bluuebunny/crossref_metadata_2025 huggingface dataset:
0491 Sleep among Adolescents in Juvenile Detention
Authors: Levenson Jessica , London Sarah , Ekas Deana , Woods Mary , Vojtash Misty , Mulvey Edward , Miller Elizabeth
Published: May 2022

Introduction

Adolescents involved in the juvenile justice system demonstrate high rates of psychiatric disorders, suicidality, and trauma, all of which is associated with poor sleep. Poor sleep is common among adolescents and is associated with numerous adverse outcomes like inattention, school absenteeism, emotion dysregulation, and substance use, outcomes that are related to juvenile justice system involvement. Yet very little is known about the sleep of adolescents involved in the juvenile justice system. We conducted a medical chart review and survey of detained adolescents to describe the sleep patterns and problems among these youth.

Methods

We reviewed a random sample (26%) of the medical charts of youth detained in a juvenile detention center (n=31) over four days in Summer 2021. We reviewed all medical encounters in the month prior to the date of chart review. Additionally, 13 youth completed the Patient Reported Outcome Measurement Information System Pediatric Sleep Disturbance Short Form (PROMIS-SD). Twelve of them reported their sleep patterns while in detention.

Results

Sleep was mentioned in 23% of all medical encounters, 62% of which indicated poor sleep. Sleep treatment was documented in 24% of notes, all consisting of pharmacotherapy. A sleep diagnosis was documented on 37% of billing sheets of all youth seen by a medical provider in the detention center in July 2021. On average, participants reported lights out around 9pm (SD=35min), sleep onset latency of 74mins (SD=75mins), wake time after sleep onset of ~20 minutes (SD=16mins), and wake-up time of 7:50am (SD=67min). Youth reported average sleep duration of more than 9 hours while detained (SD=103mins). Average PROMIS-SD score was 66.2 (range 51.5-79.1)

Conclusion

Though most youth obtain the recommended amount of sleep while detained, sleep disturbance is highly common among this population and average sleep disturbance is more than one standard deviation above the average. These data may inform the type of sleep interventions that are most relevant to detained youth. Future work should focus on further examining the sleep of adolescents in the juvenile justice system and identifying feasible, acceptable, and useful strategies for implementing evidence-based sleep interventions in this setting.

Support (If Any)

Dr. Levenson’s effort was supported by K23HD087433
0518 Clinical Correlates, Diagnosis, and Management of Sleep-disordered Breathing in Young Children with Down Syndrome
Authors: Seither Katelyn , Suhrie Kristen , Helm Benjamin
Published: May 2022

Introduction

Individuals with Down syndrome (DS) have high rates of sleep-disordered breathing and demonstrate more severe manifestations of obstructive sleep apnea (OSA) compared with non-syndromic patients. The consequences of untreated OSA in childhood include pulmonary hypertension, cognitive dysfunction, and abnormal growth. The American Academy of Pediatrics recommends that children with DS have a sleep study by age four years. It is unclear if these guidelines are sufficient to address the burden of disease in very young patients. There is also a paucity of data regarding clinical characteristics associated with OSA and outcomes following medical or surgical intervention in this population.

Methods

A retrospective cohort study was performed at Cincinnati Children’s Hospital Medical Center for all children with DS born between 2013-2019. Electronic medical record data were extracted including demographics, use of PSG, incidence of OSA, age at diagnosis, OSA severity, and interventions utilized. Statistical analysis used Fishers exact tests and analysis of variance with a significance threshold of p < 0.05.

Results

A total of 397 patients met inclusion criteria and 235 (59%) had a sleep study. Most patients (n = 221, 94%) had an abnormal PSG and 60% had moderate or severe disease. There was an inverse relationship between age at first sleep study and OSA severity (p <0.0001). Most patients (82%) had a sleep study due to the presence of symptoms; among asymptomatic patients, 91% met polysomnographic criteria for OSA. OSA severity was associated with increased rates of failure to thrive (p < 0.01), aspiration (p = 0.005), G-tube feeding (p = 0.025), and pulmonary hypertension (p = 0.005). Most patients (n=178, 79%) required multiple interventions to manage their OSA.

Conclusion

In this cohort of infants and young children with DS who underwent PSG, a majority had moderate to severe OSA. The pervasiveness of severe disease in young infants suggests that current surveillance guidelines are inadequate. Infants should be evaluated with PSG in the first month of life regardless of clinical symptoms. Further study is needed to prospectively evaluate the impact of early diagnosis and intervention on long term outcomes.

Support (If Any)
0528 Development of Pediatric OSA Health Communication Messaging for and with Parents
Authors: Honaker Sarah , McQuillan Maureen , Binion Kelsey , Brann Maria
Published: May 2022

Introduction

Pediatric obstructive sleep apnea (OSA) is often undetected, due in part to gaps in parental awareness of OSA symptoms. To activate parents to talk to their child’s provider about OSA symptoms, there is a need for effective OSA health communication messaging.

Methods

We developed a health communication message in the form of an infographic, designed to help parents recognize the link between nighttime and daytime OSA symptoms. The message encouraged parents who saw these symptoms in their child to speak with their child’s provider. The infographic was iteratively reviewed, rated, and refined through a series of twelve virtual focus groups with three types of stakeholder: parents of children with OSA symptoms (n=24), primary care providers (n=9), and sleep medicine specialists (n=4). During groups, we elicited reactions and asked participants to rate various aspects of the message.

Results

Stakeholder feedback (semi-structured sessions and anonymous ratings) was elicited for the initial draft and two subsequent iterations of the message that incorporated prior feedback. Anonymous stakeholder ratings were measured on a scale from 1-5, with 5 denoting stronger endorsement of the construct. Parents rated the message positively for content (M=4.77; SD=0.44), literacy demand (M=4.92, SD=0.28), graphics/design (M=4.69, SD=0.63), and activation (M=4.77, SD=0.44). Sleep medicine providers perceived the message as accurate (M=5.0, SD=0) and primary care providers rated it as acceptable (M=4.67, SD=0.58) and feasible (M=4.33, SD=0.58) for display and dissemination in primary care settings.

Conclusion

We developed a pediatric OSA health communication message that was rated highly by parents, primary care providers, and sleep medicine specialists. Next steps are to disseminate and evaluate the impact of the message on pediatric OSA detection.

Support (If Any)

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL150299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0540 First Year PAP Trajectories among Treatment-Naive Youth with Sleep Disordered Breathing
Authors: Krietsch Kendra , Duraccio Kara , Peugh James , Carmody Julia , Simmons Danielle , Byars Kelly
Published: May 2022

Introduction

Little is known about the time course for youth adjusting to and achieving optimal PAP adherence.

Methods

This retrospective study identified 12-month PAP trajectories and treatment persistence following treatment initiation in youth. Participants were first-time PAP initiators receiving care at Cincinnati Children’s Hospital from 07/2017-12/2019. Electronic downloads provided monthly PAP use. Adherence indicators were frequency (percentage of nights PAP used each month) and duration of use (average usage hours on nights used each month). Persistence of group-level adherence (frequency and duration) was measured via descriptive statistics in SPSS. Adherence sub-groups were identified using longitudinal mixed models in MPlus.

Results

The sample was 169 youth ages 2-22yrs started on PAP. Within the first month, 55% of participants were using PAP >50% of nights and 43% were using for >4 hours/night. Adherence (frequency and duration, respectively) decreased by month as follows: month 3 - 48% and 42%; month 6 - 41% and 41%; month 12 - 36% and 32%. Longitudinal mixed models identified 5 trajectories for frequency of use (based on the model of best fit using BIC index): “starts high, stays high” (34% of sample); “starts high, slowly decreasing” (7%); “starts high, rapidly decreasing” (12%); “starts low, slowly increasing” (8%); “starts low, stays low” (39%). Two trajectories were identified for duration (average hours worn on nights used, also based on model of best fit) and included: “starts high, slowly increasing” (40%) and “starts low, stays low” (60%).

Conclusion

At the group level, PAP adherence was sub-optimal in the first month of use (around half of participants using PAP >50% of nights or for >4 hours) and declined over the subsequent 11 months. However, mixed models identified distinct adherence subgroups, with about 40% of the sample falling into subgroups with relatively high adherence by month 12. This suggests acclimation to PAP takes time in a pediatric population. Findings may help clinicians/policy makers set realistic expectations around time to achieve optimal PAP adherence among youth, and highlights the need for further PAP adherence promotion interventions.

Support (If Any)

First, and fourth authors’ time supported by NIH post-doctoral training grants (T32 DK063929 and T32HD068223, respectively).
0542 Pediatric Obstructive Sleep Apnea and Poor Appetite
Authors: Tah Sumeer , Modi Meet , Brennan Christine , Rangan Pooja , Castro Walter , Lee-Iannotti Joyce , Rihawi Anas , Knobbe Kirstin
Published: May 2022

Introduction

Obstructive Sleep Apnea (OSA) has many impacts on homeostasis. In pediatrics, there have been links observed between health problems and OSA including failure to thrive, obesity, and behavioral disorders. Existing literature evaluates the links between excess weight, obesity, and OSA. However, there is a lack of research exploring the association between OSA and reduced appetite as a contributor to failure to thrive in the pediatric population. In this study, we hypothesized there is a positive correlation between OSA severity and the presence of poor appetite.

Methods

We analyzed data retrospectively through medical records of 155 pediatric patients (age < 18 years old) who were diagnosed with OSA by pediatric criteria via polysomnography from April through November 2021. Data was collected from a pre-completed questionnaire done by the guardian or child during the sleep study intake. Poor appetite symptoms were ranked on a Likert scale of occurring “never”, “rarely”, “occasionally”, “frequently”, “regularly”, or “don’t know.” The presence of poor appetite symptoms was compared to the severity of pediatric OSA diagnosed during the sleep study. Pearson chi-squared test and Spearman’s correlation coefficient were calculated on the data sets.

Results

Of 155 patients, 33 (21.3%) were diagnosed with mild OSA, 70 (45.2%) with moderate OSA, and 52 (33.5%) with severe OSA based on pediatric criteria. A total of 53 patients reported poor appetite occasionally, frequently, or regularly. 29.4% of patients with mild OSA reported poor appetite, along with 45.7% of patients with moderate OSA, and 21.2% of patients with severe OSA. Of all patients who reported poor appetite, 60.3% had moderate OSA. However, there was a non-statistically significant correlation between apnea hypopnea index (AHI) and the presence of poor appetite symptoms, Spearman's correlation coefficient of -0.1044 (p-value 0.1960).

Conclusion

Overall our data did not show a significant correlation between OSA severity and poor appetite symptoms. There was an association between poor appetite and moderate OSA, however this data is limited by selection bias as 45.2% of patients were categorized as moderate OSA. Further studies are needed, including analyses with similar size populations of each OSA severity category.

Support (If Any)
0546 An Informatics Approach to Assessing Quality of Care Metrics for Restless Legs Syndrome/Willis-Ekbom Disease
Authors: Bongers Quinn , Kunisaki Ken , Irfan Muna
Published: May 2022

Introduction

Management of restless legs syndrome (RLS, aka Willis-Ekbom Disease) with dopaminergic agents is often complicated by development of augmentation. Clinical practice guidelines and stepwise algorithms suggest that prior to prescribing dopaminergic agents, clinicians should assess iron stores and consider alpha-2-delta agents (e.g. gabapentin). We developed an informatics approach to assess quality of care metrics for RLS management.

Methods

We used Veterans Affairs (VA) electronic health record data to identify a cohort of patients at a single tertiary care academic VA facility prescribed dopaminergic agents between 01 Jan 2018 to 31 Dec 2019. Patients with any prior codes for Parkinson’s disease were excluded. A random sample of charts were manually reviewed to determine if dopaminergic drugs were being prescribed for RLS or other indications. We then assessed for evidence of prior iron store assessments, iron repletion if appropriate, and alpha-2-delta agents (gabapentin, pregabalin).

Results

We identified 1160 patients treated with dopaminergic agents and no prior Parkinson’s codes. Chart reviews indicated 95% accuracy of this methodology to identify dopaminergic use for RLS. Evidence of pre-treatment iron storage assessment was missing in 30.2% for ferritin and 33.5% for transferrin saturation. Among those with iron studies present, lack of iron replacement was noted in 34% of those with ferritin <75 mcg/L and 33% of those with transferrin saturation <20%. Prior or concomitant prescriptions of alpha-2-delta agents was present in 59.7% of the cohort.

Conclusion

Our informatics approach provides an accurate and efficient means to quantify RLS care metrics. Results were most notable for a high proportion of dopaminergic-treated RLS patients without iron assessments and without iron repletion when stores were low. This methodology will inform future quality improvement initiatives to improve the delivery of guideline concordant RLS care.

Support (If Any)

This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Health Care System, Minneapolis/USA.
0563 Association between actigraphic sleep measures and lymphocyte subsets in people with chronic HIV infection
Authors: Sharma Malvika , Borker Priya , Macatangay Bernard , Punjabi Naresh , Rinaldo Charles , Wolinsky Steven , Cho Joshua Hyong-Jin , McKay Heather , Patel Sanjay
Published: May 2022

Introduction

While inadequate sleep is known to increase inflammation in immunocompetent individuals, it is unknown if poor sleep worsens inflammation in people living with HIV. The ratio of CD4+/CD8+ T cells is a readily derived measure of chronic inflammation in people living with HIV. We sought to investigate the association between lymphocyte subsets and actigraphy-derived sleep measures in a cohort of HIV seropositive men.

Methods

HIV seropositive men on antiretroviral therapy for > 1 year and with undetectable (< 20 copies/mL) plasma HIV-1 RNA participating in the Multicenter AIDS Cohort Study underwent a sleep evaluation with 1 week of wrist actigraphy. Data from 287 participants with ≥ 5 days of actigraphy were analyzed. We evaluated three dimensions of sleep: mean nocturnal sleep duration, sleep onset latency, and sleep maintenance efficiency. Linear regression was used to assess the association between each sleep dimension with CD4+ and CD8+ T-cell counts. Because of a U-shaped association, nocturnal sleep duration was also modelled dichotomously as a normal (6-8 hrs) vs. abnormal duration (<6 or >8 hrs).

Results

Participants had a mean (±SD) age of 55 ± 12 years, mean CD4+ count of 723 ± 293 cells/ml, and 7.0 ± 1.7 days of actigraphy data. None of the sleep measures were associated with CD4+ counts. However, participants with abnormal sleep duration had 129 ± 31 cells/mL higher CD8+ counts compared to those with normal sleep duration (p=0.01). There were also nonsignificant trends whereby every 30-minute increase in sleep latency was associated with a 138 cells/ml increase in CD8+ count (p=0.07) while every 10% reduction in sleep efficiency was associated with a 56 cells/ml increase in CD8+ count (p=0.12). These findings were unchanged after adjusting for age and body mass index.

Conclusion

Among men with treated HIV infection, abnormal sleep duration (both short and long) is associated with increased circulating CD8+ T cell count, suggesting increased chronic inflammation.

Support (If Any)

NIH AI0355041, HL082610 and American Thoracic Society ASPIRE Fellowship
0570 Does CBT-I Dose effect Sleep Duration and Fatigue in Breast and Prostate Cancer Patients?
Authors: Muench Alexandria , Posner Donn , Seewald Mark , Upton Caitlyn , Boyle Julia , Reddy Varudhini , Thompson Michelle , Vargas Ivan , Perlis Michael
Published: May 2022

Introduction

Cancer-related fatigue (CRF) is highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing some level of CRF. While CRF commonly co-occurs with sleep disturbance during and/or after cancer treatment, CRF is defined as occurring independent of sleep considerations. The present analysis is based on an ongoing pilot study where CBT-I dose (4 & 8 [Low] vs 10 & 12 [High] sessions) is being assessed for whether improved sleep continuity and/or increased TST can improve CRF in subjects diagnosed with breast and prostate cancer.

Methods

This interim analyses includes seven adult subjects (6 females, mean age=57.1 yrs.; n=3 [Low dose], n=4 [High dose]). CBT-I was provided by a master CBT-I therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries, and weekly measures of fatigue (FACIT) and insomnia severity (ISI) questionnaires.

Results

Subjects in the low dose group exhibited a 9% improvement and subjects in the high dose group had a 21% improvement on the FACIT. This corresponded to a 28% improvement on the ISI (low group) and a 68% improvement on the ISI (high group). With respect to TWT, subjects in the low dose group decreased their wake time by 36% and those in the high dose group decreased their wake time by 43%. Finally, TST decreased by 7% in the low dose group but increased by 12% in the high dose group.

Conclusion

Preliminary results indicate that a higher CBT-I dose may significantly decrease fatigue, stabilize sleep schedules, and improve sleep continuity in patients with CRF, where the high dose group showed more than double the improvement on the FACIT and ISI (as compared to the low dose group). Not surprisingly, TWT was roughly comparable between the groups while TST was more substantially impacted by high dose CBT-I. This study is ongoing.

Support (If Any)

Support: 5T32HL00795320;K24AG055602
0575 Characterization of the Prevalence of Sleep Disturbances in Cardiovascular and Neurological Patients from the Rush Heart Center for Women
Authors: Johnson Andrew , Goel Namni , Casale Courtney , Volgman Annabelle , Aggarwal Neelum
Published: May 2022

Introduction

Anecdotally, patients with cardiovascular and neurological medical conditions present with sleep disturbances in duration, efficiency, and timing, or with sleep disorders such as obstructive sleep apnea. The frequency of such disturbances remains unknown as does whether they result from cardiovascular and neurological conditions or contribute to the development of these conditions. Thus, characterizing the prevalence of sleep disturbances in this unique clinical population is a first step to establishing the important role of sufficient, healthy sleep for patient care and treatment.

Methods

We conducted a retrospective electronic chart review of patients from the Rush Heart Center for Women (RHCW) based on the following: age, sex, race, body mass index (BMI), blood pressure (BP), sleep studies, cardiac testing, and neurologic testing. Patients were also characterized based on prevalent disease (cardiac, neurologic, or both) including the following: cardiac—coronary artery disease, ischemic vs. non-ischemic heart disease, atrial fibrillation, heart failure, etc; neurologic—vascular etiology, mild cognitive impairment, dementia, Alzheimer’s Disease, etc. We then performed a database search to identify patients who also met the criteria for sleep apnea or for whom a sleep study was ordered due to sleep disturbances.

Results

103 patients (mean age±SD, 68.71±12.55 years; 78 females; mean BMI±SD, 28.65±5.28; 79 White, 14 African American, 4 Asian, 1 Native Hawaiian, 5 Other; mean BP±SD, 128/72±20/9; mean±SD Mini-Mental State Examination (MMSE), 27.47±3.24) had cardiovascular and/or neurological conditions. Of these, 53 patients (mean age±SD, 68.31±9.35 years; 40 females; mean BMI±SD, 29.91±5.73; 39 White, 7 African American, 2 Asian, 1 Native Hawaiian, 4 Other; mean BP±SD, 129/73±21/9; mean MMSE±SD, 27.67±2.99) also presented with sleep apnea symptoms or sleep disturbances.

Conclusion

A strikingly high percentage (51.5%) of patients at the RHWC who had cardiovascular and/or neurological conditions also presented with sleep apnea or sleep disturbance symptoms. The prevalence of this trifecta of disease (cardiovascular, neurological, and sleep apnea/disturbance) demonstrates the criticality of considering the interplay between these various domains when administering clinical care to patients. Future research capitalizing on the physiological and neurobehavioral benefits of adequate, healthy sleep in this population is warranted.

Support (If Any)

RMC Dean’s Award Summer Research Fellowship; NASA NNX14AN49G and 80NSSC20K0243; NIH R01DK117488
0593 Maxillomandibular Advancement Referrals and Follow-up After Drug Induced Sleep Endoscopy
Authors: Rodin Julianna , Fiorella Michele , Taub Daniel , Champion Allen , Boon Maurits , Huntley Colin
Published: May 2022

Introduction

Several surgical options exist for treating obstructive sleep apnea (OSA), but few correct airway obstruction at multiple levels like maxillomandibular advancement (MMA). MMA has been shown to significantly improve OSA, decrease sleepiness, and also improve quality of life. Despite the accepted success of MMA surgery, it is unclear if patients referred for MMA undergo MMA or are lost to follow-up in real world clinical care. This quality improvement study aims to determine if patients referred for MMA by ENT sleep surgeons then undergo MMA surgery by oral maxillofacial surgeons (OMFS).

Methods

At our academic urban hospital, all drug induced sleep endoscopy (DISE) cases performed on OSA patients by two otolaryngology sleep surgeons were reviewed over a one year period. Patients who were not recommended for MMA based on DISE findings were excluded. Retrospective chart review included VOTE classification, DISE findings, and referrals for MMA to the OMFS clinic. Other data included age, BMI, past medical history, sleep study data including AHI and oxygen nadir, and if MMA or other OSA treatments were done.

Results

Out of 408 DISE performed, 58 patients (14.2%) were referred to our OMFS for MMA. Patients’ demographics were: male (48; 82.8%); average age: 51; average BMI: 32.5; 39 (67.2%) with comorbidities. Sleep studies included: 32 HSATs, 22 PSGs, 4 missing. 41 patients (75.9%) had severe OSA. Average O2 nadir was 75%. On DISE, most patients had some level of obstruction at all anatomic subsites (94.8%). All patients had complete obstruction at the level of the palate or velum. 41 (70.7%) also had additional anatomic abnormalities noted including maxillary constriction, midface hypoplasia, retrognathia or micrognathia. From 58 patients recommended for MMA, 35 (60.3%) followed up in OMFS clinic and 11 (31.4%) underwent MMA surgery. Five patients (14.3%) received OATs. 11 patients (19%) had CPAP re-evaluation. 27 patients (46.6%) were lost to follow-up.

Conclusion

Of patients referred by ENT to OMFS following DISE, only 60% were seen at OMFS clinic and only half of these patients underwent MMA. While some received other treatments, nearly half were lost to follow-up altogether. We propose a revised workflow to improve patient education, acceptance, and coordination of OSA care and follow-up.

Support (If Any)
0596 Sleep Disturbances in Cystic Fibrosis and Primary Ciliary Dyskinesia Over Time, Before and After Modulator Therapy
Authors: Cohen-Cymberknoh Malena , Lehavi Maya , Atia Ohad , Gileles-Hillel Alex , Reiter Joel
Published: May 2022

Introduction

Prior studies have shown that cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are associated with sleep disturbances affecting quality of life (QOL).Our aim was to analyze changes in sleep complaints over time in patients with CF and pancreatic insufficiency (CF-PI), pancreatic sufficiency (CF-PS) and PCD, and explore the effect of CFTR modulators.

Methods

Patients completed age-appropriate sleep quality questionnaires (SDSC, PSQI), quality of life questionnaires (PedQL, QOL-BE) and the Epworth sleepiness scale (ESS). They repeated the same questionnaires 3 years later. In addition, medical records were reviewed for clinical data.

Results

Of a total of 50 patients, 27 were children and 23 were adults: 33 CF-PI, 8 CF-PS and 9 PCD. On the 3-year follow up questionnaires the PSQI revealed reduced sleep quality in 11 adult patients (47%), and the SDSC score was pathological, in 5 children (18.5%), suggestive of high rates of disturbed sleep. In children the mean SDSC score had not changed from baseline (41.1±11.5) to follow up (42.5±12.35; p=0.778). In adults the PSQI increased from 3.7±2.5 to 4.5±2.8 (p=0.075), most pronounced in adults that were not on modulators (3.9±2.7 to 4.8±3.4; p=0.027). This effect was driven primarily by changes in sleep initiation and maintenance domains. There were no other differences in the sleep complaints between CF-PI, CF-PS and PCD patients, or between patients on and off modulator therapy during the study period.

Conclusion

Over time, quality of sleep worsened in patients with CF and PCD, particularly the ability to initiate and maintain sleep. Our results may suggest that modulator treatment attenuates the worsening of sleep complaints, however, larger studies are needed to clarify this.

Support (If Any)

None
0603 Changes in Healthcare Visits and Exercise habits Associated with Poor Sleep in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Kokonda Manasa , Debian Ahmad , Arentson-Lantz Emily , Shaib Fidaa , Nowakowski Sara
Published: May 2022

Introduction

Patients may be experiencing increased stress and sleep disturbance due to healthcare and changes in daily habit during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and daily habits on sleep.

Methods

Sleep medicine clinic patients completed an online survey during the pandemic and again 6 months later (December 2020 - May 2021), where they answered questions about COVID-19 (COVID-19 vaccination and test results, changes in health care visits and habits during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). General linear regression model was performed using SAS to determine if changes in healthcare and daily habits predicted poorer sleep.

Results

Among 81 patients who completed baseline survey, 54 (aged 55.2±18.4 y, 61% female, 70% Caucasian) completed the 6-month follow-up survey. Among them, 6% tested positive for COVID-19 and 83% were vaccinated. 30% changed their healthcare office appointments to telephone visits, 50% changed to video visits; whereas 22% cancelled and 30% rescheduled their healthcare appointments. At baseline, changes in health care visits had significant increase on ISI (3.98 ± 1.66, p=0.02). Upon follow-up, changes in health care visits had significant increase on ISI (4.77 ± 2.12, p=0.03) and Sleep Impairments (7.97 ± 3.83, p=0.04). A decrease in exercise predicted lower Sleep Disturbance (6.81 ± 3.31, p=0.04).

Conclusion

Sleep medicine patients who reported changes in health care visits at baseline and 6-month follow up reported higher insomnia severity, and sleep-related impairments. Changes in healthcare had deleterious effects on sleep and should be considered when managing patients’ healthcare. Unexpectedly, patients who reported a reduced level of exercise reported improved sleep. Pandemic public policies (e.g., gym closures) may have made it more difficult to exercise but allowed for greater opportunity to sleep.

Support (If Any)

This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0606 A Paradigm for Testing the Accuracy of Digital Sleep Staging Systems
Authors: Gerardy Bethany , Tomson Heather , Kuna Samuel , Pack Allan , Walsh James , Kushida Clete , Younes Magdy
Published: May 2022

Introduction

Despite evidence showing that agreement between human and some automatic staging systems is generally comparable to agreement between human scorers, automated scoring is rarely used in clinical practice, even though it offers time savings and consistency. We propose a paradigm for testing digital systems that reveals their true accuracy vs. highly experienced academic scorers. As an example of a digital method to be tested, we used Michele Sleep Scoring (abbreviated:Digital).

Methods

70 PSGs were scored by 6 experienced technologists from 3 academic centers. Staging results were compared to digital staging results using an epoch-by-epoch approach. For each PSG we carried out 6 cycles of comparisons. Each cycle consisted of two steps, one comparing one scorer (tested scorer) with the scoring of the five remaining scorers (judges), and one comparing Digital as the tested scorer with the same 5 judges. Error 1 was assessed when all judges disagreed with the tested scorer but there was disagreement between the judges. Error 2 was assigned when all judges disagreed with the tested scorer but agreed unanimously on the stage. For each PSG the number of epochs with types 1 and 2 errors was counted for each scorer (n=6 scorers) and for Digital. Results of all 70 PSGs were pooled, and percent of types 1 and 2 errors is reported for all scorers and Digital.

Results

70 PSGs (females aged 51.1 ± 4.2 years) were evaluated. Average times in different sleep stages (manual scoring) were 43±18, 244±47, 30±21, and 81±25 minutes for stages N1, N2, N3 and REM, respectively. TST was 398±52 minutes, and sleep efficiency was 84±8%. There was a total of 65,053 epochs scored by each scorer and Digital. The average percent of type 1 errors made by scorers for all epochs was 6.4% (0-33.2) vs. 7.8% (1.68-26.6) made by Digital. The average percent of type 2 errors made by scorers for all epochs was 3.9% (0-28.6) vs. 4.3% (0-17.3) made by Digital.

Conclusion

This study provides an objective way of testing the accuracy of automated scoring systems and supports evidence that the accuracy of Michele Sleep Scoring is comparable to manual scoring.

Support (If Any)

None
0620 Is SVI a Risk Factor for Sleep and Cardiometabolic Health Among Blacks?
Authors: Locklear Clarence , Jin Peng , Seixas Azizi , Briggs Anthony , Rogers April , Turner Arlener , Blanc Judite , Jean-Louis Girardin
Published: May 2022

Introduction

The Social Vulnerability Index (SVI) is a novel metric that incorporates a multitude of population factors to predict the susceptibility of communities to deleterious effects of disaster, natural hazards, and environmental insult. Studies show socioeconomic status (SES), an important component of SVI, is a risk factor for cardiometabolic disease and sleep quality. Objectives: This study examined the effect of SVI on cardiometabolic and sleep health among Blacks.

Methods

We utilized harmonized data extracted from two NIH-funded studies enrolling Blacks (i.e., MetSO and PEERS-ED registries). Participants (N=1,497) included New York residents; 65% were male, with a mean(SD) age of 55(±16.2). Data were collected via self-reports (e.g., ARES questionnaire) for sleep quality/duration and cardiometabolic factors (e.g., weight and diet). SVI components included SES, household composition, minority status, and housing type. Mixed-effect logistic regression models were applied, which assessed the effect of SVI and its many subcomponents on each health-related variable of interest. The model was adjusted for age, sex, and education to account for the effects of these factors overlapping in the SVI subcomponents.

Results

Approximately 81% of the sample population was obese, 37.9% were diabetic, 62.3% had a history of hypertension, and 18.4% with a heart disease. Regarding sleep health, 7.7% suffered from sleep apnea, 66.6% were short sleepers, 6.64% were long sleepers, and 14.2% reported insomnia. They had a mean(SD) sleep time of 5.92(±2.05) hours. “Overall SVI” was associated with hypertension (OR=3.98) and “housing type & transport” was correlated with heart disease (OR=4.44) prior to adjusting the model. Applying the adjusted model, “minority status & language” predicts obesity (OR=5.32). Also, “overall SVI” and “SES” were associated with diabetes (OR=3.26; OR=2.71) and hypertension (OR=4.00; OR=3.95). “Household composition” approaches significance as a predictor for sleep apnea (unadjusted - OR=0.26; adjusted - OR=0.26) despite the relatively low case proportion.

Conclusion

SVI seems to be a good indicator of cardiometabolic health among Blacks. However, it is likely a poor marker for sleep health in that population, although trends were observed suggesting that it might play an important role. Further studies are necessary to elucidate the role of SVI on sleep health among Blacks.

Support (If Any)

R01HL142066, R01HL095799, RO1MD004113, R01HL152453
0630 A 4-Week Sleep Intervention that Advances and Stabilizes Sleep Timing Leads To Meaningful Improvements in Pain and Physical Function in People With Fibromyalgia
Authors: Burgess Helen , Bahl Sonal , Wilensky Katelyn , Spence Emily , Jouppi Riley , Rizvydeen Muneer , Goldstein Cathy , Williams David , Kim Myra , Burns John
Published: May 2022

Introduction

Fibromyalgia is characterized by chronic widespread pain, mood and sleep disturbance, and affects over 20 million Americans. Pharmacological treatments (antidepressants, antiepileptics, opioids) often have small treatment effects and adverse side-effects. Exercise therapy requires significant patient motivation, and psychotherapy requires specialized personnel. Here we report on a randomized clinical trial in which we tested a 4-week sleep-wake scheduling intervention with either a dim or bright daily 1 hour morning light treatment.

Methods

Fifty-four adults (52 females, 18-78 years) meeting ACR 2011 diagnostic criteria for fibromyalgia completed a 5-week protocol. In the first week each participant slept at home, ad lib, on their usual sleep schedule. Thereafter, they followed a fixed sleep schedule and a daily 1-hour morning light treatment (randomized to dim or bright light). The sleep schedule advanced each participant’s individual sleep-wake timing by no more than 1 hour, and focused on stabilizing sleep timing. Participants were monitored with wrist actigraphy throughout the study. Outcomes were assessed at baseline, 2 weeks and 4 weeks after the intervention.

Results

The 4-week intervention resulted in an average 36-minute advance in participants’ sleep timing in both groups (ps<0.001). Night-to-night variability in sleep timing also significantly decreased in both groups (ps<0.01). Pain and physical function improved equally in both groups (Fibromyalgia Impact Questionnaire-Revised, PROMIS Pain intensity, PROMIS Physical Function, ps<0.01). Across both groups, a greater shift in morningness (Owl-Lark score) was associated with a greater reduction in depressive symptoms (PHQ-9; r=-0.45, p<0.001). No significant side effects were reported in either group. Treatment expectations were not significantly correlated with symptom improvement (all rs nonsignificant).

Conclusion

Results suggest that 4 weeks of an advanced and stabilized sleep schedule can lead to meaningful improvements in pain and physical function in people with fibromyalgia. The addition of a bright vs. dim morning light treatment did not further increase symptom improvement. A reduction in depressive symptoms during the intervention may have contributed to the improvements in pain and physical function. Sleep-wake scheduling should be further explored as a potentially feasible, acceptable and effective adjunctive non-pharmacological treatment for fibromyalgia.

Support (If Any)

Grant awarded from NINR R21 NR016930.
0632 Early sleep-disordered breathing in moderate-to-severe traumatic brain injury (TBI) is linked with chronic pain status at long-term follow-up: A TBI Model Systems study
Authors: Martin Aaron , Tang Xinyu , Pinto Shanti , Hoffman Jeanne , Schwartz Daniel , Wittine Lara , Walker William , Kane Georgia , Takagishi S , Nakase-Richardson Risa
Published: May 2022

Introduction

Sleep disorders and chronic pain (pain of >3 months duration) are common after traumatic brain injury (TBI). A recently completed multi-center trial found that two-thirds of adults with moderate-to-severe TBI had sleep apnea diagnosed during polysomnography (PSG) completed during inpatient rehabilitation. Although a bidirectional relationship between sleep and pain exists, attention to sleep apnea as a specific diagnosis and its possible role in chronic pain following TBI has not been explored. We hypothesized that PSG-derived respiratory indices shortly following TBI would be worse among those reporting chronic pain at 1- to 2-year follow-up compared to those without chronic pain.

Methods

Sample (N=66) derived from overlapping cohorts across two separate multicenter studies. Participants with moderate to severe TBI underwent PSG during inpatient rehabilitation and completed a telephone follow-up interview to assess chronic pain status using standardized measures at 1-2 years post-TBI (610-day average). Pairwise comparisons across participants with and without chronic pain were made to determine the magnitude of clinically significant differences on respiratory indices including oxygen desaturation, central and obstructive apneas, and total apnea-hypopnea index (AHI).

Results

Presence of chronic pain at follow-up was associated with elevated central apnea events (2.6) and oxygen desaturation (19.6) relative to those without chronic pain (0.8 and 7.9, respectively). Important differences were also seen between obstructive and total apnea hypopnea index (AHI) using Centers for Medicaid and Medicare Services scoring criteria, with those in the chronic pain cohort being 6.5 and 8.7 points higher than their non-pain counterparts, respectively. Group differences on obstructive and total AHI were considered minor when using the American Academy of Sleep Medicine scoring criteria, although those with current pain experienced categorically worse sleep apnea (total AHI = 19 versus 12.4).

Conclusion

This is the first study to find an association between PSG-derived respiratory indices and long-term chronic pain status following moderate-to-severe TBI. Sleep apnea represents an important modifiable factor following injury that may contribute to long-term pain-related outcomes. Given the prominence of chronic pain several years post injury, future studies should investigate the role of sleep apnea and early intervention among those following moderate-to-severe TBI to determine impact on long-term rehabilitation and pain outcomes.

Support (If Any)

PCORI; CER-1511-33005); VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901.
0634 Symptoms of insomnia and depression among individuals with Multiple Sclerosis before and during the COVID-19 – results from a prospective longitudinal study
Authors: Sadeghi-Bahmani Dena , Mohammadian Youkhabeh , Piri Nahid , Bahmani Laleh Sadeghi , Brand Serge , Goldstein-Piekarski Andrea , Khazaie Habibollah , Gross James
Published: May 2022

Introduction

There is some -- but inconsistent -- evidence that sleep and psychological health have deteriorated in the general population as a result of the COVID-19-pandemic and its related social restrictions. In the present study, we investigated whether and to what extent symptoms of insomnia, depression, fatigue, and paresthesia changed from before to during the COVID-19-pandemic among women diagnosed with multiple sclerosis (MS).

Methods

A total of 90 women with MS (mean age; 37.62 (SD = 8.61) years; EDSS score: median: 2.5 (range: 0-6.50)) completed a series of self-rating scales at two time-points: Nine months before the COVID-19-outbreak in May 2019 (baseline) and during the COVID-19-pandemic (study end; 12 months after baseline: May 2020). Self-rating questionnaires covered sociodemographic and disease-related information, symptoms of insomnia, depression, fatigue, and paresthesia.

Results

Symptoms of depression increased over time (medium effect size: Cohen’s d = 0.53), while symptoms of insomnia (small effect size: Cohen’s d = 0.43), fatigue (trivial effect size: Cohen’s d = 0.19), and paresthesia (trivial effect size: Cohen’s d = 0.08) did not. The only predictor for insomnia during the COVID-19-pandemic was insomnia before the COVID-19-pandemic (β = 0.36; p = 0.001); the only predictor for depression during the COVID-19-pandemic was insomnia before the COVID-19-pandemic (β = 0.66; p = 0.001).

Conclusion

Overall, among a sample of female individuals with MS the COVID-19-pandemic and its related social restrictions may have had a modest influence on participants’ core concerns of insomnia, depression, fatigue, and paresthesia.

Support (If Any)
0638 Circadian rhythms among youth with craniopharyngioma
Authors: Kamara Dana , Crabtree Valerie McLaughlin , Crowley Stephanie , Hancock Donna , Semko Joshua , Merchant Thomas , Mandrell Belinda
Published: May 2022

Introduction

Craniopharyngioma is an intracranial tumor located in the hypothalamic and pituitary region. Despite high survival rates for youth with craniopharyngioma, quality of life is substantially affected. Morbidity includes high rates of sleep disruption, particularly disorders of hypersomnolence. Circadian rhythms may also be affected due to the proximity of the tumor and subsequent treatment to the hypothalamic-pituitary-adrenal axis, though the role of circadian rhythms has been less studied in this patient population. To evaluate circadian rhythms among youth with craniopharyngioma, dim light melatonin onset (DLMO), an established marker of the circadian system, was estimated.

Methods

Fifty-five patients between the ages of 7 and 20 years participated in this study. Data were collected prior to completion of proton therapy (if indicated). Participants provided hourly saliva samples, in their homes, starting 3 hours prior to habitual bedtime until 1 hour following in dim light conditions (<30 lux). DLMO was calculated based on a threshold of 4 pg/ml. Participants also wore actigraphs to measure sleep patterns. We derived bedtime and waketime from actigraphy and calculated phase angles to bedtime and waketime. DLMO timing and phase angles were compared to published norms for healthy youth ages 9 to 17 years.

Results

DLMO could not be estimated for almost half of the sample (n=25), most often due to a melatonin value above the threshold at the first collection time point. Higher grade of hypothalamic involvement and the presence of diabetes insipidus predicted inability to capture DLMO. Subsample analyses of participants with DLMO (n=30) showed later DLMO timing and shorter phase interval to bedtime than the healthy reference sample.

Conclusion

With standard practice for DLMO estimation, we only obtained estimates for slightly more than half our sample. This may reflect circadian rhythm disturbances or advanced circadian phase. Relative to published norms, those with captured DLMO had later DLMO timing and shorter phase angles to bedtime, indicating sleep at an earlier circadian phase. These findings suggest possible circadian rhythm disruption in pediatric craniopharyngioma. Methodological differences among samples may also contribute to findings. Further examination of circadian rhythm disruption and relations with other sleep disturbances is needed.

Support (If Any)

This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.
0666 Sleep Quality and Depression Among High-Risk Perinatal Women: Impact of the COVID-19 Pandemic
Authors: Okun Michele , Kohl Vanessa , Wisner Katherine
Published: May 2022

Introduction

The COVID-19 pandemic has negatively impacted sleep and mood on a global scale. To date, a handful of studies have reported on sleep and mood in perinatal women during the pandemic. They suggest that many pregnant women have poor sleep quality and depression. However, since these studies are cross-sectional with no comparison group, it is difficult to determine whether they are suffering more now.

Methods

The current study compared sleep quality and the presence of likely clinical depression in perinatal women from two studies (one prior to the pandemic (~1998)) and one during the pandemic (Aug 2020 – April 2021). All women had a history of MDD/PPD. Sleep quality and depression were ascertained at ~36 weeks and 4 weeks postpartum for both groups. Sleep quality was characterized by the Pittsburgh Sleep Quality Index (PSQI). Depression was ascertained by the Hamilton Depression Rating Scale (HRDS) for the non-pandemic group and the Edinburgh Postnatal Depression Scale (EPDS) for the pandemic group. PSQI scores were analyzed continuously and categorically, while the depression scales were categorized according to published cutoffs.

Results

The Mage = 31.1 (4.2) and did not differ between groups; 84% were White. Sleep quality in late pregnancy did not differ between groups (7.62 (3.5) vs 7.16 (3.8), (ns), pre-pandemic vs pandemic), but they did differ at 1 month PP (7.10 (3.1) vs 8.7 (2.6), P < .001). The number of women who met criteria for depression in late pregnancy differed (28(41.1%) vs 7 (7.5%) X2 = 26.1, P < .001), but not at 1 month PP (9 (13.2%) vs 18(19.3%), X2 = 1.05, P = .31). Sleep quality in late pregnancy was correlated with whether a woman met criteria for depression during pregnancy (r = .22, P = .005), but not at 1-month postpartum (ns).

Conclusion

Our findings suggest that the pandemic negatively impacted sleep quality in the first month postpartum, but not the rate of depression. We interpret these findings with caution due to varying methodologies. The pre-pandemic group was a RCT of 4 drug treatment groups in postpartum, and the pandemic group women used the SNOO®, a robotic, responsive bassinet.

Support (If Any)

Happiest Baby, Inc