Ilene Rosen - Academia.edu (original) (raw)

Papers by Ilene Rosen

Research paper thumbnail of Residents' Work Hours

Annals of Internal Medicine, 2004

Research paper thumbnail of Exploring Nurse Practitioner Students’ Perceptions of a Sleep e-Learning Program

Nursing education perspectives, Jul 1, 2023

AIM The aim of this study was to explore nurse practitioner (NP) students’ perceptions of a sleep... more AIM The aim of this study was to explore nurse practitioner (NP) students’ perceptions of a sleep e-learning program. BACKGROUND Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis. METHOD The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis. RESULTS Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices. CONCLUSION NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.

Research paper thumbnail of Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students

Journal of Clinical Sleep Medicine, Oct 1, 2022

Research paper thumbnail of Sleep Apnea and Commercial Motor Vehicle Operators

Research paper thumbnail of 0369 Sleep Education for the Nurse Practitioner: Nurse Practitioner Student Focus Group Findings

Sleep

Introduction Primary care nurse practitioners (NPs) receive little to no sleep education in gradu... more Introduction Primary care nurse practitioners (NPs) receive little to no sleep education in graduate programs despite being first-line providers for patients presenting with sleep-related symptoms. Sleep curriculum has been consistently identified as a gap in nursing education and confirmed in recent survey studies of nurses and NPs. Methods Qualitative descriptive study to explore NP students’ reactions to an asynchronous, case-based sleep e-learning program. Data were collected as part of a larger pre-/post-study assessing the program. Six asynchronous online modules were offered to a cohort of primary care NP students in a single academic institution’s master’s degree in primary care nursing program. At the end of the course, students were invited to participate in one-hour, online, focus group sessions. Directed content analysis, guided by the Kirkpatrick training evaluation model, was used to analyze the qualitative data to understand NP students’ experience with the program an...

Research paper thumbnail of 0363 Perceptions of the Need for Perioperative OSA Education: An Interdisciplinary and Multi-Institutional Survey

Sleep

Introduction Advanced Practice Providers (APPs; Advanced practice registered nurses, physician as... more Introduction Advanced Practice Providers (APPs; Advanced practice registered nurses, physician assistants) and physicians-in-training (residents, fellows) receive inadequate education on obstructive sleep apnea (OSA)/perioperative OSA risks. However, they are front-line providers assessing these patients. Failure to mitigate this risk has led to significant postoperative morbidity/mortality. We assessed these providers’ perceptions to OSA/perioperative OSA training. Methods Surveys were sent to three provider roles, APPs, residents, and fellows, in four categories of practice at nine academic institutions between May 9-June 30, 2021. Chi-square and Fisher’s exact tests assessed association between survey responses and participant characteristics. False discovery rate adjustment accounted for multiple comparisons, threshold of q<0.05 for statistical significance. Cochran-Mantel-Haenzsel tests evaluated associations stratified by institution. Results 2236 of 6724 (33.3%) participan...

Research paper thumbnail of and the National Sleep Foundation

M edical research supports the finding that obstructive sleep apnea (OSA) is a significant cause ... more M edical research supports the finding that obstructive sleep apnea (OSA) is a significant cause of motor vehicle

Research paper thumbnail of Sleep Well to Be Well: Importance of Healthy Sleep during Medical Training

DeckerMed Psychiatry, 2019

Sleep is vital for our survival and wellness; lack of sleep is associated with significant cognit... more Sleep is vital for our survival and wellness; lack of sleep is associated with significant cognitive, behavioral and physical health consequences, including increased mortality. In resident physicians and other health care providers, scheduled in-house calls, frequent pager/phone calls, and work required during nights are the norm. These phenomena along with the normal pull for work/life balance lead to acute and chronic partial sleep restriction, sleep disruption and circadian misalignment. As is true for the general population, residents are not immune to sleepiness and performance deficits associated with curtailed sleep. Residents are also at risk for metabolic dysregulation, including increased risk of obesity, cardiovascular disease, and mood disturbances that accompany disrupted sleep and circadian misalignment. Initial data suggesting worse patient outcomes when residents work >80 hours weekly, pushed Accreditation Council for Graduate Medical Education (ACGME) to limit r...

Research paper thumbnail of Gotcha! Using Patient Safety Event Reports to Report People Rather Than Problems

Journal of Graduate Medical Education, 2020

The authors would like to thank Emmanuel King, MD, for bringing this case example to their attent... more The authors would like to thank Emmanuel King, MD, for bringing this case example to their attention; Robert Burke, MD, MS, for his review of a previous version of this manuscript; and the nurse, intern, and resident involved in this real case for granting the authors permission to write about their experiences.

Research paper thumbnail of Strategies to improve patient care for obstructive sleep apnea: a report from the American Academy of Sleep Medicine Sleep-Disordered Breathing Collaboration Summit

Journal of Clinical Sleep Medicine, 2020

None In Chicago, Illinois, on Saturday, Nov. 10, 2018, the American Academy of Sleep Medicine (AA... more None In Chicago, Illinois, on Saturday, Nov. 10, 2018, the American Academy of Sleep Medicine (AASM) hosted 35 representatives from 14 medical societies, nurse practitioner associations and patient advocacy groups for a one-day Sleep-Disordered Breathing Collaboration Summit to discuss strategies to improve the diagnosis and treatment of obstructive sleep apnea (OSA). This report provides a brief synopsis of the meeting, identifies current challenges, and highlights potential opportunities for ongoing collaboration.

Research paper thumbnail of Competency-based sleep medicine fellowships: addressing workforce needs and enhancing educational quality

Journal of Clinical Sleep Medicine, 2020

The path for physicians to become credentialed sleep medicine specialists has changed in many way... more The path for physicians to become credentialed sleep medicine specialists has changed in many ways in the last few decades. Currently, sleep medicine is recognized as an independent subspecialty with appropriately rigorous and comprehensive training required to become a board-certified sleep medicine physician. However, added time for requisite fellowship training, coupled with an aging sleep medicine physician workforce, have had the unintended consequence of decreasing the number of sleep medicine physicians at a time when the demands for sleep medicine care continue to rise. Thus, new training pathways that provide flexibility to trainees, while ensuring high-quality, comprehensive, and multidisciplinary sleep medicine training are needed to maintain a workforce that can meet the sleep health needs of the present and future. Here, we describe two pilot programs that apply principles of competency-based medical education to sleep medicine fellowship training. These novel models are likely to attract additional well-qualified physicians to the field who might otherwise not pursue a career in sleep medicine.

Research paper thumbnail of Driving While Sleepy Should Be A Criminal Offense

Journal of Clinical Sleep Medicine, 2005

Research paper thumbnail of Medical Cannabis, Synthetic Marijuana Extracts, and Obstructive Sleep Apnea

Journal of Clinical Sleep Medicine, 2018

Research paper thumbnail of Change is the Only Constant in Life (and in Sleep Medicine)

Journal of Clinical Sleep Medicine, 2018

Heraclitus, a philosopher who lived nearly 500 years before the common era, made the assertion th... more Heraclitus, a philosopher who lived nearly 500 years before the common era, made the assertion that "Life is Flux," meaning that change is the only constant in life. Modern medicine, inclusive of the field of sleep medicine, has undergone dramatic changes over the last 10 years. For the American Academy of Sleep Medicine (AASM) specifically, the last year has been one of great change. Yes, change happens, but with great change comes even greater opportunity. As AASM president, I have been focused on staying abreast of the changes in our health care system while anticipating and preparing to adapt to challenges in our field. In June 2017, given all the changes in our health care delivery system, I challenged the AASM membership and our field to adapt our models of care to reduce the number of patients with undiagnosed and untreated obstructive sleep apnea (OSA) by 10% over 5 years. This article will provide a brief update describing how the AASM board of directors has responded to my challenge and capitalized on change in the areas of the physician pipeline, patient access, advocacy, new technology and strategic research. Change is inevitable and often beyond our control, but how we anticipate and respond to change is entirely within our power. As sleep specialists, it is our responsibility not only to respond to change so that we can deliver the best possible care for our patients, but also to be the leading voice for change so that we all achieve better health through optimal sleep.

Research paper thumbnail of A Guide to Management of Sleepiness in ESKD

American Journal of Kidney Diseases, 2020

Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance... more Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance dialysis and following successful kidney transplantation. Sleepiness may be secondary to medical comorbid conditions, medication side effect, insufficient sleep syndrome, and sleepdisordered breathing or the result of a primary central disorder of hypersomnolence, such as narcolepsy. Unrecognized and untreated sleep disorders are associated with substantial morbidity and mortality among patients with end-stage kidney disease. Effective management of hypersomnolence can improve quality of life in patients with kidney disease. This review focuses on the principal causes of sleepiness in patients with end-stage kidney disease. Awareness of these disorders by treating nephrologists is crucial. This review provides a systematic approach to guide providers through the recognition, early diagnosis, and treatment of hypersomnolence, which is commonly encountered in this patient population. Areas of future research are also suggested. Clinical Vignette PJ is a 52-year-old woman with end-stage kidney disease (ESKD) in the setting of longstanding type 2 diabetes mellitus and hypertension who has been receiving in-center hemodialysis for the past 2 years. She reports chronic fatigue, difficulty concentrating, and trouble staying awake. She has been falling asleep while using the computer and recently received a formal warning at work. She states that she has fallen asleep at the dinner table and while talking on the telephone with friends. She usually retires to bed at 11:00 PM and falls asleep with the television on after midnight. She has 1 to 2 brief nocturnal awakenings and wakes up at 5:00 AM on dialysis days. On nondialysis weekdays, she wakes up at 10:00 AM to get to her part-time job. She sleeps until noon on weekends. On her last vacation, her sister commented about her loud snoring. She drinks 4 cups of coffee daily to stay awake. Dialysis has been going well, and last month's delivered Kt/V was 1.4. Her diabetes is wellcontrolled with low-dose insulin, but her blood pressure remains elevated at 149/82 mm Hg despite good adherence to treatment with 3 antihypertensive agents. Her body mass index is 29 kg/m 2. She is currently active on the kidney transplant waiting list.

Research paper thumbnail of Study design considerations for sleep-disordered breathing devices

Journal of Clinical Sleep Medicine, 2020

In recent years, sleep-disordered breathing (SDB) has been recognized as a prevalent but under-di... more In recent years, sleep-disordered breathing (SDB) has been recognized as a prevalent but under-diagnosed condition in adults and has prompted the need for new and better diagnostic and therapeutic options. To facilitate the development and availability of innovative, safe and effective SDB medical device technologies for patients in the United States, the US Food and Drug Administration collaborated with six SDB-related professional societies and a consumer advocacy organization to convene a public workshop focused on clinical investigations of SDB devices. Sleep medicine experts discussed appropriate definitions of terms used in the diagnosis and treatment of SDB, the use of home sleep testing versus polysomnography, clinical trial design issues in studying SDB devices, and current and future trends in digital health technologies for diagnosis and monitoring SDB. The panel's breadth of clinical expertise and experience across medical specialties provided useful and important insights regarding clinical trial designs for SDB devices.

Research paper thumbnail of Utility of the modified Mallampati grade and Friedman tongue position in the assessment of obstructive sleep apnea

Journal of Clinical Sleep Medicine, 2020

STUDY OBJECTIVES The modified Mallampati (MM) grade and Friedman tongue position (FTP) are common... more STUDY OBJECTIVES The modified Mallampati (MM) grade and Friedman tongue position (FTP) are commonly used scales that assess the oropharynx during evaluation for obstructive sleep apnea (OSA). Though used by many practitioners, there is controversy in the literature regarding their practical utility. The goal of this review will be to review the history of how the MM and FTP were developed, to discuss current evidence for their usefulness in the workup of OSA, and to provide future direction to better understand their utility in the workup of OSA. METHODS We searched the literature (PubMed) for the terms "modified Mallampati" and "Friedman tongue position." Articles were selected based on our study objectives emphasizing articles discussing the utility of MM and FTP in managing OSA. CONCLUSIONS MM and FTP have the potential to be useful assessment tools in the evaluation of OSA. When performing this examination, it is important for physicians and other medical providers to understand the pitfalls of the MM and FTP including the potential difficulty in performing the exam and the lack of consistency between examiners in both the terminology and execution of this physical exam finding. Better methods to standardize the assessment are necessary to ensure consistent evaluation among individual examiners while at the same time keeping the method simple and convenient for wide use as a clinical screening tool.

Research paper thumbnail of Clarifying Requisite Sleep Medicine Content for the Pulmonary and Critical Care Medicine Fellow

Research paper thumbnail of Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2018

The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent hea... more The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have d...

Research paper thumbnail of The Risk of Fatigue and Sleepiness in the Ridesharing Industry: An American Academy of Sleep Medicine Position Statement

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2018

The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming qu... more The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. While riders are experiencing the benefits of convenience and affordability, two key regulatory and safety issues deserve consideration. First, individuals who work as drivers in the ridesharing industry are often employed in a primary job, and they work as drivers during their "off" time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. Second, these drivers are often employed as "independent contractors," and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea. Some ridesharing companies now require a rest period after an extended driving shift. This measure is encouraging, but it is insufficient to impact driving safety appreciably...

Research paper thumbnail of Residents' Work Hours

Annals of Internal Medicine, 2004

Research paper thumbnail of Exploring Nurse Practitioner Students’ Perceptions of a Sleep e-Learning Program

Nursing education perspectives, Jul 1, 2023

AIM The aim of this study was to explore nurse practitioner (NP) students’ perceptions of a sleep... more AIM The aim of this study was to explore nurse practitioner (NP) students’ perceptions of a sleep e-learning program. BACKGROUND Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis. METHOD The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis. RESULTS Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices. CONCLUSION NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.

Research paper thumbnail of Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students

Journal of Clinical Sleep Medicine, Oct 1, 2022

Research paper thumbnail of Sleep Apnea and Commercial Motor Vehicle Operators

Research paper thumbnail of 0369 Sleep Education for the Nurse Practitioner: Nurse Practitioner Student Focus Group Findings

Sleep

Introduction Primary care nurse practitioners (NPs) receive little to no sleep education in gradu... more Introduction Primary care nurse practitioners (NPs) receive little to no sleep education in graduate programs despite being first-line providers for patients presenting with sleep-related symptoms. Sleep curriculum has been consistently identified as a gap in nursing education and confirmed in recent survey studies of nurses and NPs. Methods Qualitative descriptive study to explore NP students’ reactions to an asynchronous, case-based sleep e-learning program. Data were collected as part of a larger pre-/post-study assessing the program. Six asynchronous online modules were offered to a cohort of primary care NP students in a single academic institution’s master’s degree in primary care nursing program. At the end of the course, students were invited to participate in one-hour, online, focus group sessions. Directed content analysis, guided by the Kirkpatrick training evaluation model, was used to analyze the qualitative data to understand NP students’ experience with the program an...

Research paper thumbnail of 0363 Perceptions of the Need for Perioperative OSA Education: An Interdisciplinary and Multi-Institutional Survey

Sleep

Introduction Advanced Practice Providers (APPs; Advanced practice registered nurses, physician as... more Introduction Advanced Practice Providers (APPs; Advanced practice registered nurses, physician assistants) and physicians-in-training (residents, fellows) receive inadequate education on obstructive sleep apnea (OSA)/perioperative OSA risks. However, they are front-line providers assessing these patients. Failure to mitigate this risk has led to significant postoperative morbidity/mortality. We assessed these providers’ perceptions to OSA/perioperative OSA training. Methods Surveys were sent to three provider roles, APPs, residents, and fellows, in four categories of practice at nine academic institutions between May 9-June 30, 2021. Chi-square and Fisher’s exact tests assessed association between survey responses and participant characteristics. False discovery rate adjustment accounted for multiple comparisons, threshold of q<0.05 for statistical significance. Cochran-Mantel-Haenzsel tests evaluated associations stratified by institution. Results 2236 of 6724 (33.3%) participan...

Research paper thumbnail of and the National Sleep Foundation

M edical research supports the finding that obstructive sleep apnea (OSA) is a significant cause ... more M edical research supports the finding that obstructive sleep apnea (OSA) is a significant cause of motor vehicle

Research paper thumbnail of Sleep Well to Be Well: Importance of Healthy Sleep during Medical Training

DeckerMed Psychiatry, 2019

Sleep is vital for our survival and wellness; lack of sleep is associated with significant cognit... more Sleep is vital for our survival and wellness; lack of sleep is associated with significant cognitive, behavioral and physical health consequences, including increased mortality. In resident physicians and other health care providers, scheduled in-house calls, frequent pager/phone calls, and work required during nights are the norm. These phenomena along with the normal pull for work/life balance lead to acute and chronic partial sleep restriction, sleep disruption and circadian misalignment. As is true for the general population, residents are not immune to sleepiness and performance deficits associated with curtailed sleep. Residents are also at risk for metabolic dysregulation, including increased risk of obesity, cardiovascular disease, and mood disturbances that accompany disrupted sleep and circadian misalignment. Initial data suggesting worse patient outcomes when residents work >80 hours weekly, pushed Accreditation Council for Graduate Medical Education (ACGME) to limit r...

Research paper thumbnail of Gotcha! Using Patient Safety Event Reports to Report People Rather Than Problems

Journal of Graduate Medical Education, 2020

The authors would like to thank Emmanuel King, MD, for bringing this case example to their attent... more The authors would like to thank Emmanuel King, MD, for bringing this case example to their attention; Robert Burke, MD, MS, for his review of a previous version of this manuscript; and the nurse, intern, and resident involved in this real case for granting the authors permission to write about their experiences.

Research paper thumbnail of Strategies to improve patient care for obstructive sleep apnea: a report from the American Academy of Sleep Medicine Sleep-Disordered Breathing Collaboration Summit

Journal of Clinical Sleep Medicine, 2020

None In Chicago, Illinois, on Saturday, Nov. 10, 2018, the American Academy of Sleep Medicine (AA... more None In Chicago, Illinois, on Saturday, Nov. 10, 2018, the American Academy of Sleep Medicine (AASM) hosted 35 representatives from 14 medical societies, nurse practitioner associations and patient advocacy groups for a one-day Sleep-Disordered Breathing Collaboration Summit to discuss strategies to improve the diagnosis and treatment of obstructive sleep apnea (OSA). This report provides a brief synopsis of the meeting, identifies current challenges, and highlights potential opportunities for ongoing collaboration.

Research paper thumbnail of Competency-based sleep medicine fellowships: addressing workforce needs and enhancing educational quality

Journal of Clinical Sleep Medicine, 2020

The path for physicians to become credentialed sleep medicine specialists has changed in many way... more The path for physicians to become credentialed sleep medicine specialists has changed in many ways in the last few decades. Currently, sleep medicine is recognized as an independent subspecialty with appropriately rigorous and comprehensive training required to become a board-certified sleep medicine physician. However, added time for requisite fellowship training, coupled with an aging sleep medicine physician workforce, have had the unintended consequence of decreasing the number of sleep medicine physicians at a time when the demands for sleep medicine care continue to rise. Thus, new training pathways that provide flexibility to trainees, while ensuring high-quality, comprehensive, and multidisciplinary sleep medicine training are needed to maintain a workforce that can meet the sleep health needs of the present and future. Here, we describe two pilot programs that apply principles of competency-based medical education to sleep medicine fellowship training. These novel models are likely to attract additional well-qualified physicians to the field who might otherwise not pursue a career in sleep medicine.

Research paper thumbnail of Driving While Sleepy Should Be A Criminal Offense

Journal of Clinical Sleep Medicine, 2005

Research paper thumbnail of Medical Cannabis, Synthetic Marijuana Extracts, and Obstructive Sleep Apnea

Journal of Clinical Sleep Medicine, 2018

Research paper thumbnail of Change is the Only Constant in Life (and in Sleep Medicine)

Journal of Clinical Sleep Medicine, 2018

Heraclitus, a philosopher who lived nearly 500 years before the common era, made the assertion th... more Heraclitus, a philosopher who lived nearly 500 years before the common era, made the assertion that "Life is Flux," meaning that change is the only constant in life. Modern medicine, inclusive of the field of sleep medicine, has undergone dramatic changes over the last 10 years. For the American Academy of Sleep Medicine (AASM) specifically, the last year has been one of great change. Yes, change happens, but with great change comes even greater opportunity. As AASM president, I have been focused on staying abreast of the changes in our health care system while anticipating and preparing to adapt to challenges in our field. In June 2017, given all the changes in our health care delivery system, I challenged the AASM membership and our field to adapt our models of care to reduce the number of patients with undiagnosed and untreated obstructive sleep apnea (OSA) by 10% over 5 years. This article will provide a brief update describing how the AASM board of directors has responded to my challenge and capitalized on change in the areas of the physician pipeline, patient access, advocacy, new technology and strategic research. Change is inevitable and often beyond our control, but how we anticipate and respond to change is entirely within our power. As sleep specialists, it is our responsibility not only to respond to change so that we can deliver the best possible care for our patients, but also to be the leading voice for change so that we all achieve better health through optimal sleep.

Research paper thumbnail of A Guide to Management of Sleepiness in ESKD

American Journal of Kidney Diseases, 2020

Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance... more Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance dialysis and following successful kidney transplantation. Sleepiness may be secondary to medical comorbid conditions, medication side effect, insufficient sleep syndrome, and sleepdisordered breathing or the result of a primary central disorder of hypersomnolence, such as narcolepsy. Unrecognized and untreated sleep disorders are associated with substantial morbidity and mortality among patients with end-stage kidney disease. Effective management of hypersomnolence can improve quality of life in patients with kidney disease. This review focuses on the principal causes of sleepiness in patients with end-stage kidney disease. Awareness of these disorders by treating nephrologists is crucial. This review provides a systematic approach to guide providers through the recognition, early diagnosis, and treatment of hypersomnolence, which is commonly encountered in this patient population. Areas of future research are also suggested. Clinical Vignette PJ is a 52-year-old woman with end-stage kidney disease (ESKD) in the setting of longstanding type 2 diabetes mellitus and hypertension who has been receiving in-center hemodialysis for the past 2 years. She reports chronic fatigue, difficulty concentrating, and trouble staying awake. She has been falling asleep while using the computer and recently received a formal warning at work. She states that she has fallen asleep at the dinner table and while talking on the telephone with friends. She usually retires to bed at 11:00 PM and falls asleep with the television on after midnight. She has 1 to 2 brief nocturnal awakenings and wakes up at 5:00 AM on dialysis days. On nondialysis weekdays, she wakes up at 10:00 AM to get to her part-time job. She sleeps until noon on weekends. On her last vacation, her sister commented about her loud snoring. She drinks 4 cups of coffee daily to stay awake. Dialysis has been going well, and last month's delivered Kt/V was 1.4. Her diabetes is wellcontrolled with low-dose insulin, but her blood pressure remains elevated at 149/82 mm Hg despite good adherence to treatment with 3 antihypertensive agents. Her body mass index is 29 kg/m 2. She is currently active on the kidney transplant waiting list.

Research paper thumbnail of Study design considerations for sleep-disordered breathing devices

Journal of Clinical Sleep Medicine, 2020

In recent years, sleep-disordered breathing (SDB) has been recognized as a prevalent but under-di... more In recent years, sleep-disordered breathing (SDB) has been recognized as a prevalent but under-diagnosed condition in adults and has prompted the need for new and better diagnostic and therapeutic options. To facilitate the development and availability of innovative, safe and effective SDB medical device technologies for patients in the United States, the US Food and Drug Administration collaborated with six SDB-related professional societies and a consumer advocacy organization to convene a public workshop focused on clinical investigations of SDB devices. Sleep medicine experts discussed appropriate definitions of terms used in the diagnosis and treatment of SDB, the use of home sleep testing versus polysomnography, clinical trial design issues in studying SDB devices, and current and future trends in digital health technologies for diagnosis and monitoring SDB. The panel's breadth of clinical expertise and experience across medical specialties provided useful and important insights regarding clinical trial designs for SDB devices.

Research paper thumbnail of Utility of the modified Mallampati grade and Friedman tongue position in the assessment of obstructive sleep apnea

Journal of Clinical Sleep Medicine, 2020

STUDY OBJECTIVES The modified Mallampati (MM) grade and Friedman tongue position (FTP) are common... more STUDY OBJECTIVES The modified Mallampati (MM) grade and Friedman tongue position (FTP) are commonly used scales that assess the oropharynx during evaluation for obstructive sleep apnea (OSA). Though used by many practitioners, there is controversy in the literature regarding their practical utility. The goal of this review will be to review the history of how the MM and FTP were developed, to discuss current evidence for their usefulness in the workup of OSA, and to provide future direction to better understand their utility in the workup of OSA. METHODS We searched the literature (PubMed) for the terms "modified Mallampati" and "Friedman tongue position." Articles were selected based on our study objectives emphasizing articles discussing the utility of MM and FTP in managing OSA. CONCLUSIONS MM and FTP have the potential to be useful assessment tools in the evaluation of OSA. When performing this examination, it is important for physicians and other medical providers to understand the pitfalls of the MM and FTP including the potential difficulty in performing the exam and the lack of consistency between examiners in both the terminology and execution of this physical exam finding. Better methods to standardize the assessment are necessary to ensure consistent evaluation among individual examiners while at the same time keeping the method simple and convenient for wide use as a clinical screening tool.

Research paper thumbnail of Clarifying Requisite Sleep Medicine Content for the Pulmonary and Critical Care Medicine Fellow

Research paper thumbnail of Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2018

The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent hea... more The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have d...

Research paper thumbnail of The Risk of Fatigue and Sleepiness in the Ridesharing Industry: An American Academy of Sleep Medicine Position Statement

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2018

The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming qu... more The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. While riders are experiencing the benefits of convenience and affordability, two key regulatory and safety issues deserve consideration. First, individuals who work as drivers in the ridesharing industry are often employed in a primary job, and they work as drivers during their "off" time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. Second, these drivers are often employed as "independent contractors," and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea. Some ridesharing companies now require a rest period after an extended driving shift. This measure is encouraging, but it is insufficient to impact driving safety appreciably...