treated with solriamfetol reported worsening on the PGI-C from weeks 4 to 6 (20% vs 50%; P = .0005). Common adverse events included headache, dry mouth, nausea, dizziness, and insomnia. CONCLUSIONS: This study demonstrated maintenance of solriamfetol efficacy and safety over 6 weeks. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02348619; URL: www.clinicaltrials.gov; EudraCT No.: 2014-005515-16.

18 Article Obstructive sleep apnea, sleep symptoms, and their association with cardiovascular disease. 2019

Oh, Melissa S / Bliwise, Donald L / Smith, Andrew L / Collop, Nancy A / Quyyumi, Arshed A / Dedhia, Raj C. ·Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A. · Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A. · Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A. · Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A. ·Laryngoscope · Pubmed #31532856.

ABSTRACT: OBJECTIVES: To determine the frequency of obstructive sleep apnea (OSA), insomnia, restless legs, and other sleep symptoms in patients with cardiovascular disease and the association of these sleep disorders with quantitative cardiovascular measures. METHODS: Study design was a cross-sectional survey and retrospective chart review. A questionnaire containing validated sleep symptoms was distributed to 202 patients with cardiovascular disease at a tertiary referral cardiology clinic. Following a focused review of these patients' medical charts, their questionnaire responses were examined for associations with clinical cardiovascular parameters. RESULTS: Twenty-one percent of patients reported a prior diagnosis of OSA. A total of 115 patients (60%) had at least one additional sleep symptom. Clinically significant insomnia was significantly associated with heart disease (relative risk [RR] = 1.5, confidence interval [CI] = 1.1 to 2.1), prior myocardial infarction or cerebrovascular accident (RR = 2.1, CI = 1.2 to 3.6), and heart failure (RR = 2.2, CI = 1.3 to 3.8). Left ventricular ejection fraction was significantly associated with insomnia by Insomnia Severity Index (β = -0.52, CI = -0.89 to -0.13). CONCLUSION: The frequency of OSA in patients in this tertiary cardiology clinic was higher than the general population in the United States, with the majority of patients experiencing at least one sleep symptom. Insomnia symptoms were shown to be associated with multiple cardiovascular measures, including left ventricular ejection fraction. These findings imply an interwoven relationship between cardiovascular and sleep symptoms as captured by validated sleep questionnaires. LEVEL OF EVIDENCE: IV Laryngoscope, 2019.

19 Article Sleep-Disordered Breathing and Cardiovascular Correlates in College Football Players. 2017

Kim, Jonathan H / Hollowed, Casey / Irwin-Weyant, Morgan / Patel, Keyur / Hosny, Kareem / Aida, Hiroshi / Gowani, Zaina / Sher, Salman / Gleason, Patrick / Shoop, James L / Galante, Angelo / Clark, Craig / Ko, Yi-An / Quyyumi, Arshed A / Collop, Nancy A / Baggish, Aaron L. ·Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia. Electronic address: jonathan.kim@emory.edu. · Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia. · Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia. · Sports Medicine, Furman University, Greenville, South Carolina. · Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. · Emory Sleep Center, Atlanta, Georgia. · Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts. ·Am J Cardiol · Pubmed #28823486.

ABSTRACT: This study sought to determine the cardiovascular physiologic correlates of sleep-disordered breathing (SDB) in American-style football (ASF) participants using echocardiography, vascular applanation tonometry, and peripheral arterial tonometry. Forty collegiate ASF participants were analyzed at pre- and postseason time points with echocardiography and vascular applanation tonometry. WatchPAT (inclusive of peripheral arterial tonometry) used to assess for SDB was then performed at the postseason time point. Twenty-two of 40 (55%) ASF participants demonstrated SDB with an apnea-hypopnea index (pAHI) ≥5. ASF participants with SDB were larger (109 ± 20 vs 92 ± 14 kg, p = 0.004) and more likely linemen position players (83% vs 50%, p = 0.03). Compared with those without SDB, ASF participants with SDB demonstrated relative impairments in left ventricular diastolic and vascular function as reflected by lower lateral e' (14 ± 3 vs 17 ± 3 cm/s, p = 0.007) and septal e' (11 ± 2 vs 13 ± 2 cm/s, p = 0.009) tissue velocities and higher pulse wave velocity (5.4 ± 0.9 vs 4.8 ± 0.5 m/s, p = 0.02). In the total cohort, there were significant positive correlations between pAHI and pulse wave velocity (r = 0.42, p = 0.008) and inverse correlations between pAHI and the averaged e' tissue velocities (r = -0.42, p = 0.01). In conclusion, SDB is highly prevalent in youthful collegiate ASF participants and associated with relative impairments in cardiac and vascular function. Targeted efforts to identify youthful populations with SDB, including ASF participants, and implement SDB treatment algorithms, represent important future clinical directives.

20 Article Validated Measures of Insomnia, Function, Sleepiness, and Nasal Obstruction in a CPAP Alternatives Clinic Population. 2017

Lam, Austin S / Collop, Nancy A / Bliwise, Donald L / Dedhia, Raj C. ·Emory University School of Medicine, Atlanta, Georgia. · Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia. · Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia. · Department of Neurology, Emory University School of Medicine, Atlanta, Georgia. · Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia. ·J Clin Sleep Med · Pubmed #28633723.

ABSTRACT: STUDY OBJECTIVES: Although efficacious in the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) can be difficult to tolerate, with long-term adherence rates approaching 50%. CPAP alternatives clinics specialize in the evaluation and treatment of CPAP-intolerant patients; yet this population has not been studied in the literature. To better understand these patients, we sought to assess insomnia, sleep-related functional status, sleepiness, and nasal obstruction, utilizing data from validated instruments. METHODS: After approval from the Emory University Institutional Review Board, a retrospective chart review was performed from September 2015 to September 2016 of new patient visits at the Emory CPAP alternatives clinic. Patient demographics and responses were recorded from the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), Epworth Sleepiness Scale, and Nasal Obstruction Symptom Evaluation questionnaires. RESULTS: A total of 172 patients were included, with 81% having moderate-severe OSA. Most of the patients demonstrated moderate-severe clinical insomnia and at least moderate nasal obstruction. FOSQ-10 scores indicated sleep-related functional impairment in 88%. However, most patients did not demonstrate excessive daytime sleepiness. CONCLUSION: This patient population demonstrates significant symptomatology and functional impairment. Because of the severity of their OSA, they are at increased risk of complications. In order to mitigate the detrimental effects of OSA, these significantly impacted patients should be identified and encouraged to seek CPAP alternatives clinics that specialize in the treatment of this population.

21 Article SAVE Me From CPAP. 2016

Collop, Nancy / Stierer, Tracy L / Shafazand, Shirin. ·Emory Sleep Center, Emory University, Atlanta, GA. · Johns Hopkins Center for Sleep at Howard County General Hospital, Johns Hopkins University, Baltimore, MD. · Miller School of Medicine, Miami University, Miami, FL. ·J Clin Sleep Med · Pubmed #27855746.

ABSTRACT: -- No abstract --

22 Article Prediction of obstructive sleep apnea using visual photographic analysis. 2016

Cheung, Kristin / Ishman, Stacey L / Benke, James R / Collop, Nancy / Tron, Lia / Moy, Nicole / Stierer, Tracey L. ·Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Division of Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: drishman@yahoo.com. · Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Emory Sleep Center, Emory University, Atlanta, GA, USA. · Department of Anesthesiology, Lankenau Hospital, Wynnewood, PA, USA. · Department of Anesthesia & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·J Clin Anesth · Pubmed #27290943.

ABSTRACT: STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been historically underdiagnosed and may be associated with grave perioperative complications. The ASA and American Academy of Sleep Medicine recommend OSA screening prior to surgery; however, only a minority of patients are screened. The objective of this study was to determine the proficiency of anesthesiologists, otolaryngologists, and internists at predicting the presence of OSA by visual photographic analysis without the use of a computer program to assist, and determine if prediction accuracy varies by provider type. DESIGN: Prospective case series SETTING: Tertiary care hospital-based academic center PATIENTS: Fifty-six consecutive patients presenting to the sleep laboratory undergoing polysomnography had frontal and lateral photographs of the face and torso taken. INTERVENTIONS: Not applicable. MEASUREMENTS: Polysomnography outcomes and physician ratings. An obstructive apnea hypopnea index (oAHI) ≥15 was considered "positive." Twenty anesthesiologists, 10 otolaryngologists, and 11 internists viewed patient photographs and scored them as OSA "positive" or "negative" before and after being informed of patient comorbidities. MAIN RESULTS: Nineteen patients had an oAHI <15, 18 were ≥15 but <30, and 19 were ≥30. The mean oAHI was 28.7 ± 26.7 events/h (range, 0-125.7), and the mean body mass index was 34.1 ± 9.7 kg/m(2) (range, 17.4-63.7). Overall, providers predicted the correct answer with 61.8% accuracy without knowledge of comorbidities and 62.6% with knowledge (P < .0001). There was no difference between provider groups (P = .307). Prediction accuracy was unrelated to patient age (P = .067), gender (P = .306), or race (P = .087), but was related to body mass index (P = .0002). CONCLUSION: The ability to predict OSA based on visual inspection of frontal and lateral photographs is marginally superior to chance and did not differ by provider type. Knowledge of comorbidities did not improve prediction accuracy.

23 Article Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center. 2016

Colvin, Loretta J / Dace, Gayla A / Colvin, Ryan M / Ojile, Joseph / Collop, Nancy. ·Maryville University, St. Louis, MO. · Clayton Sleep Institute, St. Louis, MO. · Southeast Health, St. Louis, MO. · Washington University, St. Louis, MO. · Emory Sleep Center, Emory University, Atlanta, GA. ·J Clin Sleep Med · Pubmed #26715403.

ABSTRACT: STUDY OBJECTIVES: To assess positive airway pressure (PAP) therapy adherence in commercial motor vehicle (CMV) drivers presenting to a sleep center. METHODS: A retrospective chart review of 120 drivers evaluated for obstructive sleep apnea OSA and 53 initiated on PAP therapy in a single sleep center over a one-year period (2012); PAP therapy data were collected up to 1 year. RESULTS: Early PAP usage best predicted adherence up to 1 year (p < 0.0001) compared to patient factors, OSA disease characteristics, and treatment elements analyzed. The proportion of participants adherent to therapy was 68.0% at 1 week, decreasing to 39.6% at 1 year, with 31.1% lost to follow-up by 1 year. In the group categorized based on adherence at week 1, 80.6% were adherent at 1 month, decreasing to 52.8% at 1 year. For the group non-adherent at 1 week, 29.4% were adherent at 1 month, decreasing to 11.7% at 1 year. Participants were predominantly male (75.8%), middle-aged (median 50.5 years), and African American (71.7%). Of those referred to the sleep center, 86.7% had OSA (median apnea-hypopnea index [AHI] or respiratory event index [REI] 20.1), with 51.0% of the OSA group having an AHI or REI > 20 and initiating PAP therapy. CONCLUSIONS: Early PAP utilization patterns predicted one year adherence for our CMV driver population within a sleep clinic setting. OSA testing of these CMV drivers after occupational health referral identifies high proportions of undiagnosed OSA, with approximately half requiring PAP therapy based on current published treatment recommendations.

24 Article Prevalence of Undetected Sleep Apnea in Patients Undergoing Cardiovascular Surgery and Impact on Postoperative Outcomes. 2015

Foldvary-Schaefer, Nancy / Kaw, Roop / Collop, Nancy / Andrews, Noah D / Bena, James / Wang, Lu / Stierer, Tracey / Gillinov, Marc / Tarler, Matt / Kayyali, Hani. ·Cleveland Clinic Sleep Disorders Center, Cleveland, OH. · Cleveland Clinic Department of Hospital Medicine and Anesthesiology Outcomes Research, Cleveland, OH. · Emory Sleep Disorders Center, Atlanta, GA. · Cleveland Clinic Quantitative Health Sciences, Cleveland, OH. · Johns Hopkins Department of Anesthesiology, Baltimore, MD. · Cleveland Clinic Department of Cardiac and Thoracic Surgery, Cleveland, OH. · Cleveland Medical Devices Inc., Cleveland, OH. ·J Clin Sleep Med · Pubmed #26094932.

ABSTRACT: STUDY OBJECTIVE: We examined the prevalence of obstructive sleep apnea (OSA) among patients undergoing cardiac surgery and its impact on postoperative outcomes. METHODS: Subjects were recruited from inpatient cardiovascular surgery units at two tertiary care centers. Crystal Monitor 20-H recorded polysomnograms preoperatively. Regression analyses were performed to explore associations between OSA using different apnea-hypopnea index (AHI) cutoffs and postoperative outcomes adjusting for key covariates. Prevalence of postoperative outcomes was compared among groups defined by AHI and left ventricle ejection fraction (LVEF) median cutoffs. RESULTS: Of 107 participants, the AHI was ≥ 5 in 79 (73.8%), ≥ 10 in 63 (58.9%), ≥ 15 in 51(47.7%), and ≥ 30 in 29 (27.1%). Patients with AHI ≥ 15 had significantly lower LVEF (p < 0.001). Logistic regression analyses with OSA cutoffs as above adjusting for age, gender, race, BMI, and LVEF found no significant increase in odds for any postoperative outcomes. No significant differences were found in %Total sleep time (TST) with SpO2 < 90% between AHI or LVEF groups, or by presence/absence of complications. Patients with any amount of TST with SpO2 < 90% had greater BMI, longer OR tube time, and greater prevalence of prolonged intubation (p = 0.007, 0.035, 0.038, respectively). CONCLUSIONS: OSA is highly prevalent in patients undergoing cardiovascular surgery. It could not be shown that OSA was significantly associated with adverse postoperative outcomes, but this may have been due to an insufficient number of subjects. AHI ≥ 15 was associated with lower LVEF. Larger samples are required to explore the impact of OSA on key postoperative outcomes that have clinical and economic importance in the care of cardiovascular surgery populations. COMMENTARY: A commentary on this article appears in this issue on page 1081.

25 Article Quality measures for the care of adult patients with obstructive sleep apnea. 2015

Aurora, R Nisha / Collop, Nancy A / Jacobowitz, Ofer / Thomas, Sherene M / Quan, Stuart F / Aronsky, Amy J. ·Johns Hopkins University, School of Medicine, Baltimore, MD. · Emory Sleep Center, Atlanta, GA. · ENT and Allergy Associates and Mount Sinai Hospital, New York, NY. · American Academy of Sleep Medicine, Darien, IL. · Division of Sleep Medicine, Harvard Medical School, Boston, MA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA. · Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ. · CareCentrix, Hartford, CT. ·J Clin Sleep Med · Pubmed #25700878.

ABSTRACT: ABSTRACT: Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA.