bluuebunny/crossref_metadata_2025 huggingface dataset:
0818 Comorbid obstructive sleep apnea and insomnia in type 2 diabetes: Association with diabetes-related distress and glycemic control
Authors: Jeon Bomin , Chasens Eileen , Luyster Faith
Published: May 2023

Introduction

It is unclear how comorbid insomnia and sleep duration may influence diabetes-related distress and glycemic control in adults with obstructive sleep apnea (OSA) and type 2 diabetes (T2D). This analysis examined whether diabetes-related distress mediates the associations of OSA and insomnia severity with glycemic control in adults with T2D and OSA based on sleep duration.

Methods

This study was a secondary analysis of merged baseline assessment data from two clinical trials of adults (N=240) with self-reported T2D and OSA. OSA (apnea-hypopnea index ≥ 5) was determined by a home sleep study. Participants completed questionnaires to elicit insomnia severity, diabetes-related distress, sleep duration, daytime sleepiness, and global sleep quality. Sleep duration was classified as normal (>6 h) or short (≤ 6h). Glycemic control was measured by HbA1c (%). Mediation analyses with bootstrapped samples were employed after controlling for sociodemographic covariates in participants with normal and short sleep durations.

Results

More participants (mean age 57.8 years; 49.6% female; 65% White; 56.3% post high school education, mean HbA1c 7.93%) had short sleep duration (n=128; 53.5%) than normal sleep duration (n=111, 46.5%). Participants with short sleep duration had significantly worse sleep quality, daytime sleepiness, insomnia, and HbA1c levels compared to those with normal sleep duration (all p<.05). In participants with normal sleep duration, insomnia severity was associated with diabetes-related distress (b=0.942, p=0.008); diabetes-related distress did not mediate the association between insomnia severity and HbA1c (indirect effect [IE]=0.013, 95% CI: -0.003, 0.036). In participants with short sleep duration, insomnia severity was significantly associated with diabetes-related distress (b=1.470, p< 0.001), and diabetes-related distress mediated the association between insomnia severity and HbA1c (IE=0.023, 95% CI: 0.001, 0.053). Regardless of sleep duration, OSA severity was not associated with diabetes-related distress or HbA1c.

Conclusion

Only among participants with short sleep duration, comorbid insomnia significantly contributes to greater diabetes-related distress, which leads to higher HbA1c levels. Short sleep duration in persons with insomnia could be a potential mechanism involved in the association between diabetes-related distress and glycemic control in adults with T2D and OSA.

Support (if any)

The NIH (R01- DK0960281; K24-NR016685) and the CTSI grants (UL1-RR024153; UL1-TR000005) funded the parent studies
0821 Nighttime Average and Dipping Blood Pressure Can Differ Based on the Temporal Distribution of Ambulatory Measurements at Nighttime
Authors: Brito Leandro , Bowles Nicole , McHill Andrew , Rice Sean , Butler Matthew , Rueda Jose , Emens Jonathan , Shea Steven , Thosar Saurabh
Published: May 2023

Introduction

Ambulatory blood pressure (BP) monitoring is recommended in preference to office BP as it enables BP assessments across the night and quantification of the degree of nocturnal BP dipping (dipping” = nighttime/daytime BP of < 0.9; non-dipping = ≥0.9). Both nighttime BP and dipping% are independent predictors of adverse cardiovascular events. Standard guidelines recommend at least ≥20/7 daytime/nighttime measurements for reliable ambulatory BP monitoring, but newer reports suggest ≥8/4 daytime/nighttime measurements are sufficient. Considering BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. To test whether this new recommendation holds for extreme examples of temporal distribution, we compared average nighttime BP and dipping% when using BP measurements only in the first (1st-half) vs. only in the second half (2nd-half) of the night.

Methods

Seventeen females and twenty-six males (50±10 years [mean±SD]) without cardiovascular disease or severe sleep disorders wore an ambulatory BP monitor for 24 hours, programmed to measure BP every 20 minutes when awake and every 30 minutes during a self-selected 8-hour time-in-bed for nighttime. We compared the nighttime BP averages and the calculated dipping% when using the first four measurements from the 1st-half of the nighttime, from the 2nd-half of the nighttime, and all measurements during the nighttime (All nighttime, AN). Repeated measures ANOVA was conducted with significance set as p< 0.05.

Results

Systolic BP was higher using 1st-half than 2nd-half but similar to AN (111±9 vs.107±11 vs. 109±9 mmHg, p< 0.01), while systolic BP dipping% using 1st-half was lower than 2nd-half and AN (9.7±7.4 vs.13.0±7.6 vs. 11.4±6.7 %, p< 0.01, respectively). Diastolic BP and diastolic dipping% were similar among the 1st-half, 2nd-half, and AN segment (63±6 vs. 63±7 vs. 62±7 mmHg, p=0.19) and (17.2±7.6 vs. 17.2±8.8 vs. 18.4±8.8 %, p=0.16), respectively.

Conclusion

In adults without cardiovascular disease or severe sleep disorders, nighttime BP and dipping% may depend upon when BP measurements are taken. The minimum threshold of 4 measurements for a reliable nighttime BP readout should be used cautiously.

Support (if any)

NIH F32-HL131308, R01HL163232, R01HL125893, R35HL155681, Medical Research Foundation, and OHSU OFDIR fellowship.
0824 The Effect of CBT-I Dose on Sleep Outcomes in Cancer Survivors at 3-month Follow-up
Authors: Muench Alexandria , Lampe Elizabeth , Posner Donn , Seewald Mark , Boyle Julia , Vargas Ivan , Thompson Michelle , Grandner Michael , Perlis Michael
Published: May 2023

Introduction

Cancer-related fatigue (CRF) is highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing such symptomatology. While CRF commonly co-occurs with sleep disturbance during and/or after cancer treatment, CRF is (nevertheless) defined as occurring independent of sleep considerations. Last year it was reported (based on preliminary findings from a pilot study), that CBT-I affects both sleep continuity and fatigue, with high dose CBT-I producing up to a 72% reduction in pre-to-post measures of Fatigue. The present analysis is based on a completed pilot study where we evaluate the durability of the anti-fatigue and sleep continuity effects of CBT-I in patients diagnosed with breast and prostate cancer.

Methods

This descriptive analysis (percent change from post-treatment to three month follow-up) includes 11 adult subjects (91% female; Mage=57.8±7.7yrs). CBT-I was provided by a master CBT-I therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries, and weekly measures of fatigue (FACIT), and insomnia severity (ISI) questionnaires. In order to evaluate durability, post-treatment scores were compared to three-month follow-up scores, where all subjects were typed for whether or not they retained > 90% of their clinical gains as assessed with the ISI and the FACIT.

Results

82% of the subjects in our pilot study maintained their clinical gains with respect to fatigue and 64% maintained their gains with respect to insomnia.

Conclusion

This preliminary analyses suggest that clinical gains via CBT-I are remarkably robust for fatigue outcomes. The findings with respect to the ISI, while less robust, are within the range that is typical for insomnia RCTs (~70% of subjects maintain treatment responses at follow-ups). If these results are replicated, this may suggest that the anti-fatigue effects of CBT-I are more durable than the “insomnialytic” effects.

Support (if any)

5T32HL00795320;K24AG055602
0826 Chronotype, unhealthy lifestyle, and diabetes risk in middle-aged US women: A prospective cohort study in Nurses’ Health Study II
Authors: Kianersi Sina , Liu Yue , Guasch-Ferre Marta , Redline Susan , Schernhammer Eva , Sun Qi , Huang Tianyi
Published: May 2023

Introduction

Chronotype refers to one’s inclination to earlier or later sleeping times. Late chronotype has been linked to increased diabetes risk, which may be mediated through adherence to unhealthy lifestyle. This study aimed to evaluate the interplay among chronotype, lifestyle factors, and diabetes risk.

Methods

In 2009, 63,594 diabetes-free women (mean age=54 yrs) from the Nurses’ Health Study II self-reported their chronotype using a validated question from the Morningness-Eveningness Questionnaire and were prospectively followed for incident type 2 diabetes (T2DM) until June 2017. Unhealthy lifestyle was defined by having < 4 of the following 6 healthy lifestyle factors: high diet quality (AHEI≥49), physical activity (≥3.5 MET-hours/week), moderate alcohol intake (≥5 and < 15 g/day), normal body mass index (≥18.5 and < 25 kg/m2), non-current smoking, and 7-9 hours of sleep. T2DM was self-reported and confirmed using a validated supplementary questionnaire. We used modified Poisson regression models to estimate the cross-sectional associations between chronotype and unhealthy lifestyle. Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHR) for incident diabetes risk according to chronotype and assess the proportion of the association explained by lifestyle factors (mediation analyses).

Results

Participants reporting a “definitely-evening” type were 55% (95% CI: 1.51-1.60) more likely to have an unhealthy lifestyle compared with participants reporting a “definitely-morning” type. We documented 1,921 T2DM cases over 468,555 person-years of follow-up. With increasing eveningness, the risk of T2DM became significantly higher (Ptrend< 0.0001). Compared with the “definitely-morning” type, the aHR (95% CI) for T2DM was 1.10 (0.97-1.24) for “more-morning”, 1.01 (0.81-1.27) for “intermediate”, 1.26 (1.11-1.42) for “more-evening”, and 1.65 (1.44-1.90) for “definitely-evening” chronotypes, after adjusting for sociodemographic factors, shift-work, depression and family history of diabetes. Additional adjustment of unhealthy lifestyle explained 56.8% (95% CI: 39.4%-72.6%) of the association [aHR (95% CI) for “definitely-evening” versus “definitely-morning”: 1.27 (1.10-1.46)].

Conclusion

Women with a late chronotype are more likely to engage in unhealthy lifestyle behaviors. Late chronotype is prospectively associated with increased diabetes risk, which is partly explained by unhealthy lifestyle behaviors. Our results suggest that lifestyle interventions may potentially reduce the adverse impact of late chronotype on diabetes risk.

Support (if any)

R01HL155395, K01HL143034, U01CA176726
0827 Effect of virtual cognitive behavioral therapy for insomnia on perceived cognitive functioning among cancer survivors
Authors: Garland Sheila , Tulk Joshua , Rash Joshua , Seal Melanie , Browne Sondria , Thoms John , Laing Kara , Urquhart Robin , Savard Josée
Published: May 2023

Introduction

Comorbid insomnia and perceived cognitive impairments (PCI) affect up to 26% of individuals diagnosed with cancer. Given the association between sleep and cognition, and the lack of interventions to improve PCI, the present study examined the impact of cognitive behavioral therapy for insomnia (CBT-I) on PCI among cancer survivors with insomnia disorder and cognitive complaints (clinicaltrials.gov:NCT04026048).

Methods

Cancer survivors (N=122) with insomnia and PCI were randomized to 7 weekly virtual CBT-I treatment sessions (n=56) or waitlist control (WLC: n=66). Participants completed the Insomnia Severity Index and the Functional Assessment of Cancer Therapy – Cognitive Function upon entering the study (baseline; T0), and then again at 4 (T1), and 8 (T2) weeks. A series of 2 (treatment group: CBT-I and WLC) by 3 (time: T0, T1, T2) mixed ANOVAs were performed to assess changes in insomnia symptoms, PCI, perceived cognitive abilities (PCA), and impact of cognitive function on quality of life (QOL).

Results

Participants were, on average, aged 60 years, had 16 years of education, and 79% were female. Breast cancer was the most reported cancer type (46%). No significant differences were observed between groups at T0 for demographic or clinical variables (p>.05). There was a significant group by time interaction for insomnia [p=<.001, partial eta squared (pes)=.36]. Individuals randomized to CBT-I reported significant decreases in insomnia symptoms post treatment compared to WLC (CBT-I: -11.5; WLC: -2.7). Significant interactions were also observed for PCI (p=<.001, pes=.11), PCA (p=<.001, pes=.16), and impact on QOL (p=<.001, pes=.15). Participants randomized to CBT-I reported significantly less PCI (CBT-I: 14.7; WLC: 4.1), better PCA (CBT-I: 5.8; WLC: 1.1), and less impact on QOL (CBT-I: 4.9; WLC: 1.1) than participants in the WLC.

Conclusion

In addition to improving insomnia, CBT-I significantly improve perceived cognitive functioning and quality of life among cancer survivors. Further research is needed to understand the mechanisms underlying improvements in cognition following CBT-I.

Support (if any)

Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.
0840 Exploring the relationship between sleep disturbances and Alzheimer’s disease using machine learning
Authors: Bonfa Antonia , Zhang Weiping , Keller Yvo , Barbisch Florin , Schürmann Patrick , Moguel Leticia Fernández , Seixas Azizi , Ramos Alberto , Rogers April , Jean-Louis Girardin , Çöltekin Arzu
Published: May 2023

Introduction

Alzheimer’s Disease (AD) is one of the most common neurological diseases, affecting about 50 million people worldwide. Despite its prevalence and many promising recent developments, the factors that contribute to AD are still poorly understood. In this study, we examined the influence of sleep disturbances (sleep apnea, insomnia, and poor sleep quality) on the chances of developing AD and conversion from normal cognitive functioning (NL), to mild cognitive impairment (MCI) to AD, using the ADNI dataset and state-of-the-art machine learning models.

Methods

We conducted a series of Random Tree classifiers to determine whether sleep disturbances predicted changes in cognitive status (NL, MCI, or AD). Using three sleep target variables OSA, insomnia, and Neuropsychiatric Inventory’s sleep related questions (NPIK) markers, participants that were surveyed for sleep patterns (n=1848) self-declared if they have insomnia (n=49), obstructive sleep apnea (OSA) (n=65), or poor sleep quality via NPIK (n=114). NPIK contains 11 variables, including OSA and NPIK, we explored a total of 7089 observations. Following that, a logistic regression and k-nearest neighbor (KNN) model using only the NPIK questionnaire as NPIK provides a rich and coherent inventory of sleep parameters.

Results

Based on Random Tree classifiers, the best model predicted a change from MCI to AD with an accuracy of 70%. Logistic regression and KNN models predict that caregiver distress, frequency of sleep disturbances and excessive daytime sleepiness play important roles in worsening the cognitive functioning status from MCI to AD. For the MCI patients, a random forest model with 60% accuracy predicted re-conversion from MCI to NL. Caregiver distress, frequency of sleep disturbances, and OSA predicted re-conversion from MCI-NL, and was most pronounced among males.

Conclusion

Our research broadly suggests that sleep disturbances increases Alzheimer's disease risk. However, the data on sleep in the ADNI dataset has limitations. All markers for sleep were subjectively reported by the patients or their caregivers and were not verified with objective observations. Further research under clinical conditions would be of value to find conclusive evidence of sleep disturbance as a risk factor for Alzheimer's Disease.

Support (if any)
0841 Feasibility of Actigraphy during a Daytime Bright Pilot Study in the Medical ICU
Authors: Lukas Molly , Doyle Margaret , Intihar Taylor , Wright Kenneth , Redeker Nancy , Pisani Margaret , Yaggi H , Knauert Melissa
Published: May 2023

Introduction

Medical intensive care unit (MICU) light patterns are inadequate for proper circadian alignment. Sleep disruption and circadian misalignment are observed in MICU patients and adversely impact patient outcomes. We sought to establish the feasibility of using longitudinal actigraphy to measure diurnal rest-activity patterns, as a in the context of a pilot study evaluating daytime bright light (DBL). In an exploratory manner, we analyzed diurnal rest-activity characteristics.

Methods

Patients >50 years admitted to the MICU without pre-existing circadian disruption were enrolled. An actigraph was placed (wrist) on study day 1 (D1) and remained for up to 5 days. DBL exposure (>1200 lux, 5000K) began at 09:00 on D2 and continued until D5 (varied lengths of exposure among patients). Actigraphy feasibility was assessed via (1) total recording duration and (2) proportion of total recording with activity data (e.g., proportion of epochs on wrist with data capture). In an exploratory analysis, we evaluated rest-activity characteristics from D1 and D2 for fit with gamma distribution cosinor analysis. Characteristics included ratio of day/total activity, mesor (midline estimation statistic of circadian rhythm), and circadian quotient (normalized amplitude/mesor).

Results

Thirteen of fourteen enrolled patients completed actigraphy. Mean (SD) age was 74 (11) years. Mean APACHE II illness severity score was 21 (4). Patients had a mean 3.7 (1.3) days of actigraphy recording and a mean activity data proportion of 92% (16%). There were only two reports of temporary actigraph removal related to patient care. All actigraphy patients had fit using cosinor analysis. D1 median (IQR) day/total ratio was 0.76 (0.68,0.82), mesor was 10.31 (6.36,13.00), and circadian quotient was 0.82 (0.48,0.99). D2 (after DBL start) median (IQR) day/total ratio was 0.76 (0.64,0.78), mesor was 11.90 (8.97,15.83), and circadian quotient was 0.89 (0.65,0.95).

Conclusion

Here we demonstrate the feasibility of actigraphy as a measure of diurnal rest-activity patterns in MICU patients based on successful collection and analysis of data in all patients. While cohort size remains a limitation of this study, Actigraphic rest-activity patterns are being explored in an ongoing RCT evaluating the impact of DBL versus usual light exposure on circadian rhythms in critical illness.

Support (if any)

K23HL138229, AASM Foundation
0844 Impact of Obstructive Sleep Apnea on patients admitted with Influenza Viral Pneumonia, A Nationwide Study
Authors: El Labban Mohamad , Chaaban Toufic , Khan Syed
Published: May 2023

Introduction

There is evidence of increased risk of admission with influenza in patients with untreated obstructive sleep apnea (OSA). There is however limited evidence of the impact of OSA on patients admitted with influenza pneumonia. We aim to study this association on a nationwide scale.

Methods

Using the National Inpatient Sample (NIS) Database from 2017 to 2020, a retrospective study of adult patients with principal diagnosis of influenza viral pneumonia with secondary diagnosis with or without obstructive sleep apnea (OSA) according to ICD-10 codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p value less than 0.05 considered statically significant.

Results

The study included 174,339 patients admitted with an influenza pneumonia, 13,094 of which had OSA. The Mean age for patients with and without OSA was 67 and 70 years, respectively. In the OSA group, 48% were females compared to 55% in the non-OSA group. Around 73% in both groups were Caucasian white. Statistically significant comorbidities noticed in the OSA group included chronic kidney disease (29% vs. 22%), Diabetes Mellitus (48% vs. 31%), COPD (47% vs. 31%) . In-hospital mortality rate was not higher in the OSA group with statistical significance (2.1% vs. 2.3%, p =0.48). The adjusted Odds ratio was 0.51 without statistical significance. In-hospital mechanical ventilation and tracheotomy rates were higher in the OSA group with statistical significance (5.3 % vs. 3.7%, p < 0.01) (0.31 % vs. 0.12%, p 0.013 ) however the adjusted odds ratio was not statistically significant in either (aOR 1.27, p value 0.14). (aOR 0.9, p value 0.98). The length of stay was higher in the OSA group (5.5 vs. 4.9 days, adjusted means +0.4 days, p value 0.04) Patients in the OSA group had a higher total charge (59,949$ vs. 44,091$, adjusted means +1,997$ p value 0.45)

Conclusion

Patients admitted with influenza viral pneumonia with associated OSA were not found to have worse clinical outcomes and a higher economic burden.

Support (if any)
0847 Real-World Idiopathic Hypersomnia Total Health Model (RHYTHM): Clinical Burden of Patients Diagnosed With Idiopathic Hypersomnia
Authors: Lillaney Prasheel , Saad Ragy , Profant Deb , Fuller Douglas , Alvord Trevor , Prince Patricia , Whalen Marisa , Macfadden Wayne , Ni Weiyi , Black Jed
Published: May 2023

Introduction

Idiopathic hypersomnia (IH) is a rare neurologic disorder that can cause debilitating symptoms, including excessive daytime sleepiness, severe sleep inertia, prolonged nighttime sleep, long and unrefreshing naps, and cognitive dysfunction. Limited research has investigated the clinical burden associated with IH. This study compared the clinical profile of patients diagnosed with IH versus matched non-IH controls.

Methods

MarketScan® administrative claims were analyzed between December 2013 and February 2020. Eligible patients were aged ≥18 years upon cohort entry and had 365 days of continuous medical coverage (gaps ≤30 days allowed) before and after cohort entry. IH cases entered the cohort upon the first medical claim containing an IH diagnosis and without history of cataplexy. Non-IH controls were matched 5:1 to patients with IH on age, sex, region, payer type, and cohort entry date. Prevalence estimates of Clinical Classification System Multilevel (CCSM) categories and comorbid conditions during the 2-year study period were compared between cohorts using logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.

Results

The final cohorts included 11,428 and 57,138 patients with IH and non-IH controls, respectively. Approximately two-thirds of the sample was female (65.0%); median age was 45 years. Compared with non-IH controls, patients with IH experienced significantly higher prevalence of all CCSM categories. Prevalence estimates of conditions associated with sleep disorders, such as sleep apnea (OR: 26.1 [CI: 24.8, 27.6]), mood disorders (OR: 3.7 [CI: 3.6, 3.9]), and headache/migraine (OR: 2.9 [CI: 2.7, 3.0]), were higher among patients with IH. Similarly, cardiovascular conditions, including cardiovascular disease (OR: 2.2 [CI: 2.1, 2.4]), stroke (OR: 2.2 [CI: 2.0, 2.4]), major adverse cardiovascular events (OR: 2.2 [CI: 2.0, 2.4]), a composite of hypertension diagnosis or use of antihypertensive medications (OR: 2.0 [CI: 2.0, 2.1]), and heart failure (OR: 2.0 [CI: 1.8, 2.3]), were significantly more prevalent among patients with IH.

Conclusion

Patients with IH experience a significant burden of psychiatric and medical comorbidities, including acute and chronic cardiovascular illnesses. This is consistent with observations in other sleep disorders, namely, narcolepsy. Holistic treatment strategies for IH patients are needed, requiring careful consideration of patients’ overall clinical profile when selecting therapies.

Support (if any)

Jazz Pharmaceuticals.
0849 A Cross-Sectional Survey of Cannabis as a Sleep Aid in Canadian Cancer Survivors
Authors: Lee Rachel , Harris Nicholas , Donnan Jennifer , Garland Sheila
Published: May 2023

Introduction

Cannabis is increasingly used to manage cancer treatment-related symptoms. This study investigated the use and perceived effects of cannabis as a sleep aid in Canadian cancer survivors.

Methods

Canadian cancer survivors (N=1492) completed a self-report questionnaire about their use of cannabis as a sleep aid.

Results

Of participants, 24% (n=356) reported currently using cannabis as a sleep aid (Mage = 61; 88% white, 78% in remission). Two thirds (67%; n=238) report only starting to use cannabis for sleep after their cancer diagnosis. Reported benefits include that cannabis helps them relax (59%) and fall asleep faster (48%). Half of participants (49%) use cannabis for sleep over 4-6 times a week, meeting the criteria for regular cannabis use and 53% have been using cannabis as a sleep aid for more than 2 years. Cannabis is most commonly used in the form of edibles (58%) and oils/ sprays (45%). Only 19% have authorization from a healthcare provider and 56% obtain their cannabis from a government regulated site. There was a mix of cannabinoid content in the products used, including products that contain mostly CBD (22%), mostly THC (35%), balanced amounts of CBD and THC (32%), and 8% do not know the formulation of the cannabis they consume. The most common reasons for trying cannabis for sleep were a recommendation from family/friends (43%), their own research (35%), and that they believed it to be more natural than medication (31%). Of those who use cannabis for sleep, 31% also use it to reduce pain and 23% use it recreationally.

Conclusion

Estimates suggest that one in four Canadian cancer survivors’ regularly use cannabis to improve their sleep. Given the prevalence and potential impact, more research is needed to examine the actual efficacy of cannabis as a sleep aid.

Support (if any)

Rachel Lee is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds generously provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).
0851 Evaluation of a new sleep focused nasal obstruction symptom evaluation (NOSE) tool
Authors: Zahir Nada , Sharma Abhay , Woodson B Tucker
Published: May 2023

Introduction

Nasal obstruction is a common patient complaint in the sleep clinic. The nasal obstruction symptom evaluation (NOSE) scale is a validated questionnaire to assess symptoms and quality of life. However, it has weaknesses when evaluating patients in the sleep clinic because it does not differentiate awake and sleep related nasal obstruction. Our primary goal was to compare the old NOSE scale to a new sleep NOSE scale that separates awake and sleep related nasal obstruction.

Methods

A retrospective study was completed to compare the known NOSE scale (old NOSE) with a revised clinical scale more relevant to the sleep clinic (new sleep NOSE and new awake NOSE). 169 adult participants completed the 3 scales in a sleep clinic specializing in otolaryngologic interventions. The collected data compared median scores (Wilcoxon’s signed rank test), agreement (Cohen’s kappa), and correlation (Spearman correlation). Wald’s test was also used to compare the scores between subgroups of insomnia and obstructive sleep apnea (OSA).

Results

The old NOSE scale scores were not significantly different from the sleep NOSE score (p=0.4) but was significantly different from the awake NOSE scale (p< 0.001). The new sleep NOSE scores were also significantly higher than then awake NOSE scores (p<.001). Patients with insomnia tended to score higher on the sleep NOSE scale than the awake NOSE scale.

Conclusion

This study suggests that in the sleep clinic setting, patients score the NOSE scale according to sleep related obstruction. In addition, insomnia patients relate more nighttime than daytime nasal obstruction. Further studies are needed to determine if the NOSE scale needs to be revised to better encompass nasal complaints related to sleep.

Support (if any)
0853 Neighborhood disorder and pain: The mediating role of sleep
Authors: Holloway Breanna , Waldstein Shari R , Quiton Raimi , Sun Shuyan , Evans Michele , Zonderman Alan , Bediako Shawn M
Published: May 2023

Introduction

Neighborhood factors are related to poor sleep, and sleep problems are known to have a strong relationship with pain. The underlying mechanisms for this association remain unclear. The present study evaluated whether sleep duration, sleep quality, or global sleep quality mediated the relation between perceived Neighborhood Disorder (ND) and pain intensity or interference. The study also explored whether adjusting for depressive symptoms accounted for significant mediational pathways found in Aim 1.

Methods

Participants were drawn from Wave 4 (September 2013 to September 2017) of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) epidemiologic cohort study (n=1,071). Perceived ND was measured using the HANDLS Neighborhood Problems Scale, which assesses how often a particular neighborhood problem occurs. The Patient Reported Outcomes Measurement Information System Pain Intensity short form 3a was used to assess how much a person hurt in the past 7 days, and pain interference was measured by the bodily pain subdomain of the 12-item Short-Form Health Survey. The Pittsburgh Sleep Quality Index was used to assess sleep duration, subjective sleep quality, and global sleep quality.

Results

Results of the study revealed mediating effects of global sleep quality on the relation of perceived ND and pain intensity (indirect effect = .5527, SE =.1355, 95% CI [.2914, .8316]) and pain interference (indirect effect = .0579 (SE = .0143), 95% CI [.0312, .0876]) and also of subjective sleep quality on pain intensity (indirect effect = .5801, SE =.1337, 95% CI [.3206, .8468]) and pain interference (indirect effect = .0587 (SE =.0137), 95% CI [.0327, .0867]). Results revealed that mediating effects of sleep quality and global sleep on the relation of perceived ND and pain intensity and pain interference remained significant after adjustment for depressive symptoms.

Conclusion

These findings provide preliminary evidence to support the notion that select sleep dimensions, particularly sleep quality, is a pathway by which subjective neighborhood factors may impact pain intensity and pain interference. More research is needed to understand potential pathways underlying the perceived ND and pain relation.

Support (if any)

NIH Intramural Research Program Inter-laboratory proposal provided by the National Institute on Aging Intramural Research Program
0854 Observation-based Diurnal Sleepiness Inventory (ODSI) is associated with Objective Sleepiness via Psychomotor Vigilance Task
Authors: Pak Victoria , Russell Kate , Gooneratne Nalaka , Cox John , Servaes Stijn , Lee Taekyu , Onen Hakki , Onen Fannie
Published: May 2023

Introduction

The Epworth Sleepiness Scale (ESS) is commonly used to assess excessive daytime sleepiness, but its accuracy is limited. In this study, we aim to compare the ESS with the Observation-based Diurnal Sleepiness Inventory (ODSI), a subjective measure of sleepiness that has been validated using the ESS in older adults, to objective measures of sleepiness obtained through the Psychomotor Vigilance Task (PVT). Despite being validated with the ESS, the ODSI has not yet been tested with objective measures of sleepiness. By comparing subjective measures of sleepiness (ODSI and ESS) to objective measures (PVT), we aim to expand the usage of ODSI to other populations.

Methods

91 persons with newly diagnosed obstructive sleep apnea and not yet treated on continuous positive airway pressure (CPAP) were administered the ESS, ODSI, and PVT sleepiness tests, and the results were analyzed for correlations using linear regression. The average age was 50.48 ± 12.74, the mean body mass index (BMI) was 35.9 ± 9.3, the mean apnea hypopnea index was 30.9 ± 23.7, and 53.5% were male. The ESS and ODSI scores were run against PVT lapses and transformed average reaction time, which are the two primary outcomes of PVT.

Results

PVT lapses were significantly different between sleepy and non-sleepy individuals as defined by both ESS and ODSI categorization. Both the ODSI and the ESS were significantly correlated to the transformed average reaction time. The second question on the ODSI was also significantly correlated to PVT lapses as well as the transformed average reaction time.

Conclusion

The ODSI and ESS correlated well with objective measures of sleepiness through the PVT. The ODSI is a suitable measure of sleepiness appropriate for usage in middle-aged adults with obstructive sleep apnea.

Support (if any)

R00NR014675-05 (PI: Pak)
0855 Patient-reported sleep symptoms across four cycles of chemotherapy among adults with lymphoma: A pilot study
Authors: Fox Rina , Kalam Faiza , Gaumond Julia , Crawford Abigail , Karmali Reem , Morelli Whitney , Hibler Elizabeth , Knutson Kristen
Published: May 2023

Introduction

Sleep disturbance is one of the primary symptoms reported by cancer survivors before, during, and after treatment. To better understand trajectories of sleep disturbance over the course of chemotherapy, we evaluated patient-reported symptoms among adults being treated for lymphoma.

Methods

Participants were 18-74 years old, English-speaking, and scheduled to be treated with a full course of anthracycline-based chemotherapy. Among other assessments, participants completed a battery of patient-reported outcome measures prior to the first cycle of chemotherapy (T1) and on the final days of the second (T2) and fourth (T3) cycles. Sleep symptoms were assessed with the Insomnia Severity Index (ISI), PROMIS Sleep Disturbance (PROMIS-SD), and PROMIS Sleep-Related Impairment (PROMIS-SRI) measures. Given the small sample size, descriptives and effect sizes were calculated rather than conducting inferential analyses.

Results

Participants were 9 adults with Hodgkin’s (n=5) or Non-Hodgkin’s (n=4) lymphoma, mean age 41 years (SD=13.9), mostly male (89%), White (78%), and non-Hispanic (89%). The majority had higher scores on the ISI (85.7%), PROMIS-SD (71.4%), and PROMIS-SRI (71.4%) at T2 than T1, demonstrating more sleep disturbance mid-chemotherapy than prior to chemotherapy. Conversely, the majority had lower scores at T3 than T2 (ISI: 80.0%, PROMIS-SD: 80.0%, PROMIS-SRI: 100.0%), demonstrating less sleep disturbance at late-chemotherapy than mid-chemotherapy. For most participants scores remained higher at T3 than T1 (all 3 measures: 75.0%), indicating more sleep disturbance at late-chemotherapy than pre-chemotherapy. Averaged across participants, differences in scores from T1 to T2 were small-to-medium (ISI: Hedges’ g=0.42, PROMIS-SD: g=0.44, PROMIS-SRI: g=0.62), from T1 to T3 were small (ISI: g=0.26, PROMIS-SD: g=0.26, PROMIS-SRI: g=0.23), and from T2 to T3 were medium-to-large (ISI: g=0.98, PROMIS-SD: g=0.73, PROMIS-SRI: g=0.53).

Conclusion

Patient-reported sleep symptoms worsened over the first two cycles of anthracycline-based chemotherapy. Symptoms improved over the subsequent two cycles; however, for most participants they remained worse than baseline levels. Pending replication in a larger sample, intervening before initiating chemotherapy or during the early cycles thereof may be beneficial to diminish sleep disturbance among patients with lymphoma.

Support (if any)

The project described was supported by the Robert H. Lurie Comprehensive Cancer Center. RSF was supported by NCI grant #K08CA247973. EH was supported by NHLBI grant #K01HL152009.
0857 Associations between Functional Vision and Sleep Performance
Authors: Joyce Daniel , Fernandez Kaitlin , Ricketts Emily
Published: May 2023

Introduction

Conserved early visual pathways set visual perception and sleep consolidation and timing, but the associations between functional vision and sleep are not well established. Here, we determine these associations in a nationally-recruited adult cohort and contrast them with health outcome covariates.

Methods

Data were drawn from 5973 adults aged 20 to 85 years (M=41.32, SD=21.82), obtained from the US National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008 cohorts. Adults reported demographics, sleep duration, vision, body size (body mass index; BMI), depression (Patient Health Questionnaire-9), and social support information. Spearman’s rank correlations were performed to determine the association between self-reported measures of functional vision and self-reported typical nightly sleep duration. To determine the influence of covariates thought to moderate health outcomes on this association, ordinal logistic regression was performed with sleep as the predictor and ‘general eyesight condition’ or ‘vision limiting activities’ as the dependent variables; and age, BMI, depression, and emotional support as covariates.

Results

Typical nightly sleep duration correlated very weakly with general eyesight condition (r=-.07, p<.001), vision limiting activities (r=-.03, p=.001), eyesight worry (r=-.09, p<.001), difficulty reading newsprint (r=-.06, p<.001), and difficulty discriminating objects (r=-.03, p=.007). For general eyesight condition, (exponentiated) odds ratios were minorly improved with increasing typical nightly sleep duration (B=.93, p<.001), but these effects were eclipsed by psychosocial factors such as PHQ-9 depression score (B=1.11, p<.001) and emotional support availability (B=.71, p<.001), while ageing had a minor effect (B=1.02, p<.001) and BMI did not associate (p=.29). For vision limiting activities; odds ratios were not influenced by typical nightly sleep duration (p=.086), psychosocial factors such as PHQ-9 depression score (B=1.13, p<.001) and emotional support availability (B=0.63, p<.001) meaningfully enhanced odds ratios, while ageing (B=1.03, p<.001) and BMI had minor effects (B=1.01, p=.009).

Conclusion

Despite shared sensory pathways, the neuroprotective effects of sleep on functional vision appear limited. Unlike for many disorders, BMI and ageing did not meaningfully associate with functional vision deficits. Psychosocial support mechanisms had the strongest beneficial association with functional vision, and such mechanisms should be given more consideration during optometric care.

Support (if any)

BBRF NARSAD (#28056). KTEF Career Starter (#NNO). NAM Catalyst (#2000012740).
0859 Characterizing Comorbid Chronic Pain in Veterans with Obstructive Sleep Apnea
Authors: Saconi Bruno , Polomano Rosemary , Compton Peggy , Keenan Brendan , Kuna Samuel , Sawyer Amy
Published: May 2023

Introduction

Evidence suggests that chronic noncancer pain (CP) and obstructive sleep apnea (OSA) are highly prevalent in the adult civilian population. As military veterans are disproportionally affected by both CP and OSA, greater understanding of the frequency and characteristics of CP that most commonly affect veterans with OSA is needed. Thus, this study characterized CP among veterans with OSA in terms of frequency, location, duration, severity, interference on daily activities, and etiology (neuropathic versus not).

Methods

A descriptive, observational, cross-sectional survey of veterans with newly diagnosed, untreated OSA and reporting pre-existing CP (N=107). Descriptive statistics characterized the sample and comorbid CP outcomes.

Results

In total, 69.5% (107/154) of participants with OSA who consented for the study had CP. Among participants with CP completing the survey (66.4% [71/107]), CP symptoms persisted for 15 years (IQR = 10-26.5). On average, Brief Pain Inventory – Short Form scores (0-10 scale) indicate moderate pain severity (5.2 ± 2.0) and interference on daily activities (5.7 ± 2.3). Greater pain interference was with sleep (6.3 ± 3.1) and enjoyment of life (6.0 ± 2.5). Pain affected multiple body regions and symptoms of predominantly neuropathic origin (defined as Self-completed Leeds Assessment of Neuropathic Symptoms and Signs scores ≥ 12) were reported by 49.3% of the sample.

Conclusion

CP is commonly comorbid with OSA. Primary care, pain management, and sleep medicine providers should prioritize CP screening, OSA screening, and management among patients with OSA. Future investigations of CP and OSA should focus on their association and how the effective treatment of one affects the severity of the other.

Support (if any)

SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.
0860 Comparative description of sleep, thyroid-stimulating hormone and calcium metabolism in 5 vitiligo patients under phototherapy
Authors: Xerfan Ellen , Facina Anamaria , Tomimori Jane , Tufik Sergio , Andersen Monica
Published: May 2023

Introduction

Vitiligo is an autoimmune skin disease represented by melanocytes destruction. Clinically, it evolves with spots that are lighter than normal skin color. Periodical evaluation of patients is recommended, including thyroid function. Phototherapy is its gold standard treatment, consisting in specific range of ultraviolet B (UVB) light sections. Sleep may play an immunological role, and should be investigated in vitiligo. The study aimed to compare results of thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium and vitamin D 1.25(OH)2D and 25(OH)D; and Pittsburgh Sleep Quality Index (PSQI) scores of vitiligo patients before and after phototherapy period.

Methods

Five individuals with vitiligo were evaluated at a University Dermatology Service, following ethical guidelines. Blood collection and PSQI application were performed before and after phototherapy. Laboratory elements were those related to calcium metabolism (PTH, calcium and vitamin D) and TSH.

Results

The sample included 4 female individuals with 21, 46, 65 and 70 years old; and a 57 years old male. Three of them had large skin involvement and 2 had localized vitiligo. After 6 months under phototherapy, patients returned for reassessment. All showed skin lesions improvement. Quantitative increase in TSH, PTH, 1.25(OH)2D and 25(OH)D was observed; serum calcium varied among the sample. Regarding PSQI before phototherapy, all 5 scores were >5 (1 score>10). The PSQI was reapplied only in 3 of the 5 volunteers after phototherapy; 2 scores reduced, and 1 score increased. This results, although from few individuals, alert to the possible role of UVB phototherapy on TSH and calcium metabolism substrates. Vitamin D increase may be associated to improvement of subjective sleep of 2 individuals. It was described that vitamin D in sufficient concentration could be related to better sleep quality. Phototherapy, by acting on clinical improvement of vitiligo, may influence subjective sleep, as reported in PSQI; and it could influence on melatonin and circadian rhythm.

Conclusion

The interaction between vitiligo/autoimmunity, phototherapy, vitamin D and sleep is complex and may have interrelated pathways. A better understanding of this pathophysiology through larger studies is worthy for benefiting clinical management of vitiligo and associated sleep disorders.

Support (if any)

AFIP, CAPES and CNPq.
0861 Does Cognitive Behavioral Therapy for Insomnia Reduce Productivity Loss in Cancer Survivors with Cognitive Impairment?
Authors: Tulk Joshua , Browne Sondria , Ajith Harsha , Garland Sheila
Published: May 2023

Introduction

Insomnia and perceived cognitive impairments (PCI) affect 1 in 4 cancer survivors and negatively affects work productivity. This study explores the impact of cognitive behavioral therapy for insomnia (CBT-I) on work presenteeism and absenteeism in cancer survivors with comorbid insomnia and PCI.

Methods

A sub-sample of 42 Atlantic Canadian survivors with insomnia disorder and PCI who were currently working for pay were analyzed as part of a larger randomized clinical trial. Participants completed 7 virtual sessions of CBT-I. The Work Productivity and Activity Impairment Index Specific Health Problem Questionnaire (WPAI: SHP) was administered pre-and post-treatment. Absenteeism was defined as the percentage of time absent from work, while presenteeism was defined as the extent to which health problems affected productivity at work in the past 7 days. Costs were calculated by the human capital method. Significant changes in productivity loss were defined at ≥15% or 20% change in absenteeism and presenteeism, respectively. Descriptive statistics and paired samples t-tests were used to measure changes in productivity following treatment. Average net benefit was calculated by subtracting the average treatment cost from average treatment benefits after 1 year to reflect cost savings after CBT-I. The cost of treatment was estimated in terms of average cost per session and lost time at work.

Results

Participants (76% Female) were, on average, 50.4 years old with 16.6 years of education. Breast cancer was the most reported cancer type (43%). Overall rates of presenteeism were significantly lower at post-treatment (p=<.001, d=0.55), with 52.4% reporting significant reductions. Absenteeism rates from pre- to post-treatment were not significant (p=.11, d=0.20). Reduced productivity loss post-treatment was associated with an average savings of CAD$10,979/person/year. Average net benefits for the first-year post-treatment equaled CAD$9348/person.

Conclusion

CBT-I can improve work productivity in cancer survivors. Investments to increase and provide access to evidence-based treatment may lead to significant savings for individuals and businesses.

Support (if any)

Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.