bluuebunny/crossref_metadata_2025 huggingface dataset:
0219 Interplay of School Days and Free Days with Sleep Midpoint on the Association of Visceral Adiposity with Blood Pressure in Adolescents
Authors: Morales-Ghinaglia Natasha , Larsen Michael , Calhoun Susan , He Fan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: May 2022

Introduction

The circadian timing of sleep, including its variability, has emerged as an important contributor to obesity and cardiovascular health, such as elevated blood pressure. Adolescence is a particularly vulnerable period for circadian misalignment, which may express differently if youth are in school or on free-days. We examined whether deviations in sleep midpoint increase the impact of visceral adiposity on elevated blood pressure in adolescents as a function of being entrained to school or not.

Methods

We analyzed cross-sectional data from the Penn State Child Cohort follow-up study, a random population-based sample of 303 adolescents (16.2 ± 2.2 y; 47.5% female; 21.5% minority). Actigraphy-measured sleep midpoint was calculated as the midpoint (zeroed to midnight) of the sleep period for weekdays (5-nights) and weekends (2-nights). Actigraphy-measured sleep regularity was calculated as the intra-individual standard deviation of the 5-night weekdays sleep midpoint. Visceral adipose tissue (VAT) was measured via dual-energy X-ray absorptiometry scan. Systolic (SBP) and diastolic (DBP) blood pressure was measured three times in the seated position. Multivariable linear regression models were stratified by “in school” and “on break” to test sleep midpoint and sleep regularity as effect modifiers of VAT on SBP/DBP levels. Analyses were adjusted for sex, race/ethnicity, age, actigraphy-measured sleep duration and polysomnography-measured apnea/hypopnea index.

Results

When participants were studied while “in school”, significant interactions were found between VAT and weekdays sleep midpoint on SBP (p-interaction=0.027) and DBP (p-interaction=0.046), so that the later the sleep midpoint on school days, the greater the association of VAT with SBP/DBP. When participants were studied while “on break”, a significant interaction was found between VAT and weekdays sleep regularity on SBP (p-interaction=0.039), so that the higher the sleep irregularity on weekdays, the greater the association of VAT with SBP. No other significant interactions were found.

Conclusion

A delayed and an irregular sleep midpoint during school days and during breaks, respectively, best identified those adolescents with greater cardiovascular risk associated with visceral obesity. These data suggest that not only the circadian timing of sleep contributes to adverse cardiovascular outcomes but its distinct biomarkers require measurement under different entrainment conditions in adolescents.

Support (If Any)

National Institutes of Health (R01HL136587, UL1TR000127)
0254 Association of Slow Wave Activity and Odds Ratio Product with Internalizing and Externalizing Problems in Children and Adolescents
Authors: Fernandez-Mendoza Julio , Ricci Anna , He Fan , Calhoun Susan , Fang Jidong , Younes Magdy , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: May 2022

Introduction

The association of metrics of sleep microstructure with internalizing and externalizing problems in youth has remained elusive. While one study found increased frontal slow wave activity (SWA) in depressed adolescents, there is lack of evidence for a relationship between dimensional measures of behavior and metrics of sleep depth/intensity. We examined the association between two measures of sleep depth/intensity, slow wave activity (SWA) and odds ratio product (ORP), with internalizing and externalizing problems in children and adolescents.

Methods

We calculated SWA and ORP during non-rapid eye movement (NREM) sleep at central, frontal and fronto-occipital derivations in 639 children (5-12y, median 9y) and 418 adolescents (12-23y, median 16y) from the Penn State Child Cohort via in-lab polysomnography. ORP provides a standardized measure of NREM sleep depth, while ORP-9 (average ORP in the 9-seconds following NREM arousals) provides a metric of arousability. SWA (0.4-4Hz) absolute power (µV2) was determined during NREM sleep. Internalizing and externalizing problems were assessed on Achenbach’s Behavior Checklist by parent (subjects≤17y) or self-report (subjects≥18y). For each scale, T-scores with a mean of 50 and standard deviation of 10 were obtained following standardized scoring. Multivariable-adjusted linear regression models examined the association between SWA/ORP and clinical outcomes.

Results

At ages 5-12, fronto-occipital SWA was negatively associated with externalizing behaviors (p=0.05), while fronto-occipital and frontal ORP, and frontal ORP-9 were positively associated with internalizing symptoms (all p<0.01). At ages 12-23, central SWA was negatively associated with internalizing symptoms (p=0.05), while central (p=0.05) and frontal (p=0.03) ORP and central ORP-9 (p=0.03) were positively associated with externalizing behaviors.

Conclusion

Reductions in SWA in childhood or adolescence are associated with developmentally appropriate behavioral problems, as depression/anxiety are more prevalent in adolescence. In contrast to SWA, increased ORP (lighter sleep) and ORP-9 (greater arousability) are associated with more anxiety/depression in childhood, yet more externalizing behaviors in adolescence. These distinct associations, such as SWA with externalizing behaviors and ORP with internalizing symptoms during childhood, may reflect how SWA captures local/synaptic control, while ORP global/state control, of sleep depth, making both sleep EEG biomarkers important from a developmental standpoint.

Support (If Any)

National Institutes of Health (R01MH118308, UL1TR000127)
0365 Evaluation of Sleep Medicine Fellowship Program Websites
Authors: Shenoy Shanti , Akberzie Wahida , Gutierrez Jeremy S Landeo , Guerrero Christopher R Leon , Karroum Elias G
Published: May 2022

Introduction

Fellowship program websites often serve as the initial resource applicants use to learn about programs. Websites have likely become even more important due to social distancing mandates related to the on-going Covid-19 pandemic. In this study, we evaluated the websites of sleep medicine fellowship programs and analyzed the comprehensiveness of their content.

Methods

Sleep medicine fellowship programs in the United States (US) for the 2021 match cycle were identified using the Electronic Residency Application Service (ERAS) directory and the Fellowship and Residency Electronic Interactive database (FREIDA). Twenty-two prespecified website content criteria related to education, recruitment, and compensation were evaluated. Programs’ website comprehensiveness was compared based on geographic location (Northeast/Midwest/South/West); type of programs (Community/University); programs matching status (Complete/Partial or No matching status); core specialty (Internal medicine/Other specialties); and program size (based on number of sleep fellows).

Results

A total of 78 US sleep fellowship program’ websites were evaluated. Most (80.8%) had a direct functional link to ERAS or FREIDA websites. The percentage of sleep medicine fellowship program’ websites reporting each of the twenty-two-criterion was highly variable (range: 2.6%-98.7%). The percentage of overall website comprehensiveness among sleep medicine fellowship programs was 56.8%±16.5% (range:13.6%-90.9%). There was a significantly higher educational website content comprehensiveness for the Internal medicine compared to other specialties-based sleep programs (p = 0.002). There were no significant association between the overall, educational, recruitment, and compensation website content comprehensiveness of sleep programs and their US region location, type of affiliation, matching status, or program size.

Conclusion

Website content comprehensiveness amongst sleep fellowship programs in the US is variable with a lower educational content on website pages of non-internal medicine-based sleep programs. Improvement in website content of sleep medicine programs is a potentially easy way for programs to improve fellow recruitment, and more importantly, allow prospective sleep fellow applicants to make a more informed decision with regards to program selection.

Support (If Any)

This study was not funded.
0369 Sleep Education for the Nurse Practitioner: Nurse Practitioner Student Focus Group Findings
Authors: Watach Alexa , McPhillips Miranda , Saconi Bruno , Lang-Gallagher Rebecca , Lyons M Melanie , Renz Susan , Rosen Ilene , Sawyer Amy
Published: May 2022

Introduction

Primary care nurse practitioners (NPs) receive little to no sleep education in graduate programs despite being first-line providers for patients presenting with sleep-related symptoms. Sleep curriculum has been consistently identified as a gap in nursing education and confirmed in recent survey studies of nurses and NPs.

Methods

Qualitative descriptive study to explore NP students’ reactions to an asynchronous, case-based sleep e-learning program. Data were collected as part of a larger pre-/post-study assessing the program. Six asynchronous online modules were offered to a cohort of primary care NP students in a single academic institution’s master’s degree in primary care nursing program. At the end of the course, students were invited to participate in one-hour, online, focus group sessions. Directed content analysis, guided by the Kirkpatrick training evaluation model, was used to analyze the qualitative data to understand NP students’ experience with the program and elicit their perspectives about sleep education.

Results

Participants in the course (N=67) were predominantly female (88%) and ≤35 years old (81%). Twenty-four students participated in the focus group sessions. Two overarching themes emerged, including positive reactions to (1) course design and (2) course content. Students reported the case-based scenarios and quizzes enhanced their learning and kept them engaged, noted the user-friendly format, and appreciated that the course was asynchronous. After completing the modules, students recognized they had a previous knowledge gap related to sleep and perceived the information they received to be relevant to their practice/patient population and to their own personal health/wellbeing. Students also discussed their intentions to incorporate sleep assessments into practice.

Conclusion

Given the increasing sleep health needs of the population and the growing shortages of sleep providers, there is a critical need to ensure NP’s have the proper education to recognize and identify implications of poor and disordered sleep in their patients. In this study, NP students enthusiastically embraced sleep education, identified knowledge gain, and had intentions to apply their learned skills in practice highlighting the feasibility of increasing curricular exposure to sleep medicine.

Support (If Any)

The work reported herein was supported by National Institutes of Health (R25HL120874 Rosen, PI).
0388 Dosing and Reasons for Transitioning From Sodium Oxybate to Lower-Sodium Oxybate in People With Narcolepsy: Data From the Real-World TENOR Study
Authors: Husain Aatif , Leary Eileen , Fuller Douglas , Macfadden Wayne , Whalen Marisa , Bae Charles , Zee Phyllis
Published: May 2022

Introduction

Lower-sodium oxybate (LXB) contains 92% less sodium than sodium oxybate (SXB) and is approved for treating cataplexy or excessive daytime sleepiness in patients with narcolepsy (aged ≥7 years) and for treating idiopathic hypersomnia in adults. The Transition Experience of persons with Narcolepsy taking Oxybate in the Real-world (TENOR) study examines the impact of transitioning from SXB to LXB in a real-world setting.

Methods

TENOR is a patient-centric, prospective, observational, noninterventional, virtual-format study (NCT04803786). Eligible participants include US adults with narcolepsy (type 1 or 2) transitioning from SXB to LXB within the previous/upcoming 7 days. Longitudinal data are collected for 21 weeks post-transition. These analyses include data collected at initiation of LXB treatment from all qualifying participants.

Results

The analyses included 85 participants with confirmed narcolepsy (type 1, n=45; type 2, n=40). Mean (SD) age was 40.3 (13.0) years; most participants were female (73%) and White (87%) and took ≥1 concomitant medication for narcolepsy at baseline in addition to SXB (79%, with 38% taking 1 concomitant medication, 33% taking 2, and 8% taking ≥3). Mean (SD) time on current SXB regimen was 57.8 (52.1) months. Almost all (96%) participants took SXB twice nightly. After transitioning, 98% of participants took LXB twice nightly. Mean (SD) total nightly SXB (n=85) and starting LXB (n=84) doses at baseline were 7.7 (1.5) g and 7.7 (1.5) g, respectively; SXB-LXB dose conversions at baseline were gram-for-gram in 87% of participants. The most common total nightly LXB dose was >7.5 g (56%), followed by >6.0 to ≤7.5 g (21%), >4.5 to ≤6.0 g (15%), and ≤4.5 g (7%). Participant-reported reasons for transitioning to LXB (multiple selections allowed) included lower sodium content for long-term health (93%), physician recommendation (47%), to avoid cardiovascular issues (39%), to avoid side effects (31%), to improve control of narcolepsy symptoms (18%), and other (14%).

Conclusion

The majority of participants transitioned from SXB to LXB using a gram-for-gram dose conversion. The most common reason cited for switching was for long-term health due to the lower sodium content of LXB.

Support (If Any)

Jazz Pharmaceuticals.
0391 Physician Perspective on Idiopathic Hypersomnia: Awareness, Diagnosis, and Impact on Patients
Authors: Whalen Marisa , Roy Bailey , Steininger Teresa , Dronamraju Nalina , Enson Daniel
Published: May 2022

Introduction

Idiopathic hypersomnia is a debilitating central disorder of hypersomnolence characterized by excessive daytime sleepiness, severe sleep inertia, and prolonged nighttime sleep. Awareness of idiopathic hypersomnia among physicians and the general public is believed to be low, and diagnosis may be delayed by years.

Methods

US physicians completed an online survey (February 5–12, 2021) assessing familiarity with idiopathic hypersomnia and understanding of the diagnostic process and impact on patients’ lives. Eligible physicians had been in practice for ≥2 years and had treated ≥2 patients for idiopathic hypersomnia and ≥2 patients for narcolepsy.

Results

There were 305 respondents, including 62 primary care physicians (PCPs), 67 neurologists, 82 psychiatrists, 90 pulmonologists, and 4 sleep specialists. Most were male (73%), White (58%), and 35–54 years of age (62%); mean years in practice was 16.6, and median number of patients with idiopathic hypersomnia was 30. Overall, 48% of physicians reported being extremely familiar with idiopathic hypersomnia (PCPs, 29%; neurologists, 60%; psychiatrists, 34%; pulmonologists, 62%), and 64% agreed that most healthcare providers have an insufficient understanding of idiopathic hypersomnia. Fewer than half (46%) considered the diagnostic process for idiopathic hypersomnia to be clear (strongly/somewhat agree), a lower proportion compared with other sleep disorders (93% for obstructive sleep apnea, 76% for restless legs syndrome, 72% for narcolepsy type 1, and 67% for narcolepsy type 2). Most considered the diagnostic process to be challenging (strongly agree, 40%; somewhat agree, 47%; neither agree nor disagree, 9%; somewhat disagree, 4%; strongly disagree, 1%) and agreed that patients with idiopathic hypersomnia are often misdiagnosed (strongly/somewhat agree, 90%) and that the negative impact of idiopathic hypersomnia is underestimated (strongly/somewhat agree, 92%). Estimated years to diagnosis of idiopathic hypersomnia were 0–1 (11%), 1–2 (32%), 2–5 (39%), 5–10 (15%), and 10+ (2%). Most considered idiopathic hypersomnia to be both a daytime wakefulness disorder and a nighttime sleep disorder (64%).

Conclusion

The survey findings highlight the need for more healthcare provider education and increased understanding of idiopathic hypersomnia, its diagnosis, and its impact on patients’ lives.

Support (If Any)

Jazz Pharmaceuticals, with participation of the Hypersomnia Foundation.
0392 Patient Perspective on Idiopathic Hypersomnia: Impact on Quality of Life and Satisfaction With the Diagnostic Process and Management
Authors: Whalen Marisa , Roy Bailey , Steininger Teresa , Dronamraju Nalina , Enson Daniel
Published: May 2022

Introduction

Idiopathic hypersomnia is a debilitating central disorder of hypersomnolence characterized by excessive daytime sleepiness (EDS), severe sleep inertia, and prolonged nighttime sleep. The impact of idiopathic hypersomnia on quality of life (QoL) and patient satisfaction with the diagnostic process and management have not been well established.

Methods

US patients with idiopathic hypersomnia completed an online survey (June 10 to July 2, 2021) assessing symptoms, impact, diagnosis, and management.

Results

Respondents (N=290) were mostly female (88%), White (88%), and 25–44 years of age (mean, 38 years), had postsecondary education (88%), and were employed at least part time (63%). Self-reported years to idiopathic hypersomnia diagnosis were 0–1 (31%), 1–2 (16%), 2–5 (21%), 5–10 (13%), and 10+ (19%). Overall, 67% reported unreasonable delays to diagnosis (strongly/somewhat agree); 61% reported being misdiagnosed prior to their idiopathic hypersomnia diagnosis. Diagnoses of depression/anxiety, sleep apnea, or narcolepsy type 2 were reported by 72%, 25%, and 10% of respondents, respectively; these diagnoses were later removed and changed to idiopathic hypersomnia in 26%, 30%, and 57%, respectively. Symptoms of IH endorsed (strongly/somewhat agree) by ≥95% of patients were EDS (99%), reduced mental energy level and motivation to carry out daily activities (99%), and feeling as if they could never get enough sleep (98%). The following statements were endorsed by ≥90% of patients: idiopathic hypersomnia has had a significant negative effect on my QoL (79% strongly agree, 19% somewhat agree), has prevented me from being who I want to be (66% strongly agree, 26% somewhat agree), and is often unrecognized and under-diagnosed (67% strongly agree, 24% somewhat agree), and the idiopathic hypersomnia community is underserved (67% strongly agree, 24% somewhat agree). Specific QoL impacts (strongly agree) included constantly struggled with maintaining relationships (65%), had suicidal thoughts (34%), and chose not to have children (25%). Nearly half (49%) of patients reported dissatisfaction with the management of their idiopathic hypersomnia (not very/not at all satisfied).

Conclusion

The survey findings indicate that patients with idiopathic hypersomnia experience a profound negative impact on QoL and dissatisfaction with their diagnostic journey and management.

Support (If Any)

Jazz Pharmaceuticals, with participation of the Hypersomnia Foundation.
0417 Odds Ratio Product reveals distinct sleep phenotypes in idiopathic hypersomnia
Authors: Thomas Robert , Gerardy Bethany , Blattner Margaret , Younes Magdy
Published: May 2022

Introduction

The pathophysiology of idiopathic hypersomnia with long sleep times (IH) remains an enigma. Alternate methods to characterize sleep such as the Odds Ratio Product (ORP), a continuous measure of sleep depth, has the potential to improve understanding of IH.

Methods

The Odds ratio product is a continuous measure of sleep depth and propensity ranging 0 (very deep sleep) to 2.5 (Least sleep propensity). The difference between 2.5 and ORP in any epoch indicates extent of wake suppression (sleep depth) for that epoch. The cumulative sleep index (CSI) is the integral of sleep suppression across recording time thereby reflecting both the duration and depth of sleep over specified intervals (higher value is deeper and longer sleep). 36 patients with long sleep (600 minutes or longer) recorded through unconstrained polysomnography were analyzed using ORP across the full study (12.7±1.7 hours). Participants were divided into quartiles, 9 patients each(Q1-Q4) based on accumulated sleep across the entire study.

Results

The mean age for the cohort was 35.8 ± 16.2, of which 29/36 were females. Total sleep time by visual scoring was 679.4 ± 96.4 minutes (range: 601.5 - 1145) minutes). The whole night CSI mean was 989.39 ± 271.64 units (range: 345 to 1427). The quartile values were 618.33 ± 178.83, 919.33 ± 67.27, 1142.89 ± 39.01, and 1277 ± 69.39 units, and not related to total recording or sleep time. The NREM sleep ORP was 1.43± 0.32, 1.06 ± 0.22, 0.73± 0.13 and 0.67 ± 0.19, respectively. This distribution was true for REM sleep ORP also: 1.52 ± 0.30, 1.26 ± 0.19, 1.05 ± 0.25, and 0.84 ± 0.21, respectively. The trait-like ORP-9 (9 seconds post-arousal), and a reflection of sleep fragmentation propensity, was also similarly distributed: 1.60 ± 0.30, 1.29 ± 0.27, 0.92 ± 0.15, and 0.80 ± 0.18, respectively. All comparisons were statistically significant by Tukey multiple comparisons.

Conclusion

Patients with IH are not homogenous, showing a range of sleep depth in both NREM and REM sleep regardless of total sleep time. These phenotypes of IH could reflect unique endotypic mechanisms, requiring different therapies or have differential treatment responses.

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0436 Effect of sleep on the relationship between pain related disability and neural correlates of pain processing in adults with fibromyalgia and insomnia
Authors: Nair Neetu , Curtis Ashley , Craggs Jason , McCrae Christina
Published: May 2022

Introduction

Up to 80% of adults with fibromyalgia experience insomnia. While sleep and pain are known to be associated, sleep's role in the association between pain related disability and neural correlates of pain processing is unknown. We evaluated whether sleep moderates the association between brain activity in response to painful stimuli and pain related disability in adults with fibromyalgia and insomnia (FMI).

Methods

Twenty-nine adults with FMI (Mage=57.2, SD=13.1) wore Actiwatch 2s over 14 days, completed the Pain Disability Index (PDI), and underwent fMRI using a quantitative sensory testing (QST) protocol involving thermal stimuli. Twelve brain regions with significant activation changes to QST (identified previously, PMID34310276) were included as dependent variables, PDI score as independent variable and actigraphic sleep variables (Sleep Onset Latency (SOL), Total Sleep Time (TST), Sleep Efficiency (%SE)) as moderators in the analysis. For moderation at significance levels of p<0.05 (and trends at p<0.1), significance of simple slopes at high (1 SD above), average and low (1 SD below) sleep levels were examined.

Results

%SE moderated the relationship between right cingulate gyrus (rCG) activity and PDI score (B=0.0009, SE=0.0003, p=.016, R^2=0.22). At lower values of %SE (but not at average or higher levels), there was a negative association between rCG activity and PDI score (B=-0.0166, SE=0.0064, p=0.016). Moderating impact of SOL (B=-0.0002, SE=0.0001, p=.05, R^2=0.14) and TST (B=0.0002, SE=0.0001, p=.06, R^2=0.15) trended towards significance. [MCS1] PDI and rCG activity showed negative associations at highest levels of SOL, while PDI and right inferior frontal gyrus activity showed positive associations at highest levels of TST.

Conclusion

Since the rCG is involved in gating, integration and classification of pain signals, decreased activation in rCG could reflect reduced modulation of pain processing in the region. Preliminary results indicate that at lower levels of sleep efficiency, this decrease in modulation of pain processing is associated with greater perceptions of disability related to pain. Further studies in larger samples are warranted to understand the causal effects, if any, of sleep on pain related disability and the neural correlates of pain processing.

Support (If Any)

NIAMS-R01AR055160/S1; PI-McCrae
0446 Trends and Patterns in Prescriptions of Hypnotics for The Treatment of Insomnia in Japan: Analysis of A Nationwide Japanese Claims Database
Authors: Okuda Shoki , Qureshi Zaina , Yanagida Yukiko , Ito Chie , Honma Yuji , Tokita Shigeru
Published: May 2022

Introduction

Optimal treatment of insomnia is uncommon, given the lack of awareness regarding insomnia management. While the treatment landscape for insomnia has evolved following the introduction of orexin receptor antagonists (ORA), few studies have examined prescribing patterns of hypnotics. We analyzed data from a claims database to examine real-world use of hypnotics in Japan.

Methods

Patients (aged ≥20 to <75 years old) with insomnia diagnosis, prescribed ≥1 hypnotic and continuous enrollment for ≥12 months before the index date were extracted from the JMDC claims database between April 1st, 2009 and March 31st, 2020. Patients were classified as new users of hypnotics or long-term users (prescribed the same mechanism of action [MOA] for ≥180 days). Trends (2010–2019) and patterns (2018–2019) in hypnotics prescriptions were analyzed.

Results

The analysis comprised of 130,177 new users and 91,215 long-term users (2010–2019). Nearly all new users (97.1%–97.9%) were prescribed a single MOA in each year. In 2010, almost all new users (94.0%) of hypnotics were prescribed GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs). The proportions of patients prescribed BZD declined over time (from 54.8% in 2010 to 30.5% in 2019), whereas those prescribed z-drugs remained stable (~40%). The proportion of patients prescribed a melatonin receptor agonist increased slightly (3.2% to 6.3%), while those prescribed ORA increased substantially (0% to 20.2%). Among long-term users, the proportion of patients prescribed BZD steadily declined over time, but more than half were prescribed BZD. Unlike new users, a lower proportion of long-term users were prescribed ORA (0% in 2010, 4.3% in 2019). Analyses using 2018–2019 data showed that a combination of multiple (≥2) MOAs was prescribed to a higher proportion (18.2%) of long-term users than new users (2.8%). The prescription patterns of hypnotics were comparable among patients stratified by age, sex, medical specialty, and psychiatric comorbidities.

Conclusion

The present study showed distinct characteristics in the patterns and trends of the prescriptions of hypnotics among new users and long-term users in Japan. The high proportion of long-term BZD users suggests the need for educating clinicians about the optimal care pathway for insomnia.

Support (If Any)

MSD K.K., Tokyo, Japan
0517 Association of THC Usage on Diet, Exercise, and Sleep in Hispanic/LatinX Teenagers
Authors: Malhotra Niamh , Marganski Jordan , Merz William , Advani Ira , Crotty-Alexander Laura
Published: May 2022

Introduction

Diet, exercise, and sleep are recognized as the three pillars of health, with the assertion that failure to address one will compromise the other two. We have previously observed an association between inhalant use on sleep in adolescents (JCSM 2021). Our previous data raised concern for disruption induced by nicotine among teenagers. Given the recent increase in THC consumption, we sought to test the hypothesis that THC use among teenagers and young adults would be associated with deleterious lifestyle factors including poor diet and minimal exercise. We further sought to test whether Hispanic/LatinX status was predictive of poor health practices.

Methods

We conducted a social media survey using Twitter and Instagram to gather data on willing participants. We obtained IRB approval and used validated instruments to gather data on variables of interest. We assessed past and current THC use including in what form (inhalant, edible etc) and concurrently obtained data on diet and exercise patterns using standardized questionnaires. People self reported race, ethnicity, gender, and other factors.

Results

Of the 471 responders who provided data, we removed suspicious data based on identical responses at a given time suggestive of ‘bots’. We isolated the n=58 (37.3% Hispanic LatinX) who were in our target age range (13-25yrs) with complete data. For THC use, 27/58 participants (46.6%) responded “yes” to current usage, whereas 0 reported previous usage and 31 reported “no” (53.4%). Among people who self-identified as Hispanic/Latinx, 81.8% reported using THC currently whereas among people self-identifying as non-Hispanic, only 24.3% reported current THC use. Among the people reporting regular THC use, diet and exercise tended to be non-favorable compared to non-THC users. Of the 58 participants, only 19 reported never vaping (32.8%) while 15 (25.9%) reported vaping daily or weekly. For cigarettes only 20 people (34.5%) reported never using cigarettes whereas 14 (24.1%) reported using daily or weekly.

Conclusion

Based on our social media survey, we observed a high prevalence of vaping, cigarette smoking and THC use among adolescents and young adults. People who self-identified as Hispanic/LatinX reported high rates of THC use compared to non-Hispanic people. The implications of these findings for the sleep health of teenagers and young adults are unclear, but may provide a therapeutic target for future research.

Support (If Any)

Dr. Crotty-Alexander is funded by VA Merit award and by NIH.
0535 Prevalence of various forms of sleep disordered breathing in infants with Down syndrome
Authors: Cho Yeilim , Kwon Younghoon , Ruth Chris , Cheng Samuel , DelRosso Lourdes
Published: May 2022

Introduction

Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). Undiagnosed SDB in younger children may confer further risks of cardiovascular and neurocognitive complications associated with DS. However, there is paucity of studies examining SDB in infants with DS. The purpose of the study was to examine the prevalence of obstructive sleep apnea (OSA), sleep hypoventilation (SH) and hypoxemia in infants with DS.

Methods

Infants (≤12 months old) with DS who underwent first polysomnography (PSG) at Seattle Children’s hospital over a 6-year period were included. Data collected included obstructive apnea hypopnea index (oAHI), central apnea hypopnea index (CAHI), time spent with CO2 levels > 50 mmHg, time (minutes) spent with saturations <88% (T88), and saturation nadir (minO2sat). Exclusion criteria: follow up studies, and studies post procedures. Data presented by descriptive statistics and comparison by unpaired t-test.

Results

A total of 526 children with DS underwent PSG during the collection time. Forty two fit criteria (Mean age 6.6 months, male 66%). Diagnostic (n=13), split to oxygen (n=29, 69%). Split studies were more severe when compared with full diagnostic AHI (Mean 44.7 vs. 14.8, p=0.0007), T88 (Mean 12.5 vs. 0.2 p=0.03) and minO2sat (77.6 vs. 85.8%, p=0.01). Overall mean oAHI was 33.7 (S.D. 30) CAI was 3.4 (S.D. 3.1). 5/31 with reliable capnography had SH (16.1%) with no difference in age vs. the non-SH group (6.0 [3.2] vs. 6.6 [3.1], p>0.05). Overall, oAHI was more severe in infants with hypoventilation (58.9 [23.6] vs. 29.3 [63],p>0.05). Ten infants spent >5 min with saturations <88% (21.4%). All infants with hypoxemia had OSA (oAHI Mean 66.5 SD 40). Infants with OSA and hypoxemia had worse oAHI than those without hypoxemia (p<0.05).

Conclusion

Our data shows that a large percent of infants with DS (69%) required a split study due to severe OSA (mean oAHI 66.5) or hypoxemia (21.4%). The overall mean AHI for this age group was 33.7. Hypoventilation was present in 16.1%. This study highlights the high prevalence of SDB in infants with DS and supports early PSG assessment in this patient population.

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0543 The association of sleep-disordered breathing and daytime asthma burden among former premature school age children with bronchopulmonary dysplasia
Authors: Gunnlaugsson Sigfus , Mukharesh Lana , Greco Kimberly , Petty Carter , Gaffin Jonathan
Published: May 2022

Introduction

Sleep-disordered breathing (SDB) and asthma have a bidirectional relationship. Almost half of former premature school age children with bronchopulmonary dysplasia (BPD) have asthma or asthma-like symptoms. Prematurity is a known risk factor for sleep-disordered breathing. However, little is known about the association of SDB and asthma symptoms in former premature school age children with BPD.

Methods

Study sample comprised of participants in an ongoing cohort study, the AERO-BPD study. Participants were 6-12 years old, were born < 32 weeks gestational age and had been diagnosed with BPD. We administered the Pediatric Sleep Questionnaire (PSQ) and asthma symptom questionnaires. The prevalence of SDB was determined based on a PSQ > 0.33. The relationship between SDB and daytime asthma symptoms was assessed by multivariate logistic regression, adjusting for sex, race, BMI, rhinitis, asthma controller medication and days on respiratory support in the NICU.

Results

There were 33 subjects with a mean age of 8.8 years, roughly half were male and one third were overweight/obese. About half (48.5%) had daytime asthma symptoms and 39.4% had SDB. About half were on controller medication (inhaled corticosteroid or leukotriene receptor antagonist) and 39.4% had rhinitis. Among the 13 subjects with SDB, 11 reported daytime asthma symptoms and 5 of the 20 subjects without SDB reported daytime asthma symptoms. Subjects with SDB had over 17 times the odds of daytime asthma symptoms (OR 17.61, 95% CI [1.23, 251.76], p=0.035) compared to subjects without SDB, while adjusting for sex, race, BMI, rhinitis, controller medications and days on respiratory support in the NICU.

Conclusion

Our findings suggest that SDB is highly prevalent among former premature school age children with BPD. The findings suggest a relationship between SDB and daytime respiratory symptom burden among these patients rather than mere co-existence.

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0571 Associations Between Sleep Problems and Cardiovascular Disease and All-Cause Mortality in Asthma-COPD Overlap
Authors: Luyster Faith , Scott Paul , Chasens Eileen , Imes Christopher , Jeon Bomin , Shi Xiaojun , Strollo Patrick , Baniak Lynn
Published: May 2022

Introduction

Sleep problems (i.e., short and long sleep duration and sleep disorders) are common in persons with either asthma or chronic obstructive pulmonary disease (COPD) and have been linked to increased cardiovascular risk and mortality. This study determined whether sleep problems are associated with increased cardiovascular disease (CVD) prevalence and all-cause mortality in adults with asthma-COPD overlap (ACO).

Methods

Cross-sectional analysis of the 2007-2012 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index. Participants (n=7616) were stratified into four groups, using self-report and spirometry data: asthma (n=483), COPD (n=1006), ACO (n=398), and those without asthma or COPD (controls; n=5729). Sleep duration hours were categorized as short (≤5), normal (6-8), and long (≥9). Self-report of physician diagnosis of a sleep disorder (Yes/No) and cardiovascular disease (angina, congestive heart failure, coronary heart disease, hypertension or myocardial infarction) were collected. Logistic and Cox regression models adjusted for covariates were employed.

Results

Prevalence of sleep disorders in ACO (24.7%) was roughly two times higher than rates in the asthma (10.7%) and COPD (13.5%) groups and 5 times higher than controls (4.6%). The ACO group had a higher proportion of short sleepers (27.6%) compared to COPD (19.2%) and controls (11.7%) and higher proportion of long sleepers (6.9%) compared to COPD (5.5%). Short sleepers had higher odds for CVD (OR=1.70, 95% CI, 1.34–2.15) compared to normal sleepers. Relative to ACO with normal sleep, long sleepers in the other groups had lower odds for CVD (all P-values <0.05). Both short and long sleepers in the control (HR=0.19, 95% CI 0.07–0.47, and HR=0.07, 95% CI 0.02–0.35, respectively) or COPD (HR=0.38, 95% C, 0.19–0.77, and HR=0.24, 95% CI 0.12–0.51, respectively) groups had lower hazards of all-cause mortality compared to ACO with normal sleep. The influence of presence of sleep disorders on CVD and mortality did not vary between groups.

Conclusion

Associations between sleep duration and increased risk of CVD and all-cause mortality were stronger in ACO as compared to COPD and controls. Persons with ACO may represent a high-risk group that should be targeted for assessment and treatment of sleep problems.

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0594 Functional Limitations and Well-Being Throughout the Adult Lifespan: The Moderating Role of Sleep
Authors: Williams Claire , Dautovich Natalie , Dzierzewski Joseph
Published: May 2022

Introduction

Functional limitations represent individuals’ difficulty with completing essential activities of daily living, such as sitting, stooping, and walking. Though functional limitations have been linked to lower well-being outcomes, less is known about potential protective factors for well-being in the lived experience of functional limitations. This study aimed to examine the potential moderating effect of sleep quality on the association between functional limitations and life satisfaction, a common indicator of well-being, across the adult lifespan.

Methods

The present study used archival data from the Midlife in the United States Refresher study. Participants included 696 individuals (50.6% female, Mage=51.58 years, SD=13.61 years) who completed measures of functional limitations (Functional Status Questionnaire), global sleep quality (Pittsburg Sleep Quality Index), and life satisfaction (single-item measure). A moderated moderation analysis was conducted to examine the moderating role of sleep quality on the association between functional limitations and life satisfaction. Age was included as a secondary moderator in the analysis to determine differences between age groups (younger, middle-aged, elders). Demographic variables of gender and racial identity were used as covariates in study analyses.

Results

Participants’ global sleep score was a significant moderator of the association between functional limitation status and life satisfaction (B = 0.16, p < .001). Overall better global sleep quality buffered the association between higher functional limitations and worse life satisfaction. A significant three-way interaction between age, global sleep, and functional limitations was detected (β = -0.003, ΔR2 = .02, F(1, 686) = 12.25, p < .001). The effect of global sleep on the association between life satisfaction and functional limitation status was significant for younger adults (B = 0.07, p < .001) and middle-aged adults (B = 0.02, p = .0224), but not for elders (B = -0.02, p = .2223). Better global sleep quality buffered the negative association between functional limitations and life satisfaction specifically for younger and middle-aged adults.

Conclusion

The current study provided evidence for the importance of sleep quality in the lived experience of functional limitations, particularly for younger and middle-aged adults. This study contributes to a rapidly growing body of literature that seeks to identify protective factors for individuals experiencing lower functioning. In the future, clinicians should integrate sleep quality screeners in medical and mental health care settings in order to identify at-risk individuals who are experiencing functional limitations, and potentially consider establishing preventative, education-based interventions concerning sleep in the experience of functional limitations.

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0601 Predicting Incident Outcomes from the Microstructure of Sleep
Authors: Sun Haoqi , Adra Noor , Ayub Muhammad , Ye Elissa , Ganglberger Wolfgang , Thomas Robert , Westover M Brandon
Published: May 2022

Introduction

Sleep contains rich information about health status, relevant to future health outcomes including dementia, cerebrocardiovascular diseases, psychiatric diseases, and mortality. We hypothesized that the risk of these outcomes is predictable from quantitative analysis of sleep microstructure.

Methods

We included participants who underwent a diagnostic study and age older than 18 years. We excluded participants with missing demographics or PSGs < 2.5 hours in duration. We considered 11 outcomes including dementia, mild cognitive impairment or dementia, ischemic stroke, intracranial hemorrhage, atrial fibrillation, myocardial infarction, type 2 diabetes, hypertension, bipolar disorder, depression, and mortality. The outcomes were determined using ICD codes, brain imaging reports, medications, and/or cognition scores. We extracted 86 spectral and time-domains features from overnight sleep EEG recordings, including 57 features from NREM sleep epochs, 21 from REM, and 8 covariates including age, sex, body mass index, and medication prescriptions including benzodiazepines, antidepressants, sedatives, antiseizure medications, and stimulants. We modeled risk using Cox survival analysis with death as a competing risk. Model calibration was assessed using the difference in 10-year cumulative incidence (10y-CI) between Cox estimate vs. Aalon-Johansen estimate (ground truth).

Results

There were 8673 participants with an average age of 51 years; 51% were female. Participants were partitioned into three groups: poor sleep (hazard > 3rd quartile (Q3)), average sleep (Q1 ≤ hazard ≤ Q3), and good sleep (hazard < Q1). The model was able to predict the 10y-CI not significantly different from the ground truth, except for the risk of intracranial hemorrhage in the poor sleep group. The outcome-wise mean prediction difference in 10y-CI was 2.3% for the poor sleep group, 0.5% for the average sleep group, and 1.3% for the good sleep group. The outcomes with the top three poor-to-average risk ratios (RR) were dementia (RR = 6.2 95% confidence interval [4.5 – 9.3]), mortality (RR = 5.7 [5.0 – 7.5]), and MCI or dementia (RR = 4.0 [3.2 – 4.9]).

Conclusion

Sleep EEGs contain decodable information about the risk for future incidence of mortality, dementia, cerebrocardiovascular and psychiatric diseases. The findings strengthen the concept of sleep as a window into brain and general health.

Support (If Any)

This work is supported by the AASM Foundation 2019 Strategic Research Award.
0617 Association Between Green, Blue, and Open Spaces and Sleep Health in a Black Population: An Analysis of the MetSO Dataset
Authors: Moore Jesse , Jin Peng , Briggs Anthony , Grisby Diana , Seixas Azizi , Jean-Louis Girardin
Published: May 2022

Introduction

Blacks have a high burden of poor sleep health outcomes. Environmental determinants, such as green space or open environments, represent an underexplored contributor to sleep burden among Blacks. The extent these environmental factors affect sleep health outcomes within this population has not been adequately explored. To fill this gap in the literature, we investigated associations between environmental factors and sleep outcomes among Blacks in a large urban city. Objectives included (1) examine if zip-code derived open spaces (defined as proportion of open space in residential area,) green spaces (defined as open tree coverage of the ground) and blue spaces (proportion of water space) sleep apnea risk, and insomnia symptoms; (2) Examine if open, blue, and green spaces predict sleep outcomes independent of sex, age, and education level.

Methods

Our study used data from the Metabolic Syndrome Cohort Study (2009-2014), a studythat examined behavioral intervention methods to improve sleep apnea outcomes among Blacks. Sleep Apnea was assessed with the ARES (apnea risk) scale and insomnia status was collected through self-report (“Do you have difficulty staying/falling asleep or waking up?”) in a subset of 344 participants. Logistic regression analyses were performed to predict the effect green, blue, and open spaces had on sleep outcomes. To account for within zip-code correlation, mixed effects models (unadjusted and adjusted) account for sex, age, and education were considered.

Results

We found that none of the green, blue, or open space variables predicted sleep outcomes in the unadjusted model. In adjusted models, green space predicted sleep apnea risk scores, (OR=1.03, P<.05), but not insomnia.

Conclusion

Our study examined the extent which green, blue, and open spaces predicted insomnia and sleep apnea in urban blacks. We found that only green spaces were associated with sleep apnea, and none of our environmental variables predicted insomnia. Given the large amount of literature detailing a complex and multifactorial process on how environment affects sleep outcomes, our findings suggest that the link between urban environments, green spaces, and sleep outcomes may not be as definitive as they seem. Further research should explore the differential effect environment has on diverse populations’ sleep outcomes.

Support (If Any)

NIH R01HL142066, R01HL095799, RO1MD004113, R01HL152453
0621 Overcoming Obstacles to Recruitment and Community Engagement During COVID-19 and Development of a Digital Community Outreach program
Authors: Oliveira Bruno Carucci , Vidal Crystal , Pichardo Yakira , Hahn Kaitlin , Locklear Clarence , Moore Jesse Jesse , Jean-Louis Girardin , Seixas Azizi , Blanc Judite
Published: May 2022

Introduction

COVID-19 disrupted traditional research infrastructures and processes most notably in-person community recruitment, especially in underrepresented populations like racial ethnic minorities. To find creative and effective strategies, our group implemented and tested the efficacy of a culturally tailored community outreach plan (COP) developed during the US COVID-19 pandemic.

Methods

In February 2021, we developed an 11 step culturally-tailored community outreach program to support the implementation of three NIH funded community-based sleep studies. The following steps include: (1) description of the situation statement, 2) definition of goals, 3) engagement of audience/stakeholders, 4) tailoring message, 5) defining incentives, 6) choice of outreach methods, 7) identification of spokesperson, 8) choice of tools to assess progress, 9) identification of media outlets, 10) creation of study timeline, and 11) implementation of the plan. The studies leveraged several recruitment channels: 1) community settings (Place of worship, “community recruiter”, health fairs, word of mouth, & healthcare providers/doctors’ clinics), 2) online platforms (Facebook, Twitter, LinkedIn and Research Match), and 3) preexisting datasets in NYC.

Results

All three studies successfully met recruitment goals. ESSENTIAL [n= 224, 69% females, mean age= 36], MOSAIC [n=109, 61% females; mean age= 64] and Latinx/Hispanics: DORMIR[n=260, 61.3% of female; 32.4]. Among the three NYC cohorts, the most common recruitment channels were: preexisting datasets (74%), community settings (19%), & online platform (7%) for ESSENTIAL; preexisting datasets (85%) & community settings (15%) for MOSAIC, and (71.7%) online platform for DORMIR. However, the Miami cohorts came mostly from community settings 90% for Essential and 97% for MOSAIC.

Conclusion

Overall, the TSCS community outreach plan seems to be an effective tool to engage minoritized populations in greater NY and Miami. Our current field experience indicates that recruitment channels must be adapted to age, and community resources. Limited access to technology, particularly among older Blacks seem to be a major barrier for field staff to successfully engage the disenfranchised communities.

Support (If Any)

NIH R01HL142066-04; R01HL152453-01 R01HL142066, R01HL095799, RO1MD004113