bluuebunny/crossref_metadata_2025 huggingface dataset:
0829 Insomnia with Objective Short Sleep Duration is Associated with Hypertension
Authors: Li Yun , Dai Yanyuan , Chen Baixin , Chen Le , Fernandez-Mendoza Julio , Karataraki Maria , Tang Xiangdong , Vgontzas Alexandros
Published: May 2023

Introduction

Insomnia with objective short sleep duration (ISSD) has been proposed as the most biologically severe phenotype of the disorder associated with cardiometabolic morbidity in population-based samples.

Methods

In this study, we investigated the association between ISSD and hypertension in a large clinical sample. We studied 348 patients diagnosed with chronic insomnia disorder (CID) based on International Classification of Sleep Disorders (ICSD-3) criteria and 150 normal sleepers. Objective short sleep duration was defined by the median total sleep time (TST) of the sample (< 7 hours) measured with 1-night polysomnography. Hypertension was defined based on blood pressure (BP) levels, antihypertensive medication use and/or a physician diagnosis.

Results

After adjusting for potential confounders, patients with CID who slept < 7 hours were associated with 2.8-fold increased odds of hypertension compared to normal sleepers who slept ≥7 hours (odds ratio [OR]=2.81, 95% confidence interval [95%CI]=1.068–7.411) or < 7 hours (OR=2.75, 95%CI=1.005-7.542), whereas patients with CID who slept ≥ 7 hours (OR=1.52, 95%CI=0.537-4.285) or normal sleepers who slept < 7 hours (OR=1.07, 95%CI=0.294-3.904) were not significantly associated with increased odds of hypertension compared to normal sleepers who slept ≥ 7 hours. Linear regression analyses showed that, for every hour decrease in TST, systolic and diastolic blood pressure increased by 1.014 mmHg (p=0.045) and 0.923 mmHg (p=0.015), respectively, in patients with CID but not in normal sleepers.

Conclusion

Our findings further support that ISSD is a risk factor for hypertension and objective short sleep duration may be a useful marker of the biological severity of CID in clinical practice.

Support (if any)

This study was supported by the National Natural Science Foundation of China (81970087), Guangdong Province Science and Technology Special Fund Project (200115165870512), and the 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (2020LKSFG05B). The authors report no conflict of interest.
0831 Sleep in Long-Term Childhood Cancer Survivors Compared to Siblings: A Report from the Childhood Cancer Survivor Study
Authors: Daniel Lauren , Wang Huiqi , Brinkman Tara , Ruble Kathy , Zhou Eric , Palesh Oxana , Stremler Robyn , Howell Rebecca , Mulrooney Daniel , Oeffinger Kevin , Neglia Joe , Yasui Yutaka , Armstrong Greg , Krull Kevin
Published: May 2023

Introduction

Sleep problems following treatment for childhood cancer may persist into adulthood. Because some sleep problems increase with age, it is important to understand whether cancer elevates this risk and assess associations with co-morbidities that frequently develop in long-term childhood cancer survivors. The current study compares sleep in long-term survivors to sibling controls.

Methods

Childhood cancer survivors (≥5 years from diagnosis; n=12,340; 51.5% female; mean [SD] age=39.4 [9.6] years; years since diagnosis=30.9 [7.9]; age at diagnosis=8.5 [5.8]) and siblings (n=2395; 57.1% female; age=44.6 [10.5]) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Binary sleep behaviors (Total Score >5, Short Sleep Duration [< 6 hours], Frequent Snoring [>3 times/week], Frequent Sleep Medication Use [≥3 times/week]) were compared between survivors and siblings using a multivariable generalized estimating equation with Poisson error to account for intra-family correlations, adjusting for age, sex, race, and BMI. Poisson regression models evaluated treatment and chronic health conditions (CHCs) as predictors of PSQI Total Score among survivors with the same adjustment variables.

Results

Survivors were more likely to report Short Sleep Duration (12.0% vs 10.6%; adjusted prevalence ratio [aPR] 1.18, 95% confidence interval [CI] 1.04-1.34), elevated PSQI Total Score (45.1% vs 40.0%; aPR 1.17, 95%CI 1.11-1.23), Frequent Snoring (18.0% vs 17.4%; aPR 1.11, 95%CI 1.01-1.23), and Frequent Sleep Medication Use (13.2% vs 11.5%; aPR 1.28, 95% CI 1.14-1.45) compared to siblings. Among survivors, elevated PSQI Total Score was associated with female sex (aPR 1.29, 95%CI 1.21-1.37) and BMI (overweight: aPR 1.13, 95%CI 1.06-1.22; obese: aPR 1.32, 95%CI 1.23-1.42), while age at diagnosis and cancer treatment exposures (i.e., chemotherapy/radiation) were not significantly associated. Survivors with 2+ CHCs had increased prevalence of elevated PSQI Total Score (aPR 1.39, 95%CI 1.28-1.50) relative to survivors without CHCs.

Conclusion

Childhood cancer survivors exhibit elevated risk for poor sleep quality, short sleep, and snoring relative to siblings well into middle age. These sleep problems are driven by demographics and current chronic health conditions rather than prior treatment exposures. Elevated use of sleep-promoting medications suggests interest in managing sleep difficulties and an opportunity for future behavioral sleep intervention trials.

Support (if any)

NCI 5U24CA055727-26 (PI: Armstrong)
0832 ABOUT CLOCKS, SLEEP, PAIN AND THEIR INTERACTIVE ROLE IN TMJ OSTEOARTHIRIS - A CASE REPORT
Authors: Oliveira Simone , Cruz Miguel Meira e
Published: May 2023

Introduction

As a major cause of disability among older people, Temporomandibular Joint Osteoarthritis (OA) remain a critical issue for both geriatric medicine and public health. While etiologic foundations of this condition are still unclear, it is well known that 24h-driven biological (circadian) rhythms are basic physiological requirements for the homeostatic control of peripheral tissues, such as skeletal muscle, bone and particularly cartilage. Sleep, as the most conspicuous circadian rhythm rooling health and welbeing, is also relevant for anabolic and catabolic processes within cartilage, with nocturnal sleep regulating other factors from which depend important metabolic pathways . Pain, which is chronically coupled to OA is not only impacted by both circadian rhythms and sleep but is itself a contributor to circadian misalignment and sleep disruption which therefore increase pain propensity maintaining a deleterious vicious cycle. Hence, knowledge on such interactive structural and functional composition should be of great relevance both for preventing and successfully treating this chronic, debilitating, neurodegenerative disorder.

Methods

Authors are reporting an interesting case of a patient in which circadian disruption, impaired sleep and exacerbated persistent pain co-ocur within OA. Sleep questionnaires (Insomnia Severity Index - ISI, STOP-BANG

Results

NA

Conclusion

From this singular case, a chronobiological approach (phototherapy) directed to circadian alignment and sleep improvement showed to be effective both for general clinical improvement and for its long-term prognosis associated to OA.

Support (if any)
0835 Cancer Patient-Caregiver Dyad Reports of Insomnia, Depression, Anxiety, Symptom Management and Healthcare Utilization
Authors: Carter Patricia , Dorsey Leah , Acker Kristi , Welch Teresa
Published: May 2023

Introduction

More than 1.9 million new cases of cancer were diagnosed in 2022; 30,210 of those were in Alabama. Both caregivers and patients report high levels of insomnia, depression, anxiety and stress that can be linked to a cancer diagnosis, cancer therapies, and the stressful cancer journey. Insomnia, depression, and anxiety may lead to poor symptom management at home and inappropriate (over or under) utilization of healthcare resources. However, these relationships in cancer patients and family caregivers need further exploration. This cross-sectional study is using a community-engaged research approach to gather data to support the development and testing of a model of these relationships and targeted interventions.

Methods

Caregiver-patient dyads are being recruited at a rural oncology clinic. Each dyad completes a role specific survey one-time during a clinic visit. Sleep is assessed with PSQI and ISI, Depression with PHQ-9, Anxiety with GAD-7, and Stress with PSS. Healthcare resource utilization is captured by self-report. Caregivers report patient symptoms and level of confidence with home symptom management. Patients report quality of life with FACT-G. Target enrollment is 50 dyads for the full study.

Results

To date we have enrolled 33 patient-caregiver dyads (66% of target). Sleep quality (PSQI) and insomnia levels (ISI) ranged from no difficulties to significant difficulties for both groups. Similar variances in depression (PHQ-9), anxiety (GAD-7), and perceived stress (PSS) have been reported. On these measures, some dyad members appeared to mirror each other, whereas others reported vast differences. Caregivers who reported a greater number of patient symptoms tended to report lower levels of confidence in home symptom management. Approximately 50% of the participants have reported healthcare resource utilization, with a majority reporting little to no use of healthcare services. Indicating possible underutilization.

Conclusion

The cancer journey impacts both patients and caregivers. However, the impact is reflected differently in each member of the dyad. More research is needed to explore the individual and dyadic experiences along the cancer journey and to model the relationships to develop effective interventions for both the cancer patient and family caregiver.

Support (if any)

Project funding- Office of Research & Economic Development, University of Alabama.
0837 Could sleep quality and excessive sleepiness be associated with knee pain? A cross-sectional study
Authors: Kakazu Viviane , Pinto Rafael , Dokkedal-Silva Vinicius , Fernandes Guilherme , Gobbi Cynthia , Pires Gabriel , Dias Tayna , Andersen Monica , Tufik Sergio , Morelhão Priscila
Published: May 2023

Introduction

Osteoarthritis (OA) is common among the older population, and sleep deprivation and depression appear to be associated with worse OA pain. The scientific literature is inconsistent in respect of overall sleep quality and daytime sleepiness in studies that consider knee pain specifically. To examine the association between sleep quality, daytime sleepiness and knee pain in older adults.

Methods

This was a cross-sectional study. The sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) and sleepiness was evaluated by Epworth Sleepiness Scale. Older adults with knee pain classified as having OA according to the National Institute for Health and Care Excellence (NICE) guidelines. Eligibility criteria were preserved cognitive functions and being over 60 years old. Logistic regression analyses, adjusted for potential covariates (age, body mass index and sex), were performed to assess potential associations between sleep parameters and knee pain.

Results

The total sample was 451 older adults. Poor sleepers were associated with knee pain (OR=1.93, 95%Confidence interval [CI]: 1.26 to 299). Participants with daytime sleepiness were related with knee pain (OR=1.68, 95%CI: 1.100 to 2.80).

Conclusion

Sleep quality and daytime sleepiness were correlated with knee pain in the older adults. Social sleep education strategies for patients with knee pain may be important for pain control. Therefore, these variables are important in the management of patients with knee pain. Future studies should investigate whether there is a prognostic relationship between sleep quality and knee pain in the older population.

Support (if any)

Our studies are supported by grants from the Associacão Fundo de Incentivo à Pesquisa (AFIP) and the Sao Paulo Research Foundation (FAPESP 2022/00328-5 to VAK). CG and PKM are supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES)-Finance Code 001). GLF is supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq—#141445/2021-1). MLA, ST and RZP are Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) fellowship recipientes.
0843 Identifying the Minimum Number of Ambulatory Blood Pressure Measurements to Classify a Reliable Blood Pressure Dipping Status
Authors: Brito Leandro , Bowles Nicole , Butler Matthew , McHill Andrew , Rice Sean , Emens Jonathan , Shea Steven , Thosar Saurabh
Published: May 2023

Introduction

Ambulatory blood pressure monitoring (ABPM) is recommended over office BP assessment as it enables quantification of the degree of nocturnal BP dipping (classifications: “dipping” = nighttime/daytime BP of < 0.9; “non-dipping” = ≥0.9), a robust predictor of future adverse events. However, ABPM can cause discomfort jeopardizing adherence to the 24-hour assessment. Current guidelines recommend at least 20/7 daytime/nighttime BP measurements for reliable classification of nocturnal dipping status, but recent reports suggest 8/4 daytime/nighttime measurements may be sufficient. This threshold for classification can reduce patient burden and potentially enhance clinical practice. We aimed to identify the minimum number of ambulatory BP measurements to determine a reliable dipping status.

Methods

Forty-three ostensibly healthy participants (50±10 years [mean±SD]) wore an ambulatory BP monitor for 24 hours with measurements every 20/30 minutes during the daytime/nighttime, respectively (maximum 48/16 daytime/nighttime measurements). We calculated each participant's dipping status using all available systolic BP measurements. We randomly selected 20-daytime plus 8-nighttime measurements, identified dipper statuses from all possibilities of 1-20 daytime and 1-8 nighttime measurements separately, and calculated the proportion of participants whose dipping status remained unchanged. We then evaluated all possible combinations starting with a minimum of 8 daytime/5 nighttime for consistency with participants’ full data set using a second random selection of 20/8 measurements

Results

We found that using 8-daytime (plus all available nighttime) measurements was sufficient for unchanged dipper status in 90% of possible combinations, and using 5-nighttime (plus all available daytime) measurements was sufficient for unchanged dipper status in 92% of possible combinations. Confirmatory analyses revealed that 8/5 daytime/nighttime combinations correctly identified dipper status in 84% of the >7 million combinations. 10/8 daytime/nighttime combination improved this to 86%, similar to 87% returned from the guidelines’ recommended combination of 20/7 daytime/nighttime measurements.

Conclusion

In ostensibly healthy people, current thresholds for ambulatory BP monitoring recommendation could result in ~13% misclassifications of dipping status compared to full datasets. However, considering that this measurement can cause discomfort and that dipping statuses can be unstable in 30% of individuals, 10/8 daytime/nighttime measurements may be a reliable alternative.

Support (if any)

NIH F32HL131308, R01HL163232, R01HL125893, R35HL155681, OHSU MRF and OFDIR.
0845 Individuals with Persistent Low Back Pain Have Less Time in Deep Sleep Stage than Asymptomatic Controls
Authors: Wang Xuewen , Kishman Erin , Gilliam John , Vendemia Jennifer , Silfies Sheri
Published: May 2023

Introduction

Sleep consists of stages of light sleep, deep sleep, and rapid eye movement (REM), which have different characteristics. These stages are thought to be associated with different physiological and psychological processes. Pain is an unpleasant sensory and emotional experience generated by neural activity that potentially impacts several networks in the brain. There is limited information regarding the potential association between objectively determined sleep characteristics and persistent low back pain (pLBP). The purpose of this study was to examine whether sleep characteristics differ between individuals with pLBP and asymptomatic controls.

Methods

Individuals in a current episode of back pain with symptoms impacting function and persisting greater than 3 months (pLBP group, n=20) and asymptomatic individuals (control group, n=16) participated in the study. They wore a home sleep test device (Zmachine® Insight+, General Sleep Corporation) for three nights.

Results

The pLBP and control groups had similar age (24.8 ± 5.8 and 25.4 ± 4.3 years, respectively; mean ± SD), height, weight, and waist and hip circumferences. The two groups also had similar total sleep time (6.0 ± 1.2 and 6.6 ± 1.0 hours, for pLBP and control groups, respectively), sleep efficiency (82.8 ± 8.8% and 84.9 ± 5.7%), and wake time after sleep onset (35.8 ±27.4 and 31.5 ±18.1 minutes). The duration in REM (1.5 ± 0.5 and 1.5 ± 0.6 hours) and light sleep (3.1 ± 0.7 and 3.4 ± 0.9 hours) stages were also similar. However, the pLBP group had less deep sleep time (1.4 ± 0.4 hours) than the control group (1.7 ± 0.3 hours) (p = 0.029).

Conclusion

Individuals with pLBP had less deep sleep time than asymptomatic controls, although other objectively determined sleep characteristics appear to be similar. These results suggest an association between the deep sleep stage and persistent low back pain that requires further investigation.

Support (if any)

National Institutes of Health R01HD095959 and University of South Carolina ASPIRE 80004373.
0846 Prevalence of Obstructive Sleep Apnea Among Medical ICU Patients
Authors: Ehrenberg Madeline , Kongpakpaisarn Kullatham , Intihar Taylor , Doyle Margaret , Knauert Melissa
Published: May 2023

Introduction

The prevalence of Obstructive Sleep Apnea (OSA) among medical intensive care unit (MICU) patients is unknown. However, OSA prevalence in the general population and in conditions that are frequently comorbid in ICU populations (e.g., diabetes and cardiovascular disease) suggests that OSA may be common among MICU patients. Our objective is to prospectively examine the prevalence and severity of OSA in patients admitted to a tertiary academic MICU.

Methods

This was a prospective observational study that included patients admitted to the MICU from July to December 2022. Patient charts were reviewed for patient demographics, clinical characteristics, and evidence of pre-existing OSA. Pre-existing OSA was assessed via in depth review of the electronic medical record and included data fields such as the past medical history, documentation of OSA treatment, description of OSA diagnosis in outpatient provider notes, and/or sleep study records. Based on chart review, we also assigned confidence ratings for the OSA diagnosis (high versus low) and noted patients for whom outpatient providers had a high clinical suspicion for OSA in the absence of definitive sleep evaluation.

Results

Herein, we present preliminary analysis of 345 MICU patients. Mean age (SD) was 64 (18) years; 49% were female, 23% were Black, and 67% were White. Acute respiratory failure (36%) and septic shock (24%) were the leading reasons for admission. Mean (SD) APACHE II severity of illness score was 19.6 (8.8) and body mass index was 27.5 (8.5). Pre-existing OSA was identified in 19% of patients; 63% of pre-existing OSA patients were characterized as “high confidence” in OSA diagnosis. An additional 6% of patients had high clinical suspicion of OSA. Severity data was sparse in the chart with only 17% of OSA patients having severity data available; OSA severity distribution was as follows: mild 9%, moderate 27%, and severe 64%.

Conclusion

Our preliminary analysis indicates that OSA is notably prevalent among MICU patients. We hypothesize that OSA is under-recognized and consequently undertreated in MICU patients. With this in mind, future directions include investigation of the recognition, treatment, and outcomes related to pre-existing OSA in critically ill patients.

Support (if any)

NHLBI, NIH T35HL007649
0850 Association of Actigraphy-Assessed Sleep Parameters and Physical Functioning following Acute Hospitalization in Older Adults
Authors: Arentson-Lantz Emily , Deer Rachel , Kokonda Manasa , Meers Jessica , Carreon Samantha , Shetty Sharonya , Boyle Julia , Taffet George , Vahidy Farhaan , Agarwal Kathryn , Volpi Elena , Nowakowski Sara
Published: May 2023

Introduction

Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Identifying factors, such as sleep continuity, that may be related to recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between actigraphy-assessed sleep parameters and physical functioning after an acute hospitalization in community dwelling older adults.

Methods

Participants (n=24; age 68.9±5.5y, 71% female, 96% white), were recruited during an acute hospitalization. Participants completed physical performance testing using the Short Physical Performance Battery (SPPB) during acute hospitalization (baseline) and at 4-weeks post-discharge (follow-up). At the time of discharge, participants were given Philips Actiwatch-2® device to record sleep continuity for four weeks following hospital discharge. Actigraphy parameters included total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL) and wake after sleep onset (WASO). We conducted multivariate regression analyses using Poisson distribution to determine whether actigraphy-derived sleep parameters predicted of physical function.

Results

Increase in actigraphy-derived SE was associated with greater SPPB Balance (0.05±0.02, p=0.04) at the 4-week follow-up assessment. Increased TST was associated with improvements in SPPB total score (0.004±0.002, p=0.05) change score from baseline to 4-week follow-up. SE (0.11±0.04, p=0.01) and TST (0.004±0.002, p=0.005) were positively associated, whereas WASO (0.03±0.01, p=0.05) and SOL (0.15±0.07, p=0.03) were inversely associated with improvement in SPPB Balance change score from baseline to 4-week follow-up.

Conclusion

Together, these results demonstrated that improvements in actigraphy-derived sleep parameters (increased sleep efficiency and total sleep time; and decreased wake after sleep onset and sleep onset latency) were associated with improvements in physical functioning from hospital to 4-week follow up. Improving sleep during hospitalization may reduce hospital deconditioning and improve functional recovery.

Support (if any)

This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi) Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0858 Associations between Sleep Duration and Cholesterol Levels among Hispanics: Findings from the National Health Interview Survey
Authors: Carrasco Mary , Moore Jesse , Locklear Clarence , Blanc Judite , Chung Debbie , Rogers April , Zizi Freddy , Jean-Louis Girardin , Seixas Azizi
Published: May 2023

Introduction

Short sleep (< 7 hours of sleep/24 hr. period) duration is associated with unhealthy cholesterol levels, a significant cardiovascular risk marker. Precious epidemiological studies indicate that Hispanics are at increased risk for hypercholesteremia. However, little is known about whether sleep duration contributes to high cholesterol levels, among Hispanics. We sought to investigate the following: 1) Examine whether sleep duration predicts cholesterol levels; 2) Examine whether this relationship differs in Hispanics in comparison to non-Hispanics.

Methods

This study was based on the 2020 National Health Interview Survey. Cholesterol, the outcome, is defined as whether an individual had high cholesterol during the last 12 months. Sleep quantity was categorized as follows: short sleep (< 7 hours), healthy sleep (7-8 hours), and long sleep (≥9 hours). For stratified analyses, we investigated whether the relationship between sleep duration and cholesterol differed between Hispanics and non-Hispanics. We performed unadjusted and fully adjusted binary logistic regression analyses, with age, sex, education, income, and BMI as covariates.

Results

In our unadjusted models, Hispanic short sleepers had increased odds of high cholesterol (OR: 1.39 p<.01 ), while long sleepers (OR: 1.25, n.s. p=.129) did not, compared to individuals who slept 7-8 hours. Non-Hispanic short (OR: 1.14 p<.01) and long (OR: 1.47, p< .01) sleepers had greater odds of high cholesterol, compared to individuals who slept 7-8 hours. For our fully adjusted models, Hispanic short sleepers had increased odds of high cholesterol (OR: 1.29, p<.05), while long sleepers did not (OR: 1.15, n.s. p=.55), compared to individuals who slept 7-8 hours. Non-Hispanics short sleepers had greater odds of high cholesterol (OR: 1.13 p<.01), while among long sleepers, no significant relationship was observed (OR: 1.05, p=.46), compared to individuals who slept 7-8 hours. Overall, Hispanic short sleepers had greater odds of high cholesterol compared to their non-Hispanic counterparts.

Conclusion

Hispanic short sleepers have an increased risk for high cholesterol. Further studies are needed to elucidate the pathophysiological mechanisms that affect the relationship between short sleep and cholesterol levels among Hispanics. This will enable tailored risk and protective profiling of Hispanic individuals to reduce their risk for high cholesterol.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, and R01HL152453
0864 Evolution of Sleep Symptoms over Time Among Youth with Craniopharyngioma
Authors: Hopper Kayce , Mandrell Belinda , Caples Mary , Hancock Donna , Merchant Thomas , Wise Merrill , Crabtree Valerie
Published: May 2023

Introduction

Craniopharyngioma is a non-malignant tumor that arises in the suprasellar region of the intracranial compartment. Hypothalamic dysfunction is common and associated with diabetes insipidus, hormone deficiencies, neurocognitive impairment, sleep disturbance, obesity, and decreased health-related quality of life. Patients with craniopharyngioma commonly have excessive daytime sleepiness, and are often diagnosed with narcolepsy without cataplexy and even obstructive sleep apnea (OSA). This study examined the change in apnea/hypopnea index (AHI) and prevalence of disorders of hypersomnia among pediatric patients with craniopharyngioma, from the time of diagnosis to 3 years after the completion of proton therapy.

Methods

A total of 110 pediatric patients diagnosed with craniopharyngioma were prospectively evaluated on a protocol of limited surgery and proton therapy or observation. Prior to proton therapy , patients age ≥4 years completed a baseline overnight polysomnography (PSG) and the next day multiple sleep latency test (MSLT) when age ≥7 years. Follow-up PSG and MSLT were repeated 3 years later. Patients were excluded from the analysis if they did not complete the sleep study at either time points.

Results

71 completed the baseline and 3-year PSG/MSLT. A paired samples t-test determined the change between time points. When compared to baseline (M=1.30, SE=.22) the AHI significantly increased at the 3-year evaluation (M=3.00, SE=.60), with a difference of t=-1.69, (p=.002). Fifty-one patients completed the baseline and 3-year MSLT. At baseline, 8 patients did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical disorder and 13 were diagnosed with narcolepsy due to medical disorder. At the 3-year MSLT, 2 of the 51 did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical condition and 19 were diagnosed with narcolepsy due to medical condition.

Conclusion

Pediatric patients with craniopharyngioma have disorders of hyposomnolence at diagnosis. The number impacted by hypersomnia increase with time, with the added burden of hypothalamic obesity and OSA. Interventions should be initiated early after diagnosis for promotion of wakefulness and prevention of obesity to deter the onset of OSA.

Support (if any)

This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.
0865 Feasibility of a Disposable Home Sleep Test Device in a Chronic Pain Population Prescribed Opioids
Authors: Finlay Myles , Bindler Ross , Wilson Marian
Published: May 2023

Introduction

Opioids are a common pain treatment in the United States with approximately 143 million prescriptions dispensed in 2020. Long-term opioids for chronic pain increase risk of misuse and overdose. Opioids can also disrupt sleep and cause respiratory depression while poor sleep can exacerbate pain. In-lab polysomnography is the standard for diagnosing sleep disorders. However, polysomnography is less effective for observing patterns over multiple days and is not always representative of at-home sleep. This study investigates the feasibility of using a disposable home sleep test device with adults prescribed opioids for chronic pain and its ability to screen for sleep disorders and overnight oxygenation.

Methods

Participants were recruited from clinics and public advertisements. Key inclusion criteria were: ≥18 years of age, moderate daily level of pain (≥5 on the 0-10 Numeric Pain Scale [NPS]), prescribed opioids, and internet access. The NightOwl mini disposable home sleep test (Ectosence, Leuven, Belgium) was used to record total sleep time (TST), time in bed (TIB), sleep efficiency (SE), oxygen saturation (SaO2) and apnea-hypopnea index (AHI) for 5 consecutive nights.

Results

All enrolled participants (N=9) completed 5 days with no missing data. The sample was 66% female with an average age of 60±12 (Mean ± SD). Mean NPS scores indicated moderate pain intensity (6.3±1.9). Participants spent an average of 8.0±1.4h TIB and slept for 5.4+/-1.3h TST resulting in a SE of 68.5±17.9%. On average, AHI was 7.3±7.7 (mild range for sleep apnea). 56% of participants displayed a SaO2 nadir below 88%, the recommended threshold for supplemental oxygen. All individuals agreed that they were at least somewhat satisfied with the ease and amount of time participating in the study. All agreed or strongly agreed that they felt comfortable participating.

Conclusion

Participants used the disposable sleep test device at home with relative ease as indicted by complete data recording, values within expected norms, and satisfaction survey responses. The device could be an acceptable screening tool for sleep disorders and respiratory events that may otherwise go undetected in this population prescribed opioids and at risk for apnea and respiratory depression.

Support (if any)

NCATS/NIH # Ul1 TR002319 and The Rayce Rudeen Foundation
0867 Lower Bedtime HRV is Associated with Higher WASO in Middle-Aged Adults with Chronic Insomnia
Authors: Huskey Alisa , Taylor Daniel , Emert Sarah , Kim Kelly , Nagy Sam , Leete Jackie , Olson Ethan , Lopez Nicole
Published: May 2023

Introduction

Short sleepers (< 6 hours per night) represent a unique phenotype of insomnia associated with more severe biological implications compared to insomnia with normal sleep duration. A primary contributor to shorter sleep duration is more time spent awake after sleep onset (i.e., WASO), which has deleterious effects on long-term cardiac physiology. For instance, short sleepers with higher WASO have lower parasympathetic activity at sleep onset compared to those with lower WASO or greater sleep duration.

Methods

Results presented here are derived from baseline assessments collected as a part of a clinical trial comparing three modalities of cognitive behavioral therapy for insomnia in middle-aged adults (50-65yrs) with chronic insomnia (N = 23). During their baseline assessment, individuals first completed one night of in-home polysomnography. Total sleep time was PSG derived. The following night, they wore an Equivital Harness equipped with an electrocardiogram (ECG) for 24 hours. In this investigation, inter-beat intervals were derived from ECG in 10-minute segments just before and just after bedtime (i.e., when the individual tried to sleep). WASO was calculated using sleep diaries during the night they wore the Harness and the following week.

Results

Preliminary data N = 23) show that high frequency (0.15-0.4Hz) heart rate variability (HRV; i.e., parasympathetic activity) at bedtime is not associated with WASO that night or WASO averaged across the following week. However, when the sample was narrowed to short sleepers only (□6hours; n = 7), lower levels of bedtime HRV (B = -.81, p = .028) is associated with greater WASO during the following week. In short sleepers, mean score of both before and after bedtime HRV predicted 65% of variance in WASO averaged across the next seven nights (R2 = .653, F (1, 5) = 9.41, B = -0.81, p = .28). These effects were not significant in individuals with sleep durations longer than 6 hours.

Conclusion

In this small sample, short sleepers display a unique, inverse relationship between cardiac vagal activity and sleep continuity, replicating similar findings regarding parasympathetic activity at sleep onset and subsequent WASO.

Support (if any)

This project is supported by the Psychology Department at the University of Arizona.
0883 Understanding how naps may modulate tinnitus
Authors: Guillard Robin , Philippe Vincent , Hessas Adam , Faraut Brice , Léger Damien , Londero Alain
Published: May 2023

Introduction

Tinnitus is a debilitating auditory symptom that globally impacts the quality of life of patients. Sound exposure, stress, and somatosensory stimuli (e.g. neck and jaw movements) are tinnitus modulators that have been commonly described and studied. Napping may also increase tinnitus loudness upon awakening in a minority of subjects. To our best knowledge this modulation and its potential pathophysiological mechanisms has never been systematically assessed.

Methods

For this observational prospective study, we studied 37 tinnitus subjects complaining of significant naps-related tinnitus modulations. All subjects performed 6 naps attempts under polysomnography over 2 days. Audiological, electrophysiological as well as jaw and neck muscles mobility and sensitivity assessments were completed before and after each nap. In addition, subjects filled a screening questionnaire and underwent a tinnitus pitch-matching procedure.

Results

197 naps attempts were collected. It was confirmed that overall naps were increasing tinnitus loudness (p< 0.001). First naps of the day yielded more important tinnitus modulations than second (p< 0.05) and third naps (p< 0.01) suggesting a saturation effect. Analyses conducted so far highlight that nap sleep duration correlates with observed tinnitus modulation (p< 0.05) and that audiometric thresholds at tinnitus closest frequency do not seem to be affected by tinnitus modulation. Neither jaw mobility nor sensitivity were correlated with tinnitus modulation. Analyses to come will assess if sleep apnea, sleep bruxism, cervical mobility or sleep position may correlate with tinnitus nap modulations.

Conclusion

This study demonstrated that in a subgroup of tinnitus patients naps may modulate tinnitus. Nap sleep duration more than jaw muscles sensitivity seem to be correlated with these modulations.

Support (if any)

This study was supported by Felicia and Jean-Jacques Lopez-Loreta Foundation, Robin Guillard EIRL and Université Paris Cité VIFASOM
0884 User Needs and Preferences for a Smartphone App to Treat Insomnia in Cancer Survivors
Authors: Kutana Samlau , Garland Sheila
Published: May 2023

Introduction

Cancer patients with insomnia have unique needs and require tailored healthcare interventions. iCANSleep is a mobile health intervention aimed at providing evidence-based insomnia treatment via a smartphone app. As part of a user-centered development process, virtual needs assessment interviews were conducted with cancer survivors who report insomnia to determine the needs and preferences of this patient group for insomnia treatment.

Methods

22 cancer survivors from 5 Canadian provinces completed an online survey and participated in a needs assessment interview. Surveys were analyzed using descriptive statistics, while interviews were transcribed and analyzed using thematic analysis.

Results

81.8% (18/22) of cancer survivors report that their insomnia started or was exacerbated during the time of their cancer diagnosis and treatment. Of the participants who discussed insomnia with a medical provider, hypnotic medications were prescribed in 64.3% (9/14) of cases. With some exceptions, participants reported strong familiarity with smartphone technology, had experience using apps for health management, and found an insomnia treatment app highly acceptable. Participant-identified facilitators of app use included ease of access, lack of cost, anonymity, empirical basis, and recommendation by local care teams. Smartphone ownership, cumbersome user interface, and limited access to internet were raised as potential challenges of implementation. Additional functionality identified by participants included options to link consumer wearable devices, additional modules to address comorbid conditions such as pain and anxiety, and an anonymous peer support forum.

Conclusion

Mobile apps hold promise as an avenue for the effective delivery of insomnia treatment; however, treatments must be evidence-based, and apps must be designed for maximum ease of use. Findings provide novel insight into how to best promote uptake and sustained use of mobile health interventions in cancer survivors and will be used to develop functional guidelines.

Support (if any)

Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).
0885 Alzheimer’s disease progression risk in Cognitive Normal Older Adults with Obstructive Sleep Apnea using NIA-AA Research Framework
Authors: White Payton , Azad Dishari , Cesar Oliver , Kovbasyuk Zanatta , Wahab Ariana , Jacobs Tovia , Kam Korey , Mullins Anna , Parekh Ankit , Rapoport David , Ayappa Indu , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo , Bubu Omonigho
Published: May 2023

Introduction

We determined risk profiles of strata-specific cognitive-normal (NL) older-adults with obstructive sleep apnea (OSA) characterized by their Aβ, P-Tau & T-tau (ATN) burden, on prospective AD stage-transition

Methods

Longitudinal study utilizing data from 167 community-dwelling NL older-adults participating in NYU studies on memory, sleep and aging. Subjects had baseline CSF AD-biomarker data and at least two follow-up clinical and neuropsychological data. OSA was defined using AHI4%. Using the NIA-AA Research Framework, data-driven, clinically relevant thresholds for CSF-Aβ42 (≤375pg/ml), P-tau (≥53.7pg/ml) and T-tau (≥367 pg/ml) indicated ATN status respectively. Twenty-four participants with suspected non-AD pathologic change defined as A-T+ were excluded leaving 143 for the analysis. Main outcome was AD stage-transition (i.e., change from Global Deterioration Scale (GDS) 1 or 2 [NL] at baseline to ≥3 [≥ MCI] during follow-up). Logistic mixed-effects models with random intercept and slope were used to assess associations between ATN characterized OSA subjects, and longitudinal AD stage transition, controlling for age-at-baseline, sex, APOE4-status, years-of-education, and their interactions with time.

Results

Of the 143 participants, 91 (63.8%) were women. The mean (SD) age was 69.6 (7.3) years and follow-up time was 4.73 (3.45) years. Sixteen (11.2%) were OSA+/A+/TN-, and 21 (14.7%) were OSA-/A+/TN-. Ninety-two (64.3%) had normal AD biomarkers (OSA+/A-/T- [n=45] and OSA-/A-/T- [N=47]). To generate strata-specific risks, subjects were combined into groups: (i) OSA subjects with AD pathologic change OSA+/A+/TN [n=25] consisting of OSA+/A+/TN+ [n=9] plus OSA+/A+/TN- [n=16] (ii) non-OSA subjects with AD pathologic change OSA-/A+/TN [n=26]) consisting of OSA-/A+/TN+ [n=5] and OSA-/A+/TN- [n=21] Fourteen subjects (9.8%) transitioned from NL to MCI (i.e., OSA+/A+/TN [6/25], OSA-/A+/TN [3/26], OSA+/A-/TN- [4/45] and OSA-/A-/TN- [3/47]). OSA+/A+/TN subjects were at higher risk of AD stage-transition relative to OSA-/A-/TN- (β = 1.31, 95%CI, 1.02, 1.62); OSA+/A-/TN- (β = 0.89, 95%CI, 0.42, 1.37); and OSA-/A+/TN subjects, (β = 0.71, 95%CI, 0.38, 1.04); P < .01 for all. OSA+/A-/T- vs. OSA-/A-/T- participants did not show differences in cognitive change over time (β = 0.22, 95%CI, -0.15, 0.39, P =.17).

Conclusion

Among ATN characterized NL older-adults with OSA, those with evidence of AD pathologic change have the greatest risk of developing AD.

Support (if any)

AASMBTS#231-BS-20, NIAK23AG068534A, AARG-D- 21-848397, BFFA2022033S
0886 Daytime Sleepiness in the Development of Alzheimer's Disease
Authors: Espejo Kimberly , Holloway Breanna M , DeYoung Pamela , Bosompra Naa-Oye , Ancoli-Israel Sonia , Malhotra Atul
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is common in older adults and has recently been implicated in pathogenesis of Alzheimer’s disease (AD). Sleep disruption is a possible reversible cause of memory impairment. Furthermore, quality of sleep has been determined to be one of the most important variables affecting overnight memory consolidation. Men and women differ in frequency and type of sleep complaints. As part of a larger study, data are presented on sex-stratified correlations between sleepiness and sleep-dependent memory consolidation in cognitively normal older adults with OSA.

Methods

Forty-Three participants (age 65 to 81 years; M=70.5 years, SD=4.3) deemed cognitively normal based on a Montreal Cognitive Assessment [MOCA] score of >26 were analyzed. The sample was 48.9% women; 86% White; 90.7% Non-Hispanic; and 73.8% with a bachelor's degree or higher. The Epworth Sleepiness Scale (ESS) was used to assess general daytime sleepiness. Sleep-dependent memory consolidation was assessed using the Word-pairs Association (WPA) task. The WPA task shows a word pair for 5 seconds for the participant to learn and the next morning, post-sleep, the delayed recognition test is performed.

Results

Preliminary descriptive analyses revealed women had an average ESS of 5.4 (SD=3.0) and WPA score of 29.6 (SD=4.3); while men had an average ESS of 6.9 (SD=2.99) and WPA of 29.5 (SD=7.4). Non-parametric correlations, assessed to examine the association between ESS sum scores and WPA scores, revealed a significant negative correlation between ESS and WPA for female sex, but not for male sex. That is, in women, greater daytime sleepiness scores were associated with worse sleep-dependent memory consolidation (r=-.66, p= .01).

Conclusion

Preliminary findings of the ongoing study provide support for a sex specific association between daytime sleepiness and sleep-dependent memory consolidation. Further research on this topic is needed to determine optimal preventative strategies for older adults at risk of cognitive decline.

Support (if any)

1R01AG063925-01A1 provided by National Institute on Aging
0888 Individuals with REM sleep behavior disorder show increased parkinsonism with comorbid neurotrauma: A NAPS Consortium substudy
Authors: Elliott Jonathan , Ligman Brittany , Bryant-Ekstrand Mohini , Keil Allison , Powers Katherine , Olivo Cosette , Neilson Lee , Postuma Ronald , Boeve Bradley , Ju Yo-El , Lim Miranda ,   NAPS Consortium
Published: May 2023

Introduction

Introduction: Rapid eye movement (REM) sleep behavior disorder (RBD) is strongly associated with progressive phenoconversion to an overt synucleinopathy (e.g., parkinsonism). Neurotrauma [i.e., traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD)], increases the odds of RBD diagnosis by ~2.5-fold and is associated with an increased later diagnosis of Parkinson’s Disease (PD), a service-connected illness in Veterans. Thus, RBD and neurotrauma are both independently associated with parkinsonism; however, it is unclear how neurotrauma influences neurological symptoms and exam findings in patients with RBD.

Methods

Methods: Participants ≥18 years of age with overnight polysomnogram-confirmed RBD were enrolled between 8/2018 to 4/2021 as part of the North American Prodromal Synucleinopathy (NAPS) Consortium. Standardized assessments for RBD, TBI, and PTSD history, as well as cognitive, motor, sensory and autonomic function were completed. This sub-study applied a cross-sectional, case-control (1:4 ratio) analysis comparing cases (n=24; RBD+TBI+PTSD) to controls (n=96; RBD) matched for age (±2 years), sex, and years of education (±2 years).

Results

Results: Participants with neurotrauma reported an earlier age of RBD symptom onset and more severe RBD phenotype, more severe anxiety and depression, greater frequency of hypertension, and significantly worse cognitive, motor, and autonomic function compared to participants without neurotrauma.

Conclusion

Conclusion: This cross-sectional, matched case:control study showed that individuals with comorbid neurotrauma and RBD have significantly worse neurological outcomes related to common features of early parkinsonism. Although confirmatory longitudinal studies are still ongoing, these results may be a sign of further/faster progression of synucleinopathy in those with comorbid neurotrauma and RBD.

Support (if any)

Support: NIH R34 AG056639, NIH U19 AG071754, VA RRD 1K2 RX002947, Parkinsons Center of Oregon
0893 Long objective sleep duration is a marker of cognitive impairment among older elderly: findings from the Cretan Aging Cohort
Authors: Basta Maria , Skourti Eleni , Zampetakis Alexandros , Alexopoulou Christina , Ganiaris Andronikos , Aligizaki Marina , Zaganas Ioannis , Simos Panagiotis , Vgontzas Alexandros
Published: May 2023

Introduction

We have previously shown that although sleep duration is similar between cognitively non-impaired (CNI) elders and patients with Mild Cognitive Impairment (MCI), long sleep duration is associated with disease severity in patients with multi-domain MCI and Dementia. Our aim was to examine the associations between sleep duration and cognitive status in subjects with CNI and MCI followed 8 years later.

Methods

A sub-sample of 110 participants (77.3% females) were recruited from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years). Participants with an initial diagnosis of CNI (n=57) and MCI (n=53) (mean age at baseline=72.7 years [SD=6.8]) were followed-up 8 years later (mean age at follow up=80.5 years [SD=6.7]). All participants underwent neuropsychiatric/neuropsychological evaluation (baseline & follow-up) and a 7-day 24h actigraphy (follow-up). Sleep duration measured as night Total Sleep Time (TST) at follow-up was compared between the diagnostic groups using ANCOVA controlling for age, gender, depression symptom severity, psychotropic medication. Long sleep duration was defined by values >75% percentile of the total sample distribution on each sleep index.

Results

At follow up 62.7% of participants have deteriorated cognitively with 29 being diagnosed with CNI, 49 with MCI and 32 with dementia. Patients with dementia had significantly longer night TST (mean=493, SD=106 min) than persons with MCI (mean=453, SD=68 min, p=0.05) who in turn had longer night TST than CNI participants (mean=409, SD=58 min, p=0.02). Also, long night sleep duration was significantly more prevalent among dementia patients and MCI compared to CNI individuals [67.7% vs. 36.7% vs. 10.3%, respectively; all p< 0.02)].

Conclusion

Our study confirms and expands previous findings that objective long sleep duration is a marker of worse cognitive status in elderly with MCI or Dementia and that this association is even stronger in old-old individuals.

Support (if any)

National Strategic Reference Framework (NSRF)-Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397