bluuebunny/crossref_metadata_2025 huggingface dataset:
0582 Effects of non-melanoma skin cancer on sleep and quality of life among renal transplant recipients
Authors: Xerfan Ellen , Leandro Gabriela , Pires Gabriel , Andersen Monica , Tufik Sergio , Facina Anamaria , Tomimori Jane
Published: May 2022

Introduction

Non-melanoma skin cancer (NMSC) is highly prevalent in renal transplant recipients (RTR), due to the immunosuppressive effects of anti-rejection therapy after transplantation. Sleep disturbances can impair the immune system and enhance the repercussions of oxidative stress, which may play an important role in the carcinogenesis pathways. This survey aimed to compare data on quality of life and sleep in RTR with and without NMSC in a dermatology service.

Methods

The study comprised 126 individuals, distributed in the following groups: RTR with NMSC (n=42), RTR without NMSC (n=43) and healthy controls (n=41). Participants answered a set of questionnaires, including the WHOQOL-bref, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Berlin Respiratory Disorder questionnaire (BRD).

Results

The proportion of men were significantly higher among RTR (p=0.034). No statistically significant differences were observed regarding age, body mass index (BMI) and socioeconomic class. Transplantation living donors were statistically more frequent among RTR with NMSC (67% against 37% in the RTR without NMSC group; p=0.005). Among patients of the RTR with NMSC group, 9% had only basal cell carcinoma, 42% had only squamous cell carcinoma and 49% had both types of NMSC. There were no statistically significant differences on the final scores of the sleep questionnaires, except in 3 domains of the PSQI: sleep quality (p<0.001), sleep latency (p=0.01) and daytime dysfunction (p=0.02). Worse sleep quality was seen in the RTR with NMSC and controls, while worse sleep latency and more daytime consequences were found in both RTR clusters. All groups were predominantly composed of subjects with morning-type chronotype, low sleep quality and increased daytime sleepiness. In the WHOQOL, the physical domain was significantly impaired in the RTR groups (p<0.001).

Conclusion

Although all groups were mainly composed of individuals with excessive daytime sleepiness and low sleep quality, there were no differences regarding quality of life and sleep between RTR and controls. Further long-term examination of kidney transplant recipients and their sleep pattern are warranted, as poor sleep may have a link with immunosuppression and organism imbalance, as well as on quality of life of these individuals.

Support (If Any)

AFIP, CAPES, CNPq, and FAPESP.
0583 Tolerance and feasibility of daytime bright light in medical intensive care unit patients
Authors: Intihar Taylor , Samojedny Veronica , Korwin Amy , Knauert Melissa
Published: May 2022

Introduction

Sleep and circadian disruption in critical illness are associated with poor outcomes. Normal circadian entrainment requires bright light exposure during the day and dim or no light during the night. Disruption of this diurnal light pattern can cause circadian abnormalities. To leverage this highly influential circadian entrainment cue, our study investigates the tolerance and feasibility of a daytime bright light (DBL) intervention in the medical ICU (MICU). We hypothesize that DBL is tolerable and has high fidelity and sustainability (i.e., feasibility).

Methods

Here we present the findings of a pilot randomized control trial of DBL in MICU patients. Patients were randomized to receive light for either 4 hours, 8 hours, or no light (usual care). For DBL groups, the light was turned on at 09:00 daily for 4 consecutive days. Metrics of tolerability (percentage of days patient agreed to light), fidelity (percentage of intended hours light was delivered), and sustainability (percentage of days light delivered out of days patients allowed light) were collected.

Results

Sixteen patients were enrolled; 5 were assigned to 8 hours of DBL, 9 were assigned to 4 hours of DBL, and 2 were assigned to usual care. Mean (standard deviation) patient age was 73 (10) and mean severity of illness, as determined by Acute Physiology and Chronic Health Evaluation II score, was 21(5). Patients who received 4 hours of DBL averaged 69% tolerability, 55% fidelity, and 94% sustainability. Patients who received 8 hours of DBL averaged 70% tolerability, 57% fidelity, and 90% sustainability. Further analysis of light delivery data showed that the 8-hour group was subject to a higher number of requests to delay light start or end light early and more care related breaks versus the 4-hour group.

Conclusion

Our study demonstrates the feasibility of a DBL intervention for MICU patients. While fidelity was lower than expected, the findings support that DBL is tolerable and sustainable in critically-ill patients. These findings have influenced the design of our ongoing randomized control trial further evaluating the impact of daytime bright light on circadian phase in critical illness.

Support (If Any)

This work was supported by the NHLBI (K23 HL138229), the Academy of Sleep Medicine Foundation, and the Fund to Retain Clinical Scientists at Yale sponsored by the Doris Duke Charitable Foundation award #2015216 and the Yale Center for Clinical Investigation.
0588 Relationship Between Congestive Heart Failure and Poor Sleep Quality in the US Population
Authors: Blethen Caroline , Mason Brooke , Wills Chloe , Killgore William , Grandner Michael
Published: May 2022

Introduction

Few recent, population-level datasets have explored the relationship between congestive heart failure (CHF) and sleep difficulties.

Methods

The 2017 - March 2020 data from the National Health and Nutrition Examination Survey (NHANES) were used. Sleep difficulties were self-reported as difficulties “falling asleep, staying asleep, or sleeping too much” within the previous two weeks, categorized as “never,” “less than half the days,” “more than half the days,” and “nearly every day.” Sleep duration was self-reported and categorized as normal (6.5-8.5h), short (<6.5h), and long (>8.5h). A modified STOP-BANG score was created based on NHANES measures of snoring, daytime tiredness, snorting/gasping during sleep, hypertension, body mass index, age, and gender (no measure of neck circumference). Covariates included sex, age, race/ethnicity, education, and relationship status. Analyses were unweighted, with weighted results forthcoming.

Results

Those who reported sleep difficulties more than half the days (OR: 1.78, [1.20,2.65], p=0.004) and nearly every day (OR: 2.76, [2.01,3.78], p<0.001) were more likely to also report a history of CHF, relative to those without sleep difficulties. After adjusting for covariates these relationships were maintained for those who reported sleep difficulties more than half the days (OR: 1.71, [1.14,2.58], p=0.010) and nearly every day (OR: 2.45, [1.76,3.41] p<0.001). When adding sleep duration category as a covariate (normal, short, or long sleep), those diagnosed with CHF were more likely to have sleep problems nearly every day (OR: 2.21, [1.38,3.25], p<0.001). Those diagnosed with CHF are also likely to have a high risk for OSA (OR: 1.67, [1.39,1.95], p<0.001).

Conclusion

Poor sleep quality is associated with history of CHF, independent of sleep duration. CHF is also associated with population-level sleep apnea risk. Screening for sleep disorders (insomnia and/or sleep apnea) in CHF patients may improve outcomes.

Support (If Any)
0595 Inflammatory Plasma Biomarker Cluster Associations with Sleep in People with and without HIV
Authors: Bakewell Nicholas , Mallon Patrick , Sabin Caroline , Winston Alan , Post Frank , Sachikonye Memory , Doyle Nicki , Redline Susan , Kunisaki Ken
Published: May 2022

Introduction

Sleep problems are commonly reported in people with HIV (PWH) and may be exacerbated by HIV-induced inflammation. We determined associations between systemic inflammation and objective/subjective sleep measures in PWH and demographically/lifestyle similar HIV-negative controls.

Methods

Objective sleep measures from 7-day actigraphy (e.g. mean/standard deviation (SD) of wake after sleep onset [WASO], sleep duration/efficiency), overnight oximetry (oxygen desaturation index [ODI]), and patient-reported measures (Insomnia Severity Index [ISI] and Patient-Reported Outcomes Measurement Information System [PROMIS] sleep questionnaires) were assessed in participants in the multicenter POPPY-Sleep Study in the UK and Ireland. Principal Component Analysis using 31 plasma inflammatory biomarkers followed by cluster analysis previously identified 3 distinct inflammatory clusters: 1 (low inflammation), 2 (immune activation) and 3 (systemic inflammation). Baseline characteristics and between-cluster differences in sleep outcomes were assessed using Kruskal-Wallis or logistic regression/Chi-squared tests.

Results

The 465 participants (74% PWH, median [interquartile range] age 54 [50-60] years) were mainly male (80%), men having sex with men (71%) and white (88%). Among PWH, most (98%) were on antiretroviral therapy, 92% had viral load ≤50 cps/mL and CD4 cell count was 610 [470-785] cells/mm3. Overall, 18% met ISI criteria for insomnia (ISI≥ 15), and other sleep measures suggested generally good sleep (e.g., ODI 3.1/hr [1.5-6.4]). Clusters 1 (n=209), 2 (n=47) and 3 (n=209) differed significantly for HIV status (73%, 60%, 78%, p=0.03); BMI (24.8, 25.9, 26.2 kg/m2, p=0.002); systolic blood pressure (126, 135, 126 mmHg, p=0.002); cardiovascular disease (39%, 28%, 53%, p=0.001) and arthritis (8%, 9%,16%, p=0.02) – all factors associated with sleep problems. There were no clinically relevant between-biomarker-cluster differences in the proportions with insomnia (17%, 18%, 20%) either before (p=0.76) or after (p=0.75) adjustment for potential confounders. Few associations were observed among other actigraphy, oximetry and PROMIS measures.

Conclusion

Despite observed differences in clinical factors associated with sleep problems, we found no consistent or strong associations between inflammatory biomarker clusters and a range of sleep outcomes. Although associations could exist with other sleep outcomes (e.g. sleep architecture) or biomarker types (e.g. cerebrospinal fluid) not assessed, our findings do not support a strong association between sleep and plasma inflammatory biomarkers in this population.

Support (If Any)

NIH R01HL131049
0599 Sleep duration across the lifespan in type 1 diabetes and association with cardiometabolic risk
Authors: Simon Stacey , Snell-Bergeon Janet , Schauer Irene , Nadeau Kristen
Published: May 2022

Introduction

Individuals with type 1 diabetes (T1D) are at high risk for morbidity and mortality from cardiovascular disease which begins as early as adolescence. Some studies have reported a high prevalence of insufficient sleep in this population which may be due to behavioral and physiological aspects of T1D and its management. Emerging evidence suggests a link between short sleep duration and increased cardiometabolic risk, but this has not been specifically examined across the lifespan in individuals with T1D.

Methods

Inclusion criteria were T1D duration > 9 months, HbA1c 6.5-10% for adults and ≤ 12% for adolescents, and ages 12-60 years. Participants completed home monitoring for one week with continuous glucose monitoring (CGM) and wrist actigraphy prior to a study visit with anthropometric measurements, fasting autonomic/orthostatic and laboratory testing. Peripheral arterial stiffness was measured by Dynapulse brachial artery distensibility (BAD), and insulin sensitivity was estimated by the validated CACTI equation utilizing waist circumference, fasting triglycerides, adiponectin, and diastolic blood pressure. Sleep variables, glycemic markers and health parameters were examined by age group (adolescent vs. adult) using students t-test for univariate comparisons, and linear regression models for age, sex and diabetes duration-adjusted comparisons by age group.

Results

Forty-two adolescents (mean age 16 ± 3 years, diabetes duration 7.4 ± 5 years, HbA1c 8.4 ± 1.1%) and 42 adults (mean age 41 ± 10 years, diabetes duration 21 ± 13 years, HbA1c 7.4 ± 0.9%) completed the study. Sixty-two percent of adolescents and 74% of adults obtained insufficient sleep (< 7 hours of sleep per night). When examined in linear regression adjusted for age group, sex, diabetes duration and age, insufficient sleep was associated with higher BMI (adults), BMI percentile (adolescents), waist circumference, systolic blood pressure, and lower estimated insulin sensitivity and BAD (all p < 0.05).

Conclusion

Most adolescents and adults with T1D obtained insufficient sleep. Objectively-estimated insufficient sleep was associated with worse markers of cardiometabolic risk. Further study examining the impact of sleep health interventions in this population is warranted as sleep may be an important and novel target for improving cardiometabolic health in individuals with T1D.

Support (If Any)

JDRF grant 3-SRA-2015-125-M-R
0602 Rapid Eye Movement (REM) Sleep Duration Is Inversely Related To Daytime Pruritus Severity: Preliminary Findings in Posttraumatic Stress Disorder (PTSD) Patients
Authors: Gupta Madhulika , Gupta Aditya
Published: May 2022

Introduction

Pruritus (itching) is one of the most distressing symptoms of dermatologic disease. There can be a bidirectional relationship between pruritus severity and sleep. Pruritus during sleep is most frequently encountered during stages N1 and N2 and sleep fragmentation can exacerbate pruritus. Often there are limited effective treatments available for pruritus. In this study we examined REM sleep data obtained from PTSD patients who reported somatic complaints including daytime pruritus. To our knowledge there are no studies of REM sleep and pruritus during wakefulness.

Methods

Seventy-five consenting patients with mild-to-moderate PTSD (all female; mean ±SD age 48.89 ±13.50 years) completed a battery of psychiatric and sleep ratings and underwent ≥ 1 home sleep apnea test (Watch PAT200; Itamar) which provided measures of %REM and REM duration. Exclusion criteria were use of benzodiazepines or narcotics. Pruritus was measured using Item 2 of the Pennebaker Inventory of Limbic Languidness (PILL), which assesses the frequency of common physical symptoms. For PILL Item 2 patients self-rated the frequency with which they experienced “Itchy eyes or skin” with a rating of “1” = “”never or almost never”, “2”=”less than 3 or 4 times per year”, “3”=”every month or so”, “4”=”every week or so’, and”5”=”more than once every week”.

Results

The mean±SD % REM was 21.78 ±7.64 (range 1.76% to 40.69%); and overall duration of REM sleep (mean ±SD) was 91.37±38.20 minutes (range 5.01 to 194.47 minutes). The frequency of pruritus ratings were as follows:: 39.5% endorsed a rating of “5” . The remainder self-endorsed the following frequencies: “4” (15.8%), “3” (21.1%), “2” (15.8%), and “1” (7.9%).. Pearson product moment correlation between the pruritus rating (item 2 of PILL) and REM sleep parameters were as follows: % REM (Pearson r= -0.172; p=0.144) and REM duration (Pearson r= -0.247; p=0.035).

Conclusion

Daytime pruritus was inversely related to the duration of REM sleep in a sample of PTSD patients. Pruritus can be a difficult condition to manage. Optimization of REM sleep may have a role in the management of pruritus.

Support (If Any)

None
0610 Development of a Rule-Based Text Mining Algorithm to Identify Sleep Complaints in Primary Care Progress Notes
Authors: Horner Matthew , Abul-el-rub Noor , Mays Mary , Mazzotti Diego
Published: May 2022

Introduction

Sleep complaints are among the most common reasons to seek medical attention, yet sleep disorders are largely underdiagnosed in primary care settings. The ability to process large collections of unstructured clinical notes might offer an opportunity to promote screening of patients suffering from significant sleep disorders. The goal of this study was to develop a simple rule-based algorithm to identify sleep complaints in progress notes from primary care encounters and validate the performance of the algorithm against manual chart review.

Methods

De-identified progress notes of a random sample of patients with primary care encounters at the University of Kansas Health System in 2019 were extracted from the institution’s clinical research data warehouse (Healthcare Enterprise Repository for Ontological Narration). Review of 163 notes from patients enriched for presence (N=95) or absence (N=68) of sleep disorders based on the International Classification of Disease (ICD)-10 code hierarchy G47 guided the development of a vocabulary of sleep complaints and symptoms, including corresponding negation terms. The vocabulary was used to design a rule-based, regular expression matching algorithm, which was evaluated against manual chart review of the same patient cohort (training dataset). An independent set of notes from another sample of patients with primary care encounters (N=77; testing dataset) was also manually reviewed and used to assess the validation performance of the algorithm.

Results

In the training dataset, the algorithm had a sensitivity=75%; specificity=91%, positive predictive value (PPV)=90%, and a negative predictive value (NPV)=87%. The area under the receiver operating characteristics (AUC) curve in the training set was 0.84. When the algorithm was evaluated in the testing dataset, we found a sensitivity=53%, specificity=91%, PPV=78%, and NPV=77%. The AUC in the testing dataset was 0.78.

Conclusion

A simple pattern matching algorithm designed to identify sleep complaints in primary care progress notes showed good performance in the training set and acceptable performance in the testing set. Further refinement of this algorithm with potential incorporation of natural language processing might offer a feasible approach to screen patients for underdiagnosed sleep disorders using primary care clinical notes.

Support (If Any)

NIH CTSA UL1TR002366.
0618 Association between Ambient Light Exposure, Race/Ethnicity, and Vitamin D among Adults in the United States: Analysis of the National Health and Nutrition Examination Survey
Authors: Moore Jesse , Narcisse Rachelle , Briggs Anthony , Rogers April , Grandner Michael , Seixas Azizi , Jean-Louis Girardin
Published: May 2022

Introduction

The prevalence of vitamin D deficiency (VitD) in the United States is 41 percent, with the highest rate among Blacks 82 percent. Vitamin D deficiency has been linked to chronic diseases. The extent to which the association between light exposure and vitamin D serum levels can vary by individual’s race/ethnicity of which has not been studied at a national level. We aim to explore the associations of ambient light exposure between race/ethnicity and vitamin D.

Methods

The study used data from the National Health and Nutrition Examination Survey (2013-14). For detection of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 nmol/L, ultra-high-performance liquid chromatography-tandem mass spectrometry was performed based on serum samples from adults aged ≥ 18 years. Light levels (lux) data were gathered using 24-hour actigraphic monitoring over /a 7day period. Weighted generalized linear models were fitted examining association between light exposure and VitD adjusting for age, sex, family income/poverty ratio, education, employment, house tenure, marital status, birthplace, number of people in household, smoking, physical activity, and sedentarity. To compare this association across race/ethnicity, a product term between lux and race/ethnicity was included in adjusted models.

Results

Among 4,251 participants, White adults had the highest levels of VitD (mean=76.0; se=1.3), then other/multiple races (mean=65.1; se=2.2), Asians (mean=62.5; se=1.4); Hispanics (mean=57.4 nmol/L; se=1.6), and Blacks (mean=50.1; se=1.4). Regression analysis revealed estimated mean VitD of 64.9 nmol/L and positive association between light exposure and VitD ( 0.020). Blacks had significantly lower VitD levels ( -19.3) followed by Asians (-12.1) and Hispanics (-12.6) (all p-values <0.001). The association between light exposure and VitD depended on participant’s race/ethnicity

Conclusion

To our knowledge, this is the first study showing associations between objectively measured light exposure and VitD serum levels using a large representative sample of the US population. Although the study revealed racial/ethnic disparities in VitD levels, light exposure was associated with VitD even when race/ethnicity was adjusted for in the model. Further research on racial/ethnic differences in VitD is warranted.

Support (If Any)

R01HL142066, R01HL095799, RO1MD004113, R01HL152453, R25HL105444
0619 The Relationship Between Sleep Disturbance and Inflammatory Markers in Individuals with 22q11.2 Copy Number Variations
Authors: O'Hora Kathleen , Chiem Emily , Grigoryan Vardui , Amir Carolyn , Irwin Michael , Chiang Jessica , Bearden Carrie
Published: May 2022

Introduction

The 22q11.2 locus contains genes critical for brain development. Individuals with copy number variations (i.e. a deletion or duplication; CNV) at this locus have greatly increased risk of developmental neuropsychiatric disorders, as well as immune dysfunction and sleep problems. However, it remains unknown if sleep disturbance and immune dysfunction are related to each other in this population, as they are in typically developing individuals.

Methods

We examined the relationship between self-reported sleep disturbance and blood cytokine levels in 22q11.2 deletion (22qDel; n= 40, Mage = 17.5±8.4 years, 45% males) and duplication (22qDup; n=28, Mage =16.8±12.9 years, 45% males) carriers. Blood plasma samples were obtained to measure interlukein-6 (IL-6), interlukein-10 (IL-10), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF) and interferon-gamma (IFN) using a MesoScale Discovery multiplex immunoassay. We also measured levels of C-reactive protein (CRP) using an ELISA. Subjects were classified as either good or poor sleepers based on the sleep disturbance score on the Structured Interview of Psychosis-Risk Symptoms (SIPS). Linear regression models were used to test the effect of sleep disturbance, subject group (22qDel vs. 22qDup), and a group-by-sleep interaction on each cytokine level while controlling age, sex, body mass index, and collection time. We corrected for multiple comparisons using False Discovery Rate (FDR) correction.

Results

Overall, 22qDup carriers had higher levels of IL-8 (q<0.001) and TNF (q<0.001) relative to 22qDel. Across CNV groups, poor sleepers had higher levels of IL-8 (p=0.046) and IFN (p=0.028), but these effects did not survive FDR correction (q>0.18). There was a group-by-sleep interaction for IL-8 (p=0.013), TNF (p=0.048), and IFN (p=0.034) such that sleep disturbance had a greater effect on cytokine levels in the 22qDel group, but only the interaction for IL-8 survived as a trend towards significance after FDR correction (q=0.076).

Conclusion

Our findings suggest that poor sleep may contribute to immune dysfunction in 22q11.2 CNV carriers. Further, there may be differential impacts of sleep on immune function, depending on gene dosage at the 22q11.2 locus. Future research in larger samples is required to determine if immune disruption and sleep problems are related to elevated psychiatric symptoms in 22q11.2 CNV carriers.

Support (If Any)

RO1MH085953; U01MH10171
0622 Influence of Cannabis Use Disorder on Sleep Quality among College Students
Authors: Turner Arlener , Keen Larry , Bernard Mark , Blanc Judite , Seixas Azizi , Jean-Louis Girardin
Published: May 2022

Introduction

Poor sleep, which has numerous deleterious effects, is one of the most common health complaints among college students. Both race/ethnicity and sex are associated with poor sleep outcomes, with Black college women potentially having higher risk. The college experience is often associated with an increase in stress, as well as drastic shifts in lifestyle and sleep patterns. Research indicates that college students report cannabis use enables them to cope with life stressors and negative emotions and is often used as a sleep aid. The use of cannabis as a to cope may lead to more chronic cannabis use, and the development of Cannabis Use Disorder (CUD), which is most prevalent in individuals aged 18-25. Therefore, this study examined the influence of CUD symptomatology on sleep among Black female college students.

Methods

Participants included 200 Black/African American women (age range: 18-25 years) attending a Historically Black College/University. Each participant completed an Qualtrics online survey including assessment of DSM-5 CUD criteria, and validated measures of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and perceived stress (Perceived Stress Scale [PSS]).

Results

11.5% of the sample met criteria for CUD. There were no significant differences between the CUD and non-CUD groups in perceived stress, however, all participants endorsed moderate stress levels (M=19.51, SD=5.33). Additionally, all participant’s PSQI scores met criteria for impaired sleep (score >5). [MOU1] [TAD2] T-test analyses indicate that the CUD subgroup reported poorer sleep quality (M=9.04, SD=3.69 vs M=7.07, SD=3.28), more sleep disturbances (M=1.52, SD=0.59 vs M=1.15, SD=0.74), and longer sleep latency (M=37.70, SD=25.28 vs M=25.92, SD=23.95), than the non-CUD group (all p<.05).

Conclusion

Black/African American female college students who met criteria for CUD reported more sleep disturbances, longer sleep latencies, and poorer overall sleep quality. Given the lack of difference in perceived stress, these results suggest that the use of cannabis as a coping aid may exacerbate poor sleep. Previous research indicates that Black women are not only more likely to report poor sleep, but that they also report exploring non-traditional strategies to address their sleep problems. These findings suggest a need to examine these non-traditional coping strategies for possible paradoxical and deleterious effects.

Support (If Any)

Funding: R01HL142066, R01HL095799, RO1MD004113, R01HL152453, 1R15 DA052886-01A1
0623 Neural Dynamics During Sleep in Parkinson’s Disease Patients
Authors: Abunimer Luma , Vess Gavin , Kvavilashvili Andrew , Williams Della , Vijayan Sujith
Published: May 2022

Introduction

Parkinson’s Disease (PD) is a neurodegenerative disease marked by tremor, body tone changes, and cognitive decline with deficits in motor task learning. Characteristic neural patterns during non-Rapid Eye Movement (NREM) sleep have been correlated with learning procedural motor memory tasks. We seek to understand how the neural dynamics of NREM sleep (e.g., sleep spindles and slow waves) interact with motor learning ability in a neurodegenerative disease process. This information might be used to identify electrical biomarkers that could be therapeutically targeted.

Methods

PD subjects and healthy age-matched controls were identified by physician interview, flyering, and medical chart review. Eligibility requirements for subjects precluded severe cognitive decline and untreated sleep disorders. Baseline sleep characteristics were ascertained via survey data collected prior to and on the day of the sleep study. Subjects were fitted with EEG electrodes prior to an all night polysomnogram. Subjects were also fitted with EMG and EOG electrodes for sleep scoring purposes. Motor tasks were performed prior to and following overnight sleep.

Results

Surveys indicated worse sleep quality among PD subjects compared to age-matched controls prior to their sleep session. Sleep macro-architecture of PD subjects showed a smaller percentage of sleep time in N2/N3 stages, and at the spectral level, there were indications of reduced power for slow waves and spindling. Furthermore, we observed aberrant patterns of coupling between slow waves and spindling in PD subjects.

Conclusion

Our study has implications for sleep as a component of motor skill learning and as a marker for a neurodegenerative movement disorder. NREM sleep rhythms such as sleep spindles and slow waves, and their relationships to one another, are thought to be important in motor learning and memory. Aberrations in these rhythms and their coupling may inform potential therapies to enhance motor learning and mitigate the progression of PD.

Support (If Any)

NCATS of the NIH, Award Number UL1TR003015.
0626 Nocturnal Pulse Event Frequency in Multiple System Atrophy: An Exploratory Pilot Study
Authors: McCarter Stuart , Coon Elizabeth , Benarroch Eduardo , Louis Erik St
Published: May 2022

Introduction

Risk of sudden death in multiple system atrophy (SuD-MSA) is greatest during sleep. Mechanisms underlying SuD-MSA may involve impaired brainstem arousal and cardiovascular responses to hypercapnia in MSA patients. We hypothesized that nocturnal arousal-related tachycardia events are reduced in MSA patients. We analyzed whether nocturnal pulse event frequency was altered in patients with MSA compared to patients with sleep disordered breathing without MSA utilizing portable overnight oximetry.

Methods

We retrospectively analyzed 46 probable MSA and 46 age-sex matched patients with sleep disordered breathing (SDB) without MSA, excluding patients receiving cardioactive medications. Nocturnal oxyhemoglobin desaturation indices (ODI) and pulse event indices (PEI) were automatically recorded for all patients using portable overnight oximetry. We calculated a PEI/ODI ratio to determine the relationship between probable breathing-related arousals and pulse rate change. Cardiovagal function was assessed by heart rate to deep breathing and Valsalva ratio in patients with MSA and Composite Autonomic Severity Score was assigned. Group comparisons were made with non-parametric tests. Multivariable regression explored relationships between oximetry variables and clinical characteristics.

Results

Average age at overnight oximetry was 62.9 ± 7.7 years. Total respiratory events between MSA patients compared with OSA controls were similar (95.0 ± 118.6 vs 73.5± 54.2, p=0.61). Total pulse events were lower in MSA than OSA controls without MSA (25.5±44.2 vs 111.6±120.2, p<0.001), as were pulse events per hour (3.1 ± 5.3 vs. 12.8 ± 10.8, p <0.001). The ratio of PEI/ODI was lower in MSA than OSA patients without MSA (p<0.001). Twelve (26%) MSA patients had zero pulse rate events, while all OSA patients without MSA had at least 1 pulse rate event (p<0.001). The number of pulse events was not associated with severity of cardiovagal dysfunction on daytime autonomic function testing.

Conclusion

Patients with MSA have fewer pulse rate events when compared with SDB patients without MSA, despite similar overall respiratory event frequency. The number of pulse events was not explained by severity of daytime autonomic dysfunction in those with MSA. Whether nocturnal pulse event response to sleep disordered breathing is a marker of disease severity or plays a role in SuD-MSA deserves further study.

Support (If Any)
0629 Metabolic syndrome in narcoleptic children
Authors: Zhang Min , Thieux Marine , Guyon Aurore , Arvis Laura , Villanueva Carine , Lin Jian-Sheng , Franco Patricia
Published: May 2022

Introduction

Narcolepsy is a disabling neurological disorder characterized primarily by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis, rapid eye movement (REM) behavior disorder (RBD) and disturbed nocturnal sleep. Over 50% of children with narcolepsy are obese. Metabolic syndrome (MetS), a constellation of disturbances associated with obesity, is increasingly seen in narcolepsy. A higher prevalence of MetS was revealed both in adults and children with narcolepsy. The objective of the present study was to compare clinical and sleep characteristics in children with narcolepsy with different components of MetS to clarify the mechanisms in MetS in these children.

Methods

This retrospective study included 58 children with narcolepsy. Data on blood pressure, High density lipoprotein (HDL) cholesterol, triglyceride, glucose, insulin and anthropometry (height and weight) were collected. MetS was defined when ≥3 of the following criteria were met: (1) Body mass index (BMI) ≥IOTF-30, (2) Blood pressure ≥90th percentile, (3) HDL-C ≤0.4 g/L, (4) Triglycerides ≥1.3 g/L, (5) homeostasis model assessment of insulin resistance (HOMA-IR) ≥75th percentile. Then, clinical and sleep characteristics were compared in groups with different MetS components.

Results

A total of 17 % of children with narcolepsy had MetS including 79% with high HOMA, 26% with high BMI, 24% with low HDL cholesterol and 12% with high triglycerides, but no patient with high blood pressure. 58% of the patients without obesity had at least 1, 2 or ≥3 MetS risk factors (78%, 15% and 6%, respectively). 55% of them were overweight. In children with narcolepsy with at least two MetS risk factors, there was a higher proportion of night eating, a lower percentage of N3 sleep, a higher arousal index, a shorter mean sleep latency and more sleep onset REM periods (SOREMPs) compared to patients with fewer MetS risk factors.

Conclusion

Altered sleep architecture and eating behavior are closely associated with risk factors of MetS in children with narcolepsy, even without obesity. We recommend to evaluate MetS risk in all children with narcolepsy to prevent complications such as type 2 diabetes and cardiovascular outcomes.

Support (If Any)
0637 Associations between Alzheimer’s Disease Pathology and the Psychomotor Vigilance Task in Cognitively Unimpaired Adults with and without Obstructive Sleep Apnea
Authors: Plante David , Tran Kieulinh , Cook Jesse , Hagen Erika , Peppard Paul , Kollmorgen Gwendlyn , Suridjan Ivonne , Blennow Kaj , Zetterberg Henrik , Carlsson Cynthia , Johnson Sterling , Bendlin Barbara
Published: May 2022

Introduction

Daytime sleepiness is a risk factor for Alzheimer’s disease (AD) pathology and is associated with more severe cardiometabolic sequalae in persons with obstructive sleep apnea (OSA). However, limited studies have examined objective measures of decreased alertness in the context of AD. Here, we examined performance on the psychomotor vigilance task (PVT) in relation to AD pathology as indexed by AD biomarkers in cerebrospinal fluid (CSF), among individuals with and without OSA.

Methods

Sixty-one cognitively unimpaired adults (39 women), mean age 66.1±7.5 years, enrolled in the Wisconsin Alzheimer’s Disease Research Center completed a multifaceted sleep assessment. WatchPAT at-home overnight recordings characterized OSA severity, defined by the apnea-hypopnea index (AHI). Actigraphy determined habitual sleep-wake characteristics. 10-minute PVT measured neurobehavioral alertness. CSF biomarkers were measured using the Roche NeuroToolKit assays (Roche Diagnostics International Ltd, Rotkreuz, Switzerland), an exploratory panel of immunoassays for neurodegeneration. Generalized linear models examined associations between AD biomarkers, AHI, and PVT performance. Primary AD biomarkers of interest were phosphorylated-tau (p-tau) and amyloid-beta (Ab) 42/40 ratio, measured in CSF. The primary PVT variable of interest was the mean response time of the 10% slowest responses, which is associated with daytime sleepiness and default mode network activity. Log transformed PVT and AHI+1 were utilized for analysis. Covariates included age, sex, body mass index, total sleep time, sleep efficiency, APOEe4 status, years of education, AD parental history, biomarker-to-sleep assessment time interval, and Ab42/40 (for p-tau).

Results

No significant relationship of AHI or PVT was observed for Ab42/40. In fully adjusted models, a significant AHI*PVT interaction was observed for p-tau (p=0.0003). Specifically, among individuals with OSA (AHI>5/hour; n=24), slower PVT was associated with increased p-tau (b=13.2, p=0.006), an association that was not significant among those without OSA.

Conclusion

PVT performance may be an objective measure of sleepiness relevant to AD pathology, particularly among individuals with OSA. Replication and expansion of these findings in larger and longitudinal datasets are indicated.

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R03AG063274 and P30-AG062715.
0639 Polysomnographic Biomarkers of Sleep Disruption and Sleep Disordered Breathing in Migraine: a Large Matched Case Control Clinical Registry-Based Study
Authors: Gruenthal Eric , Foldvary-Schaefer Nancy , Wang Lu , Milinovich Alex , Saab Carl , Bucklan Julia , Mehra Reena
Published: May 2022

Introduction

Sleep disruption and sleep architectural changes in relation to migraine are not well characterized. Disruption in sleep may serve as a risk for migraine or result from migraine. We leveraged a large clinical cohort to examine the hypothesis that those with migraine have greater degrees of sleep architectural alterations and sleep disordered breathing (SDB).

Methods

This was a polysomnogram-based retrospective case (migraine) control (non-migraine) study of patients aged >18 matched 1:3 on age, sex, race, body mass index (BMI), and year of polysomnogram. Two domains were considered: 1)Sleep architecture (arousal index:AI, (primary predictor), total sleep time (TST), percentage of sleep stage time) and 2)SDB (apnea hypopnea index (AHI:primary predictor), mean oxygen saturation) were considered. Comparisons were performed by two-sample t-test or Wilcoxon rank sum test for continuous variables, and chi-square test or Fisher’s exact test for categorical variables.

Results

4,783 migraine cases (47.5 ±13.3 years, 76.4% Caucasian, body mass index:BMI 33.7 ±8.6kg/m2) were matched to 14,287 controls. In migraine patients vs those without, TST was lower (359.0[307.0, 421.0] minutes vs 363.0[306.0, 432.5] minutes,p=0.01), percentage of N2 was higher (67.8%[59.6, 75.6] vs 67.0%[58.4, 74.8],p<0.001), percentage of REM was lower (16.7% [10.0, 22.0] vs 17.0% [11.1, 22.2],p=0.012), AHI was lower (7.4 [2.6, 17.0] vs 9.5 [3.7, 22.1],p<0.001), AI was lower (19.6 [12.8, 30.9] vs 22.6 [14.7, 34.9],p<0.001), and mean oxygen saturation was higher (93.7%±2.4 vs 93.3±2.6,p<0.001).

Conclusion

In this largest study of its kind, we identify novel associations of migraine in relation to curtailed sleep and sleep architectural alterations, i.e. increase in N2 and reduced REM sleep and lower AI compared to contemporaneously matched controls. Directionality of these relationships requires further elucidation given the cross-sectional nature of this study. Interestingly, we observed lower degree of sleep apnea and hypoxia burden in patients with migraine. As Calcitonin Gene-Related Peptide (CGRP), a neuropeptide increased during and between migraine attacks in migraine patients, and serotonin are implicated in arousals due to apnea-related increases in CO2, there is biologic plausibility for migraines patients to exhibit potential protection from SDB. Further investigation is needed to confirm these findings.

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0640 North American Prodromal Synucleinopathy Consortium: Baseline characteristics in 251 patients with REM Sleep Behavior Disorder
Authors: Elliott Jonathan , Lim Miranda , Keil Allison , Avidan Alon , Bliwise Don , Gagnon Jean-François , Howell Michael , Huddleston Daniel , McLeland Jennifer , Postuma Ronald , Louis Erik St , Videnovic Aleksandar , Boeve Bradley , Ju Yo-El
Published: May 2022

Introduction

Introduction: Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is characterized by a lack of muscle atonia during REM sleep with dream enactment. RBD is regarded as a prodromal synucleinopathy as a high proportion of patients eventually phenoconvert to Parkinson’s Disease and related synucleinopathies, suggesting RBD may be an early non-motor symptom of disease. Accordingly, patients with RBD are ideally situated to test potential therapeutic interventions to prevent phenoconversion to synucleinopathy. However, RBD itself, and associated patient registries, are rare. The North American Prodromal Synucleinopathy Consortium (NAPS) establishes a multisite registry of RBD patients with standardized neurological, neuropsychiatric, and neuropsychological assessments and biomarker collection. The present work reports baseline characteristics of this RBD patient database at its current state.

Methods

Methods: Participants >18 years of age with overnight polysomnogram-confirmed RBD by ICSD-3 criteria who did not meet criteria for the diagnosis of PD, dementia, MSA, or narcolepsy were enrolled from 10 sites across North America (8/2018 to 4/2021). Data collection included family and personal history of RBD and related symptoms, as well as standardized assessments related to cognitive, motor, sensory and autonomic function. Additionally, all subjects have contributed blood, and a subset of subjects have contributed cerebrospinal fluid samples to the National Centralized Repository for Alzheimer's Disease and Related Dementias for future analysis.

Results

Results: A total of n=251 participants were enrolled. Outcomes are reported based on sex (n=202 male, n=49 female). Data were further examined based on participants’ history of antidepressant use (n=142 with, n=103 without) and based on participants’ extent of synucleinopathy burden (n=70 defined as isolated RBD, n=181 defined as RBD+ [i.e., exhibiting ≥1 abnormality]). Any observed sex differences among the data did not persist after correction for antidepressant use.

Conclusion

Conclusions: This prospective, cross-sectional data on history, demographic, cognitive, motor, sensory, and autonomic function in n=251 participants with RBD highlight the lack of sex differences and the high preponderance of concomitant neurological abnormalities with RBD, and provide a valuable registry for future longitudinal studies and neuroprotective clinical trials.

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NIH NIA R34 AG056639 (YJ, BB)
0645 Associations of Objective Sleep Parameters and Gray Matter Microstructure in community dwelling cognitive normal older adults
Authors: Bubu Omonigho , Zanetta Kovbasyuk , Mbah Alfred , Korey Kam , Anna Mullins , Parekh Ankit , Umasabor-Bubu Ogie , Rapoport David , Ayappa Indu , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo
Published: May 2022

Introduction

Disturbed sleep measures differentially alter white-matter microstructure. We examined whether obstructive sleep apnea (OSA)-severity, sleep fragmentation and duration measures were associated with gray-matter diffusion tensor-imaging metrics (DTI) (i.e., fractional anisotropy [FA], mean diffusivities [MD] and kurtoses [MK]) in community-dwelling cognitive-normal older-adults.

Methods

Gray-matter DTI metrics from MRI including mean FA, MD and MK measures of the hippocampus, thalamus, medial prefrontal-cortex (mPC) and Alzheimer’s Disease (AD) vulnerable regions (temporal [inferior, middle, and superior], parietal [inferior and superior], entorhinal cortex, and precuneus) were determined from 85 subjects. OSA-severity measures included AHI3a and AHI4%. Other sleep measures included sleep efficiency (SE), non-rapid eye movement (NREM) slow wave sleep (SWS) duration, percent time spent in SWS (%SWS), slow wave activity (SWA), total sleep time (TST), and wake after sleep onset (WASO). To analyze the data, first, we utilized factor analysis using varimax rotation to account for the DTI metrics as multivariate outcomes. Using factor loadings, we anticipated a two or three-factor model was sufficient to explain the variance of the DTI metrics. Second, we investigated predictive associations between the sleep parameters and the loaded DTI factors, and explored age, sex, BMI, education and APOE4 as covariates underlying any differences.

Results

Of the 85 participants, 60 (70.6%) were women, 67 (78.8%) were non-Hispanic Whites. Mean (SD) age, BMI and education was 66.7 (5.3) years, 27.9 (6.1) kg/m2 and 16.8 (2.4) years respectively. We selected the two primary loadings’ factor model based on AIC criteria. FA metrics of the investigated brain regions except thalamus, loaded on one factor, conceptualized as manifest indicators for FA. MD and MK metrics of all the investigated brain regions loaded on the second factor, conceptualized as manifest indicators for MD/MK. SWS, %SWS, TST were predictors of FA (P ≤0.01 for all). AHI3a, AHI4%, and SWA were predictors of MD/MK (P ≤0.05 for all). Additionally, sex, age, APOE4 and education were predictors of FA (P ≤0.01 for all).

Conclusion

In this limited sample of cognitively-normal older-adults, sleep duration measures predicted gray-matter FA, OSA-severity measures predicted gray matter MD and MK. Demographic, genetic and SES factors explained the differences in these relationships.

Support (If Any)

AASM 231-BS-20, AARGD-21-8488397, NIH/NIA/NHLBI (K23AG068534, L30-AG064670, CIRAD P30AG059303 Pilot, NYU ADRC P30AG066512 Developmental Grant, R25HL105444, SRG, R01AG12101, R01AG022374, R01AG13616, RF1AG057570, R01HL118624, R01AG056031)
0656 Demographic and Clinical Features of Nocturnal Suicide
Authors: Arevalo Sabrina , Tubbs Andrew , Fernandez Fabian-Xosé , Karp Jordan , Klerman Elizabeth , Chakravorty Subhajit , Perlis Michael , Grandner Michael
Published: May 2022

Introduction

The risk for suicide is greatest at night after adjusting for population wakefulness, possibly due to sleep- and circadian-dependent changes in neurophysiology to promote sleep. Those who die by suicide at night, however, may differ by demographic and/or clinical characteristics from those who die by suicide during the day.

Methods

An archival analysis of the National Violent Death Reporting System for 2003-2017 identified 77,784 suicide deaths with time of fatal injury. Cases were divided into daytime (5AM to 10:59PM) or nighttime (11PM to 4:59AM) and characterized by age, sex, race, ethnicity, marital status, military service, education, prior diagnosis of an anxiety disorder, bipolar disorder, depression, history of suicidal ideation, PTSD, and schizophrenia, as well as the presence of an opiate or cannabis, and blood alcohol level (BAL) on autopsy. Bidirectional stepwise regression and robust Poisson models characterized significant predictors of nocturnal suicide using incident risk ratios (IRR).

Results

Nocturnal and daytime suicides differed on all sociodemographic variables. Nocturnal suicides were more prevalent among those with bipolar disorder, PTSD, an elevated BAL, and those who tested positive for cannabis. Stepwise models identified a significant age by BAL interaction. Using adults 35-64 with BAL=0mg/dl as the reference, adults 35-64 with a BAL<80mg/dl had a 46% greater risk of suicide at night, and those with a BAL≥80mg/dl had a 78% greater risk. Individuals 15-34 had a nighttime suicide that was 26% greater with BAL=0mg/dl, 84% greater with BAL<80mg/dl, and 298% greater with BAL≥80mg/dl. Conversely, individuals 65 and older were 27% less likely to die at night with BAL=0mg/dl, while those with a BAL>0mg/dl did not differ from those aged 35-64 with BAL=0mg/dl. The risk of nocturnal suicide was also 17% greater among those with a prior history of suicidal ideation, and 13% less likely among those with documented depression.

Conclusion

Nocturnal suicide is more prevalent among intoxicated younger adults and those with previous suicidal ideation. However, suicide victims with depression were less likely to die at night. Further research is needed to target suicide prevention efforts at appropriately times for those with mood, substance, and alcohol use disorders.

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