bluuebunny/crossref_metadata_2025 huggingface dataset:
1218 To Order, or Not to Order Pre-Operative Adenotonsillectomy Polysomnography, That Is the Question
Authors: Phanthok Tenzing , Revana Amee
Published: April 2024

Introduction

Adenotonsillectomy (AT) is one of the most-commonly performed surgery with over 500,000 cases in children under 15 years of age annually. Two of the most common indications include sleep disordered breathing (SDB) and recurrent tonsillitis. Prior to surgery, preoperative polysomnography is commonly ordered to identify high risk patients for postoperative complications. We report a case of postoperative complication following an elective adenotonsillectomy in a patient suspected of sleep disordered breathing.

Report of case(s)

elective Adenotonsillectomy. He was evaluated by otolaryngology for a 1-year history of snoring, witnessed apneas, night terrors in the setting of 3+ tonsillar hypertrophy. No recurrent infections or prior sleep study. Intraoperative findings of adenotonsillar hypertrophy which resulted in adenotonsillectomy without any complications. Post-op complication included hypoxemia (oxygen saturations in the mid 80s while asleep). He was admitted for overnight observation and placed on a facemask with 5 L/min oxygen to keep his saturations >90%. Due to persistent desaturations with sleep, patient was transferred to ICU for a trial of PAP therapy with sleep. Postoperative CXR with ultrasound of the diaphragm demonstrated right hemidiaphragm paresis. Echocardiogram was unremarkable. Patient was discharged home with BPAP, steroids, oral antihistamine/steroid nasal spray with plans on outpatient polysomnogram.

Conclusion

Though, adenotonsillar hypertrophy is the most common cause of SDB; tonsillar size does not always correlate with the severity of SDB. A polysomnography is the gold standard to diagnose and assess the severity of SDB. The 2011 American Academic of Otolaryngology-Head and Neck Surgery guidelines recommend pre-AT PSG in children with SDB and high-risk comorbidities, including obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidosis. Pre-AT PSG guides medical decision-making, assess surgical candidacy, and optimize peri-operative monitoring in pediatric patients. Currently, there are no standardized guidelines for perioperative screening for SDB in children. Several barriers contribute to obtaining pre-AT PSG which includes access to pediatric sleep labs, long wait times, and high cost for PSG. Nevertheless, pre-AT PSG in pediatric patients to identify high-risk patients needs to be standardized to provide safer and efficacious pediatric care.

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1219 Diagnosing Narcolepsy by MSLT Without Taking in the Full Picture
Authors: Das John , Stahl Stephanie
Published: April 2024

Introduction

Narcolepsy is typically diagnosed by symptoms and an abnormal multiple sleep latency test (MSLT). However, many factors can affect the results of the MSLT, leading to an overdiagnosis of narcolepsy.

Report of case(s)

A 37-year-old female was referred with prior diagnoses of narcolepsy, depression, post-traumatic stress disorder, polysubstance abuse, obstructive sleep apnea (OSA), and hypertension. The patient obtained the diagnosis of narcolepsy by polysomnography/MSLT through another facility and was prescribed amphetamine/dextroamphetamine. The overnight polysomnogram demonstrated: total sleep time 285 minutes, rapid-eye movement (REM) latency 223 minutes, overall apnea-hypopnea index (AHI) 6/h, and REM AHI 45/h. The next day MSLT demonstrated a mean sleep latency of 7 minutes and 2 sleep-onset REM periods on the second and fourth naps. A urine drug screen (UDS) was not obtained. She reported 4-6 hours of sleep/day at the time of her MSLT. She denied cataplexy, sleep paralysis, or sleep-related hallucinations.

Conclusion

This case is one of many seen at our tertiary referral center of patients presenting with a diagnosis of narcolepsy by MSLT, but the MSLT was performed in invalid conditions. Many medications, substances, insufficient sleep, inappropriate timing of testing, untreated OSA, and other medical conditions all have the potential to lead to an abnormal MSLT that would appear consistent with narcolepsy, but often these factors are not considered. Insufficient sleep at home or on the preceding polysomnogram can lead to an abnormal MSLT. Though our patient had a history of polysubstance abuse, a UDS was not obtained. The American Academy of Sleep Medicine enjoins a polysomnogram for a duration of a 7-hour minimum (with 6 hours of sleep) prior to conducting an MSLT. Our patient only slept for 4.75 hours in the overnight polysomnogram. Her polysomnogram also showed OSA. A combination of these factors likely contributed to the patient’s daytime sleepiness. Her insufficient sleep, OSA, and use of sedating medications/substances should have been addressed first before performing an MSLT. We strongly encourage providers to ensure the MSLT is done in valid conditions to prevent the misdiagnosis of narcolepsy and initiation of unnecessary treatment.

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1220 Polysomnography in Children with Joubert Syndrome
Authors: Rani Seema , Cohen Alexandra , Strang Abigail , Chidekel Aaron
Published: April 2024

Introduction

Joubert syndrome is autosomal recessive, clinically and genetically heterogeneous with multiorgan involvement. Classic breathing symptoms include episodes of hyperpnea followed by apnea and periodic breathing. Gas exchange abnormalities include hyperventilation with low CO2s and intermittent desaturations. Purpose of this abstract is to report prolonged survival, describe the PSG findings and treatment modalities in 2 cases.

Report of case(s)

8-year-old female with Joubert syndrome, global developmental delay, hydrocephalus, hypotonia, cortical blindness presented for initial evaluation of sleep apnea. PSG revealed primarily central sleep apnea with upper airway resistance with snoring with arousal and few episodes of obstructive and mixed apnea and hypopnea. Gas exchange demonstrated episodic, brief desaturations, associated with central apneas. Repeat PSG at 13 years showed intermittent hyperpnea followed by apnea, low ETCO2s with self-limiting desaturations and periodic breathing. Gas exchange revealed low ETCO2 and desaturations. She was treated with clinical observation. PSG at age 20 year demonstrated intermittent hyperpnea followed by episodes of prolonged central apneas, with low ETCO2s and desaturations, and few obstructive hypopneas. Most central apneas associated with self-limiting desaturations, with significant number associated with oxygen saturation below 90%. Gas exchange demonstrated low ETCO2s and episodic desaturations. Supplemental oxygen was prescribed. 20-month-old female with diagnosed Joubert syndrome, cleft lip, polydactyly, hypotonia, dysphagia, and developmental delay presented for loud snoring and gasping during sleep and apneas while awake. Sibling with Joubert Syndrome and a tracheostomy had died. Presented for a second opinion for tracheostomy due to PSG at OSH demonstrating OSAHS with AHI of 18.2, OAI of 3.9 and CAI of 14.3, minimal hypoxemia, normal ETCO2 and SaO2 nadir was 75%. Repeat sleep study done at our center; AHI of 27.7 and OAI of 0.83. ETCO2 was normal, SpO2 nadir was 75% and minimal hypoxemia. Overall PSG demonstrated primarily central apneas with a few obstructive apneas and hypopneas and minimal O2 desaturations. Subsequently underwent BLPAP titration study and treated with non-invasive modality.

Conclusion

PSG in Joubert syndrome demonstrated intermittent hyperpnea and prolonged central apneas with low ETCO2's and brief desaturations. All events were predominantly present in REM sleep. Patients did well with low respiratory support and did not require tracheostomy.

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1221 Multiple Sleep Latency Testing in Patients with Comorbid Psychiatric Conditions: A Case Report
Authors: Hope Christopher , Rangel Nancy Arellano
Published: April 2024

Introduction

Excessive daytime sleepiness (EDS) has an estimated prevalence of 10-25%. Disorders of central hypersomnolence such as narcolepsy and idiopathic hypersomnia pose a diagnostic challenge since commonly used psychotropic medications can alter REM sleep parameters on polysomnography (PSG). The American Academy of Sleep Medicine has published protocols for the multiple sleep latency test (MSLT), including a 2-week medication discontinuation period (MDP) prior to testing, however discontinuation must be carefully considered.

Report of case(s)

A 22-year-old female with obsessive compulsive disorder, attention deficit hyperactivity disorder, and optic nerve hypoplasia presented with episodic EDS for several years. Epworth was 14 despite amphetamine-dextromphetamine 30mg twice daily. These episodes would last for 1-2 weeks without associated hypersexuality, increased food seeking behaviors or changes in cognition. Additionally, she would experience periods of not sleeping for days at a time, but not decreased need for sleep. She denied cataplexy, sleep-related hallucinations, or sleep paralysis. No symptoms of bipolar disorder reported. Initial polysomnography showed 432 minutes of sleep, REM latency of 39.5 minutes and AHI of 0.1. MSLT showed a mean sleep latency of 11.5 minutes without sleep onset REM periods. She reported later that she was unable to complete the MDP for escitalopram. The diagnosis at that time was hypersomnolence related to a mental disorder, and referred back to psychiatry. She returned 20 months later with more persistent hypersomnolence and a MDP was attempted again, this time with confirmation. She stopped venlafaxine and stimulant per protocol. PSG was again unremarkable and MSLT showed mean sleep latency of 7 minutes across 5 naps and SOREMP in 4 naps, resulting in the diagnosis of type 2 narcolepsy.

Conclusion

Sleep symptoms are common in patients with comorbid psychiatric conditions, and MDP can pose safety risks or be poorly adhered to. Longitudinal follow-up, repeat testing for persistent and worsening symptoms of EDS, and careful questioning about adherence to MSLT protocol can help clarify the eventual diagnosis.

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1223 REM-related Leg Cramps
Authors: Prier Jillian , Phipps Kristin , Alattar Maha
Published: April 2024

Introduction

Nocturnal leg cramps are common in the general population and is reported in 30% of adults. It is described under sleep related movement disorders in the International Classification of Sleep Disorders. It is a painful sensation in the legs that occurs during sleep or out of sleep but is not necessarily associated with a particular stage of sleep, relieved by stretching. We present a case of nocturnal leg cramps occurring during REM sleep.

Report of case(s)

Patient is a 53-year-old female reporting a history of waking from sleep with leg cramps. She underwent a CPAP titration study at our facility for a previously documented obstructive sleep apnea (AHI of 28, REM AHI of 74.1). On video, she was seen to wake abruptly out of each of the three REM sleep episodes, sitting and rubbing her calves, and reporting to the technician that she was having leg cramps. She would then get up and walk around to relieve the cramps but was able to return to sleep. Each episode lasted 3-5 minutes and was only relieved with movements or massage. No leg cramps were reported from non-REM sleep during this study. She denied symptoms of restless legs syndrome. Her periodic limb movements of sleep indices during her diagnostic and CPAP polysomnograms were 2.0 and 5.1 respectively and occurred during non-REM sleep. Medical history includes asthma and COPD (oxygen supplementation as needed), heart disease, prior polysubstance use disorder, and treated infective endocarditis in 2011.

Conclusion

Our case characterizes nocturnal leg cramps that occurred at a particular sleep stage, in this case strictly during REM sleep. Nocturnal leg cramps have been reported in the literature in association with various medical comorbidities including vascular disease and OSA. Further, it has been reported that CPAP therapy for OSA results in near or total elimination of leg cramp burden. It is unclear what is the mechanism of REM-related leg cramps, but it could be the REM OSA. To our knowledge, this is the first documented case of REM-related nocturnal leg cramps. We hope to add to the present literature on the mechanism of this disorder.

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1225 Vagal Nerve Stimulator-induced Sleep Disordered Breathing
Authors: Faryad Shujaa , Tran Jenny , Prasad Bharati
Published: April 2024

Introduction

Vagus nerve stimulator (VNS) is used for the treatment of refractory epilepsy. It can alter breathing patterns leading to sleep-disordered breathing (SDB). Screening for SDB is recommended before and after initiation of VNS therapy. We present a case of VNS-induced SDB which responded to continuous positive airway pressure (CPAP) therapy.

Report of case(s)

A 40-year-old Caucasian female underwent a home sleep apnea test (HSAT) due to symptoms of snoring, difficulty initiating sleep, teeth grinding, vivid dreams, nightmares, excessive daytime fatigue, and sleepiness. She denied parasomnia, symptoms of narcolepsy, and restless leg syndrome. Her habitual sleep duration was 9 hours with a sleep latency of 1 hour. She had 2-3 nighttime awakenings without nocturia. Pertinent medical history included refractory focal epilepsy, traumatic brain injury, insomnia, and attention deficit disorder. Medications were eslicarbazepine 800 mg daily, topiramate 200 mg twice daily, lamotrigine 100 mg daily, trazodone 300 mg nightly, and Adderall 60 mg daily. She had a VNS implanted 5 years ago. VNS settings were frequency of 20 Hz with on and off time of 30 and 60 seconds respectively. Her body mass index was 21 and Epworth Sleepiness Scale score was 15. HSAT showed significant periodic breathing without Cheyne stokes respiration and a 4% apnea-hypopnea index (AHI) of 9.6/hour. Follow-up diagnostic polysomnogram (PSG) revealed periodic breathing with the respiratory events occurring during VNS on time and abnormal sleep architecture including prolonged sleep and rapid eye movement (REM) latency, increased slow wave sleep, and pseudo spindles. The respiratory events were not associated with significant sleep fragmentation or desaturation. The AHI was 6.4/hour. Respiratory events improved with CPAP 7 cmH20 during titration PSG. She will be followed up in the sleep clinic to evaluate the effectiveness of CPAP therapy.

Conclusion

There is a complex relationship between epilepsy and SDB. Antiepileptics and VNS can cause new onset or worsening SDB. Management options for VNS-induced SDB include PAP therapy, changing VNS settings, or alternate therapies for refractory epilepsy. A multimodal approach requiring input from the patient, a sleep specialist, and an epileptologist is recommended for optimal results.

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1226 Shift Workers Acting Out? A Case of Shift Work Sleep Disorder Causing REM Behavior Disorder
Authors: Bhimineni Charishma , Mushlin Neil
Published: April 2024

Introduction

Rapid eye movement behavior disorder (RBD) is the manifestation of dream enactment with the failure of muscle atonia during rapid eye movement (REM) sleep. Shift work sleep disorder presents as sleep disruption and/or excessive sleepiness due to an atypical work schedule. Here we show a unique case of RBD provoked by a longstanding history of shift work sleep disorder.

Report of case(s)

67-year-old male with shift work sleep disorder, hypertension, and depression who presented for evaluation of RBD. Patient recently retired as a night shift worker and was taking melatonin and citalopram for more than 20 years. For the past several months, the patient has been having episodes of acting out his dreams, such as punching his wife if he was dreaming about punching someone in his sleep. Patient’s polysomnography showed REM sleep without atonia (RWA) in the chin and limb leads with 30% of the 30-s epochs having chin EMG activity with bilateral flexor digitorum superficialis (FDA) phasic EMG activity. Patient’s melatonin dose was increased and he was also started on benzodiazepine with control of his symptoms.

Conclusion

The common risk factors of RBD include Parkinson’s Disease, occupational toxin exposure, antidepressants, psychological stress (PTSD), or compromised health conditions (such as smoking or cardiovascular diseases). The patient has a chronic use of citalopram but antidepressant-induced RBD usually presents in the fourth/fifth decade of life. A review of literature indicates no cases of shift work disorder causing RBD. However, disruptions in the circadian rhythm put shift workers at an increased risk for conditions such as cardiovascular disease, metabolic syndrome, and psychological disorders, all exposures for RBD. Patient developed shift work sleep disorder causing sleep-onset and sleep-maintenance insomnia with a disturbance in the circadian rhythm, ultimately leading to an increased risk for developing RBD. Treatment for RBD includes melatonin as the first-line treatment with addition of low-dose clonazepam or cholinergic agents. With the increasing prevalence of shift work, it is imperative to understand the risks of shift work and identify sleep disorders that may arise, such as RBD, through more research.

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1227 Spinal Stenosis as a Rare Cause of Central Sleep Apnea
Authors: Rashed Albatol , Bedaiwi Nora
Published: April 2024

Introduction

Central sleep apnea is characterized by lack of drive to breathe during sleep, resulting in periods of insufficient ventilation and compromised gas exchange. CSA causes based on the awake Paco2 either hypercapnic and a nonhypercapnic group. Common causes include high-altitude, congestive heart failure, and chronic use of opioids and its very rare to be secondary to spinal stenosis.

Report of case(s)

49 years old male patient known to have hypertension and cervical spondylosis causing severe canal stenosis on epidural steroid injection. He was Referred to sleep medicine clinic for the assessment of possible obstructive sleep apnea, as he has interrupted sleep, history of snoring and witnessed apnea. Calculated STOP BANG 6. on examination, BMI 33, neck circumference 44 cm, micrognathia and malapati class 4, Split night sleep study showed severe respiratory events with AHI of 125.4 mainly central apneas with total 177 episodes, Frequent arousals related to events and oxygen desaturation were recorded to 82%. End tidal CO2 reached 57 mmhg during the study. CPAP titration was initiated and pressure gradually increased and ended at 12.0 cmH2O where all respiratory events were controlled with REM sleep supine position. Day time arterial blood gas showed PH 7.437 PaCo2 39mmhg, PaO2 86.9 mmhg and Hco3 26.2 mmol/ liter with base excess +2.1. Investigation for the cause of central sleep apnea were negative except for cervical MRI which showed multilevel degenerative disc disease at the level of C3-C4 ,C4-5, C5-6 and C6-7 causing different severity of neural foramen stenosis and nerve root compression. Based on the investigations the patient was diagnosed with severe central sleep apnea secondary to severe spinal stenosis, he was started on CPAP 12 cmh2o well tolerated and complaint to the PAP and his latest CPAP data showed AHI of 8/hour. For the spinal stenosis he is following with spine surgery and pain management team for pain control.

Conclusion

To diagnose the cause of central sleep apnea it is mandatory to exclude all other possible causes and consider spinal stenosis when facing a case with isolated central sleep apnea.

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0123 Family Economic Strain Is Associated with Parent-Child Sleep Interactions
Authors: Scheibner Hannah , Xu Wanli , Walsh Stephen , Condon Eileen
Published: April 2024

Introduction

Family economic strain is perceived financial hardship that can be experienced regardless of income level but is more prevalent among families of low socioeconomic status (SES). Low SES is an important social determinant of health and is associated with poor sleep in children, but pathways between financial hardship and child sleep are unclear. In this study, we examine the role of family processes in this relationship, including caregiver stress and parent-child sleep interactions (sleep location, praise, tantrums).

Methods

We conducted a cross sectional study of caregivers in the United States with children aged 3-5 years. Caregivers completed the Family Economic Strain Scale (FESS), Parent-Child Sleep Interactions Scale (PSIS), Perceived Stress Scale (PSS), and a demographics form via Qualtrics. Participants were recruited through social media and community flyers. Adjusting for child age, household size, and caregiver relationship status, we conducted multivariate linear regression to examine associations between economic strain, perceived stress, and parent-child sleep interactions. We then tested mediation using 5,000 bootstrap samples.

Results

111 caregivers completed all questionnaires. Higher family economic strain (β=.472, p<.001) and perceived stress (β=.357, p<.001) were associated with more problematic parent-child sleep interactions. Family economic strain was also associated with increased perceived stress (β=.559, p<.001). However, perceived stress did not mediate the relationship between family economic strain and problematic parent-child sleep interactions (95% CI -0.46, 2.4).

Conclusion

Increased family economic strain is associated with increased stress in caregivers, and both economic strain and caregiver stress are associated with problematic parent-child sleep interactions. Therefore, supporting caregivers in promoting healthy bedtime interactions may be an important approach for intervention to promote sleep and reduce inequities related to financial strain and stress. Further, our findings suggest the relationship between family economic strain and parent-child sleep interactions is not attributable to increased caregiver stress. Additional research is needed to understand the relationship between family economic strain and child sleep, including the role of other social determinants such as caregiver shift work, employment, housing, and the neighborhood environment. Findings from this study and future research may inform multi-level and policy interventions to support children at risk for unhealthy sleep.

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1231 It Is All About the Mask
Authors: Shammah Alaa , Shah Sachin , Stahl Stephanie
Published: April 2024

Introduction

Positive airway pressure (PAP) therapy is the mainstay of treatment for adults with obstructive sleep apnea. One important factor for PAP therapy is choosing the optimal mask type. Multiple studies demonstrate a higher residual apnea-hypopnea index (AHI) and more leaks with the use of oronasal masks compared with nasal masks, yet oronasal masks are routinely chosen as the first-line option.

Report of case(s)

An 80-year-old man had a split polysomnogram with a diagnostic apnea-hypopnea index (AHI) 65.8/h, central apnea index (CAI) 0.4/h, and oxygen nadir 76%. During the study, on continuous positive airway pressure (CPAP) 10 cmH2O with an under-the-nose nasal mask, sleep-disordered breathing was resolved with a residual AHI of 0.7/h with supine REM sleep achieved. The patient was set up with CPAP 10 cmH2O; however, after 1 week of CPAP treatment, a notification indicated that his PAP-AHI was elevated in the 40s/h. After exploring several possible causes, we discovered that he was using an oronasal mask at home. A change to a nasal mask or pillows was recommended. While awaiting mask refit, he was also changed to auto-titrating PAP (APAP) settings of 10-20 cmH2O. PAP download data are as follows. On CPAP 10 cmH2O with an oronasal mask: 12/12 days used, 95th percentile leak 0.3 lpm, AHI 31.7/h (CAI 4.3/h). On APAP 10-20 cmH2O with an oronasal mask: 6/6 days used, median pressure 14.9 cmH2O, average maximum pressure 19.6 cmH2O, 95th percentile leak 0.0 lpm, AHI 26.0/h (CAI 3.6/h). On APAP 10-20 cmH2O with a nasal mask + chin strap: 45/45 days used, median pressure 10.4 cmH2O, average maximum pressure 12.5 cmH2O, 95th percentile leak 5.5 lpm, AHI 2.2/h. Average nightly use of PAP was >6 h at all assessments.

Conclusion

Individuals involved in PAP management, including providers, sleep technologists, and durable medical equipment groups, need to be aware that oronasal masks may not provide the same level of benefit as nasal masks or pillows. Additionally, the type of PAP mask used during in-laboratory PAP titration compared to home use is also of importance as therapeutic pressures may be largely different as demonstrated in this case.

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1233 Delayed Sleep-Wake Phase Disorder: Your PCP’s Insomnia
Authors: Bhamrah Paul , Damia Carla , Hall Catherine , Ghildiyal Naomi , Monceaux Brittany , Bhamrah Malti , Bhamrah Manjit , Liendo Cesar , Chernyshev Oleg , Koothirezhi Rupa
Published: April 2024

Introduction

Delayed Sleep-Wake Phase Disorder (DSWPD) is commonly mistaken for sleep onset insomnia although it is one of the most frequently seen circadian rhythm sleep-wake disorders. These patients typically deal with comorbid depression that is more severe than the general population. Delayed diagnosis can lead to impaired cognitive function, metabolic changes, and a compromised quality of life. Hence, we report a case of a young adult referred to our clinic for management of DSWPD masked as sleep onset insomnia.

Report of case(s)

A 30-year-old female with past medical history of Ulcerative Colitis and Depression initially presented to PCP for “trouble sleeping”. Patient states she was given multiple medications including melatonin, Trazodone, and Seroquel. With no improvement of symptoms, the patient was referred to Sleep Medicine. On evaluation, a sleep log revealed the patient was consistently falling asleep around 830am and waking up between 330-630 pm with few mid sleep disturbances. She revealed the sleep problems started after a car wreck ten years prior and worsened significantly in the past two years. Of note, the patient dealt with snoring, daytime tiredness, and apneas for which a home sleep apnea test (HST) was done. HST revealed an AHI of 0.0 and oxygen nadir of 91%. Patient had significant strife with sleeping pattern as she was unable to socialize during the daytime and experienced worsening depression. A comprehensive plan was made to slowly advance the sleep phase with Melatonin 0.5mg-1mg to be started at 2am with plan for further advancement once new steady state was achieved; along with, light therapy upon awakening and cognitive behavioral therapy.

Conclusion

Although there has been improvement in sleep training, there is still a significant need for increased exposure to sleep pathology in residency programs. Our patient experienced a delay in diagnosis for over two years. The patient had worsening depression in this time and was improperly managed. DSWPD is a relatively common sleep disorder and thorough clinical assessment of sleep and wake up times can help elucidate a diagnosis. This case cries to our need to improve sleep education among trainees so that we can better serve our patients.

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1235 Sleep Architecture in School-age Children with Spastic Cerebral Palsy
Authors: Torres-Damian Yereth , Quintana-Vega Verónica , Vargas Ángel Daniel Santana , Millán-Rosas Gabriela , Gutierrez-Escobar Romel , Alarcón-Cabrera Ernesto , Palafox-Sánchez Arturo , Santana-Miranda Rafael
Published: April 2024

Introduction

10 cases of school-age children with a diagnosis of spastic cerebral palsy (CP) are described, which are within the APAC. Comprehensive Care Model. where diagnosis, rehabilitation, formal and alternative education are received in which polysomnography (PSG) with the international 10-20 system and simultaneous video was indicated, due to neurological risk factors and a recently implemented diagnostic protocol.

Report of case(s)

10 children (age: 8.3±1.8; females: n=7 [70%]. An increased sleep latency was shown (32.8 ± 32), with expected REM sleep latency (103.1 ± 37.7), without alterations regarding the sleep macrostructure, with an increased awakening rate (10.9 ± 4.8). Regarding the respiratory part, with a mean apnea-hypopnea index (AHI) of (5.5 ±4.7), 50% of the participants had more than 4 events per hour with a predominance of hypopneas during REM and supine position. Abnormal activity was recorded in 100%, with predominance in the left hemisphere (60%), with detection of motor manifestations in 80%; Only 70% of these patients have treatment for epilepsy. Finally, sweating artifact was detected in 60% of cases.

Conclusion

These are school-age children diagnosed with CP who have data on sleep fragmentation associated with the presence of abnormal electroencephalographic activity and obstructive sleep apnea-hypopnea syndrome. Multidisciplinary management of the detected nosological entities is recommended, with the aim of reducing sleep fragmentation, regulating EEG activity and respiratory events; Likewise, continue with rehabilitation plans in order to improve spasticity that would help change position and reduce nocturnal diaphoresis.

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1236 A Challenging Transition Between Volume Assured Modes in a Patient with Congenital Lung Abnormalities
Authors: Nuschke John , Judd Brooke
Published: April 2024

Introduction

The advent of volume-assured modes for non-invasive ventilation (NIV) has improved treatment of more complicated sleep-disordered breathing (SDB), although can present challenges in choosing ventilatory modes in patients with abnormal pulmonary anatomy.

Report of case(s)

Our Patient is a 44 year-old female with hypoplastic right lung, pulmonary hypertension and chronic hypercapnic/hypoxic respiratory failure on nocturnal NIV for complex sleep disordered breathing. She failed CPAP, BIPAP and BIPAP S/T. Average volume assured pressure support (AVAPS) NIV was initiated with stabilization in awake carbon dioxide levels, improved sleep quality and daytime energy . She was transitioned to an iVAPS (intelligent volume-assured pressure support) ventilator when eligible for new NIV. Initial settings were empiric, targeting Alveolar Ventilation 3.3 l/min to approximate similar minute ventilation set on previous AVAPS (Assumed dead space ventilation 1.05 l/min or 70 cc x 15rr). Despite relatively similar recorded pressures and respiratory parameters between the two volume-targeted ventilators, she experienced air hunger, palpitations and increased morning headaches after change from AVAPS to iVAPS. Alveolar ventilation target was increased to 4.5 l/min, yet symptoms persisted. She subsequently returned to AVAPS, with symptom resolution.

Conclusion

This case highlights the uncertainty in transitioning volume assured ventilator modes that use different algorithms to achieve ventilatory targets. We hypothesized incorrect dead space estimates in the setting of her abnormal pulmonary anatomy may lead to inequivalent respiratory targets between modes, but this does not appear to be the case based on available data. The sensation of dyspnea is complex, thus it is possible subtle changes in rise time, breath delivery, cycling and triggering may have contributed to air hunger. Furthermore, many assumptions are made when transitioning between intelligent ventilator modes and these assumptions are based on “normal” respiratory dynamics.

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Note- Chart would not transfer, abbreviated data placed below. Settings- (both modes) EPAP 6, Min ipap 17, max IPAP 30 AVAPS- Tidal volume 300, T insp max 2 second, rise time 200 ms iVAPS- Alveolar ventilation 3.3 l/min, T insp max 2 sec, rise time 200 ms Outcome AVAPS- RR 14-15, TV 301-313, MV 4.3, IPAP 20.6, triggered 36% iVAPS- RR 15-32, TV 300-480, MV 4.5, IPAP 20.6, Triggered 30%
0124 The Effects of Family Arguments on Parental Sleep Quality
Authors: Price Garrett , Shi Elliott , Kim Debora , Garrison Michelle
Published: April 2024

Introduction

Previous studies indicate that stress and trauma within family systems can affect the sleep quality of all family members. While most research on parent-child conflict and sleep has focused on child outcomes, this study aims to investigate the potential role of familial stress caused by arguments between families on the quality of parent’s sleep through the lens of Bowen’s Family Systems Theory.

Methods

Cross-sectional data from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) 2011 cohort’s 5th grade parent surveys in 2016 were utilized to understand the feelings of parents and other guardians on how often they argue with their children, how often they felt restless during their sleep, and how often they feel depressed. To assess the effects of parent-child conflict on parent report of restless sleep, two survey-weighted logistic regression models were created, both adjusting for parent and child age and one also adjusting for parental depression, and average marginal effects were calculated.

Results

The analysis included 8,375 parents and guardians, with a mean age of 39.9 years (SE = 0.17), of whom 14.0% reported mostly or always arguing with their child, 15.0% usually experiencing restless sleep, and 3.9% that they feel depressed most or all of the time. The first regression model found that parents report of frequent parent-child conflict was associated with an 13.2% increase (95%CI 10.4 to 16.1) in the predicted probability of parent restless sleep, an effect which decreased in size but remained significant after adjusting for parental depression (to a 9.1% increase, 95%CI 6.5 to 11.6), which may be a partial mediator of this effect.

Conclusion

These results emphasize the significant impact of familial arguments on parental restlessness, emphasizing the critical role of family cohesion in shaping parent’s sleep quality. One important limitation is the temporality and causality of the relationship between familial arguments, depression, and restless sleep, which cannot be evaluated with these models and requires further research.

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0125 The Association Between Maternal Closeness and Sleep Health During Adolescence
Authors: Ngam Christa-Maria , Master Lindsay , Reichenberger David , Hale Lauren , Chang Anne-Marie
Published: April 2024

Introduction

Quality of the parent-child relationship is an important factor for children's psychological health and adequate sleep. Few studies, however, have focused specifically on maternal closeness and adolescent sleep. We hypothesized that there would be an association between maternal closeness and improved dimensions of sleep health including timing, duration, and quality in adolescents.

Methods

Data were from the age 15 wave of the Future of Families and Child Wellbeing Study, a longitudinal birth cohort. Adolescents self-reported maternal closeness on a continuous scale with four levels (“not very close,” “fairly close,” “quite close,” and “extremely close”) and bedtime, sleep duration, and nights with difficulty falling or staying asleep (N=3,241). A subset of adolescents wore an actigraph to assess sleep onset, duration, wake after sleep onset, and sleep maintenance efficiency (N=775). Separate multiple linear regression models tested maternal closeness and sleep outcomes, adjusting for age, sex, race/ethnicity, household income, family structure, and caregiver education level.

Results

Results showed that 84.4% of adolescents reported feeling “quite close” or “extremely close” to their mother. For each unit closer to their mother, adolescents’ self-reported sleep duration was 12.2 minutes longer (p< 0.001), bedtime was 11.3 minutes earlier (p< 0.001), and they reported 1.7 fewer nights with difficulty falling asleep (p< 0.001) and 1.3 fewer nights with difficulty staying asleep (p< 0.001). With the smaller actigraphy sample, maternal closeness was not associated with actigraphic sleep outcomes.

Conclusion

Cross-sectional findings suggest that maternal closeness is associated with improved self-reported sleep health as measured by longer sleep duration, earlier bedtime, and fewer nights of insomnia symptoms. However, it is not clear whether closeness directly affects sleep or whether sleeping well improves the parent-child relationship. Future research should leverage micro-longitudinal studies to assess the daily fluctuations in maternal closeness and sleep.

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R25-HL147668, R01HD073352, R01HD36916, R01HD39135, and R01HD40421
0126 Adverse Life Events and Emotion Dysregulation in Adolescents: Sleep Disturbances as a Potential Moderator
Authors: Moates Sydney , Bui Christy , Clifford Sierra , Lemery-Chalfant Kathryn , Doane Leah
Published: April 2024

Introduction

Adverse life events (ALEs) are linked with emotion dysregulation, negative affect, and risk for psychopathology. Sleep is adaptive for processing stressors and emotion, and inadequate sleep can increase negative emotions and alter individuals’ understanding, management, and expression of these emotions. Although research suggests that sleep disturbances can impact emotion regulation abilities, research has focused on clinical rather than community samples. Therefore, this study examined the association between ALEs and emotion dysregulation in a community sample of adolescents, and whether sleep disturbances moderated this relationship.

Methods

Participants were twin adolescents (N = 452; 50.8% female; 58.2% non-Hispanic White; 29.1% Hispanic/Latino) participating in a larger longitudinal study examining the influences of sleep and stressors on physical and mental health (Lemery-Chalfant et al., 2019). Twins completed questionnaires at the 13-year study wave (Mage = 13.62, SD = .95) including reports of total sleep disturbances over a typical week (Children’s Report of Sleep Patterns; α = .79; Meltzer et al., 2013), total adverse life events experienced (adapted Adverse Life Events Questionnaire; Tiet et al., 1998), and emotional dysregulation (Difficulties in Emotion Regulation Scale; α = .90; Gratz & Roemer, 2004). To account for nested data (twins within families), a mixed-effects model was conducted in SPSS to examine the main effect of ALEs on emotion dysregulation, and whether sleep disturbances moderated this association. Covariates included age, sex, race/ethnicity, and socioeconomic status.

Results

ALEs (b = .07, SE = .01, p <.001) and sleep disturbances (b = .74, SE = .07, p <.001) each significantly predicted greater emotion dysregulation, but sleep disturbances did not moderate the relationship between ALEs and emotion dysregulation (b = .02, SE = .02, p = .39).

Conclusion

Our findings suggest that interventions focused on increasing sleep quality and reducing ALEs may support adolescent emotion regulation. However, sleep did not serve as a moderator and our study was limited by cross-sectional self-report of sleep and retrospective self-report of adverse life events. Future research measuring sleep objectively may clarify whether typical sleep patterns (as opposed to sleep problems) may protect against emotion dysregulation for adolescents exposed to ALEs.

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NIH 2R01HD079520
0127 Sleep Problems Mediate the Indirect Effect of Adverse Childhood Events on Undergraduates' Psychological Functioning
Authors: Uhlman Charlotte , Magzoub Muram , Shanley Nina , Fiduccia Victoria , Peltz Jack
Published: April 2024

Introduction

Adverse Childhood Events (ACEs) are highly prevalent, with two-thirds of U.S. adults reporting at least one ACE and one-sixth reporting four or more occurrences before age 18 (Rasmussen et al., 2023). Recent research further suggests that ACEs promote vulnerability to sleep problems, and with upwards of 60% of college students reporting deficient sleep (Lund et al., 2010), addressing the association between ACEs and college students’ sleep is warranted. The need to address this issue is only increased by the robust links between poor sleep and mental health problems in college students (Peltz et al., 2019). Accordingly, the current study sought to clarify the prospective links between college students’ ACEs and their psychological functioning via their levels of sleep disturbance.

Methods

Based on a 2-wave design (baseline and 2-month follow-up), the current study included a sample of 331 participants (86% female) who were assessed through an online survey. The sample’s mean age was 21.3 years (SD = 2.4; range 18-34), and 65.9% of participants identified as white, with 18.4% Asian or Pacific Islander, 6.6% Latinx, 5.7% Black, and 3.3% multi-racial or “other.” Students’ mean family income was $108,391 (SD = $62,579), with approximately 22% of students reporting family incomes of $50,000 or less and 16.3% with family incomes greater than $200,000.

Results

Mediation analyses, conducted using the PROCESS macro for SPSS (v. 4.3, Hayes, 2022), examined if ACEs predicted indirect, residual changes in psychological flexibility (i.e., a critical set of skills that alter the function of difficult or unwanted thoughts, emotions, and experiences in individuals’ lives) via sleep disturbance. Controlling for students’ reports of their sleep hygiene, sleep environment, gender, and socioeconomic status, results suggested ACEs were cross-sectionally associated with higher levels of sleep disturbance, which, in turn, predicted residual decreases in psychological flexibility across the 2-month period.

Conclusion

Given the influence of ACEs on college students’ sleep and psychological functioning, findings highlight the importance of addressing the potential early impact of adversity on college students.

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0128 Links Between Bicultural Stress and Sleep Problems in College: The Role of Cultural Congruence and School Belonging
Authors: Aguilar Karen , Sasser Jeri , Doane Leah
Published: April 2024

Introduction

Latino youth experience both physiological (i.e., sleep) and psychosocial health difficulties (i.e., bicultural stress), that are linked to adjustment. The current study focused on: 1) concurrent and longitudinal links between weekly bicultural stress, cultural promotive factors (cultural congruity, school belonging), and sleep problems; 2) whether cultural congruity and school belonging were protective between bicultural stress and sleep problems.

Methods

Participants were 181 Latino young adults(T1:Mage= 19.59; 32.8% male; 61.3% second generation immigrants; 67.4% first generation college students) at a large Southwestern public institution who completed surveys during their second (T1) and fourth (T2) year of college. Students reported on past-week bicultural stressors (T1), cultural congruity (T1; α=.80), school belonging (T1; α=.87), and sleep problems (T1, T2; PSQI).

Results

Cross-sectional regression analyses suggested that cultural congruity (b= -.82, p<.001), but not school belonging (b= -.58, p=.09) or bicultural stress (b=-.33, ns), were linked with concurrent sleep problems (T1). Further, there were no main effects of these variables on sleep longitudinally. There was a significant interaction between bicultural stress and school belonging in the prediction of concurrent sleep problems. Youth with high school belonging exhibited a significant positive association between bicultural stress and sleep problems, while bicultural stress and sleep problems were negatively linked for students with low levels. There was also a significant interaction between bicultural stress and cultural congruity in the prediction of sleep problems two years later. Youth with high cultural congruence had a negative link between bicultural stress and sleep problems, while associations were not significant for youth with low levels.

Conclusion

We found that cultural congruity was a promotive factor such that higher levels were linked with fewer sleep problems. Greater school belonging exacerbated the effects of bicultural stress on sleep problems, suggesting that those youth may be more reactive to bicultural stressors. Students high in cultural congruity who experienced higher bicultural stress had greater decreases in sleep problems two years later. Future interventions should focus on the roles of belonging and cultural fit when examining Latino students’ stress and sleep health in college.

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0129 The Role of Alertness in Cognitive and Affective Empathy
Authors: Curran Breanna , Miller Anthony , Krizan Zlatan
Published: April 2024

Introduction

Lack of sleep may harm the ability to accurately identify and experience others’ emotions. Yet it is unclear what outcome of sleep disruption is responsible for these effects. Specifically, can decreased alertness, a key outcome of insufficient sleep, help explain less empathizing? To this end, three studies tested the hypothesis that higher alertness foreshadows better empathic accuracy and higher empathic concern.

Methods

College-age participants took part in three studies (N’s of 227, 269, and 823). In all three studies, participants first reported on their subjective alertness using the Karolinska Sleepiness Scale and completed a 10-min Psychomotor Vigilance Test (PVT) to gauge their objective alertness. To measure cognitive and affective empathy, participants completed the Multifaceted Empathy Test (MET) where they had to accurately identify emotions from facial expression portraits (cognitive empathy) and report their empathic concern for each one (affective empathy). Study 2 was a replication of Study 1 using more diverse stimuli. In Study 3, some participants were randomly assigned to ingest 300 mg of caffeine before completing the tasks to experimentally increase their alertness (or received a placebo), and all participants completed an additional measure of affective empathy (Pictorial Empathy Test).

Results

In studies 1 and 2, slower response time on the PVT was significantly associated with lower levels of empathic concern (e.g. r= -.19, Study 1). Across all three studies, PVT lapses (e.g. r= -.24, Study 2) and false starts on the PVT, were significantly associated with poorer empathic accuracy (e.g. 1 r= -.31, Study 1). In study 3 those in the caffeine-administration group were more objectively alert and reported significantly higher affective empathy, measured by the pictorial empathy test (with only a trend on the MET), then the placebo and control group (d= .19).

Conclusion

These findings provide robust evidence that implicates lower alertness as a predictor of muted empathic responding and suggests alertness may support both cognitive and affective empathy. Changes in alertness may help explain how sleep disruption undermines individuals’ ability to empathize.

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