bluuebunny/crossref_metadata_2025 huggingface dataset:
1167 Chasing Centrals
Authors: Jordan Melissa , Bliton Kyle , Patterson Patricia , Aulakh Puneet
Published: April 2024

Introduction

Distinguishing between obstructive and central hypopneas raises a clinical challenge when evaluating sleep apnea. Currently, absence of snoring, inspiratory flow limitation, and paradoxical thoraco-abdominal excursions can aid in identifying a central hypopnea. Defining these events is imperative as it affects options for therapy. This case highlights the importance of appropriate classification of central hypopneas.

Report of case(s)

A 57 YO F with PMH of HTN presents for snoring, frequent awakenings, and suffocation disrupting sleep. Her BMI is 35.5. Epworth Sleepiness Scale is 15. She has a family history of sleep apnea. Her STOP-BANG score is 4. In conjunction with sleep disordered breathing evaluation, she was undergoing neurologic evaluation of oropharyngeal dysphagia resulting in ILD from aspiration, weakness and numbness in bilateral hands, and worsening balance. Imaging showed a Chiari 1 Malformation. She underwent PSG to evaluate SBD and split for CPAP titration due to frequent apnea and hypopnea events. Despite titration, events worsened. Upon further review of the study, it was noted the hypopnea events were majority central in nature. The diagnostic portion showed 32 central apneas, 2 obstructive apneas, 0 mixed apneas, 49 central hypopneas and 4 obstructive hypopneas. The total AHI was 44/h with a central index of 42/h and O2 nadir of 71% with O2 less than 88% for 70 minutes. She returned for ASV versus Bipap ST titration. Again, pressures were increased due to presence of hypopneas and at the termination of the study, apnea was poorly controlled. The residual AHI of 50/h on BIPAP 18/8 rate 16. Review of PSG found optimal settings to be BIPAP 15/6 rate16. AHI on these settings was 8.9/h, nadir SPO2 82%. She is currently scheduled for chiari decompression.

Conclusion

This case demonstrates that detection of central hypopneas affects ability to titrate PAP therapy and determine best treatment options. This case is further complicated by a clinical history concerning for obstructive sleep apnea.

Support (if any)

Javaheri S, Rapoport DM, Schwartz AR. Distinguishing central from obstructive hypopneas on a clinical polysomnogram. J Clin Sleep Med. 2023 Apr 1;19(4):823-834. doi: 10.5664/jcsm.10420. PMID: 36661093; PMCID: PMC10071374.
1169 Hypersomnia in an Adolescent Following COVID-19 Infections
Authors: Long Ariel , Hussain Shahnoor , Viorritto Erick
Published: April 2024

Introduction

The International COVID-19 Sleep Study found a 2 to 3-fold increase in hypersomnolence in persons reporting COVID-19 infection. Although the pathophysiology of COVID-19-associated hypersomnolence is still unclear, a para-infectious pathogenesis has been proposed, similar to cases of post-influenza narcolepsy observed following the Spanish flu epidemic of 1918.

Report of case(s)

A 16-year-old male presented to neurology clinic with complaints of fatigue, anorexia and headaches. His parents reported the sudden onset of excessive daytime sleepiness and sleep attacks in September 2022, severely impacting his daytime functioning. His reported sleep duration was appropriate for his age, and sleep hygiene was adequate. He denied cataplexy and hallucinations, but was having sleep paralysis 1-2 times weekly. He had never been vaccinated against COVID-19, and had two confirmed COVID-19 infections in January and June of 2022. His laboratory evaluation showed no other infectious causes, nor evidence of thyroid dysfunction or other endocrine abnormalities. His brain MRI was unremarkable. In April 2023, he had an overnight polysomnography followed by a multiple sleep latency test. PSG total sleep time was 7 hours and 22 minutes, and sleep efficiency was 93.1%. His sleep latency was 5.3 minutes and REM latency was 99 minutes. His AHI was 1.9 events per hour and his SpO2 nadir was 89%. The mean sleep latency on his MSLT was reduced, at 4 minutes and 36 seconds, and there were no sleep-onset REM periods. At his sleep clinic evaluation in April 2023, his Epworth Sleepiness Scale (ESS) score was 22. He was started on Adderall, which caused severe mood changes and worsening anorexia. This was switched to Modafinil, with significant improvement in subjective sleepiness, and his ESS score was 3 at follow-up.

Conclusion

Untreated hypersomnia has been associated with behavioral problems, mood disturbances, depression, and impaired neurocognitive function especially in adolescents. Hypersomnia is also associated with long-term increased risk of cardiovascular, endocrine, and metabolic disorders. According to the World Health Organization, there have been over 700 million confirmed COVID-19 cases to date. Given the health implications of hypersomnia, the relationship between COVID-19 and CNS hypersomnia and its etiology needs further investigation.

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0118 Sleep Quality Among Sexually Abused and Non-abused Females in the Female Growth and Development Study
Authors: Omisakin Olusola , Dungula Francisca , Master Lindsay , Noll Jennie , Buxton Orfeu
Published: April 2024

Introduction

Lower sleep quality in adulthood can be a manifestation of trauma experienced during earlier stages of development. Sleep problems are also common among adults with chronic health conditions, such as diabetes and heart disease. However, there is scarcity of evidence on potential moderating effect of chronic health conditions in the association between post-traumatic stress disorder (PTSD) and poor sleep in adulthood. We examined the relationship between PTSD symptoms (PTSS), biomarkers of diabetes type 2, and sleep health.

Methods

Participants are comprised of sexually abused (as children) and non-abused females from the Female Growth and Development Study (FGDS), a longitudinal study following participants across seven waves from childhood to adulthood (1987-2019). From Comprehensive Trauma Interviews at waves 4-6, we identified trajectories of PTSD using growth mixture modeling. At wave 7, actigraphy was conducted and blood samples were used to measure Hemoglobin A1C. We focused on participants with ≥ 3 valid days of actigraphy data (n = 100). Analysis of covariance (ANCOVA) examined the relationship between PTSS, Hemoglobin A1C (normal, prediabetes, diabetes) and sleep [duration, efficiency, and wake time after sleep onset (WASO)], controlling for sexual abuse status, age and race.

Results

Over half of the participants (51%) ever had PTSS and 16% had HbA1C at prediabetes or diabetes stages. Although ANCOVA results did not detect significant interaction effects of PTSS and diabetes on sleep, we found heterogeneity in the distributions of the sleep measures. For instance, sleep efficiency was lower among participants who had co-occurrence of PTSS and prediabetes /diabetes (M = 88.0 %, SD = 5.1) relative to those who had prediabetes /diabetes but no PTSS (M = 91.1 %, SD = 2.0). Compared with participants with prediabetes /diabetes but no PTSS (M = 39.9 min/night, SD = 12.8), those with PTSS and prediabetes had greater mean WASO (M = 50.0 min/night, SD = 21.6).

Conclusion

Participants who had both PTSS and prediabetes/diabetes experienced elevated sleep problems. Future research should investigate how chronic health conditions may affect sleep among individuals with PTSS related to childhood maltreatment.

Support (if any)

T32HD101390, R01AG059682, R01HD072468, R01AG04879
1185 Cheyne-Stokes Respirations and Central Sleep Apnea in the Setting of Lacunar Infarct: A Case Report
Authors: Tripathi Poulomee , Murray Robert
Published: April 2024

Introduction

Cheyne-Stokes respirations and central sleep apnea have been correlated to large areas of cerebral infarction and with smaller events such as transient ischemic attacks. Few studies and cases have analyzed and reported the association between Cheyne-Stokes respirations and lacunar infarct, an intermediary of the two extremes of cerebral events.

Report of case(s)

Mr. T is an 87 year old male who originally was referred to the University of Kentucky sleep medicine clinic due to symptoms of worsening daytime hypersomnia and snoring; he had never had a sleep study. His Epworth Sleepiness Scale score was 11. Patient underwent sleep study, which found severe obstructive sleep apnea with concern for Cheyne-Stokes respirations and central sleep apnea. Medications were reviewed, none of which were contributory. With patient’s history of transient ischemia attack and atrial fibrillation, work up included an echocardiogram, which showed an ejection fraction of 50-60%, CPAP titration study, which showed severe CSA, and an MRI brain, which showed evidence of old lacunar infarct. Ultimately, the patient had BIPAP S/T titration which ordered pressures of 21/13 and rate of 12. Currently patient’s pathologies are well controlled, as evidenced by his last sleep study and AHI of 1.8. He continues to have some issues with leak, for which he is trialing different masks.

Conclusion

Cheyne-Stokes respirations and central sleep apnea are present in patients with history of multiple types of cerebral events. With lacunar strokes constituting 25% of ischemic strokes, it is imperative to make the correlation between Cheyne-Stokes respirations, central sleep apnea, and lacunar infarct in patients with otherwise no clear etiology of those sleep pathologies.

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1188 Decreased Tolerance to Hypoglossal Nerve Stimulator After Cardioversion
Authors: Van Dongen Kimberly , Knapp Sarah , Chan Lawrence
Published: April 2024

Introduction

Hypoglossal nerve stimulator (HNS) therapy is a treatment for moderate to severe obstructive sleep apnea (OSA) in patients who cannot tolerate positive airway pressure (PAP) therapy. HNS is an implanted device that stimulates tongue protrusion at the start of inspiration [1,2,3]. OSA is associated with atrial fibrillation and increased risk of recurrence after cardioversion and catheter ablation [4]. Currently, the presence of atrial fibrillation is not a contraindication to HNS implantation. However, there are accumulating reports that HNS patients requiring external cardioversion for atrial fibrillation have resulted in device dysfunction. [5]

Report of case(s)

An eighty-two-year-old female with past medical history of obstructive sleep apnea with respiratory event index (REI) of 27.8 and atrial fibrillation/flutter who was implanted with HNS on 3/11/22. She was activated with configuration +-+ and functional threshold of 2.0 volts and able to increase her amplitude comfortably to 2.5V. Two months after activation, she underwent cardioversion for persistent atrial fibrillation and immediately found her stimulation intolerable. She reduced her amplitude to 1.8V and was able to gradually escalate to 2.7V. Her device was checked with no apparent malfunction. She received a second cardioversion with similar results, and again reduced her amplitude and slowly increased to 2.5V. Her subsequent titration study determined that 2.6V was ideal. Following an ablation 2 months later, stimulation was intolerable once more. Therapy was paused for 2 weeks; her amplitude was reduced to 1.4V and eventually returned to 2.0V. Follow up home study showed REI of 10.5 on 2.0V.

Conclusion

This case report highlights a rare occurrence of HNS intolerance after cardioversion. There has been one other report of device intolerance related to neurapraxia after cardioversion. The neuropraxia was believed to have been a direct effect of nerve injury related to electrical current traveling along the lead body to the electrode-tissue interface [6]. It is possible that the intolerance in our case is related to a similar mechanism. Clinicians should be aware of potential complications given the high incidence of atrial fibrillation in patients with OSA. This case may also serve as an example of how to re-introduce therapy in patients with HNS intolerance proceeding cardioversion.

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1199 A Novel Approach to REM Sleep Behavior Disorder Safety Measures
Authors: Ballenberger Matthew , Koo Brian
Published: April 2024

Introduction

Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. Behaviors include yelling, punching, kicking, and complex or violent movements causing a fall out of bed and result in injury to the patient or their partner. The American Academy of Sleep Medicine recommends maintaining a safe environment for patients. For patients with uncontrolled severe symptoms, recommendations include having partners sleep separately from patients. This may not be practical for small living spaces, may result in loss of intimacy between partners, or delay response to injuries caused by RBD. We present the case of a patient devised novel approach to keep their partner safe while maintaining close-proximity while sleeping.

Report of case(s)

A 63-year-old man with a past medical history of moderate obstructive sleep apnea (OSA) on CPAP presented to sleep clinic with symptoms of dream enactment. Behaviors included yelling, punching, and kicking. He had kicked his wife and had fallen out of bed resulting in an injury. He underwent a polysomnogram that showed REM sleep without atonia and was diagnosed with RBD. He was advised on safety precautions and started high dose melatonin. Clonazepam was added, but symptoms were not eliminated. He and his wife did not want to sleep separately, so he pushed two twin beds together and separated them with a large sheet of plexiglass. He reported he had hit the plexiglass many times without inuring himself and prevented injury to his wife. The patient’s wife was able to safely sleep near him which helped maintain their sense of intimacy.

Conclusion

We report a novel approach to create a safe environment for patients with RBD while maintaining partner proximity and intimacy. As patients struggle with progressive neurodegenerative disease, it is important to have their partners nearby overnight when patients are at risk for falling and self-injury. With two twin beds separated by plexiglass, a patient can safely sleep next to their partner and significantly reduce the risk of injuring them. This may be a useful technique for patients with severe, refractory symptoms of RBD.

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0120 Sleep Patterns Among Haitians: “To Sleep at Night Then Wake up at 11 pm to Run”
Authors: Carrenard Niara , Mondestin Wilmar , Chery Maurice , Elvariste Stessie , Auguste Evan , Bigdeli Tim , Jean-Louis Girardin , Blanc Judite
Published: April 2024

Introduction

This study examines the effects of political and gang violence on the mental and sleep health of Haitians in the United States and Haiti.

Methods

In the Haitian Well-Being Study, we conducted four Zoom focus groups, involving 28 participants (20 Haitian women and 8 men) aged 23 to 60, located in both the United States and Haiti. These sessions, lasting approximately 60 minutes each, aimed to assess the mental health repercussions of traumatic events in Haiti. Qualitative analysis of the focus group transcripts was employed using thematic analysis.

Results

Our study identified six key themes: 1) Poor Mental Health: Participants reported persistent anxiety, chronic acute stress, and symptoms akin to post-traumatic stress disorder (PTSD), attributed to the deteriorating situation in Haiti and interpersonal traumas such as kidnappings and sexual assault. 2) Poor Sleep Health: Concerns about daily and nocturnal gang violence, traumatic experiences, and mobility restrictions disrupted sleep patterns and quality. 3) Lack of Access to Resources: Limited access to healthcare, especially mental health services, was a recurring concern, emphasizing the need for culturally appropriate support within Haitian communities. 4) Mental Health Stigma: Seeking help from psychologists was stigmatized, discouraging individuals from seeking mental health support. 5) Cumulative Trauma Exposure: Participants shared past traumatic experiences, including PTSD symptoms such as re-experiencing and nightmares triggered by specific images, which continued to impact their mental health. 6) Recommendations for Mental Health Programs: Participants emphasized the urgency of restoring security in Haiti, enabling those displaced by gang violence to return to safe housing and reunite with loved ones. They also suggested community-based interventions, raising awareness about mental health, and significant investments in mental health training to address the widespread impact of violence in Haiti.

Conclusion

This study highlights the profound and complex effects of political and gang violence on the mental and sleep health of Haitians. To address these challenges effectively, participants stressed the importance of restoring security in Haiti, expanding access to mental health resources, reducing stigma, and implementing community-based interventions to support those affected by violence. Additionally, this qualitative study underscores the role of sleep health in disaster relief and global health efforts.

Support (if any)

5R01HL142066-06
1206 Combination of Nasal Steroid and Nasal Oxymetazoline: A Way to Improve PAP Tolerance in OSA Patients with Rhinitis
Authors: Anokwute Akudo , Wallach Paul , Manchanda Shalini
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is the most common cause of sleep-disordered breathing, and positive airway pressure (PAP) therapy is the gold standard for treatment. PAP therapy adherence remains a challenge especially in patients with nasal disease. Our case is that of a patient with OSA and long-standing allergic rhinitis who had significant improvement in PAP adherence with the use of daily intranasal oxymetazoline and fluticasone.

Report of case(s)

A 62-year-old man with history of allergic rhinitis on intranasal fluticasone presented to our sleep clinic for discussion about OSA treatment options because he was intolerant of PAP therapy. He had OSA documented for 18 years and had twice attempted PAP therapy unsuccessfully despite high motivation. Baseline AHI was 25/hr. He had tried a mandibular assist device (MAD) with good control of snoring until he gained more weight and the MAD no longer controlled symptoms. He attempted PAP therapy again and tried nasal oxymetazoline with a nasal steroid and was able to tolerate the use of PAP machine for an entire night and so continued using the combination therapy. He has been tolerant of PAP for a year on this regimen without the development of rhinitis medicamentosa (RM). The presence of rhinitis before or after starting PAP therapy is a strong negative predictor of PAP adherence. Intranasal oxymetazoline is an option for treatment of sinusitis but has been known to cause rhinitis medicamentosa when used alone. Our index patient did not notice any improvement in tolerance of PAP while on intranasal fluticasone, but a combination of intranasal fluticasone and oxymetazoline led to better tolerability in our patient. There are limited studies for long-term use of oxymetazoline. Two studies showed that using oxymetazoline along with a nasal steroid once daily for 4 weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa.

Conclusion

PAP therapy compliance remains a challenge in patients with allergic rhinitis. Combination therapy of intranasal steroid and intranasal oxymetazoline may be helpful in improving PAP adherence in these patients, and further study is warranted.

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1222 These Boots Were Made for Walking, but Not Sleeping
Authors: Adesina Joyce , Khan Safia
Published: April 2024

Introduction

Somnambulism occurs during slow wave sleep, prompted by an arousal, followed by sitting up or walking, disorientation with no recollection of the event, and falling back asleep. While somnambulism/sleepwalking is a parasomnia that is not typically associated with Ehlers-Danlos syndrome (EDS), it was the presenting sleep disorder in a patient, with multiple etiologies of insomnia.

Report of case(s)

A 54-year-old female with a history of chronic insomnia, attention-deficit/hyperactivity disorder (ADHD), EDS, and osteoporosis presents with somnambulism. Patient reports sleepwalking since childhood and continuing to sleepwalk into adulthood. Fifteen years prior, she became a paramedic, worked 24-hour shifts, and developed insomnia. Patient started her first insomnia treatment with zolpidem 5 years ago, which increased her sleepwalking frequency from twice a week to daily and included more complex behaviors like preparing food. Patient retired with disability 4 years prior due to recurrent fractures and joint deformities secondary to her osteoporosis and EDS. She took cyclobenzaprine, methocarbamol, oxycodone-acetaminophen, and pregabalin for chronic pain, and dextroamphetamine-amphetamine for ADHD. Patient presented to Sleep Medicine clinic July 2023 where zolpidem was changed to clonazepam. At her follow up December 2023 visit, exam was notable for her wearing a left post operative short boot. Her sleepwalking had ceased, but insomnia worsened. It was taking her 3 hours to fall asleep after her 6PM bedtime, and 1 hour to fall asleep after nocturia-related awakenings 1-2 times per night. Since her surgery three weeks prior, she had been dozing off during the day, likely from her sedative pain medications. We recommended delaying her evening pain medications and bedtime and ordered a sleep study.

Conclusion

Chronic pain, fatigue, and pain medications used to treat EDS contribute to this population's higher rates of sleep disorders like insomnia. They also have higher rates of obstructive sleep apnea due to nasal-maxillary cartilage changes, that are successfully treated with nasal CPAP. Psychiatric disorders, including anxiety, mood disorders, and ADHD are also more common in this population, and carry their own sleep pathology. While the patient’s primary sleep complaint was somnambulism, it was important to evaluate for and treat underlying sleep disorders for optimal outcomes.

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1224 Management of Dopaminergic Augmentation of Restless Legs Syndrome with Concurrent High Dose Benzodiazepine Therapy
Authors: Ottra Sneha , Palmquist Aaron
Published: April 2024

Introduction

Restless Legs Syndrome (RLS) or Willis-Ekbom disease, is sleep related movement disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable and unpleasant sensations. Over the years, dopaminergic agonists (DAs) have served as the primary treatment for RLS. However, the emergence of dose-dependent augmentation has prompted a shift in the management approach. This change is marked by a growing emphasis on prioritizing alpha2-delta calcium channel ligands (A2D) as alternative therapeutic agents

Report of case(s)

We report a case of a 70-year-old woman with a 15-year history of RLS, with crawling and unpleasant sensation of her legs preventing from falling asleep, successfully managed initially with pramipexole 0.5mg at night and eventually started on clonazepam. With escalating symptoms, Pramipexole and Clonazepam gradually increased. Despite dose escalation of pramipexole to 0.75mg and clonazepam to 4mg nightly, symptoms persisted and even intensified. Abruptly discontinuing Pramipexole and transitioning to ropinirole at 1mg and continuing Clonazepam 4mg nightly failed to yield improvement. Patient presented for consultation at this time highlighting the severity of RLS augmentation as moderate. Recommendation in this situation is to introduce A2D or possible opiate medication to ameliorate symptoms before tapering DA. The patient's high-dose benzodiazepine regimen increases respiratory depression and fall risk, hindering the standard approach of introducing alternative agents. In response, a tailored strategy was implemented, gradually tapering clonazepam while initiating gabapentin therapy, RLS symptoms began to improve. Subsequent cautious tapering of ropinirole contributed to sustained relief. This case demonstrates the need for individualized approaches in managing dopaminergic augmentation in RLS, especially when high-dose benzodiazepines are involved.

Conclusion

In navigating the intricacies of RLS treatment, our case highlights the effectiveness of a nuanced approach when confronted with dopaminergic augmentation alongside concurrent high-dose benzodiazepine therapy. Tapering benzodiazepines and introducing gabapentin proved successful, emphasizing the importance of tailored interventions. This case contributes to the understanding of RLS management in complex scenarios.

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0130 Negative Peer Interactions Among Adolescents Are Associated with More Difficulty Sleeping
Authors: Winton John , Reichenberger David , Mathew Gina , Master Lindsay , Rodriguez Isaac , Hale Lauren , Chang Anne-Marie
Published: April 2024

Introduction

Adolescence is a turbulent time for sleep health and social and psychological well-being. Adolescents commonly experience negative peer interactions and relationships. Few studies have investigated the associations of physical bullying and social exclusion with sleep, and those that have done so are not generalizable across the United States. The aim of this study was to assess whether negative peer interactions were related to sleep problems among a national, diverse sample of adolescents.

Methods

Data were from the age 15 wave of the Future of Families and Child Wellbeing Study, a longitudinal birth cohort of adolescents from 20 US cities. Adolescents self-reported whether they experienced different forms of bullying (i.e., being picked on, hit or threatened with physical violence, or purposely excluded) and the number of nights they experienced having difficulty falling or staying asleep throughout the week (N=3,305). Poisson regression analyses for each sleep outcome were adjusted for age, sex, race/ethnicity, family socioeconomic status, family structure, and caregiver education level.

Results

About 16% of the sample reported experiencing some form of bullying, and about half reported no nights with difficulty falling or staying asleep. Adolescents who were picked on reported 30% more nights with difficulty falling asleep (p< 0.001) and 39% more nights with difficulty staying asleep (p< 0.001). Those who reported being hit or threatened with physical violence reported 27% more nights with difficulty falling asleep (p< 0.001) and 44% more nights with difficulty staying asleep (p< 0.001). Adolescents who were purposely excluded from activities reported 19% more nights with difficulty falling asleep (p< 0.001) and 38% more nights with difficulty staying asleep (p< 0.001).

Conclusion

Results support our hypothesis that negative peer interactions at schools across the US are associated with more nights with difficulty falling or staying asleep. If adolescents are already at risk for difficulty sleeping, experiencing bullying may further exacerbate risk. Schools should therefore identify and attempt to prevent negative peer interactions to protect adolescent sleep health and well-being.

Support (if any)

R01HD073352, R01HD36916, R01HD39135, and R01HD40421
0131 Depression, Anxiety, Stress, Sleep Quality, and Perceived Academic Performance in College Students
Authors: Walther Sam , Hughes Joshua , Holladay Cathryn , Reynolds Alexandria
Published: April 2024

Introduction

There is a significant amount of research which suggests that college students who exhibit poor sleep quality tend to have worse academic performance. Additionally, studies have shown correlations between stress levels and academic performance. In the current study, it was expected that college students with higher stress levels and lower sleep quality would report worse perceived academic performance.

Methods

Participants included 130 (male=21) full-time undergraduate students (mean age=19.65, SD=1.54 years). Participants completed an online survey that consisted of a series of questionnaires that examined demographics, perceived levels of academic performance, depression, anxiety, stress (Depression Anxiety Stress Scale; DASS-21), and sleep quality and duration (Pittsburgh Sleep Quality Index, PSQI).

Results

Preliminary data analyses were conducted. Average sleep duration (PSQI) was 7.00 hours per night (SD=1.36) and sleep quality (PSQI) was poor (M=6.86, SD=3.33). Mean depression (M=21.66) and stress (M=28.46) scores fell into severe categories, whereas anxiety scores (M=23.06) were extremely severe. Pearson correlations revealed that depression (r=.472, p<.001), anxiety (r=.419, p<.001), and stress (r=.527, p<.001) were related to sleep quality. A One-Way ANOVA (F(4, 124)=2.507, p=.045) revealed that students who perceived making all A’s had the best sleep quality (M=5.22) compared to those who perceived making mostly A’s (7.00) or A’s/B’s (7.57). Depression, anxiety, and stress were not significantly related to perceived academic performance.

Conclusion

Higher rates of depression, anxiety, and stress were associated with poorer sleep quality. Students with better sleep quality perceived better academic performance compared to those with poorer sleep quality. A ceiling effect may have occurred with stress, potentially explaining the lack of relationship with perceived academic performance. Limitations include preliminary data analyses and the surveys were completed by participants within the last three weeks of the semester. The end of the semester likely contributed to high levels of stress and anxiety.

Support (if any)

None.
0137 Exploring the Nexus of Sleep Restlessness and Depressive Symptoms : A Study of Venezuelan Dyads in the U.S
Authors: Scaramutti Carolina , Seixas Azizi , Schwartz Seth
Published: April 2024

Introduction

Sleep is a critical component of overall well-being, influencing physical health, cognitive function, and emotional stability. In the context of mental health, sleep disturbances, particularly restlessness, have been identified as potential indicators of psychological distress. In the Venezuelan population, understanding the relationship between sleep, mental health, and familial dynamics is of paramount importance. The continued difficulties in Venezuela and the migration process for these immigrants may contribute unique factors influencing sleep patterns and mental well-being. This study aims to delve into the relationship between self-reported sleep restlessness, as indicated by responses to CES-D question 4, and depressive symptoms among Venezuelan parents and their children.

Methods

The investigation employed a two-wave design to capture the dynamics of these associations over time. Participants completed surveys at two distinct time points, Time Point 1 and Time Point 2, providing data on sleep restlessness (specifically, CES-D question 4) and overall depressive symptoms assessed by the Center for Epidemiological Studies Depression Scale (CES-D).

Results

In Wave 1, parental reports indicated that 17% experienced restless sleep moderately or all of the time (n=27), while 38% reported some or little restlessness (n=60). Among adolescents, 22% reported moderately restless or almost all the time (n=35), and 28% reported some or little restlessness (n=43). The CES-D scores revealed a concerning trend among parents, with a mean score of 19, surpassing the clinical depression cutoff. Approximately 75% of parents scored 26 or higher on the CES-D, indicating a substantial prevalence of depressive symptoms. Adolescent mean CES-D scores were 21, and a noteworthy 94.3% scored 16 or above, reflecting a significant proportion experiencing elevated depressive symptoms. Persisting into Wave 2, the scores and reported restlessness among both parents and adolescents remained consistent, suggesting that these symptoms endured over time without significant mitigation.

Conclusion

This study provides a comprehensive examination of the enduring relationship between sleep restlessness and depressive symptoms among Venezuelan parents and their children living in the United States. The findings underscore the significant prevalence of restlessness and depressive symptoms within this population, revealing a concerning pattern that persists over a two-wave study period.

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0142 Evaluating the Efficacy of Light and Odour for Mitigating Sleep Inertia Under Conditions of Sleep Restriction
Authors: Owen Mikaela , Yates Crystal , Grosser Linda , Shattuck Nita , Matthews Raymond , Matsangas Panagiotis , Sakovits Brooke , Banks Siobhan
Published: April 2024

Introduction

Sleep inertia (SI) poses challenges in safety-critical and high-performance environments. Sleep restriction is known to exacerbate SI. To minimise the experience of SI under conditions of sleep restriction, we assessed the role of two quick and easily implementable reactive countermeasures – light and odour – to increase alertness on waking.

Methods

N=31 (20F, 25.13±5.72y, 24.36±2.1kg/m2) were monitored at home for a week with actigraphy and then in the laboratory underwent an initial night of 7h, followed by 4 days where sleep was split across a 4h sleep opportunity at night and a 1h daytime nap, with a final night of 8h TIB for sleep. Participants were randomly allocated to one of three groups - control, light, or odour. The group allocation determined the countermeasure received on waking before commencing a battery of tests. Performance during SI was assessed using the Psychomotor Vigilance Test (PVT), and the Karolinska Sleepiness Scale (KSS) at 3, 18, 33, 48, and 63min after awakening. Outcomes included reciprocal median reaction time (RRT) and lapses (RT>500ms) on the PVT, and KSS scores. Data were analysed with mixed-model ANOVAs with condition, time since awakening, time of day, and day as fixed factors, and participant as a random factor, and posthocs simple effects analysis.

Results

There were significant time awake by time-of-day interactions on PVT RRT and PVT Lapses p<.05 and a main effect of time awake and time-of-day for KSS (p<.05). Faster RRTs and fewer Lapses were found across the afternoon wake (i.e., afternoon nap) SI period compared to the morning wake (i.e., night sleep). The progress through the SI period was consistent across time of day for KSS. Condition had no significant main effect or interaction effect with time awake onto measures of SI (e.g., RRT, Lapses, and KSS) (p>.05)

Conclusion

These findings indicate that light and odour for a short period at waking do not improve SI under conditions of sleep restriction. Instead, the findings indicate that a daytime nap may reduce the exacerbating effects of sleep restriction preventing the accumulation of SI during a 4-day simulated work week.

Support (if any)

Naval Postgraduate School
0147 Social Jetlag and Poor Sleep Quality Predict Worse Grades in First-Year College Students
Authors: Fitzsimmons Corinne , Carter Jason , Scullin Michael
Published: April 2024

Introduction

Poor sleep is common amongst college students and is hypothesized to negatively impact academic performance. However, much of the work on this topic has been cross-sectional and not accounted for fluid intelligence or baseline mental health, thereby limiting understanding of causal direction. In the current work, we examined whether sleep duration, quality, and timing in the first year of college were predictive of end-of-year grade point average (GPA) when accounting for known predictors such as demographics, mental health, and fluid intelligence.

Methods

First year college students (N=491, Mage=18.3; 71.1% female; 54.5% non-white; mean ACT=29.6) were recruited to complete a baseline session that included measures of sleep quality (PSQI), social jetlag (difference in midpoint of sleep across weekdays and weekends), chronotype (morningness-eveningness questionnaire), daytime sleepiness (Epworth sleepiness scale), mental health (depression and anxiety inventories), and fluid intelligence (Raven’s progressive matrices). End-of-year cumulative GPA data were extracted from university records.

Results

Students averaged 6.78 hours of total sleep time, 88.3 minutes of social jet lag, and approached clinically poor levels of global sleep quality (M=5.77) and daytime sleepiness (M=9.05). After adjusting for depression symptoms, trait anxiety, fluid intelligence, age, race/ethnicity, and sex (R2=.09, F=6.79, p<.001), the sleep measures explained significant unique variance in end-of-year GPA (delta R2=.05, p<.001). The strongest individual predictors of lower GPAs were poorer global sleep quality (β=-.154, p=.02) and greater social jetlag (β=-.15, p=.002; sleepiness and chronotype were not significant predictors in adjusted models, ps>.05). Sleep quality and social jetlag remained significant predictors of GPA when additionally controlling for standardized test scores (ACT; ps<.05). Students who completed the year with a perfect GPA (4.0) showed 1.2 points better global sleep quality (p=.006) and 23 min lower social jetlag (p=.04) than the remaining students, after correcting for demographic, mental health, and intelligence factors.

Conclusion

Poor sleep quality and social jetlag early in college are independent risk factors for lower future academic success, even when accounting for mental health, fluid intelligence, and demographics. There is a need for individual and environmental interventions to improve sleep health in first year students.

Support (if any)

Support provided by the National Science Foundation (1920730).
0153 Look Before Leaping: Relationship Between Circadian Preference, Sleep Quality, Fatigue, and Injury Risk in Soldiers
Authors: Paulus Erin , Eldringhoff Hannah , Huang Kathleen , Chaudhury Sidhartha , Mantua Janna , Jones Rachell
Published: April 2024

Introduction

In a previous study, we found that morning circadian preference and increased fatigue were associated with increased injuries during a nocturnal parachute jump. The purpose of the present study was to replicate this finding, and expand upon it by determining whether, and the extent to which, subjective sleep ratings are also predictive of injury during parachute jumps.

Methods

Participants included 27 male active duty Soldiers aged 23.7 ± 2.9 years (M ± SD). Participants completed a series of questionnaires at baseline (1 week prior to jump), pre-jump (1 hour before), and post-jump (1 hour after). Questionnaires about sleep; insomnia symptoms; circadian preference (morning vs. evening); injuries; and subjective experiences of sleepiness, fatigue, and jump quality were administered.

Results

Circadian preference was correlated with ‘sleep quality over the previous month’ (r = -.537, p < .01) and week (r = -.502, p < .01) with those indicating evening preference reporting poorer sleep quality. There was no correlation between circadian preference and average total sleep time. No participants had Insomnia Severity Index (ISI) scores above the clinical threshold for insomnia. However, those indicating an evening circadian preference had higher ISI scores (r = .635, p < 0.001). No significant correlations between circadian preference and previous jump injuries, subjective ratings of parachute landing fall (PLF) quality, or landing hardness were found. Likewise, momentary sleepiness and subjective fatigue were not significantly correlated with PLF or landing hardness.

Conclusion

In this sample of young Soldiers, evening circadian preference was associated with poorer subjective sleep quality and more insomnia-related symptoms. However, neither circadian preference nor fatigue level was significantly correlated with number of previous jump injuries or subjective ratings of jump performance. Given the small sample size and the generally high skill level of the population of parachutists, it is possible that the present n was not sufficient to detect an effect of circadian preference on injuries or jump quality. In future studies, objective measures of sleep should be added, the n should be increased, and the subject sample should include parachutists with a broader range of experience and training.

Support (if any)

Department of Defense Military Operational Medicine Research Program (MOMRP)
0169 Nighttime Safety of Daridorexant: Response to Noise Stimuli, and Effects on Postural Stability, Walking and Memory
Authors: Muehlan Clemens , Koopmans Ingrid , Magliocca Massimo , Vaillant Cedric , Zuiker Rob , Dingemanse Jasper
Published: April 2024

Introduction

Daridorexant is a dual orexin receptor antagonist approved for the treatment of adult patients with insomnia disorder. Following single-dose administration at bedtime to healthy non-elderly and elderly subjects, pharmacodynamics (PD) and safety were investigated in the middle of the night (MOTN) after forced awakening to a noise stimulus.

Methods

Double-blind, placebo-controlled, randomized, 3-way crossover study (placebo, 25, and 50 mg daridorexant in the evening) in 36 male and female non-elderly and elderly subjects (1:1 sex/age ratio). Four h after bedtime administration, the auditory awakening threshold (AAT) was determined (increasing noise signal up to 100 dB). Next, the main PD endpoint postural stability (body sway) as well as basic functional mobility (Timed Up and Go (TUG) test), and cognitive function/memory using the Visual Verbal Learning Test (VVLT) were assessed. Thereafter, subjects returned to bed.

Results

All 36 subjects completed the study. The average AAT was approximately 60 dB across treatments with no differences between daridorexant and placebo. Body sway showed a small, dose-dependent increase vs placebo with differences in least square means (LSM) 95% confidence interval (CI) of 36.7 (2, 71) and 65.9 (31, 100) mm, for daridorexant 25 and 50 mg, respectively. The overall increased body sway was driven by non-elderly subjects, as effects in elderly were similar to placebo. Subjects completed the TUG test in 6–8 s across treatments, with a small, dose-dependent increase vs placebo with a difference in LSM (95% CI) of 0.14 (0.02, 0.27) and 0.47 (0.34, 0.59) s for daridorexant 25 and 50 mg, respectively. The VVLT (immediate and delayed number of correctly recalled words) showed minimal differences in LSM (95% CI) to placebo of up to –1.0 (–1.5, –0.5) and –0.7 (–1.2, –0.2) words for daridorexant 25 and 50 mg, respectively. During delayed word recognition, subjects correctly recognized 77–79% true positive and true negative words across treatments with no difference to placebo for either daridorexant dose.

Conclusion

Following bedtime administration, daridorexant preserved the ability to respond to external noise stimuli and subjects were able to operate safely during the night.

Support (if any)

Idorsia Pharmaceuticals Ltd
0177 Improving Watchstanding Schedules on US Navy Watchfloors
Authors: Shattuck Nita , Matsangas Panagiotis , McClernon Christopher
Published: April 2024

Introduction

This project assessed the work/rest schedules of shift workers on information warfare enterprise (IWE) watchfloors. Our objectives were to document and evaluate the watchbills used, assess the watchstanders’ state, and develop fatigue mitigation recommendations tailored to the watchfloors.

Methods

Data were collected from two US Navy watchfloors (N=82 participants; 62.2% males, median age of 27 years (range 19 to 54 years, 85.4% enlisted). Using a quasi-experimental, longitudinal approach, participants wore ŌURA rings and completed questionnaires at the beginning and end of the study (Epworth Sleepiness Scale-ESS; Insomnia Severity Index-ISI; Profile of Mood States-POMS). The first watchfloor used a 4-section/12hr-shift watchbill; the other used a 6-section/8hr-shift watchbill. Watchstanders rotated between all shifts in their watchbill every 30 days. The sleep/wake patterns of watchstanders were modeled with the Sleep, Activity, Fatigue, and Task Effectiveness model implemented in the Fatigue Avoidance Scheduling Tool (SAFTE/FAST).

Results

Participants slept a median 6.7hrs/day with 62.3% sleeping < 7hrs/day and 14.5% sleeping < 6hrs/day. Approximately 89% of participants were classified as poor sleepers, 30.5% reported symptoms of excessive daytime sleepiness, 20.7% reported symptoms of insomnia, and 20.7% had all three conditions. Approximately 74% of participants scored worse than the 50th percentile of the normal adult population on total mood disturbance; 79.0% scored worse on tension-anxiety, 80.3% on vigor-activity, 72.8% on fatigue, and 80.3% on confusion-bewilderment subscales (all p< 0.05; POMS). While the watchstanders preferred the 6-section/8hr-shift watchbill compared to the 4-section/12hr-shift watchbill, no differences were observed in any of the variables of interest (daytime alertness, insomnia symptoms, mood, daily sleep duration, napping, long sleep episode variables; all p>0.10).

Conclusion

The 6-section/8hr-shift watchbill with shorter shifts and more duty sections is generally preferable to the 4-section/12hr-shift watchbill. Based on these findings, FAST model predictions, background literature on shiftwork, and other studies conducted by the NPS Crew Endurance Team, we developed fatigue mitigation guidelines and recommendations.

Support (if any)

This study was funded by the Naval Postgraduate School, Naval Research Program (NRP Project ID: NPS-23-N055-A).
0182 Distinct Spectral Pattern of Cognitive, Drowsiness, and Fatigue-related Theta/alpha EEG Activity During Wakefulness
Authors: Beldzik Ewa , Yang Zinong , Williams Stephanie , Lewis Laura
Published: April 2024

Introduction

Increases in midfrontal theta (4-8 Hz) EEG power have been observed in two markedly different conditions: during high cognitive demand, and when experiencing sleepiness or tiredness. Theta power increases during engagement in attention, working memory, or cognitive control processes. However, sleep restriction and mental fatigue also cause widespread increases in theta/alpha (9-13 Hz) power. Interestingly, these phenomena with potentially similar topography have contradictory interpretations: first, as a marker of cognitive control; and second, as local sleep waves in the awake state, which reflect homeostatic sleep pressure that is detrimental to cognition.

Methods

In this study (N=22), we explored this paradox by implementing a psychomotor vigilance task in an overnight EEG study, during a 12-hour sleep deprivation period. We investigated which EEG dynamics were linked to sleep pressure, time-on-task, and task performance. We applied a linear mixed-effect model incorporating time-of-night, run number, and response time (RT) variables to pre-stimulus and post-stimulus time epochs in a trial-by-trial fashion. Additionally, another model accounting for omission vs. correct trials was run to capture spectral dynamics of attentional lapses.

Results

In line with the views that theta reflects ongoing cognitive processing, midfrontal low-theta power (peak at 4.2 Hz) showed a positive stimulus-related correlation to RT. The time-of-night effect revealed a persistent widespread increase in the high-theta band (peak at 8 Hz) over time. Further, omission trials were marked with decreased power in that particular frequency range at the central EEG channels suggesting that high theta reflects compensatory mechanisms. Finally, the time-on-task effect showed a pronounced centroparietal increase in alpha power (peak at 10 Hz) for both pre-and post-stimulus epochs. Interestingly, activity in this oscillatory range with similar topography showed negative RT correlations indicating another form of compensatory mechanism that speeds up responses.

Conclusion

Our results indicate that cognitive effort, drowsiness, and fatigue processes can be disentangled by distinct spectral and topographical EEG characteristics. Moreover, neither high theta nor alpha power could be interpreted as a local sleep phenomenon due to their beneficial effects on performance. Furthermore, this work provides a basis for neuroimaging investigations of the neural circuit dynamics underlying these distinct oscillatory patterns.

Support (if any)