bluuebunny/crossref_metadata_2025 huggingface dataset:
0463 Sleep Assessed by Actigraphy during Discontinuation of Chronic Hypnotic Use
Authors: Parashar Vartika , Koshorek Gail , Roth Thomas , Roehrs Timothy
Published: May 2022

Introduction

Inability to discontinue chronic hypnotic use by people with insomnia remains a clinical problem. Sleep was recorded by actigraphy during a two-week discontinuation in an on-going “blinded” clinical trial in which people with insomnia were instructed to discontinue their study medication after 6 months of nightly use.

Methods

DSM-V diagnosed people with insomnia (n=39, 34 females), aged 26-61 yrs, with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=15, B: n=11, C: n=13). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). Sleep was recorded by actigraphy and sleep latency (LAT), wake after sleep onset (WASO), and sleep efficiency (SE) were determined.

Results

Twenty subjects (51%) stopped taking study medication when told to discontinue, while 19 took a median of 3 capsules over the 14 nights. The number of capsules chosen declined from week 1 to week 2 (p<.005), while WASO (7-night means) increased from week 1 to week 2 (p<.02). However, LAT, WASO, and SE never went beyond the 7-night means recorded at baseline. Discontinuation night 1 and 2 also did not differ from baseline nights 1 and 2.

Conclusion

Most participants successfully discontinued hypnotic use when instructed to do so. While some degree of sleep disturbance returned, it never exceeded the baseline levels.

Support (If Any)

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs.
0470 Pre-treatment Objective Short Sleep is Associated with Poor Treatment Response in Patients with Insomnia and Major Depression: A Report from the TRIAD Study
Authors: Edinger Jack , Eldridge-Smith E Devon , Buysse Daniel , Thase Michael , Krystal Andrew , Wisniewsk Stephen , Manber Rachel
Published: May 2022

Introduction

Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral insomnia therapy insomnia (CBT-I) but such studies have not included patients with comorbid conditions. This study was conducted to determine whether pre-treatment sleep duration moderates the response of patients with major depression (MDD) and insomnia (ID) disorders to a combined CBT-I and antidepressant medication treatment.

Methods

This study involved a secondary analysis of data from the TRIAD trial that tested combined CBT-I/antidepressant medication treatment of patients with MDD and ID. Participants (N=99; 70 women; Mage = 47.7 +/-12.4 yrs.) completed pre-treatment polysomnography (PSG) and were randomly assigned to a 12-week treatment comprised of antidepressant medication combined with CBT-I or a sham quasi-desensitization therapy for insomnia (DTI). Short and longer sleepers were defined using PSG total sleep time cutoffs of <5, <6 and <7 hours for short sleep. Insomnia and depression remission determined respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned.

Results

Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of <5 hours of sleep was used to define “short sleep.” CBT-I recipients with > 5 hours of sleep were significantly more likely to achieve insomnia remission than were either the DTI recipients with > 5 hours of sleep (OR = 6.72; 95% CI = 2.03 – 22.26) or the CBT-I recipients with short sleep (OR = 18.92; 95% CI = 2.03 – 178.69). The longer sleeping CBT-I group was also more likely to achieve insomnia and/or depression remission than was either the longer sleeping DTI group (OR = 3.12 95% CI = 1.11 – 9.53) or the shorter sleeping CBT-I group (OR = 8.464; 95% CI = 1.40 – 51.12).

Conclusion

Sleeping <5 hours may dispose patients with comorbid MDD/ID to a poor response to combined CBT-I/antidepressant medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted.

Support (If Any)

National Institutes of Health, Grant Numbers MH078924, MH078961, MH079256 and HL096492.
0471 Identifying Trauma-Informed Adaptations to Cognitive Behavioral Therapy for Insomnia among Women Veterans: Results of an Expert Panel
Authors: Carlson Gwendolyn , Saldana Kathryn , Kelly Monica , McGowan Sarah Kate , DeViva Jason , McCarthy Elissa , Pigeon Wilfred , Martin Jennifer
Published: May 2022

Introduction

Trauma-informed care is an emerging area of health services research. While trauma-focused care specifically targets symptoms of posttraumatic stress disorder (PTSD), trauma-informed care involves tailoring interventions to meet the unique needs of patients who have experienced trauma. Insomnia and PTSD are common comorbid disorders, but no known previous studies have identified trauma-informed adaptations to cognitive behavioral therapy for insomnia (CBT-I).

Methods

We identified PTSD clinical presentations that may interfere with the delivery of effective CBT-I and possible adaptations to standard CBT-I that may address these clinical presentations based on a literature review. We then incorporated trauma-informed adaptations into a 5-session CBT-I protocol. Four Veterans Affairs (VA) Expert Trainers in CBT-I were sent the trauma-informed CBT-I materials and rating forms. They were asked to rate the extent to which PTSD clinical presentations serve as barriers to CBT-I (1=low barrier; 5=high barrier), the feasibility of possible adaptations (1=low feasibility; 5=high feasibility), and to provide qualitative feedback. A 60-minute panel meeting was convened and aggregated data from rating forms were presented and discussed. We then revised the trauma-informed CBT-I materials. Panelists reviewed the revised trauma-informed CBT-I materials and completed post-panel rating forms.

Results

The highest-ranked clinical presentations based on rating forms and panel consensus included: sleep avoidance/nighttime arousal, sleep-related self-efficacy, substance/medication use to induce sleep, and safety behaviors intended to reduce nighttime arousal. Panel meeting consensus identified the following trauma-informed adaptations to CBT-I: PTSD-related nighttime hyperarousal psychoeducation, identification of alternatives to PTSD-related safety behaviors, nightmare psychoeducation, psychoeducation about PTSD avoidance in the context of substance/medication use, cognitive techniques, and behavioral tracking to challenge beliefs and avoidant behaviors. Panelists agreed the revised trauma-informed CBT-I materials adequately addressed the PTSD clinical presentations that may limit the effectiveness of standard CBT-I for patients with comorbid PTSD.

Conclusion

This was the first study to use an expert panel to identify trauma-informed adaptations to CBT-I. Trauma-informed adaptations, including supplemental materials, may improve CBT-I outcomes for patients with comorbid PTSD. Future studies should incorporate feedback from patients with insomnia and PTSD to refine trauma-informed adaptations to CBT-I further.

Support (If Any)

VA HSR&D (RCS-20-191, Martin), NHLBI (K23HL143055, Martin)
0478 The Impact of Non-pharmacological Insomnia Therapy on Mood and Sleep in Morning and Evening Chronotypes in Older Adults
Authors: Lopez Mateo , Krause Adam , O'Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Goldstein-Piekarski Andrea
Published: May 2022

Introduction

As individuals age, the circadian-driven timing of their sleep shifts to an earlier hour. Whether such a shift moderates the effectiveness of insomnia treatment on sleep disturbances and mood in older adults is unknown.

Methods

We tested the hypothesis that circadian preference moderates improvements in mood and insomnia symptoms following a non-pharmacological insomnia treatment. Older adults (N=111, age=69±6.4 years, female=65%) with insomnia (Insomnia Severity Index (ISI) score >10) received a 6-session treatment regimen. Circadian preference was measured at baseline with the Composite Scale of Morningness (CSM mean score=41.2±7.3, median=42). Chronotypes were classified based on a median split of CSM scores. Depression, (Geriatric Depression Scale, GDS), insomnia severity (ISI), cognitive arousal (Glasgow Content of Thoughts Inventory, GCTI), and time in bed (TIB), total sleep time (TST), and sleep efficiency (TST /TIB=SE) from sleep diaries were collected pre- and post-treatment. Tests of proportion were used to characterize differences in demographic variables between chronotypes. Ranked correlation tests were used to test associations between circadian preference and variables of interest at pre- and post-treatment. T-tests with unequal variance were used to examine whether treatment outcomes differed between chronotypes.

Results

In this study, 58% of females and 38% of males were later chronotypes (p=0.04). Later chronotype was associated with greater pre-treatment TIB (p=0.01), and earlier chronotype was associated with higher post-treatment cognitive arousal (p=0.04). Later chronotypes had greater reduction in depression symptoms (Cohen’s d=0.43, p=0.04), cognitive arousal (d=0.39, p=0.05), and a trend for greater reduction in TIB (d=0.37, p=0.07). Earlier chronotypes had a greater increase in TST (d=0.42, p=0.04). However, both chronotypes saw equivalent changes in SE (d=0.12, p=0.58).

Conclusion

Later chronotypes had a greater reduction in TIB, while earlier chronotypes demonstrated a significant increase in TST due to insomnia treatment, and both chronotypes had improved SE. These patterns suggest that treatment equivalently improves the consolidation of sleep, but the mechanism of this treatment effect differs by chronotype. That is, a moderating effect of circadian preference on the mechanism of improved sleep consolidation by insomnia treatment in older adults. These results suggest greater attention to age-related changes in chronotype in insomnia treatment.

Support (If Any)

NIMHR01MH101468-01; MIRECC at the VAPAHCS
0482 Virtual Reality Guided Imagery for Insomnia (iVR): Preliminary Feasibility and Outcomes
Authors: McCrae Christina , McGovney Kevin , Berry Jasmine , Simenson angelynn , Dillon McCann
Published: May 2022

Introduction

Chronic insomnia affects approximately 10% of adults and is associated with reduced quality of life, fatigue, impaired cognition, and increased risk for illness. Cognitive behavioral therapy for insomnia (CBT-I) is a recommended frontline treatment for chronic insomnia, but is not widely accessible as the number of trained CBT-I clinicians (<500) falls significantly short of the number of patients needing treatment. Digital delivery holds great potential for increasing access to CBT-I as well as other behavioral treatment approaches. Our team recently developed and conducted preliminary testing of a novel, brief virtual reality guided imagery for insomnia (iVR) in adults with chronic insomnia.

Methods

12 adults (Mage=38.2 years, SD=20.7, 50% female) with chronic insomnia completed 4-weeks of iVR delivered via Oculus Go headsets equipped with blue light blocking lenses and pre-loaded with a guided relaxation application, sleep hygiene instructions, and modified stimulus control instructions. Participants completed a Satisfaction Survey at post-treatment and the following outcome assessments at baseline, post-treatment, and 1-month follow-up: Insomnia Severity Index, State-Trait Anxiety Inventory, Fatigue Severity Scale, and 1-week of sleep diaries (sleep onset latency, wake time after sleep onset, total sleep time, sleep quality [1-poor, 5-excellent]). [KM1] Paired one-tailed t-tests were used to examine preliminary outcomes. Effect sizes (ES) are reported as Hedges G.

Results

Adherence (#treatment weeks completed, M=3.5, SD=0.78) and Satisfaction (greater >8.8/10 on average for overall experience and likelihood of recommending to a friend) were high. Insomnia severity (7/28, ES=1.13, p<0.01), wake time after sleep onset (12 mins, ES=0.40, p=0.03), sleep onset latency (10 mins, ES = 0.36, p=0.04), and sleep quality (0.5/5, ES=1.08, p<0.01) improved following treatment. Gains were maintained at 1-month along with additional improvements in total sleep time (36 mins, ES=0.67, p=0.03) and trending improvement in fatigue (9/100, ES=0.46, p=0.05). State Trait Anxiety Inventory and Fatigue Severity Scale scores did not improve.

Conclusion

Our pilot findings suggest iVR is feasible and promising treatment for chronic insomnia. Because the intervention can be pre-installed, iVR may be particularly useful for individuals with limited internet access (e.g., rural populations, military). Future research with a larger sample, randomized controlled design, and longer-term follow-up appears warranted.

Support (If Any)

Healium, Inc-PI McCrae
0486 Sleep patterns of children with cri du chat syndrome and autism spectrum disorder during the COVID-19 pandemic
Authors: Xavier Sandra , Silva Vinícius , Pires Gabriel , Fernandes Guilherme , Tufik Sergio , Andersen Monica
Published: May 2022

Introduction

The COVID-19 pandemic has subjected most of the world population to changes in daily life activities, mostly related to social isolation, family distancing and home confinement. Children with autism spectrum disorder (ASD) and other neurodevelopmental syndromes, such as cri du chat syndrome (CDC) might be especially sensitive to the consequences of the pandemic, as they usually require a predefined and strictly controlled routine. Even before the pandemic, sleep disorders and complaints were more frequent in these children compared with neurotypical (NT) children. This study aimed to evaluate the sleep pattern of children with CDC and ASD before and during the pandemic, comparing it with NT children.

Methods

Children and adolescents between 0-18 years` parents or legal guardians were asked to answer the adapted Brief Infant Sleep Questionnaire, related to both before and during the COVID-19 pandemic.

Results

Before quarantine, children with CDC and ASD had increased chances of sleeping in their parents’ bed, of needing parental assistance to fall asleep, of taking >30min to fall asleep and of having a wake after sleep onset time >30min compared to children with typical development. Being part of the CDC group significantly increased the odds of having awakenings during the night. After quarantine, there were a decrease in the proportion of children sleeping in their own bedrooms and an increase in the odds of awakening during the night in all groups. Children with CDC and ASD had increased chances of sleeping in their parents’ bed and had a significantly higher chance of taking more than 30min to fall asleep. Both the CDC and ASD group presented worse sleep patterns during the COVID-19 pandemic.

Conclusion

Our results indicated that the ASD and CDC groups usually have more sleep problems and complaints than NT children. The CDC group showed worse sleep parameters overall, even before quarantine.

Support (If Any)

Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.
0490 Longitudinal associations between sleep and behavior and cognition in preschoolers from five European birth-cohorts
Authors: Guerlich Kathrin , Cadman Tim , Charles Marie-Aline , Fernandez-Barres Silvia , Guxens Monica , Heude Barbara , Inskip Hazel , Julvez Jordi , Lawlor Deborah , Salika Theodosia , Koletzko Berthold , Grote Veit , Plancoulaine Sabine
Published: May 2022

Introduction

There has been little focus on sleep and its relation to behavior and cognition in preschool-aged children. We aimed to investigate the association between sleep duration in early preschoolers (» 3.5 years of age) and later behavioral and cognitive outcomes (» 5 years of age) in European children.

Methods

We used harmonized data from five cohorts from the EU Child Cohort Network, established by the LifeCycle Project (n=16.444 children): ALSPAC and SWS from UK, EDEN and ELFE from France and INMA from Spain. Within all cohorts, total sleep duration per day and behavioral and cognitive information were reported by parents. Internalizing and externalizing behaviors were measured with the Strengths and Difficulties Questionnaire and treated as percentile scores. Verbal and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or with the McCarthy Scales of Children’s Abilities depending on the cohort and treated as standardized scores. All scores were cohort specific. Associations between sleep duration during early preschool age and later behavior and/or cognition were estimated using linear regression and pooled with two-stage individual participant data meta-analysis adjusted for child, maternal and household information. Analyses were done in DataSHIELD.

Results

Global mean sleep duration was 11h54 ± 1h00 per day at mean age 3.5 years but differed by country, with children from France showing longer sleep duration than children from the UK or Spain. In multivariate meta-analysis, 1 hour of additional sleep duration per day at mean age 3.5 years was associated with reduced internalizing and externalizing behavior percentile scores at mean age 5.1 years (internalizing behavior: badjusted= -1.05, 95%-CI [-1.93, -0.18], I2: 30.3%; externalizing behavior: badjusted= -2.12, 95%-CI [-2.78, -1.47], I2: 0.0%). No association was observed between sleep duration and subsequent verbal or non-verbal intelligence

Conclusion

Longer sleep duration in early preschool age (» 3.5 years of age) was associated with subsequent lower internalizing and externalizing behavior scores (» 5 years of age), but not with verbal or non-verbal intelligence. Adequate sleep duration at an early age is important for children’s later mental health.

Support (If Any)

KG was granted a LifeCycle fellowship.
0502 Harmony in the Sleep Lab: A Focus on Recognition of Hypoventilation and Direct Feedback Improves Quality of Pediatric Titrations
Authors: DiMaria Michelle , Schultz Brian , Falvo Jennifer , Matthews Edward , Ward Michelle , Land Jordan , Tauber Danna , Beck Suzanne
Published: May 2022

Introduction

Over 350 pediatric polysomnogram titrations (T-PSGs) are performed each year at the Sleep Laboratory at Children’s Hospital of Philadelphia in three locations by 24 different polysomnography technologists (PSGTs) on a diverse patient population, typically performed as outpatient procedures and occasionally at the bedside as inpatients. PSGTs are responsible for titration of continuous or bilevel positive airway pressure based on flow, work of breathing, arousals, and/or gas exchange. PSGTs have varying degrees of experience; thus, maintaining quality of T-PSGs is challenging. We hypothesized that a quality improvement (QI) approach to reviewing T-PSGs with interdisciplinary education and regular feedback would improve T-PSGs. Our goal was to have >/= 80% of titrations of optimal quality.

Methods

Each T-PSG record was reviewed by a sleep physician for optimal quality, defined as appropriate signal integrity, titration, and documentation to permit definitive interpretation. Exclusion: RAM cannula use, illness, or external signal interference. Titration QI (T-QI) comments were reviewed by the sleep lab QI team bi-weekly to plan feedback. Improvement interventions for PSGTs included didactic education: lectures, presentations, and cases focusing on recognition of hypoventilation; direct feedback with teaching points by sleep physician and small group sessions with clinical supervisors to review areas for improvement; and communication of specific titration goals. Satisfaction surveys regarding recognition/titration for OSA/hypoventilation, transcutaneous CO2 signal integrity, and documentation were administered to sleep physicians.

Results

From September 2020-November 2021, PSGT education included: 1 synchronous and 2 asynchronous didactic presentations; 1:1 review of didactics with each night PSGT (n=24); T-QI feedback (2/week); and small group review sessions (4/week). 408 titrations were completed; 42 (10.3%, 2.8/month) were excluded; 366 (89.7%, 24.4/month) were reviewed for T-QI. 54.8% [50,71%] were deemed optimal during the first three months (pre-intervention) vs. 80.1% [63,96%] during the intervention period. QI satisfaction survey showed improvement in 3 of 4 domains.

Conclusion

Quality of T-PSG is enhanced by QI review of each titration, highlighting teaching points and areas for improvement via direct feedback and small group review. Education and communication among physicians, supervisors and technologists are important to support development which can result in better titrations and satisfaction.

Support (If Any)

none
0503 The Relationships between the Impact of COVID-19 Pandemic, Parent Insomnia, Infant Temperament, and Infant Sleep: a Path Analysis
Authors: Jiao Nana , Pituch Keenan , Petrov Megan
Published: May 2022

Introduction

Increased sleep problems in adults have been repeatedly reported during the COVID-19 pandemic. However, infant sleep was understudied. We aimed to examine the relationships between the impact of the COVID-19 pandemic, parent insomnia, infant temperament, and infant sleep during the COVID-19 pandemic.

Methods

Parents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited through social media from 2/27/2021 to 8/7/2021. A sample of 70 parents (baby age 5.5±3.5mo; parental age: 31.7±5.0y) completed the COVID-19 Exposure and Family Impact Survey Part 2 (CEFIS-Part 2, range: 12-60), a measure of the impact of the COVID-19 pandemic on families with higher scores indicating greater negative impact/distress; the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), with higher scores indicating better sleep quality, more positive sleep perception, and parent behaviors promoting healthy sleep; and the Insomnia Severity Index (ISI, range: 0-28, cutoff: 10). Infant temperament was assessed with the Infant Behavioral Questionnaire-Revised (IBQ-R), including the subscale Negative Affect. Path analyses were conducted based on the Transactional Model of Infant Sleep to identify the direct effect of CEFIS scores, and indirect effects of parent ISI scores and infant IBQ-R Negative Affect scores on BISQ-R scores, with z scores of all variables and infant age as a covariate.

Results

The parent sample was predominantly female (94.3%), identified as White (72.9%), had obtained a bachelor’s degree or above (71.5%), was married or in a domestic partnership (98.6%), and had household incomes > US$70,000 (57.1%). More than one third (35.7%) experienced insomnia symptoms. The means of CEFIS, ISI, IBQ-R subscale Negative Affect, and BISQ-R scores were 29.3±9.5, 8.7±5.2, 4.1±1.1, and 68.8±12.7, respectively. After adjusting for infant age, the COVID-19 related family impact was not directly associated with BISQ-R scores, whereas parent ISI scores (β=-0.11, 95%CI [-.25, -.01]) and infant IBQ-R Negative Affect scores (β=-0.10, 95%CI [-.25, -.002]) significantly mediated the relationship.

Conclusion

The study highlighted the indirect effects of parent insomnia symptom severity and infant negative affect on infant sleep from the family impact of the COVID-19 pandemic. Future research should investigate how best to support healthy sleep for families during global crises.

Support (If Any)
0504 Identifying Risk Factors for Developing Sleep Disorders
Authors: Johnson Amanda , Gonsalves Vanessa , Walker Brittany , Santos Amanda , Araujo Leana Goncalves , Santos Anael , Ajayi Akinyemi
Published: May 2022

Introduction

Sleep disorders in the pediatric clinical setting are often overlooked and under-screened. The study compared a set of clinical behavior questions and physiological risk factors with potential to increase the risk for sleep disorders within children.

Methods

A retrospective archive from electronic medical records was analyzed from 695 pediatric patients, 7-14 years old, that visited a pediatric clinic from March-November of 2019. Children or their parents reported on the presence of eight behavioral and physiological factors on the Kids Sleep Screener Questionnaire (KSSQ), which were used as potential risk factors for sleep disorders. The propensity of daytime sleepiness was measured using the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). Univariate analysis was performed to find frequencies to summarize the risk factors. Chi square test was used to test for associations between risk factors and ESS-CHAD. Multiple logistic regression (MLR) was used to predict different combinations of factors with ESS-CHAD. Odd ratios (ORs) and 95% CI were used to quantify the level of association. Receiver operating characteristic (ROC) with area under the curve analysis was used to compare three MLR models.

Results

The risk factors were positively (p<0.05) associated with ESS-CHAD. Excessive daytime sleepiness and increased sleep duration were risk factors with greater potential to predict sleep disorder. They presented 3 times greater (p<0.05) potential to predict sleep disorder than snoring, and 4 times than restless sleep and sleep onset latency. The two combined risk factors with greatest potential to predict sleep disorder are restless sleep with excessive daytime sleepiness, and sleep onset delay with excessive daytime sleepiness.Risk for potential sleep disorders is best assessed when considering the different risk factors with gender. Considering gender, the risk factors with greatest relationship to predict potential sleep disorders were sleep duration, excessive daytime sleepiness, night wakings and the previous discussed combinations (restless sleep with excessive daytime sleepiness, and sleep onset delay with excessive daytime sleepiness).

Conclusion

The Kids Sleep Screener Questionnaire is a potential tool to predict sleep disorder. Further studies are warranted to explore the behavior and physiological risk factors with potential to increase the risk for sleep disorders.

Support (If Any)
0505 Maintenance of Wakefulness Test Characteristics In Pediatric Populations With Central Hypersomnia
Authors: Wisniewski Benjamin , Witt Rochelle , Cole Melissa , Gurbani Neepa , Huang Guixia , Hossain Md Monir , Simakajornboon Narong
Published: May 2022

Introduction

Children with central hypersomnia often have residual daytime sleepiness despite treatment with medical therapies. The Maintenance of Wakefulness Test (MWT) is an objective measure used to assess daytime alertness and responsiveness to treatment in patients with hypersomnia. There are limited data on MWT characteristics among pediatric populations. The purpose of this study was to: (1.) Compare MWT characteristics and subjective assessment between patients who passed and failed the MWT; (2.) Determine clinical management changes following MWT.

Methods

A retrospective review was conducted of all children who underwent MWT at Cincinnati Children’s Hospital Medical Center from September, 2008 to June, 2021. Pass and fail assessment designations were determined by the clinician as recorded in the medical record. Demographics, Epworth Sleepiness Scores (ESS), MWT characteristics, and pharmacological modifications were recorded. A majority of patients underwent MWT prior to driving. Descriptive statistics as well as Chi-square, Fisher’s exact, and Wilcoxon rank-sum testing were utilized. All variables were reported as medians with interquartile ranges.

Results

109 MWTs were performed on 79 children with a median age of 17.7 years [16.6, 18.6]. MWTs were indicated for 4 primary diagnoses: hypersomnia (n=5), idiopathic hypersomnia (n=11), narcolepsy type 1 (n=56), and narcolepsy type 2 (n=37). 55 (50.5%) were documented as pass (P) and 54 as fail (F). No differences in age (17.5 years) [16.2,18.5] (P) vs. (17.8) [16.9,18.9] (F) (p=NS) or other demographics existed between the two groups. As expected, mean sleep latency was significantly higher among those who passed (37.3 minutes) [31.2,40.0] (P) vs. (10.8) [7.9,16.6] (F) (p<0.001). However, no significant differences were observed in ESS 12.0 [8.0,17.0] (P) vs. 11.0 (6.0,14.0) (F) (p=NS). Pharmacologic adjustments were made in 42/54 (77.8%) (F) vs. 17/54 (31.5%) (P). Medications were not modified in 12/54 (22.2%) (F) assessments.

Conclusion

MWT provides useful objective assessment and often leads to management changes in adolescents with central hypersomnia. A subjective sleepiness assessment (ESS) does not correlate with objective MWT assessments. We speculate that an altered perception of sleepiness in children with hypersomnia may play a role in the inaccuracy of subjective assessments commonly utilized in clinical practice.

Support (If Any)

Cincinnati Children’s Research Foundation.
0524 Polysomnographic Characteristics of Adolescent Patients with Class III Obesity and Severe OSA (AHI ≥30)
Authors: Strang Abigail , Crain Benjamin , Nguyen Linhda , Chidekel Aaron
Published: May 2022

Introduction

Adolescents with obesity are at increased risk for obstructive sleep apnea (OSA). Polysomnographic characteristics of pediatric patients with severe OSA (defined as AHI ≥30 events/hour) have not been frequently described. This study aims to describe clinical characteristics and polysomnographic data from a cohort of adolescents with both severe (class III, BMI ≥40 kg/m2) obesity and severe OSA.

Methods

This IRB-approved, retrospective review examines clinical and polysomnographic data from pediatric patients (ages 8-18) at Nemours Children’s Hospital, Wilmington, Delaware, who had initial baseline diagnostic polysomnogram performed from December 2012-September 2021. Subgroup analysis and descriptive statistics were performed in patients with severe OSA (AHI ≥30 events/hour).

Results

259 (mean age 15.2 years, range 8 – 18 years, 64.4% female, 40.2% white, 46.7% black, mean BMI 50.3 kg/m2) pediatric patients with severe obesity completed initial baseline diagnostic polysomnogram in the study period. Of these patients, 41/259 (15.8%) met criteria for severe OSA (mean age mean age 15.4 years, range 12 – 18 years, 43.9% female, 46.3% white, 43.9% black, mean BMI 53.7 kg/m2). Of these studies, the mean total AHI was 65.2 (range 31.4-159.4) events/hr, obstructive apnea index (OAI) of 11.4 (range 0 – 69.4) events/hr and hypopnea index of 47.8 (range 12.9 – 108.8) events/hour. Mean SpO2 nadir was 78.9 (range 52 – 98)% with peak ETCO2 of 53.2 (range 39 – 69) mmHg. 12/41 (29.2%) of patients met polysomnographic criteria for hypoventilation (EtCO2 >50 mmHg for >25% of TST). Sleep architecture was notable for decreased mean sleep efficiency at 62.8% and elevated arousal index (mean 62.4 arousals/hour).

Conclusion

Adolescents with both severe OSA and obesity demonstrated a high frequency of hypopneas compared to apneic events and disrupted sleep architecture with high arousal index and decreased sleep efficiency. Interestingly, even among those with severe OSA, ventilation was acceptable in a majority of the patients. Further analysis will be completed to correlate patient clinical characteristics, including co-morbidities and lung function measurements, to help identify which patients with severe obesity are at risk for the most severe OSA.

Support (If Any)

None
0529 Average volume-assured pressure support as rescue therapy after CPAP failure in pediatric obstructive sleep apnea
Authors: Peng Victor , Hwig Nauras , Lasso-Pirot Anayansi , Isaiah Amal , Diaz-Abad Montserrat
Published: May 2022

Introduction

Average volume-assured pressure support with autotitrating EPAP (AVAPS-AE) is an automatically titrating mode of noninvasive ventilation (NIV) which provides a targeted tidal volume through adjustment of inspiratory pressures within a set range. In pediatric obstructive sleep apnea (OSA), adenotonsillectomy (AT) is often the first-line treatment and CPAP is often poorly tolerated as an alternative. We aimed to evaluate the efficacy of AVAPS as a potential option for children in whom CPAP titration is unsuccessful.

Methods

Retrospective review of records of children diagnosed with OSA with failed CPAP titration and in whom an in-laboratory AVAPS titration was performed.

Results

A total of 9 patients with OSA (8 male, age (95% CI) = 6.7 ± 2.6, BMI percentile (95% CI) = 81.0 ± 18.9) were identified. Of these patients, 6 had prior AT. All 9 patients had failed CPAP titration prior to AVAPS titration: 3 failed due to inability to control the apnea-hypopnea index (AHI, events/hour), 2 due to persistent hypercapnia, 2 due to treatment-emergent central sleep apneas, and 2 due to pressure intolerance. All 9 patients showed improvement in AHI following AVAPS titration (mean change = -17.9, 95% CI = 17.9 ± 9.5) as well as improvement in AHI from initial PSG to AVAPS titration (mean change = -42.5, 95% CI = 42.5 ±24.6). 7 patients had reduction in total sleep time with oximetry recording below 90% (T<90) from CPAP to AVAPS titration (mean change = -4.7 minutes, 95% CI = 4.7 ± 14.7), while 8 patients had reduction in T<90 from initial PSG to AVAPS titration (mean change = -14.0 minutes, 95% CI = 14.0 ±24.5). 7 patients had increase in REM sleep from CPAP to AVAPS titration (mean change = +15.9 minutes, 95% CI = 15.9 ±18.3), while 6 patients had increase in REM sleep from initial PSG to AVAPS titration (mean change = +7.7 minutes, 95% CI = 7.7 ±26.6).

Conclusion

In this case series of children with OSA and with failed CPAP titration, AVAPS is an effective treatment modality.

Support (If Any)
0534 Dysphagia Severity is Associated with Worse Sleep Disordered Breathing in Infants with Trisomy 21
Authors: Cho Yeilim , DelRosso Lourdes , Sobremonte-King Michelle
Published: May 2022

Introduction

Hypotonia is common in infants with Trisomy 21. This can cause masticatory and oropharyngeal muscle weakness increasing the risk for dysphagia and sleep disordered breathing. Data describing the occurrence of dysphagia and sleep disordered breathing in infants with Trisomy 21 is limited. This study aims to determine the frequency and severity of dysphagia and its relationship to polysomnogram parameters in infants with Trisomy 21.

Methods

Retrospective chart review of patients with Trisomy 21 <12 months old that underwent polysomnography at Seattle Children’s Hospital between October 1, 2015-August 23, 2021. Data collected included: sex, age, presence of dysphagia, recommended thickener type and polysomnographic data.

Results

A total of 526 polysomnograms in patients with Trisomy 21 were performed. Forty-one studies were identified in <12 months old. Results in mean ± SD showed: age 6.5 months + 3, 66% were male and 73% were diagnosed with dysphagia through a video fluoroscopic swallow study. In those with dysphagia, 16% can tolerate thin liquids, 20% prescribed nectar-thick, 7% prescribed honey-thick and 57% were G-tube dependent. In patients with dysphagia compared to those without dysphagia: there was higher total AHI of 43.3 +/- 35.3 vs. 22.6 +/- 10.6 (p=0.006), oAHI of 39.7 +/- 35.5 vs. 17.2 +/- 11.6 (p=0.004), CAI of 3.4 +/- 3.4 vs. 3.4 +/- 1.8 (p=0.11), oxygen saturation nadir of 78.6 +/- 10.6 vs. 83.1 +/- 6.6 (p=0.11) and percentage total sleep time TcCO2 >50 mmHg of 44.6 +/- 42.6 vs. 31 +/- 40.3 (p=0.44). Worse dysphagia was positively correlated with a higher oAHI (r=0.38, p=0.03).

Conclusion

There is a high incidence of dysphagia and sleep disordered breathing in infants with Trisomy 21. Dysphagia severity correlated with oAHI severity. Dysphagia in OSA can be due to the sensory and motor changes of the pharynx with impaired swallow-breathing mechanism. Chronic microaspiration can also result in decreased pulmonary reserve from lower airway inflammation or lung parenchymal disease, which may lead to worse sleep disordered breathing. Current guidelines suggest screening at school age or when there are clinical symptoms of OSA in Trisomy 21. However, results suggest the need to evaluate and intervene earlier especially in infants with dysphagia.

Support (If Any)
0548 Behavioral Validation of the University of Michigan REM Behavior Disorder Questionnaire in the Synucleinopathies
Authors: Dworetz Alex , Trotti Lynn Marie , Bliwise Donald
Published: May 2022

Introduction

Questionnaires that inquire about REM sleep behavior disorder are typically validated by reference to polysomnographic findings of REM sleep without atonia. We sought validation for such a questionnaire by examining observed REM-based dream enactment over two nights in a sleep laboratory.

Methods

Participants with alpha-synucleinopathic disease underwent two consecutive nights of polysomnography attended by a single sleep technologist who was instructed to observe for and document any abnormal behaviors occurring out of sleep. We evaluated University of Michigan REM Behavior Disorder Questionnaire responses completed by either the participant or bed-partner prior to polysomnographic recording and analyzed associations between questionnaire responses and observational data in the sleep laboratory. We subsequently cross-validated the technologist’s observations with hypnogram tracings from nights when dream enactment was observed to determine whether the timing of observed behavior aligned with the timing of REM sleep.

Results

We studied 92 participants [idiopathic Parkinson’s disease, n = 67; Dementia with Lewy bodies, n = 14; Multiple Systems Atrophy, n = 3; Idiopathic REM sleep behavior disorder, n = 8]. Of 92 participants studied, 30 (32.61%) exhibited dream enactment during REM sleep observed on either night of polysomnographic recording (11 on both nights, 19 on one night). There was a statistically significant difference (p = 0.041 by 2-tailed test) in mean questionnaire scores between participants with observed dream enactment during REM sleep (mean score 0.43; [95% CI mean 0.34-0.52]) and those without dream enactment on either night (mean score 0.32; [95% CI mean 0.26-0.38]). When limiting the sample to participants whose questionnaire responses were derived from the bed-partner (n = 74), the difference approached, but did not reach, statistical significance (p = 0.066).

Conclusion

These data provide further validation of the University of Michigan REM Behavior Disorder Questionnaire as a useful tool in evaluating REM-based dream enactment behavior in patients with alpha-synucleinopathic disease.

Support (If Any)
0559 Prevalence of Cannabis Use in Patients with Restless Leg Syndrome for Symptomatic Relief
Authors: Kachechian Talar , Jamil Saad Bin , Armache Maria , Fleet Benjamin , Grewal Ritu
Published: May 2022

Introduction

Restless leg syndrome (RLS) can be debilitating and have a significant negative impact on sleep. Most patients respond well to dopamine agonists, alpha 2 delta ligands, iron supplementation, and opioids. Some patients report persistent symptoms despite using recommended therapies.

Methods

We investigated the prevalence of cannabis use and its potential therapeutic effects in patients with RLS through a retrospective chart review over a three-year period. All patients with diagnosis of RLS and cannabis/marijuana use listed in the electronic health record were included. Data was collected from each patient's chart pertaining to the prevalence of cannabis use including method of use and frequency, patient demographics, use of certain medications, and whether they found symptom relief when using cannabis.

Results

41 patients were identified who has a diagnosis of RLS and cannabis use. 25 of 41 (61%) were using medical marijuana and 8 of 41 (20%) were using marijuana recreationally. 12 of 41 (29.3%) patients found overall relief in their sleep while 4 (9.7%) patients did not and 25 (61%) patients we were unable to determine through chart review.Among the patients who were using medial marijuana, 5 patients were using it for pain and insomnia, 4 patients were using it for RLS, and 4 patients were using it for anxiety. 3 out of 4 (75%) patients who were using medical marijuana for RLS reported regular use. 3 of the patients inhaled cannabis while the remaining patient used an ointment containing cannabis. 2 of the 4 (50%) found symptom relief of RLS when using medical marijuana. 1 patient did not find relief with marjiuana but found relief when using Methadone instead. The remaining 3 patients also used Gabapentin and 2 of the 3 (67%) patients found symptom relief with the addition of a dopamine agonist.

Conclusion

Patients with RLS may use Cannabis for symptomatic relief. We believe this association should be recognized by sleep physicians and documented when conducting their patient's history.

Support (If Any)
0567 When Loud Sleep Aids a Silent Killer: A Prevalence Study on Obstructive Sleep Apnoea in Type-2 Diabetics from a Tertiary Care Hospital in Western India
Authors: Desai Khushi , Ghanchi Firoj , Rami Kinjal
Published: May 2022

Introduction

Type-2 diabetes mellitus is a highly prevalent multisystemic disorder having bidirectional association with Obstructive sleep apnoea. These disorders, when present as co-morbidities, can lead to life-threatening cardiovascular complications. The current prevalence of Obstructive sleep apnoea in Type-2 diabetics is largely unknown, especially in developing nations like India. This study was aimed at determining its prevalence and other risk factors in Type-2 diabetics visiting a tertiary-care hospital in Western India.

Methods

Adult patients with Type 2 diabetes mellitus visiting the Departments of Pulmonary medicine and Non-communicable diseases on an out-patient basis at a tertiary-care hospital were recruited for the study. Those with unstable medical illnesses or other forms of diabetes were excluded. Participants were interviewed and examined based on a case-study form, including Epworth Sleepiness Scale, STOP-BANG and OSA-50 questionnaires, followed by a Home Sleep Apnoea Test. Apnoea-Hypopnoea Index(AHI) was used to evaluate for Obstructive sleep apnoea.

Results

A sample of 62 diabetics (median age: 61(16) years; 34 males; 28 females) was analysed. Obstructive sleep apnoea(Apnea-Hypopnea Index [AHI] ≥ 5.0/h) was diagnosed in 55 subjects(88.7%, median AHI – 20.95/h). 62.9% had moderate-to severe Obstructive sleep apnoea(OSA)(AHI ≥ 15/h), 21% had positional OSA and 48.4% had OSA syndrome(OSAS). AHI had significant positive correlation with waist circumference(rho- 0.318, p- 0.012), neck circumference(rho-0.363, p-0.004), Modified Mallampati score(rho-0.372, p-0.003) and Epworth Sleepiness Scale(rho-0.403, p-0.001). No significant association of glycaemic control, duration of Type-2 diabetes and Random Blood Sugar level with AHI was identified. Sensitivity and specificity of STOP-BANG questionnaire for diagnosing OSA was 69.1% and 71.4% and that of OSA-50 questionnaire was 94.5% and 14.3%, respectively.

Conclusion

Obstructive sleep apnoea(OSA) is more prevalent in adult population with Type-2 diabetes mellitus(T2DM) than in the general population. A high index of suspicion for OSA in patients with T2DM is warranted, because they may not have overt daytime sleepiness or presence of high-risk predictors. Waist and neck circumferences are better predictors of OSA syndrome than body mass index(BMI). Home Sleep Apnoea Test is a more reliable test for OSA detection compared to screening questionnaires and hence can be a useful tool for diagnosis and management planning of OSA in high-burden, low-resource settings.

Support (If Any)
0569 COVID-19 and Fatigue: Does Fatigue Persist Beyond Diagnosis?
Authors: Muench Alexandria , Boyle Julia , Reddy Varudhini , Thompson Michelle , Perlis Michael , Vargas Ivan
Published: May 2022

Introduction

While it is not surprising that COVID is associated with increased fatigue, there is emerging data that COVID-19 symptoms extend well beyond the acute illness period. This phenomenon, known as “Long COVID”, may include fatigue (persistent fatigue post viral infection). The present analysis was undertaken to evaluate fatigue in subjects with and without COVID-19 virus at two time points separated by ~ one year’s time.

Methods

The parent study was a large online study of subjects during the COVID lockdown which was designed to evaluate the effects of social distancing on mood and sleep (n=4052; 3,184 women; X̅age= 46.0 years). The proband subsample of interest was the subjects that reported having COVID as compared to matched controls (whole sample n=242; 195 women [80.6% female]; 206 identified primarily as white [85.1%]; X̅age=42.0 years). Subjects who reported testing positive for COVID-19 provided additional information on COVID-19 symptoms (e.g., severity and duration per symptom). The PROMIS Fatigue scale was administered at time one (T1: April-June 2020) and one year later (T2: January-March 2021). Control subjects were matched based on age, sex, and race to reduce potential confounding or effect modification by these variables.

Results

The mean PROMIS Fatigue scores for the COVID-19 group and Control groups at baseline (T1) were X̅=52.9 + 8.2 (n=121) and X̅=50.7 + 10.4, (n=121), p<0.06, respectively. The mean PROMIS scores for the COVID-19 group and Control groups at follow-up (T2) were X̅=55.3 + 8.7 (n=121) and X̅=52.6 + 8.4, (n=121), p<0.017, respectively. Overall, the groups were found to significantly differ at both time points, p<0.001. No group-by-time interaction was observed. Both groups exhibited a small increase in fatigue from T1 to T2, p<0.716.

Conclusion

As expected, there were significant differences in patient reported fatigue between the COVID-19 and the control group. The between group differences were modest. Significant and large scale group differences were not evident for T2 (during follow-up). This suggests that COVID is associated with increased fatigue but we did not detect “Long COVID” effects. This may be due to methodologic considerations. In order to observe “Long COVID” the data will need to be anchored to illness onset and offset.

Support (If Any)

Support: 5T32HL00795320;K24AG055602