bluuebunny/crossref_metadata_2025 huggingface dataset:
0842 Parent Engagement with Digital Sleep Health Interventions for Young Children: A Global Scoping Review
Authors: Chung Alicia , Nechyba Ashley , Deaton Laurel , Miller Jennifer , Mansour Rania , Johnson Margarita , Elvariste Stessie , Liu Jenny , Metayer Menessa , Shorter Shayla , Vieira Dorice
Published: April 2024

Introduction

It is widely recognized that young children may experience sleep problems early in life that affect child development outcomes. Digital technology offers an accessible platform to reach and engage families of young children with sleep health solutions early in life.Our global scoping review aimed to investigate the use of digital technology as a resource to facilitate parental interventions aimed at enhancing sleep health among children in early childhood (3 –8 years old).

Methods

We performed a scoping review of peer-reviewed articles published from inception to 2023 for the following databases: PubMed, Embase, Web of Science including FSTA and Scielo, MEDLINE, Cochrane Library, Engineering Village, CINAHL, APA PsycInfo, Global Health and citation searching. In conjunction with the authors, two librarians conducted an extensive literature search, and the strategies can be found at [osf.io/74hba]. Our methodological approach encompassed a systematic review of key terms related to sleep, communication, parental involvement, and internet-based intervention. Inclusion criteria included intervention studies with parents of children 3-8 years old via digital communications (e.g. social media, telehealth, websites, mobile apps, wearable devices) to address sleep health in their child. Exclusion criteria included platforms unrelated to sleep, studies that digitally recruited participants but did not use a digital platform, studies with children outside the target age, or protocol studies. Review Registration: https://doi.org/10.17605/OSF.IO/TNFY2

Results

Four articles met the final inclusion criteria. A final sample size of 194 parent-child dyads across Australia, Canada, the Netherlands, and the United States were enrolled. Mean child age was 5 years old and mean parent age was 37. Sleep health behavior outcomes in children addressed by digital mobile health solutions included bedtime resistance, night wakings, sleep onset, sleep duration, obstructive sleep apnea, sleep latency and independent sleep in child’s own bed. Sleep health outcomes also included positive improvements in parent sleep health education.

Conclusion

Parent engagement with child sleep health interventions yielded favorable outcomes, enhancing the overall sleep health of children. More research is needed to understand tailored interventions for sustained sleep health improvements in child sleep.

Support (if any)

K01HL169419-01
0843 Improving Daytime Sleepiness in Children with Narcolepsy: A Quality Improvement Initiative
Authors: Gurbani Neepa , Dye Thomas , Simmons Danielle , Pascoe John , Mullen Lisa , Schuler Christine , Simakajornboon Narong
Published: April 2024

Introduction

Narcolepsy affects 25-100/100,000 people in the US. Daytime sleepiness associated with pediatric narcolepsy negatively impacts quality of life (QoL), academics, vocational function, and personal safety. The Epworth sleepiness scale (ESS) is a validated tool that measures daytime sleepiness. We aimed to improve daytime sleepiness in children with narcolepsy at our center using quality improvement process to increase the percentage of narcolepsy patients with at least a 30% improvement of ESS from baseline.

Methods

We created a multidisciplinary quality improvement (QI) team in 2019 and used standard QI methods. Key drivers included access to care, patient and family engagement in care, follow up tracking, and complete provider documentation. We conducted plan-do-study-act (PDSA) cycles and tracked progress with a run chart. Interventions included pre-visit planning tool enhancement, tracking duration between visits and missed clinic visits, contacting patients with ≥2 missed visits, tracking prescriptions, identifying patients without referrals for behavioral/psychological support, and treating comorbid sleep disorders. Process measures included the ESS completion rate and days between visits. The primary outcome measure was improvement on the ESS. A secondary outcome measure was improvement in QoL (10% improvement in the PedsQL score).

Results

Between 2019 and 2023, 101 patients had 605 visits. The ESS completion rate (>90% pre-COVID), decreased during COVID to 57% and improved to a median of 70% in 2023. The ESS completion rate was lower for telehealth (36%) than in-person visits (90%). Pre-COVID, the median days between visits was below goal (< 200 days) at 156 days but increased to 210 days in December 2020. Approximately three years after project initiation, 62% of patients had at least a 30% improvement in the ESS score. Improvements were sustained over 16 months. Average decrease in ESS score was 9.9 points (score range: 0-24)since 1/2020. The median baseline PedsQL score was 64.7 (borderline unhealthy) and increased by 14%.

Conclusion

Using QI methods and multiple interventions, we increased the percentage of narcolepsy patients with at least a 30% improvement in the ESS score to >60%. Ongoing challenges include accommodating increased patient volume, reducing process variation in ESS completion, and standardizing documentation practices for ESS scores.

Support (if any)
0845 The Contributions of Sleep and Circadian Parameters to Adolescents ADHD Symptoms
Authors: Gruber Reut , Alyagon Michal , Saha Sujata , Somerville Gail , Gauthier-Gagne Gabrielle , Little Charlotte , Wise Merrill
Published: April 2024

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a chronic and debilitating disorder that negatively impacts adolescents’ academic achievements and interpersonal relationships. Individuals with ADHD are two to three times more likely to experience sleep problems. It has been proposed that untreated sleep problems exacerbate ADHD. However, empirical evidence regarding the relative contributions of specific sleep issues to the daytime manifestation of ADHD symptoms among adolescents is limited. The objective of this study was to determine the relative contributions of sleep and circadian parameters to adolescents' ADHD symptoms.

Methods

A sample of 40 unmedicated adolescents (26 girls, 18 boys) between the ages of 12 to 15 years (M= 13.9; SD = 0.95) with no psychiatric or medical comorbidities participated in the study. Sleep EEG was recorded using a single night of ambulatory sleep EEG (Sleep Profiler) monitoring with frontal derivations during the school week in the child’s home. Automated sleep/wake scoring was performed using the system followed by visual scoring and analysis by an experienced pediatric sleep specialist. In addition, adolescents were asked to complete questionnaires regarding insomnia and circadian problems and ADHD symptoms. Parents were asked to provide demographic information and complete questionnaires regarding their child’s ADHD symptoms, sleep, and daytime behavior.

Results

Linear regression analysis revealed that PSG-based sleep duration, adolescents’ reported insomnia symptoms, and parents' reported Restless Leg Syndrome symptoms contributed to the manifestation of adolescents’ ADHD symptoms above and beyond gender or SES. No other effects were significant.

Conclusion

Adolescents’ ADHD symptoms were related to different sleep problems requiring different interventional strategies. These findings provide compelling motivation for the development of interventions that use sleep as a means to improve the daytime functioning of adolescents with ADHD. Clinical Implications Given the negative impact of unhealthy sleep on adolescents’ mental, cognitive, and physical health, it is essential that clinicians integrate sleep assessments and interventions into their screening, diagnosis and ongoing care for adolescents, particularly when caring for adolescents with behavioral and functional difficulties.

Support (if any)

CIHR Grant 418638 to Dr. Reut Gruber
0846 Development of a Pediatric Sleep Routine Questionnaire for Black Families: A Human-centered Design Approach
Authors: Chung Alicia , Iruka Iheoma , Brotman Laurie , Jean-Louis Girardin , Huang Keng-Yen
Published: April 2024

Introduction

Bedtime routines are the hallmark for sleep guidance in young children. Yet, Black children have an 80% increased likelihood of not having a bedtime routine, compared to white children. To promote healthy bedtime routines, a comprehensive assessment tool that capture children’s bedtime routine behaviors and relevant bedtime environment and context is needed to guide the targeting areas for intervention. However, existing sleep routine questionnaires do not capture sleep contexts that are relevant to Black families. Thus, the objective of our study was to develop a comprehensive sleep routine questionnaire that captures child’s bedtime routine behaviors, and household adult-child interaction and bedtime environment that support health bedtime behaviors. As the first step of the measurement development, we focused on study cultural relevance, salience and appropriateness of the three bedtime measures: 1. the Parent-Child Sleep Interaction Scale, 2. Bedtime Routines Questionnaire, and 3. Child Routines Inventory scales, prior to formal administration.

Methods

A human-centered design process, Ecological Theory (considering individual, home, black community contexts), and qualitative formative research methods were applied to guide sleep routine questionnaire adaptation. A convenience sample of five Black caregivers with preschool-aged children were interviewed and provided feedback for the bedtime routine surveys. Interview questions were guided by human-centered design, centering the lived experience of the caregivers, as well as multiple-domains of sleep contexts and behaviors to understand child sleep routine practices, household structure, child sleep environment, social-family connection, social support and child sleep decision-making.

Results

Thematic areas of caregiver feedback fell into the following three areas: 1. deficit-based and focused on punitive discipline, 2. Do not capture child weekend sleepovers at Grandparent’s house, 3. Two-home households were not reflected, 4. Racial options for mixed children were not reflected and 5. age-appropriate activities were not reflected in the measures.

Conclusion

Current pediatric bedtime routine sleep measures are not culturally tailored for Black families of preschool aged children. Future steps include holding caregiver focus groups to glean relevant survey items/domains for the development of a new comprehensive culturally tailored measure for Black preschool-aged children that can be used to guide the intervention and intervention theory of testing.

Support (if any)

NIH K01HL169419-01
0851 Sleep Moderates Behavioral Difficulties and Quality of Life in Autistic Children
Authors: Martin Annie , Stearns Melanie , McGovney Kevin , Curtis Ashley , Mazurek Micah , Davis Beth Ellen , Sohl Kristin , Beversdorf David , McCrae Christina
Published: April 2024

Introduction

Research indicates a relationship between increased behavioral difficulties (e.g., irritability, social withdrawal, stereotypic behaviors, noncompliance, inappropriate speech) and poor quality of life (QoL) in autistic children. However, little is known about how sleep may be associated with this relationship. To assess the mechanistic role of sleep, we examined whether autistic school-age child sleep moderated the relationship between behavioral difficulties and QoL.

Methods

Children with autism spectrum disorder (N=65; Mage=8.95, SD=2.01, range 6-12; 74% male), verbal IQ >70, and parent reported sleep complaints completed 14 days of sleep diaries (with parental assistance) and their parents completed surveys (Child Sleep Health Questionnaire-CSHQ, Pediatric Quality of Life-PedsQoL, Aberrant Behavior Checklist-ABC). Multiple regressions (SPSS PROCESS Model 1) examined whether sleep (subjective diary total sleep time-TST; CSHQ total score) moderated associations between behavioral difficulties (irritability, inappropriate speech, stereotypic behaviors, hyperactivity) and QoL (health, social, emotional, school) in baseline data. Analyses controlled for age.

Results

CSHQ moderated associations between irritability and social QoL (β=.34, p=.04). In children with the best overall sleep health, less irritability was associated with better social QoL, β=-6.32, p=.002. CSHQ also moderated associations between hyperactivity and school QoL (β=.25, p=.02). Similarly, in children who had the best overall sleep health, less hyperactivity was associated with better school QoL β=-3.84, p=.001. TST moderated associations between inappropriate speech and social QoL (β=-.12, p=.02). At the longest TST, less inappropriate speech was associated with better social QoL, β=-3.45, p=.001. TST moderated associations between stereotypic behaviors and social QoL (β=-.10, p=.04). At the longest TST, less stereotypic behaviors were associated with better social QoL β=-15.14, p=.004.

Conclusion

The present findings suggest that, in autistic children, the relationship between behavioral difficulties and school/social QoL depends on overall sleep health, particularly TST. It is possible that improving sleep through behavioral sleep treatments may change the relationship between problematic behaviors QoL in this population. However, more research using longitudinal, experimental, and trial methodology and perhaps even examining other aspects of TST (e.g., variability) are needed.

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0854 Obstructive Sleep Apnea with Obesity Hypoventilation Syndrome: Deep Vein Thrombosis Risk After Bariatric Surgery
Authors: Fowler Cosmo , Makadia Briana , Chism Lauren , Pastores Stephen , Auckley Dennis
Published: April 2024

Introduction

Morbidity and mortality in patients with untreated obesity hypoventilation syndrome (OHS) is significant. The vast majority of OHS patients have concomitant obstructive sleep apnea (OSA), known to be associated with worse cardiovascular outcomes following bariatric surgery. However, there is limited data on the post-bariatric surgery outcomes of patients with OHS.

Methods

We queried TriNetX Analytics, a federated health record and claims-derived database of >115 million patients across 5 countries. We established two cohorts of patients with OSA (ICD-10-CM G47.33) who underwent laparoscopic bariatric surgery (CPT 1007387) between 5/1/2008-5/1/2023: one with superimposed OHS (E66.2) and one without. We examined the 30-day incidence of deep vein thrombosis [DVT (I82)], pulmonary embolism [PE (I26)], stroke [CVA (I63)], and myocardial infarction [MI (I21)]. We then re-examined these outcomes following extensive in-platform propensity score matching (PSM) to account for demographic and comorbidity antecedents.

Results

A total of 66,085 bariatric surgery patients were isolated, all in the US. Of these, 26,392 (40%) were diagnosed with OSA prior to surgery, of which 1,176 (1.8%) also carried a diagnosis of OHS. Prior to PSM, the OSA+OHS cohort experienced a significant excess incidence of all outcomes besides CVA when compared to the cohort with OSA alone: DVT risk was 3.9 vs 1.1% (OR 3.5, CI 2.6-4.4), PE risk 2.6 vs 0.9% (OR 3.0, CI 2.1-4.5), composite DVT/PE risk 5.4 vs 1.8% (OR 3.2, CI 2.4-4.1), CVA risk 0.9 vs 0.6%, MI risk 1.4 vs 0.4% (OR 3.3, CI 2.0-5.5), composite CVA/MI risk 2.0 vs 1.0% (OR 2.0, CI. 1.3-3.2). Following PSM, which generated two like sub-cohorts of 1,167 each, significant risk excess was retained only for DVT incidence: DVT risk was 3.8 vs 2.0% (OR 1.9, CI 1.2-3.2), but not for PE risk 2.4 vs 2.1%, DVT/PE risk 5.1 vs 3.7%, CVA risk 0.9 vs 1.2%, MI risk 1.5 vs 1.5%, and CVA/MI risk 2.0 vs 2.4%.

Conclusion

Our findings suggest that patients with OSA and OHS undergoing bariatric surgery experience similar rates of adverse cardiovascular events in the first postoperative month as those with OSA alone. The exception is DVT risk, which appears greater in the OHS-OSA cohort despite matching.

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0855 Investigate Factors That Modulate Temporal Risk for Developing New Hypertension Among Patients with Sleep Apnea
Authors: Te Tue , Fung Constance H , Boland Mary Regina
Published: April 2024

Introduction

Obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder, often occurs in the context of multimorbidity. The primary purpose of our study was to investigate the temporality of comorbidity that modulate the risk for developing hypertension (HTN) among patients with OSA without pre-existing HTN at baseline OSA diagnosis.

Methods

Our cohort consisted of cases with OSA and the 20 most common comorbidities defined using our previously validated EHR-based algorithm. We then constructed a survival model, controlling for age, sex, and BMI. In our survival model, the index date was date of first OSA diagnosis and we estimated time-to-first HTN diagnosis. Because our survival analysis requires accurate dates of diagnosis both for OSA and HTN, we also performed a validation of the dates of diagnosis of OSA and HTN identified from our algorithm by utilizing clinical chart reviews in 400 randomly chosen EHR-defined cases.

Results

We identified 76,519 OSA cases, among 53,035 cases diagnosed from 2012 to 2021. 31,741 cases (59.8%) without pre-existing HTN diagnosis at the date of OSA diagnosis met our inclusion criteria. Within our survival cohort, 15,830 (49.9%) OSA cases did not develop HTN. Age, Black race, BMI, atrial fibrillation, coronary atherosclerosis, pure hyperlipidemia, hypercholesterolemia, GERD, type 2 diabetes, tobacco use, other anemia, osteoarthrosis increased risk of HTN development. Female sex, allergic rhinitis, malaise and fatigue, joint pain, vitamin D deficiency were observed not to increase risk of HTN development. Moreover, clinical chart review demonstrated that OSA diagnosis and HTN diagnosis were documented in notes a median of 38 days and 738 days (respectively) prior to being coded in the EHR.

Conclusion

Our study, which used a large sample of patients, demonstrates the power of leveraging the EHR to identify factors that modulate risk for developing HTN among patients with OSA. In addition, we described differences between the true diagnosis dates of OSA and HTN and diagnosis dates based on our EHR-based algorithm. Overall, this study provides new insights into disease heterogeneity and potential personalized medicine approaches.

Support (if any)
0856 Association of Naturally Occurring Mild Intermittent Hypoxemia and Health Outcomes in Sleep Apnea
Authors: Jawde Samer Bou , Esmaeili Neda , Sands Scott , Redline Susan , Mateika Jason , Azarbarzin Ali
Published: April 2024

Introduction

Hypoxic conditioning, or the intentional exposure of mild intermittent hypoxia (MIH), has been shown to have protective cardiovascular outcomes. We investigated if naturally occurring MIH exposure during sleep has the same effect as controlled exposure. We hypothesized that larger number of respiratory events with MIH is associated with lower risk of adverse outcomes in OSA participants (apnea-hypopnea index ≥ 5 events/hour).

Methods

Participants from the Sleep and Heart Health Study cohort were analyzed. Respiratory events that were associated with MIH included all those accompanied with a 2-4% desaturation. Those with an oxygen desaturation > 4% were called non-MIH. For each participant, the frequency of MIH (AHI-MIH) and non-MIH (AHI-nonMIH) were calculated. Participants were categorized into 5 groups: those 1) without OSA (AHI 3% or arousal < 5 events/hour; reference group), 2) with OSA and high AHI-MIH (≥ median) but low AHI-nonMIH (< median), 3) with OSA and low AHI-MIH(< median) but high AHI-nonMIH(≥median), 4) with OSA and low AHI-MIH(< median) and low AHI-nonMIH(< median), and 5) with OSA and high AHI-MIH(≥ median) and high AHI-nonMIH(≥ median). Several logistic regression models examined the subgroups’ association with hypertension, diabetes, and Epworth Sleepiness Scale after adjusting for age, gender, race, and body mass index as confounders. In secondary analyses, we adjusted for the “hypoxic burden” as a measure of cumulative event-related intermittent hypoxia.

Results

5634 participants were analyzed (means and standard deviations – age: 63.1±11.2 years; BMI: 28.2±5.1 kg/m2; gender: 52.5% females; AHI 17.9±16.1 events/hour). Compared to participants without OSA, individuals with low AHI-MIH but high AHI-nonMIH were at increased risk of hypertension (odds ratio [95% Confidence Interval]: 1.57 [1.25-1.96]). This risk was lower in participants with high AHI-MIH and high AHI-nonMIH(1.19 [0.99-1.43]) followed by the high AHI-MIH/low AHI-nonMIH subgroup (1.06 [0.85-1.31]) and the low AHI-MIH/low AHI-nonMIH subgroup (0.97 [0.82-1.15]). Similar findings were observed for diabetes and sleepiness. After adding hypoxic burden, hazards ratios were reduced, but the same pattern was observed across these groups for all outcomes.

Conclusion

Presence of MIH events appear to dilute health outcome risks associated with more severe desaturation events. This warrants further investigation to the role of MIH during sleep.

Support (if any)
0857 Evidence for an Independent Association of Cardiovascular Disease in Patients with Narcolepsy
Authors: Kaufmann Christopher , Riaz Munaza , Park Haesuk , Lo-Ciganic Wei-Hsuan , Wilson Debbie , Malhotra Atul , Wickwire Emerson , Bhattacharjee R
Published: April 2024

Introduction

Narcolepsy is a lifelong disabling disorder causing profound daytime sleepiness. Symptoms present as early as childhood and result in marked disturbances in the life course of many persons with narcolepsy (PWN). Further, PWN experience several health conditions, including cardiovascular disease (CVD). Importantly, PWN often present with several co-occurring sleep disorders, including obstructive sleep apnea, which is a prominent risk factor for CVD. This study examined the association between narcolepsy and CVD comprehensively accounting for potential confounders predisposing PWN to CVD.

Methods

This retrospective cohort study used the 2005-2021 IBM® MarketScan® Commercial and Medicare supplemental databases to identify newly diagnosed PWN from at minimum 2 outpatient claims using the International Classification of Diseases–Clinical Modification (ICD-9/10-CM) diagnosis codes. In addition, we identified a comparison cohort of persons without narcolepsy or other hypersomnolent disorders, using propensity score (PS) matching [1: up to 3 ratios] to balance groups based on underlying demographics, the presence of relevant health conditions, including sleep apnea and diabetes, and other confounders. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (95%CI) to estimate CVD risk outcomes (including major adverse cardiovascular events [MACE], heart failure, stroke, atrial fibrillation, and myocardial infarction [MI]) for PWN compared to non-narcolepsy. Patients were censored at the end of enrollment or up to December 13, 2021.

Results

Among 134,067 patients included (mean age=40±16.8 years; 62% female), 34,562 were PWN and 100,405 were matched non-narcolepsy patients. Compared to non-narcolepsy patients, PWN were associated with a 77% increased risk of any CVD (HR=1.77, 95%CI=1.65-1.89) and an 82% increased risk of MACE (HR=1.82, 95%CI=1.66-1.99). PWN also were associated with an increased risk of heart failure (HR=1.64, 95%CI=1.47-1.83), any stroke (HR=2.04, 95%CI=1.82-2.29), atrial fibrillation (HR=1.58, 95%CI=1.40-1.77), and MI (HR=1.64, 95%CI=1.37-1.96) compared to non-narcolepsy patients.

Conclusion

Using a large representative commercial insurance claims database, our study provides evidence that narcolepsy is an independent risk factor of CVD after comprehensive matching and adjustment for relevant confounders, including sleep apnea.

Support (if any)

This study was supported by the Sleep Research Society Foundation (Grant #: 23-FRA-001).
0859 Impact of Social Determinants of Health and Sleep on Cardiometabolic Health in Pregnant African American Women
Authors: Irsheed Ghada Abu , Steffen Alana , Quinn Laurie , Chen Pei , Meinel Monya , Burke Larisa , Izci-Balserak Bilgay
Published: April 2024

Introduction

Cardiometabolic Disease disproportionately impacts African American (AA) women with higher gestational diabetes risk compared to their White counterparts, often progressing to post-partum type 2 diabetes across the United States. Thus, pregnancy is a critical period to assess cardiometabolic health (CMH) in this population. This study aimed to explore the impact of Social Determinants of Health (SDoH) and sleep-related outcomes on insulin resistance.

Methods

Data from 70 AA pregnant women enrolled in the BETTER lifestyle counseling study (NCT05234125) who completed surveys and provided blood samples were analyzed. SDoH factors encompassed stress level (Perceived Stress Scale), social support perceptions (Multidimensional Scale of Perceived Social Support), and demographic indicators such as income and education. Sleep assessments included evaluations of sleep quality (Pittsburgh Sleep Quality Index), sleep apnea risk measuring the apnea-hypopnea index (Watch-PAT One), insomnia symptoms (Insomnia Severity Index), and sleep hygiene (Sleep Hygiene Index). Insulin resistance was quantified using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) as the outcome variable. Multiple regression analyses including demographic variables with a p< 0.2 in bivariate analyses were performed to determine the predictive capacity of SDoH and sleep variables on HOMA-IR.

Results

The mean age was 30.4 (SD 5.72; range:18.5-42 years); mean gestational weeks (GWs) was 18.03 (SD 3.021; range:10.6-23.1); and mean body mass index (BMI) was 33.09 kg/m2 (SD 5.63; range:16.2-47.1). After controlling for covariates (age, GWs, BMI, income, and education), higher stress (β=.251, p<.05), poor sleep quality (β=.279, p<.05), and higher insomnia symptoms (β=.248, p<.05) were significantly associated with higher insulin resistance. These results contribute important insights into the impact of both SDoH and sleep-related outcomes on insulin resistance among AA women during pregnancy.

Conclusion

SDoH and sleep, particularly stress and sleep disturbances, are linked to CMH, highlighting the importance of comprehensive assessment to address cardiometabolic disease risks for AA women during their pregnancy. Further research is needed to understand the causal aspects of these associations and develop targeted interventions to optimize the CMH, and enhance maternal and child health outcomes in this population.

Support (if any)

The National Center on Minority Health and Health Disparities at The National Institute of Health of the United States, R01MD015724.
0860 Sleep Fragmentation Is a Robust Independent Predictor of Diastolic BP Among Blacks in a Real-World Context
Authors: Montalvo Jessica , Blanc Judite , Bernard Mark A , Rogers April , Gallop Erin-Leigh , Oliveira Bruno , Seixas Azizi , Jean-Louis Girardin
Published: April 2024

Introduction

Sleep quality is a critical determinant of cardiovascular health, and its influence on blood pressure regulation has been extensively explored. However, there remains a notable gap in research concerning the relationship between sleep fragmentation and blood pressure among Black in a naturalistic setting.

Methods

A total of 195 Black adult participants (75% Female; mean age 48 years) were enrolled in the NIH-funded ESSENTIAL and MOSAIC studies and underwent a 7-day home-based sleep study. Sleep fragmentation, a key variable of interest, was quantified using SleepImage ring devices, which amalgamate various cardiopulmonary disturbance metrics into a comprehensive Sleep Fragmentation score. Diastolic blood pressure (DBP) was measured six times during the study using the iHealth BP monitor, and the average DBP was employed in our subsequent analyses. Our research approach encompassed t-tests and correlation matrices to explore the associations between DBP and a wide array of factors, including sociodemographic characteristics, cardiovascular disease risk diagnosis, age, sleep fragmentation, psychosocial factors, and health behaviors.

Results

The results of our regression analysis revealed several important findings. Age exhibited a small positive coefficient but was not statistically significant, indicating a weak association with DBP. Depression, while displaying a positive coefficient, was marginally significant (p = 0.056), suggesting a potential moderate impact on DBP. Similarly, alcohol consumption exhibited a positive coefficient, marginally significant (p = 0.051), implying a potential moderate effect on DBP. However, the most striking finding was the robust association between sleep fragmentation and DBP. Sleep fragmentation exhibited a positive coefficient (B = 0.303) and was statistically significant (p = 0.005), firmly establishing it as the strongest independent predictor of diastolic blood pressure among Black adults.

Conclusion

This study contributes valuable insights into the relationship between sleep fragmentation and diastolic blood pressure among Black individuals, in a real-world context. Our findings underscore the significance of addressing sleep quality and fragmentation as a potential modifiable risk factor in cardiovascular health management, particularly within Black communities. Further research in this area may have implications for targeted interventions and strategies to mitigate the adverse cardiovascular effects of sleep fragmentation among at-risk populations.

Support (if any)

NIH R01HL142066 and R01AG067523
0861 Beat Right, Sleep Tight: Pilot Study of Depression’s Role on Blood Pressure and Sleep in Older Adults with Insomnia
Authors: Sebastian Celestine , Costa Amy , McCrae Christina , Curtis Ashley
Published: April 2024

Introduction

Insomnia disorder and hypertension are common in aging adults, making older adults at increased risk for cardiovascular disease. A bidirectional relationship between insomnia symptoms and hypertension exists, but mechanisms underlying this association are not fully understood. Depressive symptoms have been linked to insomnia. Additionally, there is a known association between depression and hypertension, but investigations of non-invasive blood pressure metrics are limited, which limits conclusions regarding disease markers and potential targets for intervention. This pilot study tested whether blood pressure interacted with depressive symptoms in its association with sleep in older adults with insomnia.

Methods

Older adults with insomnia disorder (DSM-5 criteria plus sleep diary confirmation of >30 minutes of sleep onset latency or wake time after sleep onset 3+ nights/7; N=38, Mage=68.5±6.4 years, 24 women) completed the Beck Depression Inventory-II (BDI-II), Insomnia Severity Index (ISI), and resting blood pressure reading. Multiple linear regressions tested if cardiovascular activity [pulse pressure (systolic BP – diastolic BP), systolic BP, diastolic BP] interacted with depressive symptoms in its association with insomnia severity, controlling for Body Mass Index and number of medications.

Results

Depressive symptoms interacted with systolic BP in its association with ISI (R2-change=.08, p=.02). Specifically, higher systolic BP was associated with worse insomnia severity only at highest levels of depression (BDI-II score=14.61; B=.12, p=.03).

Conclusion

Preliminary findings suggest higher levels of depression may exacerbate the relationship between higher systolic blood pressure and more severe insomnia symptoms in older adults. These results point to a dynamic interplay between autonomic nervous system dysregulation, peripheral vasoconstriction, and potentially neural circuits involved in emotional processing that mediate depressive symptoms. Prospective studies in larger samples are needed to untangle the temporal nature of this relationship. Additionally, it may be important to concurrently monitor depressive symptoms and blood pressure in older adulthood as well as evaluate whether behavioral interventions in depression (e.g., Cognitive Behavioral Therapy for Depression) may reduce systolic blood pressure and in turn improve insomnia severity in older adults.

Support (if any)

This research was made possible by an award (PI:Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.
0867 Machine Learning Analysis of Polysomnography Variables to Predict Hypertension
Authors: Chow Christine , Kang Hyojung , Logan Jeongok , Liu Xiaoyue , Kwon Younghoon
Published: April 2024

Introduction

Sleep plays an important role in the regulation of blood pressure (BP) and BP variability (BPV), both of which are associated with cardiovascular disease. However, studies in this area have typically focused on a single domain of sleep traits. We aimed to examine whether multidimensional sleep measures incorporating a wide array of polysomnography (PSG) data along with other patient characteristics can be used to predict hypertension and high BPV using a machine learning (ML) approach.

Methods

We retrieved patient characteristics and PSG data from a single academic sleep center. BP data with at least 3 measures within 1 year following PSG were used to determine hypertension (systolic BP ≥130 mmHg or on antihypertension medication) and high BPV (coefficient of variation > 0.1). We used three commonly used supervised ML models including the logistic regression model, random forests, and eXtreme Gradient Boosting (XGBoost) to predict hypertension and high BPV. To improve the model performance by including the most predictive variables, we additionally conducted feature engineering and ran ML models using the selected variables from the process. We employed two variable reduction

methods

least absolute shrinkage and selection operator (LASSO) and principal component analysis (PCA).

Results

Among 2,827 patients, 2074 (73.4%) patients had hypertension and 1,188 patients (42%) had the high BPV group. Overall, the three models showed a good performance in predicting hypertension in which XGBoost performed the best in terms of accuracy (0.67 – 0.75), recall (0.72 – 0.96), precision (0.76 – 0.83), and AUC (0.68 – 0.70). Models built with LASSO-selected variables generally performed more favorably than models built with PCA-constructed features. However, the performance of the ML models to predict high BPV was low with an accuracy of 0.56, recall of 0.2, precision of 0.45, and AUC of 0.53 at best.

Conclusion

ML modeling of multiple PSG sleep features along with common patient characteristics was predictive of hypertension in patients undergoing PSG. PSG data may be better utilized in cardiovascular risk assessment beyond its role as a diagnostic tool for OSA assessment.

Support (if any)

Engineering in Medicine Grant (University of Virginia)
0869 Association Between Accelerometer-Measured Irregular Sleep Duration and Incidence of Obesity in Older Adults
Authors: Kianersi Sina , Potts Kaitlin , Wang Heming , Sofer Tamar , Noordam Raymond , Rutter Martin K , Redline Susan , Huang Tianyi
Published: April 2024

Introduction

Abnormal sleep duration is an established risk factor for obesity. However, the potential adverse effects of sleep's nightly variability, including fluctuations in duration, remain less explored. Irregular sleep duration may increase circadian disruption and subsequently contribute to metabolic alterations, behavioral and mood changes, and obesity development.

Methods

From 2013-2015, a subsample of the UK Biobank (UKB) participants wore accelerometers for a week. Our longitudinal study included 8,438 participants (mean age: 64 years) with ≥5 days of accelerometer data and repeated weight measurements who had BMI< 30 kg/m2 at baseline. Irregular sleep duration was assessed by the within-person standard deviation (SD) of 7-night accelerometer-measured sleep duration. Weight was objectively measured at UKB center visits or extracted from UK general practice records at two timepoints. The baseline measurement was taken in a period spanning from two years before to one year after the accelerometer study. The follow-up measurement was obtained on average 3.6 years after the baseline measurement (interquartile range: 1.8-5.0) and at least 6 months after the accelerometer study. Poisson regression with robust error variance was used to estimate relative risk (RR) for incident obesity (BMI≥30 kg/m2) according to sleep duration-SD categories.

Results

A total of 419 participants developed obesity at the follow-up measurement. Compared with participants with a sleep duration-SD < 30 minutes, the RR (95% CI) for incident obesity was 1.22 (0.86, 1.73) for 31-45 minutes, 1.60 (1.14, 2.26) for 46-60 minutes, and 2.01 (1.45, 2.80) for >60 minutes (p-trend=0.0024), after adjusting for age, sex, race, and follow-up period. Additional adjustment for lifestyle (smoking, physical activity, diet, and alcohol use), co-morbidities (dyslipidemia, hypertension, and depression), and other sleep-related factors including average sleep duration resulted in a weaker but statistically significant association (RR comparing >60 versus < 30 min: 1.73; 95% CI: 1.24, 2.41). The association was similar in men and women (P-interaction in the fully-adjusted model=0.84).

Conclusion

Irregular sleep duration was associated with higher risk of incident obesity in older adults, independent of average sleep duration and other obesogenic behaviors.

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R01HL155395
0870 Association Between Narcolepsy and Cardiovascular Outcomes: A Matched Cohort Study Adjusting for Medication Use
Authors: Riaz Munaza , Kaufmann Christopher , Bhattacharjee Rakesh , Lo-Ciganic Wei-Hsuan , Wilson Debbie , Wickwire Emerson , Malhotra Atul , Park Haesuk
Published: April 2024

Introduction

Emerging research suggests that narcolepsy, a chronic disabling condition characterized by excessive daytime sleepiness, directly impacts the cardiovascular system, leading to increased risk of cardiovascular disease (CVD). Existing studies evaluating CVD risk among persons with narcolepsy (PWN) have not considered medications to treat the symptoms of narcolepsy (e.g., stimulants). We aimed to assess the real-world association of narcolepsy with CVD risk while accounting for medications.

Methods

We conducted a retrospective cohort study using 2005-2021 MarketScan® Commercial and Medicare Supplemental databases. Patients with newly diagnosed narcolepsy with ◻2 outpatient claims identified using International Classification of Diseases – Clinical Modification diagnosis codes were included (narcolepsy group). A comparison cohort of patients without narcolepsy and hypersomnia (non-narcolepsy group) was matched at a ratio of 1 up to 3 using propensity score (PS) matching based on baseline demographics, comorbidities, and medication use. After PS matching, we used multivariable Cox regression to compare the risks of CVD (i-e., stroke, atrial fibrillation, heart failure (HF), myocardial infarction (MI), or acute coronary syndrome) and major adverse cardiac events (MACE) (i-e., MI, ischemic stroke, HF, acute coronary syndrome, coronary artery bypass grafting, or percutaneous coronary intervention) between the two groups after controlling for baseline wake promoting agents and stimulants use, and post-index time-varying stimulants use. Follow-up continued until the occurrence of outcomes, end of enrollment, or December 31, 2021.

Results

134,967 patients (34,562 PWN and 100,405 non-narcolepsy; mean age 40±16.78 years and 62% female) were identified. The crude incidence of CVD was 1.50 and 0.85 per 100 person-years for narcolepsy and non-narcolepsy groups, respectively. After controlling for baseline and time-varying covariates, PWN was associated with a 93% higher CVD risk compared to non-narcolepsy group (adjusted hazard ratio (aHR), 1.93; 95% confidence interval (95% CI), 1.75-2.13). Similarly, PWN was associated with a 97% higher MACE risk compared to non-narcolepsy group (aHR,1.97; 95%CI, 1.72-2.26).

Conclusion

In this PS-matched cohort study, PWN experienced increased risk of developing CVD or MACE relative to propensity-matched patients without narcolepsy after controlling for baseline medication use (stimulant and wake promoting agent), and post-index time-varying stimulant use.

Support (if any)

Sleep Research Society Foundation (23-FRA-001).
0871 Sleep Disturbance and Disability Severity After Stroke Hospitalization
Authors: Gonzalez Alvis , Jurado Ammie , Aguirre Jennifer , Shechter Ari
Published: April 2024

Introduction

Stroke survivors frequently report sleep disturbance and feelings of not being back to where they were, physically, prior to their event. Post-stroke sleep disturbance may be a factor related to sub-optimal recovery.

Methods

Data came from the Reactions to Acute Care and Hospitalizations (ReACH) Stroke-Sleep Study, an observational cohort assessing the relationship of sleep with secondary cardiovascular risk in the year following stroke or transient ischemic attack (TIA). Data were collected using self-reported questionnaires at 1 month and chart reviews. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), with a score >5 indicating poor sleep quality. Insomnia symptoms were assessed with a single item from the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): “In the past month, how much were you bothered by trouble falling or staying asleep?” with a rating of “moderately,” “quite a bit,” or “extremely” indicating presence of insomnia symptoms. Degree of disability was assessed using the Simplified Modified Rankin Scale Questionnaire (smRSq), with presence of disability defined as smRSq score >2. Binary logistic regression was used to analyze the relationships between presence of poor sleep and insomnia, separately, with presence of disability at 1-month post-hospitalization. Analyses were adjusted for age, gender, race/ethnicity, and stroke severity (NIH Stroke Scale).

Results

The sample included n=436 participants (mean [SD] age=60.2 [15.5] y, 52% Hispanic/Latino, 59% female). Fifty-six percent of participants reported poor sleep quality, 27% reported presence of insomnia symptoms, and 23% reported presence of disability at 1 month. Poor global sleep quality (vs. good sleep) was significantly associated with presence of disability (adjusted OR: 2.45, 95% CI: 1.48-4.04, p< 0.001). Insomnia (vs. no or mild symptoms) was also significantly associated with presence of disability (adjusted OR: 2.40, 95% CI: 1.50-3.85, p< 0.001).

Conclusion

More than half of participants reported poor sleep quality, and over a quarter reported insomnia symptoms, 1 month after stroke hospitalization. Compared to those without sleep problems, individuals with sleep disturbance had nearly 2.5 times higher odds of disability. While causal relationships cannot be concluded based on this cross-sectional analysis, findings suggest that sleep may play a role in stroke survivors’ outcomes and recovery.

Support (if any)

R01HL141494
0873 Impact of Obstructive Sleep Apnea Treatment on Mortality in Atrial Fibrillation Patients
Authors: Sattani Ashrine , Karca Ayla , Naik Sreelatha , Suryanarayanana Manoj , Tejwani Dimple
Published: April 2024

Introduction

The intricate relationship between atrial fibrillation (AF) and obstructive sleep apnea (OSA) has garnered attention due to its potential impact on morbidity and mortality. This study explores the characteristics of individuals with both AF and OSA, aiming to shed light on associated outcomes.

Methods

Utilizing data from the Geisinger Health System (2007-2023), we focused on cardiology patients with AF. Inclusion criteria comprised age > 18, AF and OSA diagnosis, and polysomnography with an apnea-hypopnea index (AHI) > 5. Data collected included age, gender, body mass index (BMI), mean AHI, oxygen desaturation index (ODI), ablation, cardioversion rates, and electrophysiology (EP) clinic follow-ups.

Results

Among 29,000 patient encounters, 2,971 unique patients met inclusion criteria. 64% were male, with a mean age of 74.9 for deceased patients versus 68.1 for the alive cohort (p < 0.001). Deceased patients had a higher mean BMI (35.8 vs. 34.3, p = 0.003) and AHI (27 vs. 25, p = 0.0143). Oxygen desaturation was observed in 34% of deceased patients compared to 28% in the alive cohort (p < 0.0001). Ablation and cardioversion did not significantly impact mortality. The all-cause mortality rate was 12.7%.

Conclusion

Analysis revealed that prolonged hypoxia increased mortality risk in AF and OSA patients. Although higher AHI was noted in deceased patients, its clinical significance was limited. We also found that ablation and cardioversion did not improve mortality. Effective OSA treatment in AF patients can potentially improve outcomes. Further studies are necessary to determine if reducing oxygen burden reduces mortality in this population.

Support (if any)

A study published in the American Journal of Respiratory and Critical Care Medicine found that CPAP therapy reduced the incidence of AF-related mortality. The data from over 10,000 patients, demonstrated that those receiving effective sleep apnea interventions, such as CPAP, exhibited a 35% reduction in all-cause mortality compared to untreated counterparts. This research highlights the potential life-saving benefits of addressing sleep-disordered breathing in the management of AF.
0875 The Impact of Non-compliance with CPAP Therapy on Mortality in Atrial Fibrillation Patients
Authors: Sattani Ashrine , Naik Sreelatha , Suryanarayanana Manoj , Tejwani Dimple
Published: April 2024

Introduction

Atrial Fibrillation (AF) patients commonly experience comorbidities such as sleep apnea, emphasizing the need for effective management strategies. This study investigates the association between non-compliance with Continuous Positive Airway Pressure (CPAP) therapy and increased mortality in AF patients.

Methods

Utilizing data from the Geisinger Health System (2007-2023), we focused on cardiology patients with AF. Inclusion criteria comprised age > 18, AF and OSA diagnosis, and polysomnography with an apnea-hypopnea index (AHI) > 5. Data collected included age, gender, body mass index (BMI), mean AHI, adherence within 1st three months of starting CPAP therapy, Medicare adherence percentage, and CAI.

Results

Among 29,000 patient encounters, 2,971 unique patients met inclusion criteria. We chart reviewed 100 patients by looking at compliance reports within the first three months of CPAP use. Mean adherence time within the first three months was 5 hours 39 minutes for the alive cohort vs 4 hours 9 minutes for the patients that died (p=0.02). Mean Medicare medical adherence percentage for alive cohort was 73% vs 71% for the patients that died (p=0.361). Deceased patients had higher association of having AHI > 5 (p=0.016). Mean CAI for the alive cohort was 0.81 vs 0.62 for the deceased cohort (p=0.912). All-cause mortality rate was 12.7%.

Conclusion

Our findings underscore the critical impact of CPAP compliance on mortality outcomes in AF patients. Non-compliance with CPAP therapy within the first three months of use and AHI >5 emerged as a significant predictor of increased mortality, emphasizing the need for targeted interventions to enhance adherence in this population. The implications of our study extend beyond mortality, encompassing broader cardiovascular outcomes and healthcare utilization. Studies have established the relationship between AF and sleep apnea. Sleep apnea, prevalent in up to 50% of AF patients, exacerbates the arrhythmia's progression and increases the risk of cardiovascular events. While CPAP therapy has demonstrated efficacy in ameliorating the cardiovascular impact of sleep apnea, limited research has explored its effect on mortality in AF patients. Studies examining CPAP therapy's impact on AF outcomes have primarily focused on surrogate markers such as AF recurrence and symptom severity.

Support (if any)