Christian Guilleminault

Stanford University | SU · Sleep Medicine Division

Introduction: The aim of this study was to analyze the skeletal, dental and airway changes with endoscopically assisted surgical expansion (EASE) to widen the nasomaxillary complex for the treatment of sleep apnea in adults. Methods: One hundred and five consecutive patients underwent EASE. Cone beam computed tomography (CBCT) was conducted preo...

Aim: The focus of this report was to analyze patients who presented for second opinion due to complications and failure following maxillomandibular advancement (MMA)performed elsewhere. Methods: During a five-year period, 16 patients presented with complications and/or failure of MMA. The indication for treatment was obstructive sleep apnea (OSA...

Introduction: The aim of this study was to evaluate the impact of nasomaxillary expansion using skeletally anchored transpalatal distraction (TPD) in children without transverse maxillary deficiency that were previously treated by rapid palatal expansion (RPE). Materials and methods: Twenty-nine consecutive children were treated by TPD. Twenty-f...

Objective: The focus of this report is to analyze the pattern of maxillary expansion and complications in patients following surgical and non-surgical maxillary expansion presented for evaluation and second opinion. Materials and methods: During a 30-months period, 28 patients presented for second opinion following maxillary expansion performed...

Study objectives: Kleine-Levin-syndrome (KLS) is a rare recurrent hypersomnia. Our study aimed at monitoring the movements of patients with KLS using actigraphy and evaluating their circadian rhythm. Methods: Twenty young patients with KLS and 14 age-matched controls were recruited. Each individual wore an actigraphy for more than 6 months to mo...

Transverse maxillary deficiency is one of several common craniofacial structure characteristics observed in patients with obstructive sleep apnea (OSA). Conventional maxillary expander treatment has been used in children with OSA to expand constricted maxilla to increase nasal flow and to allow the tongue to protrude forward and upward. With the in...

Study Objectives To evaluate the objective and subjective long-term outcome of maxillomandibular advancement (MMA) in Far-East Asian patients with moderate to severe obstructive sleep apnea (OSA). Methods This is a long-term follow-up study to evaluate the treatment outcome of MMA in OSA patients by objective polysomnography (PSG) and subjective q...

Background: Inflammation is often considered relating to pediatric obstructive sleep apnea (OSA). We conducted a study investigating cytokines, including Il-17 and Il-23, in children with OSA before and after adenotonsillectomy (T&A), compared with controls. Methods: Children with OSA between age 4 and 12 receiving T&A were prospectively followe...

Objective Distraction osteogenesis maxillary expansion (DOME) is a reliable method to expand the nasal floor and hard palatal vault in adults with obstructive sleep apnea (OSA). DOME results in a reduction in the apnea-hypopnea index (AHI) and subjective report of improved nasal breathing. Using rhinomanometry augmented computational fluid dynamic...

Purpose To examine the craniofacial and airway morphology as well as the quality of life before and after passive myofunctional therapy (PMFT) for 1 year in children with obstructive sleep apnea (OSA). Methods Forty children with OSA wearing an oral device nightly (treatment group) and seventeen without the device (control group) were followed up...

Article

Study objectives: Early in life impairment of orofacial growth leads to sleep-disordered breathing (SDB). Normal lingual gnosis and praxis are part of this early development related to the normal sensorimotor development of the tongue and surrounding oral musculature. The aim of this retrospective study was to explore if lingual praxia is impaired...

Obstructive sleep apnea (OSA) is a highly morbid disease associated with increased risk for all-cause mortality. The incidence and prevalence of OSA is increasing in the adult population. While alcohol is a known risk factor for increasing severity of OSA, the exact impact of alcohol on AHI and LSAT is not well-defined in the literature. The goal...

Background: Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-re...

Introduction To examine the craniofacial and airway morphology as well as the quality of life before and after passive myofunctional therapy (MFT) for one year in children with obstructive sleep apnea (OSA). Methods Twenty-six children with OSA wearing an oral device nightly (treatment group) and 9 without the device (control group) were followed...

Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Revie...

Cyclic alternating pattern (CAP) is a neurophysiological pattern that can be visually scored by international criteria. The aim of this study was to verify the feasibility of visual CAP scoring using only one channel of sleep electroencephalogram (EEG) to evaluate the inter-scorer agreement in a variety of recordings, and to compare agreement betwe...

Introduction: Upper airway resistance syndrome (UARS) as obstructive sleep apnea syndrome (OSAS) has been described as abnormal breathing during sleep, based on the recording technologies and knowledge of the time. These terms have advanced the field, but the question raised is are they still useful? Area Covered: Historically, the definition of UA...

Introduction: Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Some pediatric studies have shown cardiovascular effects in children who do not fit the criteria for OSA; namely children with mild sleep disordered breathing. Objective: We investigated heart rate variability (HRV) d...

Introduction: Midface retrusion creates a size deficiency problem in the upper airway that has been improved in children using surgical midface advancement and orthopedic protraction of the maxilla. The results of these treatments have been mostly promising at enlarging the pharyngeal airway. Recently introduced bone anchored maxillary protraction...

Objective: To characterize sleep-disordered breathing patterns not related to hypoxia resulting in fragmented sleep in children. Methods: We reviewed the polysomnogram (PSG) data of children with sleep complaints who were being evaluated for sleep-disordered breathing and had an apnea-hypopnea-index ≤ 3. These data were compared to the recording...

Introduction: Obstructive sleep apnea (OSA) is highly prevalent and constitutes a major health hazard. Current pharmacotherapy is ineffective in correcting sleep-disordered breathing and is used adjunctively to address residual sleepiness. A new drug, solriamfetol, a selective norepinephrine-dopamine reuptake inhibitor, is the first drug of its cla...

Introduction: Sleep problems, neuro-developmental development, and sleep-disordered-breathing (SDB), are reported as more prevalent in premature infants than in full-term infants. We investigated the relationship between neuro-development, and SDB in preterm infants at 24 months corrected age (CA) with a narrow palatal presentation over time. Met...

Objective: The aim of this retrospective study was to evaluate the results of an outpatient surgical procedure known as endoscopically-assisted surgical expansion (EASE) in expanding the maxilla to treat obstructive sleep apnea (OSA) in adolescent and adults. Methods: Thirty-three patients (18 males), aged 15-61 years, underwent EASE of the maxi...

Backgrounds: Myofunctional therapy has been reported to be a valid adjunct treatment to OSA, but compliance was mentioned as an issue. We performed a prospective study on age matched randomized children submitted to myofunctional therapy (MFT) or to a functional device used during sleep (passive MFT). Methods: 110 children 4 to 16 were recruited...

According to the 2005 International Classification of Sleep Disorders (ICSD-2), narcolepsy and idiopathic hypersomnia are considered hypersomnias of central origin (American Academy of Sleep Medicine. International Classification of Sleep Disorders. Diagnostic and coding manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005). In thi...

Chronic insomnia affects 57% of the elderly in the United States, with impairment of quality of life, function, and health. Chronic insomnia burdens society with billions of dollars in direct and indirect costs of care. The main modalities in the treatment of insomnia in the elderly are psychological/behavioral therapies, pharmacological treatment,...

Objectives Mandibular distraction osteogenesis and mandibular advancement, collectively referred to as mandibular advancement surgeries (MAS), have been used to treat children with mandibular insufficiency and obstructive sleep apnea (OSA). The objective is to perform a systematic review and meta-analysis for MAS as treatment for obstructive sleep...

PurposeOropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy. Methods PubMe...

Objective: To analyze differences in functional brain images collected in patients with type 2 and type 1 narcolepsy compared to normal controls and the relationship among brain images, objective Neuropsychologic tests, and sleep findings. Methods: Data collection included comprehensive clinical investigation, study of sleep/wake with actigraphy...

There are several types of hypersomnia, having many causes, some still unknown. They can be caused by a variety of medical and/or psychiatric conditions, in addition to disorders disruptive of sleep, including obstructive sleep apnea, upper airway resistance syndrome and periodic limb movements. Once the known causes of hypersomnia have been exhaus...

Excessively sleepy teenagers and young adults without sleep‐disordered breathing are diagnosed with either narcolepsy type 1 or narcolepsy type 2, or hypersomnia, based on the presence/absence of cataplexy and the results of a multiple sleep latency test. However, there is controversy surrounding this nomenclature. We will try to find the differenc...

Objectives: Patients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis. Methods: Four authors searched five databases fro...

Purpose: Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and...

The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there i...

Although sleep and sleep disorders have been studied for centuries, it was the development of sophisticated tools to monitor eye movements, brain waves, and muscle tone in the mid-20th century that led to modern sleep research. These tools allowed neuroscientists to distinguish between different “states” or “phases” of sleep, and to relate these fi...

“Sleep Medicine” is now a specialty in its own right. Currently, there is increasing recognition of the very negative impact sleep disorders have on learning, education, safety, and quality of life. Technological advances will help us to break down diagnoses (e.g., narcolepsy has now been subdivided into types 1 and 2, depending upon the hypocretin...

Pediatric obstructive sleep apnea (OSA) was initially described in 1976. In 1981, Dr. Guilleminault emphasized that pediatric OSA was different from the clinical presentation reported in adults. It was characterized by more disturbed nocturnal sleep than excessive daytime sleepiness, and presented more behavioral problems, particularly school probl...

A narrow maxilla with high arched palate characterizes a phenotype of obstructive sleep apnea (OSA) patients that is associated with increased nasal resistance and posterior tongue displacement. Current maxillary expansion techniques for adults are designed to correct dentofacial deformity. We describe distraction osteogenesis maxillary expansion (...

Obstructive sleep apnea syndrome (OSAS) is a common, often under recognized, medical disorder characterized by repeated episodes of upper airway closure during sleep. The course is a slowly progressive one. The patient’s daytime performance becomes insidiously more impaired, until the patient eventually decompensates and presents to the healthcare...

Background/purpose: The prematurely born and obstructive sleep apnea (OSA) could affect craniofacial and airway growth. The purpose of this study is to compare the differences in craniofacial and airway morphology between preterm and full-term children both with OSA problem. Materials and methods: The differences in craniofacial and airway morpholo...

Introduction Systemic inflammation is commonly advanced as related to pediatric obstructive-sleep-apnea. Increase in high-sensitive CRP has been shown in association with the syndrome, with decrease following adenotonsillectomy. Many inflammatory factors have been identified with complex interaction between factors. We performed a study of interleu...

Introduction: Obstructive sleep apnea (OSA) is a highly prevalent condition affecting persons of all age with an increasing public health burden. It is implicated in cardiovascular disease, metabolic syndrome, neurocognitive impairment, reductions in quality of life, and increased motor vehicle accidents. The goals of OSA treatment are to improve...

Vivien C Abad, Christian Guilleminault Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University Outpatient Center, Redwood City, CA, USA Abstract: Narcolepsy is a life-long, underrecognized sleep disorder that affects 0.02%–0.18% of the US and Western European populations. Genetic predisposition is suspected...

Background It is well recognized that sleep is severely disturbed in patients in intensive care units (ICU) and that this can compromise their rehabilitation potential. However, it is still difficult to objectively assess sleep quantity and quality and the determinants of sleep disturbance remain unclear. The aim of this study was therefore to eval...

Study objectives: Catathrenia is an underrecognized nocturnal vocalization phenomenon that can be a source of perplexity to patients, bed partners, and medical providers. Catathrenia is distinct from both sleep talking (a parasomnia with loud talking during sleep) and snoring (noise due to vibration of upper airway soft tissues related to variatio...

Case: Carly is a 5-year-old girl who presents for an interdisciplinary evaluation due to behaviors at school and home suggestive of attention-deficit hyperactivity disorder (ADHD). Parent report of preschool teacher concerns was consistent with ADHD. Psychological testing showed verbal, visual-spatial, and fluid reasoning IQ scores in the average...

Objective The objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then the identified studies would be used to develop a checklist de novo. Study design Systematic...

Purpose The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review...

Objective: To evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Methods: Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy...

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder; however, it remains underdiagnosed and undertreated. Although screening tools such as the Berlin questionnaire (BQ), STOP-Bang questionnaire (SBQ), STOP questionnaire (STOP), and Epworth sleepiness scale (ESS) are widely used for OSA, the findings regarding their diagnostic accurac...

This review aims to evaluate the performance of obstructive sleep apnea (OSA) screening questionnaires during pregnancy. A systematic review and meta-analysis was performed using Medline, Scopus, CINAHL, and the Cochrane Library. A bivariate meta-analysis was applied for pooling of diagnostic parameters. Six of the total 4,719 articles met the incl...

An historical review on the discoveries on pediatric obstructive sleep apnea syndrome and sleep-disordered breathing is outlined. Starting with the description by Dickens of "Joe" the obese, snoring and sleepy individual, the authors trace more than 50 years of questions and research starting with the lean adult to the child and from the recognitio...

Objectives/Hypothesis To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE and eight additional databases. Review Methods Three authors independently and systematically reviewed the inte...

Background/purpose: Myofunctional therapy is one of the recommended treatments for obstructive sleep apnea, but the level of compliance has often been low in children. This study aims to investigate the therapeutic effect of passive myofunctional therapy using an oral appliance during sleep in children suffering from obstructive sleep apnea. Meth...

Objective: This study aimed to evaluate neurocognitive function in adult patients with residual excessive sleepiness (RES) after appropriate treatment of obstructive sleep apnea (OSA) with CPAP and good adherence to treatment. Methods: This was a prospective controlled study. We included patients of both sexes, aged 35-60 years with OSA and an a...

Pediatric obstructive sleep apnea (OSA) is associated with chronic systemic inflammation and with cognitive impairments. This study aimed to investigate the status of proinflammatory cytokines, particularly interleukin 17 (IL-17) and interleukin 23 (IL-23) and cognition in pediatric OSA. Controls and OSA children participated in the study. Exclusio...

A short lingual frenulum has been associated with difficulties in sucking, swallowing and speech. The oral dysfunction induced by a short lingual frenulum can lead to oral-facial dysmorphosis, which decreases the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep. Clinical investigat...

OBJECTIVES: Temperature-controlled radiofrequency volumetric reduction (TCRF), a minimally invasive procedure, has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome (OSAS). An adjunctive method was objectively evaluated. METHOD: A prospective, nonrandomized clinical study was undertaken on 20 consecutive OSAS patients w...

BACKGROUND: Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome. METHODS: One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures...

Kleine-Levin syndrome is a rare recurrent hypersomnia associated with symptoms of behavioral and cognitive impairment. This article reviews common presenting symptoms, differential diagnosis, diagnostic workup, and potential treatment options. Current updates on functional imaging studies and long-term neuropsychological studies are reviewed.

Introduction The aim of this retrospective study was to evaluate the results of bimaxillary expansion as a treatment option for pediatric sleep-disordered breathing. Methods Forty-five children, aged 3–14 years, with sleep-disordered breathing underwent bimaxillary expansion. They were subjected to baseline clinical evaluations, cephalometric X-ra...

Objective/background: The objective of this study was to evaluate medical comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Patients/methods: This was a retrospective medical claims data analysis. Truven Health Analytics MarketScan® Research Databases were accessed to identify individuals ≥18 years of age with ≥1...

Opinion statement: Kleine-Levin Syndrome [KLS] is often under-recognized and also misdiagnosed. When suspicion for KLS is raised, a thorough clinical evaluation should be performed, including detailed history from family members and a neurologic and psychiatric examination. Additional studies may include PSG, EEG, neuroimaging, as well as serologi...

Narcolepsy with cataplexy (NC) is a rare, debilitating complex sleep disorder that affects approximately 0.026 % of the general population. The disorder is characterized by excessive daytime sleepiness ( EDS ), fragmented nocturnal sleep, dissociated manifestation of rapid eye movement sleep phenomena such as sleep paralysis and hypnagogic hallucin...

The relationship between functional brain images and performances in narcoleptic patients and controls is a new field of investigation. We studied 71 young, type 1 narcoleptic patients and 20 sex- and age-matched control individuals using brain positron emission tomography (PET) images and neurocognitive testing. Clinical investigation was carried...