bluuebunny/crossref_metadata_2025 huggingface dataset:
0242 Intraindividual Variability in Sleep Duration Blunts Response to Academic Stressors
Authors: Do Alexander , Gao Chenlu , Scullin Michael
Published: May 2022

Introduction

Cross-sectional studies indicate that greater intra-individual variability (IIV) in sleep is correlated with poorer cognitive-emotional outcomes. Yet, the causal direction of these relationships is unclear. Therefore, we conducted an experimental study to compare cognitive and stress outcomes following random assignment to normal sleep, sleep restriction, and irregular/IIV sleep conditions.

Methods

Ninety college students (mean age=19.16, SD=0.98; 77.78% female) completed an Organic Chemistry virtual lecture during session 1. Then, for the next five days, participants were randomly assigned to the following conditions: normal sleep (8h in bed every night), sleep restriction (6h in bed every night), or IIV sleep (nightly oscillation between 6.5h and 9.5h in bed, with mean of 8h/night). Adherence was confirmed using actigraphy. On the sixth day (session 2), participants took a test on the Organic Chemistry lecture (retention measure) and then completed a new lecture and test (acquisition measure). Participants reported their stress levels across the lectures and tests.

Results

ANCOVA tests showed that sleep condition did not affect retention (F=0.50, p=.611) or acquisition of Organic Chemistry knowledge (F=1.33, p=.275; adjusted for Grade Point Average). Interestingly, participants in the IIV condition reported lower stress levels throughout session 2 than students in the normal sleep condition, adjusting for baseline stress levels (p=.025). Furthermore, when collapsing across conditions, correlation analyses confirmed that greater IIV in TST predicted lower stress throughout session 2, after adjusting for mean TST and baseline stress level (r=-.33, p=.014). This “blunted” stress response following nightly sleep fluctuations was in contrast to the heightened stress levels that were associated with shorter mean TST (r=-.22, p=.051).

Conclusion

Brief sleep variability and mild sleep restriction had minimal impact on laboratory measures of STEM knowledge retention and acquisition. However, greater sleep IIV blunted reactivity to academic stressors, which may reflect altered hypothalamic–pituitary–adrenal axis functions and have implications for student metacognition and course persistence. Future research should investigate the chronic effect of maintaining irregular sleep patterns and whether improving regularity of sleep across longer time intervals promotes cognitive and emotional functioning.

Support (If Any)

American Psychological Association, APAGS, Psi Chi, National Science Foundation (1920730, 1943323)
0297 Exploring sex and strain differences in mouse models of sleep disruption
Authors: Harper Kathryn , Nikolova Viktoriya , Conrad Monika , Moy Sheryl
Published: May 2022

Introduction

Sleep abnormalities are a common feature of neurodevelopmental disorders (NDDs), and can have severe consequences for the affected individual and their families. Although mouse models can be used to investigate the mechanistic basis for social deficits and other symptoms of NDDs, recapitulating sleep phenotypes in mice has proven to be difficult. In this study, we determined whether a sleep-disruption challenge could reveal or exacerbate sex and strain differences in sleep patterns, using two well-validated mouse models of autism-like behavior; the BALB/cByJ and C58/J inbred strains.

Methods

Mice were placed in a piezoelectric sleep system for 3 days to evaluate baseline sleep rhythms. Mice were then exposed to a series of novel environments, including open field boxes and activity wheel cages, for 3 hours during the morning period of the light cycle. Sleep rebound was determined by comparing percent time spent sleeping and average sleep bout length in the three 6-hr intervals before and after the sleep disruption. Subjects were males and females of the C57BL/6J, BALB/cByJ and C58/J strains.

Results

At baseline, the C57BL/6J and BALB/cByJ females showed significantly reduced percent sleep, in comparison to males. During rebound from sleep disruption, BALB/cByJ mice had higher percent time and longer sleep bouts than C57BL/6J, suggesting a greater vulnerability to the effects of sleep disruption. Additionally, female C58/J mice lacked the highly robust increase in percent sleep seen in C57BL/6J in the early night interval after sleep disruption.

Conclusion

Overall, the data provide evidence that this sleep disturbance procedure can induce a sleep rebound effect, which could be helpful in revealing strain and sex differences in NDD mouse models.

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0315 Quantifying the Temporal Relationship Between Self-report Sleep Quality and Cognition in Older Adults
Authors: Tapia Amanda , Yu Lan , Lim Andrew , Barnes Lisa , Hall Martica , Butters Meryl , Buysse Daniel , Wallace Meredith
Published: May 2022

Introduction

Poor sleep is a promising modifiable risk factor for impaired cognition in older adults. However, the relationship between sleep and cognition is likely bi-directional, and few studies have examined these temporal associations. We seek to investigate the temporal relationships between self-report sleep quality and global cognition.

Methods

Our analytic sample includes 1,610 participants from the Memory and Aging Project and Minority Aging Research Study without cognitive impairment at the initial visit (41% black, 77% female, mean[min,max] age = 77[54,100] years). Participants have cognition and sleep quality measured at an initial visit and up to 14 years of annual follow-up (median 6 years). Sleep quality was measured using a modified 10-item Pittsburgh Sleep Quality Index score (higher scores indicating worse quality) and standardized; global cognition was a composite z-score computed from an average of 19 cognitive tests. We used linear mixed effects models to quantify the concurrent and prospective (1-year) relationships of sleep quality and global cognition. Quadratic terms were also tested to allow for a potentially U-shaped relationship.

Results

When examining same-year associations with cognition as the outcome, sleep quality and cognition exhibit a negative quadratic association (linear term BL[p] = 0.01[0.021]; quadratic term BQ[p] = -0.01[0.051]), indicating that both better- and worse-than-average sleep quality are associated with lower cognition. Regarding 1-year associations, both better- and worse-than average sleep quality predict worse next-year global cognition (BL[p] = 0.01[0.008], BQ[p] = -0.01[0.033]). In contrast, better-than-average cognition predicts worse next-year sleep quality (B L[p] = 0.05[p=0.005]; BQ[p] = -0.01[0.650]) with a stronger association in this direction.

Conclusion

Understanding the temporal association between sleep and cognition has important implications for screening and development of novel treatments and interventions. The finding that both better and worse sleep quality are associated with worse cognition may reflect an underreporting of poor sleep symptoms in older adults with worsened cognition. Future work will examine these associations considering specific domains of self-report sleep (e.g., timing, efficiency, duration) and cognitive function (memory and perception), consider mechanisms relating sleep and cognition, and use objective measures of sleep (e.g., actigraphy).

Support (If Any)

RF1AG056331 (PI: Wallace), R01AG17917, R01AG22018
0352 Compliance to Sleep Recommendations: A Big Data Analysis In Users of a Consumer Sleep Technology
Authors: Raymann Roy , Watson Nathaniel , Gahan Luke , Gottlieb Elie
Published: May 2022

Introduction

The National Sleep Foundation has published sleep time duration (Hirshkowitz et al., 2015) and sleep quality (Ohayon et al., 2017) recommendations across the lifespan based on expert panel input. These recommendations offer sleep guidance to millions of individuals. Many individuals are using commercially available sleep tracking devices to measure their sleep. We analyzed the data of two non-contact radiofrequency sleep measurement devices (SleepScore Max (SleepScore Labs) and S+ (ResMed), both validated against PSG) to determine how well the users of these devices are sleeping.

Methods

Total Sleep Time (TST), sleep latency (SL) and sleep efficiency (SE) data of 40,892 users between 15 and 98 years old were used in this analysis, covering 5,513,369 nights of data, and averages per user were calculated. In alignment with the aforementioned papers, the data were split in 3 age groups; Young Adults (18-25), Adults (26-64) and Older Adults (>=65), and the criteria as listed were used, classifying the sleep indicators in 3 bins; Appropriate/Recommended, Uncertain/ May be Recommended, and Inappropriate/Not Recommended. Proportion of users meeting the Appropriate/Recommended, Uncertain/May be Appropriate and Inappropriate/Unlikely were calculated for each age group.

Results

In the Young Adults group most users had an Appropriate SL (SL<= 30 min; 79.7 %), an Appropriate SE (SE>=85%; 53.6 %), but only 30.0% had a Recommended TST (7 to 9 h.). In the Adult group, larger proportions of users met on average the Appropriate measures for SL (SL<= 30 min; 84.8%), SE (SE>= 85%; 58.4%), but only 27.3% slept on average the Recommended hours (TST 7 to 9 h). In the Older Adults group, the average SL and SE was considered Appropriate for most elderly users (SL<30min; 84.3: SE>=85%; 59.6%), but only 28.2% slept the Recommended amount (TST 7 to 8 h).

Conclusion

30% or less users slept on average the recommended amount, whereas slightly over half of the users showed the recommended sleep efficiency, and at least 79.7% fell on average asleep within 30 minutes. These results show that sleep improvement campaigns need to focus on extending the sleep duration and sleep hygiene to improve SE.

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0374 A sleep health educational module for social work students is associated with improvements in sleep knowledge and sleep quality
Authors: Spadola Christine , Groton Danielle , Freeman Katherine , Burke Shanna , Hilditch Cassie , Pandey Abhishek , Littlewood Kerry , Zhou Eric , Bertisch Suzanne
Published: May 2022

Introduction

Insufficient sleep is highly prevalent, particularly among underserved groups. Social workers often work with underserved populations who are at risk for sleep deprivation and are well-positioned to promote healthy sleep behaviors. However, sleep health training is rarely integrated into social work curriculums. To address this gap, we developed and tested a 2-hour online sleep health educational intervention, designed to improve sleep-related knowledge among social work students.

Methods

We recruited 106 social work students via a departmental listserve to participate in a 1-hour sleep education module. Pre-post module changes in knowledge and beliefs were assessed using the Sleep Beliefs Scale (SBS) and the Sleep Practices and Attitudes Questionnaire (SPAQ). We also assessed changes in self-reported sleep quality using the Pittsburgh Sleep Quality Index (PQSI). Wilcoxon Signed-Rank tests were used to assess pre- to post-module scores. We conducted qualitative research (open-ended questions and focus groups) to assess acceptability and to inform future module refinement.

Results

Of the 106 students participating in the module, mean age was 28.3±8.8 yrs, 92.5% were female, 4.7% male, and 2.8% other. The sample was racially/ethnically diverse with 37.7% identifying as non-Hispanic White, 34.0% African American/Black, 22.6% Hispanic/Latino, 0.9% Asian, and 4.7% other. Ninety (84.9%) participants completed the questionnaires. Demographics did not differ between students who completed the training and those who did not. Students participating in the module reported improvements in the Sleep Beliefs Scale (Median=2.0, range: -4, 10 [positive change=increased knowledge]), the SPAQ (Median=-10, range: -37, 95 [negative change=increased importance of sleep]), and the Global PQSI Score (Median=-1, range: -7, 4 [negative change = improved sleep quality]). Qualitative data supported the module’s acceptability and utility (e.g., “Not only will I adapt these healthy sleep habits, I will always ask my clients how they are sleeping!”). Suggestions for improvement included adding additional topics (e.g., over-the-counter sleep aids) and shortening the training duration.

Conclusion

Participation in an online educational module was associated with not only improvements in sleep knowledge but also self-reported sleep among social work students, suggesting feasible ways to expand providers promoting sleep health.

Support (If Any)

American Academy of Sleep Medicine Foundation
0382 Optimizing Obstructive Sleep Apnea Screening and Education in Underserved Community
Authors: Singh Jasmin , Corso Michael , Jones Willie , Campbell Onae , Moskos Frank
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. There are many conditions associated with OSA, including obesity hypoventilation syndrome, congestive heart failure, atrial fibrillation, pulmonary hypertension and pulmonary diseases. Majority of patients endorse daytime sleepiness, but family often report snoring and apneas. There are multiple screening tools, including the STOP-BANG. Scores 5 or above are high risk for OSA. Untreated OSA worsens comorbidities and increases risk of myocardial infarction and stroke. We provided physicians with this screening tool to help risk stratify, thus providing better patient education and treatment.

Methods

Physicians educated on OSA, STOP-BANG and documentation in didactic sessions. Patients ages 18 and older provided with questionnaire. Physicians measured neck circumference and BMI. Questionnaire reviewed with patient and education given. If high risk, sleep medicine referral recommended. Physicians documented in charts about discussion, risk category and referral status.

Results

Total of 407 patients completed the questionnaire, but 67 patients were excluded for no neck circumference. Remaining 340 patients stratified by STOP-BANG scores: 128 Low, 142 Intermediate, 70 High Risk. From High Risk category, 20 patients referred to Sleep Medicine. Only 18 charts from the 50 not referred explained why, which included patient declining, already on CPAP, referral already in, and because outpatient sleep study was ordered instead. Data stratified for age, gender, BMI and neck circumference. Age range from the 340 total was 19-87-years-old. From High Risk, 39 were male and 31 female. BMI range for total was 17-61, while High Risk was 22-61. Neck circumference range for total was 12-21 inches, while High Risk was 12.5-17.5 inches.

Conclusion

The goal was not only to provide a validated screening tool, but also provide better OSA education for physicians and patients. Results indicate many patients were intermediate or high risk. Majority of patients had multiple comorbidities, including obesity, hypertension and diabetes. This study highlights the prevalence of OSA in an inner-city primary care clinic and challenges involved in screening all at risk patients. Further investigations could include the effect of more education, continued screening and effect of lifestyle changes in this vulnerable population.

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0383 Clinical Impact of Pitolisant on Excessive Daytime Sleepiness and Cataplexy in Adults With High Burden of Narcolepsy Symptoms
Authors: Meskill Gerard , Davis Craig , Zarycranski Donna , Doliba Markiyan , Schwartz Jean-Charles , Dayno Jeffrey
Published: May 2022

Introduction

This post hoc analysis evaluated the clinical impact of pitolisant for the reduction of excessive daytime sleepiness (EDS) and cataplexy in adults with a high burden of narcolepsy symptoms. When evaluating results of randomized, placebo-controlled trials, the clinical impact of a treatment can be assessed using effect size metrics that include Cohen’s d (the standardized mean difference of an effect) and number needed to treat (NNT; number of patients that need to be treated to achieve a specific outcome for one person).

Methods

Data were pooled from 2 randomized, placebo-controlled, 7- and 8-week studies of pitolisant (individually titrated; potential maximum dose, 35.6 mg/day) in adults with narcolepsy. Analyses included 3 independent patient subgroups with high symptom burden: (1) baseline score of ≥16 on the Epworth Sleepiness Scale (ESS), (2) sleep latency of ≤8 minutes on the Maintenance of Wakefulness Test (MWT), and (3) ≥15 cataplexy attacks per week. Efficacy measures included the ESS, MWT, weekly rate of cataplexy (WRC), and Clinical Global Impression of Change (CGI-C). Cohen’s d was derived from the least-squares mean difference between treatment groups (pitolisant vs placebo), and NNTs were calculated from response rates. Missing values were imputed using a last observation carried forward approach.

Results

The high-burden populations included 118 patients for the ESS subgroup (pitolisant, n=60; placebo, n=58), 105 for MWT (pitolisant, n=59; placebo, n=46), and 31 for cataplexy (pitolisant, n=20; placebo, n=11). Cohen’s d effect size values for pitolisant versus placebo were 0.80 for ESS, 0.31 for MWT, and 1.31 for WRC. NNTs for pitolisant were 3 for ESS score reduction (≥3-point decrease from baseline or final score ≤10) in the ESS subgroup and 2 for WRC reduction (≥50% decrease from baseline) in the cataplexy subgroup. For the CGI-C for EDS (“much” or “very much” improved), NNT was 5 in the ESS subgroup and 4 in the MWT subgroup; for the CGI-C for cataplexy, NNT was 3 in the cataplexy subgroup.

Conclusion

The results of this analysis demonstrate the robust efficacy of pitolisant for the reduction of both EDS and cataplexy in patients with severe narcolepsy symptom burden.

Support (If Any)

Bioprojet Pharma and Harmony Biosciences, LLC.
0406 Efficacy of Once-Nightly Sodium Oxybate (ON-SXB; FT218) Across Stimulant Use Subgroups: Post-hoc Analyses From the REST-ON Trial
Authors: Thorpy Michael , Dauvilliers Yves , Roth Thomas , Morse Ann Marie , Roy Asim , Bogan Richard , Seiden David , Dubow Jordan , Gudeman Jennifer
Published: May 2022

Introduction

In the REST-ON trial (NCT02720744), once-nightly sodium oxybate (ON-SXB; FT218) was associated with significant improvement vs placebo for mean sleep latency on the Maintenance of Wakefulness test (MWT) and Clinical Global Impression of Improvement (CGI-I) rating in the overall population (both P<0.001) and in subgroups of participants taking concomitant stimulants (both P<0.05). Post-hoc analyses of ON-SXB efficacy on disturbed nocturnal sleep (DNS) and Epworth Sleepiness Scale (ESS) score were conducted.

Methods

Participants (≥16 years of age) with narcolepsy type 1 or 2 were randomized 1:1 to ON-SXB (1 week, 4.5 g; 2 weeks, 6 g; 5 weeks, 7.5 g; 5 weeks, 9 g) or placebo. Mixed-effects models for repeated measures calculated P values for change from baseline vs placebo at weeks 3 (6 g), 8 (7.5 g), and 13 (9 g) in ESS score, sleep shifts (ie, number of shifts from N1, N2, N3, and rapid eye movement [REM] sleep to Wake and from N2, N3, and REM sleep to N1), nocturnal arousals (NA), and patient-reported outcomes of sleep quality and refreshing nature of sleep on a 100-point visual analog scale.

Results

In the modified intent-to-treat population (n=190), 119 participants took concomitant stimulants (ON-SXB, n=66; placebo, n=53); 71 did not take stimulants (ON-SXB, n=31; placebo, n=40). Improvements with ON-SXB vs placebo were reported: ESS (stimulants: all doses, P≤0.01; no stimulants: 6 g, directional improvement; 7.5 g, P<0.01; 9 g, P<0.001), sleep shifts (stimulants: 6 g, P<0.01; 7.5 and 9 g, P<0.001; no stimulants: all doses P<0.001), NA (stimulants: 6 g, directional improvement; 7.5 g, P<0.01; 9 g, P=0.001; no stimulants: 6 and 7.5 g, P<0.05; 9 g, P=0.01), sleep quality (stimulants: 6 and 7.5 g, P<0.01; 9 g, P<0.05; no stimulants: all doses P<0.001), refreshing nature of sleep (stimulants: 6 and 9 g, P<0.05; 7.5 g, P<0.001; no stimulants: 6 and 7.5 g, P<0.01; 9 g, P=0.001).

Conclusion

Data from these post-hoc analyses were consistent with the previously reported results from REST-ON and support the efficacy of ON-SXB for EDS and DNS, as measured by objective and subjective endpoints whether or not stimulants were concurrently used.

Support (If Any)

Avadel Pharmaceuticals
0412 Post-Traumatic Narcolepsy in 9 Military Veterans with a History of a Head Injury
Authors: Stultz Debra , Osburn Savanna , Burns Tyler , Gills Thomas , Shafer Christina , Walton Robin , Stoner Jamie , Roe Star , Pawlowska-Wajswol Sylvia
Published: May 2022

Introduction

Head injuries can be associated with hypersomnia acutely and chronically and can occur in those with mild/moderate/severe head injuries and with or without loss of consciousness. If hypersomnia persists, additional evaluation is warranted. Head injuries are increasingly reported in the military due to falls, assaults, motor vehicle accidents, and IED explosions, with some reporting, repeated blast injuries; secondary narcolepsy should be considered within the differential. Untreated narcolepsy can lead to safety issues for both the patient and others; therefore, aggressive evaluation is necessary with a PSG/MSLT combination and/or by the patient meeting the diagnostic criteria outlined in the DSM-V.

Methods

At the 2021 SLEEP conference, we presented a poster on our retrospective chart review of 176 patients diagnosed with narcolepsy from 2013 through 2020, with 50 patients having a history of head injury (28.4%). Of those 50 patients, nine were military veterans who reported a history of some degree of traumatic brain injury. While the majority had coexisting psychiatric disorders and/or other sleep disorders, the complaints of excessive daytime sleepiness were persistent despite aggressive treatment of the other associated diseases. The diagnosis of narcolepsy was confirmed by MSLT and/or DSM-V criteria.

Results

This study is a case series of 9 U.S. military veterans diagnosed with narcolepsy and a head injury history. There were eight males and one female, with the average age being 48. Five of the patients were diagnosed with type 1 narcolepsy with cataplexy, the other four without cataplexy were all on long-term treatment with antidepressants. The use of antidepressants while evaluating narcolepsy should be considered as they are REM suppressants, can interfere with MSLT findings, and can inhibit cataplexy symptoms preventing the appropriate diagnosis of Narcolepsy by DSM-V criteria.

Conclusion

Persistent hypersomnia in a patient with a history of a head injury could suggest a disorder of narcolepsy, and appropriate evaluation for this disorder appears indicated. The military having a high risk of head injuries may require assessment of narcolepsy while in active duty or long after discharge as the hypersomnia may be chronic and previously undiagnosed.

Support (If Any)

**No support was given for this research
0431 Examining the indirect effects of acculturation stress on insomnia through alcohol use and brooding among Latinx women and men
Authors: Cosenzo Luciana Giorgio , Alcántara Carmela
Published: May 2022

Introduction

Acculturation stress, a type of sociocultural stress, and insomnia have been consistently, positively associated among Latinx populations; however, the mechanisms of this association remain elusive. Models of insomnia suggest maladaptive coping strategies, such as brooding and alcohol use, may drive the relationship between stress and this disorder. Because acculturation stress has been positively associated with brooding and alcohol use, these coping strategies may explain the relationship between acculturation stress and insomnia among Latinxs. Additionally, gender differences in the use of these coping strategies and insomnia have been well documented. Thus, we examined the indirect effects of acculturation stress on insomnia through brooding and alcohol use among Latinxs and explored gender differences in these effects.

Methods

Separate bias-corrected boot-strap tests of mediation with case resampling (1000 replications) were conducted to examine the indirect effect of acculturation stress measured using the Hispanic Stress Inventory(HSI), on insomnia, measured with the Insomnia Severity Index(ISI), through brooding and alcohol use. These tests were conducted using cross-sectional survey data from healthy Latinx adults participating in the Latino Sleep and Health Study(n=187). Unadjusted models were the primary models. Progressive adjustments were made to account for age and socioeconomic status. Stratified analyses by gender were conducted to explore potential differences in the mediation models between Latinx women and men.

Results

Participants were Mage=37.43(SD=13.67), 64.17% were women, and 30.48% were of low socioeconomic status. Participants reported a mean HSI of 9.28(SD=9.51), brooding score of 9.44(SD=2.88), and ISI of 6.65(SD=5.51). In a typical week, participants consumed M=2.61 alcoholic beverages(SD=4.68). In primary models, the total and direct effects of acculturation stress on insomnia were significant, (b=0.04,95%CI:0.02-0.06; b=0.02,95%CI:0.004-0.04). The indirect effects of acculturation stress through brooding were also significant (b=0.02, 95%BCa CI:0.01-0.03). Among women, these indirect effects had larger coefficients than among men (b=0.02,95%BCa CI:0.01-0.04; b=0.01,95%BCa CI:0.004-0.04). Alcohol use was not a significant mediator in this relationship, (b=-0.001,95%BCa CI:-0.004-0.0002).

Conclusion

These findings suggest that psychological interventions targeting Latinxs should aim to reduce brooding as a coping strategy for acculturation stress to promote healthy sleep. Future studies should replicate these analyses in temporally ordered data to test the causal relationships among these variables.

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0450 Effect of Lemborexant on Early Morning Awakening in Subjects with Severe Problems with Waking Too Early
Authors: Moline Margaret , Zee Phyllis , Kumar Dinesh , Pappadopulos Elizabeth , Malhotra Manoj
Published: May 2022

Introduction

Lemborexant (LEM) is a dual orexin receptor antagonist approved in multiple countries for the treatment of adults with insomnia. In Study E2006-G000-304 (Study 304; NCT02783729), LEM improved sleep onset and sleep maintenance. This analysis evaluated treatment with LEM in subjects reporting “problems waking up too early” on the Insomnia Severity Index (ISI) Item-3 as assessed by wake after sleep onset in the second half of the night (WASO2H).

Methods

Study 304 was a 1-month, randomized, double-blind, placebo(PBO)-controlled and active-comparator (zolpidem extended-release 6.25mg [ZOL]) study of LEM 5mg (LEM5) and LEM 10mg (LEM10). Subjects whose baseline scores were ≥3 (severe/very severe) for ISI Item-3 were included in this analysis. WASO2H was defined as minutes of wake during the interval from 240 minutes after lights off until lights on (based on 8hr time in bed). WASO2H was measured at Days 1/2 and 29/30 using polysomnography and averaged across consecutive nights; change from baseline was analyzed using mixed effect model repeated measurement analysis.

Results

Treatment groups were (number of subjects: treated/had ISI Item-3 scores ≥3) LEM5 (220/140), LEM10 (219/140), ZOL (216/158) and PBO (180/122). Baseline mean (standard deviation) WASO2H (minutes) ranged from 77.8-82.25 (30.3-35.5) across treatment groups. By Day 1/2, WASO2H improved significantly with LEM versus ZOL and PBO. Least-squares mean (LSM; standard error [SE]) WASO2H change from baseline at Day 1/2 was -15.56(2.3) (PBO), -34.19(2.2) (LEM5), -42.54(2.2) (LEM10), and -27.82(2.1) (ZOL); all P<0.0001 versus PBO, P=0.0222 and P<0.0001 for LEM5 and LEM10 versus ZOL, respectively. Improvements in WASO2H were maintained through Day 29/30. LSM (SE) change from baseline in WASO2H at Day 29/30 was -15.07(2.5) (PBO), -30.06(2.4) (LEM5), -34.30(2.4) (LEM10), -25.30(2.3) (ZOL); all P<0.002 versus PBO, P=0.1187 and P=0.0033 for LEM5 and LEM10 versus ZOL, respectively. ISI Item-3 improved from ≥3 at baseline to <3 for most LEM5 (97/137[70.8%]) and LEM10 (92/133[69.2%]) treated subjects.

Conclusion

LEM provided significant benefit in WASO2H versus PBO (LEM5 and LEM10) and versus ZOL (only LEM10 at Day 29/30) among subjects with severe/very severe problems with waking too early. Improvements reported for ISI Item-3 for LEM subjects supports this benefit.

Support (If Any)

Eisai Inc.
0475 Prevalence and Potential Benefits of Cannabis Use in Patients with Insomnia
Authors: Jamil Saad Bin , Kachechian Talar , Fleet Benjamin , Grewal Ritu
Published: May 2022

Introduction

Insomnia is highly prevalent amongst patients presenting to sleep centers and it can be challenging to treat. Current treatment modalities include pharmacological intervention and cognitive behavioral therapy. Cannabis use is widely prevalent and has been approved in most states in the United States for medical use. Insomnia has been approved in some states as a qualifying condition for prescribing medical marijuana. Although the sedative effects of cannabis are well known, there are no established clinical guidelines with regards to its use for the treatment of insomnia.

Methods

We conducted a retrospective chart review to determine the use and potential benefits of cannabis in patients with insomnia over a three-year period at a tertiary care academic center. All patients with cannabis/marijuana and insomnia use listed in their electronic health record were included.

Results

Our cohort included 159 patients (67 males, 91 females; mean age= 48.4 years) who had a diagnosis of insomnia and used cannabis. 62 out of 159 (39%) patients reported improvement in sleep symptoms, whereas 18 (11.3%) patients denied any improvement. The status of remaining 79 patients (49.7%) was undetermined. 40 patients were African American, 103 were white, 4 were Hispanic; the remaining were of other or unknown ethnicities. 80 (50.3%) patients were using medically prescribed marijuana for various disorders; 50 (31.4%) were using non prescribed cannabis and prescription status was undetermined in 29 (18.2%) patients. Average use of cannabis was 4.9 days per week as reported by 47 patients who used cannabis regularly.50 out of the 62 patients with diagnoses of insomnia and cannabis use who reported improvement in symptoms had a history of comorbid anxiety, whereas 37 of 62 (59.6%) patients had comorbid depression. 29 out of 62 (46.7%) patients were using selective serotonin receptor uptake inhibitors (SSRI) and 24 of 62 (38.7%) were using benzodiazepines.

Conclusion

Cannabis use is highly prevalent among patients with a diagnosis of insomnia. Patient with cannabis use may have comorbid mood and anxiety disorders and may be taking SSRIs or benzodiazepines. Sleep physicians need to be aware of cannabis use and its impact on sleep symptoms in patients with insomnia.

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0520 Effect Of Sleep Disordered Breathing On Control And Severity Of Asthma On Pediatric Population
Authors: Singla Aarushi , Bagla Jyoti , Gothi Dipti , Kumari Sweta , Sasidharan Jaseetha , Mishra Ruchi , Dubey Anand , Patro Mahismita , Vaidya Sameer
Published: May 2022

Introduction

Pediatric sleep disordered breathing (SDB) can co-exist with asthma, affecting its control and severity, adding to the overall health care burden. Our aim was to determine the association of SDB with control and severity of asthma, and to evaluate any concomitant risk factors associated with both.

Methods

Based on the Sleep-Related Breathing Disorder scale extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5 – 15 years) with persistent asthma were classified as: with SDB (SDBS-PSQ ≥ 0.33) and without SDB, in a cross – sectional study. Characteristics like age, gender, body mass index and spirometry were compared. Control of asthma was categorized into well-controlled, not-well, and poorly controlled using childhood – asthma control test (c-ACT ≥20, 12-19 and ≤12, respectively). Correlation between SDBS-PSQ and c-ACT was analysed. Correlation of risk factors like adeno-tonsillar hypertrophy, gastroesophageal reflux disease, obesity and allergic rhinitis (AR) with presence of SDB in asthma was also assessed.

Results

Among sixty asthmatics, mild, moderate, and severe persistent asthma was observed in 26.67%, 40% and 33.33%, respectively. 18.33% asthmatics had risk for SDB (mean SDBS-PSQ of 0.45 ± 0.11 vs 0.07 ± 0.07 in those without SDB, p<0.001). Baseline and spirometric characteristics were similar in both groups. Asthmatics with SDB had higher rates of severe persistent (63.6% vs 26.5%, p = 0.018) and uncontrolled asthma (100% vs 30.6%, p<0.001), and a lower mean c–ACT score (14.45 ± 3.20 vs 20.04 ± 4.56, p<0.001) compared to asthmatics without SDB. Amongst asthmatics with SDB, mean SDBS-PSQ score was higher in not-well and poorly controlled asthmatics (0.41 ± 0.07 vs 0.12 ± 0.08, p <0.001 and 0.58 ± 0.08 vs 0.01 ± 0.07, p<0.001; respectively), compared to those without SDB. Negative correlation was confirmed between c-ACT and SDBS-PSQ scores (p<0.001, r2 = 0.36). Only AR was associated with SDB (p = 0.001, correlation coefficient <0.001).

Conclusion

Control and severity of asthma is adversely affected by SDB, independent of other risk factors. AR can increase the risk of SDB in asthmatic children, further affecting the control. Therefore, children with severe and difficult-to-control asthma should be screened for SDB using objective questionnaires like SDBS-PSQ.

Support (If Any)

Nil
0531 Characterization of Sleep-Disordered Breathing among Newborn Infants with Myelomeningocele
Authors: Hassan Fauziya , Mason Thornton , McCaffery Harlan , Chervin Ronald , Shellhaas Renee
Published: May 2022

Introduction

Myelomeningocele (MMC) is a neural tube defect associated with hindbrain herniation (Chiari II malformation) and respiratory center dysfunction. Prior cross-sectional polysomnographic studies indicated that older children with MMC have an elevated risk of sleep-disordered breathing (SDB), a risk factor for sudden death. Most infants with MMC (78%) had abnormal pneumograms, reported predominantly as central sleep apnea (CSA) and sleep-related hypoventilation (SRH). Pneumograms, however, have significant limitations compared with full polysomnography (PSG).

Methods

The North-American Fetal Therapy Network (NAFTNet) with nine participating sites has collaborated in a prospective study of SDB among infants with MMC. Bedside PSGs were conducted among infants >35 weeks post-menstrual age without supplemental oxygen or respiratory support. PSGs were scored by a pediatric-experienced RPSGT using the American Academy of Sleep Medicine infant sleep staging and pediatric scoring criteria for respiratory events. PSGs were reviewed independently by two board-certified pediatric sleep faculty who then reached diagnostic consensus.

Results

Twenty-eight PSGs were evaluated as an interim analysis from 4 of 9 participating sites. Many (11/28, 39.3%) infants had predominantly frequent hypopneas, which could not be distinguished confidently as central vs. obstructive by two experienced pediatric physicians. The proportions of neonates with CSA (3/28, 10.7%), OSA (6/28, 21.4%) and SRH (1/28, 3.6%) were small by comparison. Only 10/28 infants (35.7%) did not display significant SDB and 14/28 had PSG abnormalities considered clinically concerning. Across all subjects the median [IQR] hypopnea index was 18 [10, 33], central apnea index was 4 [1,7]) and obstructive apnea index was 1.0 [0, 6]. The median [IQR] apnea-hypopnea index was 28 [15, 46].

Conclusion

This ongoing study already provides the largest available cohort of neonates with MMC and PSG data. Predominant hypopneas were far more common than any other classified expression of SDB and were challenging to distinguish as central or obstructive. These data confirm the high frequency of SDB in MMC (64%), suggest that PSG may be an important consideration in neonates with MMC, but highlight that current scoring criteria may not always allow confident separation of central from obstructive SDB processes.

Support (If Any)

National Institutes of Health 1 R01 HL147261-01A1
0538 “Something is Wrong!” A Qualitative Study of Racial Disparities in Parental Experiences of OSA Detection among Their Children
Authors: Chung Alicia , Farquharson Leone , Gopalkrishnan Akila , Seixas Azizi , Jean-Louis Girardin , Honaker Sarah
Published: May 2022

Introduction

Blacks are 4-6 times more likely to have obstructive sleep apnea (OSA) than white children. Yet disparities in detection, diagnosis and treatment persist. Our study objective was to examine parents’ perceptions and experiences with OSA detection among their children.

Methods

Semi-structured phone interviews were conducted with 30 parents of children (ages 2-12 years) who were referred for overnight polysomnography due to OSA. Parents who identified as Black non-Hispanic (n=19) or White non-Hispanic (n=8) were included in the current analysis. Qualitative thematic analysis was conducted using a grounded theory approach, with themes organized in NVivo 12 software. Twenty-one themes falling into five categories were identified. To examine racial/ethnic disparity in parental experiences, themes were classified as convergent (presented by Black and White parents) or divergent (presented by one racial/ethnic group but not the other).

Results

Participating parents were primarily mothers (92.59%). Children were 51.90% female; aged range from 3 to14 years old (M=7.93 years, SD=3.08). Delayed OSA detection was observed among Black children (M=9.00 years), compared to white children (M=5.78 years). Analysis of themes by race/ethnicity identified both shared experiences and perspectives, as well as those that were specific to or more salient for parents of one race. Convergent themes that overlapped among both groups included “Wanting to Know, Worries, and Child Daytime Symptoms.” Divergent themes experienced by White caregivers included “Low threshold for raising concerns with provider, Institutional delays, and Trust in provider.” “Misplaced blame, Whatever it Takes, Something is wrong, OSA Awareness, and Missing the day-night connection,” were divergent themes named by Black parents/caregivers.

Conclusion

Black and white parents experience different paths to detection and diagnosis for their child’s OSA, which may be affected by individual awareness, education, patient-provider interactions and experience with the healthcare system.

Support (If Any)

Research is supported by K23HL150290
0551 Movement Parasomnias in a Community Sample: Associations with Sleep Health and Mental Health
Authors: Thesz Isadora , Hale Lauren , Branas Charles , Killgore William , Wills Chloe , Grandner Michael
Published: May 2022

Introduction

Movement-related parasomnia symptoms are associated with several sleep disorders and are associated with adverse health, mental health, and social outcomes. Current literature lacks data regarding parasomnia prevalence in the general population. This study examined prevalence of these symptoms and correlates in a community-based sample.

Methods

Data were from the Sleep and Healthy Activity, Diet, Environment and Socialization (SHADES) study, consisting of N=1,007 working-age adults. Parasomnia symptoms were assessed with, “I have been told that I walk, talk, eat or act strange or violent while sleeping.” Responses were categorized as Never (1/year or less), Sometimes (<1/week), or Often (>=1/week). Sleep health variables included sleep duration, categorized as very short (<=4h), short (5-6h), normal (7-8h, reference group) or long (>=9h), Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Brief Index of Sleep Control, frequency of loud snoring, and frequency of sleep medication use. Mental health variables included PHQ9 depression score, GAD7 anxiety score, Perceived Stress Scale, and self-reported survival of severe physical/emotional trauma (None, Possible, Definite). Covariates included age, sex, race/ethnicity, education, income, employment, and body mass index.

Results

Parasomnia symptoms were reported sometimes by 24% and often by 7% of the sample. The following sleep-related variables were associated with more movement-related symptoms sometimes: very short sleep (RRR=2.26), higher ISI (RRR=1.08), ESS (RRR=1.09), and FSS (RRR=1.05), and frequent snoring (RRR=2.84). The following were associated with more symptoms often: very short sleep (RRR-4.40), higher ISI (RRR=1.18), ESS (RRR=1.18), FSS (RRR=1.07), frequent snoring (RRR=7.38) and medication use (RRR=5.99), and less sleep control (RRR=0.43). Regarding mental health, more symptoms sometimes or often was associated with higher depression (RRR=1.11 and 1.16, respectively), anxiety (RRR=1.12 and 1.17, respectively), and stress (RRR=1.06 and 1.10, respectively) scores. Trauma survivors were more likely to report symptoms often (RRR=4.78).

Conclusion

Movement-related parasomnia symptoms are fairly prevalent and may impact nearly one third of community-dwelling working-age adults. Those exhibiting symptoms are more likely to experience shorter sleep duration, poor sleep quality, daytime dysfunction, and worse mental health. Screening efforts for subclinical symptoms should be increased, and further work should explore pathways linking these symptoms to health and functional outcomes.

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0566 Impact of Obstructive Sleep Apnea in Patient Admitted For Diabetic Ketoacidosis. Analysis Of The National Inpatient Sample
Authors: Yusuf Mubarak , Aldiabat Mohammed , Al-khateeb Mohannad , Horoub Ali , Jabiri Yazan Al , Kilani Yassine , Abdulkarim Faridat , Garba Kazeem , Thompson Pytregay
Published: May 2022

Introduction

The prevalence of type 2 diabetes mellitus in patients with obstructive sleep apnea has been estimated to be 15-30%. Studies have shown increased severity of diabetes in patients with underlying OSA independent of other confounders such as age and obesity.We aim to assess the effect of obstructive sleep apnea on patients admitted for diabetic ketoacidosis.

Methods

We queried the National Inpatient Sample (NIS) 2016, 2017, and 2018. We searched the NIS for adult patients hospitalized with DKA as principal diagnosis with exposure of OSA as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality, while secondary outcomes were length of stay (LOS), total hospital charge, cerebral edema, cardiac arrest, acute respiratory failure (ARF), and health cost utilization defined by total hospitalization costs. Multivariable logistic and linear regression analysis was applied to estimate the clinical outcomes. STATA software was used to analyze the data.

Results

There were about 367,555 adult hospitalizations principally for DKA, of which 2.5% had OSA as a secondary diagnosis. Demographic characteristics based on OSA vs non-OSA cohorts with mean age of 52.3 years (CI 51.6-52.9) vs 40.4 years (CI 40.2-40.5), females (43.2% vs 49.7%), Whites (64.7% vs 57.2%), Black (25.6% vs 26.7%), and Hispanic (7.1% vs 11.6%). A total of 1,440 inpatient mortality (0.39%) occurred in hospitalizations for DKA. After adjusting for age, sex, disease severity and race, hospitalizations for DKA with OSA had similar inpatient mortality [0.59% vs 0.39%, AOR 0.81, 95% CI: 0.423 - 1.565, p=0.538], total hospital charge [$38,790 vs $30,516 P=0.185], LOS [4.19 vs 3.27 days, P=0.064], cerebral edema [0.32% vs 0.1% AOR 1.25, 95% CI: 0.437 - 3.616, p=0.671], cardiac arrest [0.54% vs 0.27% AOR 1.01, 95% CI: 0.493 - 2.105, p=0.959] compared to those without DM. However patient with OSA had an increased odds of ARF [0.55% vs 0.22% AOR 1.48, 95% CI: 1.173 - 1.867, p=0.001].

Conclusion

In conclusion, patients admitted primarily for DKA with co-existing OSA had similar inpatient mortality, LOS, total hospital charges, cerebral edema, and cardiac arrest compared to those without OSA. However, the OSA group had more odds of ARF.

Support (If Any)

1. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest. 2017;152(5):1070-1086. doi:10.1016/j.chest.2017.05.0092. Mahmood K, Akhter N, Eldeirawi K, et al. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med. 2009;5(3):215-221.3. Morgenstern M, Wang J, Beatty N, Batemarco T, Sica AAL, Greenberg H. Obstructive sleep apnea: an unexpected cause of insulin resistance and diabetes. Endocrinol Metab Clin North Am 2014;43:187–204
0643 Sleep Quantity, Quality and Sleep Apnea Risk for Inpatients on a Neurology Unit
Authors: Poulakis Alexander , Ibarra Michael , Lin Jennifer , Wielgus Oskar , Eisner Lauren , McGauley David , Kadura Sullafa
Published: May 2022

Introduction

Sleep disorders frequently complicate neurological disorders such as stroke and epilepsy. Despite these known relationships, sleep disorders screening is insufficient in the inpatient neurology setting. We aimed to assess patient sleep quantity and obstructive sleep apnea (OSA) risk on an inpatient neurology unit.

Methods

From April 2021 to November 2021, patients completed the Epworth Sleepiness Scale, Berlin Questionnaire, and Karolinska Sleep log to assess sleep quality and duration from the previous night. Surveys were administered three times a week to patients oriented, available to participate, and slept on the unit for at least one whole night. T-tests and chi-squared were utilized for analysis of statistical significance.

Results

Of the preliminary sample (n=117), 45% were male with mean age of 53 and mean BMI of 30.3. The top primary diagnoses were seizures (35.0%) and acute strokes (27.4%). Seventeen patients had known OSA, and 30% had an Epworth Sleepiness Scale score greater than 10 prior to admission, indicating daytime sleepiness. 37% screened high-risk for OSA without a known diagnosis - 46.9% of these patients presented with an acute stroke, and 32% with seizures. The mean (SD) total sleep time across 129 completed surveys was 7.02 hours (2.43), with an average sleep efficiency of 83.0% (18%), wake after sleep onset of 52.6 minutes (63.12), and 2.69 (2.66) awakenings a night. Patients with known sleep apnea had significantly increased sleep latency (43 minutes vs. 26 minutes, p=0.04) and increased awakenings (2.8 vs. 1.6, p=0.039). There was no statistical significance in sleep logs between high and low-risk Berlin patients, although there was a trend towards increased sleep latency in high-risk patients (32 minutes vs. 23 minutes, p=0.08).Between high and low-risk patients, there was no statistically significant difference in sleep aid ordering (p=0.48). Sleep aids were more likely to be ordered for patients in shared rooms than private (75% vs. 25%, p= 0.0025).

Conclusion

This study demonstrated that underlying sleep apnea significantly affected sleep latency and awakenings; preliminary data shows that Berlin risk may affect sleep latency. We will continue to review these trends as data collection continues. Future studies should compare objective data with patient-reported sleep logs.

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