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When teams travel back home, every additional 500km reduces the likelihood of winning by approximately 4% (p= 0.038). Finally, after withdrawing the Away-Home sequence, traveling eastward significantly increases the chance of winning (p= 0.024) compared to westward travel but has no significant impact on the probability of winning compared to neutral time zone travel (p= 0.091).

The accumulation of travel fatigue and the chronic circadian desynchronization that occurs over the NBA season can acutely disturb sleep and recovery. It appears that tailored sleep and recovery strategies need to be dynamically developed throughout the season to overcome the different challenges of the NBA schedule.

The accumulation of travel fatigue and the chronic circadian desynchronization that occurs over the NBA season can acutely disturb sleep and recovery. It appears that tailored sleep and recovery strategies need to be dynamically developed throughout the season to overcome the different challenges of the NBA schedule.Kleine-Levin syndrome (KLS) is a rare disorder of recurrent hypersomnolence. The pathophysiology continues to be poorly understood. Autoimmunity, genetic polymorphisms, dysfunction of the hypothalamic axis, and abnormalities in functional imaging have been proposed. Several triggers have been described, including infection, toxins, head trauma, sleep deprivation, lactation, and menses. We present the first case report in the medical literature of KLS triggered by pregnancy and the first KLS from Armenia. Our patient has a pattern of mostly pregnancy-related episodes of several day sleepiness occurring monthly. This case adds to the published literature as we present a new association and explore the pathophysiology of KLS.We rerpot a case of a 65-year-old obese female who developed a unilateral nasal cerebrospinal fluid (CSF) leak after starting autotitrating positive airway pressure therapy for obstructive sleep apnea. The CSF leak was confirmed by beta-2 transferrin testing of the nasal fluid, as well as by identification of the leak through the anterior cribriform plate after administration of intrathecal fluorescein. The CSF leak was successfully repaired endoscopically, and autotitrating positive airway pressure was reinitiated one month postoperatively.

Monitoring electrocardiogram (ECG) is an integral component of pediatric polysomnography (PSG). There is limited data regarding arrhythmia and conduction disturbances in the pediatric population undergoing a PSG. Cyclopamine ic50 In this work we present abnormal ECG findings during PSG in our sleep center.

A retrospective chart review from children who underwent PSG read by a single Sleep Medicine physician in the last year was carried out. Findings in children without cardiac disease and with first or second degree atrioventricular block (AVB) were compared to those from children with premature ventricular contractions (PVC).

A total of 1,235 PSGs were included. Twenty-four children (9 girls and 15 boys) aged 2-17 years (median 9 years) were identified with arrhythmias or conduction disturbances (1.9%). Nineteen out of 24 of these children (79.2%) had obstructive apnea-hypopnea index (oAHI) > 1 event/h; this frequency was not significantly different from that found in the whole group of 1,235 children. No statistically significant difference was found between children with AVB or PVC. Seven out of nine children with AVB and seven out of 10 with PVC had oAHI > 1 event/h, while eight children with AVB out of nine and four out of 10 with PVC were males (Fisher exact test p=0.04). None of the children were found to have a structural or conduction abnormality when referred to cardiology.

Our study supports that ECG abnormalities are rare in PSGs of children and not associated with cardiac disease or sleep disorders but appear more commonly in males.

Our study supports that ECG abnormalities are rare in PSGs of children and not associated with cardiac disease or sleep disorders but appear more commonly in males.The mainstay of treatment for obstructive sleep apnea (OSA) is positive airway pressure (PAP). PAP therapy may be difficult to tolerate for some patients which may compromise adherence, requiring alternative therapies. Hypoglossal nerve stimulation (HGNS) has become an option for those who meet implantation criteria. Implantation of the device is an ambulatory surgical procedure and is generally well-tolerated, though rare adverse events have been reported. We report an unusual complication of HGNS in a patient who had initial success with this therapy. After three years of treatment, the sensor lead penetrated into the pleural space. Components of the HGNS were explanted, and a new sensor lead and generator were reimplanted. The new device was activated, and therapy was successfully resumed. This case demonstrates that there is a potential for a delayed complication of sensor lead penetration into the pleural space which has only rarely been reported.

Both obesity and airways disease can lead to chronic hypercapnic respiratory failure, which can be managed with positive airway pressure (PAP) therapy. The efficacy of PAP has been studied in obesity hypoventilation syndrome as well as in chronic hypercapnic COPD patients, but not in patients where both obesity and airway obstruction coexist. This pilot study aims to compare the efficacy of continuous positive airway pressure (CPAP) versus bilevel positive airway pressure spontaneous mode (BPAP S mode) in the treatment of hypoventilation disorder with obesity and obstructive airways disease.

We sequentially screened PAP naïve patients with stable chronic hypercapnic respiratory failure (PaCO

> 45 mmHg), obesity (BMI > 30 kg/m

) and obstructive airways disease. Subjects were randomized to CPAP or BPAP S mode treatment for 3 months. Subjects were blinded to their PAP allocation. Change in awake PaCO

was the primary endpoint. Secondary endpoints included change in lung function, daytime sleepiness, sleep quality, quality of life, PAP adherence and neurocognitive function.

A total of 32 subjects were randomized (mean ± SD Age 61 ± 11 years, BMI 43 ± 7 kg/m

, PaCO

54 ± 7mmHg, FEV

1.4 ± 0.6L, AHI 59 ± 35 events/h). Sixteen participants in each PAP group were analyzed. BPAP yielded a greater improvement in PaCO

compared to CPAP (9.4mmHg, 95% CI 4.3 to 15 mmHg). There were no significant differences in PAP adherence, sleepiness, sleep quality or neurocognitive function between the two therapies.

Although both PAP modalities improved hypercapnic respiratory failure in this group of subjects, BPAP S mode showed greater efficacy in reducing PaCO

.

Although both PAP modalities improved hypercapnic respiratory failure in this group of subjects, BPAP S mode showed greater efficacy in reducing PaCO2.

To evaluate facial 3D stereophotogrammetry's effectiveness as a screening tool for pediatric obstructive sleep apnea (OSA) when used by dental specialists.

One hundred forty-four subjects aged 2-17 years, including children fully diagnosed with pediatric OSA through nocturnal polysomnography (nPSG) or at high- or low-risk of pediatric OSA, participated in this study. 3D stereophotogrammetry, Craniofacial Index (CFI) and Pediatric Sleep Questionnaire (PSQ) were obtained from all participants. Ten dental specialists with interest in pediatric sleep breathing disorders classified OSA severity twice. Once, based only on 3D stereophotogrammetry, and then based on 3D stereophotogrammetry, CFI and PSQ. Intra-rater and inter-rater reliability, and diagnostic accuracy of pediatric OSA classification, were calculated. A cluster analysis was performed to identify potential homogeneous pediatric OSA groups based on their craniofacial features classified through the CFI.

Intra-rater and inter-rater agreement suggest interested in SDB. Some craniofacial traits, more specifically significant sagittal overjet discrepancies and an arched palate, seem to influence participating dental specialist's classification.

There is minimal guidance around how to optimize inspiratory positive airway pressure (IPAP) levels during use of adaptive servo ventilation (ASV) in clinical practice. This real-world data analysis investigated the effects of IPAP and minimum pressure support (PSmin) settings on respiratory parameters and adherence in ASV-treated patients.

A US-based telemonitoring database was queried for patients starting ASV between 1 August 2014 and 30 November 2019. Patients meeting the following criteria were included US-based patients aged ≥18 years; AirCurve 10 device (ResMed); and ≥1 session with usage of ≥1 hour in the first 90 days. Key outcomes were mask leak and residual apnea-hypopnea index (AHI) at different IPAP settings, adherence and therapy termination rates, and respiratory parameters at different PSmin settings.

63,996 patients were included. Higher IPAP was associated with increased residual AHI and mask leak but did not impact device usage per session (average >6 h/day at all IPAP settings; 6.7 h/day at 95

percentile IPAP 25 cmH

O). There were no clinically relevant differences in respiratory rate, minute ventilation, leak and residual AHI across all possible PSmin settings. Patients with a higher 95

percentile IPAP or with PSmin of 3 cmH

O were most likely to remain on ASV therapy at 1 year.

Our findings showed robust levels of longer-term adherence to ASV therapy in a large group of real-world patients. There were no clinically important differences in respiratory parameters across a range of pressure and pressure settings. Future work should focus on the different phenotypes of patients using ASV therapy.

Our findings showed robust levels of longer-term adherence to ASV therapy in a large group of real-world patients. There were no clinically important differences in respiratory parameters across a range of pressure and pressure settings. Future work should focus on the different phenotypes of patients using ASV therapy.Narcolepsy type 1 (NT1) results from probable autoimmune disruption of hypothalamic hypocretinergic neurons. Secondary narcolepsy can occur as a result of other conditions affecting the central nervous system, including limbic paraneoplastic encephalitis (PE). We report the case of a 19-year-old patient presenting with acute-onset diurnal hypersomnolence, hyperphagia, sexual dysfunction and psychiatric disturbances. Further investigations revealed a limbic PE associated with mediastinal thymic seminoma. Tumour removal and immunosuppressive treatment resulted in a partial benefit on psychiatric disturbances but did not improve daytime sleepiness. A comprehensive sleep assessment led to the diagnosis of secondary NT1 with reduced CSF hypocretin-1 levels and revealed the presence of the HLA DQB1*0602 allele, typically associated with idiopathic narcolepsy, for which we hypothesize a possible immunopathogenic role. Sodium oxybate was successfully administered. Narcolepsy is often overlooked in patients with limbic PE. A prompt assessment and an adequate symptomatic treatment can improve the disease burden.

References for the evaluation of obstructive sleep apnea (OSA) often exceed the sleep clinic's capacity. We aimed to assess the non-inferiority of a nurse-communicated model, compared with a traditional physician-led model, for the initial management of uncomplicated OSA in the sleep clinic.

In this non-inferiority, open-label randomized controlled trial, patients referred to the for the evaluation of uncomplicated OSA (home sleep apnea test with respiratory event index ≥ 20 events/hour), were randomized to a nurse-communicated or a physician-led management. The primary endpoint was non-inferiority in the mean change from baseline of the Epworth Sleepiness Scale (ESS) score at 3 and 6 months, assuming a non-inferiority margin of -2.0 points. Secondary outcomes included quality of life [Quebec Sleep Questionnaire (QSQ)] and positive airway pressure (PAP) adherence.

200 participants were randomized to a nurse-communicated (n=101) or physician-led management (n=99). Overall, 48 participants were lost at follow-up (27.