Two and One Half Years Down, Many More to Go

it is for this reason that the admission ticket for recognition as a new medical specialty by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties includes a suffi cient number of active training programs and trainees in the prospective specialty. Because without practitio-ners, there is no specialty. In the most recent Sleep Medicine fellowship match, 64 programs offered 129 positions to start in July 2013. Thus, it is alarming that 31 positions or ~25% went unfi lled. It is possible that in some cases programs deliberately did not rank any candidates leading to seemingly unfi lled positions on the match list. Conversely, candidates may have per-ceived that some programs were of insuffi cient qual-ity. However, given the openings in some prestigious programs, it is likely that there is a paucity of demand. This begs several questions. Is this the beginning of a trend, i.e., the proverbial “Canary in the coal mine”? And if so, why?Unfortunately, it is impossible to know if this past year’s match is a blip in the radar or a harbinger of future results. However, if these results portend the outcome of future matches, several explanations are possible. First, potential trainees have become aware that there is decline in polysomnography use and re-imbursement, thus making specialization in Sleep Medicine less fi nancially attractive. Second, many trainees enter the fi eld after having already completed 4 to 6 years of post graduate medical training. Thus, some may view the extra year of training required for Sleep Medicine as neither intellectually nor fi nancial-ly worthwhile. Third, and perhaps the most potential-ly worriesome, Sleep Medicine may not be perceived as intellectually stimulating with most patients being evaluated and treated for sleep disordered breathing problems.What can be done? Obviously, there must be in-creased efforts to develop new practice paradigms to make Sleep Medicine fi nancially viable and not com-pletely dependent on performing laboratory polysom-nography. More importantly, we as Sleep Medicine practitioners need to promote our fi eld to potential trainees. Large numbers of the general populace suffer from sleep disorders and thus the potential to improve the quality of life for many is great. Furthermore, there is diversity to the fi eld. It is not just about treat-ing sleep disordered breathing although some believe this to be the case. Moreover, there are few disciplines where medical devices, pharmaceuticals and behav-ioral modalities are all used as primary treatments for patients. We should be communicating to potential trainees that Sleep Medicine is a diverse and complex specialty with the potential to help many patients. If we can do this, our fi eld will have a promising future. If not, there will be uncertainty.

Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients

Background: The purpose of this study was to identify the top 100 cited articles dedicated to sleep medicine published in journals that have made key contributions to the field. Methods: We performed a search of journals and selected 100 top-cited articles by utilizing the Institute for Scientific Information database available under the banner of the Web of Science. Next, we manually reviewed the contents of the top 100 cited articles. We examined the characteristics of the articles, such as the number of citations, ranking, authorship, article title, year of publication, publishing journal, publication type, and topic categories. Results: The top-cited articles were published in 49 journals, and the most frequently cited journal was Sleep (23 articles). The top 100 cited articles originated from institutions in 9 countries, with the USA contributing 67 articles. The institution associated with the largest numbers of sleep medicine citation classics was Stanford University (11 articles). Morin CM, who was the first author for 6 articles, was listed most frequently in the sleep medicine citation classics. The publication years were concentrated in the 2000s, when 42 articles were published. The topics included 35 insomnia studies, 25 sleep physiology studies, 22 obstructive sleep apnea studies, and 19 other studies. Conclusions: The present study provides a detailed list of the most-cited articles on sleep medicine. This currently relevant approach provides an opportunity to recognize the classic articles on sleep, to provide useful insights into international leaders, and to describe research trends in the field of sleep medicine.

Artificial intelligence (AI) has impacted many areas of healthcare. AI in healthcare uses machine learning, deep learning, and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes. In the sleep medicine field, a large amount of physiological data is gathered compared to other branches of medicine. This field is primed for innovations with the help of AI. A good quality of sleep is crucial for optimal health. About one billion people are estimated to have obstructive sleep apnea worldwide, but it is difficult to diagnose and treat all the people with limited resources. Sleep apnea is one of the major contributors to poor health. Most of the sleep apnea patients remain undiagnosed. Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors, and AI can help in this situation. AI can also help in the diagnosis and management of other sleep disorders such as insomnia, hypersomnia, parasomnia, narcolepsy, shift work sleep disorders, periodic leg movement disorders, etc. In this manuscript, we aim to address three critical issues about the use of AI in sleep medicine: (1) How can AI help in diagnosing and treating sleep disorders? (2) How can AI fill the gap in the care of sleep disorders? and (3) What are the ethical and legal considerations of using AI in sleep medicine?

The evaluation of medical evidence derived from the literature obviously requires the ability to understand and critique published studies. In this chapter, the design and analysis of observational and interventional studies will be discussed, with specific reference to selected papers in the field of sleep medicine. The approach taken is to first review the various types of research designs used in clinical epidemiology, e.g., cohort, case–control, experimental, quasi-experimental, etc., with examples from the recent literature. After the design of these studies has been described, an introduction to statistical methods is provided with an explanation of how these methods were applied to the analysis of the papers under consideration. Although a comprehensive treatment of research design and analysis is clearly beyond the scope of this chapter, it is hoped that the treatment provided herein will provide the reader with the basic skills and enthusiasm to delve further into the analytical methods applied to sleep medicine studies.

Sleep medicine education in US and Canadian orofacial pain residency programs: Survey outcomes

Sleep disorders are defined on the basis of diagnostic criteria presented in medical classifications. However, no consensus has emerged on the exact list of operational symptoms that should be systematically investigated in the field of sleep medicine. We propose a systematic analysis of sleep symptoms that figure in a set of self-reported multiple sleep disorder screening questionnaires for adult populations, to identify the content overlap of symptoms that probe the presence of central sleep symptoms, and to highlight the potential level of heterogeneity among sleep disorder questionnaires. The method comprises three steps: (i) the selection of self-reported multiple sleep disorder screening questionnaires; (ii) item extraction and selection; (iii) the extraction of symptoms from items. Frequency of sleep symptoms and content overlap (Jaccard Index) are analyzed. We extracted 469 items that provide 60 different symptoms from 12 questionnaires. Insomnia, somnolence, and sleep-related breathing symptoms were found in all the questionnaires. The mean overlap among all questionnaires evaluated with the Jaccard Index is 0.44, i.e., moderate similarity. Despite limitations related to the selection of questionnaires and the symptom extraction and harmonization, this study underlines the need to standardize sleep symptom contents for sleep medicine in order to enhance the practicability, reliability, and validity of sleep disorder diagnoses.

Introduction: Considerable interest has been shown in the field of sleep medicine in recent decades. Obstructive sleep apnoea (OSA) is a common condition that remains neglected in most parts of the world. Data are scarce, if any, when it comes to developing countries. We sought to describe the patient population in a single private tertiary care center from such a country.Materials and Methods: A cross-sectional study that included a total of 203 patients over a five-year period was conducted. Polysomnographic studies were conducted in a dedicated sleep laboratory, under the supervision of sleep physicians. Data were described and analyzed based on clinical and self-reported outcomes, as well as polysomnographic characteristics, and compared them between genders and severity.Results: With the participants having an average age of 50.84 years and a BMI of 34.7 kg/m2, the study found that the increase in age and BMI was significantly correlated with an increase in the severity of obstructive sleep apnea in the Pakistani population. There was a significant difference in sleep latency (20.6 min in women vs. 10.8 min in men; p-value = 0.001) and efficiency (63.7% in women vs. 69.8 in men; p-value = 0.02) between the two genders. Decreases in nadir saturation, total sleep time, and sleep latency were also associated with an increase in the level of severity.Conclusion: There is a dire need for Pakistani, and in extension Asian, medical professionals to ramp up their pace to meet the needs of their population with regard to sleep medicine.

There are a huge number of patients with sleep-associated diagnoses that affect their mortality and morbidity. Sleep-associated diagnoses negatively affect the most commonly seen medical and psychiatric disorders in primary care practice: hypertension, obesity, cardiovascular disease, arrhythmias, mood disorder/depression, and anxiety. The associated personal and medical costs of untreated sleep disorders are staggering. The associated daytime sleepiness negatively affects driving and work performance and when untreated contributes to a large number of motor vehicular accidents, injuries, and deaths. The field of sleep medicine is in the midst of major changes, with payers and changes in technology forcing care from the sleep laboratory into the primary care office. It is impingent for the field of sleep medicine that primary care physicians have a cogent understanding of sleep disorders. It is only through the incorporation of primary care physicians into the field that the important high-quality care required to reduce can be made available to the patients with sleep-associated diagnoses.

Sleep is vital for health and well being and involves a complex set of neuro-physiological processes [1]. A complex set of derangements characterize critical illness, and involve almost every organ system, including the neurological system. It follows that when these two spheres of complexity meet, i.e., the study of sleep during critical illness assumes an even higher level of complexity. Despite such hurdles, the potential rewards to better understanding sleep during critical illness have immense bearing to both sleep medicine and critical care fields [2]. While the field of sleep medicine needs further mechanistic data to determine the effect of sleep on survival, existing evidence suggests that sleep disturbances exert deleterious effects on patients with critical illness. Therefore, the focus of this chapter is to provide the reasons as to why, and what, a pulmonologist needs to know about sleep and critical illness.KeywordsSleepCritical illnessMechanical ventilationArtificial respirationNoiseIntensive care unit

Using preprints in evidence synthesis: Commentary on experience during the COVID-19 pandemic

Humans spend one third of their life sleeping. Sleep, a vital life process, is an essential part of human health. In response to people's growing needs concerning sleep health, sleep medicine was born and is growing rapidly, and there is also an upsurge in the construction of sleep medicine centers in China and other countries. Unfortunately, there are no Chinese standards available for the construction of sleep medicine centers and the sleep medicine centers already constructed are of varied quality. In view of this academic problem, Professor Lu Lin, an academician of Chinese Academy of Sciences and the president of Peking University Sixth Hospital, organized Chinese experts with outstanding achievements in the field of sleep medicine to draft "Guideline for the Standardized Construction of Sleep Medicine Centers in China". This guideline mainly introduces the overall status of standardized construction of sleep medicine centers and the status of the construction of specialized sleep medicine centers in China, aiming to guide the construction of high-quality and high-standard sleep medicine centers in China, to promote the development of sleep medicine, and to safeguard people's sleep health.

Introduction Lack of exposure to the field of Sleep Medicine at the medical student level hinders sleep training. Instead of the traditional didactic style, there is a need for innovative collaborative measures to spark interest in the younger generation of learners. The goal of this educational endeavor was to introduce medical students to the field of Sleep Medicine through the platform of Student Interest Group in Neurology (SIGN). Methods An interactive session was conducted for SIGN at the University of Minnesota. 24 second-year medical students were divided into 6 groups. The session consisted of introduction, videos of common sleep disorders and interactive briefing afterward. 5-point Likert scale pre and post-session surveys were administered to measure the level of knowledge regarding sleep, familiarity with diagnostic tools, available education, pathways to Sleep Medicine, learner’s interest and impact of the session. Wilcoxon matched-pairs signed-rank test was performed to compare pre- and post-surveys. Results There was a significant improvement in measures of students’ knowledge about sleep diagnostic modalities (p =7.8*10-5), education received (p= 3.2*10-5) and pathways to sleep medicine (p=4.1*10-5). Survey also showed improvement in students’ interest in pursuing a Sleep Medicine career (p=0.07). There was no difference in knowledge about the importance of sleep for health (p=0.69). All of the students found the session to be informative. Conclusion Early exposure to sleep disorders in interactive format was well received by the medical students with significant improvement in scores regarding sleep education, awareness of diagnostic modalities, career pathway and interest in sleep medicine (p=0.07). Integration of exposure to Sleep Medicine within the medical curriculum in an innovative format should be done to instigate interest in this field. Further larger studies are warranted to evaluate the changes in the students’ interest in the subspecialty with an introduction in the early stages of their career. Support

Evolution in Reimbursement for Sleep Studies and Sleep Centers

This rapid review examines how sport and exercise psychology (SEP) research has engaged with esports over the last five years, highlighting the academic acceptance of esports in SEP journals and on the psychological factors that influence esports performance and well-being. In addition to searching for recent empirical studies, we identified systematic reviews, meta-analyses, and scoping reviews to capture the breadth of existing syntheses. Following rapid review guidelines (Sabiston et al., 2022) and adapting the PRISMA framework (Page et al., 2021), two systematic searches were conducted in the Web of Science Core Collection and EBSCO host (SPORTDiscus) databases. First, we identified 13 syntheses of the esports literature highlighting the main topics of interest across scholars in relation to SEP. Then, we identified 125 relevant peer-reviewed empirical publications on esports in SEP context, of which 18 appeared in SEP-specific journals. Findings reveal increasing academic attention in affective, cognitive-motor processes, team dynamics, training structures, and health behaviors (e.g., mental health, physical activity, sleep, nutrition) unique to esports while revealing the need for theoretical and methodological attention. Overall, we highlighted how esports and SEP appear to benefit one another in a reciprocal way. Esports offer a controlled, data-rich performance environment for testing and refining SEP theories. Meanwhile, SEP principles enhance professionalism in esports by informing evidence-based training methods and well-being initiatives. Future research should consider longitudinal designs, open science practices, and interdisciplinary collaboration such as data science, sleep medicine, and nutrition to address the nuanced psychological demands in this rapidly evolving performance domain.