Merrill S. Wise

Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.

ABSTRACT Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.

Objective measures of sleepiness and wakefulness: application to the real world?

Summary: The impact of excessive sleepiness on the individual and on society is immense, and chronic sleepiness is one of the most common complaints evaluated by sleep medicine specialists. The author explores how measures of sleepiness and wakefulness using the Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) can be clinically useful. A companion article presents a counterpoint discussion of the limitations and drawbacks associated with the MSLT and MWT. Both presentations use an evidence-based approach to understanding the operating characteristics of these tests, and the overall goal is to clarify for sleep medicine specialists the positive and negative attributes of the MSLT and MWT. The MSLT and MWT are the most widely accepted objective measures of an individuals ability to fall asleep and ability to remain awake, respectively. The MSLT is a well-validated and extensively published objective measure of the speed at which a subject falls asleep under standardized laboratory conditions, and it is associated with good to excellent interrater and intrarater reliability, and excellent test-retest reliability. The MSLT is indicated as part of the evaluation of suspected narcolepsy and it may be helpful in differentiating narcolepsy from idiopathic hypersomnia. Mean sleep latency values less than 5 minutes are observed in the majority of subjects with narcolepsy, and the presence of two or more sleep-onset rapid eye movement periods is strongly correlated with a diagnosis of narcolepsy. An MSLT should be performed to address specific clinical questions, and should not be used as a screening tool. The MWT has clinical usefulness in evaluating response to treatment following intervention for conditions associated with excessive sleepiness, and in assessing individuals who must remain awake for safety reasons. However, the sleep medicine specialist should not rely solely on mean sleep latency values as a single indicator of impairment or risk of accidents, but findings should be integrated with the clinical history, compliance, patient judgment, and other factors to form a global impression regarding the individuals response to treatment. Future challenges include refinement of normative ranges in different populations using rigorous statistical methods, and improved understanding of the specific operating characteristics of the MSLT and MWT in different age groups. Additional study is necessary regarding the impact of MSLT and MWT findings on clinical decision-making, patient outcome, and patient and physician satisfaction. From a safety and regulatory standpoint, additional study is needed to establish the correlation between MWT findings and the risk of adverse consequences of sleepiness such as accidents. Because the MSLT and MWT are in-laboratory tests, it is important that investigators also develop novel techniques that provide reliable assessment of sleepiness and wakefulness in the actual work environment over extended periods. In summary, the MSLT and MWT are not perfect tests, but they are the best objective measures currently available for characterization of ability to fall asleep and ability to remain awake.

Extraction of motion strength and motor activity signals from video recordings of neonatal seizures

Presents two methods developed to extract quantitative information from video recordings of neonatal seizures in the form of temporal motion strength and motor activity signals. Motion strength signals are extracted by measuring the area of the body parts that move during the seizure and the relative speed of motion using a combination of spatiotemporal subband decomposition of video, nonlinear filtering, and segmentation. Motor activity signals are extracted by tracking selected anatomical sites during the seizure using a modified version of a feature-tracking procedure developed for video, known as the Kanade-Lucas-Tomasi (KLT) algorithm. The experiments indicate that the temporal signals produced by the proposed methods provide the basis for differentiating myoclonic from focal clonic seizures and distinguishing these types of neonatal seizures from normal infant behaviors.

The association between sleep spindles and IQ in healthy school-age children

Recent studies have suggested that sleep is associated with IQ measures in children, but the underlying mechanism remains unknown. An association between sleep spindles and IQ has been found in adults, but only two previous studies have explored this topic in children. The goal of this study was to examine whether sleep spindle frequency, amplitude, duration and/or density were associated with performance on the perceptual reasoning, verbal comprehension, working memory, and processing speed subscales of the Wechsler Intelligence Scale for Children-IV (WISC-IV). We recruited 29 typically developing children 7-11 years of age. We used portable polysomnography to document sleep architecture in the natural home environment and evaluated IQ. We found that lower sleep spindle frequency was associated with better performance on the perceptual reasoning and working memory WISC-IV scales, but that sleep spindle amplitude, duration and density were not associated with performance on the IQ test.

Quantifying motion in video recordings of neonatal seizures by regularized optical flow methods

This paper presents the development of regularized optical flow computation methods and an evaluation of their performance in the extraction of quantitative motion information from video recordings of neonatal seizures. A general formulation of optical flow computation is presented and a mathematical framework for the development of practical tools for computing optical flow is outlined. In addition, this paper proposes an alternative formulation of the optical flow problem that relies on a discrete approximation of a family of quadratic functionals. These regularized optical flow computation methods are used to extract motion strength signals from video recordings of neonatal seizures.

Computerized motion analysis of videotaped neonatal seizures of epileptic origin.

Summary:  Purpose: The main objective of this research is the development of automated video processing and analysis procedures aimed at the recognition and characterization of the types of neonatal seizures. The long‐term goal of this research is the integration of these computational procedures into the development of a stand‐alone automated system that could be used as a supplement in the neonatal intensive care unit (NICU) to provide 24‐h per day noninvasive monitoring of infants at risk for seizures.

Automated Detection of Videotaped Neonatal Seizures of Epileptic Origin

Summary:  Purpose: This study aimed at the development of a seizure‐detection system by training neural networks with quantitative motion information extracted from short video segments of neonatal seizures of the myoclonic and focal clonic types and random infant movements.

Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors.

Improvements in treatment and management for pediatric central nervous system (CNS) tumors have increased survival rates, allowing clinicians to focus on long‐term sequelae, including sleep disorders. The objective of this study was to describe a series of CNS tumor survivors who had sleep evaluations that included polysomnography (PSG) with attention to sleep disorder in relation to the tumor site.

Quantifying motion in video recordings of neonatal seizures by robust motion trackers based on block motion models

This paper introduces a methodology for the development of robust motion trackers for video based on block motion models. According to this methodology, the motion of a site between two successive frames is estimated by minimizing an error function defined in terms of the intensities at these frames. The proposed methodology is used to develop robust motion trackers that rely on fractional block motion models. The motion trackers developed in this paper are utilized to extract motor activity signals from video recordings of neonatal seizures. The experimental results reveal that the proposed motion trackers are more accurate and reliable than existing motion tracking methods relying on pure translation and affine block motion models.

Confronting Drowsy Driving: The American Academy of Sleep Medicine Perspective

ABSTRACT Drowsy driving is a serious public health concern which is often difficult for individual drivers to identify. While it is important for drivers to understand the causes of drowsy driving, there is still insufficient scientific knowledge and public education to prevent drowsy driving. As a result, the AASM is calling upon institutions and policy makers to increase public awareness and improve education on the issue, so our society can better recognize and prevent drowsy driving. The AASM has adopted a position statement to educate both healthcare providers and the general public about drowsy driving risks and countermeasures.