G. Pillar - Academia.edu (original) (raw)

Papers by G. Pillar

Sleep Disorders, 2014

During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomn... more During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients’ satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P<0.05). 597 CPAPs were purchased in 2007-2008 compared to 831 in 20...

Respiration, 2018

Background: Several studies in animal models and human with obstructive sleep apnea syndrome (OSA... more Background: Several studies in animal models and human with obstructive sleep apnea syndrome (OSAS) demonstrated an increase in cancer aggressiveness and mortality. However, there is a need for further clinical evidence supporting a correlation between OSAS and cancer incidence. Objectives: To reveal whether OSAS presence and severity is correlated with cancer incidence in a large homogenous patients’ cohort. Methods: We analyzed a cohort of over 5,000 concurrently enrolled patients, age > 18, with suspected OSAS, from a tertiary medical academic center. Patients underwent whole night polysomnography, the gold standard diagnostic tool for OSAS, and were classified for severity according to the Apnea Hypopnea Index (AHI). Data on cancer incidence were obtained from the Israel National Cancer Registry. A multivariate Cox proportional-hazards analysis, adjusted for age, gender, and BMI, was performed to estimate the hazard-ratio of new cancer incidence. Results: Among 5,243 subjects...

Sleep and Breathing, 2008

The exact pathophysiology leading to pharyngeal collapse in obstructive sleep apnea syndrome (OSA... more The exact pathophysiology leading to pharyngeal collapse in obstructive sleep apnea syndrome (OSAS) remains incompletely understood. Prior research has shown that normal men have a longer pharyngeal airway than women, and it has been hypothesized that this difference may play a role in the gender-related differences in OSAS. In the current study, we sought to study the potential relationship between the length of the collapsible pharyngeal segment, the upper airway length (UAL), and the severity of OSAS. The hospital records were searched for all patients who had had polysomnography and also had had a computed tomography of the neck. A total of 24 such patients were identified who participated (15 men and nine women). The UAL, the distance between the lower posterior part of the hard palate bone to the upper posterior part of the hyoid bone, was measured for all participants in the midsagittal plane. A correlation coefficient (Pearson r) of 0.406 was found between Respiratory Disturbance Index (RDI) and UAL (p = 0.049). When UAL was normalized to body height, a correlation coefficient (r) of 0.423 was found (p = 0.039). A gender-related difference in UAL was also found. Men with OSAS were found to have longer UAL even when normalized to body height (p = 0.003, unpaired t test) as compared with OSAS women. This study provides potential clinical relevance to prior studies in normal subjects, by demonstrating that men with OSAS have longer UAL than women with OSAS, independent of body size. In addition, the significant correlation between UAL and OSAS severity suggests that UAL may play a role in the pathophysiology of OSAS. These findings are consistent with our predictions from computational modeling studies.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 29, 2016

Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturb... more Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturbance as a hallmark manifestation. A growing body of research has suggested a link between obstructive sleep apnea and PTSD, potentially due to obstructive sleep apnea (OSA) related sleep disruption, or via other mechanisms. We examined the hypothesis that treatment of OSA with positive airway pressure would reduce PTSD symptoms over 6 months. A prospective study of Veterans with confirmed PTSD and new diagnosis of OSA not yet using PAP therapy were recruited from a Veteran's Affairs sleep medicine clinic. All subjects were instructed to use PAP each night. Assessments were performed at 3 and 6 months. The primary outcome was a reduction in PTSD symptoms at 6 months. Fifty-nine subjects were enrolled; 32 remained in the study at 6 months. A significant reduction in PTSD symptoms, measured by PCL-S score was observed over the course of the study (60.6±2.7 versus 52.3±3.2 points; p <...

American Journal of Hypertension, 2006

Background: Obstructive sleep apnea (OSA) is associated with hypertension. In the current study w... more Background: Obstructive sleep apnea (OSA) is associated with hypertension. In the current study we sought to determine whether the evening-morning differences in blood pressure (BP) would correlate with the severity of OSA and whether there are gender-related differences. Methods: A total of 2009 consecutive patients referred to sleep examination because of suspected sleep apnea were retrospectively included. The patients comprised 1566 men, of whom 870 were nonhypertensive (non-HT) and 696 hypertensive (HT) and 443 women, of whom 258 were non-HT and 185 HT. Four BP measurements, two in the evening and two in the morning, were taken. The relationship between evening-morning differences in BP and the number of apneas/hypopneas divided by hours of sleep (AHI) were analyzed separately for HT and non-HT men and women. Results: In men, increase in AHI was associated with increase in morning BP, and the evening-morning difference for both systolic and diastolic BP became negative. These trends were found to be significant by linear regression analyses both for HT (for systolic BP, r ϭ 0.75, P Ͻ .05, for diastolic BP r ϭ 0.96, P Ͻ .05) and non-HT patients (for systolic BP r ϭ 0.93, P Ͻ .05, for diastolic BP r ϭ 0.94, P Ͻ .05). In women (unlike in men), increasing AHI was not associated with a linear increase in the evening-morning BP differences. None of the regression lines fitted to the data was significant. Conclusions: Our results demonstrate that the evening to morning difference in BP in men with OSA is linearly related to the severity of OSA, both in patients with HT and in those with non-HT. These results may have practical relevance in screening for patients with OSA and may have prognostic clinical value in predicting future cardiovascular events.

The Israel Medical Association journal : IMAJ, 2013

Nature and Science of Sleep, 2020

Background: Early diagnosis and treatment of sleep apnea in patients with atrial fibrillation (AF... more Background: Early diagnosis and treatment of sleep apnea in patients with atrial fibrillation (AF) is critical. The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea; however, studies using the WatchPAT device have thus far excluded patients with arrhythmias due to the potential effect of arrhythmias on the peripheral arterial tonometry (PAT) amplitude and pulse rate changes. Purpose: To examine the accuracy of the WP in detecting sleep apnea in patients with AF. Patients and Methods: Patients with AF underwent simultaneous WP and PSG studies in 11 sleep centers. PSG scoring was blinded to the automatically analyzed WP data. Results: A total of 101 patients with AF (70 males) were recruited. Forty-six had AF episodes during the overnight sleep study. A significant correlation was found between the PSG-derived AHI and the WP-derived AHI (r=0.80, p<0.0001). There was a good agreement between PSG-derived AHI and WP-derived AHI (mean difference of AHI:-0.02 ±13.2). Using a threshold of AHI ≥15 per hour of sleep, the sensitivity and specificity of the WP were 0.88 and 0.63, respectively. The overall accuracy in sleep staging between WP and PSG was 62% with Kappa agreement of 0.42. Conclusion: WP can detect sleep apnea events in patients with AF. AF should not be an exclusion criterion for using the device. This finding may be of even greater importance in the era of the COVID19 epidemic, when sleep labs were closed and most studies were home based.

Sleep Medicine, 2013

Background: Restorative sleep is expected to promote improved endothelial function (EF) in the mo... more Background: Restorative sleep is expected to promote improved endothelial function (EF) in the morning compared to the evening. However, in adults with obstructive sleep apnea (OSA) EF is not only adversely affected, but it worsens during the night. Data in pediatric OSA are scarce, and overnight changes have not been explored. Therefore, we sought to examine potential associations between pediatric OSA and overnight changes in EF. Methods: 59 habitually snoring children with various degrees of sleep-disordered breathing (age range, 4-16 years) underwent EF assessment (reactive hyperemia test by EndoPAT, Itamar Medical, Israel) in the evening before and the morning after an overnight polysomnography (PSG). Two brachial occlusion periods (1 min and 5 min) also were tested. Potential associations between evening-to-morning changes in EF and polysomnographic parameters were explored. Results: Evening-to-morning changes in children with OSA displayed severity-dependent deterioration of EF, and occlusions lasting 1 or 5 min during the reactive hyperemia test yielded similar findings. Conclusions: In children deterioration in EF during the night significantly correlated with the severity of OSA. Furthermore, the reactive hyperemia test can be reliably performed with only 60 seconds of arterial flow occlusion in children. These findings support our hypothesis that similarly to adults, sleep apnea in children results in endothelial dysfunction (ED). We speculate that pediatric OSA is less commonly associated with cardiovascular complications possibly due to the shorter duration of the syndrome.

Chest, 2003

Background: Diagnosis of obstructive sleep apnea syndrome (OSAS) by ambulatory systems is a growi... more Background: Diagnosis of obstructive sleep apnea syndrome (OSAS) by ambulatory systems is a growing practice in view of the large number of patients awaiting correct diagnosis. The Watch PAT100 (WP100) [Itamar Medical; Caesarea, Israel] is a portable device based on the peripheral arterial tone (PAT) signal, and is designed for unattended home sleep studies. Objectives: To evaluate the efficacy, reliability, and reproducibility of the WP100 device for the diagnosis of OSAS as compared to in-laboratory, standard polysomnographic-based manual scoring. Design and methods: One hundred two subjects (78 men; 69 patients with OSAS and 33 normal volunteers; mean ؎ SD age, 41.4 ؎ 15.2 years; body mass index, 26.8 ؎ 5.5) underwent inlaboratory full polysomnography simultaneously with WP100 recording. Fourteen subjects also underwent two additional unattended home sleep studies with the WP100 alone. The polysomnography recordings were blindly scored for apnea/hypopnea according to the American Academy of Sleep Medicine criteria (1999), and the polysomnography respiratory disturbance index (RDI) [PSG-RDI] was calculated. The WP100 data were analyzed automatically for the PAT RDI (PRDI) by a proprietary algorithm that was previously developed on an independent group of subjects. Results: Across a wide range of RDI levels, the PRDI was highly correlated with the PSG-RDI (r ‫؍‬ 0.88, p < 0.0001), with an area under the receiver operating characteristic curve of 0.82 and 0.87 for thresholds of 10 events per hour and 20 events per hour, respectively. The PRDI scores were also highly reproducible, showing high correlation between home and in-laboratory sleep studies (r ‫؍‬ 0.89, p < 0.001). Conclusion: The WP100 may offer an accurate, robust, and reliable ambulatory method for the detection of OSAS, with minimal patient discomfort.

Journal of the American College of Cardiology, 1999

Лёгочная реабилитация больных хронической обструктивной болезнью легких с учётом типа реагировани... more Лёгочная реабилитация больных хронической обструктивной болезнью легких с учётом типа реагирования на заболевание Pulmonary rehabilitation of patients with chronic obstructive pulmonary disease and the type of disease-related response

Sleep and Breathing, 2006

This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonom... more This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonometry (Watch_PAT 100) to detect residual episodes of respiratory disturbance during continuous positive airway pressure (CPAP) therapy. Concurrent polysomnography was used as the reference standard to identify sleep disordered breathing (SDB) events. The study was conducted in three sleep laboratories affiliated with tertiary care academic medical centers. Seventy patients using CPAP to treat obstructive sleep apnea for at least 3 months, following an in-laboratory titration to determine the optimal therapeutic positive airway pressure, participated in this study. Symptoms indicating suboptimal therapy were not required for participation, but self-reported adherence to CPAP therapy was necessary for inclusion. Interventions are not applicable in this study. The accuracy of the PAT-derived respiratory disturbance index (PAT RDI scored by automated algorithm) to detect residual SDB on CPAP was assessed against polysomnography (PSG) using Bland-Altman analysis, receiver-operator characteristic (ROC) curves, and likelihood ratios for increasing (LR+) and decreasing (LR-) the probability of moderate-severe SDB in the study population. Respiratory events on the PSG were quantified using standard criteria for research investigations (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Chicago criteria&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;) to yield a PSG RDI.C. Based on the PSG results, 19% of the participants had moderate-severe SDB (PSG…

Urology, 2006

Objectives. To examine whether treatment with continuous positive airway pressure (CPAP) reduces ... more Objectives. To examine whether treatment with continuous positive airway pressure (CPAP) reduces nocturia in patients with obstructive sleep apnea (OSA). Methods. This prospective clinical study recruited patients referred to the Rambam Sleep Laboratory with suspected OSA. After polysomnography, those found to have no OSA were excluded from the study, and the remainder were treated with CPAP. Nocturia was assessed at four time points: baseline (average number of awakenings to urinate per night during 1 week at home before polysomnography); diagnostic night in the laboratory; CPAP titration in the laboratory; and after 1 to 3 months of stable CPAP treatment at home (average number of awakenings to urinate per night for 1 week). Results. Ninety-seven patients (75 men and 22 women) completed the study. The mean Ϯ SD age was 55 Ϯ 12 years, body mass index was 33 Ϯ 7 kg/m 2 , and respiratory disturbance index was 34 Ϯ 24/hr. The mean number of awakenings to void at home before CPAP was 2.5 Ϯ 2.4 times/night; during CPAP, it was 0.7 Ϯ 0.6 time/night (P Ͻ0.001). A total of 73 patients reported improvement in nocturia. The mean number of awakenings to void in the laboratory was 1.1 Ϯ 0.9 before CPAP, with a decrease to 0.5 Ϯ 0.6 during CPAP (P Ͻ0.001). Weak, but significant, correlations were found in the number of awakenings to void before treatment with the respiratory disturbance index (r ϭ 0.25, P ϭ 0.01) and with minimal oxygen saturation (r ϭ Ϫ0.23, P ϭ 0.02). Conclusions. CPAP appears to be an effective treatment for nocturia associated with OSA. UROLOGY 67: 974-977, 2006.

Israel journal of medical sciences, 1996

Several surgical procedures have been developed for the treatment of sleep apnea syndrome. These ... more Several surgical procedures have been developed for the treatment of sleep apnea syndrome. These include nasal, uvulopalatopharyngeal, and head and neck surgery, weight reduction surgery, and tracheostomy. Despite over 15 years of experience with some of these operations, there is still a lack of consensus regarding the indications, success rate, complications, and long-term prognosis associated with these procedures. The current status of these surgical procedures is reviewed.

Journal of Applied Physiology

Although pharyngeal muscles respond robustly to increasing Pco 2 during wakefulness, the effect o... more Although pharyngeal muscles respond robustly to increasing Pco 2 during wakefulness, the effect of hypercapnia on upper airway muscle activation during sleep has not been carefully assessed. This may be important, because it has been hypothesized that CO2-driven muscle activation may importantly stabilize the upper airway during stages 3 and 4 sleep. To test this hypothesis, we measured ventilation, airway resistance, genioglossus (GG) and tensor palatini (TP) electromyogram (EMG), plus end-tidal Pco 2(Pet CO2 ) in 18 subjects during wakefulness, stage 2, and slow-wave sleep (SWS). Responses of ventilation and muscle EMG to administered CO2(Pet CO2 = 6 Torr above the eupneic level) were also assessed during SWS ( n = 9) or stage 2 sleep ( n = 7). Pet CO2 increased spontaneously by 0.8 ± 0.1 Torr from stage 2 to SWS (from 43.3 ± 0.6 to 44.1 ± 0.5 Torr, P < 0.05), with no significant change in GG or TP EMG. Despite a significant increase in minute ventilation with induced hypercapn...

American Journal of Hypertension

Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to ... more Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46 ؎ ؎ 14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO 2 min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO 2 min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.

Sleep

Arousals from sleep are associated with increased sympathetic activation and are therefore associ... more Arousals from sleep are associated with increased sympathetic activation and are therefore associated with peripheral vasoconstriction. We hypothesized that digital vasoconstrictions as measured by peripheral arterial tonometery (PAT), combined with an increase in pulse rate, would accurately reflect arousals from sleep, and can provide an autonomic arousal index (AAI). Based on a previously studied group of 40 sleep apnea patients simultaneously recorded by both polysomnography (PSG) and PAT systems, an automated algorithm using the PAT signal (and pulse rate derived from it) was developed for detection of arousals from sleep. This was further validated in a separate group of 96 subjects (85 patients referred with suspected obstructive sleep apnea and 11 healthy volunteers mean age 46.2±14.4 years, BMI 28.5±5.4 kg/m 2). All underwent a whole night PSG with simultaneous PAT recording. The PSG recordings were blindly manually analyzed for arousals based on American Academy of Sleep Medicine (AASM) criteria, while PAT was scored automatically. There was a significant correlation between PSG and PAT arousals (R=0.82, p<0.0001) with a good agreement across a wide range of values, with a ROC curve having an area under the curve (AUC) of 0.88. We conclude that automated analysis of the peripheral arterial tonometry signal can detect EEG arousals from sleep, in a relatively quick and reproducible fashion.

Proceedings of the American Thoracic Society, Jan 15, 2008

Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity... more Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of...

Pediatric Neurology, 2003

Sleep disturbances were reported in patients during the acute stage after minor head injury, and ... more Sleep disturbances were reported in patients during the acute stage after minor head injury, and for some of these patients, the disturbances may become chronic. The purpose of the present study was to assess the prevalence and risk factors of the long-term sleep disturbances in adolescents after minor head injury. Unselected adolescents (98) who had experienced a minor head injury 0.5-6 years before the institution of the study and 80 matched control subjects were interviewed and completed a detailed questionnaire. The prevalence of sleep disturbances was significantly larger among adolescents who experienced minor head injury compared with the control subjects (28% versus 11%, P < 0.05). Within the study group, those who developed long-term sleep disturbances manifested a greater body mass index (20.8 ؎ 4.0 vs 18.4 ؎ 2.8 kg/m, P ‫؍‬ 0.005) and poorer parental education (fathers 11.0 ؎ 4.0 vs 13.4 ؎ 3.0 years, mothers 11.8 ؎ 3.3 vs 13.2 ؎ 2.9 years, P < 0.05 for both), compared with those who did not develop sleep disturbances. Our data indicate that subjective sleep disturbances may be evident in a fairly high percentage of adolescents after minor head injury, up to 28%, suggesting that minor head injury may not be as benign as previously estimated. Risk factors include heavier body mass and poorer parental education.