Yoel Green, MD

All Publications

• The Clinical Impact of Periodic Limb Movements During Sleep (PLMS): Under-Recognition in Sleep Disordered Breathing and Associations with Key Clinical Outcomes in 481,857 Patients. Sleep Green, Y. D., Cederberg, K. L., Moore I V, H., Ferri, R., Gimenez, U., Hanif, U., Mignot, E. 2026

  Abstract

  To evaluate periodic limb movements during sleep (PLMS) in a large sleep disorders cohort and explore associations with sleep-disordered breathing (SDB), demographics and key clinical comorbidities.A retrospective analysis including 481,857 adults who completed overnight polysomnography (PSG) and a sleep/medical history questionnaire. Data collection spanned 240 sleep centers across 30 U.S. states. Periodic limb movement index (PLMI) was calculated from technician-scored PSGs, and all PSG measures were scored in accordance with American Academy of Sleep Medicine guidelines. Associations with PLMI were assessed using multivariable linear regression, with self-reported and objective measures analyzed separately, first in predictor-specific and then in simultaneous models.The sample included 54.1% males, with a mean age of 54.4 ± 14.4 years (range: 18-107), average PLMI of 10.3 ± 22.1 events/hour and average Apnea Hypopnea Index (AHI) of 14.7 ± 19.1 events/hour. PLMI was highest among White individuals; lower among Hispanic, Asian, and Black individuals. PLMI was strongly negatively associated with SDB measures, persisting even when stratified by CPAP usage.In both predictor-specific and simultaneous multivariable models, PLMI was associated with diagnosed depression, insomnia score, elevated blood sugar and anemia. Objectively, PLMI was associated with arousal index and lower sleep efficiency.Our findings highlight the potential clinical relevance of PLMS across neuropsychiatric, cardiometabolic, and sleep domains. Racial disparities may reflect genetic and sociocultural factors. Most strikingly, in the setting of increased SDB, PLMS may be undercounted, potentially warranting further evaluation of scoring criteria. These results support further genetic and mechanistic investigations.

  View details for DOI 10.1093/sleep/zsag269

  View details for PubMedID 42878538

• Kleine-Levin Syndrome and Emergent Manic Symptoms in a Young Patient After Ramelteon Initiation: A Case Report Green, Y., Mignot, E. OXFORD UNIV PRESS INC. 2025: A627-A628

  View details for DOI 10.1093/sleep/zsaf090.1464

  View details for Web of Science ID 001490759300039

• From Foot-Bread to Flip-Flop Circuits: What History Can Teach Us About Sleep and How to Treat It. Biological psychiatry Green, Y. D., Green, Y. S., Yau, B. N., Ross, D. A. 2023; 94 (8): e29-e31

  View details for DOI 10.1016/j.biopsych.2023.08.007

  View details for PubMedID 37718032

• A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit. The American journal of hospice & palliative care Perri, G. A., Yeung, H., Green, Y., Bezant, A., Lee, C., Berall, A., Karuza, J., Khosravani, H. 2018; 35 (1): 92-99

  Abstract

  Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD.A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the "Nurses Knowledge and Attitudes Survey Regarding Pain" (NKASRP) tool.Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level.The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.

  View details for DOI 10.1177/1049909116684765

  View details for PubMedID 28256899