Meir H Kryger

Meir H Kryger
Yale University | YU · Section of Pulmonary and Critical Care Medicine

Doctor of Medicine

About

305
Publications
35,699
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20,445
Citations
Citations since 2017
27 Research Items
4793 Citations
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20172018201920202021202220230200400600800
20172018201920202021202220230200400600800
20172018201920202021202220230200400600800

Publications

Publications (305)
Article
Background: Evaluation and interpretation of the literature on obstructive sleep apnea is needed to consolidate and summarize key factors important for clinical management of the OSA adult patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International C...
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Objective: A novel ring-worn oximeter (Circul) uses reflective photoplethysmography and automated signal processing to calculate oxygen desaturations. We evaluated the ability of Circul to detect obstructive sleep apnea in Chinese adults. Methods: We recruited 207 Chinese Han subjects: 70% males, mean age 48.2±14.7 years, mean BMI 27.6±4.8 kg/m2...
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Purpose Since hypoxia increases erythropoietin production and inflammation, the complete blood count (CBC) has been proposed as an inexpensive alternative for obstructive sleep apnea (OSA) screening. The objective of this study was to determine whether or not intermittent hypoxia and OSA severity, as measured by the mean oxygen saturation (SpO2) an...
Chapter
Positive airway pressure (PAP) therapy remains the treatment of choice for patients with sleep-disordered breathing (SDB). Achieving adequate adherence to PAP therapy remains as one of the biggest challenges. A threshold of less than 4 h of nightly PAP use on 70% of nights has been adopted to define non-adherence. One of the most common barriers to...
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Orofacial myofunctional therapy has been shown to be effective in the multidisciplinary management of obstructive sleep apnoea syndrome in children, adolescents, and adults, and is prescribed at several stages of such management. However, given the lack of consistency in treatment protocols and outcome measures, the lack of research on the type, fr...
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La rééducation myofonctionnelle orofaciale a été montrée efficace dans la prise en charge multidisciplinaire du syndrome d’apnées obstructives du sommeil chez l’enfant, l’adolescent et l’adulte, et elle est prescrite à plusieurs étapes de ces prises en charge. Cependant, compte tenu du manque d’homogénéité des protocoles de traitement et de mesures...
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Study objectives: Centers for Medicare and Medicaid Services (CMS) reimbursement for positive airway pressure (PAP) devices for obstructive sleep apnea treatment is dependent on patients meeting adherence expectations within the first 3 months on therapy. Adherence is defined as usage of the device for at least 4 hours per night on 70% of nights d...
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Purpose: Obstructive sleep apnea has been associated with chronic inflammation triggered by nocturnal hypoxemia. The neutrophil-to-lymphocyte ratio (NLR) is a measure of subclinical systemic inflammation. We hypothesize that NLR levels would improve as chronic inflammation diminishes in obstructive sleep apnea (OSA) patients treated with mandibula...
Chapter
The mainstay treatment for sleep-disordered breathing is positive airway pressure therapy. There is robust evidence to suggest PAP therapy improves cardiovascular, metabolic, psychiatric, and mental health outcomes. In addition, patients enjoy significant symptomatic benefit as well as improvement in neuropsychomotor function. Unfortunately, many p...
Article
Introduction Nocturnal eating can be dangerous in addition to causing adverse health conditions. When assessing for nocturnal eating behaviors medical etiologies must be ruled out. Report of Case A 17-year-old male presents to the sleep clinic for nocturnal eating. His medical history is significant for obesity with a body mass index of 35.9 kg/m2...
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Introduction Traditional apnea-hypopnea measures, especially with home sleep apnea testing (HSAT) without arousal data are inadequate for representing clinically significant events in mild obstructive sleep apnea (OSA). Optimizing assessment of obstructive burden may improve the identification of patients at risk for adverse outcomes from OSA. We p...
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There are normal changes to sleep architecture throughout the lifespan. There is not, however, a decreased need for sleep and sleep disturbance is not an inherent part of the aging process. Sleep disturbance is common in older adults because aging is associated with an increasing prevalence of multimorbidity, polypharmacy, psychosocial factors affe...
Article
Positive airway pressure (PAP) is considered first-line therapy for moderate to severe obstructive sleep apnea and may also be considered for mild obstructive sleep apnea, particularly if it is symptomatic or there are concomitant cardiovascular disorders. Continuous PAP is most commonly used. Other modes, such as bilevel airway pressure, autotitra...
Article
Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for dut...
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Article
Objectives: Current hours of service regulations governing commercial truck drivers in place in the United States, Canada, Australia, and the European Union are summarized and compared to facilitate the assessment of the effectiveness of such provisions in preventing fatigue and drowsiness among truck drivers. Methods: Current hours of service p...
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Objective To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome. Data sources PubMed database for English-language studies with no start date restrictions and with an end date of September 2014. Methods A comprehensive literature review was performed to identify all studies that...
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To investigate the respiratory effects of suvorexant, an orexin receptor antagonist for treating insomnia, in patients with obstructive sleep apnea (OSA). This was a randomized, double-blind, placebo-controlled, 2-period (4 days per period), crossover, sleep laboratory study. Twenty-six patients aged 18-65 years with mild (apnea-hypopnea index [AHI...
Article
Central sleep apnea (CSA), in association with obstructive disordered breathing, occurs in patients using opioids chronically and those with congestive heart failure. In these patients treatment with continuous positive airway pressure (CPAP) frequently fails. The current Adaptive Servo-Ventilation (ASV) devices are promising for the treatment of c...
Article
There is a general concern that hypnotic medications in patients with respiratory disorders have the potential to decrease respiratory effort and blunt the arousal response to hypoxemia which may lead to sleep breathing disorders. We investigated whether suvorexant, an orexin receptor antagonist approved for treatment of insomnia at a maximum daily...
Article
Background: Obstructive sleep apnea (OSA) is associated with increased risk of postoperative complications. The authors investigated whether preoperative diagnosis and prescription of continuous positive airway pressure therapy reduces these risks. Methods: Matched cohort analysis of polysomnography data and Manitoban health administrative data...
Article
Study objectives: The choice and variety of pediatric masks for continuous positive airway pressure (CPAP) is limited in the US. Therefore, clinicians often prescribe modified adult masks. Until recently a mask for children aged < 7 years was not available. This study evaluated apnea-hypopnea index (AHI) equivalence and acceptability of a new pedi...
Article
Restrictive lung disease leads to ventilatory defects and diffusion impairments. These changes may contribute to abnormal nocturnal pathophysiology, including sleep architecture disruption and impaired ventilation and oxygenation. Patients with restrictive lung disease may suffer significant daytime fatigue and dysfunction. Hypercarbia and hypoxemi...
Article
Background: The technologies recommended by the American Academy of Sleep Medicine (AASM) to monitor airflow in polysomnography (PSG) include the simultaneous monitoring of two physical variables: air temperature (for thermal airflow) and air pressure (for nasal pressure). To comply with airflow monitoring standards in the sleep lab setting thus o...
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In 1836 Charles Dickens published the first installment of The Posthumous Papers of the Pickwick Club. In this novel he introduces the reader to a character, Joe, the Fat Boy who is obese, sleepy, difficult to arouse, snores, and has peripheral edema. This description so intrigued the medical field that many hypotheses about the symptoms were exami...
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background There has recently been concern about the future of sleep medicine in response to the “disruptive technology” of home sleep testing (HST) and its embrace by the medical insurance industry in the USA. 1,2 A reader might surmise that the ficontract by an insurance carrier in Massachusetts to mandate HST as a fistep in apnea diagnosis was t...
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Compare automatic event detection (AED) of respiratory events using a positive airway pressure (PAP) device with manual scoring of polysomnography (PSG) during PAP treatment of obstructive sleep apnea (OSA). Prospective PSGs of patients using a PAP device. Six academic and private sleep disorders centers. A total of 148 PSGs from 115 participants w...
Book
Principles and Practice of Pediatric Sleep Medicine, 2nd Edition, written by preeminent sleep medicine experts Drs. Sheldon, Kryger, Ferber, and Gozal, is the most comprehensive source for diagnosing and managing sleep disorders in children. Newly updated and now in full color throughout, this medical reference book is internationally recognized as...
Article
We aimed to evaluate the predictive value of anthropometric measurements and self-reported symptoms of obstructive sleep apnea syndrome (OSAS) in a large number of not yet diagnosed or treated patients. Commonly used clinical indices were used to derive a prediction formula that could identify patients at low and high risk for OSAS. Two thousand si...
Article
A lower (more caudal) position of the larynx may result in a longer collapsible segment of the upper airway. One could thus hypothesize that the lower the larynx the greater the risk for obstructive sleep apnea (OSA). To test this hypothesis, we measured the upper airway length to the level of the vocal cord and the horizontal and vertical segments...
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Study objectives: Evaluate the long-term durability of treatment response and safety of a nasal expiratory positive airway pressure (EPAP) device used to treat obstructive sleep apnea (OSA). Design: A prospective, multicenter, single-arm, open-label extension to a 3-month EPAP vs sham randomized clinical trial Setting: 13 sites including both...
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(1) To determine the efficacy of automatically adjusted positive airway pressure (APAP) with a comfort feature (A-Flex) at reducing apneas and hypopneas in participants with moderate to severe OSA. (2) To determine the relative difference between A-Flex, continuous positive airway pressure (CPAP), and APAP-derived optimal pressure for CPAP (CPAP(AP...
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Investigate the efficacy of a novel nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). A prospective, multicenter, sham-controlled, parallel-group, randomized, double-blind clinical trial. 19 sites including both academic and private sleep disorder centers Obstructive sleep apnea with a pre-stu...
Article
Sleep is essential for optimal mental, physical and social wellbeing (or, generically, health). Sleep disruption and/or deprivation can have adverse health consequences, promoting or worsening cardiovascular disease and diabetes. The sleep-wake cycle is a very tightly regulated process that involves multiple neuropharmacological reciprocal interact...
Article
Obstructive sleep apnea (OSA) is a common disorder, and obesity is a known risk factor for its development. Continuous positive airway pressure (CPAP) therapy is the standard treatment in OSA but is not always well accepted by the patients, partly because of its pressure-related side effects. Daytime hypersomnia is not always present in patients wi...
Article
The understanding of the neuropharmacologic reciprocal interactions between the sleep and wake cycles has progressed significantly in the past decade. It was also recently appreciated that sleep disruption or deprivation can have adverse metabolic consequences. Multiple medications have a direct or indirect impact on sleep and the waking state. Thi...
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Obstructive sleep apnea syndrome (OSAS) is a common disorder that remains underdiagnosed in adult females. The Berlin Questionnaire is a validated tool for identifying people at risk for OSAS. The aim of this report was to evaluate the prevalence of common symptoms of OSAS in women and to estimate the risk for OSAS among females in the United State...
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Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship b...
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To determine the effect of obesity and sleep apnea on health care expenditure in women over 10 years. Retrospective observational study Tertiary university-based medical center Three groups of age-matched women: 223 obese women with OSAS (body mass index: 39.3 +/- 0.6 kg/m2), and from the general population, 223 obese controls (BMI 36.3 +/- 0.4) an...
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Study Objectives To determine the effect of obesity and sleep apnea on health care expenditure in women over 10 years. Design Retrospective observational study Setting Tertiary university-based medical center Patients and controls Three groups of age-matched women: 223 obese women with OSAS (body mass index: 39.3 ± 0.6 kg/m²), and from the gener...
Article
The ability of biological sex and sex-driven characteristics to alter sleep states may contribute to gender disparities in sleep disorders. Sex influences sleep-wake amount, the daily timing of the sleep-wake cycle, and the ability to restore sleep after extended wakefulness. Several lines of evidence suggest that in mammals, reproductive hormones...
Article
A woman's sleep is impacted by biology (menstrual cycle, pregnancy, menopause), sleep disorders (that may manifest differently than in men), and role in the home and workplace. A Women and Sleep Workshop, sponsored by the National Sleep Foundation, in March 2007 reviewed these topics. It was concluded that understanding the relationship between sle...
Article
Ramelteon, a selective MT(1)/MT(2) melatonin receptor agonist, was evaluated in subjects with mild to moderate chronic obstructive pulmonary disease (COPD) to determine whether it would have a negative effect on measures of safety and respiration. This randomized, double-blind, crossover study in 26 subjects with mild to moderate COPD compared the...
Article
Obesity is the major confounding factor in the relationship between obstructive sleep apnea and increased risk for cardiovascular disease. The aim of the study was to investigate the association of sleep apnea severity with insulin resistance, leptin, and CRP levels in a cohort of male patients. Sixty-seven men referred to our sleep laboratory for...
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This review summarizes the recent literature on the epidemiology of adult obstructive sleep apnea (OSA) from various population-based studies. Despite methodologic differences, comparisons have yielded similar prevalence rates of the OSA syndrome in various geographic regions and amongst a number of ethnic groups. Risk factors for OSA including obe...
Article
Individuals with moderate to severe chronic obstructive pulmonary disease (COPD) have poor sleep quality. This study evaluated the effects of ramelteon, an MT(1)/MT(2) melatonin receptor agonist indicated for insomnia treatment on respiration in this population. This double-blind, crossover study enrolled 25 subjects (>or=40 years) with moderate to...
Article
Some sleep disorders are common in women, but gender differences in the clinical presentation of the sleep disorders and lack of awareness of sleep disorders by medical practitioners may lead to a delayed diagnosis. Underlying medical or psychiatric diseases may cause sleep problems; conversely primary sleep disorders could lead to the development...
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Obesity hypoventilation syndrome (OHS) is characterized by obesity, daytime hypercapnia, and sleep-disordered breathing in the absence of significant lung or respiratory muscle disease. Compared with eucapnic morbidly obese patients and eucapnic patients with sleep-disordered breathing, patients with OHS have increased health care expenses and are...
Article
During pregnancy several physical and hormonal alterations may affect normal sleep and the respiratory system and predispose pregnant women to the development of sleep-disordered breathing (SDB) or worsen pre-existing obstructive sleep apnea syndrome (OSAS). SDB has been associated with several complications of pregnancy affecting maternal and feta...
Article
Cytokines are proteins produced by leukocytes and other cells that function as intercellular mediators acting on several target tissues, resulting in multiple biologic actions. Over the last decade, medical research has explored the interaction between cytokines and sleep disorders. The aim of this review is to illustrate recent advances in knowled...
Article
Ramelteon is a selective MT(1)/MT(2)-receptor agonist indicated for insomnia treatment. Because it has no depressant effects on the nervous system, it is not expected to affect the control of breathing. The potential effects of ramelteon on apneic and hypopneic events and arterial oxygen saturation (SaO(2)) in individuals with obstructive sleep apn...
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Norman Wolkove and colleagues recently presented an excellent review of sleep disorders in older people.1,2 However, they did not mention that one of the main symptoms of sleep disorders, excessive daytime sleepiness, increases the risk of automobile accidents.3 Primary caregivers should be aware that sleepy drivers (including those with untreated...
Article
Sleep apnea syndrome (SAS), a common disorder, is characterized by repetitive episodes of cessation of breathing during sleep, resulting in hypoxemia and sleep disruption. The consequences of the abnormal breathing during sleep include daytime sleepiness, neurocognitive dysfunction, development of cardiovascular disorders, metabolic dysfunction, an...
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Digital acquisition and analysis of sleep data has become more common over the past 20 years. Many investigators have developed strategies to record and analyze sleep in a quantitative way. Initially, digital recording and analysis were restricted by technical limitations. With current technology, the technical limitations of computer acquisition,...
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The 1968 Rechtschaffen and Kales (R & K) sleep scoring manual was published 15 years after REM sleep was discovered. Advances in the ensuing 28 years warranted a re-look at visual scoring of sleep stages. This paper describes the work of the AASM Visual Scoring Task Force, including methodology, a literature review and the rationale behind the new...
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SUBJECTIVE OBJECTIVES: To document healthcare utilization 2 years after diagnosis in women with obstructive sleep apnea syndrome (OSAS). Retrospective observational cohort study. Tertiary university-based medical center. Four hundred and fourteen women with OSAS were matched with 1404 women from the general population who served as controls. Patien...
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The Canadian Thoracic Society (CTS) guidelines for the diagnosis and treatment of sleep disordered breathing in adults were developed over the past year. A one-day meeting was held in Montreal, Quebec, on October 28, 2005, just before the annual CTS meeting. The meeting was facilitated by Dr R Davies (Oxford, United Kingdom), and speakers included...
Article
Many cases of insomnia may have a specific cause. Health care professionals should elucidate the cause of the symptoms and treat the cause if possible. Treatment of insomnia may require treatment of the underlying medical or mental conditions. Primary sleep disorders may manifest with insomnia in some cases. Treatment of comorbid conditions may imp...
Article
Studies from North American clinics have reported that females with obstructive sleep apnea syndrome (OSAS) are about the same age as males but are heavier, have less severe apnea and make up a much smaller proportion of cases. We examined polysomnographic differences between Greek men and women with OSAS in order to study the influence of gender o...
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A importância clínica da patologia do sono, particularmente, da síndroma de apneia obstrutiva do sono tem vindo a tornar-se cada vez mais evidente nas últimas décadas. Paralelamente, verificou-se um número crescente de doentes com a confirmação diagnóstica da doença resultante de uma maior sensibilização dos clínicos para esta patologia e consequen...