bluuebunny/crossref_metadata_2025 huggingface dataset:
1064 Perception of CBTI Treatment Modalities in Older Adults with Insomnia: Comparing Digital and Therapist-led Delivery
Authors: Tully Isabelle , Gumport Nicole , Tutek Joshua , Simpson Norah , Rosas Lisa , Zulman Donna , Dietch Jessica , Manber Rachel
Published: April 2024

Introduction

A shortage of trained providers limits access to cognitive behavioral therapy for insomnia (CBTI). Supplementing traditional in-person, therapist-led CBTI with telehealth delivery and fully automated digital CBTI (dCBTI) can improve accessibility. Characterizing perceived advantages and disadvantages of distinct delivery modalities among patients with insomnia can inform targeted resource allocation and clinical rollout of CBTI. Thus, the current study aims to describe patients’ pre-treatment preferences for therapist-led (in-person and telehealth-delivered) and automated dCBTI, as well as patient-identified advantages and disadvantages of these modalities.

Methods

Participants (N = 80) 50 years and older (M age = 64.2, SD = 7.9; female = 85.2%) were randomly selected from the RESTING Study, an RCT evaluating a triaged stepped-care model for treating insomnia disorder (DSM-5), to undergo a semi-structured interview at baseline, prior to study treatment assignment and exposure. Interviews were recorded, transcribed, and coded by three raters (inter-rater reliability: 85.0–93.0%). Response themes were identified inductively via qualitative thematic analysis.

Results

Approximately two-thirds of participants (n = 50, 62.5%) preferred therapist-led CBTI, delivered in-person or via telehealth, over automated dCBTI. The most common participant-identified advantage of dCBTI (n = 55; 68.8%) and telehealth-delivered CBTI (n = 65; 81.3%) was convenience. The most commonly reported disadvantages of dCBTI were limited customizability (n = 39, 38.75%) and lack of human connection (n = 40, 50.0%). However, some participants (n = 13, 16.30%) viewed lack of human connection as an advantage, citing the nonjudgmental nature of online programs and reduced social anxiety/fatigue. The main disadvantage identified for telehealth-delivered CBTi was loss of nonverbal communication (n = 20, 25%).

Conclusion

While participants identified advantages and disadvantages of both dCBTI and therapist-led CBTI, findings suggest a general preference for therapist-led treatment among middle-aged and older adults. This study is one of the first to examine participant preferences for and perceptions of CBTI delivery modalities prior to receiving study treatment(s). Findings can guide referring providers’ presentation of insomnia intervention options to patients and inform targeted discussions of perceived barriers to treatment. Moreover, results lay a foundation for future research examining the relationship between pre-treatment preferences/perceptions and longitudinal treatment adherence, engagement, and clinical outcomes.

Support (if any)

1R01AG057500
1066 Acceptability and Feasibility of Training to Integrate Digital CBTi in Routine Therapy: Evidence from Focus Groups
Authors: Gumport Nicole , Tully Isabelle , Stirman Shannon Wiltsey , Manber Rachel
Published: April 2024

Introduction

Over 31% of patients who enter treatment for mental health problems experience insomnia symptoms, which can be effectively treated using cognitive behavior therapy for insomnia (CBTi). However, routine psychotherapy for mental health problems does not adequately address insomnia symptoms. Integrating CBTi into routine psychotherapy in a feasible and acceptable manner could both extend the reach of CBTi and enhance mental health outcomes. Digital CBTi (dCBTi) is a promising and scalable option for integration. Supported dCBTi programs have better engagement, adherence, and clinical outcomes compared to unsupported programs. Hence, integrating dCBTi into routine psychotherapy, whereby the therapist introduces and provides support for dCBTi among patients receiving general psychotherapy for other mental health problems, may improve adherence and engagement. This study aims to determine the initial feasibility and acceptability of integrated dCBTi to providers.

Methods

Six virtual focus groups were conducted with licensed therapists with a range of graduate training. Each focus groups included 6-11 participants and lasted one hour. Inductive thematic analysis was used to extract themes. Therapists also completed a zoom poll at the end of the focus group.

Results

The sample included 52 licensed therapists (81% female, 81% White). Therapists had a range of graduate training (21 PhD/PsyD, 11 LCSW, 10 MFT, 9 LPC, and 2 MD). 83% of therapists indicated that they want training in integrated dCBTi. Two participants (5%) had some previous training in CBTi; they were the only individuals who indicated no interest in receiving the training. Six participants (12%) were unclear. Two training focused themes arose: desire for receiving CEs and a need for advanced notice to reserve the time required for a workshop. 88% reported seeing the potential value of integrated dCBTi (unclear=12%). Two themes arose regarding content of training: the need to know the contents of dCBTi and the value of consultation. As a feasibility theme, therapist highlighted that they could find 5-10 minutes of session time to provide the support for dCBTi.

Conclusion

Preliminary analyses indicate that integrated dCBTi is a feasible approach. Therapists are willing to be trained and see its potential value.

Support (if any)

AASM Foundation 300-BS-23
1073 Feasibility of Using Wearables to Track Surgeon Sleep: Results from a Pilot Study
Authors: Marquardt Matthew , Kang Ellison , Leahy Nicholas , Orr Morgan , Emerson Angela , Hagen Josh , Quatman Carmen
Published: April 2024

Introduction

It is well known that the sleep among surgeons is often of short duration and poor quality. Surgeons regularly wake up before dawn, and nighttime call can pull them out of bed at any time in the night. While limitations to resident and faculty surgeon work hours have been added in the past decades, it is unclear if surgeon sleep habits have subsequently improved. Furthermore, few studies have used objective trackers to monitor surgeon sleep.

Methods

Ten surgeons were recruited from a large midwestern academic center’s Department of Orthopedics to take part in the “Surgeons as Athletes” project. For this pilot study, surgeons were outfitted with various biometric sensors to measure their physiology before, during, and after operating. To monitor sleep-wake patterns, each surgeon was asked to continuously wear—except while operating—a commercially available sleep tracker (Oura ring) for a 14-day period. Descriptive statistics were used to understand compliance.

Results

The cohort consisted of seven residents and three faculty surgeons, four of whom identified as female and six as male. Out of 140 total nights, trackers were worn 66% of the nights (93 nights), with a median number of 9.5 nights recorded per participant. Only 30% of participants wore their tracker every night, while another 30% tracked their sleep for less than half of the nights. One participant did not wear their monitor at all during the study, despite follow-up from the researchers. Although not benchmarked against polysomnograms, 8 of the 93 wake up times (8.6%) were likely incorrect, suggesting either extremely early wake times when participants were not on call or extremely late wake times when participants were known to be operating.

Conclusion

This pilot study suggests that sleep tracking compliance among surgeons is poor, even when monitored passively by a wearable device. This could be due to the form factor of the device—a ring that must be removed while operating—requiring surgeons to remember to put it back on at the end of each day. Since surgeons are incredibly busy, an engaged study team and reminders each day has the potential to improve compliance.

Support (if any)
1083 Association Between Sleep Apnea and Health Service Utilization: Results from the Health and Retirement Study
Authors: Kaufmann Christopher , Albrecht Jennifer , Spira Adam , Malhotra Atul , Blinka Marcela D , Sekhon Vishaldeep , Amjad Halima , Roth David , Gross Alden , Tseng Chien-Yu , Wickwire Emerson
Published: April 2024

Introduction

Sleep apnea is associated with several health conditions known to increase the use of health services that may otherwise be preventable (e.g., hospitalization). We investigated the association of sleep apnea and the subsequent use of health services, independent of health conditions and other potential confounders.

Methods

We studied participants aged 50+ years in the 2016 and 2018 Health and Retirement Study (HRS), a nationally representative cohort of approximately 20,000 middle-aged and older adults in the United States. In 2016, participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder (which included sleep apnea). We categorized participants as with and without sleep apnea. In 2018, participants were asked to report on their use of health services, including hospitalization, home healthcare, and nursing home use. We used logistic regression to determine the association between sleep apnea, as reported in 2016, and the use of health services in 2018, after adjusting for demographics, BMI, health conditions, and depressive symptoms.

Results

We studied N=20,115 HRS participants, of whom 11.8% reported sleep apnea. Compared to those without sleep apnea in 2016, those with sleep apnea had a 21% higher odds of reporting future use of any health service (Adjusted Odds Ratio [AOR]=1.21, 95% Confidence Interval [CI]=1.02-1.43), after controlling for confounders. Specifically, those with sleep apnea had greater odds of hospitalization (AOR=1.21, 95% CI=1.02-1.44), and while not statistically significant, home healthcare services (AOR=1.23, 95% CI=0.99-1.54).

Conclusion

Participants with sleep apnea had increased odds for future health service utilization, including hospitalization and home healthcare. Findings highlight the importance of addressing sleep apnea to reduce their burden on the healthcare system.

Support (if any)

This study was supported by the National Institute on Aging (R01AG079391, K01AG061239, P30AG028740) and the Sleep Research Society Foundation (23-FRA-001).
1088 Sleep Resilience: A Dimension of Sleep Health Associated with Sleep Health Disparities
Authors: Sherriff Dustin , Ward Levi , Yang Chongming , Gnatiko Michael , Duraccio Kara , Wright Andrew , Calvin Danika , Klingonsmith Bryce , Kay Daniel
Published: April 2024

Introduction

Sleep health disparity refers to variations in sleep health that negatively impact disadvantaged and underserved populations. Sleep resilience is the ability to function emotionally, cognitively, and physically in the presence of sleep disturbance. In this study, we aimed to investigate whether self-reported sleep resilience in the face of future sleep disturbance is associated with current sleep disturbance and whether this association differed based on demographic variables.

Methods

A sample of 454 participants ages 18-85 (M=45) completed an online survey through Qualtrics that included demographic variables and a novel measure of projected sleep resilience. Participants also completed the PROMIS-Sleep Disturbance and the PROMIS-Sleep-Related Impairment questionnaires. The demographic variables included age, sex (male, female, non-binary), income level, race (white/non-white), relationship status (married/not married), number of dependents, and education level. Mixture modeling was used to examine whether sleep disturbance and sleep-related impairment predicted projected sleep resilience. A follow-up class analysis was used to determine whether these associations differed across demographic variables.

Results

Greater sleep disturbance and greater sleep-related impairment predicted lower projected sleep resilience. A latent class analysis revealed 2 classes (traditionally underserved and privileged) that had significant differences in the association between sleep disturbance and projected resilience. The underserved group (Class 1) included higher numbers of women who were more likely to be non-white with lower income, less educated, unmarried, fewer dependents, and more sleep disturbance. The privileged group (Class 2) included higher numbers of men who were more likely to be white with a higher income, highly educated, married, and have more dependents and less sleep disturbance. The underserved group projected lower future sleep resilience holding current sleep disturbance constant than the privileged group.

Conclusion

Sleep resilience is an important dimension of sleep health that is often overlooked and understudied. Our findings suggest that sleep resilience is lower in traditionally underserved individuals, which may compound sleep health disparities. Having lower projected sleep resilience in the face of future sleep disturbances may increase current stress levels and negatively influence sleep health behaviors. In an effort to rectify sleep health disparities, targeting the factors that contribute to lower projected sleep resilience may be a fruitful avenue.

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1089 Using Community Engagement to Increase Utilization of Primary Care for Sleep Concerns in Communities of Color
Authors: Berry Jasmine , Weiss Karen , McCrae Christina , Bell Debora
Published: April 2024

Introduction

Growing evidence suggests that there are sleep health disparities in the United States that disadvantage communities of color, and other socioeconomically marginalized groups in medical and mental health settings. Research in public policy indicates several points of intervention for increasing engagement with treatment services in communities of color at the primary care level, including individual beliefs about mental health/health issues, and perceptions of various points of treatment engagement, as well as community factors (e.g., neighbors and church; Davey & Watson, 2007). Accordingly, the current study implemented a community-level virtual intervention that targeted beliefs about sleep and perceptions of behavioral sleep treatment with the aim to increase willingness to engage with treatment at the primary care level.

Methods

We conducted 12 semi-structured qualitative focus groups with 35 individuals from communities of color about their awareness, perception of, and access to behavioral sleep treatment in healthcare settings. Transcripts were coded using the Rapid and Rigorous Qualitative Data Analysis method for themes relevant to the guiding question, 'What are people/persons of color experiences and perspectives of sleep, and specific areas of improvement to increase people/persons of color groups' utilization of behavioral sleep services?'.

Results

After a brief period of education (range = 15-20 minutes) about cognitive-behavioral therapy for insomnia (CBTi), participants perceived behavioral sleep treatment as a favorable option both over and in conjunction with pharmacological options. Medical mistrust was mentioned as the most significant barrier in each focus group, with participants highlighting that increased attention to collaborative care and comprehensive education about treatment options at the primary care level would be helpful for reducing mistrust. Pre- and post-group survey analysis indicated a significant increase in participants’ willingness to use primary care as an entry point to access/utilization of behavioral sleep treatment (pre-group willingness = 54.84%, post-group willingness = 91.42%, p<.001).

Conclusion

Findings suggest that intervention at the community level can be powerful for increasing the willingness of communities of color to engage in treatment at the primary care level. It is paramount that future research continues to examine ways to increase engagement with behavioral sleep treatment to help reduce sleep health disparities.

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1099 Impact of Good Sleep on Recovery and Care Evaluation (iGRACE)
Authors: Gould Erin , Herman Grace , Najam Usman , Mishra Archana
Published: April 2024

Introduction

Sleep is imperative to health and healing. Hospitalization may severely disrupt sleep. Our IRB-approved study aimed to evaluate sleep quality and patterns among patients admitted to general medical wards in two major teaching hospitals. It focused on understanding sleep disruption during hospitalization, intending to implement better sleep hygiene practices for inpatients following this pilot study.

Methods

Ninety patients hospitalized for two or more nights were included in this IRB approved cross-sectional study, using a 14-item questionnaire to assess sleep quality, use of over the counter pharmacological (e.g. melatonin) and non-pharmacological (eye masks and earplugs) sleeping aids. All patients were English speaking, 18 or older, and admitted to the general medicine teaching floors. Patients were excluded if pregnant, incapacitated, encephalopathic, or had a known sleeping disorder.

Results

Results revealed a 100% completion rate for interviewer-led surveys, with 58.9% of patients being male, 41.1% being female. When asked about sleep quality at home, about 30% rated their quality of sleep as poor or very poor, meanwhile in the hospital 64.4% of people rated their sleep as poor or very poor. Among our participants, when asked about their experience in the hospital, 55.5% stated they had difficulty falling asleep often or always, with 67.8% often or always having difficulty staying asleep. Prior to coming into the hospital, about 43.3% of participants had at least occasionally used sleeping aids in the 30 days prior. Only 28.9% of patients were offered a sleeping aid during their hospitalization, yet of those not offered, 56.3% wished they had been offered sleeping aids. Of those who used sleep aids, 42.9% said they were very helpful, 57.1% found them somewhat helpful.

Conclusion

In conclusion, the study highlights a significant decline in sleep quality among hospitalized patients compared to home settings. Patients faced challenges falling and staying asleep while hospitalized, and those not offered sleep aids expressed a desire for them. The study underscores the potential benefits of interventions to improve sleep quality and quantity for hospitalized patients. The high efficacy of sleep aids among recipients suggests the potential positive impact of interventions targeting sleep improvement for inpatients.

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1103 Outcomes of Interventions to Reduce Pediatric Sleep Study Interpretation Time
Authors: Karhoff Iris , Imran Sehyr , Kowatch Robert , Patel Alpa , Blubaugh Kimberly , haile-teklezghi Aregash , Kalra Maninder
Published: April 2024

Introduction

Nationwide Children’s hospital (NCH) Sleep Center mission is to improve overall health through increased access to diagnosis of sleep disorders. Timely sleep study reporting avoids delay in recognition of sleep disorders and enables early intervention. NCH Sleep center providers completes urgent sleep study interpretations within 24 hours. Delay in sleep study interpretation of non-urgent sleep studies has been a patient and referring provider dissatisfier.

Methods

Aim Statement: The project will decrease the time to interpretation of non-urgent sleep studies for outpatient NCH ENT referrals from a baseline of 11 days to a goal of 7 days, accomplished by June 30 th, 2023, and sustained for 1 year. Key Drivers: • Provider workload • Provider expectation • Scoring delay • Workflow technical issues Interventions: • Change provider sleep reading rotation to 1 week • Study number/provider capped to 25/week • Study allocation criteria established • Report templates streamlined • Scoring for weekend studies implemented • Request platform for workflow management

Results

A total of 270 children were referred by NCH ENT and underwent non-urgent overnight polysomnograms from January 2023 to July 2023 as compared to 180 children from January 2022 to July 2022. The time to interpretation of non-urgent studies ordered by ENT specialists reduced from an average of 11 days (SD 7.1 days) in 2022 to an average of 4.5 days (SD 3.3 days) in 2023 (Jan-June).

Conclusion

Our results indicate that process improvement in the pediatric sleep lab using quality improvement methodology can be utilized to improve patient experience and meet referring provider expectations.

Support (if any)
1105 Relevance of Attributes and Preferences for At-home Diagnostic Testing Differ Among Patients with Sleep Disorders
Authors: Braun Marcel , Dietz-Terjung Sarah , Ulrich Sommer , Christoph Schoebel , Heiser Clemens
Published: April 2024

Introduction

The diagnostic workup for assessment of sleep disorders commonly involves an overnight test to assess sleep patterns and identify pathological events. So far, little is known about preferences for the provision of home sleep tests to patients with disturbed sleep. This study aims to close this gap by eliciting preferences and relative importance of attributes of home sleep testing using a discrete choice experiment (DCE).

Methods

A DCE with seven attributes of at-home overnight sleep testing and three levels per attribute, which were selected based on previous qualitative research, was developed using a fractional factorial design. Patients with and without previous sleep testing experience were recruited from two large third-level sleep centers in Germany. The DCE was administered to patients with paper-based forms during their visits to the outpatient clinics. Coefficients for attribute levels were calculated using a conditional logit model with effects coding to estimate their influence on choice decisions and calculate the relative importance of each attribute.

Results

305 patients (age 54.5 ± 13,1 years, male gender 65.3% were enrolled), and 288 surveys with complete data were included for analysis, which resulted in 1,152 choice decisions available for analysis. All of the attributes, except "Diagnostic accuracy" of sleep study had statistically significant influence on choice decisions. Attributes with the greatest relevance were "Waiting time to discuss sleep study results"; "Waiting time to conduct sleep study", and "Sleep quality during measurement". Of lowest importance was "Diagnostic accuracy" of sleep study, followed by "Effort to apply sleep study device", and "Device logistics". Significant heterogeneity in choice behavior was found, including differences by gender, willingness-to-pay for sleep studies, preferred sleep study location, and previous experience with sleep studies. Preferred location for conducting the sleep test was at-home in 50.7% and in-lab in 46.9%.

Conclusion

Preferences and relative importance of home sleep test attributes vary among different subgroups. Considering those preferences and their relevance is important for clinicians and policy-makers when designing individual patient-centric care pathways and high-level planning of diagnostic testing policies for sleep disorders.

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1117 Oral Microemulsion Gel Shows Improvements in Objective and Perceived Sleep
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Carmon Kiara , Mertz Catalina , Ledesma Duvia Lara
Published: April 2024

Introduction

More empirical research is needed on the effectiveness of ingestible consumer sleep products. This study investigated the effects of a gel-delivered sleep supplement on both objectively measured and perceived sleep in a non-clinical sample of adults.

Methods

Healthy adults (58% male, ages 40-73, mean age=56) with difficulty falling asleep or staying asleep participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants tracked their sleep at home without intervention. During the 3-week intervention period, 30-minutes before bedtime, participants ingested a gel including a blend of melatonin, L-Theanine, magnesium, calcium, vitamin B6, L-Glycine, 5-HTP, lemon balm extract, and GABA. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were 822 nights of tracked sleep across 26 participants. Compared to baseline sleep, objective sleep measurements showed decreased sleep onset latency (p=.019); increased deep sleep, both in duration (p<.001) and proportion of the night (p=.001); fewer awakenings (p=.003); decreased wake after sleep onset, both in duration (p<.001) and proportion of the night (p=.001); and increased sleep efficiency (p<.001) and sleep maintenance (p=.001). Improvements also were observed in SleepScore (p=.010), a measure of overall sleep quality, and BodyScore (p=.005), a measure of deep sleep. Self-report measures revealed improvements in a variety of outcomes compared to baseline: feeling adequately sleepy during bedtime more nights per week (p=.014); feeling it was easier to fall asleep (p<.033); falling asleep in the preferred amount of time more nights per week (p=.006); feeling better able to sleep through the night without waking (p=.023); perceiving better overall sleep quality (p=.014); feeling satisfied with sleep more days per week (p=.007); and feeling well rested more days per week (p=.048).

Conclusion

In this sample of healthy adults, both objectively measured sleep and self-reported sleep improved when using the gel compared to baseline sleep without intervention.

Support (if any)

HealthyCell
1120 Measuring Sleep Depth with Odds Ratio Product (ORP) and In-ear EEG Earbuds
Authors: Meier Elias , Melnykowycz Mark , Duke Guy , Du Toit Wadda , Lambing Kari , Mozzini Federica , Guadagni Veronica
Published: April 2024

Introduction

Odds Ratio Product (ORP) is a highly validated measure of sleep depth and sleep-wake continuum derived from 3-second EEG epochs using spectral power analysis of the signal. It has been shown to be more sensitive than traditional sleep metrics to detect sleep quality and there is increasing scientific evidence of the ability of ORP to identify patient subgroups of sleep-wake disorders and guide personalized treatment. In-Ear EEG is an evolving method of measuring brain activity using in-ear electrodes. The current investigation assessed the signal quality of in-ear EEG data obtained from a single-channel in-ear EEG device (IDUN Guardian) alongside the frontal EEG using the Cerebra Prodigy to determine whether ORP calculation has the potential to be translated from frontal EEG to in-ear EEG.

Methods

18 healthy participants (9 male) were selected ensuring diversity in age (recruited in 24-60 years old range) and sex. Participants wore the Cerebra Prodigy (with forehead electrodes), IDUN Guardian (with in-ear electrodes) while sleeping at home for 3 nights. Data from the devices was collected, synchronized, anonymized, and analyzed to assess the correlation between ORP values derived from the two systems.

Results

Both in-ear and frontal EEG datasets were pre-processed separately (filtered between 0.3 - 40Hz). No artifact rejection was performed. Pearson correlation coefficient of ORP values was calculated between the two systems. An average correlation of 0.35 was found for raw signals based on 3-second epochs where the in-ear EEG seemed to overestimate ORP values. This was improved (r=0.70) by averaging over 10 ORP values (30 second epoch). This is likely due to masking of variability in signals variability in summary statistics.

Conclusion

The results showed that single channel in-ear EEG has the potential to resolve ORP values similar to forehead EEG signals. These results suggest the need for an in-depth analysis of the spectral powers in the different frequency ranges in both systems to guide work on improving alignment between the systems.

Support (if any)

This research work was made possible through the Eureka Eurostars program E2634 grant and was financially supported in Switzerland by Innosuisse - Swiss Innovation Agency and in Canada by the National Research Council Canada.
1124 Use of Scented Pillow Insert Improves Objective and Perceived Sleep Outcomes
Authors: Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Ledesma Duvia Lara , Gottlieb Elie , Fox Julia , Gibbs Laura , Anderson Stephanie , Jain Anshul , Tabert Matthias
Published: April 2024

Introduction

A non-invasive approach to mitigating sleep disturbances is using scents to promote relaxation and sleep. Preliminary mechanistic evidence suggests that olfactory-relevant areas in the brain can influence areas responsible for sleep-wake functioning, and odor can modulate arousal and respiration, indirectly affecting sleep. However, it remains unclear whether preliminary results of in-lab studies generalize to the at-home, naturalistic environment in non-clinical populations. Here, we examined whether a pillow insert embedded with a formulation of fragrance developed for sleep may improve sleep-wake parameters in healthy adults.

Methods

Healthy adults (62% female; ages 20-60, mean=41) participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants tracked their sleep at home without intervention. During the 3-week intervention period, following an initial 3-night fragrance familiarization period, participants used a scented pillow insert each week inside their pillowcase. Made from cotton and lyocell fabric, the formulation includes a proprietary blend of fragrance ingredients with notes of lavender, cedarwood, and jasmine. Sleep was measured objectively using a PSG-validated non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were nearly 600 nights of tracked sleep across 21 participants. Objective sleep measurements showed a reduction in wake after sleep onset (7% decrease, p=.034) and fewer awakenings (9% decrease, p=.045) when compared to baseline sleep. Improvements also were found for self-reported sleep outcomes, including increases in sleepiness at bedtime, perceived sleep quality, and feeling well-rested and refreshed in the morning (all ps<.01). Participants felt satisfied with their sleep 2 more days per week compared to baseline (p<.001).

Conclusion

Among healthy adults, aspects of both objectively measured sleep and self-reported sleep improved when using the scented pillow inserts compared to baseline sleep. These improvements occurred without using invasive or pharmacological interventions, which can be uncomfortable, expensive, and associated with adverse side effects.

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1127 Use of an Adjustable Bed Base Is Associated with Improvements in Objective and Perceived Sleep
Authors: Weaver Morgan , Danoff-Burg Sharon , Rus Holly , Carmon Kiara , Mertz Catalina , Ledesma Duvia Lara
Published: April 2024

Introduction

Previous research has shown that comfort of the sleep surface is essential to sleep quality. Additionally, positional adjustment of a sleep surface can help improve sleep and alleviate discomfort. This study compared sleep in an inclined position on an adjustable bed base to participants’ prior sleep when sleeping flat in their usual bed environment.

Methods

Healthy adults (71% male; ages 27-75, mean age=44) reporting difficulties with frequent awakenings or time spent awake at night participated in an 8-week field study, using a pre-post intervention design. During the 4-week baseline period, participants slept flat on their regular bed. During the 4-week intervention period, they slept in an inclined position of their choosing using Sleepy’s Adjustable Bed Base. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were 951 nights of tracked sleep across 27 participants. Objective sleep measurements showed increased total sleep time (+6 minutes, p=.038) and an increase in light sleep duration (+5 minutes, p=.045) compared to baseline. Also, improvement was observed in BodyScore, an objective measure of deep sleep quality (+2%, p=.030). Self-report measures revealed that using the bed base felt more comfortable compared to sleeping flat using the original bed base (p=.011). Improvements also were found for a variety of perceived sleep outcomes, including the perception of falling asleep more easily, less tossing and turning, better sleep quality, and feeling more well-rested in the morning (all ps<.001).

Conclusion

Several important aspects of objectively measured sleep and self-reported sleep improved when using the adjustable bed base compared to sleeping flat on the original bed base. Additionally, qualitative and quantitative self-report results indicated that the intervention was perceived as comfortable.

Support (if any)

Mattress Firm INC.
1136 Sleep Disorders in Children and Adolescents with Long COVID
Authors: Mistry Shikha , Rodgers-Melnick Samuel , Murphy Jennifer , Miller David , Edwards Amy , Ibrahim Sally
Published: April 2024

Introduction

Recognition of Long COVID is increasing and sleep disturbances are common to this population. This study describes sleep disorders and associated comorbidities in youth with Long COVID.

Methods

This is a retrospective cross-sectional study of patients initially presenting to the Long COVID clinic. We examined the prevalence of sleep disturbances (SD) and compared those with and without SD in comorbidity and symptomatology. Single-factor regression analyses were used to explore the relationship between SD and patient well-being. Multi-factor regressions analyses with PROMIS SD score as the predictor and age as a continuous covariate were analyzed for the several response variables: child well-being, general fatigue, sleep/rest fatigue, cognitive-fatigue, total fatigue, anxiety, and depression scores.

Results

Of 250 patients: age ranged 3-24 years(mean 14.6± 3.4years), predominantly female(157/250;63%), white(202/81%);and non-Hispanic(204/250;82%). Patients with SD made up 26%(64/250): 28% circadian rhythm disorders, 31% insomnia, and 1.2% hypersomnia. Compared to the non-SD group, the SD group was more likely to report comorbidities: abdominal pain(52% vs37%, p=0.035), nausea(64% vs52% p=0.084), constipation(50% vs26% p< 0.001), anxiety(89% vs53% p< 0.001), depression (48% vs27% p=0.002), ADHD(27% vs27% p=0.008), headaches(88% vs67%, p=0.002), dizziness (83% vs52%, p< 0.001), POTS(28% vs16%, p=0.027), brain fog(47% vs29%, p=0.009), fatigue (95% vs77%, p=0.001), appetite loss(47% vs29%, p=0.007), and fever(47% vs72%, p=0.053). Using regression analyses, higher PROMIS SD scores negatively associated with child well-being scores (β2= -0.71±0.2; F2, 63=6.37, P< 0.001, R2=0.17), sleep/rest fatigue(β2=-0.51±0.26; F2, 63=5.81, P=0.004, R2=0.16), and total fatigue(β2=-0.65 ±0.2; F2, 63=8.05, P< 0.001, R2=0.20). No significant relationships were found with general/cognitive fatigue scores. Positive correlations found between PROMIS SD scores and anxiety and depression t-scores(β2= 0.26±0.10; F2, 63=3.08, P=0.05, R2=0.09; and β2=0.30±0.11; F2, 65=3.74, P=0.03, R2=0.11, respectively).

Conclusion

Sleep disorders are prevalent among youth with long-COVID, often coexisting with higher rates of physical, neurological, and psychological symptoms. Higher PROMIS SD scores predict lower child well-being, and higher mood disorder scores. While other factors likely impact long-COVID outcomes, sleep plays an integral role. These findings suggest that SD is a key factor in the overall health and mood of children with Long-COVID, emphasizing the need for integrated care approaches that address both sleep and psychological health.

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1147 Sleep Enigmas in Primary Ciliary Dyskinesia: An Atypical Case of Sleep Movement Disorders and Alpha-Delta Sleep
Authors: Cardona-Quiñones Roberto , Hernandez Saidy Salem , Ramírez-Rivera Edicer , Alvarez-Torres Edwin , Vargas-Perez Noel , De Jesus-Rojas Wilfredo
Published: April 2024

Introduction

Sleep disorders are characterized by the impairment of the quality, timing, and amount of sleep, which results in daytime distress and functioning. Primary Ciliary Dyskinesia (PCD) is a rare genetic condition with oto-sino-pulmonary complications associated with various comorbidities, including sleep-related disorders. However, sleep-related research and its implications in PCD are substantially limited.

Report of case(s)

A 40-year-old Puerto Rican female with a history of RSPH4A [c.921 + 3_921 + 6delAAGT] PCD founder mutation was evaluated for sleeping difficulties. Upon taking history, the patient mentioned that she has been struggling with getting adequate sleep, where she complains of difficulty falling asleep, occasional snoring, and unexplained movements while sleeping. Physical examination presented with Mallampati (4+) but did not show significant neck circumference enlargement, body-mass index, or other neurologic deficits. Diagnostic polysomnogram did not show obstructive sleep apnea (OSA), with a baseline Apnea-Hypopnea Index (AHI) of 1.3/hr. The patient had a prolonged wake after sleep onset (WASO) period, resulting in poor sleep efficiency. The EEG showed alpha delta sleep. Moreover, Periodic Limb Movements in Sleep (PLMS) were present with important sleep fragmentation during the first half of the study (Periodic Limb Movement Index of 15.9/hr); eventually improving when the patient was able to consolidate sleep. Other movements during sleep/drowsiness were appreciated, with large amplitude and rhythmic artifacts in the EEG and legs EMG channels. These movements are most consistent with Rhythmic Movement Disorder, more notoriously in the lower extremities.

Conclusion

To our knowledge, this is a unique documented PCD case with the presence of Alpha-Delta Sleep, presenting PLMS, and Rhythmic Movement Disorder. Comprehensive screening protocols, neuropsychiatric evaluation, and additional sleep studies should be considered to evaluate these complexities in patients with PCD. Further studies are required to identify whether these sleep-related disorders are due to neurophysiologic manifestations as seen with Alpha-Delta Sleep, a neurodevelopmental or neurodegenerative process associated with this ciliopathy. Multicentric clinical trials are essential for this type of ciliopathy, especially among Puerto Rican and Hispanic populations.

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1150 Isolated Nightmares: An Unusual Presentation of Narcolepsy?
Authors: Moawad Katherine , Raizen David
Published: April 2024

Introduction

A nightmare involves an internally generated conscious experience of negative emotional valence. Nightmares typically occur during REM sleep, which is most prevalent during the second half of the night. A young female presented with isolated nightmares, occurring near sleep onset and raising suspicion for narcolepsy.

Report of case(s)

A 21-year-old female presented to the sleep center due to experiencing daily nightmares for five years. Nightmares were described as “super realistic”, “distressing”, and occurred minutes after sleep onset. Nightmare content varied. Some of her nightmare themes included an apocalypse, family members dying, and animals chasing her. She had a remote history of anxiety and was previously prescribed sertraline, which had been discontinued two years ago. She reported no hallucinations, cataplexy, sleep paralysis, dream enactment or excessive sleepiness. She had been using a hormonal transdermal patch for about 2 years. On physical exam, she was noted to have mild bilateral proptosis with white sclera visible above the iris on primary gaze. Polysomnography (PSG) revealed a sleep onset latency of 30.5 minutes, N1 1.5%, N2 47.5%, N3 20.9%, and REM 30.1%. REM sleep latency was short at 63.5 minutes. There were 21.6 arousals per hour. The apnea-hypopnea index was of 0.3 events per hour. The PSG was followed by a multiple sleep latency test (MSLT), which measured a mean sleep latency of 5 minutes 42 seconds during five nap opportunities. The patient experienced REM sleep in both the first and third nap, with a REM sleep latency of 4.5 minutes. The patient’s MSLT revealed pathological sleepiness, which supported a diagnosis of narcolepsy without cataplexy, although the patient reported nightmares and not sleepiness.

Conclusion

This is an atypical presentation for narcolepsy, which is characterized by REM sleep abnormalities. Further research, classifications, and diagnostic criteria for clinical REM phenomena associated with narcolepsy should be investigated. Clinicians who treat patients with narcolepsy should monitor not only the characteristic symptoms of narcolepsy, such as cataplexy or sleepiness, but also inquire about oneiric activity.

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1159 The Cyclical Daytime Sleeper: A Rare Case of a Sighted Teenager with Non-24-Hour Sleep-Wake Disorder
Authors: Nguyen Andrea , Chaung Matthew , Valenzuela Andrew
Published: April 2024

Introduction

Daytime fatigue in teenagers may be hand-waved as hours of screen time the night before and it can be difficult for families to accurately describe sleep habits. These factors quite often obscure an underlying sleep disorder. Here we report the rare case of a sighted teenage patient who presented with sleep disturbance and erratic bedtimes and was found to have non-24-hour sleep wake disorder (N24SWD).

Report of case(s)

16-year-old male with a past medical history of ADHD and insomnia, presented to clinic for evaluation of recurrent and inappropriate sleep time with residual hypersomnolence. Pediatrician first saw the patient for difficulty waking up for school as well as trouble falling asleep at night. Initially, it was suspected to be insomnia due to poor sleep hygiene secondary to significant electronic usage prior to bedtime. When symptoms did not improve, the patient was started on hypnotics including clonidine to help with sleep and daytime stimulant medication was adjusted to help with wakefulness. Pharmaceuticals did not help with sleep symptoms, and the patient’s hypersomnolence led to cyclical absenteeism from school and risk for expulsion. On initial presentation to the sleep clinic, patient and family had difficulty describing his erratic sleep routine. Two weeks of sleep diaries were provided to help characterize the patient’s sleep patterns. No suspicion for sleep disordered breathing, parasomnias nor restless leg syndrome were noted. Sleep diary showed a sleep pattern delaying consistently by 1-2 hours each day. Total sleep each night was 7-9 hours, with sleep onset latency of 30 minutes and no significant awakenings. This activity is classic for non-24 sleep-wake phase disorder. This patient was treated with a combination of timed tasimelteon and bright light therapy along with chronotherapy for resynchronization of the intrinsic circadian rhythm.

Conclusion

N24SWD is commonly seen in blind individuals affecting up to 50% of that population. It is very rare in sighted individuals, and may be harder to discern when confounded with conditions like ADHD or poor sleep hygiene. Having patients complete a sleep diary is a cost effective and low investment intervention that may elucidate their condition and ensure timely treatment.

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1161 From Restless to Rest – the Use of Methadone to Treat Complex RLS in Patients with Sleep Apnea: A Case Series
Authors: Bean Steven , Patel Abha
Published: April 2024

Introduction

Typically, patients with restless leg syndrome (RLS) respond well to standard therapies such as dopamine agonists and alpha-2-delta calcium channel ligands. However, patients with refractory RLS may require opioids for optimal disease control 1. In the setting of concomitant obstructive sleep apnea (OSA), characterized by upper airway collapse leading to recurrent episodes of upper airflow obstruction and intermittent hypoxemia, opioids can further increase respiratory depression. Consequently, many clinicians may be hesitant to prescribe opioids in such patients. The following cases highlight chronic opioid use in patients with concurrent RLS and OSA.

Report of case(s)

Case 1: A 77 year-old man with OSA on continuous positive airway pressure (CPAP) presented to sleep clinic for optimization of longstanding RLS. Initial interventions with standard therapy were ineffective. He was started on methadone with good control of his symptoms, but eventually developed central apneas. He was subsequently switched to BiPAP ST with a residual AHI of 2.6 events/hr. His RLS remained stable on methadone 10-12.5 mg night. Case 2: A 72 year-old man with a history of low back pain previously managed with opioids, presented to sleep clinic for severe OSA and RLS. His RLS symptoms were initially controlled with gabapentin and pramipexole, but he experienced augmentation after self-titrating to high doses. His RLS was optimized with methadone 10 mg. However, he could not tolerate CPAP despite multiple interventions. In order to continue methadone, he lost 60 pounds with significant improvement in his OSA on repeat testing (AHI 6.1 events/hr). He was able to maintain weight loss and continue methadone therapy. Case 3: A 77 year-old female with long standing RLS on methadone for 20 years presented to sleep clinic for follow up of RLS. Her RLS was refractory to standard therapy. Since initiation of methadone, she gained significant weight. A repeat sleep study demonstrated moderate OSA (AHI 28.3 events/hr). She did well on CPAP with excellent compliance (Residual AHI 5.8 events/hr). She remained stable on methadone 20-30 mg daily.

Conclusion

Here we demonstrate that in the right setting, patients with RLS in the setting of OSA can be safely treated with opioid medications.

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1162 Keratoconus in an Adolescent with Obstructive Sleep Apnea
Authors: Purewal Jaskaran , Jayakumar Archana , Perez Iris
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is common in pediatrics. Signs of OSA vary between patients commonly reflecting an obstructed upper airway with hypoventilation and hypoxemia. There is less knowledge of the ophthalmologic findings in OSA. Corneal thickness is sensitive to oxygen desaturations that occur during sleep and may contribute to the development of keratoconus. Based on the IRIS Registry, the prevalence of keratoconus in adults is 2.9% compared to 0.27% in pediatrics. We describe a pediatric patient with keratoconus, who was found to have severe OSA.

Report of case(s)

14-year-old male with history of obesity, tonsillar hypertrophy and bilateral keratoconus s/p corneal crosslinking was admitted to the hospital for corneal transplant. Post-operatively, it was difficult to wean the patient off oxygen and inpatient he required 3L oxygen due to significant nocturnal hypoxemia. With concurrent morning headaches, witnessed apneas and weight gain (BMI 52.7, >99th percentile) the patient underwent an inpatient split night polysomnogram. Results revealed severe OSA (AHI 123/hr) and hypoxemia (O2 baseline 89-91%, nadir 64% O2, ODI 105.1/hr, < 90% for 40% of TST) without significant hypoventilation (PETCO2 43 - 54mmHg, >50mmHg for 1% TST). He was titrated to CPAP 15cm H2O with resolution of sleep apnea (AHI 0.7, SpO2 92 - 98%). Echocardiogram showed normal right ventricular size, ejection fraction and negative for signs of pulmonary hypertension. Chest x-ray was unremarkable. He was initiated on PAP therapy, and subsequently underwent adenotonsillectomy 5 months later. He continues to follow with ophthalmology and uses prednisolone eyedrops regularly.

Conclusion

Ocular presentations are a less recognized sign of OSA particularly in pediatric patients. In adults, the intermittent hypoxemia and airflow limitations could contribute to ocular pathology and severity in presentation. Keratoconus has been associated with elevated levels of matrix metalloproteinases and protease inhibitors, which may play a role in corneal thinning in individuals with OSA. Pediatric keratoconus has been described as more aggressive compared to adults leading to more rapid deterioration. The progression of ocular disease in our patient may have been a consequence of untreated OSA. Our report highlights the importance of early recognition and treatment of OSA in pediatric patients.

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