bluuebunny/crossref_metadata_2025 huggingface dataset:
0540 OBESITY IS LINKED WITH HIGHER RISK OF OSA WITHOUT SUBJECTIVE HYPERSOMNIA IN MENOPAUSAL WOMEN
Authors: Marichalar José Garza , Torrecillas-Gordillo Meliza J , Chávez Luévanos Beatriz E , Martinez Carlos , de la Garza Luis , Moreno Ricardo
Published: May 2023

Introduction

Obesity is one of the biggest public health problems in the world, with the incidence of obesity estimated to be around 30% in some countries. There is a well-established link between Obstructive Sleep Apnea and obesity. This is due to many factors including a narrower airway because of fat deposits in this region, as well as decreased muscle activity. Subjective sleepiness measured with the Epworth Sleepiness Scale (ESS) is also associated with an increased risk of OSA. There are some studies that suggest that the ESS has a better predictive value in men than in women to detect Sleep Disordered Breathing, but to our knowledge, there are no studies in menopausal women

Methods

A retrospective study was performed using the data from the menopause clinic at the University Hospital in Monterrey, Mexico. All patients in the menopause clinic are evaluated using a screening protocol to detect sleep disorders, using the following tools: Pittsburgh Sleep Quality Index (PSQI), STOP-BANG questionnaire, and the Epworth Sleepiness Scale (ESS).

Results

Data were collected from 89 menopausal patients, identifying a total of 36 patients (40.44%) that had a BMI equal to or higher than 30 kg/m2. Of these 36 patients, 28 (77.7%) had a STOP-BANG questionnaire with 3 or more positive answers. Nevertheless, only 6 patients (16.6%) had an ESS of 10 or more with most having no subjective hypersomnia that was detected through this screening tool.

Conclusion

Subjective hypersomnia, which can be measured with the ESS, has been long considered an essential feature of OSA and is routinely used to screen different patient populations and decide whether a polysomnography or other sleep study is necessary for the diagnosis of OSA. Nevertheless, in menopausal women with obesity (BMI of 30 or higher), it seems that even though there may be an increased risk for OSA there is not an increase in subjective hypersomnia, which could lead to some patients with OSA not being studied properly. Better studies should be performed to get a better clinical picture of what OSA looks like in menopausal women.

Support (if any)
0543 Obstructive Sleep Apnea, Platelet Aggregation and Cardiovascular Risk
Authors: Kovbasyuk Zanetta , Ramos-Cejudo Jaime , Osorio Ricardo , Parekh Ankit , Ayappa Indu , Bubu Omonigho , Varga Andrew , Rapoport David
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) affects pathways implicated in the pathophysiology of cardiovascular disease (CVD) by poorly understood mechanisms. Platelets are key mediators of CVD risk and thrombosis and prior studies have suggested associations with OSA. We hypothesized that markers of OSA and platelet activity may be linked, and that these associations may be influenced by CVD risk factors.

Methods

Using one of the largest repositories of sleep phenotyping and platelet aggregation data available, we assessed the association of the apnea hypopnea index (AHI4%) and platelet aggregation in 482 participants dually enrolled within the Sleep Heart and Health (SHHS) and Framingham Heart Study (FHS) Offspring cohorts. Our primary outcome was the platelet aggregation response to adenosine diphosphate (ADP) 1.0 µmol/L measured by light transmission aggregometry. Other stimulation doses and OSA-related measures were used as secondary for further validation. The relationship between the AHI and platelet aggregation was assessed using standard regression models adjusted for age, sex, years of education, BMI, smoking status, hypertension, diabetes, present CVD history, aspirin use, high-density lipoprotein (HDL) cholesterol, total cholesterol, and triglycerides. We also examined the influence of OSA and CVD-related factors such as age, sex, BMI, hypertension, OSA diagnosis (AHI4% ≥ 5), and the use of platelet modifying drugs.

Results

No associations were observed between the AHI and platelet aggregation. No associations were observed when stratifying by age (< vs. ≥ 65.0), median BMI (< vs. ≥ 27.85), hypertension (51.9%), or OSA diagnosis (47.1%). AHI was associated with platelet aggregation when stratifying by aspirin use (β= 0.523; p < 0.001; n=65). Associations were found in the same group of aspirin users for secondary exposures: hypoxic burden (β= 0.358; p < 0.001), minimum saturation (β= -0.519; p = 0.026), and the ODI3% (β= 74.672; p = 0.002).

Conclusion

Our study indicates that the AHI is not associated with platelet aggregation in the general population. Our finding that the AHI is strongly associated with platelet aggregation in participants who are on aspirin for primary prevention of CVD reinforces the need for further examining the mediator role of platelet activity in the association of OSA and CVD risk.

Support (if any)
0546 Patient-reported experience with a wireless patch-based polysomnography system – results from a pilot study
Authors: Schneider Hartmut , Haisma Nicola , Mueller Syuyumbeki , Oloo Maryanne , Tijssen Marij , Stockhoff Mariele , Knoops-Borm Martine , Ermers Pieter , DeFrancisco Ruben , Coughlin Steven
Published: May 2023

Introduction

Sleep is critical for health and wellbeing. Left untreated, sleep disorders negatively impact daily functioning and quality of life. The gold-standard for sleep monitoring and diagnosis is in-lab polysomnography (PSG). Though PSG provides a comprehensive overview of sleep, it is uncomfortable due to the amount of sensors, which prohibit movement and disturb sleep. A wireless patch-based PSG system, the Onera Sleep Test System (STS), consisting of four body-worn sensors, was recently introduced to overcome these limitations. The objective of this study is to evaluate patient-reported experience when using the Onera STS.

Methods

Forty-two patients were enrolled in Germany as part of an ongoing validation study. Participants were asked to fill in two questionnaires. The first, administed before the Onera STS sleep study, asked open-ended questions on their first impression of the device. The second, administered after the Onera STS sleep study, focused on the ease of use of the device and comfort of wearing it during the night using a 5-point Likert scale.

Results

Thirty-six patients completed the first questionnaire (85%) and 39 (93%) the second. First impression of the Onera STS was positive by 86% of patients. The size of the sensors was described as acceptable by 72%. Participants stated that the device looked more comfortable than in-lab PSG and they expected improved sleep quality and a more accurate diagnosis. After completing the PSG with the Onera STS system, 69% found wearing the four sensors comfortable, and no participant expressed strong discomfort during the sleep study. The Forehead sensor was considered the most comfortable (based on 77% stating strongly agree or agree), followed by the Abdomen sensor (74%), the Leg sensor (72%), and the Chest sensor (69%). Most participants (72%) expressed confidence in their ability to fit the sensors by themselves at home. Only one participant preferred to be supported by a technician for the application of the system.

Conclusion

The first impression of the Onera STS device were positive, and participants found it comfortable during sleep. The majority considered the application simple enough for unsupervised self-application, which can allow patients to undergo a PSG in the comfort of their own home.

Support (if any)
0558 Sleep Bruxism and Sleep Breathing Disorder
Authors: Han JinKyu
Published: May 2023

Introduction

Sleep bruxism (SB) is reported by 8-9% of the adult population and is mainly associated with rhythmic masticatory muscle activity (RMMA) characterized by repetitive jaw muscle contractions (3 bursts or more at a frequency of 1 Hz). The purpose of this study was to evaluate the relationship between the nature of sleep bruxism and the sleep breathing disoredr.

Methods

We prospectively studied 32 patients who were referred to the clinical sleep apnea laboratory for study. They underwent standard nocturnal polysomnographic examination; in addition, masticatory activity was measured with a masseter electromyogram. Patients slept in the supine and lateral decubitus positions.

Results

Nocturnal clenching was higher in patients with higher respiratory disturbance index. 28 among 32 patients were included in the criteria of obstructive sleep apnea; average respiratory disturbance index (RDI) was 12.7 280 clenches demonstrated in all patients.

Conclusion

We conclude that there is an association between sleep related breathing disorder and bruxisms that sleep position affects the incidence of both sleep disordered breathing and bruxisms, and that analysis of apneas and hypopneas and clenching events in both supine and lateral decubitus sleeping positions may be helpful.

Support (if any)
0567 Tirzepatide for the Treatment of OSA: Rationale and Design of the SURMOUNT-OSA Phase 3 Trial
Authors: Malhotra Atul , Bednarik Josef , Curtis Alexandra , Dunn Julia , Weaver Terri , Grunstein Ron , Fietze Ingo , Redline Susan , Bunck Mathijs C
Published: May 2023

Introduction

Weight reduction is a standard recommended component of OSA treatment in people with obesity or overweight; however, the challenge to achieve and maintain weight reduction has limited its clinical application outside of the benefit established after bariatric surgery. Currently no FDA-approved anti-obesity medication (AOM) has demonstrated clinically meaningful improvement in OSA severity and symptomology.

Methods

Tirzepatide is a single molecule GIP and GLP-1 receptor agonist. In SURMOUNT-1, a 72-week phase 3 clinical trial in participants with obesity or overweight, tirzepatide 15mg provided average reductions in body weight of 22.5% which occurred with beneficial effects on blood pressure, lipids, and physical functioning. In a linear meta regression model, we estimated that tirzepatide treatment would provide clinically meaningful apnea-hypopnea index decrease compared to placebo-treated participants with obesity and OSA. SURMOUNT-OSA, a placebo controlled 52-week, phase 3 trial, will investigate efficacy and safety of tirzepatide for the treatment of moderate to severe OSA (defined as AHI ≥15) in participants with obesity. SURMOUNT-OSA utilizes an umbrella master protocol and 2 Intervention-Specific Appendices (ISAs): ISA 1 includes participants with no current OSA treatment and ISA 2 includes participants using positive airway pressure therapy. Approximately 412 participants will be randomly assigned to placebo or tirzepatide across the entire master protocol, with approximately 206 participants in each ISA. While participants will receive tirzepatide or placebo based on a 1:1 randomization ratio, all participants will receive background lifestyle intervention for weight reduction.

Results

The primary endpoint for the individual ISAs is the difference in AHI response measured by polysomnography between tirzepatide and placebo arms at week 52. Secondary endpoints include hypoxic burden, functional outcomes and cardiometabolic biomarkers. The trial is utilizing a unique hierarchical functional outcomes endpoint based on Functional Outcomes of Sleep Questionnaire methodology. The trial employs wearables, such as home sleep testing and accelerometry to capture time to improvement as exploratory outcomes.

Conclusion

SURMOUNT-OSA aims to explore whether tirzepatide provides clinically meaningful improvement in obesity-related OSA by targeting an underlying etiology.

Support (if any)

Eli Lilly
0580 Patient Experiences With Sodium Oxybate Therapy for Narcolepsy: A Social Listening Analysis
Authors: Horsnell Matthew , Zhang Enming , Cook Rachelle , Dougherty Lauren , Shenk Allison Foley , Ascencion Frederik , Morse Anne , Ortiz Luis , Li Wei , Wassman E Robert , DeFelice Christopher , Picone Maria
Published: May 2023

Introduction

Narcolepsy is a disorder of hypersomnolence with intermittent periods of sleep, hallucinations, and sleep paralysis. Social listening (SL) analyzes real-world data on social media to provide information on disease symptoms and impacts to inform clinicians about a community’s unmet needs. This research used SL with a proprietary artificial intelligence (AI) engine, which leverages natural language processing (NLP) to understand experiences of people living with narcolepsy treated with sodium oxybate (SO), a twice-nightly medication.

Methods

Using the proprietary AI engine to analyze text-based conversations, we evaluated 25,018 posts/comments from 15,280 participants which occurred from August 2011 to October 2022 from the subreddit r/Narcolepsy and a private Facebook group. Using a clinical entity recognition tagger, leveraging medicine ontology, conversations were filtered by mentions of (1) second dosage (e.g., second dose, 2nd) and (2) sodium oxybate (e.g., Xyrem, SO) to build a co-occurrence network for conversations discussing second doses of SO. Surveys and interviews were used to document patient SO experiences (Facebook, Discord channels, other networked contacts).

Results

Of 4275 subreddit users who mentioned SO, 398 (9.3%) communicated challenges with taking a second SO dose. The co-occurrence network revealed that second SO dose was co-mentioned with physical (e.g., nausea, headache) and mental (e.g., anxiety, depression, eating disorder) conditions. Of survey participants (N = 87 completed: patients, n = 85; caregivers, n = 2), 75% reported missing the second SO dose; effects included poor sleep quality, increased daytime sleepiness, mental health issues (especially depression), muscle spasms, work/school absences, and brain fog. Injuries resulting from waking to take the second dose (e.g., falls, stitches, concussions) were reported by 32%. Taking the second dose late (>4 hours after) was reported by 59% of patients. Effects of late dosing included grogginess, headache, and oversleeping, leading to school/work tardiness and missed responsibilities. When asked if a once-at-bedtime, premeasured SO dose would be safer, 76% of respondents agreed/strongly agreed.

Conclusion

The second nightly SO dose is associated with sleep-related issues for people with narcolepsy and their caregivers. Both the SL analysis and survey revealed that a missed/delayed second dose of SO decreased daily functioning, quality of life, and physical health.

Support (if any)

Avadel Pharmaceuticals.
0581 Patient Preferences and Nocturnal Experiences With Oxybate Therapy for Narcolepsy: RESTORE Study Interim Analysis
Authors: Roy Asim , Harsh John , Ajayi Akinyemi , Stern Thomas , Dubow Jordan , Gudeman Jennifer
Published: May 2023

Introduction

Sodium oxybate (SXB) is a standard-of-care treatment for adults with narcolepsy. Existing oxybate formulations are immediate release (IR), requiring patients to awaken for a second dose 2.5–4 hours after the first bedtime dose. Once-nightly SXB (ON-SXB; FT218), an investigational extended-release formulation, replaces this middle-of-the-night dosing with a once-at-bedtime regimen. RESTORE (NCT04451668) is an open-label/switch study evaluating the safety/tolerability of ON-SXB and patient preferences for ON-SXB or IR oxybate.

Methods

RESTORE includes participants aged ≥16 years with narcolepsy type 1 or 2 who completed the phase 3 REST-ON trial, were on stable-dose (≥1 month) IR oxybate, or were oxybate-naive. Initial doses for participants switching from IR oxybate are equivalent/closest to the previous total dose/night; incremental adjustments (1.5 g/week; maximum, 9 g/night) are allowed. A nocturnal adverse event (AE) questionnaire about switch participants’ IR oxybate experience in the previous 3 months was completed at baseline. Switch participants completed the preference questionnaire after 3 months of ON-SXB treatment.

Results

Data available from preference questionnaires (n=78) and nocturnal AE questionnaires (n=130) were analyzed at the interim data cutoff (01 July 2022). Most common AEs thus far were nausea, headache, and somnolence. The once-nightly dosing regimen was preferred by 93.6% (73/78) of participants. The second nightly IR oxybate dose was unintentionally missed in the previous 3 months by 65.4% (85/130) of switch participants; 80.2% (73/91) who intentionally and/or unintentionally missed the second dose felt worse the next day. Participants who took their second nightly IR oxybate dose >4 h after the first dose (51/130 [39.2%]) reported being somewhat, quite a bit, or extremely groggy/unsteady the next morning (26/51 [51.0%]). Inconvenience of the second dose was reported by 70.8%. Other issues related to the second dose were anxiety (29.2%) and the need to be woken by someone else (23.1%). In the past 3 months, 118 participants (90.8%) arose from bed after waking to take the second dose; 9 of these participants reported having fallen, with 5 reporting injuries.

Conclusion

These interim RESTORE data demonstrate patient preference for once-at-bedtime dosing of ON-SXB and indicate treatment burden associated with twice-nightly IR oxybate.

Support (if any)

Avadel Pharmaceuticals
0615 Racial/Ethnic and Sex Differences in Circadian Rest-Activity Rhythm Patterns: Findings from a Sample of the US Population
Authors: Narcisse Marie-Rachelle , Refinetti Roberto , Seixas Azizi , Moise Rhoda , Locklear Clarence , Moore Jesse , Turner Arlener D , Rogers April , Jean-Louis Girardin
Published: May 2023

Introduction

Circadian disruptions are associated with increased risk for morbidity and mortality. However, it is unclear whether these associations vary by race/ethnicity. We aim to explore, 1) Examine whether rest-activity rhythm (RAR) patterns vary across race/ethnicity among a representative sample of the US adult population, and 2) Examine the interaction of race/ethnicity and sex in RAR patterns.

Methods

The study was based on the National Health and Nutrition Examination Survey (2013–2014) with data from participants who wore a physical activity monitor (PAM ActiGraph accelerometer model GT3X+) continuously for seven consecutive days. After excluding pregnant participants and those with sleep minutes < 120 and >1200, the analytic sample included was 4,722 adults. The cosinor method was used based on PAM minutes time-series data to RAR outcome variables: mesor, amplitude, acrophase. and robustness. The main predictor of interest was race/ethnicity (Asian, Black, Hispanic, multi/other, and White). A sex-race/ethnicity interaction was tested to assess if racial/ethnic differences in RAR patterns differ between males and females. Other covariates included were age, marital status education federal poverty level, and employment status. Eight adjusted Generalized linear models (GLM) : four with race/ethnicity as the main predictors and four multiplicative interaction models with the product term of race/ethnicity and sex. An adjusted Wald test was used to test for interaction.

Results

Compared with White adults, Hispanic adults had increased mesor levels (ß=0.10; 95% CI:0.07;0.13), increased RAR amplitude (ß=0.10; 95% CI:0.06;0.13), and increased robustness (ß=0.07; 95% CI:0.03;0.11) whereas Black adults had decreased amplitude (ß=-0.11; 95% CI:-0.16;-0.07) and decreased robustness ( (ß= -0.14; 95% CI:-0.20; -0.09) compared to White adults. Similarly, Asians had decreased amplitude (ß=-0.06; 95% CI:-0.10;-0.01) and decreased robustness (ß=-0.11; 95% CI:-0.16; -0.06). A significant sex-race/ethnicity interaction was found for amplitude F(4,12)=3.94;p=0.029 and robustness (4,12)=6.02;p< 0.001.

Conclusion

RAR is associated with race/ethnicity, and this association varies by sex. Notably, Hispanic adults had increased mesor, amplitude, and robustness compared to Whites. Conversely, Black and Asian populations shared decreased amplitude and robustness compared to Whites. Future studies may consider further investigation of circadian health by race/ethnicity and sex for community intervention.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
0618 Are we failing our night shift workers?: A look into the unmet needs of our night shift work force
Authors: Spector Tori , Neuenschwander Eva , Kalmbach David , Sagong Chaewon , Drake Christopher , Cheng Philip
Published: May 2023

Introduction

Many night shift workers experience poor health and safety concerns associated with circadian misalignment, which is driven by an inverted sleep-wake schedule. This work schedule leads to symptoms of excessive sleepiness and insomnia which have devastating consequences, including job dissatisfaction and social impairments. Past research has focused on circadian misalignment as the predominantly cause of shift work disorder; however, circadian misalignment is only one factor in the ecology of night shift work. A more inclusive model would consider other socioecological factors that may also influence the feasibility and effectives of interventions. This study utilized a patient-centered framework to probe the impacts of night shift work beyond symptoms of shift work disorder.

Methods

Five focus groups comprising of 20 individuals with shift work disorder (ICSD-3 diagnostic criteria) were conducted. Participants were asked about their job satisfaction levels, employee support, and problems associated with shift work. Thematic analysis was done, and sample quotes were pulled to indicate levels of support and other barriers associated with shift work.

Results

Analysis revealed four main themes regarding non-sleep related impairments of night shift work: isolation, poor health, cognitive and mood disorders, and altered sense of self. Participants reported greater instances of loneliness, weight fluctuations, short tempers, alterations in self-image, and other unfavorable effects from working nights. A significant number of participants additionally indicated very little to no support or education from employers regarding their night shift work.

Conclusion

The combined results of the focus groups highlight the unmet needs of night shift workers. These data indicate that night shift workers are an under-served and under-resourced sector of our workforce, and that circadian interventions for shift workers should measure impact on quality of life beyond sleep and sleepiness. Given their critical roles in sustaining 24-7 access to essential services, it is imperative that we develop evidence-based interventions for night shift workers.

Support (if any)

Support for this study was provided from the National Institute of Health (R41HL163783) and the American Academy of Sleep Medicine Foundation (245-SR-21) awarded to Dr. Philip Cheng.
0620 Dim Light Melatonin Onset Analysis in Individuals Diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD)
Authors: Brzezynski Jennifer , Johnson Caroline , Goldberg Abigail , Miller Cameron , Kaden Alyssa , Smieszek Sandra , Polymeropoulos Christos , Birznieks Gunther , Polymeropoulos Mihael
Published: May 2023

Introduction

We are conducting a double-blind, randomized, clinical study in Delayed Sleep-Wake Phase Disorder (DSWPD) participants with extensive clinical phenotyping. We evaluated screening Dim Light Melatonin Onset (DLMO) assessments in participants with a DSWPD diagnosis to determine the proportion of participants with and without a circadian delay.

Methods

Delayed DLMO is DLMO occurring after or within 30 minutes before desired bedtime, and after 21:30. Each DLMO assessment consisted of eight saliva collections performed at five, four, three, two, and one hour before bedtime, at planned bedtime, and one and three hours after bedtime. Salivary DLMO assessments were distributed to participants at Visit 1 (screening) and Visit 3 (treatment) with a questionnaire to record planned and actual collection times. Participants were instructed to wear blue-light blocking glasses during the assessment period. The Morningness-Eveningness Questionnaire (MEQ) was also completed by participants at V1 to evaluate circadian and sleep rhythm patterns. DLMO was calculated for each phase assessment and defined as the clock time when the melatonin concentration exceeded the mean of three low consecutive values, plus twice the standard deviation of these points.

Results

Thirty-four participants with DSWPD completed the screening DLMO assessment, 33 of which had a delayed DLMO (97.06%). Sub-analyses were conducted on participants with DSWPD who had delayed DLMO (n = 33). Within this subset, the average DLMO time was 23:52 (SD = 1:58) and the average MEQ score was 34.27 (SD = 10.39). Of these 33 participants, 14 had a DLMO time after 00:00 (42.42%).

Conclusion

These initial data indicate that, on average, participants with DSWPD that completed the screening DLMO assessment had delayed DLMO. Further analyses show that almost half of this subset had a significantly delayed DLMO (00:00 or later). This study is currently ongoing and blinded. Further data will be analyzed as more participants enroll. ‘Phase typing’ will be important in further understanding the underlying pathophysiology and in the treatment selection for patients with DSWPD.

Support (if any)

This work was supported by Vanda Pharmaceuticals Inc.
0622 Clustering bipolar disorder risk variants by their effect on sleep and circadian traits
Authors: Kunorozva Lovemore , Smith Kirk , Maher Matthew , Udler Miriam S , Lane Jacqueline
Published: May 2023

Introduction

Bipolar disorder (BD) is a mood disorder that causes noticeable, sometimes extreme, changes in mood and behaviour. BD affects nearly 50 million individuals worldwide including 2-4% of the US population. Previous studies have reported sleep and circadian disturbances in patients with BD. Genetic studies have identified 63 risk variants for bipolar disorder (BD).

Methods

To enable new insights into BD disease causing pathways, we clustered BD risk variants by their effect on sleep and circadian rhythm traits. A Bayesian soft-clustering approach was used to determine if BD variants cluster according to effect on eight subjectively and two objectively measured sleep and circadian traits (using sleep and circadian trait GWAS from the UK Biobank in European ancestry, n = 453,000).

Results

We found evidence of genetic correlation between BD and sleep/circadian traits (p< 0.05). Bipolar risk variants cluster into two clusters based on their association with sleep and circadian traits. The two clusters are: Cluster 1: late chronotype, shorter time in bed (by actigraphy), difficulty waking up, longer sleep duration (self-report), longer periods of daytime sleepiness, longer and frequent naps and increasing insomnia and Cluster 2: early chronotype, longer time in bed (by actigraphy), longer sleep duration (self-report) and less insomnia. In general, cluster 1 appears to be contributing to sleep insufficiency, while cluster 2 appears to be contributing to hypersomnia or more “typical” sleep.

Conclusion

In conclusion, sleep and circadian trait clusters indicate bipolar genetic risk may function through two distinct mechanisms. Some genetic risk variants appear to be related to sleep insufficiency, while others are related to hypersomnia, suggesting that it may be possible to genetically subtype BD. This finding may allow classification of BD-patients by distinct genetic pathways linking to their sleep-circadian disturbances, potentially offering a way forward toward genetically informed diagnosis, surveillance and management of BD-patients.

Support (if any)

N/A
0649 Sex Differences in the Effects of TMS on Depression
Authors: Desai Shivani , Hildebrand Lindsey , Reich-Fuhrer Melissa , Grandner Michael , Killgore William
Published: May 2023

Introduction

As part of a larger study to examine the effects of repetitive transcranial magnetic stimulation (rTMS) over a single node of the default mode network (DMN) on sleep quality, we also examined secondary effects on depression. We hypothesized that rTMS would be more effective in females, rather than males, due to previously established higher rates of depression in the female population.

Methods

We administered continuous theta burst stimulation (cTBS) rTMS or sham stimulation, in a counterbalanced order separated by at least 5 days, over the left inferior parietal node of the DMN in 20 participants with clinical insomnia, 8 males (Mage=31.6, SD=6.7) and 12 females (Mage=23.8, SD=4.3). Beck Depression Inventory (BDI) scores obtained immediately before and after the stimulation sessions were compared using mixed (condition x time x sex) ANOVA to determine the effectiveness of rTMS in reducing symptoms of depression between the sexes.

Results

Overall, there was a large effect size (ηp2=0.207, p=0.077) in BDI scores between scores after the sham cTBS TMS session (M=12.47, SD=2.54) and scores after the active cTBS TMS session (M=10.00, SD=2.01). However, when separating for sex, males did not show a statistically significant reduction in depressive symptoms for the active session compared to the sham session (ηp2=0.08, F(1,6)=19.00, p=0.508). While the treatment did not significantly change depressive symptoms in females, large effect size was observed (ηp2=0.261, F(1,7)=18.06, p=0.16), suggesting potential efficacy of the treatment. Post-hoc pairwise comparisons reveal a greater change in depression symptom scores for active vs sham cTBS TMS in women (M=-4.00, SD=2.00), than men (M=-0.71, SD=1.43).

Conclusion

An intervention using cTBS rTMS to improve sleep also led to a trend toward reduced depression, that was more evident among women. As reported elsewhere, this treatment significantly improved polysomnographic sleep, and the present preliminary results suggest that it may also be useful for modestly improving depressive mood, but further research will be necessary due to the limited sample size. It is not clear whether the trends toward mood among women was due simply to higher baseline depression scores in that group, but the findings suggest that additional work is warranted.

Support (if any)

W81XWH2010173
0652 Subjective and objective sleep disturbances in individuals with psychotic disorders and their first-degree relatives
Authors: Arpaci Hazal , Spitzer Courtney , Raymond Nicolas , Talbot Christine , Kohnke Erin , Stickgold Robert , Manoach Dara , Keshavan Matcheri , Baran Bengi
Published: May 2023

Introduction

Sleep disturbances commonly precede or precipitate psychotic disorders. The primary goals of the present study are to compare self-reports of sleep quality and chronotype with objective measurements and to investigate their relations with clinical symptoms and psychotic-like experiences (PLEs) in early course, minimally treated patients with psychotic disorders (PSY), their young, first-degree relatives (familial high risk: FHR) and matched controls.

Methods

Seventy-three participants (13-35 yrs, n(PSY)=19, n(Controls)=30, n(FHR)=24) completed self-report measures of sleep quality (PSQI), chronotype (MEQ) and PLEs (Chapman Scales). Sleep quality and chronotype were objectively measured with actigraphy (average duration of measurements: 12 days). Psychosis and FHR groups were rated on the Positive and Negative Syndrome Scale (PANSS) by an expert clinician.

Results

PSQI was significantly different between the groups (F(2,67)= 11.8, p< .001), this reflected that compared to controls, both the psychosis (p<.001) and FHR (p=002) groups had worse self-reported sleep quality. For objective sleep quality, we observed a main effect of day-to-day variability in total sleep time (F(2,46)= 3.24, p=.048) , with significantly higher variability in PSY than controls (p= .038). Symptom severity in PSY and FHR correlated with PSQI (r=.31, p=.047), reflecting that those with higher psychotic symptoms had more sleep disturbances. PLEs in the entire sample also correlated with PSQI (r=.41, p<.001). We did not observe any correlations between objective sleep quality and symptoms. There were no group differences in chronotype (subjective or objective). Chronotype did not correlate with symptoms or PLEs.

Conclusion

While both early-course patients and their first-degree relatives report significant sleep disturbances, objective measurements corroborate this only for day-to-day variability in sleep duration in the patient group. Further, symptom severity and PLEs correlate only with subjective sleep disturbances. These findings highlight the importance of objective assessment of sleep quality in this population and are in line with our polysomnography work that reveals an isolated deficit in NREM sleep in the context of similar sleep duration and architecture in psychosis.

Support (if any)

K01 MH114012 (Baran)
0700 Parasomnia-related homicides: A systematic review and a critical analysis of the medical literature
Authors: Castelnovo Anna , Schraemli Matthias , Schenck Carlos , Manconi Mauro
Published: May 2023

Introduction

Cases of homicide allegedly committed during sleep have been described since ancient history. The strongest link between violence and sleep disorders is represented by the so-called parasomnias, a group of sleep disorders characterized by episodic undesirable behaviors and/or mental experiences that arise during sleep.

Methods

We conducted a systematic search according to the PRISMA guidelines with 4 different search engines (Pubmed, Scopus, Embase and Cochrane) with the aim of gathering and critically evaluating all described cases of homicides associated with parasomnias

Results

We identified over 30 cases of homicide allegedly committed during a parasomnia episode. The diagnosis was of NREM sleep parasomnia for all cases except one, which received a diagnosis of REM-sleep behavior disorder (RBD). Victims were more often female family members, killed by firearms or sharp objects, usually nearby the bed. Aggressors often reported delusional/hallucinatory mental experiences associated with their episodes and rarely made any effort to cover up the crime. In the majority of the cases, no objective sleep data were available. Only a minority of patients had a positive childhood or family history. The court judgement was not uniform across cases.

Conclusion

Although rarely, homicides could be committed during parasomnias episodes. Despite being more frequently associated with violent behaviors, RBD less likely led to fatal aggressions. According to the observed behaviors, subjective reports and current neurophysiological knowledge, patients are only partially conscious and largely disconnected from the external environment, and could not be considered guilty for their actions.

Support (if any)

None
0712 Improved Circadian Rest-Activity Patterns after Treatment with PAP therapy in the Patient with Idiopathic RBD and Comorbid OSA
Authors: Shin Jung-won , Park Kyoungeun , Jung Ki-Young
Published: May 2023

Introduction

Several studies suggest that sleep and circadian rhythm disruptions, and physical activity changes may serve as risk factors for the occurrence of Parkinson’s disease and its prodromal features. Obstructive sleep apnea (OSA) is commonly found in patients with RBD. The comorbid OSA is associated with non-motor symptoms, including daytime sleepiness, cogntive decline and autonomic nervous system dysfunction. Therefore, we investigated whether circadian rest-activity patterns and RBD-related symptoms will be improved after positive airway pressure (PAP) therapy in patients who had iRBD with comorbid OSA.

Methods

Seven patients were diagnosed as iRBD with OSA (AHI ≥ 10) confirmed by video-polysomnography. The patients wore actigraphy devices for 14 consecutive days befor and after PAP therapy for 3 months. The mean motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphic data. Non-parametric circadian rhythm activity including inter-daily stability(IS), intra-daily variability, least 5 average, most 10 average and relative amplitude were anlayzed. In addition, we obtainted the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I).

Results

Four of 7 patients had good compliance of PAP usage (average usage > 4hr during sleep), and three patients had poor compliance of PAP usage. In good compliance group, score of RBD-3M decreased ( p=0.029) and value of IS were increased (p=0.029 ) significantly. Also, 3 of 4 patients answered “Very much improved or much improved” in a questionnaire of CGI. In poor comliance group, there was no any significant change in all values. In addition, only one patient answered “ much imrpoved” and two patients answered “minimally improved” in CGI.

Conclusion

The PAP treatment of OSA in iRBD can be role as a lifestyle modifier that improves circadian rest-activity patterns and, it may be of value as a disease-modifying effect of behavioral or lifestyle changes that have been reported to be associated with decreased risk of neurodegenerative disorder. We will continue enroll the data and will investigate not only improvement of circadian rhythm, but also decreasing of motor activities during sleep after PAP therapy.

Support (if any)
0734 Gender Differences in US Military Personnel with Insomnia, Obstructive Sleep Apnea & Comorbid Insomnia and Obstructive Sleep Apnea
Authors: Mysliwiec Vincent , Brock Matthew , Matsangas Panagiotis , Pruiksma Kristi , Powell Tyler , Hansen Shana , Martin Jennifer , Taylor Daniel , Foster Shannon , Mithani Sara , Straud Casey , Young-McCaughan Stacey , Zwetzig Sarah , Peterson Alan
Published: May 2023

Introduction

Women constitute approximately 17% of the military. Yet, relatively little is known regarding sleep disorders and comorbid diagnoses effecting this gender. The aim of this study was to determine if there were gender-related differences in symptoms of sleep disorders and sleep-related impairment, comorbid sleep, behavioral medicine, and traumatic brain injury (TBI) diagnoses and polysomnographic (PSG) variables in military personnel with insomnia, OSA, and comorbid insomnia and OSA (COMISA).

Methods

Participants were 372 military personnel (46.2% females, 53.8% males) with an average age of 37.7±7.46 years and median BMI of 28.4 (5.50) kg/m2. Based on clinical evaluation and video-PSG, participants were diagnosed with insomnia (n = 118, 71.2% female), OSA (n = 118, 28.8% female) and COMISA (n = 136, 39.7% female). Insomnia severity, excessive daytime sleepiness, sleep quality, nightmare disorder, sleep impairment, fatigue, posttraumatic stress disorder (PTSD), anxiety, depression symptoms, and traumatic brain injury (TBI) were evaluated with validated questionnaires. Descriptive statistics, parametric and non-parametric pairwise comparisons and effect-size analyses were used to assess differences between sexes in terms of variables of interest.

Results

Female service members had significantly greater symptoms of nightmare disorder, PTSD, anxiety, and depression than their male counterparts. There were no significant differences between males and females with insomnia or OSA in sleep-related symptoms, impairment, or PSG based apnea-hypopnea index (AHI). Male service members with COMISA had a significantly greater AHI; females with COMISA had significantly greater symptoms of nightmare disorder, PTSD and anxiety.

Conclusion

In the largest study to date to clinically evaluate sleep disorders in military personnel, COMISA was the most frequent diagnosis. Surprisingly, there were minimal differences in self-reported symptoms of sleep disorders and PSG characteristics. However, male servicemembers with COMISA have more severe sleep disordered breathing while female servicemembers with COMISA have greater mental health morbidity. Military service may result in distinct sleep disorder phenotype(s).

Support (if any)

This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).
0753 Mothers’ sleep and executive function: Downstream implications for parenting and toddlers’ executive function
Authors: McQuillan Maureen , Empson Kayla , Staples Angela , Deater-Deckard Kirby , Bates John
Published: May 2023

Introduction

Mothers’ sleep is positively associated with positive parenting (e.g., responsiveness) — what has not been established is how mothers’ executive function (EF) could mediate this association, and how, in turn, mothers’ parenting could influence the development of their toddlers’ EF.

Methods

Mothers and toddlers (N = 351) were followed at child ages 30, 36, and 42 months. Mothers were M = 32.70 years old (SD = 5.03); 49% of toddlers were male. The sample was largely middle class and 90% White. Fifteen percent of mothers were single. Thirty-one percent of mothers did not work outside the home, and 28% worked full time. Mothers’ sleep was measured via actigraphy. Mothers’ positive parenting was measured both in the home and the lab. At home, the toddlers’ bedtime routine was observed and rated for mothers’ responsiveness and involvement. In the lab, mothers’ positive affect during free play with their toddler was coded (with independent, inter-rater reliability of ICC = .80). The lab measure was correlated with the home visit measure (r = .22, p < 0.01). Mothers’ EF was measured via self-report on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF), which assesses everyday metacognition, behavior regulation, and emotion regulation. The average, where higher scores reflect worse EF, was used. Toddlers’ EF was measured by coders’ ratings of toddlers’ ability to sustain focused attention during independent free play in the lab visit (ICC = .83).

Results

Cross-sectionally, mothers’ sleep was associated with their EF (B = .12, p<.05). In a structural equation model across time, mothers’ actigraphic sleep that was shorter, later, and more variable predicted worse EF (B = 0.07), which in turn predicted less positive parenting (B = - 0.08), at levels trending towards significance. Mothers’ positive parenting was associated with toddlers’ observed sustained, focused attention, both within (r = .13, p < 0.05) and across time (r = .13, p < 0.05).

Conclusion

These findings suggest that a mother’s sleep can affect her EF and parenting, which can then support toddlers’ sustained attention development, an important aspect of executive function.

Support (if any)

Grants MH099437 from NIMH and HD073202 from NICHD
0776 Effects of Perceived Discrimination on Sleep and Internalizing and Externalizing Behaviors in Hispanic/Latinx Adolescents
Authors: Durley Ingrid , Arra Nicole , Kiss Orsolya , Harkness Anya , Camacho Leticia , Baker Fiona C
Published: May 2023

Introduction

Racism negatively affects children’s health, behavior, and relationships. Current literature focuses on associations between perceived discrimination and daytime behaviors in children and adolescents, with less known about associations with sleep behavior, an essential aspect on health during development. Racial/ethnic minorities, including Hispanic/Latinx youth, are at increased risk of sleep problems, along with mental health issues. Here, we examined the relationship between perceived discrimination and sleep and behavioral problems, and the potential role of familial cultural heritage connectedness as a mediator, in Hispanic/Latinx adolescents in the Adolescent Brain Cognitive Development (ABCD) Study®.

Methods

Data were analyzed from 1,213 Hispanic/Latinx adolescents (Mean age =11.89 years, range: 10-14 years, 48.22% female), collected as part of the ongoing ABCD Study® from the 2nd year follow up. Sleep was assessed with a question about having trouble falling or staying asleep in the past two weeks from the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) (youth-report). Participants completed the Perceived Discrimination scale, an 11-item self-report about racial/ethnic perceived discrimination in the past year from teachers, peers, and other adults. Cultural heritage connectedness was gathered from the Vancouver Index of Acculturation (caregiver-report). Internalizing and externalizing behaviors were assessed using the Child Behavior Checklist (caregiver-report). Regression models examined associations between perceived discrimination and sleep behavior and externalizing/internalizing behavior, considering age, socio-demographic characteristics, parental education, and familial immigration status.

Results

Perceived discrimination correlated with more sleep problems (p< 0.01), with a stronger effect in female than male participants (p< 0.01). Perceived discrimination was also associated with internalizing and externalizing behaviors (p< 0.01). Connectedness to cultural heritage partially mediated the association between perceived discrimination and externalizing behaviors (p< 0.01), but not with sleep problems or internalizing behaviors.

Conclusion

Results show perceived discrimination is associated with sleep problems in Hispanic/Latinx adolescents, with a stronger relationship in female participants. Future investigation of links between perceived discrimination and health outcomes, including sleep and behaviors, is needed using longitudinal data and youth self-reports of the Vancouver Index of Acculturation, rather than caregiver reports to further investigate the potential role of cultural connectedness is these relationships.

Support (if any)

NIH U01DA041022
0803 Sleep Patterns in Patients with Congenital Central Hypoventilation Syndrome and Their Parents
Authors: Shah Amit , Leu Roberta , Harford Kelli-Lee , Harris Ryan , Kasi Ajay
Published: May 2023

Introduction

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disease affecting control of breathing necessitating lifelong assisted ventilation (AV) via noninvasive positive pressure ventilation (NPPV), diaphragm pacing (DP), or positive pressure ventilation via tracheostomy (PPV-T). Owing to abnormal ventilatory responses, patients require monitoring during sleep by a caregiver. The aims of this study were to assess sleep patterns in the patient-parent dyads using actigraphy and sleep diary.

Methods

Patients with CCHS and their parents completed the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), Epworth Sleepiness Scale (ESS), sleep diaries, and used wrist actigraphy for 7 days. The analyzed data included AV modality, ESS, ESS-CHAD scores, and actigraphy outcomes— sleep latency (SL), sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), and wake frequency.

Results

The median (IQR) ages of the 11 patient-parent dyads who completed the study were 11(8-13.5) and 41(39-47.5) years, respectively. AV modalities were NPPV (n=3), DP (n=2), and PPV-T (n=6). The median (IQR) ESS-CHAD and ESS scores for the patient and parents were 8(2-9) and 6(3.5-7), respectively indicating higher normal daytime sleepiness. In patients with CCHS, actigraphy showed median (IQR) SL of 14.6(10.1-19.6) minutes, decreased SE of 78.5% (72.5%-84%), decreased TST of 7.2(6.6-8.1) hours, elevated WASO of 1.7(1.1-2.3) hours, and frequent awakenings of 22.2(18.4-23.6) per night. In the parents, actigraphy showed median (IQR) SL of 7(3.6-10.9) minutes, normal SE of 81.6% (80%-86%), decreased TST of 6.7(6-6.8) hours, elevated WASO 1.1(1-1.3) hours, and frequent awakenings of 19.3(15.4-22.4) per night. Two separate patients and parents slept < 6 hours per day. Among 2 patients with nighttime home nursing, the parents had SE >85%, TST ≥7.3 hours, and reported better sleep quality.

Conclusion

Patients with CCHS and their parents are at risk for sleep disturbances. Specifically, patients with CCHS had decreased median TST and SE, and parents had decreased median TST. Both patients and parents had frequent night wakings indicating sleep disruptions. Nighttime home nursing may improve parental sleep. Apart from vigilant management of AV in patients with CCHS, clinicians should also evaluate sleep quality in patients with CCHS and their parents.

Support (if any)