Greg Maislin

Hospital of the University of Pennsylvania | HUP · Division of Sleep Medicine

Introduction The Tele-OSA randomized trial demonstrated improved PAP adherence in obstructive sleep apnea (OSA) patients receiving a telemonitoring intervention (automated messages triggered by low usage [U-Sleep, ResMed]). We conducted a sub-group analysis to explore the effect of the intervention in Black and Hispanic adults (B/H) compared to adu...

Aim To assess respiratory symptoms and nocturnal gastro-oesophageal reflux (nGER) among untreated obstructive sleep apnoea (OSA) patients, compared with the general population. Also, if nGER associates differently with respiratory symptoms among OSA patients. Methods 2 study cohorts were included: 822 newly diagnosed subjects with moderate–severe...

Chronic sleep restriction, common in today's 24/7 society, causes cumulative neurobehavioural impairment, but the dynamics of the build‐up and dissipation of this impairment have not been fully elucidated. We addressed this knowledge gap in a laboratory study involving two, 5‐day periods of sleep restriction to 4 hr per day, separated by a 1‐day do...

Aim To study the effect of positive airway pressure (PAP) treatment on nocturnal gastroesophageal reflux (nGER) and respiratory symptoms among clinical OSA patients. Methods 822 newly diagnosed patients with OSA referred for PAP treatment were recruited. 732 subjects had a 2-year follow-up visit with CPAP compliance data collected (366 full PAP us...

Introduction Black or African American and Hispanic of any race (B/H) adults are disproportionately affected by obstructive sleep apnea (OSA). Positive Airway Pressure (PAP) treatment may reduce disparities, but short-term PAP outcomes are worse among under-represented minority (URM) adults compared to other, mainly White, adults. No studies have e...

Objectives: To evaluate the cost-effectiveness of a 3-year tele-messaging intervention for positive airway pressure (PAP) use in obstructive sleep apnea (OSA). Study design: A post hoc cost-effectiveness analysis (from US payers' perspective) of data from a 3-month tele-OSA trial, augmented with 33 months of epidemiologic follow-up. Methods: C...

Rationale: Craniofacial and pharyngeal morphology are risk factors for Obstructive Sleep Apnea (OSA). Quantitative photography provides phenotypic information about these anatomic risk factors and is feasible in large samples. However, whether associations between morphology and OSA severity are influenced by genetic ancestry is unknown. Objectiv...

Background: The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. Research question: Are three-year healthcare costs associated with PAP adherence in participants from the Tele-OSA clinical trial? Study design and methods: Participants with OSA and prescribed PAP in the Tele-OS...

Study Objectives Following sleep deprivation, increases in delta power have historically been used to index increases in sleep pressure. Research in mice has demonstrated that the homeostatic delta power response to sleep deprivation is heritable. Whether this is true in humans is unknown. In the present study, we used delta power and ORP, a novel...

Category Midfoot/Forefoot Introduction/Purpose Fifth metatarsal fractures are the most commonly fractured metatarsal in adults and are associated with high rates of nonunion. This study compared the 9-month incidence of nonunion in fifth metatarsal fracture patients using EXOGEN (Bioventus LLC), low-intensity pulsed ultrasound, versus a control co...

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. Met...

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...

Background Prediction tools without patient-reported symptoms could facilitate widespread identification of obstructive sleep apnea (OSA). Research Question What is the diagnostic performance of machine-learning derived OSA prediction tools using readily available data without patient responses to questionnaires, and how do they compare to the STO...

Background: The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. Research Question: Are three-year healthcare costs associated with PAP adherence in participants from the Tele-OSA clinical trial? Study Design and Methods: Participants with OSA and prescribed PAP in the Tele-OSA stu...

Introduction The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. We explored the relationship between 3-year PAP adherence and direct healthcare cost utilizing the Tele-OSA study cohort. Methods The Tele-OSA randomized clinical trial demonstrated improved PAP adherence in patient...

Introduction Trial-based tele-obstructive sleep apnea (OSA) cost-effectiveness analyses have often been inconclusive due to small sample sizes and short follow-up. In this study, we report the cost-effectiveness of Tele-OSA using a larger sample from a 3-month trial that was augmented with 2.75 additional years of epidemiologic follow-up. Methods...

Introduction While studies support the beneficial short-term role of continuous positive airway pressure (CPAP) therapy on cardiometabolic risk in adults with obstructive sleep apnea (OSA), its sustained effect on cardiovascular disease (CVD) risk is unknown. CPAP use data linked to electronic health records (EHR) offer opportunities to understand...

Background: Necrotizing soft tissue infections (NSTI) are an acute surgical condition with high morbidity and mortality. Timely identification, resuscitation and aggressive surgical management has significantly decreased inpatient mortality. However, reduced inpatient mortality has shifted the burden of disease to long-term mortality associated wi...

The Bioventus Observational Noninterventional EXOGEN Studies (BONES) Program includes 3 concurrent studies designed to estimate the incidence of fracture nonunions in patients treated with the EXOGEN Ultrasound Bone Healing System compared with those receiving standard fracture care. This article outlines the design and methodology within the fifth...

Three recent randomized control trials (RCTs) found that treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) did not reduce rates of future cardiovascular events. This article discusses the biases in these RCTs that may explain their negative results, and how to overcome these biases in future studies. First,...

Study Objectives Sleep spindles, a defining feature of stage N2 sleep, are maximal at central electrodes and are found in the frequency range of the EEG (sigma 11-16Hz) 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 moderat...

Soft-tissue bacterial infection can progress to severe sepsis and septic shock as a result of a disproportionate inflammatory response, characterized by an excessive release of cytokines and influx of immune cells. Reltecimod (previously known as AB103 or p2TA), a peptide derived from the T-cell receptor CD28, modulates the host immune response by...

Background and objective: Reltecimod, a CD 28 T-lymphocyte receptor mimetic, inhibits T-cell stimulation by an array of bacterial pathogens. A previous phase 2 trial demonstrated improved resolution of organ dysfunction after NSTI. We hypothesized that early administration of reltecimod would improve outcome in severe NSTI. Methods: Randomized,...

Introduction Obstructive sleep apnea (OSA) is associated with increased glucose intolerance and insulin resistance, and commonly coexists with type 2 diabetes mellitus (T2DM). Research suggests an independent association between these two conditions. However, more research into the role of T2DM in the development of OSA, or vice versa, is needed....

Introduction Sustained attention is important for optimal neurobehavioral performance, but many biological and environment factors (e.g., circadian rhythm, distraction) may cause sustained attention deficits. Mastication (chewing) has been suggested to provide a countermeasure to sustained attention deficits. To investigate this, we conducted a ran...

Background We developed objective definitions of extreme phenotypes of obstructive sleep apnea (OSA) using a multivariate approach, and demonstrate their utility for identifying characteristics that confer predisposition towards or protection against OSA in a new prospective sample. Methods In a large international sample, we calculated race-speci...

Background: Joint arthrodesis often employs autograft to promote union; graft harvesting can lead to perioperative morbidity. A Canadian randomized controlled trial (RCT) demonstrated that recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) combined with beta-tricalcium phosphate (β-TCP)-collagen was a safe, effective alterna...

Many patients with obstructive sleep apnea (OSA), but not all, have a reduction in blood pressure (BP) with positive airway pressure (PAP) treatment. Our objective was to determine whether the BP response following PAP treatment is related to obesity. A total of 188 adults with OSA underwent 24‐hour BP monitoring and 24‐hour urinary norepinephrine...

Study objectives: Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinic...

Introduction An observational study of CMV drivers was undertaken to assess the operational, safety, health, and fatigue impacts of the restart provisions in Sections 395.3(c) and 395.3(d) of Title 49, Code of Federal Regulations. Methods N=235 drivers (224 males, 20-69y) participated in an observational study for up to 5 months duration. All driv...

Introduction Following sleep deprivation, sleep is presumed to be deeper than during baseline sleep due to greater sleep pressure. EEG delta power, a marker of sleep pressure is higher during sleep following sleep deprivation. Delta power also returns to baseline levels at the end of the recovery night, suggesting that full recovery occurs in one n...

Introduction Odds ratio product (ORP) is a continuous index of sleep depth derived from the relation of EEG powers in different frequency ranges to each other. It ranges from 0 (pattern only occurring during sleep) to 2.5 (pattern only occurring during wakefulness or in arousals). An ORP of 1.25 indicates a pattern with an equal probability of occu...

Introduction Numerous studies have demonstrated that positive airway pressure (PAP) treatment of patients with obstructive sleep apnea (OSA) reduces blood pressure (BP), possibly by decreasing sympathetic activity. Obesity is a risk factor for OSA and hypertension and is characterized by increased sympathetic activity. In this study, we evaluated t...

Study Objectives Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea–hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic...

Study objectives: A recent study of moderate-severe obstructive sleep apnea (OSA) patients in Iceland identified 3 clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods: Using data o...

Study Objectives Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy...

This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the...

Objective: This article describes the definition and proposed utilization of negative likelihood ratios (NLRs) as statistical parameters in breast imaging. Examples with calculations are provided using BI-RADS category 4 subcategories. Conclusion: By auditing individual performance early and often against American College of Radiology benchmark...

Obesity and obstructive sleep apnea tend to coexist. Little is known about the effects of obstructive sleep apnea, obesity, or their treatment on central aortic pressures and large artery stiffness. We randomized 139 adults with obesity (body mass index >30 kg/m2) and moderate-to-severe obstructive sleep apnea to (1) continuous positive airway pres...

Study objectives Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. The purpose of this study was to compare carotid intima-media thickness (IMT), an early sign of atherosclerosis, in obese and non-obese adults with OSA before and following positive airway pressure (PAP) treatment. Method...

Objective: Our objective was to develop and validate a composite endpoint for patients with necrotizing soft tissue infections (NSTI) that incorporates: local tissue injury, systemic organ dysfunction, and mortality. Methods: The Necrotizing Infection Clinical Composite Endpoint (NICCE) was defined as follows:(i) Alive at day 28 (ii) ≤3 debridem...

Background: Obstructive sleep apnea (OSA) is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy using digital morphometrics based on a laser ruler, and to assess differences between apneics and controls and associations with AHI (apnea-hypopnea index). This is the f...

Introduction Obstructive Sleep Apnea (OSA) is a common sleep disorder with similar prevalence in different ethnic populations. Obesity is a major risk factor for OSA; however, the impact of obesity on OSA severity may vary with ethnicity due to differential disease etiology. We hypothesized that the association between Apnea-Hypopnea Index (AHI) an...

Introduction Craniofacial morphology is a risk factor for Obstructive Sleep Apnea (OSA). Craniofacial phenotyping using simple digital photography has shown utility in predicting OSA. However, craniofacial structures that relate to OSA may vary by ethnicity. We hypothesized that the relationship between OSA severity and craniofacial photographic me...

Introduction Obstructive sleep apnea (OSA) is a common disorder with complex pathophysiology and heterogeneous clinical presentation, making it challenging to identify underlying biological factors. This study aims to characterize extreme phenotypes of OSA in a large sample of subjects from different sleep centers and ethnicities across the world....

Introduction Evidence suggests that, to maintain treatment effects, CPAP needs to be used every night. However it is not known the nightly duration of CPAP use required to normalize functioning. This study aimed to evaluate dose-response relationship between improvement of daily functioning and CPAP usage. Methods This study included 109 patients...

Introduction Current prediction tools for obstructive sleep apnea (OSA) include responses to questions about patient symptoms within subjects from a single country. We developed and determined the diagnostic performance of a symptomless OSA prediction tool in a large number of subjects seen in the member centers of the Sleep Apnea Global Interdisci...

Introduction Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for subclinical atherosclerosis in the carotid arteries. Moreover, there is a lack of information on the effect of positive airway pressure (PAP) treatment on carotid wall thickness, an early sign of atherosclerosis, and existing results are confl...

Objectives To determine if the large and highly reproducible inter-individual differences in arousal intensity and heart rate response to arousal (ΔHR) during non-REM sleep are heritable. Methods Polysomnograms of 55 monozygotic (14 male and 41 female pairs) and 36 dizygotic (15 male and 21 female pairs) same-sex twin pairs were analyzed. Arousals...

Study objectives: In mammals, there is evidence that glutamate has a role as a wake active neurotransmitter. So using video-based analysis of Drosophila behavior we undertook a study to examine if glutamate, which has been previously shown to have an excitatory role in neuromuscular junctions in Drosophila, may have a conserved wake-active role in...

Background 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 airw...

Background: Traditional surgical options for the treatment of symptomatic lumbar spinal stenosis include decompression alone vs decompression and fusion; both options have potential limitations. Objective: To report the 36-month follow-up analysis of the coflex Interlaminar Stabilization (Paradigm Spine, LLC, New York, New York) after decompress...

Study objectives: Apnea-hypopnea index (AHI) is the primary measure used to confirm a diagnosis of obstructive sleep apnea (OSA). However, there may be significant night-to-night variability (NNV) in AHI, limiting the value of AHI in clinical decision-making related to OSA management. We examined short-term NNV in AHI and its predictors during hom...

A congressionally-mandated naturalistic study was conducted to evaluate the operational, safety, fatigue, and health impacts of the restart provisions in Sections 395.3(c) and 395.3(d) of Title 49, Code of Federal Regulations. A total of 235 commercial motor vehicle drivers representative of the industry contributed data while working their normal...

Background: Necrotizing soft tissue infections (NSTI) represent a rare but devastating disease for which the systemic manifestations have been poorly characterized. In an effort to define an optimal endpoint for clinical trials in this condition, the objective of this study was to establish the pattern of organ dysfunction over time and determine...

Study objectives: The aims of this study were: (1) to use a standardized psychiatric interview, conducted by a trained psychologist to assess the prevalence of depression among patients with untreated OSA, and (2) to identify if OSA severity or other comorbid disorders (insomnia, hypertension, and diabetes) are related to depression among patients...

Approved treatment modalities for the surgical management of lumbar spinal stenosis encompass a variety of direct and indirect methods of decompression, though all have varying degrees of limitations and morbidity which potentially limit the efficacy and durability of the treatment. The coflex(®) interlaminar stabilization implant (Paradigm Spine,...

Mouse models of cyclical intermittent hypoxia (CIH) are used to study the consequences of both hypoxia and oxidative stress in obstructive sleep apnea (OSA). Whether or not a mouse model of CIH that simulates OSA patients' oxygenation characteristics would translate into improved patient care remains unanswered. First we identified oxygenation char...

Study objectives: To address whether changes in gene expression in blood cells with sleep loss are different in individuals resistant and sensitive to sleep deprivation. Design: Blood draws every 4 h during a 3-day study: 24-h normal baseline, 38 h of continuous wakefulness and subsequent recovery sleep, for a total of 19 time-points per subject...

Objectives: Accumulating evidence has shown that there is a genetic contribution to obstructive sleep apnea (OSA).The objectives were to use magnetic resonance imaging (MRI) cephalometry to (1) confirm heritability of craniofacial risk factors for OSA previously shown by cephalometrics; and (2) examine the heritability of new craniofacial structur...

The aim of this study was to evaluate changes in interleukin (IL)-6 and soluble IL-6 receptor levels in obstructive sleep apnea patients and assess the role of positive airway pressure treatment and obesity on these changes. A total of 309 newly diagnosed subjects with sleep apnea from the Icelandic Sleep Apnea Cohort were referred for treatment an...

Study objectives: Earlier work described a mutation in DEC2 also known as BHLHE41 (basic helix-loophelix family member e41) as causal in a family of short sleepers, who needed just 6 h sleep per night. We evaluated whether there were other variants of this gene in two well-phenotyped cohorts. Design: Sequencing of the BHLHE41 gene, electroenceph...

Background Elevated levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear....

Background: Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear. Methods: We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-re...

Obstructive sleep apnoea (OSA) is associated with cardiovascular disease. Dyslipidaemia has been implicated as a mechanism linking OSA with atherosclerosis, but no consistent associations with lipids exist for OSA or positive airway pressure treatment. We assessed the relationships between fasting lipid levels and obesity and OSA severity, and expl...

Study objectives: (1) To determine whether facial phenotype, measured by quantitative photography, relates to underlying craniofacial obstructive sleep apnea (OSA) risk factors, measured with magnetic resonance imaging (MRI); (2) To assess whether these associations are independent of body size and obesity. Design: Cross-sectional cohort. Setti...

IMPORTANCE Necrotizing soft-tissue infections (NSTI) have high morbidity and mortality rates despite aggressive surgical debridement and antibiotic therapy. AB103 is a peptide mimetic of the T-lymphocyte receptor, CD28. We hypothesized that AB103 will limit inflammatory responses to bacterial toxins and decrease the incidence of organ failure. OBJE...

Introduction Symptomatic chronic low back and leg pain resulting from lumbar spinal stenosis is expensive to treat and manage. A randomized, controlled, multicenter US Food and Drug Administration Investigational Device Exemption clinical trial assessed treatment-related patient outcomes comparing the Coflex® Interlaminar Stabilization Device, an i...

Symptoms of sleep-disordered breathing (SDB) are common among pregnant women, and several studies link SDB symptoms with gestational hypertension and preeclampsia. However, few prospective studies objectively measuring SDB during pregnancy have been performed. We performed a prospective cohort study examining risk factors for third trimester SDB in...

Recent articles in the lay press and literature have raised concerns about the ability to report honest adverse event data from industry-sponsored spine surgery studies. To address this, clinical trials may utilize an independent Clinical Events Committee (CEC) to review adverse events and readjudicate the severity and relatedness accordingly. We a...

To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers. Among a community-based cohort of licensed commercial vehicle drivers, we assessed utility of the joint task force criteria. We conducted full, 14-channel overnight polysomnography in all drivers, defining s-OSA as an apnea-hypopn...

The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s-OSAS) among hypertensive outpatients, with polysomnography (PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinic...