bluuebunny/crossref_metadata_2025 huggingface dataset:
0089 Examination of Post-arousal Hypersynchrony in the First-night Effect
Authors: Suzuki Yoko , Suzuki Chihiro , Abe Takashi
Published: April 2024

Introduction

The first-night effect (FNE) is a sleep disturbance caused by sleeping in a new environment. FNE observed on polysomnography includes increased wakefulness and sleep instability. Post-arousal hypersynchrony (PAH) is an arousal subtype with a post-arousal delta wave burst that antagonizes arousal and maintains sleep (Suzuki et al., 2021). Furthermore, we have shown that PAH correlates with the number of arousals; increased arousals increases PAH. Therefore, we hypothesized that the FNE would increase arousal and PAH.

Methods

Fifteen healthy adults (five women, mean ± standard deviation 21.7 ± 1.6 years) undergoing first-time polysomnography were included. After three days of sleep-wake cycle control before measurement, four nights of polysomnography were performed in the laboratory. A registered polysomnographic technologist blindly scored the participants’ sleep stages and analyzed PAH. Linear mixed models and non-parametric tests were performed on sleep variables and PAH for changes from the first to fourth measurement night.

Results

Sleep variables did not change significantly with the number of measurements. Contrary to our hypothesis, there was no FNE on the number of arousals. The number of PAH had a significant main effect on the number of measurements, showing a significant decrease on the fourth night compared to the first night.

Conclusion

Sleep variables, including arousal, were not affected by the FNE, whereas PAH was. The lack of a FNE on the sleep variables may be due to a ceiling effect caused by sleep in young healthy adults. Since the number of arousals showed no changes, the FNE of PAH could not be explained regarding inhibition on arousal, such as a role in sleep maintenance. The decreased number of PAH sleep measurements may indicate sleep stabilization.

Support (if any)

This study was supported by JSPS KAKENHI under grant number JP 23K14436 and Japan Agency for Medical Research and Development under grant number JP21zf0127005.
1001 The Role of Neurobehavioral Symptoms in the Relationship Between Insomnia Severity and Sleep Quality
Authors: Watson Kennedi , Gehrman Philip , Brownlow Janeese
Published: April 2024

Introduction

Sleep disturbance is a common symptom following head trauma. About half of those who have suffered head trauma will experience disruptions in sleep. Further, moderate to severe traumatic brain injuries (TBIs) may increase the risk for frontotemporal lobe damage, contributing to cognitive impairments. Additionally, addressing problems related to TBI among emerging adults are warranted given that brain structural maturation may be accompanied by emotional, behavioral, and cognitive changes, including changes in sleep. This study examined the role of neurobehavioral symptoms in the relationship between insomnia severity and sleep quality.

Methods

Data were obtained from adults (N=151; Mean age=24.71 (SD=9.9); 75.5% Female) who completed self-report measures. The Neurobehavioral Symptom Inventory (NSI) was used to evaluate symptoms commonly associated with post-concussion syndrome that may emerge after a mild TBI. The Insomnia Severity Index assessed for the nature, severity, and impact of insomnia symptoms with higher scores indicating greater symptom severity. The Pittsburgh Sleep Quality Index assessed for sleep quality, and disturbance, with lower scores indicating better sleep quality. All statistical analyses were conducted using IBM SPSS version 29, along with Hayes PROCESS macro for mediation analyses.

Results

Significant correlations were found between insomnia severity and neurobehavioral symptoms (r=.537, p<.001). Data also showed positive associations between sleep quality and insomnia severity (r=.681, p<.001) and neurobehavioral symptoms (r=.587, p<.001), respectively. There was a significant total effect between insomnia severity and sleep quality (B=.507, p<.001), and path a (B=1.26, p<.001) and path b (B=.099, p<.001) were both significant. Finally, when neurobehavioral symptoms entered the relationship between insomnia severity and sleep quality, the direct effect (B=.383, p<.001) was significant. The bias corrected 95% CI was .124 and CI 95% = .067 to .192 which excluded zero. Thus, neurobehavioral symptoms are considered a mediator for insomnia severity on sleep quality.

Conclusion

These findings suggest that neurobehavioral symptoms are associated with both sleep disturbance and sleep quality. The impact of neurobehavioral symptoms appeared to be indirectly due to the effects of sleep disturbance on poor sleep quality. These results suggest that while sleep-focused interventions may be warranted, it is anticipated that improved sleep may result in improved neurobehavioral outcomes.

Support (if any)

NIGMS-P20GM103653
1007 Solriamfetol on Cognition in Obstructive Sleep Apnea with Excessive Daytime Sleepiness and Impaired Cognition
Authors: Van Dongen Hans , Leary Eileen , Eglit Graham , Drake Christopher , Bogan Richard , Jaeger Judith
Published: April 2024

Introduction

Cognitive impairment is a burdensome symptom in many patients with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA). Solriamfetol (Sunosi®) is a dopamine/norepinephrine reuptake inhibitor, with agonistic properties at TAAR1 and serotonin 1A receptors, approved to treat EDS associated with OSA (37.5–150 mg/day). We evaluated the effect of solriamfetol on subjective cognitive function by examining overall scores and individual cognitive complaint and functional items of the British Columbia-Cognitive Complaints Inventory (BC-CCI).

Methods

SHARP was a randomized, double-blind, placebo-controlled, crossover trial in participants with impaired cognition associated with OSA and EDS. Participants received solriamfetol for 2 weeks (75 mg for 3 days, then 150 mg/day), and placebo for 2 weeks, separated by a 1-week wash out. Items of the BC-CCI included forgetfulness/memory problems, slow thinking speed, trouble expressing thoughts, trouble finding the right word, poor concentration, trouble figuring things out, and vocational, family/friends, and social/recreational functioning. Mixed models with repeated measures were used to examine differences in changes from baseline between placebo and solriamfetol.

Results

The SHARP study enrolled 59 participants (ages 52.2±10.7y; 36% female). Baseline overall BC-CCI scores were 11.4±2.5 (mean±SD); scores were comparable in participants randomized to the solriamfetol/placebo (n=30; mean=11.4) versus placebo/solriamfetol (n=29; mean=11.4) crossover sequences. Overall BC-CCI scores showed greater reduction from baseline (ie, more improvement in subjective cognitive function) after solriamfetol compared with place bo (P=0.002; Cohen’s d=0.45). Baseline scores on individual BC-CCI items were generally similar for participants randomized to solriamfetol/placebo versus placebo/solriamfetol. Solriamfetol led to greater reductions from baseline compared with placebo in poor concentration (P=0.007; d=0.37), slow thinking speed (P=0.009; d=0.36), trouble finding the right word (P=0.042; d=0.28), trouble figuring things out (P=0.030; d=0.30), and forgetfulness/memory problems (P=0.013; d=0.34). Trouble expressing thoughts approached significance (P=0.077; d=0.24). No significant differences were found for vocational, family/friends, and social/recreational functioning (P>0.05).

Conclusion

Consistent with previous reports showing improvement on objective cognitive measures, solriamfetol led to significant subjective improvements overall, and particularly in subjective cognitive domains that may be related to memory, executive functioning, and processing speed. Solriamfetol can improve subjective cognitive functioning in participants with impaired cognition associated with OSA and EDS.

Support (if any)

Axsome Therapeutics, Jazz Pharmaceuticals
0101 Effects of Combined Hand and Foot Bathing on Heat Dissipation, Daytime Sleep Structure, and Gender Difference
Authors: Saotome An , Hagita Maki , Saito Rinna , Fujiki Yuka , Fushimi Momo , Aritake-Okada Sayaka
Published: April 2024

Introduction

Recent reports have highlighted the usefulness of partial body bathing, such as foot bathing, in nursing care and caregiving. However, many studies have focused on subjective evaluations; limited attention has been given to the objective evaluation and underlying mechanisms of these bathing practices. In this study, we investigated the relationships among heat dissipation due to combined hand and foot warm bathing, changes in body temperature, and objective sleep structures and examined potential sex-related differences in these parameters among healthy subjects. This study was approved by the Ethical Committee of Saitama Prefectural University.

Methods

Thirty healthy adults (14 men, 16 women; mean age, 21.47 ± 1.50 years) participated in a 2-day experiment involving a baseline condition (35ºC) and warm bath condition (40ºC) using a crossover design. Under each condition, the participants took a 15-minute hand and foot bath during the day, followed by 1-hour daytime polysomnography. We measured distal skin temperatures (hands and feet) and proximal skin temperatures (subclavian region and forehead) to determine the distal–proximal skin temperature gradient (DPG). We also measured the core body temperature. A registered polysomnographic technologist scored the sleep stages in 30-second epoch periods according to the Scoring Manual of the American Academy of Sleep Medicine.

Results

The DPG during bathing, after bathing, and during sleep was significantly higher in the warm bath than baseline condition. In addition, the duration of slow-wave sleep was longer in the warm bath condition, especially at 20 to 40 minutes after bedtime. With respect to sex-related differences, the DPG during the sleep period was significantly higher and the duration of slow-wave sleep in the warm bath condition was significantly longer in women than in men. There was no significant difference in the DPG between the baseline and warm bath conditions in men.

Conclusion

A 15-minute combined hand and foot warm bath promoted heat dissipation and increased the duration of slow-wave sleep. Heat dissipation was accelerated only in women, suggesting sex-related differences in heat dissipation during sleep, even under partial bathing conditions. In future research, we will examine the factors contributing to the sex-related differences found in this study.

Support (if any)
1015 Evaluation of Actigraphy Sensors: Detecting Daytime Sleep After Stroke in an Inpatient Rehabilitation Hospital
Authors: Wang Jiayi , Sindorf Jacob , Chen Pin-Wei , Wu Jessica , Gonzales Adrian , Mattison McKenzie , Nguyen Amy , O’Brien Megan , Sunderrajan Aashna , Knutson Kristen , Zee Phyllis , Wolfe Lisa , Fiala Justin , Arora Vineet , Jayaraman Arun
Published: April 2024

Introduction

Excessive Daytime Sleepiness (EDS) is common poststroke, significantly impacting rehabilitation participation and quality of life. Early detection of EDS through prolonged daily sleep and wake monitoring is crucial for prompt intervention and improved care. Actigraphy is a promising sleep monitoring technique that circumvents the high cost and low portability of extended polysomnography and the limited reliability of self-reporting. While actigraphy is often used in healthy adults, its application to daytime sleep measurement in the poststroke population remains unexplored. This study assesses the efficacy of actigraphy and its commonly used scoring algorithms to detect daytime sleep in the poststroke population.

Methods

ActiGraph wGT3X-BT and ActiWatch Spectrum were placed on the less affected wrist of participants. Trained observers monitored daytime sleep occurrences by checking on participants every 10 minutes during non-therapy periods, recording behaviors as active, sedentary, or asleep. The average observation period for each participant was approximately eight hours. Actigraphy data were cross-referenced with on-site, time-specific observations. Both the ActiWatch (Autoscore AMRI) and ActiGraph (Cole Kripke, Sadeh) use non-data-driven algorithms to estimate wake (0) or sleep (1) given a user-determined parameter. We computed an F2 score to summarize the algorithm’s performance at differentiating wake and sleep, placing more weight on the algorithm’s sensitivity to capture daytime sleep.

Results

Twenty-seven individuals (19F/8M; average age 62.33 ± 3.04 years) were recruited from the poststroke inpatient unit of a rehabilitation hospital. The ActiGraph Cole-Kripke algorithm (configured with minimum sleep time=15 mins, bedtime=10 mins, and wake time=10 mins) yielded the highest F2 score (F2=0.59), outperforming Sadeh (F2=0.57) and ActiWatch ARMI (F2=0.52) algorithms under their respective optimized parameters. When exclusively considering data from participants lying in bed, the ActiGraph device consistently achieved superior performance (F2=0.69) with the same optimized Cole-Kripke settings.

Conclusion

In poststroke patients in an inpatient rehabilitation unit, ActiGraph (Cole-Kripke) was better than ActiWatch in detecting daytime sleep. The results could help inform specific algorithms and parameters that can be readily implemented for daytime sleep monitoring and EDS detection in poststroke patients. Future considerations for enhanced algorithms should include posture detection to maximize efficacy.

Support (if any)

NIH R01HD097786-01A1.
1016 Fractional Anisotropy Predicts Self-Report Sleep Scores During Recovery from Mild Traumatic Brain Injury
Authors: Reich-Fuehrer Melissa Melissa , Huskey Alisa , Desai Shivani , Franca Gabriela , Patterson Dianne , Killgore William
Published: April 2024

Introduction

Diffusion Tensor Imaging is a structural neuroimaging technique used to assess white matter tract integrity, and a primary metric of this technique is fractional anisotropy (FA). Our assumption is that individuals who have sustained a mild traumatic brain injury (mTBI) may have structural damage that could be reflected in FA values. As increased sleep problems are commonly reported after an mTBI, we hypothesized that individuals with lower FA values would report more sleep difficulty.

Methods

This cross-sectional study included 145 adults and compared healthy controls (HC; N=32) to individuals recovering from mTBI (N=113) at different stages post-injury: 2 weeks and 1, 3, 6, and 12 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI); higher scores on this measure indicate worse sleep quality. Participants underwent a diffusion weighted MRI scan. We used the QSIPrep preprocessing and reconstruction pipeline to extract fractional anisotropy (FA) values for 22 white matter tracts (WMTs). We ran a stepwise linear regression to determine if the average FA values of different WMTs could contribute to a model that predicts individuals PSQI global score.

Results

The stepwise linear regression revealed two significant predictors of participants’ PSQI global scores. Together, the left inferior longitudinal fasciculus (ILF) and right vertical occipital fasciculus (VOF) accounted for significant variance in self-report sleep scores (R²=.094, F(2,139)=7.185, p=.001). The left ILF had an inverse relationship with PSQI global score (β=-.344, p<.001), such that greater FA in this tract was associated with lower sleep difficulty scores. The right VOF had a positive relationship with PSQI (β=.202, p=.029), such that greater FA in the right VOF was associated with greater sleep difficulties. Post-hoc correlations showed that this positive relationship was driven by the daytime dysfunction subscale of the PSQI (p=.004).

Conclusion

Contrary to our hypothesis, we found a mixed pattern of associations between FA values and self-reported sleep. However, this may be due to the right VOF being more associated with waking dysfunction, as opposed to sleep-related dysfunction. Delving more deeply into wake versus sleep promoting WMTs may further illuminate why structural integrity has mixed effects on functioning (i.e., sleep) and performance.

Support (if any)

USAMRAA Grant: W81XWH1210386
1017 Healthy Sleep, Healthy Mind: Examining the Relationship Between Objective Sleep Measures and Delirium Development
Authors: Nameth Kyle , Sugg Elizabeth , Cai Ruixue , Haghayegh Shahab , Gao Chenlu , Li Peng , Hu Kun , Gao Lei
Published: April 2024

Introduction

Delirium is a sudden, transient, but reversible neurological condition as a result of acute stressors, such as hospitalization for surgery or acute illness, and predisposed by many underlying conditions, including age, cognitive decline, and multiple comorbidities. We recently showed that self-reported sleep disturbances prior to surgery or illness are associated with an increased risk of delirium. The current study aimed to test whether objective sleep measures derived from actigraphy predict incident delirium.

Methods

Using the UK Biobank, we analyzed actigraphy data of ~ 7 days collected from 57,556 middle-older aged UK Biobank participants who had at least one hospitalization event during follow-up of up to 8 years. Four measures were extracted from the actigraphy data to objectively define daily sleep behavior: overnight sleep duration (between 9pm-7am), wake after sleep onset (WASO), daytime sleep duration (between 9am-7pm), and daytime sleep frequency. Cox proportional hazards models analyzed whether these sleep behaviors predicted an increased risk of incident delirium defined using the IDC-10 coding (specifically, code F05).

Results

In total, 606 individuals developed delirium (10.5/1,000) after the actigraphy assessment. A U-shaped relationship between overnight sleep duration and delirium risk was observed: short (< 7h) overnight sleepers (OR 1.23, 95% CI: 1.02-1.49, p=0.029) and long (>8h) overnight sleepers (OR 1.44, 95% CI: 1.01-2.04, p=0.043) had greater relative risk compared to 7-8h sleepers. Participants with longer daytime sleep duration (OR 1.46, 95% CI: 1.35-1.59, p< 0.001) and more frequent daytime sleep (OR 1.15, 95% CI: 1.11-1.18, p< 0.001) also showed an increased risk of delirium development. WASO was not significantly associated with the risk of delirium development.

Conclusion

Nocturnal sleep duration, daytime sleep duration, and daytime sleep frequency were associated with an increased risk for delirium. Further studies are required to confirm the present results, understand the underlying pathophysiology behind the relationship, and test whether optimizing sleep health can reduce the risk of developing delirium.

Support (if any)

Dr. L Gao is funded by the NIH grant R03AG067985 and the Alzheimer’s Association Clinician Scientist Fellowship (AACSF) grant AACSF-23-1148490
1025 The Impact of Depression on Neurocognitive Functions and Conversion in Isolated REM Sleep Behavior Disorder
Authors: Yoon In-Young , Lee Minji , Hong Jung Kyung , Moon Seock Hyeon , Han Sojung , Park Chae Rin , kim Hak hyeon
Published: April 2024

Introduction

Depression is frequently observed in patients with isolated REM sleep behavior disorder (iRBD). The aim of this study was to analyze cognitive function and quantified electroencephalography (QEEG) in iRBD patients according to the presence of depression, and to evaluate the impact of depression on the conversion to neurodegenerative diseases.

Methods

A total of 90 individuals with iRBD were included in this study. They were followed for up to 9 years, and 21 of them were converted to Parkinson's disease or dementia. Phenoconversion was defined when a definitive diagnosis of parkinsonism by neurologists or any form of dementia by geriatric psychiatrists was established based on evident clinical symptoms. The diagnosis of depression (27 among 90 iRBD) was made based on the initial interview or taking antidepressant medication.

Results

The depressed group showed poor performance in the executive function (p= 0.029, Stroop color test) than the non-depressed group. The depressed group tended to have lower z-scores than the non-depressed group in global cognition, attention, memory, and frontal/executive domains. The QEEG results, the relative gamma power in the temporal and parietal region, relative high gamma power in the parietal region were significantly increased (p=0.049; p=0.032; p=0.008) in the depressed than the non-depressed group. The conversion was significantly increased in iRBD patients with depression than iRBD without depression (p=0.013). The depression in iRBD patients had 3.319 of hazard ratio (p=0.011) for the risk of conversion to neurodegenerative diseases.

Conclusion

Depressive symptoms in iRBD patients should be monitored as aggravating cognitive dysfunction and a risk factor for conversion.

Support (if any)
1026 Validation of the Situational Sleepiness Scale
Authors: Lomba Sara , Sum-Ping Oliver , Mignot Emmanuel
Published: April 2024

Introduction

The Epworth Sleepiness Scale (ESS) is the gold standard measure subjective daytime sleepiness. Since the inception of the ESS 25 years ago, modern life has evolved considerably and the situations posed by the ESS have become dated. This interim analysis introduces the Situational Sleepiness Scale (SSS) which focuses on common activities occurring in the modern world.

Methods

A group of sleep physicians and staff between Stanford and the UK Biobank developed the questionnaire. An initial set of questions were distributed to subjects, and through multiple iterations of subject feedback and subsequent revision, were refined into its current form of eleven situations. To explore further the scale as a replacement for the ESS, the SSS and the eight situation ESS were given in tandem to patients and visitors of the Stanford Sleep Clinic.

Results

A correlation coefficient between the ESS and SSS was run on 121 completed questionnaires. Our result to date indicates a strong correlation between both scales (R2=0.74, p<.0001). The mean score for the SSS was 7.74 and 7.36 for the ESS. The standard deviation for the SSS was 5.11 compared to 4.74 for the ESS. A test of variance produced a value of 25.9 for the SSS and 22.3 for the ESS. Thirty-four subjects scored ≥ 10 in this sample using the ESS and 26 of these subjects had a value ≥ 10 for the SSS. Most of the subjects who scored ≥ 10 on the ESS scored ≥ 10 on the SSS and vice versa suggesting that a similar cutoff could be used for defining daytime sleepiness on the SSS.

Conclusion

In this interim analysis, we found the Situational Sleepiness Scale to be easily administered and to correlate well with the ESS. In future studies we will examine consistency of scores across item, stability over time/ repeatability, and explore psychometric properties. Additional studies aiming at gathering several hundred subjects with various diagnoses are ongoing. As the SSS goes up to 33, but has a similar cutoff of ten on the correlation, we believe the SSS could be more discriminative than the ESS for very sleepy patients such as narcoleptics.

Support (if any)
1030 APOE Genotype and Sleep Architecture
Authors: Cho Gawon , Buxton Orfeu , Pan Yulu , Miner Brienne
Published: April 2024

Introduction

APOE4 genotype, a robust genetic risk factor for Alzheimer’s Disease, is associated with reduced functional connectivity of the basal forebrain, one of the key regulators of sleep and wakefulness. The objective of this study was to examine the association between APOE4 genotype and sleep architecture.

Methods

This study included 1,793 participants aged 65-85 from the Sleep Heart Health Study (SHHS) who completed in-home, overnight polysomnography. Primary predictor was APOE4 allele carrier status: non-carriers (reference), heterozygotes and homozygotes. Outcomes included the following three characteristics of sleep architecture: time spent in slow wave sleep (SWS), time spent in rapid eye-movement sleep (REM) and the number of arousals per hour. We used linear regression to examine the association between APOE4 carrier status and each sleep architecture characteristic, adjusting for age, sex, marital status, and educational attainment.

Results

The sample included 9.5% people of color and 52.7% women. Median age was 73 (interquartile range = 69,77). Average duration of SWS and REM (minutes/night) by APOE4 genotype was: 62.7 and 68.7 (non-carriers); 63.0 and 67.6 (heterozygotes); and 63.0 and 70.7 (homozygotes). Average number of arousals among non-carriers, heterozygotes, and homozygotes was 18.5, 17.2, and 16.2 times/hour, respectively. Linear regression models showed that APOE4 carrier status was not associated with time spent in SWS or REM. The number of APOE4 alleles showed an inverse linear trend with arousals/hour, (β=-0.77 [95%CI=-1.96,0.42] in heterozygotes; β=-4.25 [95%CI=-8.01,-0.50] in homozygotes). Additional analyses using other sleep architecture measures, including the proportion of time spent in SWS or REM, SWS or REM duration/hour, wake after sleep onset (WASO), total sleep duration, and time spent in non-SWS sleep, all yielded non-significant results, except for total arousals/night, which exhibited an inverse linear trend with the number of APOE4 alleles (β=-3.64 [-10.44,3.16] in heterozygotes; β=-22.52 [-43.97,-1.07] in homozygotes).

Conclusion

Contrary to our expectations, APOE4 carriers did not show reduced sleep quality across various indices, including time spent in SWS, REM or WASO. They also showed reduced number of arousals. Our findings suggest that non-respiratory sleep problems may not be the primary pathway leading to an increased burden of Alzheimer’s disease in APOE4 carriers.

Support (if any)

SHHS was supported by: UOIHL53940, UOIHL53941, UOIHL53938, UOIHL53916, UOlHL53934, UOIHL53931, UOIHL53937.
1034 Attenuated Heart Rate Change as Potential Sleep Digital Biomarker in Lewy Body Dementia
Authors: Cho Yeilim , Brown karl , Wilson Katie , Levendowski Daniel , Tsuang Debby
Published: April 2024

Introduction

Differentiation of Lewy body Dementia (LBD) from Alzheimer’s disease (AD) is challenging due to overlapping clinical presentation. Symptoms associated with autonomic nervous system dysfunction are common in patients with LBD, likely associated with the accumulation of α-synuclein aggregates in the neurons and glial cells. We investigated whether spontaneous heart rate acceleration or deceleration measured by autonomic activation index (AAI) with a portable home sleep test can differentiate LBD from AD. We hypothesized that individuals with LBD will have attenuated AAI compared to those with AD.

Methods

We enrolled patients with LBD (n= 10) and AD (n=6), all of whom underwent a portable home sleep test for two consecutive nights. AAI was defined based on a 6 beats per minute increase or decrease in pulse rate compared to the previous or subsequent 10th second. Each participant’s mean AAI was calculated after weighing the total sleep duration. Mean AAI, sleep efficiency, REM stage, and N3 were compared between the two groups.

Results

The mean (SD) age for the AD group was 78.5 (2.4) years old, and for the LBD, it was 70.4 (7.6). AAI was higher in AD than LBD group but differences were not statistically significant [24.1 (23.1) and 11.2 (10.6), p=0.3]. Percentage time spent in REM sleep was significantly higher in AD than LBD [18.3(4.3) and 8.4(8.2), p=0.007]. While N3 sleep state (%) was lower in AD than LBD [9.7(19.2) and 18.4(24.6), p= 0.4] and sleep efficiency (%) was higher in AD than LBD 72(0.1)and 70(0.2), p=0.8], these differences were not significant.

Conclusion

Heart rate change during sleep measured by AAI was lower in LBD patients (vs. AD) as hypothesized, but the differences were not significant, likely due to the small sample size. Percentage time spent in REM sleep was lower in LBD compared to AD. Future studies are necessary to determine if attenuated heart rate change during sleep can be a used as a digital sleep biomarker to differentiate between LBD from AD.

Support (if any)

This work was supported by grant funding from: NIA-NIH grant R21AG064271
1040 Improved Care in Neuromuscular Multidisciplinary Clinic with Sleep Medicine Incorporation
Authors: Clay Collin , Cocozza Victoria , Scheuller H Samuel , Fullam Timothy , Walter Robert , Brock Matthew , Tchopev Zahari
Published: April 2024

Introduction

Neuromuscular multidisciplinary clinical care models are becoming common in the management of the neuromuscular disease. Updated clinical practice guidelines emphasize the role of polysomnography (PSG) in determining the need for early non-invasive ventilation (NIV) in these patients to improve quality of life and disease course. Despite this and the high prevalence of comorbid sleep disorders, sleep medicine is not included in the standard model for these clinics. We sought to (1) define and improve the rate of PSG acquisition, and (2) improve detection of sleep-related comorbidities in this high acuity population with the addition of sleep medicine to an established neuromuscular multidisciplinary clinic.

Methods

Sleep medicine physicians joined a pre-established multidisciplinary clinic aimed to treat neuromuscular disease and related comorbidities. The multidisciplinary clinic was attended monthly from January to December 2023. Patients were evaluated for sleep disorders using clinical interviews and standardized sleep questionnaires. Patients were referred to the sleep disorders center to obtain diagnostic in lab video PSG with carbon dioxide monitoring. When sleep disordered breathing was detected, patients were offered therapy and followed clinically.

Results

A total of 12 neuromuscular patients (6 male (50%), average age 52) were evaluated, with75% (n=9) having no prior sleep medicine encounter. Only 50% had completed a PSG prior to sleep medicine evaluation. After sleep medicine evaluation, PSG acquisition rate improved to 100%. Obstructive sleep apnea (OSA) was detected in 83.3% (n=10, average AHI 26.6) of patients, with 8 meeting criteria for moderate-severe OSA, and 2 having nocturnal hypoventilation despite normal pulmonary function testing. The average sleep efficiency was 70%. The average Insomnia Severity Index was 8.25 and 58.3% (n=7) were diagnosed with chronic insomnia disorder. The average Epworth Sleepiness Scale was 7.6, with 41.6% (n=5) reporting excessive sleepiness.

Conclusion

Acquisition of clinically recommended PSG improved to 100% from our intervention. The detection of previously undiagnosed OSA, insomnia, and nocturnal hypoventilation is clinically meaningful. Sleep medicine incorporation into the neuromuscular multidisciplinary clinical care model contributes to improved patient care.

Support (if any)
1044 Relationship Between Core Autism Symptoms and Sleep Disturbances in Youth with Autism: A Latent Class Analysis
Authors: Lenker Kristina , Calhoun Susan , Fernandez-Mendoza Julio , Mayes Susan
Published: April 2024

Introduction

Previous studies have used cluster analysis to clarify diagnostic heterogeneity of autism, but have been limited to identifying subgroups of autism on the basis of core symptoms rather than sleep problems. The present study examined the relationship between core autism symptoms and sleep problems in children and adolescents with autism spectrum disorder (ASD).

Methods

1466 patients (1–18y, M=6.4±3.6; IQs of 8–146, M=88.9±27.25; 81.2% male, 89.0% white) diagnosed with ASD. Dimension reduction via principal component analysis (PCA) was performed on the 10 sleep items from the Pediatric Behavior Scale. Latent class analyses (LCA) was used to determine phenotypes characterized by core ASD symptoms (social interaction, perseveration, somatosensory disturbance, atypical communication/ development, mood, and selective attention/safety awareness), and sleep dimensions accounting for age, gender, IQ, and medication use.

Results

Three clusters with distinguishable sleep factors were retained from the PCA, with eigenvalues >1, with adequate goodness-of-fit (TLI=0.91;RMSEA=0.075); disturbed sleep (trouble falling asleep, restless sleep, wakes often, nightmares, and talks/walks/or cries in sleep), insufficient sleep (sleeps less, wakes early), and, hypersomnolence (drowsy/sleepy, sluggish/slow-moving, sleeps more). LCA revealed a 3-class (AIC=29164.00;BIC=29594.00;sBIC=29334.00) and 4-class model (AIC=28986.00;BIC=29489.00;sBIC=29184.00), with adequate fit. Based on IC measures, the 4-class model yielded the best model fit, with acceptable entropy (0.856). Based on conceptual grounds and considering all model fit statistics, the 4-class model was chosen. Using Class 3 (N=708;50.7%) as the reference group, Class 1 (N=71;5.1%) was categorized by more problems with social interactions, disturbed sleep, hypersomnolence, older age and increased medication use. Class 2 (N=367;26.3%) was categorized by less severe autism symptoms, particularly problems with selective attention/safety awareness, overall sleep problems, older age and higher IQ. Class 4 (N=251;18.0%) was categorized by more problems with perseveration and somatosensory disturbance, disturbed and insufficient sleep, younger age and increased medication use. Gender was not a significant covariate.

Conclusion

Using LCA we found four distinct patterns of core autism symptoms and sleep problems differing in terms of age, IQ, and medication use. This study provides strong evidence for phenotyping and targeting sleep as a standard part of therapeutic intervention in individuals with autism.

Support (if any)

Department of Health and Human Services, Health Resources and Services Administration, R4349152
1049 Are the AASM Scoring Rules Fitting for the Sleep of Patients with Chronic Disorders of Consciousness?
Authors: Marelli Sara , Sattin Davide , Castelnuovo Alessandra , Ippoliti Camilla , Magnani Francesca Giulia , Cacciatore Martina , Barbadoro Filippo , Leonardi Matilde , Sebastiano Davide Rossi , Strambi Luigi Ferini
Published: April 2024

Introduction

From a neurobiological perspective, consciousness and sleep are strictly related. It is known that regular sleep patterns may reflect the preservation of brain functions. Detailed sleep assessment Disorders of Consciousness (DOC) patients is a controversial issue.

Methods

Twenty-two patients (11 females and 11 males, mean age 52.2 + 14.5 years) with prolonged or chronic DOC were consecutively enrolled as part of a national, multicentric clinical trial aimed at evaluating the tolerance and the efficacy of treatments for sleep disorders in DOC patients. All the patients underwent to a 24h polysomnography (PG) visually inspected in order to assess their sleep stages on the basis of the AASM scoring rules.

Results

All the patients except one slept for at least 4 hours. Ten out of 21 (47.6%) patients showed a sleep lacking the features necessary for scoring; nor spindles neither K-complexes were present, the delta waves, if present, were localized; the polygraphic features of REM stage were absent. In our cases, sleep differed from wakefulness only by the decrease in muscle tone and by the reduction of eye movements and muscle artifacts on the EEG, as well as by the modification in the heart rate and heart-rate variability. Furthermore, in 4 out of 10 DOC patients with “indistinct” sleep, EEG pattern was characterized by very low voltage activity (< 20 microV), similar to what is observed in cases of deep sedation.

Conclusion

Our data push in the direction that a standardized sleep assessment procedure in DOC should be stabilized.

Support (if any)

This research was funded by the Italian Ministry of Health GR-2016-02365049—Pilot Study on sleep pathologies treatments in patients with Vegetative and Minimally Conscious State diagnosis for improving Consciousness level: the STRIVE project.
1054 Should Non-sleepy Patients Screened Positive for Sleep Apnea During Hospitalization Be Treated?
Authors: Srinivasan Priyanka , Rojas Edward , Olgers Kassandra , Knollinger Scott , Stansbury Robert , Sharma Sunil
Published: April 2024

Introduction

Studies have shown that unrecognized sleep apnea in hospitalized patients results in increased hospital readmissions. However, it is unclear if poor outcome is limited to sleepy patients (ESS>10) or non-sleepy patients (ESS< 10) as well. In a formal hospital sleep medicine program, we evaluated the outcome of hospitalized patients diagnosed with OSA by monitoring their 6-month emergency department (ED) visits, hospital readmissions and mortality.

Methods

Patients were chosen based on two criteria: report of an ESS score and diagnosis of OSA through gold-standard outpatient polysomnography (PSG). During the period of August 2019 and June 2023, a total of 123 consecutive patients from a hospital sleep medicine service who were determined to have OSA and ESS ³ 10 were compared with a control of 123 patients with OSA and ESS < 10. Over the next 6 months, patients’ ED visits, hospital readmissions and mortality were monitored. Demographics, comorbidity, and medication information were also recorded for these patients.

Results

The sleepy cohort had a mean ESS of 14 (SD 3) compared to the non-sleepy cohort of 6 (SD 2). The mean age and BMI for the sleepy versus non sleepy cohort were 57.6 (SD 12.8) versus 59.9 (SD 12) and 42 (10.8) and 39.6 (10.9), respectively. The sleepy cohort had an AHI from PSG of 26.2 (26.3) and the non-sleepy cohort had an AHI from PSG of 28.4 (23), the severity of sleep apnea was also similar. For patients with OSA and ESS > 10, the adjusted odds ratio for emergency department visits was 0.74 (95% CI 0.41-1.33). Similarly, the OR for the sleepy cohort for hospital readmission and mortality was 1.07 (CI 0.66-1.73) and 1.0 (CI 0.99-3.63).

Conclusion

Hospitalized patients who were diagnosed with OSA did not display significant differences in 6-month readmission, ED visit and mortality based on their ESS score. Given OSA’s prevalence in the community, additional measures in addition to ESS scores must be taken to manage potential cases of OSA, thus improving clinical outcomes.

Support (if any)
1057 A Tale of Two Languages: Evaluating Caregiver Satisfaction with Telemedicine in a Pediatric Sleep Medicine Clinic
Authors: Vaziri sanaz , Church Gwynne , Panek David
Published: April 2024

Introduction

The COVID-19 pandemic highlighted the ability need of telemedicine to provide comprehensive and quality care to patients remotely. Sleep medicine has been one of the subspecialties that has seamlessly integrated telehealth into its practice. However telehealth may hinder access to care and disproportionately impact vulnerable populations. owing to a growing body of research that supports its efficacy in diagnosing and managing sleep disorders. Although studies have established the similarity in quality of care between telemedicine and traditional in-person visits, there still exists a gap in our understanding of caregiver satisfaction, especially among Spanish-speaking caregivers. This study aims to assess the experiences of English and Spanish- speaking caregivers who received telemedicine services in our pediatric sleep clinic.

Methods

This was a cross-sectional anonymous one-time survey performed at the pediatric sleep clinic at University of California (UCSF) Benioff Children’s Hospital Oakland. The survey included caregivers who spoke English or Spanish and whose child had a sleep medicine appointment over Zoom. Responses were collected using Research Electronic Data Capture (REDCap), and descriptive analyses were conducted.

Results

34 participants completed this survey. 71% (n=24) were English speaking and 29% (n=10) were Spanish speaking. Among Spanish-speaking participants (n=10), 60% were satisfied compared to 92% (n=22) of English-speaking participants. The main reasons cited were decreased time missing school or work and decreased travel time. Of those who were Spanish speaking, 40% (n=4) were dissatisfied with telehealth in comparison to 8% (n=2) of English-speaking participants. The main reasons for dissatisfaction included connectivity issues and preference for in-person appointments. Spanish-speaking participants experienced more difficulties with Zoom, such as receiving the wrong Zoom ID, not receiving instructions beforehand, and not knowing who to call for help.

Conclusion

Our study suggests that while the majority of families are satisfied with telemedicine and are interested in continuing with a hybrid model of in-person and telehealth visits in the future, Spanish-speaking families were less satisfied with telemedicine than English-speaking families. Having knowledgeable and supportive staff to troubleshoot problems with connectivity, access to interpreters, and offering at least one in-person appointment can improve satisfaction with telemedicine for Spanish-speaking patients.

Support (if any)
1059 Effects of COVID-19 on Sleep Services Use and Its Recovery
Authors: Ramezani Amin , Sharafkhaneh Amir , BaHammam Ahmed S , Kuna Samuel T , Razjouyan Javad
Published: April 2024

Introduction

The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU) (Home Sleep Apnea Testing [HSAT] and Polysomnography [PSG]) were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data.

Methods

A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age ≥ 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre-pandemic (Pre-Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre-vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and postvaccination (Pan-Post-Vax). We compared STU between intervals (Pre-Pan as the reference).

Results

Among 261,371 veterans (63.7±9.6 years, BMI 31.9±6.0 kg/m², 80% male), PSG utilization decreased significantly during Pan-Mor (-56%), Pan-Pre-Vax (-61%), Pan-Vax (-42%), and Pan-Post-Vax (-36%) periods all compared to Pre-Pan. HSAT utilization decreased significantly during the Pan-Mor (-59%) and Pan-Pre-Vax (-9%) phases compared to the Pre-Pan and subsequently increased during Pan-Vax (+6%) and Pan-Post-Vax (-1%) periods. Over 70% of STU transitioned to HSAT, and its usage surged five months after the vaccine introduction.

Conclusion

Sleep testing services utilization recovered differentially during the pandemic (PSG vs HSAT), including a surge in HSAT utilization post-vaccination.

Support (if any)

Supported by National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) K25 funding (1K25HL152006-01 [J.R.]); ZOLL Respicardia (31002 [A.S.]); Airborne Hazards and Burn Pits Center of Excellence (AHBPCE, Award #: FY2024-002 [J.R.]); and the use of facilities and resources at the Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the U.S. government, or Baylor College of Medicine.
1060 Implementation of a Two-Way Automated Text Messaging Program for Common PAP-Related Problems
Authors: Watach Alexa , Friday Sadie , Schwab Allison , Staley Beth , Schutte-Rodin Sharon , Balachandran Mohan , Schwab Richard , Bae Charles
Published: April 2024

Introduction

Without consistent PAP data monitoring, clinics struggle to identify issues with patients' PAP receipt and usage. To address this, we created PennPALS (Penn PAP Automated Learning System), a cloud-based platform that filters PAP data extracted from the electronic medical record (EMR) through algorithms to identify common PAP issues, such as non-adherence, mask leaks, elevated residual AHI, or delayed setups. Patients are contacted about issues through two-way text messaging.

Methods

PennPALS auto-enrolls patients based on an EMR PAP order. Patients can opt out at any time during the 90-day monitoring program. We conducted a retrospective evaluation of PennPALS for patients enrolled June 2023.

Results

In one month, 279 patients were enrolled (mean age 54.9 (14.5) years, 56.3% male, 48.8% white, 40.5% Black or African American and 6% Hispanic). One hundred eighty-nine patients entered a 90-day data monitoring window (mean age 54.1 (14) years, 57.7% males, 45.5% white, 41.8% Black or African American, 3.8% Hispanic, and 58.7% new to PAP). Ninety patients never had PAP data in EMR. Two patients were ineligible due to invalid phone number in EMR and 25 opted out (4 at enrollment; 21 during monitoring). During the 90 day monitoring, the following number of triggers were activated: 247 non-adherence (7 day avg. < 4hrs), 571 adherence (7 day avg. >4hrs), 314 mask leak (Phillips: avg % time in large leak ≥ 30% for ≥3 of 7 days; ResMed: leak ≥ 24 L/min for ≥3 of 7 days), 8 high residual AHI (7 day avg ≥ 10 events/hr), 62 no data triggers (no data for 5 days), and 9 continued no data triggers. Of patients that completed the exit survey (n=20), average “how helpful” score (scale 0-10) was 7.9 (3.9) and Net Promotor Score (e.g., likelihood to recommend) was 87.

Conclusion

PennPALS demonstrates real-word feasibility to monitor patients and identify issues with algorithms based on discrete PAP data within EMR. Identified issues triggered two-way text messaging to improve PAP communications. The high number of patients without PAP data requires further investigation (e.g., patient did not pursue PAP, modem not linked). Patients reported that PennPALS was helpful and they would recommend it.

Support (if any)

K12HS026372
1062 VR for Stress Reduction and Sleep Health Improvement Among Perinatal Women: Insights from the Nurturing Moms Study
Authors: Blanc Judite , Scaramutti Carolina , Carasco Mary , Dimanche Stacyca , Hollimon Laronda , Gabbay Vilma , Seixas Azizi
Published: April 2024

Introduction

This qualitative study explores the multifaceted experience of motherhood and its impact on mental wellness, sleep health, and resilience, as well as examines barriers and facilitators of virtual reality (VR) use for stress management among perinatal women of color.

Methods

Two focus groups were held with perinatal women [n = 13; average age 32 years] identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. This pilot project evaluates NurtureVR, a VR-based program for pregnancy-related education and maternal wellness that integrates mindfulness techniques, relaxation, and VR-enabled guided imagery for the pregnancy and post-partum periods. An inductive and iterative approach was employed in the qualitative analysis of the focus group transcripts to identify key themes.

Results

The qualitative analysis identified five primary themes, encompassing 19 nuanced sub- themes and a total of 94 references: 1) Navigating Motherhood, 2) Maternal Mental Wellness, 3) Embodied Therapy, 4) Postpartum, and 5) Resilience. These themes cover a range of topics including the complexities of motherhood in women from the global majority, maternal mental health, attitudes towards VR for therapy, discussions on postpartum care and medication, and diverse views on resilience as an essential trait among mothers. Participants shared a variety of challenging experiences related to household management, caregiving, financial stress, breastfeeding, finding relaxation time, and achieving adequate sleep. There was also a significant interest in learning about the connection between sleep and stress, with maternal sleep health being identified as a potential area for future VR-based interventions.

Conclusion

These findings highlight the numerous challenges and barriers faced by women of color during and after pregnancy, which can significantly impact their mental and sleep health. Holistic public health programs targeting maternal health should not only incorporate screening for mental health and sleep issues but also address social determinants of health comprehensively. Additionally, culturally responsive behavioral treatments, which consider the intersection of identities including VR interventions, demonstrate the potential in providing timely and tailored mental health support to perinatal women.

Support (if any)

NIH 5R01HL142066