bluuebunny/crossref_metadata_2025 huggingface dataset:
0455 Role of Interaction Between Anterior Insula Response to Sleep-Related Pictures and Stress Levels on Sleep Disturbance
Authors: Lee M , Lee K , Lee H , Kim N , Jeon J , Jeon S , Oh S , Kim S , Kim S , Lee Y
Published: May 2020

Introduction

Literature suggests that stress may play an important role in sleep disturbance. Individuals with higher stress levels often showed hyperarousal to stressful events, possibly leading to sleep disturbance. Hyperarousal is also one of features of stress-related sleep disturbance. Here, we examined the extent to which stress levels interact with neural activity in response to sleep-related information to predict sleep disturbance.

Methods

Forty eight healthy adults (26 females, age = 35.7 ± 10.5) without sleep disorders based on nocturnal polysomnography participated in this study. They were viewing sleep-related pictures (e.g., bedroom and sunset) and non-sleep related, neutral pictures (e.g., kitchen and landscape) during fMRI scanning. They also completed questionnaires assessing stress levels and sleep disturbance using Life Experience Survey (LES) and Pittsburgh Sleep Quality Index (PSQI), respectively. Activity in response to sleep-related pictures compared to neutral pictures was extracted from our region-of-interest (ROI), the anterior insula, and entered into our moderation models. The SPSS macro PROCESS (Hayes, 2013) was used to conduct moderation analyses. Given a significant correlation between age and PSQI scores, age was included as a covariate.

Results

Our moderation analyses showed that interactions between stress levels and anterior insula response to sleep-related pictures significantly predicted sleep disturbance. Simple slope analyses showed that at higher anterior insula response, higher stress levels were associated with greater sleep disturbance, but at lower anterior insula response, stress was not significantly associated with sleep disturbance. These results indicate that individuals with high levels of stress were more likely to experience sleep disturbance if they showed greater anterior insula response to sleep-related pictures (i.e., hyperarousal in response to sleep-related information).

Conclusion

The current findings suggest that interactions between stress levels and neural substrates of hyperarousal, particularly the anterior insula, may play a critical role in sleep disturbance.

Support

Brain Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (Study No.: 2016M3C7A1904338 and NRF-2018R1D1A1B07049704).
0456 Natural History of Insomnia: Sleep Reactivity Predicts New-Onset Acute Insomnia
Authors: Vargas I , Drake C , Muench A , Boyle J , Morales K , Grandner M , Ellis J , Perlis M
Published: May 2020

Introduction

Greater vulnerability to stress-related sleep disturbance (i.e., sleep reactivity) is a risk factor for chronic insomnia (CI). What has not been investigated is whether greater sleep reactivity, as assessed by the Ford Insomnia Response to Stress Test (FIRST), predicts the onset of acute insomnia (AI), and more, whether greater sleep reactivity predicts the transition from AI to CI.

Methods

A national cohort of 1,222 good sleeper subjects (68% female; mean age=53.2 years) were prospectively assessed to estimate the incidence of AI and CI. The FIRST was completed at baseline and sleep diaries were completed on a daily basis for a period of one year. Subjects were categorized based on their FIRST scores (high, FIRST>16; low, FIRST≤16). Subjects were also grouped based on whether they developed AI (two consecutive weeks with a frequency of ≥ 3 nights per week of sleep initiation or maintenance problems) or maintained good sleep (GS; n=896). For those subjects that transitioned to AI (n=326), they were also grouped based on whether or not they developed CI (insomnia ≥ 3 nights/week for at least three months; n=23). Chi-square analyses were performed to determine if higher FIRST scores at baseline predicted the incidence of AI or CI.

Results

32.5% of subjects in the high FIRST group met criteria for AI at some point during the one-year interval, whereas 22.5% of subjects in the low FIRST group experienced AI (χ 2=15.2, p<.001). In contrast, FIRST did not predict CI status (low FIRST, 8.5% CI, high FIRST, 5.6% CI; χ 2=1.1, p=.30).

Conclusion

Greater sleep reactivity predicted incident AI but not the onset of CI. While these findings suggest that sleep reactivity may be a predisposing factor for AI, data are not consistent with previous findings showing FIRST scores are predictive of the development of CI. It’s possible that the present study was underpowered to detect these differences, given that the incidence of CI was low (less than 2% of the total sample). Additional analyses are ongoing to evaluate the temporal association between stressful life events and AI in subjects with high and low FIRST scores.

Support

Perlis: NIH R01AG041783, K24AG055602
0468 A Multiple Dose, Placebo-Controlled, Randomized Double-Blind, Multicenter Study to Investigate Triprolidine in the Treatment of Temporary Sleep Disturbance
Authors: Reyner L , Miller J E , Shea T
Published: May 2020

Introduction

American Association of Sleep Medicine guidelines states that the primary goals of the treatment of insomnia are to improve sleep quality and related daytime function. While H1 antihistamines have sedative effects, they are associated with residual daytime sleepiness and an effective dose range for hypnotic effect has hitherto not been established. Triprolidine a first generation antihistamine used to treat allergic rhinitis and the common cold has a mean half-life of 3.2 hours. We evaluated the effect of two doses of triprolodine compared with placebo on sleep onset latency and daytime sleepiness to determine the optimum dose in subjects with temporary sleep disturbance.

Methods

Multicenter, placebo-controlled, parallel group, double blind, multiple dose, randomized study of 178 patients aged 18 years or above with a primary diagnosis of temporary sleep disturbance. Patients were randomized to one of three groups. Group 1: 2 x placebo tablets; Group 2: 1 x placebo tablet + 1 x 2.5mg triprolidine tablet; Group 3: 2 x 2.5mg triprolodine tablets, taken 20 minutes before intended sleep on three consecutive evenings. Efficacy was measured objectively using the Sleep Disturbance Index using a wrist actimeter and subjectively using the Loughborough Sleep Log and Karolinska Sleepiness Scale.

Results

Both doses were statistically significantly superior to placebo in terms of quality and duration of sleep and sleep interruptions. No hangover effects or daytime sleepiness were observed with either dose compared to placebo. Patients on the 2.5 mg dose awoke more refreshed than the 5 mg dose. No serious adverse effects observed in any group and anticholinergic events i.e. dry mouth were very low.

Conclusion

Tripolidine is effective and safe in the treatment of temporary sleep disturbance. The optimum dose is 2.5mg.

Support

The study was sponsored by Boots Healthcare International.
0491 Changes in Insomnia Symptoms are Associated with Improvements in Chronic Pain
Authors: Ito K , Kadotani H
Published: May 2020

Introduction

Depression and anxiety is known to associated with insomnia. Chronic pain is also well known to be associated with insomnia. However, relationship among insomnia and anxiety and depression is not well understood. Here We conducted a retrospective cohort study whether improvement insomnia could affect chronic pain release.

Methods

Patients with chronic pain suffering for more than three months, who first visited in our pain management clinic in Shiga University of Medical Science, Otsu, Japan during 09/25/2013-01/26/2017, were included in this study. Patients were asked to complete the same questionnaire at their first visit and six-month later.We designate pain release as 30% and over improvement in numerical rating scale (NRS) for pain release.We define improvement insomnia as subjects with Athene insomnia scale (AIS) ≥6 at the first visit became AIS <6 six-month later.We also evaluated patients’ psychotic conditions by Questionnaires for anxiety and depression: HADS (Anxiety and depression) and PCS (Pain Catastrophizing score) for negative cognition, respectively. We conducted logistic regression analysis as for dependent variable was pain release.

Results

Characteristics data: n=47, mean age: 53.53±15.45, male rate: 45%, BMI: 22.81±3.49, NRS: 5.45±1.85, AIS: 8.94±2.73, HADSA: 6.04±2.57, HADSD: 6.06±2.64, PCS: 30.70±8.70, housemate rate: 81%, more than junior college graduated level: 53%, employment rate: 62%, annual income over 4oo million yen /year: 62%, antidepressant use; 26%, benzodiazepine use:11%.Logistic Regression odds ratio (OR) with 95% confidence intervals (95%CI) for relationship of improvement insomnia and not with chronic pain were unadjusted OR: 3.600 (95%CI: 1.007-12.865) and adjusted OR: 3.078 (95%CI 0.779-12.161) (adjust for PCS.)

Conclusion

We showed improvement in insomnia can affect pain release in the pain therapy, and PCS improvement may be also association with chronic pain release.

Support
0497 Rebound Insomnia During Discontinuation of Chronic Hypnotic Use
Authors: Koshorek G , Verkler J , Roth T , Roehrs T
Published: May 2020

Introduction

Rebound insomnia refers to worsened sleep relative to baseline on 1-2 nights after discontinuation of active hypnotic medication. Rebound is typically assessed using a placebo substitution. We assessed rebound in an on-going “blinded” clinical trial in which people with insomnia are instructed to discontinue their study medication (i.e., no-pill) after 6 months of nightly use.

Methods

DSM-V diagnosed people with insomnia (n=31, 26 females), aged 26-61 yrs, with a polysomnographic sleep efficiency of ≤85%, no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). On baseline and the14 discontinuation nights, sleep was recorded and scored by actigraphy for sleep efficiency (SE), sleep latency (LAT) and wake after sleep onset (WASO).

Results

Relative to the baseline night, on the first discontinuation night there was no difference in SE, LAT, and WASO. Fifteen subjects stopped taking study medication when told to discontinue and 16 subjects took study medication on one night or more. While not differing on baseline or night 1, on night 14 the last study night the medication users had a lower SE (75.9 vs 87.7 %, p<.0.004) and a longer LAT (61.5 vs 14.5 min, p<0.05).

Conclusion

Difficulty discontinuing hypnotic use is not specifically related to rebound insomnia. We reported in a companion abstract those with insomnia and hyperarousal, defined by MSLT, are those with difficulty discontinuing hypnotic use and as shown here slept poorly on the last study night.

Support

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs
0505 Insomnia: Entrapment of Binaural Auditory Beats on Subjects with Insomnia Symptoms
Authors: Choi H , Bang Y , Yoon I
Published: May 2020

Introduction

It has been reported that binaural beat stimulation, which has two different frequencies on both ears, is effective in increasing alertness, memory, reducing anxiety, and controlling mood. This study aims to clarify the brain wave entrainment effect of binaural beat and to identify the mechanism of action of the binaural beat.

Methods

Subjects with subclinical insomnia symptoms between 20 and 59 years of age were recruited from the community. Quantitative electroencephalography (EEG) was measured two times before and after the 2 weeks of binaural beat intervention period. An audio apparatus without the distortion of a sound source is set with theta (6 Hz) binaural beat. Participants used the apparatus for 30 minutes before going to bed for 2 weeks.

Results

When the music with binaural beat was played, the relative power of theta frequency increased (occipital, P=0.009). When the music only was played in the laboratory, the relative power of delta (temporal, P=0.004; parietal, P=0.005; occipital, P=0.006) and theta frequency (temporal, P=0.004; central, P=0.001; parietal, P=0.001; occipital, P=0.003) increased and the relative power of alpha decreased (frontal, P=0.008; temporal, P=0.012; central, P=0.008; parietal, P=0,004; occipital, P=0.005). After listening to music with binaural beat for two weeks, the difference of beta power before and after listening to music first in the laboratory was lower than the difference after using music-only devices (P=0.008).

Conclusion

When the binaural beat was played, the entrapment of theta wave appeared. And the music was presumed to have a nonspecific relaxation effect. After exposure to music with binaural beat for 2 weeks, beta power decreased compared to exposure to music alone. Continuous music with binaural beat exposure for 2 weeks is likely to reduce hyper-arousal state and contribute to sleep induction.

Support

None
0509 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation
Authors: Edinger J D , Walmboldt F , Holm K , Johnson R L , Simmons B , Tsai S , Morin C
Published: May 2020

Introduction

Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics.

Methods

The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up.

Results

Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2-3 nights/week compared to about 1 time every other week for the blinded taper group (p = .05). The average weekly diazepam equivalent dose of medication used by the open label tapering group was about 5 times higher than the average weekly dose used by the blind tapering group (p = .025).

Conclusion

CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence.

Support

National Institute of Drug Abuse, Grant # R34 DA042329-01
0520 Treating Sleep Maintenance Insomnia Means Treating Depression?
Authors: Batta B , Szakacs Z
Published: May 2020

Introduction

Rumination whilst awakening nightly might be a common symptom in fragmented sleep and depression as well. The problem is that the test results on BECK or MMPI DEPRESSION SCALE often do not reach the diagnostic criteria of depression on DSM-V, only the symptoms of worry, rumination and sleep maintenance problems appear as mild depressive signs. The aim of our study was to investigate the assumption to which treating everyday worries through CBT methods would affect the amount and severity of nightly rumination and the severity of depressive mood as well.

Methods

33 adult patients (M=39,55 SD=10,66) diagnosed with insomnia with the criteria of only sleep maintenance proble. Each participants filled the PSQI, the Epworth Sleepiness Scale, the Beck Depression Inventory and the Trait-Anxiety Inventory before the beginning of the CBT therapy session and 10 sessions later.

Results

Our results show a significant effect of the CBT therapy to sleep maintenance symptoms through treating everyday ruminations opposite to treating only nightly ruminations on sleeping quality (F(1, 31)= 55,358 p<0,01 η2 = 0,641). The significant improvement in sleep quality only were shown in the subgroup of everyday rumination CBT group (N=17, M=7,88 SD=2,57), but not in the subgroup of nightly ruminations CBT group (N=16, M=9,87, SD=1,92).

Conclusion

Based on our preliminary findings, treating everyday worries with CBT therapy affect sleep maintenance insomnia, while treating only nightly ruminations and worries of sleeping difficulties would not improve sleeping problems and depressive mood.

Support

No
0524 Web-Delivered CBT for Insomnia Intervention Improves Sleep Among Adults with Insomnia and Depressive Symptoms
Authors: Batterham P J , Christensen H , Thorndike F P , Ritterband L M , Gerwien R , Enman N , Botbyl J , Maricich Y
Published: May 2020

Introduction

Cognitive behavioral therapy for insomnia (CBT-I) is the first line recommended treatment for adults with chronic insomnia. In a prior randomized controlled trial (RCT), data showed web-delivered CBT-I (SHUTi) reduced insomnia severity as well as symptoms of depression, among adults with insomnia and elevated depressive symptoms. The present study aimed to further evaluate the effectiveness of web CBT-I to improve sleep outcomes as measured by prospectively entered sleep diaries in this same sample.

Methods

A large-scale RCT (N=1149) of Australian adults with insomnia and depressive symptoms compared a 9-week, web CBT-I therapeutic with an attention-matched web program at baseline, posttest and 6-, 12-, and 18-month follow-ups. Although depression outcomes have been presented previously, the online sleep-diary derived variables have not yet been presented, including sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). Sleep diaries were entered online for 10 days at each assessment period.

Results

Data showed web CBT-I participants demonstrated greater reductions from baseline to posttest compared with control for the following sleep variables: SOL (LS mean difference [95% CI]=-22.3 min [-29.2, -15.3]; p<.0001), WASO (-17.8 min [-23.4, -12.3]; p<.0001), and number of awakenings (-0.38 [-0.68, -0.09]; p=.0113). Web CBT-I also showed greater improvements in SE (9.18% [7.25%, 11.10%]; p<.0001) and sleep quality (0.41 [0.30, 0.53]; p<.0001) from baseline to posttest compared with control. TST was not significantly different between groups at posttest or 6-month follow-up, although it improved over baseline at 12 (18.73 min [7.39, 30.07]; p=.0013) and 18 months (23.76 min [9.15, 38.36]; p=.0015) relative to control. All other significant sleep treatment effects were maintained in the treatment arm at 6, 12, and 18-month follow-up.

Conclusion

Data showed web CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and elevated depressive symptoms.

Support

Clinical trial ACTRN12611000121965 was funded by the Australian National Health and Medical Research Council. The statistical analysis described here was funded by Pear Therapeutics, Inc and conducted by Provonix.
0542 Exploratory Use of Artificial Intelligence Driven Acoustic Neuromodulation Improved Sleep, Depression, Anxiety, and Stress in Adults with Persisting Post-Concussion Symptoms
Authors: Tegeler C L , Howard L J , Brown K L , Kellar D C , Shaltout H A , Gerdes L , Tegeler C H
Published: May 2020

Introduction

In prior studies, High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) reduced persisting post-concussion symptoms (PPCS) of insomnia and depression and improved heart rate variability (HRV), but is operator dependent, with difficulty scaling. Cereset Research™ (CR), a noninvasive, closed-loop, artificial intelligence (AI) driven, acoustic neuromodulation technology uses the same core technology, echoing tones linked to brainwaves, but includes updated components, standardized AI driven protocols, software management of designs, and shorter sessions to improve scalability. This open label trial explores use of CR for PPCS.

Methods

5 adults (1 female, median age = 48, 31-64) with PPCS received a median of 8 CR sessions (range 7-9, 60 minutes each) over 11 (5-18) days as part of an open label IRB-approved exploratory study of CR for diverse health conditions. Data is collected at baseline (V1), 0-21 days (V2), 4-7 weeks later (V3), and 4-7 weeks thereafter (V4). Pre- and post-CR symptom inventories included concussion (RPQ), insomnia (ISI), depression (CES-D), anxiety (GAD-7), PTSD (PCL-C), and stress (PSS). Primary outcome is change in autonomics at V3 via HRV (SDNN and rMSSD) based on 10-minute BP and HR recordings using a BIOPAC device. Formal analysis of HRV outcome is pending, but we report preliminary changes in symptom outcomes.

Results

6 subjects have enrolled for sleep trouble related to PCCS, with 1 lost to follow-up after receiving intervention. For V1-V2 (n=5), median change in RPQ score is -23, ISI -10, CES-D -16, GAD-7 -7, PCL-C -16, and PSS -7. For V1-V3 (n=4), median change in RPQ -19, ISI -10.5, CES-D -6, GAD-7 -4.5, PCL-C -14.5, and PSS -3. No serious adverse events reported.

Conclusion

Preliminary results suggest similar, clinically meaningful reductions in ISI score, and concussion symptoms, as seen with HIRREM, suggesting promise as a scalable, non-drug intervention for insomnia with PPCS. Updated results will be presented.

Support: Support

Research grant received from, The Susanne Marcus Collins Foundation, Inc.
0549 Misperception of Neutral Faces in Insomnia
Authors: Akram U
Published: May 2020

Introduction

Emotional faces have been widely used amongst populations with mental health conditions to examine alterations in attention and perception relative to controls. Insomnia is associated with reduced emotion intensity ratings for facial expressions of fear, sadness and happiness. However, research is yet to examine whether neutral faces are accurately perceived amongst individuals with insomnia. This study compared normal-sleepers and individuals experiencing insomnia symptoms in their expression intensity rating of neutral faces.

Methods

Fifty-six normal-sleepers (NS: 19.69±4.07yrs, 73% female) scoring <5 on the Insomnia Severity Index (ISI; 2.70±1.69) and 58 individuals experiencing clinically significant insomnia symptoms (INS:20.32±4.08yrs, 85% female) scoring ≥15 on the ISI (19.24±3.53), observed 12 neutral facial photographs. Between 0-100, participants were required to rate the extent to which each face appeared as: attractive; sad; happy; trustworthy; approachable; healthy; and sociable. 0 indicated not at all, 100 indicated very much so. The facial stimuli were taken from Karolinska Directed Emotional Faces database, and were presented in random order.

Results

The results revelated a main effect of group (F(1,117)=4.04,p=.047) and expression (F(7, 819)=39.08,p=.001) on intensity ratings. Whilst no significant group x expression interaction was confirmed (F(7,819)=1.03,p=.41), simple effects analysis determined that those experiencing insomnia symptoms rated neutral faces as significantly more attractive (34.30±14.82; t(117)=-2.73, p=.007; Cohens’ d=.50) and happy (34.83±13.87; t(117)=-2.23, p=.028; Cohens’ d=.41) when compared to normal-sleepers (Attractive: 26.89±14.76; Happy: 28.90±12.48). No significant differences were observed for all other ratings.

Conclusion

The present outcomes tentatively suggest that individuals experiencing clinically significant insomnia symptoms differentially perceive neutral faces when comparted with normal-sleepers. Specifically, neutral faces of other people were rated in a more positively valanced manner (i.e. more attractive and happier). Considering an individual’s capacity to correctly gauge facial expressions remains fundamental for effective social interaction, and in influencing social judgments, these outcomes present negative psychosocial implications for those with insomnia.

Support

n/a
0556 Sex-Specific Relationship Between Anxiety and Autonomic Nervous System Dysfunction in Obstructive Sleep Apnea
Authors: Pal A , Akey M A , Chatterjee R , Aguila A P , Martinez F , Aysola R , Macey P M
Published: May 2020

Introduction

Cardiovascular co-morbidities in obstructive sleep apnea (OSA) are hard to treat, perhaps due to autonomic nervous system (ANS) dysfunction. In OSA, intermittent hypoxia and poor tissue oxygen perfusion damage endothelial and nervous tissue, potentially underlying the dysfunction. Moreover, OSA is strongly associated with anxiety, which is independently associated with ANS dysfunction. We assessed sex-specific relationships between anxiety and cardiovascular markers of ANS dysfunction in OSA.

Methods

We studied people diagnosed with OSA and healthy controls. We collected 5 minutes of wakeful resting ECG, continuous non-invasive blood pressure, and respiration data. We calculated heart rate (HR), heart rate variability (HRV; sympathetic-vagal balance related to brainstem ANS output), mean arterial blood pressure (MAP), beat-to-beat MAP variability (BPV; related to peripheral autonomic function) and breathing rate (BR). We analyzed these measures with a multivariate regression model of anxiety symptoms (generalized anxiety disorder; GAD-7 scores), sex, and group (OSA vs. control), age/BMI/AHI covariates, and Bonferroni-corrected post-hoc comparisons (p≤0.05).

Results

We analyzed 64 subjects (32 OSA: AHI [mean±SEM] 24±4events/hour, 12 female, age 52±21years, BMI 33±2kg/m2; 32 control: 19 female, age 46±2; BMI 26±1). We observed significant main effects of anxiety, BMI, AHI, sex on HRV, but only group on BPV; post-hoc comparisons revealed high BPV only in OSA females. Secondary analyses included classifying by anxiety symptoms (GAD-7≥5), showing only OSA females with anxiety had higher BPV. Males showed higher HRV. AHI and anxiety were positively correlated with HRV in OSA males. AHI was negatively correlated with BR in OSA females.

Conclusion

We observed higher anxiety associated with higher BPV in OSA, especially in females. Unexpectedly, BR was lower in OSA females; longer breaths may have led to the greater BPV. Higher HRV in males complicated by OSA severity and anxiety could be related to higher sympathetic tone. The slightly older control group may have influenced the findings. Overall, our findings suggest anxiety in OSA is associated with peripheral and centrally-mediated autonomic dysfunction, but in a sex-specific manner.

Support

National Institutes of Health R56-NR-017435 and RO1-HL-135562.
0558 Sleep Disordered Breathing and Right Ventricular Electrocardiographic and Functional Characteristics in Group 1 Pulmonary Arterial Hypertension
Authors: Bhat A S , Wang L , Kaur S , Nawabit R , Highland K , Park M , Jellis C , Kwon D , Hill N , Mehra R , Pvdomics P
Published: May 2020

Introduction

Right ventricular (RV) electrophysiologic and functional alterations related to sleep disordered breathing (SDB) in pulmonary arterial hypertension (PAH) are not well understood. We hypothesize an association between SDB and RV electrophysiological/functional measures in World Symposium of Pulmonary Hypertension (WSPH) Group 1 PAH.

Methods

The NHLBI multicenter PVDOMICS study (NCT02980887) enrolls patients with PAH undergoing a battery of assessments including home sleep apnea testing(NOX-T3, Carefusion®) or with historical sleep study data. Logistic(OR,95%CI) and linear(beta coefficients,95%CI) regression models adjusted for age, sex, race, body mass index (BMI, kg/m2), PAH medications, supplemental oxygen(O2), positive airway pressure(PAP) were used to assess associations of SDB(apnea hypopnea index,(AHI), ≥3% desaturations(hypopnea), percentage recording time with SaO2<90% (TRT<90%) with electrocardiographic measures: RV hypertrophy(RVH), right bundle branch block(RBBB), and right axis deviation(RAD), echocardiographically-derived RV systolic pressure(RVSP) and RV ejection fraction(RVEF) from cardiac MRI. Analyses were performed based on an overall significance level of 0.05, using SAS software (version 9.4, Cary, NC).

Results

The analysis consisted of 182 PAH participants with age: 52.5±13.9 years, 71.4% female, 88.9% Caucasian, BMI:30.3±7.8 kg/m2, RVEF: 37.3±11.6, and RVSP: 67.0±23.4. None of the electrocardiographic measures were associated with AHI and only RVH was significantly associated with TRT<90% (1.25:1.09,1.43),p=0.001. Although AHI was not associated with RVSP, a 10% increase in TRT<90% was associated with a 2.60mmHg increase in RVSP (2.60:1.44,3.76),p<0.001. Each 10-unit increase in AHI was associated with a 2.72% reduction of RVEF (-2.72:-4.89,-0.56),p=0.014, and each 10-unit increase in TRT<90% was associated with a 0.72% reduction of RVEF (-0.72:-1.38,-0.06),p=0.033.

Conclusion

We identify nocturnal hypoxia as a predictor of RV electrophysiological and functional alterations even after consideration of confounding factors. SDB as determined by AHI was also more so associated with reduced RVEF than hypoxia. Future mechanistic studies should focus on further elucidation of SDB and nocturnal hypoxia on pathogenesis of RV dysfunction in PAH.

Support

U01HL125218/U01HL125205/U01HL125212/U01HL125208/U01HL125175/U01HL125215, U01HL125177/Pulmonary Hypertension Association
0570 Apnea-Hypopnea Index is Positively Correlated with Mood Disturbance
Authors: Stubbers K M , Thosar S S , Butler M P , Bowles N P , McHill A W , Berman A M , Herzig M X , Roberts S A , Clemons N A , Morimoto M , Shea S A , Emens J S
Published: May 2020

Introduction

The prevalence of mood disorders such as depression is higher in individuals with obstructive sleep apnea (OSA). Previous studies have found no significant correlation between the apnea-hypopnea index (AHI) and measures of mood and have only included participants who met diagnostic criteria for OSA. The current analysis sought to determine whether mood correlated with AHI in individuals with any AHI values including those that did not meet diagnostic criteria for OSA.

Methods

31 volunteers were studied (BMI=29.2±1.0 kg/m2, mean±SE), free from medication and without psychiatric illness or chronic medical conditions with the exception of untreated OSA, uncomplicated hypertension (BP<160/100), or obesity. Following 1-3 weeks of an 8h habitual at home sleep schedule, participants completed the POMS-Brief questionnaire (POMS-B) to assess mood after undergoing overnight polysomnography to determine AHI. Total mood disturbance (TMD) scores were calculated by adding the scores on the POMS-B for each mood state subscale and subtracting the score for vigor-activity.

Results

The average AHI was 15.3±3.1 (range of 1.1-74.1) events per hour. The average POMS-B TMD score was 21±1.5 (range of 4-46). There was a significant correlation between the POMS-B TMD score and AHI (p=0.037, r2=0.14). This result was also seen in only those individuals with AHI scores >5 (p=0.002, r2=0.4).

Conclusion

In this sample, individuals with higher AHI values displayed higher TMD scores. These results differ from previous data that showed no significant correlation between AHI and TMD. This is the first analysis to demonstrate a correlation between TMD and AHI while including individuals who didn’t meet diagnostic criteria for OSA. However, the relationship between AHI and TMD was also significant in those with AHI>5. More data on these measures with larger sample sizes and a more equal representation of AHI values should be gathered to provide additional evidence for this relationship.

Support: Support

NIH R01-HL125893; CTSA UL1TR000128, R21HL140377
0576 Variation in Night to Night Home Sleep Testing
Authors: Rosenberg C
Published: May 2020

Introduction

Home sleep testing (HST) is becoming common in the evaluation of Obstructive Sleep Apnea (OSA). Studies confirmed good HST AHI correlations from different nights in a single patient. The following reviewed AHI and additional measures from HST’s. (Alice Night One))

Methods

We collected data from 20 patients from two consecutive nights of HST’s. 5 F 15 M, means AGE 49 (sd 14) and BMI 36 (sd 8). Both studies had over 4 hours of good sleep and acceptable data. Measures include abs(Night 1- Night 2) of AHI (Diff.AHI), of mean EKG (Diff.EKG) mean time SaO2 less than 90% (Diff.SaO2).

Results

These results reproduced the strong correlation of AHI, Time SaO2 less than 90 %: and mean EKG between two nights, .96, .72, .87 respectively. There was a strong correlation between Diff.AHI and Diff.SaO2, .63 (p .003). There were weaker correlations between AHI and Time SaO2 less than 90% on Night 1, .67 and Night 2, .75. Linear regression: Diff.AHI on Age (p=.2), BMI (p = .9), and Diff.EKG (p=.4).

Conclusion

These results again validate the small degree of AHI variation in night to night HST. They confirm a small degree of variation in the mean EKG and Time SaO2 less than 90%. There is a high correlation between AHI and time SaO2 less than 90% as these variables are dependent and the fall in SaO2 is used to define an event, especially on the HST. The BMI did not explain variation in AHI, there is a low correlation between AHI and BMI. Age could be a factor in AHI variation; yet, this is highly speculative with an N = 20. The correlations between AHI and Time SaO2 less than 90% are likely to be due to the relative health of the subjects and small number of subjects. One night of good, greater than 4 hours HST may be sufficient. This study did not evaluate success in meeting these parameters with a single night of testing.

Support

Louis B Stokes VHA, Cleveland, OH
0577 Cluster Analysis for the Association Between Obstructive Sleep Apnea Phenotypes: A Population-Based Longitudinal Study
Authors: Tempaku P F , Silva L O , Guimaraes T M , Vidigal T A , D’Almeida V , Andersen M L , Bittencourt L , Tufik S
Published: May 2020

Introduction

The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.

Methods

We used data derived from the Sao Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to an AHI equal or greater than 15 events per hour. Cluster analysis was performed using latent class analysis (LCA).

Results

Of the 1,042 individuals in the EPISONO baseline cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.4% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 clusters for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).

Conclusion

The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.

Support

This work was supported by grants from AFIP, FAPESP and CAPES.
0583 Obesity-Associated Sleep Hypoventilation Syndrome and Adverse Post-Operative Bariatric Surgery Outcomes
Authors: Chindamporn P , Bena J , Wang L , Zajichek A , Milinovich A , Kaw R , Kashyap S , Cetin D , Aminian A , Kempke N , Foldvary-Schaefer N , Aboussouan L S , Mehra R
Published: May 2020

Introduction

Although obesity hypoventilation syndrome (OHS) is associated with right ventricular dysfunction and increased mortality, its contribution to post-bariatric surgery risk remains unclear due to non-systematic OHS assessments. We hypothesize that patients with obesity-associated sleep hypoventilation (OASH) have increased adverse post-bariatric surgery outcomes than those without.

Methods

Patients undergoing polysomnography (PSG) prior to bariatric surgery at the Cleveland Clinic from 2011-2018 were retrospectively examined. OASH was defined by body mass index (BMI) ≥30kg/m2 and either PSG-based end-tidal CO2 ≥45mmHg or serum bicarbonate ≥27mEq/L. The following were considered individually and as a composite outcome: ICU stay, re-intubation, tracheostomy, discharge disposition or 30-day readmission. All-cause mortality was also examined. Outcomes were compared using two-sample t-test or Wilcoxon rank sum test and Chi-square or Fisher exact test. A multivariable logistic regression model included age, sex, BMI, apnea hypopnea index(AHI) and diabetes to examine OAHS and the composite outcome. All-cause mortality was compared using Kaplan-Meier estimation and hazard ratios from Cox proportional hazards models. SAS software (version 9.4) was used with overall significance level of 0.05.

Results

The sample comprised 1665 patients: age 45.2±12 years, 20.4% male, BMI=48.7±9 kg/m2, and 63.6% Caucasian. OASH prevalence was 68.5%. OAHS patients were older and more likely to be male with higher BMI, AHI and HbA1c. Although some individual outcomes were higher in OASH vs. non-OASH, findings were not statistically significant: re-intubation (1.5%vs.1.3%, p=0.81) and 30-day readmission (13.8% vs.11.3%, p=0.16). The composite outcome remained significantly associated with OAHS in the multivariable model: OR=1.36, 95%CI:1.005,1.845. Mortality was 2% in OASH and not significantly higher than non-OAHS (HR=1.39, 95%CI:0.56,3.42).

Conclusion

In this largest sample to date of systematically phenotyped OASH in patients undergoing bariatric surgery, we identify increased post-operative morbidity in those with OASH. Further study is needed to identify whether peri-operative treatment of OASH improves surgical outcomes.

Support
0587 Convenience vs Accuracy: Negative Predictability of the Home Sleep Test in Clinical Practice
Authors: Morse C D , Meissner S , Kodali L
Published: May 2020

Introduction

Sleep apnea is a serious disorder associated with numerous health conditions. In clinical practice, providers order screening home sleep testing (HST) for obstructive sleep apnea (OSA); however, there is limited research about the negative predictive value (NPV) and false negative rate of this test. Providers may not understand HST limitations; therefore, what is the NPV and false negative rate in clinical practice?

Methods

A retrospective study of non-diagnostic HST is conducted in a Northeastern US rural community sleep clinic. The study population includes adult patients ≥ 18 years old who underwent HST from 2016-2019. The non-diagnostic HST result is compared to the gold standard, the patient’s nocturnal polysomnogram (NPSG). The results provide the NPV (true negative/total) and false negative (true positive/total) for the non-diagnostic HST.

Results

We identified 211 potential patients with a mean age of 43 years, of which 67% were female. Of those, 85% (n=179) underwent NPSG, with the others declining/delaying testing or lost to follow up. The non-diagnostic HST showed 15.6% NPV for no apnea using AHI<5 and 8.4% NPV using respiratory disturbance index (tRDI)<5. The false negative rate for AHI/tRDI was 84.4% and 91.6%, respectively. The AHI for positive tests ranged from 5-89 per hour (mean AHI 14.9/tRDI 16/hour), of which OSA was identified with an elevated AHI (≥5) ranging from 54.2% mild, 21.8% moderate, and 8.4% severe.

Conclusion

The high false negative rate of the HST is alarming. Some providers and patients may forgo NPSG after non-diagnostic HST due to a lack of understanding for the HST’s limitations. Knowing that the non-diagnostic HST is a very poor predictor of no sleep apnea will help providers advise patients appropriately for the necessity of the NPSG. The subsequent NPSG provides an accurate diagnosis and, therefore, an informed decision about pursuing or eschewing sleep apnea treatment.

Support

none
0590 Reliability of Simple Sleep Evaluation Device at Split-Night Polysomnography
Authors: Adachi T , Koba S , Hanyu A , Kato M , Morita M , Kawamoto T , Ida H , Watanabe Y , Shinke T
Published: May 2020

Introduction

Watch-PAT is a sleep evaluation device that measures the peripheral blood volume continuously with a probe attached to a fingertip and does not use an electroencephalogram or a nasal cannula. There has been no report on the usefulness of watch-PAT to determine the apnea diagnosis and continuous positive airway pressure (CPAP) use effects in split-night sleep study.

Methods

The consent of the study was obtained. Watch-PAT was simultaneously worn on a patient admitted for split-night polysomnography. The apnea-hypopnea index (AHI) obtained from PSG and the pAHI gained from the watch-PAT were measured when not using CPAP and when using CPAP respectively. And also we examined whether the reduction rates of AHI and pAHI could be correlated.

Results

38 subjects (32 men, age 55 ± 13 years old). BMI 28.3 ± 5.7 kg / m2. When CPAP was not used, AHI was 57.2 ± 23.3 / h and pAHI was 50.8 ± 20.3 / h (r = 0.93, p < 0.0001), when CPAP was used, AHI was 5.2 ± 4.5 /h and pAHI was 6.2 ± 4.5 h (r = 0.82, p < 0.0001), AHI reduction rate was 90.4 ± 8.0% and pAHI reduction rate was 85.4 ± 14.6% (r = 0.76, p < 0.0001).

Conclusion

It was suggested that Watch-PAT had a good correlation with AHI at split night-sleep study.

Support

None
0603 Divided Attention Steering Simulator Compared to Other Daytime Sleepiness Tests in Sleep Apnea
Authors: Penzel T , Henning S , Glos M , Huang Y , Fietze I
Published: May 2020

Introduction

Sleep apnea is often associated with daytime sleepiness. A test which may be similar to driving situations is the divided attention steering Simulator (DASS) as a surrogate for testing sleepiness at the wheel. In this study we compared DASS parameters against Epworth sleepiness score (ESS) and psychomotor vigilance test (PVT) in subjects with sleep apnea.

Methods

In 16 healthy subjects without sleep disorders and in 38 patients with sleep apnea, we tested daytime sleepiness and Performance using different methodologies. We applied the DASS twice, the PVT twice, the testbattery for attentional Performance (TAP), and the MSLT during one day after polysomnography.

Results

Sleep apnea patients had a longer response time according to DASS (p<0.05) and a larger average deviation from midline of the road (p<0.05) and left the road more frequently (p<0.05). Response time in DASS correlated well with PVT (p<0.001). We found no significant association between ESS and DASS parameters. We no correlation between MSLT sleep latency and DASS parameters.

Conclusion

The DASS is very well to mirror reaction time as determined by PVT. However, the DASS does not reflect sleepiness as determined by MSLT or ESS. The study confirms the finding that reaction time testing, even using different tools, does not relate very well with perceived subjective sleepiness by ESS nor by objective sleepiness as assessed by multiple sleep latency test. Different measures do form a complex Picture which might lead to falling asleep when driving. All tests do show some limitations regarding this assessment.

Support

This study was supported by Charite University funds.
0614 Diurnal Patterning of Autonomic Measures in Sleep Apnea and Paroxysmal Atrial Fibrillation and Response to Continuous Positive Airway Pressure Therapy
Authors: Sandhu A , Wang L , Bena J , Kaffashi F , Loparo K , Aylor J , Nawabit R , Chung M , Van Wagoner D , Walia H , Mehra R
Published: May 2020

Introduction

Diurnal patterning of autonomic function in paroxysmal atrial fibrillation (PAF) and sleep disordered breathing (SDB) is unknown. We hypothesize heart rate variability (HRV) as surrogates of autonomic function, exhibit diurnal differences in PAF relative to SDB severity and treatment.

Methods

We leveraged the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT,NCT02576587) study focused on participants with PAF and SDB (apnea hypopnea index,AHI≥15,3% oxygen desaturation hypopnea). Attended 16-channel polysomnography (PSG) and continuous ECG monitoring (Heartrak Telemetry®) for 7-21 days was performed at baseline and after 3-months of continuous positive airway pressure (CPAP). Linear mixed-effects models (least square means,95%CI) were used to assess relationships between daily average HRV measures (frequency domain:LF,HF,LF/HF;time domain:MNN,RMSSD,SD1,SD ratio and novel non-linear:DFA-alpha measures) with SDB (AHI),%sleep time with SaO2<90%(TRT<90): per 5-unit increase),effect of 3-month CPAP relative to sleep-wake and statistical interaction of sleep-wake. Analyses were conducted using SAS version v.9.4, Cary, NC.

Results

The analytic sample was comprised of 33 cases with PAF and SDB:61.1±11.7 years,62.5% male, BMI:33.9±7.2kg/m2,75% Caucasian,AHI 15.1 (IQR: 4.4,29.4) and 68.8% on atrioventricular nodal blocking medications. AHI was associated with frequency (HF:0.08[0.01,0.16] and LF/HF:-0.11[-0.20, -0.01]), time (SD1:0.08[0.02,0.14] and SD ratio: 0.09[0.04,0.14]) and non-linear (DFA-alpha1: -0.02[-0.036,-0.003]) domain measures during wake, but not sleep. Significant sleep-wake and AHI as well as TRT<90 interactions relative to HRV measures were observed (p≤0.001). Only SD ratio was associated with TRT<90 (0.12[0.03,0.24]). Baseline to follow-up CPAP time domain measures were altered mainly during wake versus sleep with MNN increased 0.13: [0.08,0.19],p<0.001; RMSSD increased 0.13 [0.08,0.19], p<0.001; SD1 increased 30% [0.09,0.55], p=0.004; SD ratio increased 20% [0.01,0.43], p=0.033,and also frequency domain: HF increased 33%[0.03,0.72], p=0.028.

Conclusion

SDB defined by AHI--more so than nocturnal hypoxia--was associated with surrogate autonomic measures impacted by CPAP intervention during wake and not sleep in PAF. SDB-related autonomic influences in PAF appear to be more pronounced during wakefulness suggesting long-term potentiation-like influences.

Support

This study was supported by the National Heart, Lung and Blood Institute (NHLBI) [Grant R01 HL108493] and National Institutes of Health (NIH) National Center for Research Resources [Grant UL1 RR024989]