Andrew Robert Spector

Background: Excessive daytime sleepiness may reflect increased vulnerability to postoperative neurocognitive disorders given its association with neurodegenerative disease, cognitive decline, and dementia. However, the role of excessive daytime sleepiness in postoperative neurocognitive disorders is unknown. Here, we investigated whether preoperative moderate–severe excessive daytime sleepiness is associated with postoperative neurocognitive disorder severity. Methods: This prospective observational cohort study included older non‐cardiac surgery patients who completed preoperative Epworth sleepiness scale questionnaires, home sleep apnea testing, and pre‐ and postoperative delirium assessments and cognitive testing. Cognitive scores were combined with reflective factor analysis into a global cognitive index. Moderate–severe excessive daytime sleepiness was defined as an Epworth Sleepiness Scale score greater than 12. Postoperative neurocognitive disorder severity was assessed by the global cognitive index change from before to 6‐weeks and 1‐year after surgery. Results: Of the 96 subjects who completed testing, 11 subjects exhibited moderate–severe excessive sleepiness. In a multivariable analysis adjusting for prespecified confounders and precision variables (age, sex, respiratory event index, baseline cognitive performance and surgery duration), moderate–severe EDS was significantly associated with 6‐week postoperative change in global cognition (mean difference −0.24; 95% CI −0.48, −0.004; p = 0.046), but was not associated with peak postoperative delirium severity scores (OR 3.66; 95% CI, 0.96, 13.91; p = 0.057). Conclusions: Preoperative moderate–severe EDS is associated with decreased 6‐week postoperative global cognitive performance after adjustment for relevant confounders and precision variables. These results suggest that pre‐existing moderate–severe excessive daytime sleepiness is a risk factor for increased postoperative neurocognitive disorder severity. Trial Registration: clinicaltrials.gov : NCT03273335.

Background/Objectives: Obstructive sleep apnea (OSA) is diagnosed using pulse oximetry, which is less accurate in patients with darker skin. Two hypopnea definitions are in use: the American Academy of Sleep Medicine allows either (A) a 30% airflow decrease with a 3% oxygen desaturation or EEG arousal (“3% Rule”) or (B) a 30% airflow decrease with a 4% oxygen desaturation (“4% Rule”). The Centers for Medicare and Medicaid Services and many payers use only the 4% Rule. We hypothesized that patients from racial minority groups with darker skin tones would be less likely to qualify for OSA treatment using the 4% Rule compared to the 3% Rule. A secondary aim was to examine sex disparities. Methods: We reviewed records of adults undergoing overnight sleep studies at an urban academic hospital. Demographics, medical history, and comorbidities were collected. Analyses controlled for age, sex, BMI, anxiety, depression, hypertension, COPD, and smoking. Results: A total of 1354 records were analyzed. We found no racial or sex disparities in the proportion of participants who met the 3% but not the 4% Rule. After controlling for covariates, no racial group differed from White participants in meeting only the 3% Rule. However, female participants were significantly less likely than males to meet the 4% Rule. Conclusions: Despite known limitations of pulse oximetry associated with skin tone, no racial differences in the diagnosis of OSA were seen in this cohort. However, female patients had lower odds of meeting the 4% Rule, suggesting a potential barrier to treatment.

Introduction Health disparities result from a complex interplay of factors, with social determinants of health and inequities in healthcare delivery playing central roles. Among these, clinicians have a significant influence on rectifying healthcare-related causes. However, many clinicians remain unaware of their potential contributions to these disparities because individual clinical practices are seldom scrutinized to identify departmental or practitioner-level disparities. This study presents a model developed by an academic neurology department to systematically track and address disparities in clinical care, offering a replicable approach for other departments. Methods To develop a scorecard, eight clinical divisions were selected, each with one binary clinical decision point analyzed. The percentage of patients who received the designated intervention was stratified by race/ethnicity to identify any disparities in care. The presence or absence of a racial disparity in the care provided was translated into a scorecard for easy communication of results. The percentage of patients who received the designated intervention was stratified by race and ethnicity to identify any disparities in care. Findings were translated into a scorecard format, assigning grades based on the presence or absence of statistically significant disparities. Results The department’s scorecard contained five As and two Bs (and one division with inadequate data) based on disparities of care identified in two divisions, stroke and epilepsy. The department’s scorecard revealed that five divisions received an “A” rating, indicating no significant racial or ethnic disparities. One division had insufficient data for grading. Conclusion Scorecards are a practical tool for identifying and addressing disparities in clinical care. This information can facilitate transparency, promote targeted practice improvements, and strengthen trust with patients and communities. By adopting scorecards, institutions can enhance equity in care delivery and build credibility through accountability.

Academic neurology departments across the country have been rapidly adding diversity, equity, and inclusion (DEI) programs over the past 5-10 years. These programs frequently come with leadership roles that carry a variety of names and responsibilities, such as vice chair of DEI or diversity officer. Furthermore, there are roles for members of the department to be involved with DEI work without being designated the departmental DEI leader. This article provides a framework for understanding the different responsibilities that are typically associated with each of these roles, along with reasonable expectations to associate with the respective job titles. Our goal is to prevent departments from asking too much or expecting too little based on the job title and support provided to the people in these positions. Likewise, we hope to empower DEI leaders who are currently asked to perform duties beyond their scope to obtain the title and support they have earned. For each departmental DEI role, we review prerequisites to success and potential impediments.

Epresent a hybrid state of wakefulness and sleep, often triggered by events that increase the frequency of arousals or make it more difficult to fully arouse from sleep. Sleep deprivation, certain medications, and untreated obstructive sleep apnea are known to provoke parasomnias, particularly in those who are genetically predisposed. Non-REM parasomnias include disorders of arousal (ie, sleepwalking, sleep terrors, and confusional arousals), sleep-related eating disorder, and exploding head syndrome. Clinical overlap exists between sleep-related eating disorder and disorders of arousal, suggesting that sleep-related eating disorder may be a fourth disorder of arousal or a manifestation of sleepwalking. Exploding head syndrome is a unique parasomnia of uncertain etiology. ESSENTIAL POINTS Non-REM parasomnias can range from minor nuisances to severe, life-altering events. While some patients with non-REM parasomnia experience significant consequences during sleep, wakefulness, or both, non-REM parasomnias do not pose a major risk to most patients. For all patients with non-REM parasomnias, safety should be explicitly discussed and addressed. Nonpharmacologic treatment should be prioritized, as increasing total sleep time, avoiding triggering substances, and treating comorbid sleep disorders is often sufficient for the management of non-REM parasomnias. If symptoms persist despite these interventions, treatment with clonazepam or other medications can be considered....

This review summarizes race-based sleep health disparities between Asian Americans and other American racial groups and compares sleep outcomes between Asian American subgroups disaggregated by ethnicity and ancestral national origin. The study identifies gaps in the existing literature, analyzes barriers to studying Asian American sleep, and recommends topics for future research. A PubMed review of research on adult Asian American sleep was conducted. The articles included utilized actigraphy, polysomnography, and questionnaires to gather sleep health metrics. Information from these articles included data on sleep duration, sleep quality, sleep disturbances, and sleep disorders. Most aggregated studies find Asian American adults experiencing lower sleep duration and poorer sleep quality compared to non-Hispanic White Americans and comparable or slightly higher sleep duration compared to Black Americans. Within Asian Americans, first-generation immigrants report better sleep quality than subsequent generations. East Asian Americans may experience better sleep outcomes compared to Southeast Asian Americans. Obstructive sleep apnea is critically underreported in South Asian Americans. Significantly more research is required in Asian American sleep disparities, specifically in South and Southeast Asian Americans. Sleep disparities between Asian Americans and other racial groups are impacted by perceived discrimination, poor mental health, and cultural attitudes toward sleep. The observed within-group disparities of Asian American sleep may be attributed to socioeconomic status and generational status/acculturation. Existing barriers to research include the model minority myth and lack of disaggregated racial sleep data. Nandagiri V, Vannemreddy S, Spector A. Sleep disparities in Asian Americans: a comprehensive review. J Clin Sleep Med. 2023;19(2):393-402.