Kingman Strohl

• BA Anthropology, MD
• Professor of Physiology & Biophysics at Case Western Reserve University

Study objectives: Despite its efficacy, long-term adherence to continuous positive airway pressure (CPAP) hovers around 50%. The V-com (SleepRes, Murfreesboro, TN), an inspiratory pressure relief (IPR) accessory, claims to improve comfort by decreasing inspiratory pressures. We aim to independently assess its impact on fixed CPAP settings in a lab...

We chose the “natural laboratory” provided by high-altitude native ethnic Tibetan women who had completed childbearing to examine the hypothesis that multiple oxygen delivery traits were associated with lifetime reproductive success and had genomic associations. Four hundred seventeen (417) women aged 46 to 86 y residing at ≥3,500 m in Upper Mustan...

[This corrects the article DOI: 10.1371/journal.pone.0258040.].

Introduction Short sleep duration and inconsistent timing have been linked to poor glycemic target achievement and greater comorbidities in individuals with type 1 diabetes (T1D), particularly adults aged 18-26 years who achieve glycemic targets at the lowest rates (only 14%). Preliminary evidence supports cognitive behavioral sleep interventions (...

Introduction Nasal expiratory positive airway pressure (EPAP) stands as a viable therapeutic solution for individuals with obstructive sleep apnea (OSA). Bongo Rx (AirAvant Medical, Deerfield Beach, Florida) has obtained FDA clearance for treating patients with mild-to-moderate OSA despite limited publication. Amidst the global continuous positive...

Objectives Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA‐related symptoms. Methods In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an e...

Onboard oxygen-generating systems (OBOGSs) provide increased inspired oxygen (FiO2) to mitigate the risk of neurologic injury in high altitude aviators. OBOGSs can deliver highly variable oxygen concentrations oscillating around a predetermined FiO2 set point, even when the aircraft cabin altitude is relatively stable. Steady-state exposure to 100%...

Objective: Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (SCI/D). Interventions focused on increasing PAP use have not been studied in this population.We aimed to evaluate the benefits of a program to increase PAP...

Study objectives: Could HSAT using a type III portable monitor (PM) Nox-T3 detect OSA in pregnant women? Methods: 92 pregnant women (34.5 ± 4.3 years old, gestational age 25.4 ± 8.9 weeks, BMI 29.9± 4.7 kg/m2) with suspected OSA underwent HSAT with the Nox-T3 PM followed by an overnight polysomnogram (PSG) and PM recording simultaneously in the...

Goal and aims: Our objective was to evaluate the performance of Belun Ring with second-generation deep learning algorithms in obstructive sleep apnea (OSA) detection, OSA severity categorization, and sleep stage classification. Focus technology: Belun Ring with second-generation deep learning algorithms Reference technology: In-lab polysomnograph...

Introduction Long COVID is common after COVID-19 infection and leads to functional limitations with most reporting substantial symptom burden from fatigue. Symptoms in sleep disorders are attributed to inflammatory dysregulation and may predispose to fatigue expression. We hypothesize prior diagnoses of sleep disorders are associated with severity...

Introduction: Whether photoplethysmography (PPG)-derived pulse rate variability (PRV) metrics can be surrogates for ECG-derived heart rate variability (HRV) is a decade-long debate. Very few studies have assessed the performance of PRV metrics in wearables. We aimed to evaluate the performance of time- and frequency-domain PRV metrics derived from...

Subjective Sleep-disordered breathing (SDB) is highly prevalent in polio survivors. Obstructive sleep apnea (OSA) is the most frequent type. Full polysomnography (PSG) is recommended for OSA diagnosis in patients with comorbidities by current practice guidelines, but it is not always accessible. The purpose of this study was to evaluate whether typ...

The purpose of this study was to explore perceptions of the first dose of a cognitive behavioral sleep self-management intervention (CB-sleep) among young adults aged 18 to 25 years with type 1 diabetes (T1D). We used a qualitative descriptive approach to conduct in-depth semi-structured focused interviews with a purposive sample of 16 young adults...

Objective We investigated intra-individual reciprocal associations between sleep health dimensions (individual and composite) and symptoms among young adults with type 1 diabetes (T1D). Design and measurements Cross-lagged multilevel models were used to analyze electronic diary-reported sleep and symptom patterns over 7 days at waketime in 42 youn...

Purpose of Review Neurostimulation is an electrical therapy for obstructive sleep apnea and is now an approved therapy option for patients whom positive airway pressure (PAP) therapy is not tolerated. This review describes its implementation, efficacy and safety, the available multi-year clinical outcomes for stimulation devices, and future prospec...

The hypocretin neurons in the lateral hypothalamus are connected not only to brain alertness systems but also to brainstem nuclei that regulate blood pressure and heart rate. The premise is that regulation of blood pressure and heart rate is altered and affected by methylphenidate, a stimulant drug in children with narcolepsy with cataplexy. The ch...

Objectives This analysis characterized changes in weight in participants with obstructive sleep apnea (OSA) or narcolepsy treated with solriamfetol (Sunosi™) 37.5 (OSA only), 75, 150, or 300 mg/d. Methods In two 12-week, randomized, placebo-controlled trials and one 1-year open-label extension study, changes in weight were evaluated from baseline...

Given the high rate of depression associated with narcolepsy or obstructive sleep apnea (OSA), this analysis compared effects of solriamfetol treatment of excessive daytime sleepiness (EDS) in participants with/without a history of depression (DHx+/DHx-). This secondary analysis included data from two randomized, controlled trials in which particip...

Introduction Expiratory positive airway pressure (EPAP) has been a treatment option for patients with obstructive sleep apnea (OSA). Among devices like Provent, Theravent, and Bongo, ULTepap is a new FDA-cleared EPAP device that seals around the nares with a nasal pillow interface. Comparisons among the expiratory pressures that these devices might...

Obstructive sleep apnea (OSA) is found at all stages of life, in all races, and with all shapes and sizes of people, and can rise to the level of a disorder (OSAHS). Early detection of it improves waketime sleepiness and inattention, quality of life, and a reduction in medical costs. The questions being addressed are how OSA conditions affect morbi...

Objective/background Expiratory positive airway pressure (EPAP) has been a treatment option for patients with obstructive sleep apnea (OSA). ULTepap is a new FDA-cleared EPAP device that seals the nares with a nasal pillow interface. Comparisons of expiratory pressures generated by ULTepap and other EPAP devices like Provent, Bongo Rx, and Theraven...

Introduction: Our laboratory investigates changes in the respiratory pattern during systemic inflammation in various rodent models. The endogenous cannabinoid system (ECS) regulates cytokine production and mitigates inflammation. Inflammation not only affects cannabinoid (CB) 1 and CB2 receptor gene expression (Cnr1 and Cnr2), but also increases th...

Simulated altitude (normobaric hypoxia, NH) is used to study physiologic hypoxia responses of altitude. However, several publications show differences in physiological responses between NH and hypobaric conditions at altitude (hypobaric hypoxia, HH). The causality for these differences is controversially discussed. One theory is that the lower air...

Context Short sleep duration and sleep disruptions are associated with impaired glucoregulation in type 1 diabetes (T1D). However, the mechanistic pathways between sleep and glucose variability remain unclear. Objective To determine within-and between-person associations between objective sleep-wake characteristics and glucose variability indices....

Many wearables allow physiological data acquisition in sleep and enable clinicians to assess sleep outside of sleep labs. Belun Sleep Platform (BSP) is a novel neural network-based home sleep apnea testing system utilizing a wearable ring device to detect obstructive sleep apnea (OSA). The objective of the study is to assess the performance of BSP...

A two dimensional finite element model of upper airway respiratory function was developed emphasizing the effects of dilator muscular activation on the human retro-lingual airway. The model utilized an upright mid-sagittal computed tomography of the human head and neck to reconstruct relevant structures of the tongue, mandible, and the hyoid-relate...

Background: The purpose of the study is to determine whether the addition of antidepressants provides measurable benefit in diminishing symptoms of depression, such as anhedonia, hopelessness and poor self-esteem, in veterans with obstructive sleep apnea (OSA) and comorbid major depressive disorder (MDD) who are on automatic positive airway pressur...

Objectives Connecting traits to biological pathways and genes relies on stable observations. Researchers typically determine traits once, expecting careful study protocols to yield measurements free of noise. This report examines that expectation with test–retest repeatability analyses for traits used regularly in research on adaptation to high-alt...

Rationale: Obstructive sleep apnea (OSA) is associated with cardiovascular disease and incident type 2 diabetes (T2DM). Seven OSA phenotypes, labeled based on their most distinguishing polysomnographic features, have been shown to be differentially associated with incident cardiovascular disease. However, little is known about the relevance of pol...

Circadian alignment is an important element in individual health, and one behavioral marker, rest- activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was...

Study objectives: The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7 - 14 days in young adults with type 1 diabetes (T1D). Additionally, person level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and g...

Introduction Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and dia...

Introduction Vagal Nerve Stimulators (VNS) are used in refractory epilepsy and depression. VNS are known to decrease airflow, oxygen saturation, and respiratory amplitude during sleep. We present a case of VNS induced OSA that was overlooked for 6 years. Report of case(s) A 63-year-old Caucasian female with refractory depression, hypothyroidism, a...

Objectif Évaluer si une perte de poids cliniquement significative (≥ 5 %) chez des participants souffrant de narcolepsie ou d’apnée obstructive du sommeil (AOS) recevant du solriamfétol 75-300 mg/jour améliorait les biomarqueurs de risque cardiométabolique. Méthodes Évaluation, dans un essai d’extension ouvert, des changements de poids, de pressio...

Study objectives: Individuals with obstructive sleep apnea (OSA), characterized by frequent sleep disruptions from tongue muscle relaxation and airway blockage, are known to benefit from on-demand electrical stimulation of the hypoglossal nerve. Hypoglossal nerve stimulation (HNS) therapy, which activates the protrusor muscles of the tongue during...

Many patients with obstructive sleep apnea (OSA) experience excessive daytime sleepiness (EDS), which can negatively affect daily functioning, cognition, mood, and other aspects of well-being. Although EDS can be reduced with primary OSA treatment, such as continuous positive airway pressure (CPAP) therapy, a significant proportion of patients cont...

Background Solriamfetol, a dopamine-norepinephrine reuptake inhibitor, is approved in the USA to improve wakefulness in adults with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) (37.5-150 mg/d). Research Question Does solriamfetol have differential effects on EDS based on adherence to primary OSA therapy and does...

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea provides the current state of knowledge regarding this novel therapy. It reviews the pathophysiologic basis of sleep apnea and the specific mechanism by which upper airway stimulation provides airway support in this disorder. It also provides practical insights into this therapy related t...

Introduction Le solriamfetol est un inhibiteur de la recapture de la dopamine et de la noradrénaline approuvé dans l’UE et aux États-Unis pour traiter la somnolence diurne excessive (SDE) du syndrome d’apnées-hypopnées obstructives du sommeil (SAHOS; 37,5–150 mg/jour). Cette analyse a permis d’évaluer si le traitement de la SDE par solriamfetol aff...

Imaging as always was a key concept in craniofacial diagnosis. Airway imaging techniques used in the diagnosis of obstructive sleep apnea (OSA) have greatly improved especially with understanding OSA pathophysiology. The measurements of the upper airway can be significantly important when studying breathing disorders. Even though sleep studies are...

Study objectives: Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the US and EU to treat excessive daytime sleepiness in obstructive sleep apnea (37.5-150 mg/d) and narcolepsy (75-150 mg/d). This analysis evaluated solriamfetol's efficacy in subgroups of participants with OSA who were adherent or nonadherent to primary O...

Study objectives: Excessive daytime sleepiness (EDS) is a frequent cause for consultation and a defining symptom of narcolepsy and idiopathic hypersomnia (IH). The associated mechanisms remain unclear. Lipocalin-type prostaglandin D synthase (LPGDS) is a plausible sleep-inducing candidate. This study is to compare cerebral spinal fluid (CSF) and s...

Rationale: Approximately a third of patients with obstructive sleep apnea (OSA) treated with hypoglossal nerve stimulation (HGNS) therapy are incomplete responders, despite careful patient selection based on baseline characteristics and drug-induced sleep endoscopy. Here we use polysomnographic endotyping to assess the pathophysiological mechanism...

Objective An increasing number of facilities offer Upper Airway Stimulation (UAS) with varying levels of experience. The goal was to quantify whether a surgical learning curve exists in operative or sleep outcomes in UAS. Methods International multi-center retrospective review of the ADHERE registry, a prospective international multi-center study...

Based on a prior anesthetized model, we developed an unanesthetized model to evaluate the effects of hypoglossal nerve stimulation (HNS) during sleep. We prepared three rabbits with injections of Hyaluronic Acid in the base of tongue to produce upper airway obstruction followed by HNS implant. Two rabbits were saline controls, and one, a passive co...

Key points Extreme aviation is accompanied by ever‐present risks of hypobaric hypoxia and decompression sickness. Neuroprotection against those hazards is conferred through fractional inspired oxygen (FI,O2) concentrations of 60–100% (hyperoxia). Hyperoxia reduces global cerebral perfusion (gCBF), increases reactive oxygen species within the brain...

Introduction There is a substantial need for an accurate and easy-to-use tool for obstructive sleep apnea (OSA) assessment. Belun Ring Platform (BRP), a novel photoplethysmography (PPG)-based home sleep apnea testing system with a proprietary deep learning algorithm, has been shown to have good sensitivity and specificity in predicting OSA in subje...

Introduction Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adher...

Cytokine production is regulated by the endogenous cannabinoid system (ECS) in many pro‐inflammatory conditions. Sepsis is a highly morbid condition that results from a dysregulated host response to infection. Our previous work showed that ventilatory pattern variability (VPV) decreased concomitantly with increased pro‐inflammatory cytokine product...

Objectif Évaluer l’efficacité du solriamfétol, un inhibiteur de recapture de la dopamine et de la noradrénaline ayant des effets favorisant la veille, pour le traitement de la somnolence diurne excessive (SDE) chez des participants atteints de syndrome d’apnées obstructives du sommeil (SAOS) ayant reçu ou recevant un traitement du SAOS. Méthodes L...

Background Upper Airway Stimulation (UAS) is a well‐established therapy option for obstructive sleep apnea (OSA). Aims There are no data on whether respiratory sensing contributes to successful UAS therapy. Materials & Methods After initial measurements of 3 implanted patients (M1), the sensing signal was inverted (M2) without changing other para...

This review will trace the elements of neurostimulation for obstructive sleep apnea and details on its implementation, efficacy and safety, immediate clinical outcomes, and future prospects. The literature on upper airway neurostimulation was surveyed from July 2013 to July 2019, with a focus on the components of devices, evidence for clinical util...

Obesity hypoventilation syndrome (OHS) is a systemic disease with negative consequences that extend beyond the respiratory system. These patients have a high prevalence of cardiovascular disease, pulmonary hypertension, neurocognitive dysfunction, hypersomnia, metabolic disorders, and elevated inflammatory markers. They usually have significant fun...

Rationale: Sex-specific changes of cardiovascular biomarkers in response to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) is limited. Objective: We hypothesize a differential sex-specific cardiovascular biomarker response with CPAP therapy for OSA. Methods: Participants with moderate-severe OSA(apnea-hypo...

Introduction Obstructive sleep apnoea (OSA) is often associated with persistent excessive daytime sleepiness (EDS) despite sleep apnoea therapy. There are currently no approved treatments in the European Union for the treatment of EDS in this population. Solriamfetol (formerly JZP-110), a dopamine and norepinephrine reuptake inhibitor, has been app...

Objective/hypothesis: The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patie...

Purpose: Sleep apnea can increase adverse outcomes during ambulatory surgery but not during gastrointestinal endoscopy. We hypothesize that STOP-BANG is associated with intraprocedural bronchoscopy respiratory complications. Materials and methods: Consecutive patients undergoing bronchoscopy under moderate sedation were prospectively administere...

Background: Positive airway pressure (PAP) and upper airway stimulation (UAS) are approved OSA treatment options. Although the effect of PAP on improvement in BP and daytime sleepiness (defined according to the Epworth Sleepiness Scale [ESS]) has been established, the impact of UAS on BP remains unclear. This study hypothesized that PAP and UAS wi...

Objective To examine whether previous palate or hypopharyngeal surgery was associated with efficacy of treatment of obstructive sleep apnea with hypoglossal nerve stimulation. Study Design Cohort (retrospective and prospective). Setting Eleven academic medical centers. Subjects and Methods Adults treated with hypoglossal nerve stimulation were e...

Introduction Upper Airway Stimulation (UAS) therapy is a treatment option for CPAP intolerant obstructive sleep apnea. An increasing number of facilities offer UAS with varying levels of experience. Referring physicians may want to know whether the first set of patients have different outcomes from subsequent patients. We sought to quantify whether...

Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor with demonstrated efficacy in treating excessive daytime sleepiness in narcolepsy and obstructive sleep apnea (OSA). Decreased appetite was a common adverse event (AE) in clinical trials and these exploratory analyses sought to characterize the effects of solriamfetol on...

Introduction Solriamfetol, a selective dopamine and norepinephrine reuptake inhibitor, reduced excessive daytime sleepiness (EDS) and increased wakefulness in participants with obstructive sleep apnea (OSA) in a phase 3 study. Post-hoc analysis evaluated timing and duration of common, early-onset, treatment-emergent adverse events (TEAEs). Methods...

The endogenous cannabinoid system (ECS) regulates cytokine production and mitigates pathophysiology in many pro‐inflammatory conditions, such as irritable bowel diseases, atherosclerosis and acute lung injury. Sepsis, a highly morbid condition, results from a dysregulated host response to infection. Despite extensive study the transcriptional regul...

Study objectives: Evaluate consequences of intermediate to high risk of undiagnosed obstructive sleep apnea (OSA) among individuals with chronic obstructive pulmonary disease (COPD). Methods: Using data from the Long Term Oxygen Treatment Trial (LOTT), we assessed OSA risk at study entry among patients with COPD. We compared outcomes among those...

Rationale: Primary treatment of obstructive sleep apnea can be accompanied by a persistence of excessive sleepiness despite adherence. Furthermore, effectiveness of sleep apnea treatment is limited by poor adherence. Currently available pharmacologic options for the treatment of sleepiness in this population are limited. Objectives: To evaluate the...

Upper airway stimulation (UAS) has been shown to reduce severity of obstructive sleep apnoea. The aim of this study was to identify predictors of UAS therapy response in an international multicentre registry. Patients who underwent UAS implantation in the United States and Germany were enrolled in an observational registry. Data collected included...

Objectives Apolipoprotein A2 (Apoa2) gene expression in the brain is deterministic of apnea in the C57BL/6J sleep apnea mouse model, with both alleles needed for brain (but not liver) mRNA expression, and post‐hypoxic pauses (Gillombardo et al. 2016). Functional Apoa2 gene products, well described in the liver, are not reported as present in CNS. T...

Background: Pulmonary medicine specialists find themselves responsible for the diagnosis and management of patients with sleep disorders. Despite the increasing prevalence of many of these conditions, many sleep medicine fellowship training slots go unfilled, leading to a growing gap between the volume of patients seeking care for sleep abnormalit...

The Central Asian Kyrgyz highland population provides a unique opportunity to address genetic diversity and understand the genetic mechanisms underlying high-altitude pulmonary hypertension (HAPH). Although a significant fraction of the population is unaffected, there are susceptible individuals who display HAPH in the absence of any lung, cardiac...

This retrospective study examined 20 patients who underwent hypoglossal nerve stimulation implantation for treatment of obstructive sleep apnea at a single institution. We utilized a modification in standard surgical technique allowing improved visualization of the distal hypoglossal nerve. Main outcome and measures included apnea hypoxia index, ox...

Introduction Two phase 3 trials in adults with excessive sleepiness (ES) and narcolepsy or ES and obstructive sleep apnea (OSA) demonstrated robust wake-promoting effects of solriamfetol with significant increase in overall mean sleep latency (MSL; mean of first 4/5 trials) on the 40-minute Maintenance of Wakefulness Test (MWT). Further analyses we...

Introduction Case of mirtazapine treatment resulting in REM-behavior disorder, nightmares and somnambulism in a patient without Parkinsonism. Report of Case 67-year-old male Vietnam Veteran on treatment for major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) was found to have mild OSA (AHI 13.9) with poor compliance on autoPA...

Introduction The apnea hypopnea index (AHI) may not be the optimal predictor of OSA-related morbidity, as health outcomes may be related to sleep apnea through distinct pathophysiologic pathways (e.g., hypoxemia, sleep fragmentation). Multiple sleep-associated polysomnographic measures (as opposed to a single index) may be used to better predict ou...