bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of male and female perspective in couples involved in sexual relationships and facing endometriosis
Authors: Helfenstein Fabienne , Kohl Schwartz Alexandra S , Imesch Patrick , Rauchfuss Martina , Wölfler Monika M , Haeberlin Felix , von Orelli Stefanie , Leeners Brigitte
Published: May 2023

Background

While the sexuality of patients with endometriosis is an established topic in research, the possible effect of endometriosis on partnership sexuality has come to the fore only recently. To improve counseling, more information is needed on how both partners experience sexuality in the context of endometriosis.

Aim

Previous research regarding endometriosis and sexuality normally focused on one partner to explore couples’ intimate relations, whereas this study provides a comparison on both partners’ perspectives on their common sexuality.

Methods

An overall 302 couples received a questionnaire based on the Brief Index of Sexual Functioning and Sexual History Form, which was modified by endometriosis specialists to better focus on endometriosis-specific aspects. To detect different perspectives on common sexuality within the couple, the Wilcoxon test and the Pearson chi-square test were performed.

Outcomes

Various aspects of couple sexuality were assessed by both partners to investigate divergent perspectives between the man and the woman within a couple.

Results

On one hand, male and female partners seem to have divergent perspectives on sexual satisfaction in general, desired frequency of sexual contacts, and the question of the female partner engaging in sexual activity despite discomfort. On the other, they have similar perspectives on who takes initiative in sexual contacts, satisfaction with variety in the sexual relationship, and the impact of sexual limitations on their satisfaction within the partnership.

Clinical implications

Endometriosis research addressing issues related to sexuality should include male partners; the same applies to consulting women with endometriosis in the context of their relationships rather than as individuals.

Strengths and Limitations

This is the first analysis conducted on a larger scale of data from both partners in couples dealing with endometriosis. As it provides quantitative information only, some qualitative information remains unexplored.

Conclusion

As both partners showed tendencies to overestimate their partners’ sexual satisfaction and had different perspectives on sensitive topics in sexuality, such as the female partner engaging in sexual activity despite discomfort, addressing sexual communication could be a starting point in counseling couples dealing with endometriosis.
Effects of tadalafil on sexual behavior of male rats induced by chronic unpredictable mild stress
Authors: Wang Heng , Liu Xue , Zhang Ziheng , Han Ziyang , Jiang Yongsheng , Qiao Yu , Liu Tao , Chen Jianhuai , Chen Yun
Published: May 2023

Background

Few studies have investigated psychogenic sexual dysfunction including psychogenic erectile dysfunction (pED); the effect of tadalafil on sexual behavior of male rats induced by chronic unpredictable mild stress (CUMS) remains unclear.

Aim

The aim was to explore the influence of CUMS on sexual behavior of male rats and the effects of tadalafil on that.

Methods

Adult male rats were divided into 3 groups, including the normal group without CUMS, the model group with 6 weeks’ CUMS, and the tadalafil group with treatment of tadalafil during CUMS. CUMS consists of water deprivation, food deprivation, stroboscopic lightning, white noise, cage tilting, weeding packing, and housing 2 unfamiliar rats. The apomorphine test and vaginal smear test were conducted with the aim to screen out male rats with good erectile function and make preparation for the sexual behavior test, respectively.

Outcomes

At the end of the study period, the level of anhedonia and sexual function were evaluated by the sucrose preference test, sexual behavior test, and measurement of serum testosterone, dopamine, and 5-HT.

Results

Sucrose preference showed significant decrease in rats after CUMS. The intromission ratio and total intromission frequency decreased significantly, while the mount latency and ejaculation latency prolonged significantly in CUMS-induced rats when compared with normal rats. Meanwhile, the treatment of tadalafil reversed the level of anhedonia and sexual function in CUMS-induced rats. However, there were no statistical differences in the levels of serum testosterone, dopamine, and 5-HT among groups.

Clinical Implications

The study constructed an animal model that can provide clinical insights into the mechanism of psychogenic sexual dysfunction and supports the application of tadalafil in pED therapy.

Strengths and Limitations

We found that CUMS-induced rats exhibited anhedonia and poor sexual function that could be prevented by tadalafil administration. Future research needs to construct the standard of pED model and explore the mechanism of tadalafil on central nervous system.

Conclusion

Tadalafil could prevent the changes of depression and poor sexual function in rats induced by CUMS, and the method of CUMS and the sexual behavior test should be used in the future for pED modeling.
Disease activity and erectile dysfunction in Japanese patients with ulcerative colitis
Authors: Furukawa Shinya , Takeshita Eiji , Miyake Teruki , Tange Kazuhiro , Tomida Hideomi , Yamamoto Yasunori , Ikeda Yoshio , Hiasa Yoichi
Published: May 2023

Background

The association between disease activity and erectile dysfunction (ED) in patients with inflammatory bowel disease (IBD) is inconsistent, although IBD, including ulcerative colitis (UC), is reported as a risk factor for ED.

Aim

The purpose of this study was to explore this association in Japanese patients with UC.

Methods

In this study, we enrolled 165 Japanese male patients with UC. Information regarding the Sexual Health Inventory for Men (SHIM) score, medication, and severity of UC was obtained from medical records, self-administered questionnaires, and reports from physicians. The definition of ED and severe ED is a SHIM score <17 and <8, respectively.

Outcomes

No association between severity of UC and ED was found in Japanese patients. Aging is independently positively associated with ED in patients with UC.

Results

The prevalence of severe ED and ED was 47.9% and 64.9%, respectively. In this study, mucosal healing, clinical remission, duration of UC, disease extent, and medication were not associated with the prevalence of ED. Older age (≥63 years of age) was independently positively associated with ED (adjusted odds ratio, 12.93; 95% CI: 4.51-43.00) and severe ED (adjusted odds ratio, 9.02; 95% CI: 3.66-23.91).

Clinical Implications

Disease severity of UC might not be associated with the prevalence of ED in patients with UC.

Strengths and Limitations

This is the first study to investigate the association between several factors regarding UC activity and ED. The limitation of this study is the definition of ED based on SHIM scores.

Conclusion

No association between severity of UC and ED was found in Japanese patients. As expected, aging may be independently positively associated with ED in patients with UC.
0008 The endogenous circadian system provides for enhanced coronary microvascular function in the morning
Authors: Thosar Saurabh , Hodovan James , Kheiri Babikir , McHill Andrew , Bowles Nicole , Rice Sean , Butler Matthew , Emens Jonathan , Shea Steven , Lindner Jonathan
Published: May 2023

Introduction

Major adverse cardiovascular events occur most commonly in the morning compared to other times of the day or night. Evaluation of coronary microvascular reserve perfusion can be used to reflect the anatomic and functional status of the coronary vascular system, both of which contribute to major adverse cardiovascular events. Prior work suggests that coronary microvascular function is attenuated in the morning, but whether the circadian system contributes to this attenuation is unknown.

Methods

To determine if the circadian system drives the morning attenuation in coronary microvascular function, we studied 13 healthy participants (8 females, 5 males; 42+/-13 years [mean+/-SD]) in a 5-day forced desynchrony protocol in dim light, where all behaviors and measurements were distributed across the 24-hour cycle. Coronary microvascular function was evaluated by vasodilator myocardial contrast echocardiography, sequentially 16 hours apart, corresponding to each participant’s morning, evening and night. We analyzed time-intensity data to calculate microvascular flux rate (beta) at rest and during hyperemia for each measurement. Circadian phases were calculated based on individual dim-light melatonin onsets. We grouped data into three ~8-hour circadian bins corresponding to each participant’s morning, evening and night. Mixed model analyses were used to determine if there were significant differences between data collected in the circadian morning compared to the other times while controlling for the measurement schedule and between-subject variability.

Results

There were no significant time-dependent differences in echocardiographic indices of ventricular function, including stroke volume, cardiac output, or myocardial work. Contrary to our hypothesis, hyperemic perfusion was lowest in the evening rather than the morning (2.49 /s vs. 2.82 /s, p=0.042) but not different between morning and night (also 2.82 /s, p=0.96).

Conclusion

In healthy people, there is no circadian-system-driven morning attenuation in coronary microvascular function: indeed, the circadian system facilitates coronary vascular flow in the morning, possibly to accommodate the anticipated behaviorally driven increases in myocardial demand after awakening.

Support (if any)

NIH KL2TR002370, R01HL163232, R35HL155681, R01HL140577, R01HL130046, R01HL078610, R01HL156948, K01HL146992, K01HL151745, ULTR00128, Sleep Research Society Foundation, Oregon Institute of Occupational Health Sciences.
0047 Mapping orexin 2 receptor pathways that improve sleepiness and cataplexy
Authors: Ishikawa Takashi , Kurimoto Emi , Joyal Adam A , Scammell Thomas E
Published: May 2023

Introduction

Narcolepsy type 1 is caused by selective loss of orexinergic neurons, resulting in poor maintenance of sleep and wakefulness, and emergence of cataplexy. Orexinergic neurons innervate many brain regions, and specific narcolepsy symptoms likely arise from dysfunction of distinct brain regions. Orexin 2 receptors (OX2R) are expressed in nearly all wake- and REM sleep-regulatory brain regions, and OX2R agonists improve narcolepsy symptoms in mouse models and human patients. However, the key brain regions and pathways through which OX2R signaling stabilizes wake and sleep and suppresses cataplexy are only partially understood. In this study, we restored OX2R expression in specific brain regions of mice lacking orexinergic neurons and OX2R, and assessed if an OX2R-selective agonist improves specific aspects of their narcolepsy symptoms.

Methods

We produced a murine narcolepsy model with the human diphtheria toxin receptor (DTR) knocked into the endogenous prepro-orexin locus (orexinDTR mice). After injection with diphtheria toxin (DTX), orexinDTR mice have severe and selective loss of orexinergic neurons. We crossed orexinDTR mice with OX2R transcription-disrupted (TD) mice to produce a new narcolepsy model lacking orexinergic neurons and OX2R (OX2R TD::orexinDTR mice). To induce focal expression of OX2R, we microinjected an adeno-associated viral vector coding for Cre recombinase into specific brain regions of OX2R TD::orexinDTR mice. At 6 weeks after DTX injection, we administered an OX2R-selective agonist OX-201 or vehicle orally to OX2R TD::orexinDTR mice expressing OX2R in the specific brain regions and evaluated the effects of OX-201 on narcolepsy symptoms including sleepiness and cataplexy.

Results

In mice expressing OX2R only in the tuberomammillary nucleus (TMN) or basal forebrain (BF) regions, OX-201 significantly improved maintenance of wakefulness but did not suppress cataplexy. In contrast, in mice expressing OX2R in the ventrolateral periaqueductal grey and lateral pontine tegmentum (vlPAG/LPT) regions, OX-201 significantly suppressed cataplexy without improving maintenance of wakefulness.

Conclusion

These findings demonstrate that OX2R signaling in the TMN and BF regions can stabilize wake and sleep, and OX2R signaling in the vlPAG/LPT region can suppress cataplexy.

Support (if any)

This work was funded by Takeda Pharmaceutical Company Limited.
0052 A Novel Biomarker of Alzheimer’s Disease Based on High-order Interactions of Low-density Electroencephalography
Authors: Herzog Rubén , Haghayegh Shahab , Ibáñez Agustín , Hu Kun
Published: May 2023

Introduction

Alzheimer’s disease (AD) causes disruptions in brain functions, which can be tracked by proper analysis of electroencephalography (EEG). Current efforts to understand the impact of AD on brain activity have leveraged the development of high-density EEG. Alternatively, we propose that AD can be discriminated from healthy controls (HC) by analyzing low-density EEG sleep recordings with nonlinear measures that capture functional interactions beyond pairwise such as the total correlation (TC), dual total correlation (DTC), O-information (O) and S-information (S).

Methods

We analyzed overnight polysomnography data with 4 EEG channels (left central, right central, left mastoid, and right mastoid) of 28 older men (14 with a self-reported history of clinical diagnosis of AD and 14 HC, matched in age and education) in the Osteoporotic Fractures in Men Study (MrOS) obtained from the National Sleep Research Resource (NSRR). Each 30-second epoch was scored as wake (W), N1, N2, N3, or rapid eye movement. Features based on low (2) and high order (3-4) interactions between electrodes (TC, DTC, O, and S) were extracted from raw and band-pass filtered data within each wake/sleep stage. Finally, a feature selection algorithm provided the optimal subset of features that maximizes the discrimination between conditions.

Results

AD was discriminated from HC with an average area under the receiver operating characteristic curve of 0.90±0.05 using just 3 features: O (triplet) measured within W stage in the high γ band (40-100 Hz), DTC (triplet) for raw N1 data, and TC (pairwise) in the δ band (0.5-4 Hz) within N stages.

Conclusion

State-of-the-art analysis of high-order interactions can maximize the discrimination of AD using a low-density sleep EEG set-up. The potential of these features to capture the physiopathology of AD and its impact on brain function should be further confirmed using larger samples.

Support (if any)

National Institutes of Health (RF1AG059867, RF1AG064312, R01AG057234); ANID/FONDECYT Regular (1210195 and 1210176 and 1220995); Alzheimer’s Association (SG-20-725707). MrOS Sleep Study was supported by R01 HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, and R01HL070839. The NSRR was supported by R24HL114473, 75N92019R002.
0090 Sleep Architecture Associations with Brain Age: A Multi-Site Model Validation
Authors: Vanasse Thomas J , Rusk Samuel , Nygate Yoav , Fernandez Chris , Shi Jiaxiao M , Arguelles Jessica , Klimper Matthew T , Wickwire Emerson , Watson Nathaniel F , Hwang Dennis
Published: May 2023

Introduction

Machine Learning (ML) can draw upon complex patient data to predict current and future health status, but the best performing ML models are often difficult to interpret. One such ML-defined health marker is the brain age index (BAI), the difference between ML-predicted age and chronological age (CA) using electroencephalogram (EEG) during sleep. BAI is associated with multiple disease states including increased risk for all-cause mortality. Still, validation of published models has been limited, and the underlying associations between polysomnography sleep architecture metrics and BAI estimation are not well understood.

Methods

A deep neural network (DNN) model was trained to predict the brain age (BA) of patients using raw EEG signals recorded during clinical polysomnography (PSG). The DNN was trained on N=54,000 PSGs. The model was then validated on two independent datasets: a Kaiser Permanente (KP) Historical PSG Dataset (N=10,694), and a multi-site retrospective PSG dataset (N=15,158). To test association with BAI, ordinary least squares (OLS) regression was performed on these validation datasets using basic features derived from sleep staging architecture and arousal data.

Results

In the validation datasets, we observed mean absolute error (MAE) of 6.67 (6.69/6.49 F/M, KP dataset) and 5.65 (5.56/5.44 F/M, independent dataset). In the OLS analysis, consistent, negative associations were detected between both N3 and REM sleep percentage vs. BAI. Furthermore, BAI was consistently positively associated with N1 sleep percentage. Each of these effects was significant at p< 0.001.

Conclusion

This study builds upon and expands prior research by evaluating large multi-site datasets and assessing the relationship of N3/REM sleep duration with the predicted brain age. Using a DNN model, BAI was associated with significantly increased N1 and concomitant decreased N3/REM. Further research is needed to determine if BA is malleable and potentially reduced with clinical intervention and positive changes in lifestyle and wellness-related behavior.

Support (if any)
0129 Delta-9-tetrahydrocannabinol (THC) ingestion before bedtime reduces nocturnal parasympathetic control of the heart
Authors: Gonzalez Joshua , Robinson LaTroy , Clemons Noal , Ellison Jacqueline , Ordaz-Johnson Omar , Emens Jonathan , Shea Steven , Bowles Nicole
Published: May 2023

Introduction

The use of cannabis as a sleep aid has increased despite inadequate evidence of its efficacy or associated risks. Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive constituent of cannabis. Acute THC administration can induce CB1R mediated reductions in total peripheral resistance resulting in dose-dependent increases in heart rate and reductions in heart rate variability (HRV) in awake subjects. However, the influence of THC on vagal-cardiac modulation during sleep is unclear.

Methods

7 individuals who use cannabis (>3x/week for 3 months; CUDIT-R = 8±1) and 8 cannabis-naïve participants (combined: age range 21-32 years; 9 female) were recruited to participate in this repeated measure, single blinded, placebo-controlled study. One hour before habitual sleep, participants received either a placebo pill or 10mg of THC. Polysomnography (PSG) and ECG were recorded over these 2 nights. HRV was assessed in both time and frequency domains in 2-min epochs of stable N2, N3 and REM sleep. Repeated measures ANOVA comparisons were made for PSG and HRV variables. [(*)=p< 0.05]

Results

There were no significant changes in total sleep duration or sleep architecture (N2%, N3%, & REM%) between the placebo and dosing night in either group. Compared to the placebo night, both individuals who use cannabis and cannabis naïve participants exhibited significant decreases in HRV variables throughout the night when dosed with THC. R-R interval decreased by 25±10* ms [mean±SE] (2%) in the naïve group and 62±11* ms (6%) in the cannabis group. RMSSD decreased by 15±3* ms (22%) in the naïve group and 11±3* ms (23%) in the cannabis group. PNN50 decreased by 9±3* % in the naïve group and 11±3* % in the cannabis group. In naïve participants high frequency spectral power decreased by 398±76* ms^2 (32%).

Conclusion

Our results suggest that THC ingestion before bedtime did not systematically affect sleep depth or duration, but did significantly reduce vagal-cardiac modulation in individuals who use cannabis as well as in cannabis naïve participants. Acute reductions in parasympathetic control of the heart may indicate increased cardiovascular stress during sleep when THC is ingested.

Support (if any)

AASM; K01HL151745; T32HL083808; OHSU OFDIR; R35 HL155681; Oregon Institute of Occupational Health Sciences
0139 Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation
Authors: Herms Emma , Wisner Krista
Published: May 2023

Introduction

Impaired sleep is an important area of intervention, as improving sleep can have beneficial effects on co-existing psychopathology. Under this framework, impaired sleep is examined as a mediator between IT (IT; i.e., trauma caused by another) and subtypes of delusional ideation (i.e., subclinical delusions). Impaired sleep may be a maintenance factor of delusional ideation following IT. Thus, this study seeks to clarify the role of impaired sleep in different types of delusional ideation, which may inform future treatment research.

Methods

Transdiagnostic-community participants (18-60 years) were utilized from the Nathan Kline Institute (N=496). An exploratory factor analysis was completed for the Peter’s Delusion Inventory (PDI) and extracted factors were used as DVs in separate mediation models. We assessed whether global sleep quality (GSQ) from the Pittsburgh Sleep Quality Index mediated the relationship between IT and subtypes of delusional ideation. GSQ is the summation of seven component scores: sleep duration, sleep disturbance, sleep latency, daytime dysfunction, sleep efficiency, subjective sleep quality, and medication use. Thus, specificity analyses examined each component of GSQ individually in mediation models to identify influential components.

Results

A three-factor solution of the PDI was identified: magical thinking, grandiosity, and paranoia. However, IT was only related to paranoia (β=0.312,p< 0.01) and grandiosity (β=0.286,p< 0.01). With GSQ as a mediator, the relationship between IT and paranoia was attenuated (direct effect=0.212,p=0.046; indirect effect=0.074,p< 0.01; 25.9% mediated). Similarly, the relationship between IT and grandiosity was attenuated by GSQ as a mediator, but less variance was accounted for (direct effect=0.269,p=0.013; indirect effect=0.044,p=0.035; 14.1% mediated). Specificity analyses highlighted that for paranoia, the components of sleep disturbance (direct effect=0.121,p=0.220; indirect effect=0.165,p< 0.01) and daytime dysfunction (ab=0.073,p=0.035; c=0.214,p=0.030) provided significant mediation of the relationship with IT. For grandiosity, only the sleep disturbance component (ab=0.092,p=0.011; c=0.221,p=0.043) mediated the relationship with IT.

Conclusion

In conclusion, impaired sleep significantly mediated the relationship between IT and paranoia, as well as grandiosity. This provides support for future research investigating impaired sleep as a target to improve specific subtypes of delusional ideation following IT, particularly paranoia. While our findings align with previous research, several limitations are considered including cross-sectional data and use of self-report measures.

Support (if any)
0155 Persistent Activation of TXNIP and NLRP3 Inflammasomes in Cortical Glia and Neurons after Mild Traumatic Brain Injury
Authors: Carey Sean , Gibbons Allison , Prabhala Rao , Kaplan Gary , Zielinski Mark
Published: May 2023

Introduction

Mild traumatic brain injuries (TBI) induce persistent dysregulated sleep, reactive oxygen species (ROS), and inflammation. Nucleotide-binding domain leucine rich family pyrin containing 3 (NLRP3) inflammasomes are protein complexes that stimulate caspase-1 to activate the somnogenic pro-inflammatory cytokines IL-1β and IL-18. ROS induce thioredoxin interacting protein (TXNIP) to activate NLRP3 inflammasomes by inhibiting thioredoxin which inhibits ROS. We previously found that mice lacking NLRP3 have increased non-rapid-eye movement (NREM) sleep and slow-wave activity (SWA) 24 h after mild TBI, but at 2 months post-injury theses values are reduced. Following up on this, we sought to determine the activity of NLRP3 inflammasomes in glia and neurons after mild TBI.

Methods

Two-month-old mice lacking NLRP3, and wild-type mice received a craniectomy and mild TBI via controlled cortical impact or sham. Frontal and somatosensory cortices were collected without a TBI and at 24 h and 2 months post-TBI. Microglia, astrocytes, and neurons were isolated using fluorescent-activated cell sorting, and reactive oxygen species (ROS), RNA and protein were quantified using RT-PCR and ELISAs. Significance was set at p < 0.05.

Results

RNA, protein, and ROS control treatment values were similar for both genotypes in cortical microglia, astrocytes, and neurons. In wild-type mice, NLRP3, IL-1β, IL-18, caspase-1, and TXNIP expression along with ROS values were significantly greater and thioredoxin expression was significantly less in cortical microglia, astrocytes, and neurons 24 h and 2 months post-TBI. In wild-type cortical microglia, astrocytes, and neurons NLRP3, IL-1β, and TXNIP expression levels were significantly greater in these cell types 2 months vs. 24 h post-TBI. Wild-type mice caspase-1 activity and NLRP3, IL-18, IL-1β, and TXNIP protein levels, were significantly greater and thioredoxin protein levels were significantly less in both cortical areas 24 h and 2 months post-TBI. Mice lacking NLRP3 showed significant increased values of TXNIP but reduced thioredoxin expression and protein levels 24 and 2 months post-TBI but no significant differences in other measures.

Conclusion

Our findings suggest that TBI induces persistent oxidative stress, TXNIP, and NLRP3 inflammasome activation in cortical glia and neurons that likely contributes to sleep dysregulation.

Support (if any)

Merit Review Award (I01BX005379)(MRZ) and SPiRE Award (I21RX003722)(GBK) Department of Veterans Affairs
0175 Poor Association Between Subjective and Objective Sleepiness in Patients Evaluated in a Clinical Sleep Center
Authors: Schwab Allison , Staley Beth , Keenan Brendan , Basner Mathias , Bae Charles
Published: May 2023

Introduction

Sleepiness is a primary symptom among patients presenting at sleep clinics. Sleepiness is typically subjectively evaluated using the Epworth Sleepiness Scale (ESS), which has been associated with worse cardiovascular outcomes among sleep apnea patients. On the other hand, functional deficits due to sleepiness can be objectively quantified using a Psychomotor Vigilance Test (PVT). To better understand the presentation of “sleepiness”, we examined the relationship between subjective ESS and objective PVT among a clinical sample. We hypothesized that these two different measures of sleepiness would be correlated.

Methods

A prospective sample of patients being evaluated for sleep disorders in the Sleep Center at the University of Pennsylvania completed the ESS and PVT at the same clinical visit. Demographic data were obtained at the visit or derived from the electronic health record. Pearson’s linear correlations were utilized to examine the association between the ESS and both the transformed lapses (sum of square root of number of lapses and square root of lapses+1) and mean reciprocal response time (RRT) on the PVT.

Results

In total, 167 patients (98 [58.7%] males) were studied, with a mean (±SD) age of 54.7±16.8 years and BMI of 34.5±9.9 kg/m2. There were a similar number of White (67 [42.1%]) and Black (71 [44.7%]) participants and 129 (77.3%) had diagnosed or suspected obstructive sleep apnea (OSA). Patients had an average ESS of 8.1±5.4, and 10.5±10.6 lapses, 5.9±2.9 transformed lapses, and mean RRT of 3.4±0.7 seconds-1 on PVT. Among all patients, there was no statistically significant correlation between ESS and either transformed lapses (rho = 0.10, p=0.200) or mean RRT (rho = -0.10, p=0.201). Results were similar when comparing the two sleepiness measures restricted to patients with OSA.

Conclusion

Within patients being evaluated in a clinical sleep center, there was only a weak association between subjective sleepiness on the ESS and objective sleepiness on PVT. Thus, not all patients reporting daytime sleepiness have objective deficits, and vice versa. Results support using both assessments to fully characterize a patient’s sleepiness. Future studies should evaluate the relationship between adverse outcomes and subjective and objective sleepiness, alone and in combination.

Support (if any)
0182 ADHD traits and psychomotor vigilance after 5 nights of experimental sleep restriction in early adolescents: preliminary results
Authors: Christiansen Taylor , Dionisos Victoria , Mason Gina , Barker David , Dickstein Daniel , Carskadon Mary , Saletin Jared
Published: May 2023

Introduction

Chronic insufficient sleep is prevalent in early adolescence with potential neurobehavioral consequences. However, individual differences examining such outcomes are understudied. Using psychomotor vigilance task (PVT) performance, we examine ADHD traits as a potential factor contributing to the vulnerability of performance following insufficient sleep in youth.

Methods

A preliminary sample of 22 children (11F; 12.25±0.91yrs) were characterized as either high [n=10] or low [n=12] on Conners-3-Parent ADHD-Probability Index [>=/< 50%tile]. In our crossover at-home protocol, 5 stabilization nights (10h time-in-bed[TIB] set to habitual risetime) were followed by 5 nights of sleep optimization (SO; 10h TIB) or restriction (SR, 7.5h TIB; delaying bedtime and advancing risetime equally), then restabilization for 2-4 nights, and the reverse SO or SR condition. Sleep was monitored via wrist-worn actigraphy (Micro MotionLogger). Following SO or SR, participants completed a 10-minute PVT as part of a larger battery administered in the lab in late afternoon. Primary variables included: mean reciprocal reaction time (RRT), mean of the 10% fastest (FRRT), and 10% slowest (SRRT) RRTs.

Results

Mixed-effects ANOVA evaluating condition (SO vs. SR) and group (low- vs. high-ADHD) showed a significant main effect of condition (F(1, 20)=10.91, p=.004, ηp2=.35) with slowed RRTs after sleep restriction (m±sd(1/s): SO=3.31±¬0.46; SR=3.07±0.58), no main effect of group or group-by-condition interaction (ps>.42). No significant effects emerged for FRRT (ps>.13); however, a significant group-by-condition interaction on SRRT(F(1, 20)=4.78, p=.04, ηp2=.19) indicated that only the low-ADHD group demonstrated slower SRRT with SR (SO=1.84±0.45, SR=1.61±0.54), an effect not evident in the high-ADHD group (SO=1.64±0.50, SR=1.69±0.61).

Conclusion

These preliminary data indicate that sleep restriction on a simulated school-night schedule impairs vigilance in young adolescents as in adults. While overall SR reaction times were slower for all participants, SR impacted the slowest 10% of RTs specifically in the low-ADHD group. In ongoing analyses, we are evaluating two empirically testable explanations for this effect: (1) potential floor or ceiling effects in the high-ADHD group (2) a paradoxical hyperactivity following sleep loss in the high-ADHD group.

Support (if any)

R01HD103655; P20GM139743
0199 Effects of acute sleep deprivation on cognitive performance in depressed individuals
Authors: Larson Olivia , Basner Mathias , Rao Hengyi , Dinges David , Barilla Holly , Goldschmied Jennifer , Boland Elaine , Sheline Yvette , Detre John , Thase Michael , Gehrman Philip
Published: May 2023

Introduction

Acute sleep deprivation (SD) is an effective, rapid antidepressant treatment. However, SD has adverse effects on cognitive performance. The effects of SD on cognitive performance in depression remain underexplored. This study investigated relationships between depression and performance on Cognition – a neurocognitive battery of 10 tests that cover a range of cognitive domains – during acute SD.

Methods

Thirty-six individuals with current depression (69.4% female; 33±9.5 yrs) and 10 euthymic controls (40% female; 35±9.5 yrs) underwent a baseline night of sleep followed by 36 hours SD in the laboratory. Participants completed the Cognition battery twice after each protocol night. Each of the 10 Cognition tests has two separate metrics of performance: speed and accuracy. Multivariable linear regressions were used to assess effects of depression status, age, and gender on each performance metric at baseline. Mixed effects models were used to assess effects of depression status, sleep deprivation, and their interaction on performance metrics. All models included a random effect over participants and were adjusted for age, gender, and time of day.

Results

At baseline, depressed individuals were significantly faster than controls on three tests of working memory (β=-72.6; p=0.03), spatial orientation (β=-2944.7; p=0.01), and emotion recognition (β=-537.5; p=0.005) respectively, although these effects did not survive correction for multiple comparisons. Mixed effects model results revealed a significant effect of depression status on the speed metric from the spatial orientation test, whereby depressed individuals were faster across the protocol (β=-2579.6; p=0.04) and a significant interaction effect between depression status and study day on the speed metric from a risk-taking behavior test, whereby depressed individuals were slower after SD (β=480.9, p=0.01); neither effect survived correction for multiple comparisons. However, sleep deprivation was significantly associated with reductions in performance in models for 10 out of 20 metrics (all adjusted ps < 0.05).

Conclusion

These results suggest that currently depressed individuals exhibit the same decrements in cognitive performance after acute SD as non-depressed individuals. Future analyses will examine whether baseline depression severity predicts cognitive performance and whether differences in performance exist between SD responders versus non-responders.

Support (if any)

This work was supported by the National Institute of Mental Health (R01MH107571).
0291 Attending Physician Perceptions of Nightshift Work in the ICU: Results from a Large Tertiary Medical Center
Authors: Johnson Kimberly , Braksick Sherri , St. Louis Erik , Somers Virend , Olson Eric , Caples Sean
Published: May 2023

Introduction

Nightshifts represent a substantial proportion of time dedicated to working in the inpatient setting, particularly among ICU staff. Our institution implemented a 24/7 in-person ICU attending model more than a decade ago. With practice growth and more than 200 ICU beds across disciplines, there are now at least 8 ICU attendings in-hospital all night. Yet, little is known about attending staff perceptions and desires about night work, so we began an exploratory analysis.

Methods

An online survey of 13 multiple-choice, slider scale, and open-ended questions were sent via email to critical care staff physicians of different disciplines within our institution.

Results

69 out of 150 physicians completed the survey (46% response rate). Half were between 35 and 45 years old; 29% were age 45 to 55 years old. About half self-identified as a morningness chronotype. Most (84%) work 3- or 4-night shifts consecutively. Most viewed night shift work as having a negative influence on their quality of life (48% “somewhat negative” and 22% “very negative”) and on their health (51% “somewhat negative” and 24% “very negative”). Most would choose to work less nightshifts (37%) or none (29%). During nightshift assignments, about half (53%) self-report an average of 5 hours of sleep per 24-hour period; 18% self-report ≤ 4hours. Only 6% reported 7 or 8 hours of sleep. Mitigating strategies utilized during series of night shifts include use of caffeine (78%), naps (66%) and use of sleeping aids (21%). Outside of the nightshift series, more than half (56%) reported no sleep difficulties while 21% reported onset or maintenance insomnia.

Conclusion

At our large tertiary hospital employing an in-house nightshift model across multiple ICUs, most staff ICU physicians have a negative perception of night shift work on their quality of life and health. The majority of respondents would choose to work less or no night shifts. How self-reports of limited sleep (average 5 hours) per 24-hour period compare to objectively measured sleep duration in this population remains to be determined in the next phase of this study.

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0303 Insomnia and Morning Drinking During the COVID-19 Pandemic: A Mediating Role of Depression
Authors: Watson Tyler , Killgore William
Published: May 2023

Introduction

The COVID-19 pandemic constructed a world of unpredictable cultural and commercial stressors to growing connectivity and proliferating society. A potential relationship between the aspects of heavy drinking and insomnia during the pandemic has not been analyzed. We hypothesized that there would be a significant correlation between morning drinking and insomnia. However, we also hypothesized that this relationship would be mediated by depression.

Methods

13,313 individuals across the United States were surveyed (M=37.19 years old; SD ± 12.375). Neurocognitive battery assessments including self-report measures of depression, insomnia symptoms, and alcohol use. The variable description for this analysis was (How often during the last year have you needed a first drink in the morning to get yourself going after heavy drinking?) The scoring was based on a five-point scale ((0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily.) Insomnia Severity Index reported symptoms qualify for (0-7 score = no clinical insomnia, 8-14 = subthreshold insomnia, 15-21 = moderate clinical insomnia, and 22-28 = severe clinical insomnia). Participants also completed the PHQ-9 Depression Scale.

Results

Morning drinking scores correlated with insomnia (r=.254, p<.001) and depression (r=.344, p<.001). A mediation model revealed a total effect of insomnia on morning drinking when the depression was not accounted for (E=.0303, p<.0001). After including PHQ-9 Depression as a mediator, the direct effect was still significant (E=.0032, p=.0406), suggesting partial mediation. On the other hand, when insomnia was the mediator variable, the total effect and direct effect had no significant change (“total effect” E=.0414 p<.0001) (“direct effect” E=.0391 p<.0001), suggesting no mediating influence.

Conclusion

These results suggest that the association between morning drinking and insomnia was significantly partially mediated by depression during the pandemic. When depression was the independent variable and insomnia as the mediated variable, there was no longer efficiency in the mediation model. These results suggest that observed associations between insomnia and morning drinking during the pandemic were partially mediated by depression.

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0430 Central Sleep Apnea and Incident Atrial Fibrillation in a Sleep Disorders Clinic
Authors: Tompkins Amanda , Patel Sanjay , Genuardi Michael , McKane Scott , Fudim Marat , Lund Lars , Mehra Reena , Song Nan , Germany Robin , DeSensi Rebecca
Published: May 2023

Introduction

Given conflicting evidence in the literature, we sought to evaluate the relative importance of central sleep apnea (CSA) and obstructive sleep apnea (OSA) on incident atrial fibrillation (AF) risk in a cohort of patients referred for sleep evaluation.

Methods

We reviewed the medical records of patients without AF at baseline who underwent in-lab diagnostic polysomnography (PSG) at six sleep laboratories within the University of Pittsburgh Medical Center (UPMC) between 2004 and 2018. Baseline characteristics including apnea hypopnea index (AHI), central apnea index (CAI), and obstructive apnea index (OAI) were extracted from the electronic health record. Among those with AHI≥15, patients were categorized as CSA if CAI≥5 and CAI>OAI or OSA if OAI≥5 and OAI>CAI. Patients with AHI< 15 were included as the reference group. Incident AF was identified based on AF as a primary or secondary diagnosis on either inpatient or outpatient UPMC visits.

Results

We identified 24,199 patients (425 CSA, 7559 OSA, 16,215 no sleep-disordered breathing [reference]) for analysis who had a mean age of 49, mean body mass index (BMI) 34, and 48% male. The incidence rates for AF ranged from 1.07 per 100 person-years in the reference group to 1.91 and 2.60 in the OSA and CSA groups (p< 0.01). Using Cox proportional hazards models, the hazard ratio for incident AF in the OSA group compared to reference was 1.78 (95% CI [1.63-1.94], p< 0.01) and in the CSA group was 2.48 (95% CI [1.92-3.21], p< 0.01). After adjusting for age, sex, race, BMI, and baseline diagnoses of diabetes, heart failure, prior heart attack, and prior stroke, OSA was no longer associated with incident AF risk (HR=1.01, 95% CI [0.92-1.12], p=0.76). However, a potentially important association between CSA and incident AF persisted (HR=1.28, 95% CI [0.99-1.67], p=0.06).

Conclusion

We found that CSA was associated with a 28% increased rate of incident AF independent of traditional risk factors, which was nearly statistically significant. This suggests CSA may be a risk factor for AF. In contrast, OSA was a risk marker but not independent risk factor for AF.

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0487 The effect of negative pressure ventilation on airflow in obstructive sleep apnea subjects undergoing drug induced sleep endoscopy
Authors: Yu Jason , Plageman Jack , Schwartz Alan
Published: May 2023

Introduction

Drug induced sleep endoscopy (DISE) is used to visually characterize pharyngeal airway collapse in obstructive sleep apnea (OSA) to help determine appropriate patients for OSA surgery. The procedure has grown in complexity with the addition of airflow recording and continuous positive airway pressure (CPAP) titration to obtain additional measures of airway collapsibility. Lung volume can also influence airway collapse in OSA but is not evaluated as part of routine DISE. The purpose of this study is to characterize the relationship between changes in lung volume and upper airway collapse during DISE to gain further insight into factors contributing to airway collapse and their potential roles in influencing surgical decision making.

Methods

This study is an ongoing IRB approved prospective clinical trial assessing the effects of negative pressure ventilation on airway collapse during DISE. Enrolled patients first undergo DISE evaluation per clinical routine including a CPAP titration. CPAP is then held at a level where patients exhibit stable flow limitation. A negative pressure ventilator shell is placed over the torso of the body and negative pressures of up to -25cmH2O are applied to expand the chest and increase lung volume. Changes to nasal airflow and tidal volume are evaluated. The negative pressure ventilator is then released and changes to airflow back to baseline are recorded.

Results

Between 6/30/2022 and 11/30/2022, 5 patients completed the study. There were 4 men and 1 woman with an average age of 60 years, BMI of 26.67kg/m2, and apnea-hypopnea index (AHI) of 44.44 events/hr. Average peak inspiratory flow increased from 8.38L/min to 13.78L/min and average tidal volumes increased from 155mL to 269mL on negative pressure ventilation.

Conclusion

Increases in lung volume from negative pressure ventilation during DISE can improve airflow and tidal volume suggesting that changes in lung volume can influence the severity of upper airway collapse. Further study to better characterize this relationship can help add additional diagnostic information regarding airway collapse characteristics to provide better informed surgical decisions and develop new interventions.

Support (if any)

Supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Numbers UL1TR002378 and KL2TR002381
0500 Impact of positive airway pressure on drug-induced sleep endoscopy to deliver precision medicine
Authors: Singh Supriya , Dang Lequan
Published: May 2023

Introduction

Sleep endoscopy during natural sleep will be ideal, to evaluate the upper airway during episodes of obstructive sleep apnea, but quite difficult to achieve. Drug-induced sleep endoscopy is an alternative standard of care to document the level and severity of the collapse of the upper airway. It is especially of benefit for patients who are intolerant to positive airway pressure and is used as a part of a work-up for alternative therapy for treating sleep apnea. Using propofol infusion and a Bi-spectral index of 50-70, to monitor the depth of sedation, the upper airway collapse can be determined with sleep endoscopy, conducted initially without CPAP and then with a CPAP ranging from 10 cmH2O to 20 cm H2O in patients who failed PAP therapy.

Methods

Drug-induced sleep endoscopy (DISE) was carried out in the bronchoscopy suite by the same Pulmonologist with an anesthesiologist to manage sedation using Propofol. Adequate depth of sedation was confirmed by the presence of snoring, and a BIS. The patient underwent the entire procedure while supine. The severity of obstructions followed the velum/oropharynx/tongue base/epiglottis and was recorded as patent/partial/complete. The obstruction pattern was classified into circumferential, anteroposterior, or lateral. Tongue base obstruction was identified when the tongue base pushed the epiglottis causing lumen obstruction. The DISE was conducted initially without CPAP followed by DISE with CPAP.

Results

Out of a total of 80 patients, upon application of the CPAP, 3 patients (4%) had patent velum and the base of the tongue. 3 (4%) with partial collapse of the velum and complete collapse of the base of the tongue. One (1%) had persistent anterior-posterior and lateral wall collapse of the velum, but the base of the tongue was patent. 68 (85%) had improved lateral wall collapse and obstruction of the velum improved from complete to partial anteroposterior collapse. Five patients (6%) continued to have persistent circumferential collapse of the velum.

Conclusion

Drug-induced sleep endoscopy performed in combination with various pressures of CPAP allows real-time visualization of the impact of these pressures on the upper airway. It allows us to provide alternative treatment options sooner than later.

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0529 Efficacy of a Novel Acceptance-Based Approach in Improving PAP Adherence in Women Veterans
Authors: Gogineni Swetha , Carlson Gwendolyn , Mitchell Michael , Swistun Dominika , Lee Diane , Song Yeonsu , Fung Constance , Kelly Monica , Erickson Alexander , Washington Donna , Yano Elizabeth , Alessi Cathy , Martin Jennifer , Zeidler Michelle
Published: May 2023

Introduction

Sleep disordered breathing (SDB) is associated with a myriad of health conditions yet is often underrecognized in women. Positive airway pressure (PAP) therapy is first line therapy for SDB; however, adherence rates are low, with women in the U.S. having lower PAP adherence than men. In studies of veterans, published research has not evaluated interventions specifically for women with SDB. Acceptance and Commitment Therapy (ACT) is a technique that utilizes individuals’ values, commitment to change, and mindfulness techniques to promote behavioral change and may be an effective technique in improving PAP adherence among women veterans.

Methods

We analyzed data from women veterans newly diagnosed with SDB who agreed to try PAP therapy (mean age=53.2 years [range 26-80], 30% African American, 28% Hispanic; n=90) who participated in a randomized controlled trial comparing an ACT-based intervention (Acceptance and Behavioral Changes to treat Sleep Apnea - ABC-SA; n=44) to a PAP educational control (n=46). Remote monitoring was used to determine days of PAP usage, days PAP used > 4 hours (main outcome), and hours of PAP used per month for the first 3 months of use. We used mixed models to compare changes in PAP adherence measures between groups over the first 3 months of use.

Results

In the ABC-SA group, mean nights of use were 20.9, 14.9, and 11.5 for months 1, 2, and 3 respectively, versus 16.9, 11.0, and 8.7 in the control group, with a non-significant trend towards more nights of use in the ABC-SA group in month 1 (p=0.056). There were no significant differences between ABC-SA and control in other PAP use outcomes in months 1, 2 or 3.

Conclusion

An ACT-based approach did not improve PAP adherence in women veterans over the first three months compared to education alone. Future studies are needed to evaluate whether subgroups may benefit from more intensive interventions such as ABC-SA and to evaluate interventions for improving PAP use long-term.

Support (if any)

This research was supported by the VA HSR&D IIR 16-244. Dr. Martin was supported by VA HSR&D RCS 20-191 and NIH/NHLBI K24 HL143055.