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Schotland H, Wickwire E, Aaronson RM, Dawson SC, Khosla S, Lee-Iannotti JK, Leu RM, Lewin DS, McCrae CS, Neubauer D, Ong JC, Heffron TM, Whittington C, Martin JL. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med 2024; 20:455-459. [PMID: 37942936 PMCID: PMC11019205 DOI: 10.5664/jcsm.10922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
Challenges exist in access to high-quality care for insomnia disorder. After the recent publication of a clinical practice guideline on behavioral and psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a 1-day virtual Insomnia Summit in September 2022 to discuss improving care for patients with insomnia disorder. Fifty participants representing a variety of organizations (eg, medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the event. Videos highlighting patient perspectives on insomnia and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions, each with 3 to 4 brief, topical presentations by content experts. Breakout groups were used to brainstorm and prioritize issues in each thematic area. Top barriers to care for insomnia disorder include limited access, limited awareness of treatment options, low perceived value of insomnia treatment, and an insufficient number of trained clinicians. Top facilitators of high-quality care include education and awareness, novel care models to increase access, expanding the insomnia patient care workforce, incorporating research into practice, and increasing reimbursement for psychotherapies. Priorities for the future include increasing awareness among patients and providers, increasing the number of skilled behavioral sleep medicine providers, increasing advocacy efforts to address insurance issues (eg, billing, reimbursement, and performance measures), and working collaboratively with multidisciplinary organizations to achieve common goals. These priorities highlight that goals set to improve accessible, high-quality care for insomnia disorder will require sustained, coordinated efforts to increase awareness, improve reimbursement, and grow the necessary skilled health care workforce. CITATION Schotland H, Wickwire E, Aaronson RM, et al. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med. 2024;20(3):455-459.
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Affiliation(s)
| | - Emerson Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Spencer C. Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | - Joyce K. Lee-Iannotti
- Department of Internal Medicine, Department of Neurology, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
| | - Roberta M. Leu
- Division of Pulmonology and Sleep, Department of Pediatrics, Emory University, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Christina S. McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - David Neubauer
- Sleep Disorders Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason C. Ong
- Nox Health, Inc, Alpharetta, Georgia
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jennifer L. Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
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Baugh AD, Acho M, Arhin A, Barjaktarevic I, Couper D, Criner G, Han M, Hansel N, Krishnan J, Malcolm K, Namen A, Peters S, Schotland H, Sowho M, Zeidler M, Woodruff P, Thakur N. African American race is associated with worse sleep quality in heavy smokers. J Clin Sleep Med 2023; 19:1523-1532. [PMID: 37128722 PMCID: PMC10394362 DOI: 10.5664/jcsm.10624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
STUDY OBJECTIVES To examine the association of self-identified race with sleep quality in heavy smokers. METHODS We studied baseline data from 1965 non-Hispanic White and 462 African American participants from SPIROMICS with ≥ 20 pack-years smoking history. We first examined the Pittsburgh Sleep Quality Index's (PSQI) internal consistency and item-total correlation in a population with chronic obstructive pulmonary disease. We then used staged multivariable regression to investigate the association of race and sleep quality as measured by the PSQI) The first model included demographics, the second added measures of health status, and the third, indicators of socioeconomic status. We next explored the correlation between sleep quality with 6-minute walk distance and St. George's Respiratory Questionnaire score as chronic obstructive pulmonary disease-relevant outcomes. We tested for interactions between self-identified race and the most important determinants of sleep quality in our conceptual model. RESULTS We found that the PSQI had good internal consistency and item-total correlation in our study population of heavy smokers with and without chronic obstructive pulmonary disease. African American race was associated with increased PSQI in univariable analysis and after adjustment for demographics, health status, and socioenvironmental exposures (P = .02; 0.44 95%CI: .06 to .83). Increased PSQI was associated with higher postbronchodilator forced expiratory volume in 1 second and lower household income, higher depressive symptoms, and female sex. We identified an interaction wherein depressive symptoms had a greater impact on PSQI score for non-Hispanic White than African American participants (P for interaction = .01). CONCLUSIONS In heavy smokers, self-reported African American race is independently associated with worse sleep quality. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Study of COPD Subgroups and Biomarkers (SPIROMICS); URL: https://clinicaltrials.gov/ct2/show/NCT01969344; Identifier: NCT01969344. CITATION Baugh AD, Acho M, Arhin A, et al. African American race is associated with worse sleep quality in heavy smokers. J Clin Sleep Med. 2023;19(8):1523-1532.
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Affiliation(s)
- Aaron D. Baugh
- University of California San Francisco, San Francisco, California
| | - Megan Acho
- University of Michigan, Ann Arbor, Michigan
| | | | - Igor Barjaktarevic
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David Couper
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Gerard Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Meilan Han
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Andrew Namen
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Michelle Zeidler
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Neeta Thakur
- University of California San Francisco, San Francisco, California
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Rurak K, Schotland H. A query on FEV 1Q: it may be useful, but is it helpful? Eur Respir J 2023; 61:13993003.01646-2022. [PMID: 36549707 DOI: 10.1183/13993003.01646-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Kevin Rurak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helena Schotland
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Baugh A, Buhr RG, Quibrera P, Barjaktarevic I, Barr RG, Bowler R, Han MK, Kaufman JD, Koch AL, Krishnan J, Labaki W, Martinez FJ, Mkorombindo T, Namen A, Ortega V, Paine R, Peters SP, Schotland H, Sundar K, Zeidler MR, Hansel NN, Woodruff PG, Thakur N. Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity. Sleep 2022; 45:6602021. [PMID: 35665826 PMCID: PMC9366643 DOI: 10.1093/sleep/zsac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Sleep is an important dimension in the care of chronic obstructive pulmonary disease (COPD), but its relevance to exacerbations is unclear. We wanted to assess whether sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) is associated with an increased risk of COPD exacerbations and does this differ by socio-environmental exposures. METHODS We included 1647 current and former smokers with spirometrically confirmed COPD from the SPIROMICS cohort. We assessed incidence rate ratios for exacerbation using zero-inflated negative binomial regression adjusting for demographics, medical comorbidities, and multiple metrics of disease severity, including respiratory medications, airflow obstruction, and symptom burden. Our final model adjusted for socio-environmental exposures using the Area Deprivation Index, a composite measure of contemporary neighborhood quality, and Adversity-Opportunity Index, a composite measure of individual-level historic and current socioeconomic indicators. We used a pre-determined threshold of 20% missingness to undertake multiple imputation by chained equations. As sensitivity analyses, we repeated models in those with complete data and after controlling for prior exacerbations. As an exploratory analysis, we considered an interaction between socio-environmental condition and sleep quality. RESULTS After adjustment for all co-variates, increasing PSQI scores (range 0-21) were associated with a 5% increased risk for exacerbation per point (p = .001) in the imputed dataset. Sensitivity analyses using complete cases and after controlling for prior exacerbation history were similar. Exploratory analysis suggested less effect among those who lived in poor-quality neighborhoods (p-for-interaction = .035). CONCLUSIONS Poor sleep quality may contribute to future exacerbations among patients with COPD. This represents one target for improving disease control. CLINICAL TRIAL REGISTRATION Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). ClinicalTrials.gov Identifier# NCT01969344. Registry URL: https://clinicaltrials.gov/ct2/show/.
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Affiliation(s)
- Aaron Baugh
- Corresponding author. Aaron Baugh, University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143, USA. E-mail:
| | - Russell G Buhr
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pedro Quibrera
- Collaborative Studies Coordination Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Igor Barjaktarevic
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Meilan King Han
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel D Kaufman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Abigail L Koch
- Department of Medicine, Veterans Administration Miami Healthcare, Miami, FL, USA
| | - Jerry Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim Labaki
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Andrew Namen
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Victor Ortega
- Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Helena Schotland
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Sundar
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Michelle R Zeidler
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Schotland H. PAP Therapy-Quick Tips for Troubleshooting to Address Problems with Use. Am J Respir Crit Care Med 2021; 204:P11-P12. [PMID: 34543160 DOI: 10.1164/rccm.2046p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zeidler MR, Martin JL, Kleerup EC, Schneider H, Mitchell MN, Hansel NN, Sundar K, Schotland H, Basner RC, Wells JM, Krishnan JA, Criner GJ, Cristenson S, Krachman S, Badr MS. Sleep disruption as a predictor of quality of life among patients in the subpopulations and intermediate outcome measures in COPD study (SPIROMICS). Sleep 2019. [PMID: 29534240 DOI: 10.1093/sleep/zsy044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Study Objectives Sleep quality is poor among patients with chronic obstructive pulmonary disease (COPD), and studies show that sleep disturbance is associated with low overall quality of life in this population. We evaluated the impact of patient-reported sleep quality and sleep apnea risk on disease-specific and overall quality of life within patients with COPD enrolled in the SPIROMICS study, after accounting for demographics and COPD disease severity. Methods Baseline data from 1341 participants [892 mild/moderate COPD (FEV1 ≥ 50% predicted); 449 severe COPD (FEV1 < 50%)] were used to perform three nested (blocks) regression models to predict quality of life (Short Form-12 mental and physical components and St. George's Respiratory Questionnaire). Dependent measures used for the nested regressions included the following: Block1: demographics and smoking history; Block 2: disease severity (forced expiratory volume 1 s; 6 min walk test); Block 3: risk for obstructive sleep apnea (OSA; Berlin questionnaire); and Block 4: sleep quality (Pittsburgh Sleep Quality Index [PSQI]). Results Over half of participants with COPD reported poor sleep quality (Mean PSQI 6.4 ± 3.9; 50% with high risk score on the Berlin questionnaire). In all three nested regression models, sleep quality (Block 4) was a significant predictor of poor quality of life, over and above variables included in blocks 1-3. Conclusions Poor sleep quality represents a potentially modifiable risk factor for poor quality of life in patients with COPD, over and above demographics and smoking history, disease severity, and risk for OSA. Improving sleep quality may be an important target for clinical interventions. Clinical Trial SPIROMICS. Clinical Trial URL http://www2.cscc.unc.edu/spiromics/. Clinical Trial Registration ClinicalTrials.gov NCT01969344.
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Affiliation(s)
- Michelle R Zeidler
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jennifer L Martin
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - Eric C Kleerup
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | | | - Michael N Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - Nadia N Hansel
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Krishna Sundar
- Department of Medicine, University of Utah, Salt Lake City, UT
| | | | - Robert C Basner
- Department of Medicine, Columbia University, New York City, NY
| | - J Michael Wells
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Gerard J Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | - Samuel Krachman
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - M Safwan Badr
- School of Medicine, Wayne State University, Detroit, MI
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Olaithe M, Eastwood PR, Bucks RS, Deacon NL, Malhotra A, Kumar VHS, Zuo L, Chuang CC, Schotland H. Commentaries on Viewpoint: Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2016; 120:1487-8. [PMID: 27306842 DOI: 10.1152/japplphysiol.00327.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Olaithe
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - P R Eastwood
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - R S Bucks
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Naomi L Deacon
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Atul Malhotra
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Vasantha H S Kumar
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Li Zuo
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Chia-Chen Chuang
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Helena Schotland
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
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Skiba V, Goldstein C, Schotland H. Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea. J Clin Sleep Med 2015; 11:597-602. [PMID: 25700868 DOI: 10.5664/jcsm.4764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/31/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA. We speculate that in most cases of suspected SDB, Pes does not add further diagnostic data and that night-to-night variability in OSA severity results in a first false-negative study. METHODS We conducted a retrospective review of PSGs between 2008 and 2012 in adults with initial PSG negative for OSA followed by a second study (with or without Pes) within 6 mo. RESULTS Of 125 studies that met inclusion criteria, a second study was completed with Pes in 105 subjects. SDB was diagnosed in 73 subjects (68.5%) completing a second PSG with Pes: 49 (46.7%) received a diagnosis based on AHI, and 24 (22.8%) received a diagnosis based on Pes (p = 0.003). There were no statistically significant differences in the mean AHI change between the two PSGs in subjects who completed the second study with or without Pes. CONCLUSIONS In patients with symptoms of SDB and initial PSG with AHI < 5, the majority met criteria for OSA on second PSG by AHI without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without Pes may be sufficient to diagnose SDB.
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Affiliation(s)
- Virginia Skiba
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Cathy Goldstein
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Helena Schotland
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
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Bauman K, Kurili A, Rodriguez G, Chiodo A, Schotland H, Sitrin R. Home-Based Diagnosis of Sleep-Disordered Breathing Complicating Spinal Cord Injury. Chest 2013. [DOI: 10.1378/chest.1703485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Schotland H. Identifying sleep apnea. Chest 2003; 123:656. [PMID: 12576402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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Affiliation(s)
- J F Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 Euclid Ave, St Louis, MO 63110, USA.
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Affiliation(s)
- H Schotland
- Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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