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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 25 Research Studies DisplayedRumble DD, O'Neal K, Overstreet DS
Sleep and neighborhood socioeconomic status: a micro longitudinal study of chronic low-back pain and pain-free individuals.
This study compared associations between neighborhood-level socioeconomic status (SES), pain-status (chronic low back pain vs. pain-free), and daily sleep metrics in 117 adults. With neighborhood-level SES gathered from Neighborhood Atlas, and with individuals completing home sleep monitoring for 7 consecutive days/nights, analyses revealed neighborhood-level SES and neighborhood-level SES pain-status interaction significantly impacted objective sleep quality.
AHRQ-funded; HS013852.
Citation: Rumble DD, O'Neal K, Overstreet DS .
Sleep and neighborhood socioeconomic status: a micro longitudinal study of chronic low-back pain and pain-free individuals.
J Behav Med 2021 Dec;44(6):811-21. doi: 10.1007/s10865-021-00234-w..
Keywords: Sleep Problems, Back Health and Pain, Chronic Conditions, Pain
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
The authors sought to investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation using data from State Inpatient Databases from seven U.S. states. They found that, overall, OSA was associated with a significantly higher incident rate of all-cause readmission. Additionally, OSA was associated with higher incident rates of readmissions for five major diseases: asthma, COPD, respiratory failure, pneumonia, and congestive heart failure, compared to non-OSA.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
J Asthma 2021 Sep;58(9):1176-85. doi: 10.1080/02770903.2020.1781887..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sleep Problems, Hospital Readmissions, Asthma, Respiratory Conditions, Chronic Conditions
Xu L, Xie D, Griffin KS
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
Although mandibular advancement device (MAD) treatment of adults with obstructive sleep apnea (OSA) is generally less efficacious than positive airway pressure (PAP), the two treatments are associated, with similar clinical outcomes. As a sub-analysis of a randomized trial comparing the effect of MAD versus PAP on blood pressure, this study compared objectively measured adherence to MAD versus PAP treatment in adults with OSA.
AHRQ-funded; HS019738.
Citation: Xu L, Xie D, Griffin KS .
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
J Sleep Res 2021 Aug;30(4):e13240. doi: 10.1111/jsr.13240..
Keywords: Sleep Problems, Patient Adherence/Compliance, Treatments, Dental and Oral Health, Respiratory Conditions
Fishbein AB, Cheng BT, Tilley CC
Sleep disturbance in school-aged children with atopic dermatitis: prevalence and severity in a cross-sectional sample.
The authors sought to estimate the US prevalence of sleep disturbance and its impact on psychological and neurocognitive function in patients with atopic dermatitis (AD). Using PROMIS (Patient Reported Outcome Measurement Information System), they found that sleep disturbance was a common symptom of AD affecting approximately 3 million US children and was associated with neuropsychiatric impairment, including depression, anxiety, and inattention. They recommended that clinicians screen for these symptoms in school-aged children, particularly with moderate-to-severe AD.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Cheng BT, Tilley CC .
Sleep disturbance in school-aged children with atopic dermatitis: prevalence and severity in a cross-sectional sample.
J Allergy Clin Immunol Pract 2021 Aug;8(8):3120-29.e3. doi: 10.1016/j.jaip.2021.04.064..
Keywords: Children/Adolescents, Sleep Problems, Skin Conditions
Alcántara C, Giorgio Cosenzo L, McCullough E
Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: a systematic review of randomized controlled trials in the United States.
This systematic review examined behavioral randomized controlled trials (RCTs) on prevalent sleep-wake disorders and sleep disturbances to determine if these studies targeted underserved populations or addressed contextual and cultural factors. The authors examined sociodemographic characteristics of behavioral RCTs that targeted underserved adults, identified types of cultural adaptations (surface-level or deep-level), and described intervention effectiveness on primary sleep outcomes. Overall out of 56 studies, 6.97% targeted underserved groups (veterans, women, racial/ethnic minorities, low socioeconomic status, disability status); and 64.9% made surface-level or deep-level cultural adaptations. Most cultural adaptions were made to behavioral therapies, and cognitive behavioral therapy for insomnia (CBT-I). Surface-level cultural adaptions made were mostly to the delivery modality and setting. Deep-level cultural adaptations to the content and core intervention components were the most typical. Intervention effectiveness varied by type of adapted intervention and the participant population. RCTs including adapted CBT-I interventions among participants showed consistent significant reductions in adverse sleep outcomes versus control.
AHRQ-funded; HS024274.
Citation: Alcántara C, Giorgio Cosenzo L, McCullough E .
Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: a systematic review of randomized controlled trials in the United States.
Sleep Med Rev 2021 Apr;56:101455. doi: 10.1016/j.smrv.2021.101455..
Keywords: Sleep Problems, Cultural Competence, Behavioral Health, Racial and Ethnic Minorities, Vulnerable Populations
Makarem N, Alcántara C, Williams N
Effect of sleep disturbances on blood pressure.
This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Recommendations include efforts to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.
AHRQ-funded; HS024274.
Citation: Makarem N, Alcántara C, Williams N .
Effect of sleep disturbances on blood pressure.
Hypertension 2021 Apr;77(4):1036-46. doi: 10.1161/hypertensionaha.120.14479..
Keywords: Sleep Problems, Blood Pressure, Respiratory Conditions
Leu GR, Links AR, Ryan MA
Assessment of parental choice predisposition for tonsillectomy in children.
The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child's consultation is not known. The objective of this study was to identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent-clinician communication.
AHRQ-funded; HS022932.
Citation: Leu GR, Links AR, Ryan MA .
Assessment of parental choice predisposition for tonsillectomy in children.
JAMA Otolaryngol Head Neck Surg 2021 Mar;147(3):263-70. doi: 10.1001/jamaoto.2020.5031..
Keywords: Children/Adolescents, Caregiving, Shared Decision Making, Surgery, Sleep Problems, Respiratory Conditions
Sterling MR, Echeverria SE, Commodore-Mensah Y
Health equity and implementation science in heart, lung, blood, and sleep-related research: emerging themes from the 2018 Saunders-Watkins Leadership Workshop.
This article discusses the key themes from a 2-day workshop that was held at the National Institutes of Health in May 2018 to promote health equity and implementation science in heart, lung, and sleep-related research. This inaugural workshop was named the Saunders-Watkins Leadership Workshop. Recommendations are offered for the future direction of this research.
AHRQ-funded; HS000066.
Citation: Sterling MR, Echeverria SE, Commodore-Mensah Y .
Health equity and implementation science in heart, lung, blood, and sleep-related research: emerging themes from the 2018 Saunders-Watkins Leadership Workshop.
Circ Cardiovasc Qual Outcomes 2019 Oct;12(10):e005586. doi: 10.1161/circoutcomes.119.005586..
Keywords: Implementation, Evidence-Based Practice, Disparities, Patient-Centered Outcomes Research, Cardiovascular Conditions, Heart Disease and Health, Respiratory Conditions, Sleep Problems
Treister AD, Stefek H, Grimaldi D
Sleep and limb movement characteristics of children with atopic dermatitis coincidentally undergoing clinical polysomnography.
Atopic dermatitis (AD) is a prevalent, chronic, itchy skin condition. Children undergoing polysomnography (PSG) may coincidentally have AD. Many children with AD have sleep disturbances. This study aimed to characterize limb movements in children with AD and their effect on sleep. The investigators found altered PSG parameters in children with AD, suggesting that clinicians should consider the diagnosis when affected children undergo PSG.
AHRQ-funded; HS023011.
Citation: Treister AD, Stefek H, Grimaldi D .
Sleep and limb movement characteristics of children with atopic dermatitis coincidentally undergoing clinical polysomnography.
J Clin Sleep Med 2019 Aug 15;15(8):1107-13. doi: 10.5664/jcsm.7800..
Keywords: Children/Adolescents, Sleep Problems, Skin Conditions
Ye L, Owens RL, Dykes P
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
The aim of this study was develop a tool that can be used to measure factors that affect patient sleep in acute care hospitals. A tool called Factors Affected Inpatient Sleep (FAIS) was developed using literature review and was validated by content validity testing. The scale was tested on 105 hospitalized patients and the most significant sleep disruptors were identified. The final FAIS scale included 14 items in three subscales. The biggest factors for sleep disruption included 1) emotional or physical impairment due to illness or hospitalization; 2) sleep disturbance due to discomfort of their care plan schedule; and 3) sleep interruption due to the hospital environment or medical care. The reliability of the scale was measured at 0.87 with Cronbach’s alpha coefficient and reliability of the subscales ranged from 0.72 to 0.81.
AHRQ-funded; HS024330.
Citation: Ye L, Owens RL, Dykes P .
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
Appl Nurs Res 2019 Aug;48:63-67. doi: 10.1016/j.apnr.2019.05.006..
Keywords: Health Promotion, Hospitalization, Hospitals, Inpatient Care, Sleep Problems
St Hilaire MA, Anderson C, Anwar J
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
This study examines the impact of reinstating extended duration (24-28) work shifts (EDWS) for postgraduate year 1 resident physicians. The performance of residents was studied for 23 male residents between 2002-2004 during a three-week on-call rotation schedule at the Medical and Intensive Care Units at Brigham and Women’s Hospital in Boston. If the sleep episodes were four hours or less then the odds of >1 attentional failure was 2.72 times higher during post-call compared to matched sessions during non-EDWS.
AHRQ-funded; HS012032.
Citation: St Hilaire MA, Anderson C, Anwar J .
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
Sleep 2019 May;42(5):pii: zsz041. doi: 10.1093/sleep/zsz041..
Keywords: Adverse Events, Education: Continuing Medical Education, Medical Errors, Patient Safety, Provider, Provider: Physician, Quality of Care, Sleep Problems, Training
Wickwire EM, Albrecht JS, Towe MM
The impact of treatments for OSA on monetized health economic outcomes: a systematic review.
This article systematically reviews published literature on the impact of treatment for obstructive sleep apnea (OSA) on monetized health economic outcomes. Customized searches were conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases; 196 articles were selected for review, and 17 studies met the inclusion criteria and were included in the final synthesis. In these selected studies, positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. Healthcare use (HCU) and quality-adjusted life years (QALYs) were most common health economic outcomes. The authors conclude that, although study methodologies varied widely, the evidence suggested that treatment of OSA was associated with favorable economic outcomes within accepted ranges of cost-effectiveness, as well as reduced HCU and monetized costs.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Albrecht JS, Towe MM .
The impact of treatments for OSA on monetized health economic outcomes: a systematic review.
Chest 2019 May;155(5):947-61. doi: 10.1016/j.chest.2019.01.009..
Keywords: Sleep Problems, Respiratory Conditions, Healthcare Costs, Outcomes
Wickwire EM, Tom SE, Scharf SM
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
The purpose of this study was to examine the impact of untreated insomnia on health care utilization (HCU) among a representative sample of Medicare beneficiaries. Insomnia was defined as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on ICD-9 or at least one prescription filled for an insomnia-related medication in Part D prescription drug files. Researchers compared HCU in the year prior to insomnia diagnosis with non-sleep disordered controls during the same period. The researchers conclude that the individuals in this randomly selected, representative sample with untreated insomnia demonstrated increased HCU and costs across all points of service.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Tom SE, Scharf SM .
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
Sleep 2019 Apr;42(4). doi: 10.1093/sleep/zsz007..
Keywords: Healthcare Costs, Healthcare Utilization, Medicare, Sleep Problems
Singh G, Agarwal A, Zhang W
Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA.
This retrospective cohort study analyzed data from a national sample of fee-for-service Medicare beneficiaries with a diagnosis of chronic obstructive pulmonary disease (COPD) and coexisting obstructive sleep apnea (OSA) who had begun positive airway pressure (PAP) therapy in 2011. The effect of PAP therapy on emergency room visits and hospitalizations for all-cause and COPD-related conditions was also examined. PAP therapy was more beneficial for older adults, those with higher COPD complexity, and those with three or more comorbidities. PAP therapy in elderly patients with overlap syndrome is associated with a reduction in hospitalization for COPD-related conditions, but not for all-cause hospitalizations or ER visits.
AHRQ-funded; HS020642; HS022134.
Citation: Singh G, Agarwal A, Zhang W .
Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA.
Sleep Breath 2019 Mar;23(1):193-200. doi: 10.1007/s11325-018-1680-0..
Keywords: Respiratory Conditions, Sleep Problems, Hospitalization, Medicare, Chronic Conditions
Albrecht JS, Wickwire EM, Vadlamani A
Trends in insomnia diagnosis and treatment among Medicare beneficiaries, 2006-2013.
In this study, the investigators examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period. In this large national analysis of Medicare beneficiaries, prevalence of physician-assigned insomnia diagnoses was low but increased over time. Prevalence of insomnia medication use was up to four-times higher than insomnia diagnoses and remained steady over time.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Wickwire EM, Vadlamani A .
Trends in insomnia diagnosis and treatment among Medicare beneficiaries, 2006-2013.
Am J Geriatr Psychiatry 2019 Mar;27(3):301-09. doi: 10.1016/j.jagp.2018.10.017..
Keywords: Diagnostic Safety and Quality, Elderly, Medicare, Sleep Problems
Starr P, Agarwal A, Singh G
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
This research letter describes a claims-based study of Medicare beneficiaries conducted by the authors that examined the diagnosed prevalence and trend of overlap syndrome (the coexistence of chronic obstructive pulmonary disease [COPD] and obstructive sleep apnea [OSA] in a single individual). A total of 159,084 patients with COPD were included in the study; 11 percent had coexisting OSA. Data were gathered from multiple files: the Medicare Denominator File, the Medicare Provider Analysis and Review File, the Outpatient Standard Analytic File, the 100% Physician/Supplier Data File, and the Durable Medical Equipment File. Medicare enrollment files were used to gather information on patient characteristics and categorize subjects by age, sex, race, and socioeconomic status. The authors note that the prevalence of diagnosed overlap syndrome has increased fourfold during the 10-year study period.
AHRQ-funded; HS020642; HS022134.
Citation: Starr P, Agarwal A, Singh G .
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
Ann Am Thorac Soc 2019 Jan;16(1):153-56. doi: 10.1513/AnnalsATS.201712-932OC..
Keywords: Sleep Problems, Respiratory Conditions, Medicare, Chronic Conditions
Wickwire EM, Schnyer DM, Germain A
Sleep, sleep disorders, and circadian health following mild traumatic brain injury in adults: review and research agenda.
A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). In this paper, the authors review relevant literature and present a research agenda to 1) advance understanding of the reciprocal relationships between sleep and circadian factors and mTBI sequelae and 2) advance rapidly the development of sleep-related treatments in this population.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Schnyer DM, Germain A .
Sleep, sleep disorders, and circadian health following mild traumatic brain injury in adults: review and research agenda.
J Neurotrauma 2018 Nov 15;35(22):2615-31. doi: 10.1089/neu.2017.5243..
Keywords: Sleep Problems, Brain Injury, Evidence-Based Practice
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
This retrospective cohort study investigated the association of coexistent obstructive sleep apnoea with acute severity markers (i.e. invasive positive pressure ventilation use and hospital length of stay) among adults hospitalised for acute exacerbation of chronic obstructive pulmonary disease.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
Intern Med J 2018 Sep;48(9):1150-53. doi: 10.1111/imj.14016..
Keywords: Respiratory Conditions, Hospitalization, Sleep Problems, Chronic Conditions
Kline CE, Burke LE, Sereika SM
Bidirectional relationships between weight change and sleep apnea in a behavioral weight loss intervention.
This study examined the relationship between weight change and obstructive sleep apnea (OSA) in the context of behavioral weight loss intervention. A total of 114 adults who were overweight or obese participated in a 12-month behavioral weight loss intervention program from April 2012 to February 2015. Over half (58%) had OSA at the baseline. Those with OSA were found to lose less weight and were less adherent to daily calorie and activity goals. The results suggest that OSA screening should be used before attempting weight loss and also may indicate additional behavioral counseling.
AHRQ-funded; HS022989.
Citation: Kline CE, Burke LE, Sereika SM .
Bidirectional relationships between weight change and sleep apnea in a behavioral weight loss intervention.
Mayo Clin Proc 2018 Sep;93(9):1290-98. doi: 10.1016/j.mayocp.2018.04.026..
Keywords: Sleep Problems, Obesity: Weight Management, Obesity, Lifestyle Changes, Respiratory Conditions
Li JC, Fishbein A, Singam V
Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study.
The aim of this prospective online questionnaire-based study was to determine the relationship between atopic dermatitis (AD) severity, sleep disturbance (SD), and sleep-related impairment (SRI). The investigators concluded that their study suggests that SD and SRI are common in adults with AD, particularly those with severe diseases. They suggest that sleep disturbances and SRI should be considered when assessing burden of AD and therapeutic decisions.
AHRQ-funded; HS023011.
Citation: Li JC, Fishbein A, Singam V .
Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study.
Dermatitis 2018 Sep/Oct;29(5):270-77. doi: 10.1097/der.0000000000000401..
Keywords: Skin Conditions, Sleep Problems
Barone Gibbs B, Kline CE
When does sedentary behavior become sleep? A proposed framework for classifying activity during sleep-wake transitions.
The Sedentary Behavior Research Network recently published a consensus definition for sedentary. The authors of this paper indicated that further clarity around issues of classifying sedentary behavior while in bed is needed, specifically during sleep-wake transitions. In this paper they propose a framework for classifying activity during sleep-wake transitions.
AHRQ-funded; HS021162.
Citation: Barone Gibbs B, Kline CE .
When does sedentary behavior become sleep? A proposed framework for classifying activity during sleep-wake transitions.
Int J Behav Nutr Phys Act 2018 Aug 22;15(1):81. doi: 10.1186/s12966-018-0712-2..
Keywords: Lifestyle Changes, Sleep Problems
Harris VC, Links AR, Kim JM
Follow-up and time to treatment in an urban cohort of children with sleep-disordered breathing.
The purpose of this study was to evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Researchers found that half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. They conclude that these findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.
AHRQ-funded; HS022932.
Citation: Harris VC, Links AR, Kim JM .
Follow-up and time to treatment in an urban cohort of children with sleep-disordered breathing.
Otolaryngol Head Neck Surg 2018 Aug;159(2):371-78. doi: 10.1177/0194599818772035..
Keywords: Access to Care, Children/Adolescents, Disparities, Healthcare Delivery, Patient-Centered Healthcare, Quality of Care, Respiratory Conditions, Sleep Problems, Urban Health
Ye L, Richards KC
Sleep and long-term care.
This review describes the nature and consequences of sleep disturbances in long-term care (LTC), clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
AHRQ-funded; HS024330.
Citation: Ye L, Richards KC .
Sleep and long-term care.
Sleep Med Clin 2018 Mar;13(1):117-25. doi: 10.1016/j.jsmc.2017.09.011..
Keywords: Quality of Care, Long-Term Care, Nursing Homes, Sleep Problems
Fishbein AB, Mueller K, Kruse L
Sleep disturbance in children with moderate/severe atopic dermatitis: a case-control study.
The researchers sought to characterize sleep in a cohort of children with moderate-to-severe atopic dermatitis (AD) and to determine methods for assessment of sleep disturbance. In nineteen patients and nineteen controls, they found that patients with AD experienced wake after sleep onset (WASO) for 103 plus or minus 55 minutes as compared with 50 plus or minus 27 minutes in the controls. They had a higher frequency of restless sleep, daytime sleepiness, difficulty falling back to sleep at night, and teacher-reported daytime sleepiness. They concluded that children with moderate-to-severe AD experience more WASO and lower sleep efficiency than healthy controls but similar bedtime and wake time, sleep duration, and sleep onset latency.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Mueller K, Kruse L .
Sleep disturbance in children with moderate/severe atopic dermatitis: a case-control study.
J Am Acad Dermatol 2018 Feb;78(2):336-41. doi: 10.1016/j.jaad.2017.08.043.
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Keywords: Children/Adolescents, Children/Adolescents, Skin Conditions, Sleep Problems
Sylvia LG, Chang WC, Kamali M
Sleep disturbance may impact treatment outcome in bipolar disorder: a preliminary investigation in the context of a large comparative effectiveness trial.
The purpose of this paper is to explore the potential impact of poor sleep at baseline on outcomes in a randomized effectiveness trial of quetiapine and lithium. Sixty-three percent of patients had baseline sleep disturbance. Individuals with sleep disturbance had worse bipolar illness severity, greater severity of depression, mania, anxiety, irritability, and psychosis, were less likely to have sustained response, and had more necessary clinical adjustments.
AHRQ-funded; HS019371.
Citation: Sylvia LG, Chang WC, Kamali M .
Sleep disturbance may impact treatment outcome in bipolar disorder: a preliminary investigation in the context of a large comparative effectiveness trial.
J Affect Disord 2018 Jan 1;225:563-68. doi: 10.1016/j.jad.2017.08.056.
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Keywords: Medication, Comparative Effectiveness, Behavioral Health, Patient-Centered Outcomes Research, Sleep Problems