Logan Schneider

All Publications

• Active and Distance Learning in Neuroscience Education. Neuron Sandrone, S., Schneider, L. D. 2020; 106 (6): 895–98

  Abstract

  With social distancing and uncertainty about the complete re-opening of laboratories and campuses, there is a pressing need for a more flexible educational experience. Seizing this opportunity to integrate active learning into adaptive curricula can fast-forward neuroscience education at every level.

  View details for DOI 10.1016/j.neuron.2020.06.001

  View details for PubMedID 32553206

• The 5-HTTLPR Long, not Short, Allele Predicts Two-year Longitudinal Increases in Cortisol and Declines in Verbal Memory in Older Adults. International journal of geriatric psychiatry Hirst, R. B., Jordan, J. T., Miryam Schussler-Fiorenza Rose, S., Schneider, L., Kawai, M., Gould, C., Anker, L., Chick, C. F., Beaudreau, S., Hallmayer, J., O'Hara, R. 2020

  Abstract

  OBJECTIVES: The short form or s-allele variant of the serotonin transporter polymorphism (5-HTTLPR), as compared with the long form or l-allele variant, has been associated with the presence of cognitive dysfunction, and particularly memory impairment in older adults. This body of cross-sectional work has culminated in the hypothesis that presence of the s-allele predicts greater memory decline in older adults (1). Yet, to date, there are no longitudinal studies which have investigated this issue.METHODS/DESIGN: Here we examine 109 community-dwelling older adults (mean and SD of age=70.7±8.7years) who underwent blood draw for genotyping, cognitive, and psychological testing at baseline, 12-month, and 24-month follow-up.RESULTS: Multilevel modeling found that s-allele carriers (ss or ls) performed worse than ll homozygotes at baseline on delayed verbal recall. Yet, s-allele carriers' memory performance was stable over the two-year follow-up period, while l-allele homozygotes experienced significant memory decline. l-allele homozygote status was associated with both increased cortisol and decreased memory over time, resulting in attenuated verbal memory performance differences compared to s-allele carriers with age.CONCLUSIONS: Overall, our findings do not support the hypothesis that presence of the 5-HTTLPR s-allele is a marker for memory decline in older adults. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/gps.5319

  View details for PubMedID 32400901

• Commentary on "The Association Between Biomarkers and Neuropsychiatric Symptoms Across the Alzheimer's Disease Spectrum". The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Beaudreau, S. A., Schneider, L. 2020

  View details for DOI 10.1016/j.jagp.2020.04.007

  View details for PubMedID 32376081

• Frequency and Severity of Autonomic Symptoms in Idiopathic Hypersomnia. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Miglis, M. G., Schneider, L., Kim, P., Cheung, J., Trotti, L. M. 2020

  Abstract

  STUDY OBJECTIVES: We aimed to quantify the symptoms of autonomic nervous system (ANS) dysfunction in a large online cohort of patients with IH, and to determine how the severity of these symptoms interacts with sleepiness, fatigue, and quality of life.METHODS: One hundred thirty-eight IH patients and 81 age- and sex-matched controls were recruited through the website of the Hypersomnia Foundation, a U.S.-based patient advocacy group. Twenty-four confirmed IH patients were selected by the study investigators as a comparison group. All participants completed a battery of online sleep, autonomic, and quality of life questionnaires including the composite autonomic symptom score-31 (COMPASS-31).RESULTS: Online and confirmed patients reported significantly higher COMPASS-31 scores (43.6 [33.6-52.7] & 32.9 [21.7- 46.8] vs. 17.6 [11.7-27.9], p<0.001), with the greatest symptom burden in the orthostatic and vasomotor domains. Online and confirmed patients reported more sleepiness (ESS), whereas only online patients reported more fatigue (CFQ). Both the ESS and CFQ positively correlated with COMPASS-31 scores. Patients reported lower quality of life as reflected by lower scores across all domains of the RAND-36, which was negatively correlated with COMPASS-31 scores.CONCLUSIONS: Symptoms of ANS dysfunction are common in IH. In addition, ANS symptom burden was positively correlated with sleepiness and negatively correlated with quality of life.

  View details for DOI 10.5664/jcsm.8344

  View details for PubMedID 32039754

• Images: Facial cataplexy with demonstration of persistent eye movements. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Schneider, L., Ellenbogen, J. 2020; 16 (1): 157–59

  Abstract

  None: A patient was transferred for management of "medication-refractory seizures" after failure of levetiracetam and valproate dual therapy. She had a life-long history of two types of events: periods in which she would rapidly and uncontrollably lapse into unconsciousness, and spells in which she would "pass out" but maintain consciousness, the latter happening with increasing frequency in association with laughing, as of late. She also reported hypnogogic/hypnopompic hallucinations, sleep paralysis, and disrupted nocturnal sleep. A clinical diagnosis of narcolepsy was made. The prevailing pathophysiological concept of narcolepsy details "partial intrusions of REM" sleep into wakefulness. Healthy REM sleep includes generalized atonia, but with preservation of eye movements, respiratory function, and sphincter tone. Cataplexy recapitulates this pattern, and is often induced by extreme emotions, laughter in this case. Despite generalized and severe weakness and areflexia during this patient's cataplectic events, she was able to volitionally move her eyes, which is consistent with the physiology of REM sleep. The diagnosis of cataplexy is often missed, due to clinicians being unfamiliar with the findings and the lack of ability to induce sufficient emotional responses to trigger an episode. This example of cataplexy is also quite characteristic of the "cataplectic facies." The ability to observe the infrequently observed phenomenon of cataplexy serves as a reminder that consciousness is preserved, as are extra-ocular muscle movements.

  View details for DOI 10.5664/jcsm.8148

  View details for PubMedID 31957646

• Study Design Considerations for Sleep Disordered Breathing Devices. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Mann, E. A., Nandkumar, S., Addy, N., Demko, B. G., Freedman, N. S., Gillespie, M. B., Headapohl, W., Kirsch, D. B., Phillips, B. A., Rosen, I. M., Schneider, L. D., Stepnowsky, C. J., Yaremchuk, K. L., Eydelman, M. B. 2020

  Abstract

  None: In recent years, sleep disordered breathing (SDB) has been recognized as a prevalent but under-diagnosed condition in adults and has prompted the need for new and better diagnostic and therapeutic options. To facilitate the development and availability of innovative, safe and effective SDB medical device technologies for patients in the United States, the Food and Drug Administration (FDA) collaborated with six SDB-related professional societies and a consumer advocacy organization to convene a public workshop focused on clinical investigations of SDB devices. Sleep medicine experts discussed appropriate definitions of terms used in the diagnosis and treatment of SDB, the use of home sleep testing versus polysomnography, clinical trial design issues in studying SDB devices, and current and future trends in digital health technologies for diagnosis and monitoring SDB. The panel's breadth of clinical expertise and experience across medical specialties provided useful and important insights regarding clinical trial designs for SDB devices.

  View details for DOI 10.5664/jcsm.8226

  View details for PubMedID 31992406

• High-Resolution Spectral Sleep Analysis Reveals a Novel Association Between Slow Oscillations and Memory Retention in Elderly Adults. Frontiers in aging neuroscience Kawai, M., Schneider, L. D., Linkovski, O., Jordan, J. T., Karna, R., Pirog, S., Cotto, I., Buck, C., Giardino, W. J., O'Hara, R. 2020; 12: 540424

  Abstract

  Objective: In recognition of the mixed associations between traditionally scored slow wave sleep and memory, we sought to explore the relationships between slow wave sleep, electroencephalographic (EEG) power spectra during sleep and overnight verbal memory retention in older adults. Design, Setting, Participants, and Measurements: Participants were 101 adults without dementia (52% female, mean age 70.3 years). Delayed verbal memory was first tested in the evening prior to overnight polysomnography (PSG). The following morning, subjects were asked to recall as many items as possible from the same List (overnight memory retention; OMR). Partial correlation analyses examined the associations of delayed verbal memory and OMR with slow wave sleep (SWS) and two physiologic EEG slow wave activity (SWA) power spectral bands (0.5-1 Hz slow oscillations vs. 1-4 Hz delta activity). Results: In subjects displaying SWS, SWS was associated with enhanced delayed verbal memory, but not with OMR. Interestingly, among participants that did not show SWS, OMR was significantly associated with a higher slow oscillation relative power, during NREM sleep in the first ultradian cycle, with medium effect size. Conclusions: These findings suggest a complex relationship between SWS and memory and illustrate that even in the absence of scorable SWS, older adults demonstrate substantial slow wave activity. Further, these slow oscillations (0.5-1 Hz), in the first ultradian cycle, are positively associated with OMR, but only in those without SWS. Our findings raise the possibility that precise features of slow wave activity play key roles in maintaining memory function in healthy aging. Further, our results underscore that conventional methods of sleep evaluation may not be sufficiently sensitive to detect associations between SWA and memory in older adults.

  View details for DOI 10.3389/fnagi.2020.540424

  View details for PubMedID 33505299

  View details for PubMedCentralID PMC7829345

• Active Learning in Psychiatry Education: Current Practices and Future Perspectives. Frontiers in psychiatry Sandrone, S., Berthaud, J. V., Carlson, C., Cios, J., Dixit, N., Farheen, A., Kraker, J., Owens, J. W., Patino, G., Sarva, H., Weber, D., Schneider, L. D. 2020; 11: 211

  Abstract

  Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.

  View details for DOI 10.3389/fpsyt.2020.00211

  View details for PubMedID 32390876

• Author response: Incorporating sleep medicine content into medical school through neuroscience core curricula. Neurology Strowd, R. E., Schneider, L., Gamaldo, C. E., Salas, R. M. 2019; 93 (3): 133

  View details for DOI 10.1212/WNL.0000000000007792

  View details for PubMedID 31308165

• Education Research: Flipped classroom in neurology: Principles, practices, and perspectives. Neurology Sandrone, S., Berthaud, J. V., Carlson, C., Cios, J., Dixit, N., Farheen, A., Kraker, J., Owens, J. W., Patino, G., Sarva, H., Weber, D., Schneider, L. D. 2019; 93 (1): e106–e111

  Abstract

  How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

  View details for DOI 10.1212/WNL.0000000000007730

  View details for PubMedID 31262995

• Autonomic Symptom Burden in Idiopathic Hypersomnia Kim, P., Cheung, J., Schneider, L., Trotti, L., Miglis, M. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965907001

• Neurological and neuroscience education: mitigating neurophobia to mentor health care providers Sandrone, S., Berthaud, J., Arista, M., Cios, J., Ghosh, P., Gottlieb-Smith, R., Kushlaf, H., Mantri, S., Masangkay, N., Menkes, D., Nevel, K., Sarva, H., Schneider, L. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965901092

• ULTRADIAN CYCLE OF SLOW-WAVE ACTIVITY IN OLDER ADULTS. Kawai, M., Schneider, L., O'Hara, R. OXFORD UNIV PRESS INC. 2019

  View details for Web of Science ID 000471071001051

• Daylight saving time transitions are not associated with increased seizure incidence. Epilepsia Schneider, L. D., Moss, R. E., Goldenholz, D. M. 2019

  Abstract

  OBJECTIVE: Given the known association of daylight saving time (DST) transitions with increased risk of accidents, heart attack, and stroke, we aimed to determine whether seizures, which are reportedly influenced by sleep and circadian disruption, also increased in frequency following the transition into DST.METHODS: Using Seizure Tracker's self-reported data from 12401 individuals from 2008-2016, 932717 seizures were assessed for changes in incidence in relation to DST transitions. Two methods of standardization-z scores and unit-scaled rate ratios (RRs)-were used to compare seizure propensities following DST transitions to other time periods.RESULTS: As a percentile relative to all other weeks in a given year, absolute seizure counts in the week of DST fell below the median (DST seizure percentiles mean ± SD: 19.68±16.25, P=0.01), which was concordant with weekday-specific comparisons. Comparatively, RRs for whole-week (1.06, 95% confidence interval [CI] 1.02-1.10, P=0.0054) and weekday-to-weekday (RR range 1.04-1.16, all P<0.001) comparisons suggested a slightly higher incidence of seizures in the DST week compared to all other weeks of the year. However, examining the similar risk of the week preceding and following the DST-transition week revealed no significant weekday-to-weekday differences in seizure incidence, although there was an unexpected, modestly decreased seizure propensity in the DST week relative to the whole week prior (RR 0.94, 95% CI 0.91-0.96, P<0.001).SIGNIFICANCE: Despite expectations that circadian and sleep disruption related to DST transitions would increase the incidence of seizures, we found little substantive evidence for such an association in this large, longitudinal cohort. Although large-scale observational/epidemiologic cohorts can be effective at answering such questions, additional covariates (eg, sleep duration, seizure type, and so on) that may underpin the association were not able available, so the association has not definitively been ruled out.

  View details for PubMedID 30889273

• Non-invasive machine learning estimation of effort differentiates sleep-disordered breathing pathology. Physiological measurement Hanif, U., Schneider, L. D., Trap, L., Leary, E. B., Moore Iv, H., Guilleminault, C., Jennum, P. J., Bjarup Dissing Sorensen, H., Mignot, E. J. 2019

  Abstract

  OBJECTIVE: Obstructive sleep-disordered breathing (SDB) events, unlike central events, are associated with increased respiratory effort. Esophageal pressure (Pes) monitoring is the gold standard for measuring respiratory effort, but it is typically poorly tolerated because of its invasive nature. The objective was to investigate whether machine learning can be applied to routinely collected non-invasive, polysomnography (PSG) measures to accurately model peak negative Pes. Approach: 1119 patients from the Stanford Sleep Clinic with PSGs containing Pes served as the sample. The selected non-invasive PSG signals included nasal pressure, oral airflow, thoracoabdominal effort, and snoring. A long short-term memory (LSTM) neural network was implemented to achieve a context-based mapping between the non-invasive features and the Pes values. A hold-out dataset served as a prospective validation of the algorithm without needing to undertake a costly new study with the impractically invasive Pes. Main results: The median difference between the measured and predicted Pes was 0.61 cmH2O with an interquartile range (IQR) of 2.99 cmH2O and 5th and 95th percentiles of -5.85 cmH2O and 5.47 cmH2O, respectively. The model performed well when compared to actual esophageal pressure signal (rhomedian=0.581, p=0.01; IQR = 0.298; rho5% = 0.106; rho95% = 0.843). Significance: A significant difference in predicted Pes was shown between normal breathing and all obstructive SDB events; whereas, central apneas did not significantly differ from normal breathing. The developed system may be used as a tool for quantifying respiratory effort from the existing clinical practice of PSG without the need for Pes, improving characterization of SDB events as obstructive or not. .

  View details for PubMedID 30736016

• Strategic considerations for applying the flipped classroom to neurology education. Annals of neurology Sandrone, S., Berthaud, J. V., Carlson, C., Cios, J., Dixit, N., Farheen, A., Kraker, J., Owen, J. W., Patino, G., Sarva, H., Weber, D., Schneider, L. D. 2019

  Abstract

  Nowadays, the 'flipped classroom' approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this manuscript, a group of neurology educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education analyze reports of flipped classroom implementation in other medical/surgical subspecialties, review the current implementation of flipped classrooms in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/ana.25609

  View details for PubMedID 31581320

• Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers. Journal of Alzheimer's disease : JAD Newkirk, L. A., Dao, V. L., Jordan, J. T., Alving, L. I., Davies, H. D., Hewett, L., Beaudreau, S. A., Schneider, L. D., Gould, C. E., Chick, C. F., Hirst, R. B., Rose, S. M., Anker, L. A., Tinklenberg, J. R., O'Hara, R. 2019

  Abstract

  Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services.To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use.California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users.Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services.Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.

  View details for DOI 10.3233/JAD-190438

  View details for PubMedID 31743997

• Neurologic and neuroscience education: Mitigating neurophobia to mentor health care providers. Neurology Sandrone, S., Berthaud, J. V., Chuquilin, M., Cios, J., Ghosh, P., Gottlieb-Smith, R. J., Kushlaf, H., Mantri, S., Masangkay, N., Menkes, D. L., Nevel, K. S., Sarva, H., Schneider, L. D. 2018

  Abstract

  Neurologic disorders are among the most frequent causes of morbidity and mortality in the United States. Moreover, the current shortfall of neurologists is expected to worsen over the coming decade. As a consequence, many patients with neurologic disorders will be treated by physicians and primary care providers without formal neurologic training. Furthermore, a pervasive and well-described fear of neurology, termed neurophobia, has been identified in medical student cohorts, residents, and among general practitioners. In this article, members of the American Academy of Neurology A.B. Baker Section on Neurological Education review current guidelines regarding neurologic and neuroscience education, contextualize the genesis and the negative consequences of neurophobia, and provide strategies to mitigate it for purposes of mentoring future generations of health care providers.

  View details for DOI 10.1212/WNL.0000000000006716

  View details for PubMedID 30568010

• Neurology residency training in 2017: A survey of preparation, perspectives, and plans. Neurology Mahajan, A., Cahill, C., Scharf, E., Gupta, S., Ahrens, S., Joe, E., Schneider, L. 2018

  Abstract

  OBJECTIVE: To survey graduating US neurology residents on the topics of debt, fellowship interview process, future plans, and their readiness for practice and business management tasks.METHODS: An electronic survey was sent to all US American Academy of Neurology member adult and child neurology residents graduating in June 2017.RESULTS: The response rate was 23.4% (n = 159). Of the 143 residents who provided information about student loans, 57% reported having debt (median $180,000). Ninety percent of respondents reported plans to pursue a fellowship after residency; 57% intended to stay at their home institution for additional training. Among respondents from adult neurology programs, 87% preferred to begin the fellowship application process after the first 6 months of the third postgraduate year. Almost half (46%) of adult neurology program residents felt they did not have enough outpatient exposure prior to making fellowship decisions compared to 14% of child neurology trainees. Although reported readiness to perform specific tasks (coding and office management) increased since 2007 (p < 0.05), only 36% of all respondents reported receiving business management training during residency.CONCLUSION: Trainees completing residency report considerable educational debt. A large majority of residents feel the fellowship application process occurs too early. Despite improvements over recent years, the majority of residents continue to feel ill-prepared for specific practice management tasks. These results suggest a need to better understand the effect of educational debt on career choices, an examination of the timing of the fellowship application process, and the incorporation of additional business management training during residency.

  View details for DOI 10.1212/WNL.0000000000006739

  View details for PubMedID 30518554

• Periodic limb movements in sleep: Prevalence and associated sleepiness in the Wisconsin Sleep Cohort. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Leary, E. B., Moore, H. E., Schneider, L. D., Finn, L. A., Peppard, P. E., Mignot, E. 2018; 129 (11): 2306–14

  Abstract

  OBJECTIVES: Periodic limb movements in sleep (PLMS) are thought to be prevalent in elderly populations, but their impact on quality of life remains unclear. We examined the prevalence of PLMS, impact of age on prevalence, and association between PLMS and sleepiness.METHODS: We identified limb movements in 2335 Wisconsin Sleep Cohort polysomnograms collected over 12 years. Prevalence of periodic limb movement index (PLMI) ≥15 was calculated at baseline (n = 1084). McNemar's test assessed changes in prevalence over time. Association of sleepiness and PLMS evaluated using linear mixed modeling and generalized estimating equations. Models adjusted for confounders.RESULTS: Prevalence of PLMI ≥15 at baseline was 25.3%. Longitudinal prevalence increased significantly with age (p = 2.97 * 10-14). Sleepiness did not differ significantly between PLMI groups unless stratified by restless legs syndrome (RLS) symptoms. The RLS+/PLM+ group was sleepier than the RLS+/PLM- group. Multiple Sleep Latency Test trended towards increased alertness in the RLS-/PLM+ group compared to RLS-/PLM-.CONCLUSIONS: A significant number of adults have PLMS and prevalence increased with age. No noteworthy association between PLMI category and sleepiness unless stratified by RLS symptoms.SIGNIFICANCE: Our results indicate that RLS and PLMS may have distinct clinical consequences and interactions that can help guide treatment approach.

  View details for PubMedID 30243181

• Incorporating sleep medicine content into medical school through neuroscience core curricula. Neurology Salas, R. M., Strowd, R. E., Ali, I., Soni, M., Schneider, L., Safdieh, J., Vaughn, B. V., Avidan, A. Y., Jeffery, J. B., Gamaldo, C. E. 2018

  Abstract

  OBJECTIVE: To present (1) justification for earmarking sleep medicine education as an essential component of all medical school curricula and (2) various avenues to incorporate sleep medicine exposure into medical school curricula through (primarily) neuroscience and neurology courses.METHODS: Per consensus of a team of leading neurology and sleep medicine educators, an evidence-based rationale for including sleep medicine across a 4-year medical school curriculum is presented along with suggested content, available/vetted resources, and formats for delivering sleep medicine education at various points and through various formats.RESULTS: Growing evidence has linked sleep disorders (e.g., sleep-disordered breathing, chronic insufficient sleep) as risk factors for several neurologic disorders. Medical educators in neurology/neuroscience are now strongly advocating for sleep medicine education in the context of neurology/neuroscience pre and post graduate medical education. Sleep medicine education is also a critical component of a proactive strategy to address physician wellness and burnout. The suggested curriculum proposes a sleep educational exposure time of 2-4 hours per year in the form of lectures, flipped-classroom sessions, clinical opportunities, and online educational tools that would result in a 200%-400% increase in the amount of sleep medicine exposure that US medical schools currently provide. The guidelines are accompanied by the recommendation for use of technological education, to facilitate more seamless curricular incorporation.CONCLUSION: Even in this era with limited flexibility to add content to an already packed medical school curriculum, incorporating sleep medicine exposure into the current medical school curriculum is both justified and feasible.

  View details for PubMedID 30185444

• Improved primary CNS hypersomnia diagnosis with statistical machine learning Jiang, L., Cheung, J., Mignot, E., Schneider, L. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000453090800116

• Automatic, ECG-based detection of autonomic arousals and their association with cortical arousals, leg movements, and respiratory events in sleep. Sleep Olsen, M., Schneider, L. D., Cheung, J., Peppard, P. E., Jennum, P. J., Mignot, E., Sorensen, H. B. 2018

  Abstract

  The current definition of sleep arousals neglects to address the diversity of arousals and their systemic cohesion. Autonomic arousals (AA) are autonomic activations often associated with cortical arousals (CA), but they may also occur in isolation in relation to a respiratory event, a leg movement event or spontaneously, without any other physiological associations. AA should be acknowledged as essential events to understand and explore the systemic implications of arousals.We developed an automatic AA detection algorithm based on intelligent feature selection and advanced machine learning using the electrocardiogram. The model was trained and tested with respect to CA systematically scored in 258 (181 training size/77 test size) polysomnographic recordings from the Wisconsin Sleep Cohort.A precision value of 0.72 and a sensitivity of 0.63 were achieved when evaluated with respect to CA. Further analysis indicated that 81% of the non-CA-associated AAs were associated with leg movement (38%) or respiratory (43%) events.The presented algorithm shows good performance when considering that more than 80% of the false positives (FP) found by the detection algorithm appeared in relation to either leg movement or respiratory events. This indicates that most FP constitute autonomic activations that are indistinguishable from those with cortical cohesion. The proposed algorithm provides an automatic system trained in a clinical environment, which can be utilized to analyse the systemic and clinical impacts of arousals.

  View details for PubMedID 29329416

• Integrating the Divided Nasal Cannula Into Routine Polysomnography to Assess Nasal Cycle: Feasibility and Effect on Outcomes JOURNAL OF CLINICAL SLEEP MEDICINE Scapuccin, M., Schneider, L., Rashid, N., Zaghi, S., Rosa, T., Tsuo, Y., Liu, S., Lazarini, P., Capasso, R., Ruoff, C. 2018; 14 (4): 641–50

  Abstract

  Patients suspected to have sleep-disordered breathing underwent an overnight polysomnography using a divided nasal cannula to gain additional information about the nasal cycle during sleep.This was a prospective, observational cohort study replacing the undivided nasal cannula with a divided nasal cannula during routine polysomnography (n = 28).Integration of the divided nasal cannula pressure transducer system into routine polysomnography was easy and affordable. Most patients (89%) demonstrated nasal cycle changes during the test. Nasal cycle changes tended to occur during body position changes (62%) and transitions from non-rapid eye movement sleep to rapid eye movement sleep (41%). The mean nasal cycle duration was 2.5 ± 2.1 hours. Other sleep study metrics did not reveal statistically significant findings in relation to the nasal cycle.Replacing an undivided nasal cannula with a divided nasal cannula is easy to implement, adding another physiologic measure to polysomnography. Although the divided nasal cannula did not significantly affect traditional polysomnographic metrics such as the apnea-hypopnea index or periodic limb movement index based on this small pilot study, we were able to replicate past nasal cycle findings that may be of interest to sleep clinicians and researchers. Given the ease with which the divided nasal cannula can be integrated, we encourage other sleep researchers to investigate the utility of using a divided nasal cannula during polysomnography.

  View details for PubMedID 29609709

  View details for PubMedCentralID PMC5886442

• Genetic Basis of Chronotype in Humans: Insights From Three Landmark GWAS SLEEP Kalmbach, D. A., Schneider, L. D., Cheung, J., Bertrand, S. J., Kariharan, T., Pack, A. I., Gehrman, P. R. 2017; 40 (2)

  Abstract

  Chronotype, or diurnal preference, refers to behavioral manifestations of the endogenous circadian system that governs preferred timing of sleep and wake. As variations in circadian timing and system perturbations are linked to disease development, the fundamental biology of chronotype has received attention for its role in the regulation and dysregulation of sleep and related illnesses. Family studies indicate that chronotype is a heritable trait, thus directing attention toward its genetic basis. Although discoveries from molecular studies of candidate genes have shed light onto its genetic architecture, the contribution of genetic variation to chronotype has remained unclear with few related variants identified. In the advent of large-scale genome-wide association studies (GWAS), scientists now have the ability to discover novel common genetic variants associated with complex phenotypes. Three recent large-scale GWASs of chronotype were conducted on subjects of European ancestry from the 23andMe cohort and the UK Biobank. This review discusses the findings of these landmark GWASs in the context of prior research.We systematically reviewed and compared methodological and analytical approaches and results across the three GWASs of chronotype.A good deal of consistency was observed across studies with 9 genes identified in 2 of the 3 GWASs. Several genes previously unknown to influence chronotype were identified.GWAS is an important tool in identifying common variants associated with the complex chronotype phenotype, the findings of which can supplement and guide molecular science. Future directions in model systems and discovery of rare variants are discussed.

  View details for DOI 10.1093/sleep/zsw048

  View details for Web of Science ID 000394129900011

  View details for PubMedID 28364486

• Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea. Sleep Koch, H., Schneider, L. D., Finn, L. A., Leary, E. B., Peppard, P. E., Hagen, E., Sorensen, H. B., Jennum, P., Mignot, E. 2017; 40 (11)

  Abstract

  To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.

  View details for PubMedID 29029253

• SLEEP AND NEUROLOGIC DISEASE Foreword SLEEP AND NEUROLOGIC DISEASE Schneider, L., Miglis, M. G. 2017: XI-XII

  View details for Web of Science ID 000422932000001

• Manual of the Neurologic Examination for Neurologists in Training Toyka, K. V., Claßen, J., Schneider, L. D., Saur, D. European Academy of Neurology. 2017
• Anatomy and Physiology of Normal Sleep Sleep and Neurologic Disease Schneider, L. D. Academic Press. 2017; 1st: 1–28

  View details for DOI 10.1016/B978-0-12-804074-4.00001-7

• Diagnosis and Management of Narcolepsy. Seminars in neurology Schneider, L., Mignot, E. 2017; 37 (4): 446–60

  View details for PubMedID 28837992

• Education Research: Neurology resident education: Trending skills, confidence, and professional preparation. Neurology Jordan, J. T., Mayans, D., Schneider, L., Adams, N., Khawaja, A. M., Engstrom, J. 2016; 86 (11): e112-7

  Abstract

  To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education.An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014.Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys.Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training.

  View details for DOI 10.1212/WNL.0000000000002463

  View details for PubMedID 26976522

• Voice of young neurologists around the world. Neurology Rakusa, M., Struhal, W., Gak, S., Tanprawate, S., Balicza, P., Khawaja, A. M., Schneider, L. D. 2016; 86 (4): e40-1

  View details for DOI 10.1212/WNL.0000000000002317

  View details for PubMedID 26810430

• Clinical Reasoning: A 44-year-old woman with rapidly progressive weakness and ophthalmoplegia. Neurology Schreck, K. C., Schneider, L., Geocadin, R. G. 2015; 85 (3): e22-7

  View details for DOI 10.1212/WNL.0000000000001761

  View details for PubMedID 26195241

  View details for PubMedCentralID PMC4516292

• Clinical Reasoning: A 68-year-old man with a first presentation of status epilepticus NEUROLOGY Schneider, L., Probasco, J. C., Newsome, S. D. 2014; 82 (14): E116-E121

  Abstract

  A 64-year-old man with transfusion-dependent myelodysplastic syndrome (MDS), hypertension, chronic obstructive pulmonary disease, hypothyroidism, blindness from treated syphilitic chorioretinitis, and no prior seizure history presented in generalized status epilepticus. His daily home medication regimen included prednisone 20 mg (chronic therapy for MDS), diltiazem 120 mg, digoxin 250 μg, tiotropium 80 μg, and levothyroxine 112 μg. On admission he was febrile to 39.9 °C and in atrial fibrillation with rapid ventricular rate. Initial hematologic profile showed 11,910 leukocytes/mm(3) (12% immature forms, 46% neutrophils, 32% lymphocytes), hematocrit of 30.8%, and platelet count of 215,000/mm(3), with an otherwise normal serum chemistry.

  View details for DOI 10.1212/WNL.0000000000000289

  View details for Web of Science ID 000336497000002

  View details for PubMedID 24711538

• International Issues: Obtaining an adult neurology residency position in the United States An overview NEUROLOGY Jordan, J. T., Sellner, J., Struhal, W., Schneider, L., Mayans, D. 2014; 82 (14): E112-E115

  Abstract

  Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.

  View details for DOI 10.1212/WNL.0000000000000279

  View details for Web of Science ID 000336497000001

  View details for PubMedID 24711537

• What We Think before a Voluntary Movement JOURNAL OF COGNITIVE NEUROSCIENCE Schneider, L., Houdayer, E., Bai, O., Hallett, M. 2013; 25 (6): 822-829

  Abstract

  A central feature of voluntary movement is the sense of volition, but when this sense arises in the course of movement formulation and execution is not clear. Many studies have explored how the brain might be actively preparing movement before the sense of volition; however, because the timing of the sense of volition has depended on subjective and retrospective judgments, these findings are still regarded with a degree of scepticism. EEG events such as beta event-related desynchronization and movement-related cortical potentials are associated with the brain's programming of movement. Using an optimized EEG signal derived from multiple variables, we were able to make real-time predictions of movements in advance of their occurrence with a low false-positive rate. We asked participants what they were thinking at the time of prediction: Sometimes they were thinking about movement, and other times they were not. Our results indicate that the brain can be preparing to make voluntary movements while participants are thinking about something else.

  View details for DOI 10.1162/jocn_a_00360

  View details for Web of Science ID 000318355000001

  View details for PubMedID 23363409

  View details for PubMedCentralID PMC4747632

• Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease NEUROLOGY Benninger, D. H., BERMAN, B. D., Houdayer, E., Pal, N., Luckenbaugh, D. A., Schneider, L., Miranda, S., Hallett, M. 2011; 76 (7): 601-609

  Abstract

  To investigate the safety and efficacy of intermittent theta-burst stimulation (iTBS) in the treatment of motor symptoms in Parkinson disease (PD).Progression of PD is characterized by the emergence of motor deficits, which eventually respond less to dopaminergic therapy and pose a therapeutic challenge. Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. iTBS is a novel type of rTMS that may be more efficacious than conventional rTMS.In this randomized, double-blind, sham-controlled study, we investigated safety and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2 weeks (evidence Class I). Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale (UPDRS), and additional clinical, neuropsychological, and neurophysiologic measures.We investigated 26 patients with mild to moderate PD: 13 received iTBS and 13 sham stimulation. We found beneficial effects of iTBS on mood, but no improvement of gait, bradykinesia, UPDRS, and other measures. EEG/EMG monitoring recorded no pathologic increase of cortical excitability or epileptic activity. Few reported discomfort or pain and one experienced tinnitus during real stimulation.iTBS of the motor and prefrontal cortices appears safe and improves mood, but failed to improve motor performance and functional status in PD.This study provides Class I evidence that iTBS was not effective for gait, upper extremity bradykinesia, or other motor symptoms in PD.

  View details for Web of Science ID 000287363800006

  View details for PubMedID 21321333

  View details for PubMedCentralID PMC3053339

• Prediction of human voluntary movement before it occurs CLINICAL NEUROPHYSIOLOGY Bai, O., Rathi, V., Lin, P., Huang, D., Battapady, H., Fei, D., Schneider, L., Houdayer, E., Chen, X., Hallett, M. 2011; 122 (2): 364-372

  Abstract

  Human voluntary movement is associated with two changes in electroencephalography (EEG) that can be observed as early as 1.5 s prior to movement: slow DC potentials and frequency power shifts in the alpha and beta bands. Our goal was to determine whether and when we can reliably predict human natural movement BEFORE it occurs from EEG signals ONLINE IN REAL-TIME.We developed a computational algorithm to support online prediction. Seven healthy volunteers participated in this study and performed wrist extensions at their own pace.The average online prediction time was 0.62±0.25 s before actual movement monitored by EMG signals. There were also predictions that occurred without subsequent actual movements, where subjects often reported that they were thinking about making a movement.Human voluntary movement can be predicted before movement occurs.The successful prediction of human movement intention will provide further insight into how the brain prepares for movement, as well as the potential for direct cortical control of a device which may be faster than normal physical control.

  View details for DOI 10.1016/j.clinph.2010.07.010

  View details for Web of Science ID 000285995400019

  View details for PubMedID 20675187

  View details for PubMedCentralID PMC5558611