Study Objectives Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovas... more Study Objectives Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic. Methods Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006 to 2010 at a tertiary hospital sleep clinic. Characteristics of these patients were compared with participants of five recent RCTs examining the effect of CPAP on adverse CV events in OSA. The percentage of patients with severe (apnea-hypopnea index, [AHI] ≥ 30 events/h) or any OSA (AHI ≥ 5 events/h) who met the eligibility criteria of each RCT was determined, and those criteria that excluded the most patients identified. Results Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to ...
Introduction Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascula... more Introduction Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic. Methods Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006–2010 at a tertiary hospital sleep clinic. Characteristics of these sleep clinic OSA patients were compared with participants of 5 well-known RCTs examining the effect of CPAP on adverse CV events in OSA. We determined the percentage of patients with severe (apnea hypopnea index, [AHI]≥30/h) or any OSA (AHI≥5/h) who met the selection criteria of each RCT, as well as identified those criteria that excluded the most patients. Results Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to be ...
Study ObjectivesSleep spindles, a defining feature of stage N2 sleep, are maximal at central elec... more Study ObjectivesSleep spindles, a defining feature of stage N2 sleep, are maximal at central electrodes and are found in the frequency range of the electroencephalogram (EEG) (sigma 11–16 Hz) that is known to be heritable. However, relatively little is known about the heritability of spindles. Two recent studies investigating the heritability of spindles reported moderate heritability, but with conflicting results depending on scalp location and spindle type. The present study aimed to definitively assess the heritability of sleep spindle characteristics.MethodsWe utilized the polysomnography data of 58 monozygotic and 40 dizygotic same-sex twin pairs to identify heritable characteristics of spindles at C3/C4 in stage N2 sleep including density, duration, peak-to-peak amplitude, and oscillation frequency. We implemented and tested a variety of spindle detection algorithms and used two complementary methods of estimating trait heritability.ResultsWe found robust evidence to support s...
The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromo... more The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO2 during sleep would be major predictors of OSAS risk. 42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO2 during wakefulness and sleep. ATV, NPAV, activated and hypotonic Pcrit, genioglossal electromyography and ventilatory response to CO2 during sleep were all associated with OSAS risk. Multivariate models adjusted for age, gender, body mass i...
Inter-individual differences in performance impairment from sleep loss are substantial and consis... more Inter-individual differences in performance impairment from sleep loss are substantial and consistent, as demonstrated and quantified here by means of the intraclass correlation coefficient (ICC) in two laboratory-based sleep deprivation studies. There is an urgent need, therefore, to consider inter-individual variability in biomathematical models of fatigue and performance, which currently treat individuals as being all the same. Traditional regression techniques do not handle inter-individual variability, but cutting-edge mixed-effects modeling techniques have recently become available to deal with inter-individual differences in the temporal dynamics of fatigue and performance. The standard two stage (STS), restricted maximum likelihood (REML), and non-linear mixed-effects modeling (NMEM) approaches to mixed-effects models are compared here using data from a chronic partial sleep deprivation experiment. Mixed-effects modeling can be incorporated in the two distinct steps (the dir...
Study Objectives Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovas... more Study Objectives Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic. Methods Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006 to 2010 at a tertiary hospital sleep clinic. Characteristics of these patients were compared with participants of five recent RCTs examining the effect of CPAP on adverse CV events in OSA. The percentage of patients with severe (apnea-hypopnea index, [AHI] ≥ 30 events/h) or any OSA (AHI ≥ 5 events/h) who met the eligibility criteria of each RCT was determined, and those criteria that excluded the most patients identified. Results Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to ...
Introduction Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascula... more Introduction Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic. Methods Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006–2010 at a tertiary hospital sleep clinic. Characteristics of these sleep clinic OSA patients were compared with participants of 5 well-known RCTs examining the effect of CPAP on adverse CV events in OSA. We determined the percentage of patients with severe (apnea hypopnea index, [AHI]≥30/h) or any OSA (AHI≥5/h) who met the selection criteria of each RCT, as well as identified those criteria that excluded the most patients. Results Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to be ...
Study ObjectivesSleep spindles, a defining feature of stage N2 sleep, are maximal at central elec... more Study ObjectivesSleep spindles, a defining feature of stage N2 sleep, are maximal at central electrodes and are found in the frequency range of the electroencephalogram (EEG) (sigma 11–16 Hz) that is known to be heritable. However, relatively little is known about the heritability of spindles. Two recent studies investigating the heritability of spindles reported moderate heritability, but with conflicting results depending on scalp location and spindle type. The present study aimed to definitively assess the heritability of sleep spindle characteristics.MethodsWe utilized the polysomnography data of 58 monozygotic and 40 dizygotic same-sex twin pairs to identify heritable characteristics of spindles at C3/C4 in stage N2 sleep including density, duration, peak-to-peak amplitude, and oscillation frequency. We implemented and tested a variety of spindle detection algorithms and used two complementary methods of estimating trait heritability.ResultsWe found robust evidence to support s...
The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromo... more The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO2 during sleep would be major predictors of OSAS risk. 42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO2 during wakefulness and sleep. ATV, NPAV, activated and hypotonic Pcrit, genioglossal electromyography and ventilatory response to CO2 during sleep were all associated with OSAS risk. Multivariate models adjusted for age, gender, body mass i...
Inter-individual differences in performance impairment from sleep loss are substantial and consis... more Inter-individual differences in performance impairment from sleep loss are substantial and consistent, as demonstrated and quantified here by means of the intraclass correlation coefficient (ICC) in two laboratory-based sleep deprivation studies. There is an urgent need, therefore, to consider inter-individual variability in biomathematical models of fatigue and performance, which currently treat individuals as being all the same. Traditional regression techniques do not handle inter-individual variability, but cutting-edge mixed-effects modeling techniques have recently become available to deal with inter-individual differences in the temporal dynamics of fatigue and performance. The standard two stage (STS), restricted maximum likelihood (REML), and non-linear mixed-effects modeling (NMEM) approaches to mixed-effects models are compared here using data from a chronic partial sleep deprivation experiment. Mixed-effects modeling can be incorporated in the two distinct steps (the dir...
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