bluuebunny/crossref_metadata_2025 huggingface dataset:
0799 Impact of Highly Effective Modulator Therapy on Obstructive Sleep Apnea in People with Cystic Fibrosis
Authors: Shakkottai Aarti , Kim Stephany , Mitchell Ron
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is frequently seen in people with cystic fibrosis (PwCF). The presence of upper airway pathology including adenotonsillar hypertrophy and chronic sinusitis is a known risk factor for OSA in PwCF. The widespread use of highly effective modulator therapy (HEMT) such as elexacaftor/tezacaftor/ivacaftor has led to improvements in nutritional status, lung function, and sinus disease among PwCF. However, the impact of HEMT on OSA is still unknown.

Methods

We conducted a single center retrospective review of polysomnographic data in PwCF between 1/1/2009-10/31/2022.

Results

Fifty-three children with CF had undergone diagnostic polysomnography during the study period. Twenty-eight (53%) patients had OSA. Frequency of OSA did not differ by race or mutation type (p>0.5). Eighteen (34%) patients were on HEMT at the time of polysomnography. Mean ages of PwCF in the post-HEMT vs pre-HEMT were 11.6±5.4(sd) vs 6.4±3.5 years respectively, p=0.001. Mean body mass index percentile was 70.8±27.4 vs 55.8±31.2 respectively, p=0.09. Mean forced expiratory volume in 1 second as a percent predicted was 97.1±22.5 vs 87.0±20.9 respectively, p=0.2. Frequency of OSA was 67% in the post-HEMT group and 46% in the pre-HEMT group (p=0.1). Snoring was present in 91% of PwCF in the pre-HEMT group and 78% of those in the post-HEMT group (p=0.2). Frequency of mouth breathing was 77% and 56% in the pre-HEMT and post-HEMT groups respectively (p=0.1). Large adenoids were present in 37% of PwCF in the pre-HEMT group as compared to 11% of those in the post-HEMT group (p=0.046). Frequency of large tonsils in the pre-HEMT and post-HEMT groups was 43% vs. 28% (p=0.3). There were no differences in frequency of chronic sinusitis between the groups (p=0.7).

Conclusion

Frequency of OSA among PwCF continues to be high even in the post-HEMT era. PwCF on HEMT showed a trend towards more frequent OSA despite having less upper airway pathology. The better nutritional status afforded by HEMT could be contributing to the high frequency of OSA in this population. Larger studies are needed to formally test this hypothesis.

Support (if any)
0804 Sleep-disordered Breathing in Myelomeningocele and Chiari II Malformation: Our Experience at a Tertiary Care Center
Authors: Imran Sehyr , Ingram David , Tam-Williams Jade
Published: May 2023

Introduction

Children with myelomeningocele (MMC) and Chiari Malformation type II (CMII) have some degree of sleep-disordered breathing (SDB), which may include central apnea, obstructive apnea, and hypoventilation. Untreated SDB may lead to growth failure, neurocognitive and behavioral abnormalities, cor pulmonale, and death. There is no standardized diagnostic and management protocol to be followed if SDB is suspected in a patient with CMII and MMC.

Methods

Variability in physician practice patterns was assessed for patients with CMII and MMC suspected of having SDB at a tertiary care center from January 2008 to December 2018.

Results

180 patients with CM2 and MMC were identified. Pulmonology/Sleep providers were consulted on 63 of them. A sleep study was ordered for 73% of these patients, with snoring being the most common indication. Most patients had obstructive sleep apnea, with mean obstructive AHI of 6 events/h. Recommendations after sleep study included supplemental oxygen (20%), non-invasive positive airway pressure initiation (9%), subspecialty referral in 35% (otolaryngology and neurosurgery), and tracheostomy with mechanical ventilation in 10% of the patients.

Conclusion

In a large tertiary care center, there was significant variability in clinical practice patterns for children with CM2 and MMC who have SDB. Clinicians caring for these patients should consider PSG to enhance early diagnosis and management of SDB. A standardized diagnostic and management protocol could complement physician judgment to care for this complex patient population.

Support (if any)
0807 The Odds Ratio Product as a Metric of Obstructive Sleep Apnea Severity in Adolescents
Authors: Fernandez-Mendoza Julio , Isely Alexis , Ricci Anna , He Fan , Calhoun Susan , Fang Jidong , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: May 2023

Introduction

Although the apnea-hypopnea index (AHI) remains the gold-standard metric of the severity of obstructive sleep apnea (OSA), it is often criticized for its limitations. The odds ratio product (ORP), a continuous standardized measure of sleep depth that ranges from 0 (deep sleep) to 2.5 (full wakefulness), has been proposed as a potential EEG-based alternative to assess the severity of OSA, including its association with cardiovascular outcomes such as elevated blood pressure (eBP).

Methods

We extracted ORP during rapid eye movement (REM) and non-REM sleep stages from the sleep EEG of 421 adolescents (median 16y) from the Penn State Child Cohort. Higher ORP indicates lower sleep depth. Systolic and diastolic BP levels were measured in the seated position and eBP was identified using American Heart Association guideline-recommended pediatric criteria. OSA was defined as an AHI of 2 or greater events per hour of sleep. Logistic regression models examined the joint of effect of AHI and ORP on eBP, while adjusting for sex, age, race/ethnicity and body mass index, and stratified by the presence of OSA.

Results

We found a significant interaction between AHI and ORP on eBP (p-interaction=0.016). Among adolescents with OSA, each additional 0.5-point increase in ORP was associated with 6.3-fold odds (95%CI=1.9-20.6, p=0.003) of eBP. Specifically, each additional 0.5-point increase in ORP was associated with 6.4 mmHg (SE=3.0, p=0.036) higher systolic BP among adolescents with OSA. These associations were not significant among adolescents without OSA (eBP: OR=0.8, 95%CI=0.4-1.8, p=0.602 for each additional 0.5 increase in ORP).

Conclusion

Our data support ORP as a prognostic sleep-EEG metric of OSA in youth. Future clinical trials should examine the added value of ORP in OSA endophenotyping, its response to treatment and role in improving cardiovascular outcomes.

Support (if any)

National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0809 Development and validation of a questionnaire to assess toddler sleep
Authors: Gupta Gita , O'Brien Louise , Dang Louis , Ibadat Shewar , Neff Katherine , Sturza Julie , Shellhaas Renée
Published: May 2023

Introduction

Few sleep questionnaires focus on toddlers, whose sleep is unique from both infants and older children. Fewer include both medical and behavioral items, or have been externally validated against polysomnograms (PSGs).

Methods

Caregivers of children 12 to 36 months old were recruited through social media, flyers in common hospital spaces, general pediatrics clinics, a pediatric neurology clinic, and at the sleep lab. A questionnaire using a 5-point Likert scale was developed. Questionnaire items pertained to behavioral issues, restless legs syndrome, sleep-disordered breathing, dysautonomia, feeding, attitudes toward sleep, and comorbidities. Factor analysis was used to determine which items represent distinct dimensions of toddler sleep. A diagnosis of sleep apnea was not included in the generation of the factors. Cronbach’s alpha was calculated to evaluate internal consistency within the derived factors. Sleep apnea was defined as the presence of either obstructive or central sleep apnea diagnosed by PSG. We used receiver operating characteristic (ROC) curves to determine which factors most closely estimate sleep apnea. Concordance of factors with the presence of sleep apnea was determined by measuring the area under the ROC curve (AUC).

Results

Responses from 720 caregivers of toddlers were used to generate the factors. External validation was performed using the PSG data of 35 children. One distinct factor emerged which had good concordance with a diagnosis of sleep apnea (AUC≥0.70). The factor was comprised of the following items: “My child has noisy breathing during sleep”, “My child snorts and gasps during sleep”, “My child snores”, “My child's breathing is heavy during sleep”, “My child breathes through their mouth while sleeping”, “My child breathes through their mouth during the day”, “My child "belly breathes" during sleep”; Cronbach’s alpha=0.83; AUC=0.70). Factors associated with daytime behavior, behavioral insomnia of childhood, and excessive daytime sleepiness were not associated with sleep apnea.

Conclusion

Obstructive features are most associated with sleep apnea, whereas daytime and bedtime behavioral characteristics, and excessive daytime sleepiness are not, unlike in studies of older children. This may reflect the natural history of sleep apnea in children. Further study with a larger sample size is required to confirm this finding.

Support (if any)

NIH 2T32HL110952-06
0810 Effect of supraglottoplasty on respiratory parameters in infants and children with laryngomalacia and oxygen dependence
Authors: Wickemeyer Johanna , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong
Published: May 2023

Introduction

Supraglottoplasty (SGP) is the surgical treatment of choice for laryngomalacia and obstructive sleep apnea (OSA). Several recent studies have shown that oxygen can act to stabilize ventilatory control in infants with OSA and high loop gain. However, there is very limited information on the effect of SGP on OSA in infants with laryngomalacia and evidence of high loop gain.

Methods

A retrospective chart review was performed in infants with laryngomalacia and OSA at Cincinnati Children’s Hospital Medical Center from January 2008 to June 2022. Only patients treated with oxygen prior to SGP were included in the analysis. The pre-surgical polysomnograms (PSGs) were classified by responsiveness to oxygen into 2 groups; oxygen responders ([R]; >50% decrease in apnea-hypopnea index (AHI) with oxygen, indirect evidence of high loop gain) and non-responders ([NR]; < 50% decrease in AHI). Data were reported as mean±SD. The comparison of AHI and obstructive AHI (OAHI) between pre-surgical and post-surgical PSGs were performed in each group using paired t-test or Wilcoxon signed rank test. The differences of percentage decreases in AHI and OAHI after surgery between R and NR were calculated using Wilcoxon Rank Sum test.

Results

Forty-nine infants (with 52 SGPs) met the study enrollment criteria, with 33 (67.3%) male and 16 (32.7%) female patients. There were no statistically significant differences in age or sex between oxygen responders and non-responders. AHI after SGP in both oxygen responders (50.1±59.2/hr [pre] vs 17.6±21.1/hr [post]; P< 0.0001) and oxygen non-responders (25.2±13.3/hr [pre] vs 12.4±9.4/hr [post] vs; P=0.0006] decreased significantly. Similarly, there were significant decreases in OAHI after SGP in both groups. Additionally, there were no significant differences in the percentage decreases of AHI (57.3±26.1% [R] vs 41.4±48.8%[NR]; P=0.6410) and OAHI (64.0±21.9% [R] vs 50.3±41.4% [NR]; P=0.5260) between the 2 groups.

Conclusion

Both oxygen responders and non-responders had significant decreases in AHI and OAHI after surgery with similar magnitude of improvement. Supraglottoplasty is an effective treatment in infants with larygnomalacia and OSA, even in those with evidence of high loop gain. We speculate that non-anatomic traits such as high loop gain would only manifest in the context of significant respiratory disturbances from anatomic traits.

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0822 Sleep and Nighttime Urine Production
Authors: Tyagi Shachi , Clarkson Becky , Newell Kandy , Perera Subashan , Resnick Neil , Buysse Daniel
Published: May 2023

Introduction

Nocturia (waking from sleep to urinate) is the most common cause of sleep interruption among older adults and nocturnal polyuria (NP; increased sleep time urine production) is its most common cause. Conversely, poor sleep with repeated awakenings contributes to both nocturia and NP. However, whether a behavioral intervention to reduce repeated awakenings can improve nocturia and NP has not been examined in a clinical trial. The current study assesses the effect of Brief Behavioral Treatment for Insomnia (BBTI) on nocturia and NP in older adults.

Methods

Fifty-six community-dwelling older adults (mean age, 72±6 years; 64% women) with nocturia frequency ≥2 per night were randomized to receive BBTI vs information-only control (IC). All participants completed a 3-day voiding and sleep diary to assess nocturia, and sleep. Participants with a nocturnal polyuria index (NPi; percent of 24-hour urine volume excreted at night) ≥35% were considered to have NP.

Results

At baseline, nocturia frequency correlated with total sleep time (r=.54, p< 0.001) and duration of the first uninterrupted sleep period (FUSP, r=-.40, p=0.004) after adjusting for age and body mass index. BBTI significantly improved nocturia frequency compared to the IC group (-1.0±0.7 vs -0.3±0.9; p=.02). FUSP increased by 54±77 minutes in the BBTI group and NPi decreased by 7.1±13.2%, but these changes were not significantly different from the IC group. Change in NPi correlated with change in FUSP (r=-.36, p=.01; longer FUSP associated with lower NPi), but not with change in total sleep time (r=-.04, p=.7).

Conclusion

In older adults with nocturia, behavioral treatment directed solely at sleep also improves nocturia. Improving sleep continuity in the first half of the night and increasing FUSP, but not total sleep time, may also improve NP.

Support (if any)

NIA AG060292
0823 Social Determinants of Sleep Disorders Among Multiethnic Americans in the NIH All of Us Research Program
Authors: Blanc Judite , Barr Peter , Seixas Azizi , Chery Maurice , Bernard Maritza , Rogers April , Jean-Louis Girardin , Bigdeli Tim
Published: May 2023

Introduction

Studies show that social characteristics associated with good health, such as a high level of education, being married, and being employed, are associated with healthier sleep health. Accordingly, we leveraged All of Us (AOU), an NIH research, to analyze sleep disorders prevalence and sociodemographic covariates.

Methods

Phecodes for diagnoses were derived from the ICD-9/10 billing codes in participants’ electronic health records (EHRs). We used 0 phecodes of the parent category of sleep disorders (insomnia and sleep apnea) (phecode 327) in a person’s EHR to classify individuals as not having a diagnosis and 2+ phecodes as having a diagnosis (those with only one instance in their EHR were dropped). Logistic regression analysis was conducted to assess associations between sleep disorders and race/ethnicity, sex, age, and education level using the R statistical framework.

Results

A total of 214, 206 participants were available for analysis; of whom 61.3% were female (mean [SD] age, 51.7 [16.6] years). Women were 1.27xmore likely to have a diagnosed sleeping problem (95% CI: 1.31,1.23; p=1.31×10-61). We observed higher rates of sleep disorders in older individuals; compared to persons between 18-30 years old, those aged 65 years or older were 4.74 times more likely to have a diagnosable sleep disorder (95% CI: 3.83, 4.33; p< 10-300). We also observed a trend of greater education attainment corresponding to an increased likelihood of sleep problems; this was most extreme when comparing individuals with some college versus those who did not complete high school (OR=1.38; 95% CI: 1.30, 1.46; p=3.65×10-29). Individuals with reported income < 25K/year were 1.44x more likely to be diagnosed than those earning >100K (95% CI:1.51, 1.37; p=1.05×10-51). Individuals identified as Black were least likely to have a diagnosis (OR=0.52; 95% CI: 0.50, 0.54; p=2.2that 2×10-208).

Conclusion

Among All Of Us populations, self-identified Blacks, men, younger adults, higher-income, and non-college-educated patients are less likely to have recorded insomnia or sleep apnea diagnoses. Some of these unexpected within-group differences could be due to self-reported versus clinically recorded diagnoses and access to healthcare. Planned analyses aim to explore further social determinants of health by incorporating geospatial and available self-report data on exposures

Support (if any)

1HL152453, R01MD007716, R01HL142066
0833 Acceptability of the Transdiagnostic Behavioral Sleep and Circadian Intervention to Individuals in Cardiac Rehabilitation
Authors: Tighe Caitlan , Phares Angela , Weiner Debra , Buysse Daniel , Forman Daniel
Published: May 2023

Introduction

Sleep health is often compromised among individuals undergoing cardiac rehabilitation and does not consistently improve over the course of treatment. Behavioral sleep and circadian interventions may improve the sleep health of cardiac rehabilitation patients but have not been widely tested in this context. We conducted a preliminary test of an adapted version of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with Veterans in cardiac rehabilitation to evaluate its acceptability with these unique patients.

Methods

Eight Veterans with sleep disturbance and/or sleep-related impairment who were participating in outpatient cardiac rehabilitation completed the adapted TranS-C intervention and post-intervention acceptability measures. Intervention acceptability was assessed quantitatively with subscales from the Multidimensional Treatment Satisfaction Measure (subscale scores range from 0-4; higher scores indicate greater satisfaction) and qualitatively via semi-structured interviews. We calculated descriptive statistics for quantitative measures and analyzed semi-structured interviews using a rapid qualitative analysis approach.

Results

Participants felt the intervention was suitable to their needs (M=3.00, SD=.94) and useful for increasing their knowledge and understanding of sleep problems and how to manage them (M=3.50, SD=.69). Participants endorsed positive attitudes toward the intervention (M=3.63, SD=.58) and high likelihood of recommending the intervention to others similarly experiencing sleep problems (M=3.63, SD =.58). Following the intervention, 62.5% of participants indicated that their sleep disturbance and sleep-impairment were ‘much better’ than at the first study visit and 37.5% indicated their sleep disturbance and sleep-related impairment were ‘somewhat better’. Qualitative findings converged with the noted quantitative findings.

Conclusion

Veteran cardiac rehabilitation patients expressed satisfaction and positive attitudes toward the adapted TranS-C intervention. All participants reported subjective post-intervention improvements in sleep disturbance and sleep-related impairment. These findings provide preliminary support for further large-scale testing of adapted TranS-C in cardiac rehabilitation.

Support (if any)

Dr. Tighe is supported by a Career Development/Capacity Building Award (IK2 RX003393) from the United States Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. This material is the result of work supported with resources and use of facilities at the VISN 4 Mental Illness Research, Education, and Clinical Center at VA Pittsburgh Healthcare System.
0834 Association of Sleep Disordered Breathing and Hemodynamics of World Symposium on Pulmonary Hypertension Groups in PVDOMICS Cohort
Authors: Musco Kaitlyn , Wang Lu , Hill Nicholas , Finet Emanuel , Mehra Reena
Published: May 2023

Introduction

As sleep disordered breathing(SDB)-related pathophysiology of intermittent hypoxia, autonomic dysfunction and intrathoracic pressure alterations, etc. likely exerts differential influences across World Symposium on Pulmonary Hypertension(WSPH) groups that have yet to be characterized , we postulate differing SDB-pulmonary hemodynamics relationships across these groups.

Methods

Pulmonary Vascular Disease Phenomics(PVDOMICS-NCT02980887), a multicenter cohort study, included patients with mean pulmonary artery pressure(mPAP) on right heart catheterization(RHC) ≥ 25mmHg and home sleep apnea testing(HSAT) within 6 weeks of RHC. SDB measures included apnea-hypopnea index(AHI, 3% desaturation hypopnea definition used) and % recording time< 90% SpO2(TRT< 90%). Pulmonary hemodynamic indices included:mPAP, mean pulmonary capillary wedge pressure(PCWP), right atrial mean pressure(RAP). Linear regression models(beta coefficients±standard error) were constructed to assess sleep indices and RHC measurements with adjustment for age, sex, race, body-mass index(BMI), PH medication and supplemental oxygen use; PH group interaction was analyzed.

Results

We included 424 participants with available data in the final analytic sample. Groups 2 and 3 were older(65.6±11.9, 64.2±10.8 years, respectively) and Group 5 had the highest % males(71.4%). Group 2 had highest BMI: 34.3±9.2kg/m2 and Group 5 lowest: 28.7±6.4k g/m2. SDB(AHI≥5), was most prevalent in Group 2(71.4%) and least in Group 4(42.9%). TRT< 90% was highest in Group 1(37.0%, [P25=2.2, P75=87.3]) followed by Group 4(35.7% [5.3,82.9]) and lowest in Group 2(6.4% [0.61,41.8]). AHI and RAP association differed across groups, p=0.027 and was strongest in Group 2; per 5-unit increase in AHI, RAP increased by 0.75mmHg (estimate=0.75, standard error[0.15,1.36],p=0.015). TRT< 90% and mPAP had significant cross-group differences, p=0.004. TRT< 90% was associated with mPAP in Groups 1 and 4:per 5-unit increase in TRT< 90%, mPAP increased by 2mmHg(2.10,[1.52,2.68],p< 0.001) and 1.4mmHg(1.40,[0.07,2.73],p=0.039) respectively. Other associations were not significant.

Conclusion

SDB prevalence differs across WSPH groups and was highest in Group 2 PH. Findings suggest that AHI and TRT< 90%SaO2 differentially contribute to the pathogenesis in PH groups; with AHI associating with RAP, especially in Group 2 PH, and TRT< 90%SaO2 with mPAP in Groups 1 and 4 PH, perhaps via hypoxia-induced pulmonary vasoconstriction and remodeling.

Support (if any)

Funding: U01 HL125218, U01 HL125205, U01 HL125212, U01 HL125208, U01 HL125175, U01 HL125215, and U01 HL125177 and the Pulmonary Hypertension Association.
0836 Chronic Pain worsens Daytime Sleepiness, Insomnia and Quality of Life in Veterans with Obstructive Sleep Apnea
Authors: Saconi Bruno , Kuna Samuel , Polomano Rosemary , Compton Peggy , Keenan Brendan , Sawyer Amy
Published: May 2023

Introduction

Chronic noncancer pain (CP) commonly co-occurs with obstructive sleep apnea (OSA) and may contribute to greater symptom burden. The study aim was to examine differences in sleepiness (Epworth Sleepiness Scale, ESS), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form Health Survey 20, SF-20) in veterans with OSA with or without pre-existing CP.

Methods

An observational, cross-sectional, study of veterans with newly diagnosed, untreated OSA was conducted. Unadjusted between-group comparisons (i.e., OSA-only versus OSA + CP) were conducted using the Welch’s t-test and Pearson Chi-Square. Regression analyses were performed to determine the influence of self-reported CP on sleep-related symptoms and quality of life while controlling for potential confounders (i.e., age, sex, OSA severity, body mass index, percentage of total sleep time spent with SpO2 < 90%, and presence of psychiatric/mental health comorbidities). The Hochberg (step-up) method was used to control for the family-wise error rate at 5%.

Results

The final sample included N=111 participants with complete survey responses. Compared to the group with OSA-only (n=40), veterans with comorbid OSA and CP (n=71) experienced significantly higher ESS (12.7 ± 5.5 vs 10.2 ± 5.2; p = .021) and ISI scores (18.1 ± 6.2 vs. 13.7 ± 7.4; p = .002), and worse quality of life across all SF-20 domains. Of note, clinically significant insomnia (ISI score > 15) was most common among veterans with comorbid OSA and CP (68.7% vs. 45.5%, p = .010). In adjusted analyses, CP diagnosis was significantly associated with higher ESS (adjusted mean difference [95% CI] = 2.72 [0.55, 4.88], p = .014) and ISI scores (adjusted mean difference [95% CI] = 3.82 [1.27, 6.37], p =.004).

Conclusion

There is a high prevalence of CP among veterans with OSA and symptom burden is higher in patients with OSA and CP. Future investigations should address symptom response and burden to OSA treatment in comorbid OSA and CP to guide outcome expectancies and residual OSA symptom treatment plans.

Support (if any)

SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.
0838 Diagnosed Prevalence of Idiopathic Hypersomnia Among Adults in the United States
Authors: Saad Ragy , Black Jed , Bogan Richard , Jensen Elizabeth , Lillaney Prasheel , Prince Patricia , Estrin Adina , Whalen Marisa , Macfadden Wayne , Ni Weiyi , Plante David
Published: May 2023

Introduction

Idiopathic hypersomnia (IH) is a rare neurologic disorder that can cause debilitating symptoms, including excessive daytime sleepiness, severe sleep inertia, prolonged nighttime sleep, long and unrefreshing naps, and cognitive dysfunction. Research reporting the burden of IH is scant. The objective of this study was to estimate the diagnosed prevalence of IH among US adults between 2019 and 2021.

Methods

Symphony Integrated Dataverse® administrative claims between November 2015 and December 2021 were analyzed. Eligible patients were aged ≥18 years and had 1 medical or prescription claim in the calendar year of interest (2019, 2020, or 2021) and in the year prior. Diagnosed prevalence included all IH cases observed in eligible patients through the last day of the year of interest. IH cases were defined as eligible patients with ≥1 medical claim containing an IH diagnosis code in any position before or during the calendar year of interest, and no history of cataplexy. Unweighted prevalence estimates were reported per 100,000 persons with 95% confidence intervals (CIs). Age- and sex-adjusted prevalence estimates were calculated using 2019 US Census Bureau data.

Results

Over 158, 168, and 187 million adults were eligible for assessment of diagnosed prevalence of IH in 2019, 2020, and 2021, respectively. The unweighted diagnosed prevalence of IH was 32.12 per 100,000 persons (CI: 31.84, 32.40), 35.71 per 100,000 persons (CI: 35.43, 36.00), and 37.03 per 100,000 persons (CI: 36.75, 37.30) in 2019, 2020, and 2021, respectively. The estimated standardized numbers of US adults diagnosed with IH were 80,603 (CI: 80,048, 81,161), 89,539 (CI: 88,954, 90,127), and 92,139 (CI: 91,545, 92,736) in 2019, 2020, and 2021, respectively.

Conclusion

To our knowledge, this is the most recent study to estimate diagnosed prevalence of IH in US adults. It is uncertain what proportion of IH cases remain undiagnosed considering the under-recognition of this condition, low utilization of sleep testing, and concerns over the reliability of multiple sleep latency testing. Furthermore, recent studies suggest only a subset of patients with IH actively seek medical care for their condition. Given its impact on patients’ lives, further research to improve surveillance of IH symptoms is needed.

Support (if any)

Jazz Pharmaceuticals.
0839 Does CBT-I Dose Improve Depression and Anxiety in Patients Diagnosed with Breast and Prostate Cancer?
Authors: Jayaraman Nirmala , Muench Alexandria , Posner Donn , Seewald Mark , Boyle Julia , Vargas Ivan , Thompson Michelle , Grandner Michael , Perlis Michael
Published: May 2023

Introduction

It has been widely reported in the literature that insomnia, depression, and anxiety are reciprocally related, and that CBT-I not only improves insomnia but also symptoms of depression and anxiety. With respect to cancer, patients of-ten report high co-morbidity of insomnia, fatigue, depression, and anxiety, with fatigue occurring in almost all patients diagnosed with cancer (irrespective of diagnoses and staging) and extending well into survivorship. The underlying mechanisms of fatigue are not well understood and, as such, there could be many contributing factors (e.g., insomnia and mood disturbance). The present analysis is based on a pilot study evaluating whether sleep continuity and CRF is improved by CBT-I dose (4 & 8 [Low dose] vs 10 & 12 [High dose] sessions). The present analysis evaluates whether dose of CBT-I effects depression and anxiety in patients diagnosed with breast and prostate cancer.

Methods

This descriptive analysis (percent change from pre to post treatment) includes 12 adult subjects (83.3% female, Mage 58.4±7.5yrs.; [Low dose, n=6], [High dose, n=6]). CBT-I was provided by a master therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries and weekly measures of fatigue (FACIT), insomnia severity (ISI), depression (PHQ-9), and anxiety (GAD-7).

Results

On the PHQ-9, subjects in the Low dose group exhibited a 57% improvement and subjects in the High dose group had a 52% improvement. On the GAD-7, this corresponded to a 26% improvement (High dose group) and 25% improvement.

Conclusion

As increasingly reported in the literature, CBT-I produced robust effects on depression as assessed by the PHQ-9. The effects on anxiety appear to be less robust. This may be the case because CBT-I’s effects on fatigue are likely to impact a variety of depressive symptoms, where this is less the case for anxiety. Analyses are ongoing, where the relative effects will be adjusted for insomnia-related items and rendered in terms of effect sizes.

Support (if any)

5T32HL00795320;K24AG055602
0848 Total sleep time, wake after sleep onset, and inflammation predict obesity in young adult African Americans
Authors: Boyd Kevin , Bell Kimberly , Chen Yuanxui , Mellman Thomas
Published: May 2023

Introduction

Sleep is vital to maintaining psychological and physiological health. Poor sleep is associated with adverse health outcomes, including obesity. Studies have shown that African Americans disproportionately suffer from poor sleep and the adverse health outcome associated with obesity. We aimed to determine if sleep quality and peripheral inflammation are significant predictors of obesity in a young adult African American sample.

Methods

Participants were healthy adults with a body mass index of less than 40 between 18- 35 who self-identified as Black or African American and completed a protocol consisting of in-lab polysomnography, ambulatory monitoring and a morning blood draw. Height and weight were collected to derive body mass index (BMI). Total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), and sleep efficiency (SE) were derived from in-home actigraphy. Venipuncture was used to collect blood samples within 15 minutes of awakening. Once samples were processed, interleukin-6 (IL-6) levels were detected and quantified using enzyme-linked immunosorbent assays (ELISA).

Results

Significant correlations were found between BMI, WASO, TST, SE, and IL-6. A forward stepwise linear regression was used to identify possible predictors of BMI out of the following candidate variables: TST, SE, WASO, and IL-6. At each step, variables were chosen according to their contribution to the model's R^2. The p-value threshold of 0.05 was used to set a limit on the total number of variables included in the final model. TST, WASO, and IL6 were the significant predictors in the final model that accounted for 26% of the variance in BMI (∆R2 = .260, p<.001). Regression coefficients suggest that IL-6 (β =.388), TST (β= -.234), and WASO (β=.205) predict obesity.

Conclusion

Total sleep time and wake after sleep onset are modifiable protective and risk factors that appear to be significant contributors to obesity in urban-residing young African Americans.

Support (if any)

This research was supported by the NIHLB grants R01HL087995 and R01HL136626 and to Dr. Thomas A. Mellman and NCATS grant for a Clinical Translational Science Award UL1-TR001409.
0852 Insomnia with Objective, but not Subjective, Short Sleep Duration is Associated with Increased Risk of Incident Hypertension
Authors: Li Yun , Dai Yanyuan , Chen Baixin , Chen Le , Fernandez-Mendoza Julio , Karataraki Maria , Tang Xiangdong , Vgontzas Alexandros
Published: May 2023

Introduction

Insomnia with objective short sleep duration (ISSD) has been associated with higher risk of cardiometabolic morbidity. In this study, we examined the association between ISSD, also based on subjective sleep duration, with incident hypertension in the Sleep Heart Health Study (SHHS).

Methods

We analyzed data from 1413 participants free of hypertension or sleep apnea at baseline from the SHHS with a median follow-up duration of 5.1 years. Insomnia symptoms were defined based on difficulty falling asleep, difficulty returning to sleep, early morning awakening, or sleeping pill use more than half days in a month. Objective short sleep duration was defined as polysomnography-measured total sleep time < 6 hours. Incident hypertension was defined based on blood pressure measures and/or use of antihypertensive medications at follow-up.

Results

Insomnia subjects who slept objectively < 6 hours had significantly higher odds of incident hypertension compared to normal sleeping subjects who slept ≥6 hours (OR=2.00, 95% CI=1.09-3.65) or < 6 hours (OR=2.00, 95%CI=1.06-3.79) or insomnia subjects who slept ≥6 hours (OR=2.79, 95%CI= 1.24-6.30). Insomnia subjects who slept ≥6 hours or normal sleepers who slept < 6 hours were not associated with increased risk of incident hypertension compared to normal sleepers who slept ≥6 hours. Finally, insomnia subjects who self-reported sleeping < 6 hours were not associated with significantly increased odds of incident hypertension.

Conclusion

These data further support that the ISSD phenotype based on objective, but not subjective measures is, similar to sleep apnea.

Support (if any)

The Sleep Heart Health Study (SHHS) was supported by National Heart, Lung, and Blood Institute cooperative agreements U01HL53916 (University of California, Davis), U01HL53931 (New York University), U01HL53934 (University of Minnesota), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL53938 (University of Arizona), U01HL53940 (University of Washington), U01HL53941 (Boston University), and U01HL63463 (Case Western Reserve University). The National Sleep Research Resource was supported by the National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002).
0856 Are African-Americans/Blacks with Asthma getting the recommended amount of sleep?
Authors: Hollimon Laronda , Moore Jesse , Rogers April , Nunes Joao , Casimir Georges , Jean-Louis Girardin , Seixas Azizi
Published: May 2023

Introduction

Asthma is one of the leading respiratory illnesses in the United States. African Americans/Blacks are particularly vulnerable to the long-term effects of this condition. In addition to general healthcare inequities, African Americans/Blacks may also have an increased vulnerability to the deleterious effects asthma may enact on health behaviors such as sleep. Comparison between races for how much asthma affects sleep health would be useful to address these vulnerabilities.

Methods

Analysis was performed on the 2020 National Health Interview Survey, the most recently collected data (n=31,568.) The sample was stratified to include only asthmatics using the survey variable that asked “Have you ever been diagnosed with asthma?” 8.6% of the sample reported having asthma (n=2123). Adjusted binary logistic regression was performed to determine how race predicts sleep health in this population. Covariates included age, sex, education, household income, and physical activity. “Healthy Sleep” was coded as self-reported 7-8 hours of sleep, and “Unhealthy Sleep” was coded as either less than 6 hours or more than 9 hours, as literature establishes short and long sleep have deleterious effects on health. “Race” was coded as White, Black, American Indian/Alaskan, or Asian. In the regression, White was used as the reference category.

Results

In the adjusted model for race predicting healthy sleep, only African-Americans/Blacks showed significance compared to other races. The model showed that Blacks who are asthmatic are 54% (p<.01) less likely to sleep for 7-8 hours per day. Asian asthmatics (p=.815), and American Indian asthmatics (p=.761) did not demonstrate significance in the model predicting healthy sleep.

Conclusion

These analyses show a pronounced connection between black racial status and unhealthy sleep amongst asthmatics. The results are in line with literature that demonstrates blacks sleep less in general and are more commonly afflicted with sleep conditions such as OSA, but there is a dearth of research examining how asthma affects sleep in this population. Further studies are needed to examine the underlying factors that may drive these vulnerabilities.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
0877 SLEEP AND PARKINSON’S DISEASE: PREVALENCE IN AN OUTPATIENT MEXICAN CLINIC
Authors: Torrecillas-Gordillo Meliza J , Ferrari-Aquino Anaké L , De la Graza-Manrique Paula M , Marichalar José Garza , Chávez Luévanos Beatriz E
Published: May 2023

Introduction

Sleep disturbance in patients with Parkinson's disease (PD) is highly prevalent. PD is the second most common progressive neurodegenerative disease, affecting about 1% of people over 60 years. Little it's said about the sleep disorders in this disease, which are very frequent and frequently underdiagnosed. In Mexico, there are not a lot of studies on PD and sleep disorders in their population. University Hospital Dr. José E. González having the only Parkinsons' clinic in the northeast of Mexico for the population without medical coverage, has recognized the importance of unreported sleep disorders in their broad patient population.

Methods

Patients of the outpatient clinic whom their medical query wasn’t about sleeping disorder were screened using the following clinical tools: the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), the STOP-BANG Questionnaire, and the Epworth Scale. A full clinical history was also taken, focusing on sleep habits and risk factors that could contribute to sleep difficulties.

Results

A total of 65 patients (26 females, 39 males) that attended the outpatient Parkinson’s clinic were screened for sleep disorders. Fifty-nine patients (90.7%) were identified with at least 3 risk factors for obstructive sleep apnoea with the STOP-BANG questionnaire and were ordered polysomnography. Using the PSQI we identified 56 patients (86.1%) with low-quality sleep (defined as a score of 5 or higher). With the PHQ-9 we identified 41 patients (63%) with a high risk of depression, none of them were receiving treatment. And the Epworth Scale helped us identify 33 patients (50%) with a possible pathological excessive daytime sleepiness, none of them diagnosed.

Conclusion

PD is associated with multiple sleep disorders, which commonly impair quality of life. Routine inquiry about sleep problems from healthcare providers can increase its detection in a clinical setting outside of a sleep clinic and better management. Further research should focus on improving screening and diagnostic tools in the PD population. With this initiative, we present our experience and results incorporating routine screening for these disorders, future exploration toward this direction may hopefully shed light on developing effective, mechanisms-driven treatment options.

Support (if any)
0900 A Community-based Survey of Personal Perspectives Regarding Prodromal Sleep Screening for Neurodegenerative Disorders
Authors: Levendowski Daniel , Berka Chris , Neylan Thomas C , Mazeika Gandis , Walsh Christine , Boeve Bradley , St. Louis Erik
Published: May 2023

Introduction

Sleep markers can assess prodromal risk for neurodegenerative disorders (NDD). In a recent study conducted by the Mayo Clinic, most isolated REM sleep behavior disorder patients preferred knowing about their risk for parkinsonism or dementia. In their email survey, patients indicated a strong preference for disclosure of prognostic NDD risk in order to spur family discussions and plan for the future. For this pilot study, the Mayo questions were modified in order to investigate the perspectives and preferences of community-based adults about potentially being at-risk of a NDD and how it might impact their lives.

Methods

A brief survey was administered to Rotary Club attendees prior to a presentation on sleep and neurodegenerative disease. Each question offered five responses: strongly disagree, disagree, neutral, agree, or strongly agree. Personal identifiers were not obtained. Thirty-four surveys were completed from approximately equal numbers of older men and women with estimated ages above 50 years. Personal information were not obtained (e.g., age and sex).

Results

When asked whether it was important to know their NDD risk given the fact that there are no known methods to prevent or cure the disease, most (83%) strongly agreed or agreed, while only 18% preferred not to know their NDD risk. The majority felt they would be more pessimistic about their future if identified as being at risk of NDD the (62% strongly agreed/agreed). Most believed their priorities and plans for living life would change (68% strongly agreed/agreed). Further, the vast majority felt that knowing NDD risk would help them plan for the future (89% strongly agreed/agreed), including planning for health resources and support (88% strongly agreed/agreed).

Conclusion

Eighty-three percent of those surveyed reported they would benefit from knowing if they were at risk of NDD, even though the majority would feel more pessimistic about their future. The vast majority (89%) responded that knowing their NDD risk would help them plan for the future. These results suggest that most community adults might be receptive to future sleep screening for NDD with results. Investigations are underway to confirm these findings in a broader community-based study.

Support (if any)

NIA-R44AG050326
0902 Comparative Analysis of Sleep Apnea Patients Selected from the Stroke Unit vs Outpatient Clinic
Authors: Seo Jun Hyeok , Yang Tae-Won , Kim Seung Hwan , Kim Mi-Ji , Ko Nak Gyeong , Jeon Byeong Gu , Kim Ji Yoon , Lee Jin Gyeong , Kwon Oh-Young , Kim Young-Soo , Kim Do-Hyung
Published: May 2023

Introduction

To our knowledge, there have been studies actively looking for patients with suspected SA in the Stroke Unit (SU), but most of them were conducted using a portable polysomnography (PSG), and no study has performed Level 1 PSG (L1PSG) to date. We conducted L1PSG to the acute stroke patients selected in the SU, and conducted L1PSG to patients who visited the Neurology Outpatient Clinic (NOC) with subjective SA symptoms at the same time. By comparison, we tried to find out the SA characteristics of acute stroke patients.

Methods

This study was conducted on patients admitted to SU from April 1, 2021 to October 31, 2022, and patients who visited NOC during the same period and underwent L1PSG. Among patients admitted to the SU, trained night shift nurses selected patients with SA symptoms with a modified mallampati score of 3 or higher. Cases under intracranial pressure control or other interventions were excluded. Outpatients were enrolled in patients who underwent L1PSG by visiting the NOC to examine only SA. The results of the pre-sleep questionnaire and L1PSG were compared.

Results

Of a total of 829 stroke patients admitted to SU, 31 SU patients received L1PSG, and during the same period, 74 patients received L1PSG for SA testing at NOC. The average age of SU and NOC was 56 and 57 years, and the median BMI was 26.9 and 26.4. In the survey, the ISI (7 vs 12, p=0.04) and PSQI (5 vs 7, p=0.021) scores were statistically significantly higher in NOC patients. As a result of the L1PSG, AHI (38.8 vs 23.1, p=0.027), AHI in Supine (59.3 vs 25.6, p=0.004) and NonREM AHI (36.3 vs 20.9, p=0.027) were statistically significantly higher in SU patients.

Conclusion

Patients screened SA at SU overlooked their symptom and thought their sleep quality was better than that of NOC patients, but the actual AHI was higher. In particular, acute stroke patients show a large difference in AHI in supine compared to NOC, so lateral position can be recommended when absolute bed rest is needed in situations where SA is suspected in SU. More follow-up studies will be needed.

Support (if any)
0904 Exaggerated hypoxia burden of sleep apnea in patients with hyperacute lateral medullary infarction
Authors: Hong Yooha , Im Hee-Jin
Published: May 2023

Introduction

Acute lateral medullary infarction (LMI) can sometimes appear with respiratory failure in the acute stage. Polysomnographic investigations have shown a specific association between LMI and sleep apnea syndrome. The aim of our study was to investigate this association in hyperacute stage of LMI.

Methods

We investigated 8 patients who underwent polysomnography (PSG) for sleep apnea during hyperacute stage of LMI and compared the data to 8 healthy control subjects matched according to age, sex, body-mass index (BMI), and apnea-hypopnea index (AHI). The PSG was performed within an average of 1.5 days after the onset of neurological symptoms. PSG recordings in the hyperacute phase of LMI were analyzed.

Results

Six patients were males (75%) and two were females (25%). The average age of the patients was 51.9 ± 14.5 years and the average BMI was 27.2 ± 3.5. According to the AHI results of patients with LMI in the hyperacute phase, there were 2 (25%) cases of mild obstructive sleep apnea (OSA), 2 (25%) cased of moderate OSA, and 4 (50%) cases of severe OSA. The central sleep apnea index was higher in the patient group (4.3 ± 5.4/hr) than the control group 0.6 ± 0.4/hr) and was statistically significant (p=0.035). On the other hand, sleep parameters (obstructive sleep apnea index, respiratory arousal index, mean saturation) related to obstructive sleep apnea were poor in the control group.

Conclusion

Our study showed that sleep apnea syndrome, particularly CSA, is common in the hyperacute phase of LMI compared to control group. Early recognition of this problem and appropriate intervention may minimize the adverse effects on the respiratory system and improve the prognosis. Further and follow-up studies are needed to clarify the clinical significance and appropriate treatment options in these patients.

Support (if any)