bluuebunny/crossref_metadata_2025 huggingface dataset:
0472 Dynamic Features of the Treatment Process Predict Different Outcomes for Patients Undergoing Cognitive Behavioral Therapy for Insomnia
Authors: Hu Yueqin , Xu Yishan , Barwick Fiona
Published: May 2022

Introduction

Individuals who undergo Cognitive Behavioral Therapy for Insomnia (CBT-I) show different trajectories during treatment and different outcomes after treatment. However, the factors contributing to this interindividual variability have not been adequately identified. Daily sleep logs might help us understand some of these factors.

Methods

Patients with insomnia (N=34), as confirmed by clinical evaluation and Insomnia Severity Index score >10, completed 4 weeks of group CBT-I conducted in Mandarin via telehealth. Participants completed daily sleep logs and self-reported sleep quality, sleep effort and anxiety before and after treatment. Predictor variables included daily sleep efficiency and daily sleep anxiety. Response variables included pre-post changes in sleep quality, sleep effort and anxiety. Multilevel structural equation modeling was performed to examine the relationship between trajectories of change in predictors and response variables.

Results

Dynamic features of sleep log data significantly predicted individual differences in response variables. The growth rate of daily sleep efficiency during treatment significantly predicted reduced sleep effort (p=.012), decreased anxiety (p=.046), and improved sleep quality (p<.01) after treatment. Conversely, the growth rate of daily sleep anxiety during treatment significantly predicted increases in sleep effort (p<.01). In addition, daily sleep anxiety had a significant negative effect on daily sleep efficiency (p<.001), and the weaker this negative effect, the greater the reduction in sleep effort (p<.001) and anxiety (p<.01) after treatment.

Conclusion

Individuals exhibit different trajectories during treatment, which are related to different outcomes after treatment. Those who experience less wakefulness at night across treatment become less anxious about sleep and exert less effort to manage sleep, leading to better sleep quality. However, those who experience increasing anxiety across treatment exert more effort to control sleep. Finally, individuals whose anxiety is not as closely associated with sleep efficiency show greater reductions in anxiety and sleep effort post-treatment. Thus, different trajectories and treatment outcomes appear to distinguish between those individuals who are less anxious about sleep during CBT-I, and thus more willing to implement recommendations, which leads to better outcomes, and those individuals who are more anxious about sleep during treatment, and thus less willing to implement recommendations, which leads to worse outcomes.

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0498 Intravenous Iron Therapy in the Pediatric Sleep Clinic: A Single Institution Experience
Authors: Ingram David , AL-Shawwa Bahauddin , Sharma Mukta
Published: May 2022

Introduction

Initial reports of intravenous (IV) iron administration have been promising for children with restless legs syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep. The aim of the current study was to further evaluate the clinical response to IV iron supplementation in children seen in a pediatric sleep clinic.

Methods

We performed a retrospective chart review of children cared for in a single pediatric sleep clinic who also underwent IV iron infusion. Data regarding their sleep symptoms and ferritin levels were abstracted.

Results

Overall, 63 pediatric sleep patients underwent IV iron infusion, mostly with ferric carboxymaltose (n=60). Of the 59 patients with clinical follow-up, 39 (73%) noted improvement in at least one symptom, and 14 (26%) did not notice improvement or noticed worsening symptoms. Of the 59 patients with pre- and post-infusion labs, the average ferritin level increased from 21.7+/-13.3 to 147.9+/-120.9, p<0.001. Comparing patients who experienced clinical improvement versus those who did not, there were no statistically significant differences in change in ferritin levels (176.6+/-127.7 vs 120.5+/-118.1, p=0.278), sex (68% in females vs 77% in males, p=0.452), or age (8.8+/-5.9 vs 7.0+/-5.1, p=0.391). In terms of immediate adverse reactions to the IV infusion, 7 (11%) experienced at least 1 side effect, with the most common being behavior change (n=6) or gastrointestinal discomfort (n=4); no episodes of anaphylaxis or extravasation were noted.

Conclusion

These data provide additional support for the efficacy and safety of IV iron for pediatric RLS, PLMD, and restless sleep recalcitrant to oral iron.

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0511 Sleep Profiles in Children with 22q Deletion Syndrome: A Study of 100 Consecutive Children seen in a Multidisciplinary Clinic
Authors: Ingram David , Raje Nikita , Arganbright Jill
Published: May 2022

Introduction

While previous studies have suggested a high prevalence of sleep disorders in children with 22q deletion syndrome (22qDS), they were limited by potential selection bias. In the current investigation, we assessed sleep characteristics in 100 consecutive children presenting to a multidisciplinary clinic.

Methods

Chart review of consecutive children presenting to 22qDS multidisciplinary clinic was performed. Children aged 2 to 17 years of age were included, and data were abstracted including sleep characteristics (sleep history, Childhood Sleep Habits Questionnaire [CSHQ], and free response questions), comorbid medical conditions, and demographics.

Results

Overall, 100 children were included in analysis, 85% of whom had scores on the CSHQ consistent with clinically meaningful sleep disorder. Sleep problems were common in all domains of the CSHQ, including daytime sleepiness (66%), sleep onset delay (54%), parasomnias (52%), night wakings (52%), sleep disordered breathing (49%), sleep duration (45%), bedtime resistance (38%), and sleep anxiety (33%). Overall CSHQ score was significantly associated with daytime behavioral problems and speech delay (F(2,97) = 10.4, p <0.001, adjusted R2 = 0.16). The most common interventions reported to be helpful for sleep by parents were behavioral (routine, bedtime story), environmental (light avoidance at night, calming music), and pharmacologic (melatonin, clonidine).

Conclusion

These data confirm a high prevalence of sleep disorders in a large, unselected sample of children with 22qDS, and suggest an important relationship between sleep dysfunction and daytime behavioral challenges. Our findings highlight the potential role for multimodal treatment approaches including behavioral, environmental, and pharmacologic interventions.

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0515 A Middle School and High School Sleep Trends Identified by a School Based Sleep Screening Program
Authors: Morse Anne , Blessing Kristina , Snyder Mallory , Liscum Denise , Vanenkenvort Erin , Winter Maive
Published: May 2022

Introduction

WUAL is a population based preventative sleep screening and education program for 7th to 12th graders through an asynchronous virtual platform. A descriptive summary of the program has been presented previously. First year results of a partnership with a middle school and high school with established delayed school start times are available and reveal unique trends across the academic year and specific patterns that differ between 7th-9th grade and 10th-12th grade.

Methods

The WUAL team consists of a board-certified pediatric sleep specialist, school guidance counselor and 2 project managers. The Protection of Pupil Rights Amendment (PPRA) was considered. A letter describing the program with an opt-out option was provided to parents prior to survey distribution. Survey data was captured using REDcap and included the Epworth sleepiness scale -CHAD (ESS) and the childhood sleep habits questionnaire (CHSQ). The surveys were completed at two-time points: December 2020 and April 2021. WUAL website was developed to serve as an educational resource and to access the surveys.

Results

A total of 346 students participated. Average weekday sleep reported by 7th- 9th graders was 8.6 hours (mean 8.9, 9 and 8 hours respectively). Average weekday sleep reported by 10th-12th graders was 7.1 hours (mean 7.1, 7 and 7.3 hours). Pairwise comparisons showed that students’ raw scores on both the ESS and the CSHQ decreased from December to April (ps ≤ .002). To examine the clinical significance of these changes, students’ trajectories were examined. There were 4 specific patterns of responses identified over the 2 time points: normal to normal, normal to pathologic, pathologic to normal and pathologic to pathologic. Despite the significant changes in raw scores, between 1/3 and ½ of the students with pathologic responses remained pathologic.

Conclusion

This method of screening has demonstrated a high degree of successful completion. Sleep patterns evolve over the course of the school year and for at least half of students appear to improve. There are additional differences observed between younger and older teenagers as observed by weekday sleep hours reported in 7th to 9th grade students compared to 10th to 12th grade students.

Support (If Any)

Grant Funding Support from Jazz Pharmaceuticals and Janet Weis Children's Hospital (Geisinger)
0523 Prevalence And Severity Of Sleep Disordered Breathing In Asthmatic Children
Authors: Singla Aarushi , Bagla Jyoti , Gothi Dipti , Kumari Sweta , Sasidharan Jaseetha , Mishra Ruchi , Dubey Anand , Vaidya Sameer , Patro Mahismita
Published: May 2022

Introduction

Children with severe and poorly controlled asthma have a higher predisposition for sleep disordered breathing (SDB). It can lead to cardiovascular, neurocognitive, and behavioral problems. Variable data exists currently whether demographic factors like age, sex, obesity, adeno-tonsillar hypertrophy tend to increase the risk of SDB in asthmatics. Our objective was to evaluate the risk factors and prevalence of SDB in asthmatics as compared to non - asthmatics and describe the polysomnographic parameters in asthmatics with SDB.

Methods

Asthmatic and non - asthmatic children aged 5 – 15 years, were recruited in this case – control study. Parameters like age, gender, body mass index, adeno-tonsillar hypertrophy, and the history of snoring were compared. All participants completed the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ) and prevalence of risk of SDB (defined as SDBS - PSQ ≥ 0.33) was calculated. A subset of asthmatics with risk of SDB underwent polysomnography, and subjects were classified into no, mild, moderate, and severe SDB [based on apnea-hypopnea index (AHI) ≤1, 1-5, 5-10, and ≥10, respectively].

Results

120 children, with 60 asthmatics were included. Amongst asthmatic group, 61.7% were male and mean age was 9.51 ± 2.50 years. Risk of SDB was significantly higher in asthmatics compared to non - asthmatics (18.33% vs 1.67%, p = 0.001; with mean SDBS-PSQ score 0.14 ± 0.17 vs 0.05 ± 0.08, p = 0.001). History of snoring was reported in 25% of asthmatic children versus 11.7% in non – asthmatics (p> 0.05). Other parameters were similar in both the groups (p> 0.05). Of the 11 asthmatics with risk of SDB, 10 underwent polysomnography. 9 patients (15% of asthmatics) were diagnosed with SDB, with a mean AHI of 4.21 ± 3.28, mean total sleep time of 279.23 ± 57.69 minutes and mean arousal index of 10.23 ± 8.67. In this subset, 60% had mild SDB.

Conclusion

Prevalence of SDB is higher in asthmatics, compared to general population. SDBS-PSQ is a useful screening tool for diagnosing SDB and should be incorporated in the daily practice, the gold standard being polysomnography. Further studies would help in a better understanding of SDB spectrum in children.

Support (If Any)

Nil
0539 Obstructive sleep apnea symptoms and their improvement with PAP in the pediatric population: A Retrospective Study in a Pediatric Sleep Disorders Center
Authors: White Jay , Scribner April , Spray Beverly , Viscioni-Wilson Lance , Jambhekar Supriya
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is estimated to occur in 1% to 5% of the pediatric population1. The Agency for Healthcare Research and Quality (2021) recently released a draft report titled, “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea.”2 The conclusions of this report determined that the published evidence reviewed by the agency did not support that positive airway pressure (PAP) affects long term, clinically important outcomes. No pediatric studies were included in this report. Pediatric patients who require PAP are held to the same standards as adults regarding adherence and insurance requirements3. However, clinical symptoms to determine improvement of OSA symptoms in adults are not the same in children. Symptoms in the pediatric population such as decreased concentration, hyperactivity, memory impairment, learning disorders, nocturnal enuresis and growth impairment have improved with PAP and are important indicators in this population of improved clinical outcomes4.

Methods

Retrospective chart review was used to examine symptoms reported by pediatric patients initiated on PAP for OSA. Symptom information was extracted before and after initiation of PAP. A chi-Square test was used to determine if there was an association between PAP treatment and improved clinical symptoms.

Results

235 patient records were reviewed. The distribution of sex was 150 (63.9%) males and 76 (32.3%) females. The mean age at PAP initiation was 12.0 (SD = 4.5), age range from 9 months to 19 years. Most frequent symptoms pre PAP initiation included excessive daytime sleepiness (51%), at least one of the daytime behaviors above (45%), and nocturnal enuresis (14%). Excluding patients with missing data, first and fourth visit post PAP initiation, 78% (221 patients; 66 missing) and 90% (90 patients; 12 missing), respectively, reported improvement in symptoms.

Conclusion

Results indicate that PAP is a beneficial treatment of OSA with improvement in symptoms specific to the pediatric population. Due to the clinically significant outcomes to growth and development that PAP provides to pediatric patients with OSA, we suggest that they should not be held to the same insurance requirements as adults and further studies should be conducted to validate these findings.

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0553 At-home Detection of REM Sleep Behavior Disorder using a Machine Learning Approach and Wrist Actigraphy
Authors: Brink-Kjaer Andreas , Gupta Niraj , Marin Eric , Zitser Jenny , Sum-Ping Oliver , Hekmat Anahid , Bueno Flavia , Cahuas Ana , Jennum Poul , Sorensen Helge , Mignot Emmanuel , During Emmanuel
Published: May 2022

Introduction

Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) affects over 1% of middle-aged and older adults and is in most cases a prodromal stage of alpha-synucleinopathy. However, a small fraction of them is currently diagnosed due to poor access to the gold-standard diagnostic procedure polysomnography (PSG). We aimed to test an ambulatory diagnostic procedure for iRBD based on wrist actigraphy alone and combined with a short questionnaire on nonmotor symptoms.

Methods

A total of 35 PSG-confirmed iRBD and 28 age-matched clinic and community control participants with and without a sleep disorder (1:1 ratio) wore high-frequency (25 Hz) wrist actigraphy for at least 7 nights and completed sleep diaries. Raw accelerometer data recorded during sleep was analyzed by deriving an activity count and extracting movement-related features for each night. Additionally, participants completed the Innsbruck RBD inventory (RBD-I) and a 3-item questionnaire on hyposmia, constipation, and orthostasis. We fitted machine learning models, specifically, boosted decision trees, in a leave-one-out cross-validation framework to classify iRBD patients from controls based on either actigraphy or questionnaire data. For each participant, model predictions from actigraphy were averaged across all available nights.

Results

The boosted decision trees classified iRBD with an area under the receiver-operator-characteristics (ROC) curve (AUC) of 0.972, a sensitivity of 97.1%, and a specificity of 89.3%. Analyses revealed that performance plateaued after one week of actigraphy. Best single feature “short immobile bursts” achieved an AUC of 0.958, a sensitivity of 94.3%, and a specificity of 78.6%. In this population, RBD-I item 3 best discriminated between groups with an AUC of 0.892, a sensitivity of 91.4%, and a specificity of 85.7%. The combination of a positive RBD-I item 3 and a positive actigraphy-based classification achieved a sensitivity of 88.6% and a specificity of 96.4%.

Conclusion

High-frequency actigraphy using machine learning detects iRBD with high accuracy. Addition of a single RBD question to this procedure increased specificity. These results need to be validated in a larger sample and lay the groundwork for an ambulatory screening paradigm in the general population.

Support (If Any)

The Klarman Family Foundation and the Feldman Foundation Ca.
0554 Proteomic Approach for Understanding the Mechanisms of Periodic Limb Movements and Restless Legs Syndrome
Authors: Cederberg Katie , Hanif Umaer , Leary Eileen , Schneider Logan , Morse Anne Marie , Blackman Adam , Schweitzer Paula , Kotagal Suresh , Bogan Richard , Kushida Clete , Mignot Emmanuel
Published: May 2022

Introduction

Periodic limb movements (PLMs) are episodes of involuntary, repetitive muscle movements that are highly associated with restless legs syndrome (RLS). Although PLMs and RLS are reportedly two separate phenomena, both are tightly correlated and may result from a similar pathology. The present study profiled plasma protein biomarkers of PLMs and RLS to contribute to the identification of mechanisms associated with each disorder/trait.

Methods

The SomaScan highly multiplexed aptamer assay was used to profile 5,000 proteins in 24–48-hour old EDTA plasma samples from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. PLMs per hour (PLMI) were derived from overnight polysomnography and RLS was classified based on affirmative responses to questions of the Alliance Sleep Questionnaire. Three linear regression models were conducted to examine significant protein markers of 1) PLMI in the sample as a whole; 2) PLMI controlling for the presence of RLS; and 3) RLS without PLMs (i.e.,PLMI<5). All models included log2-normalized relative protein expression as the dependent variable and important covariates such as age, gender, BMI, sample storage time, and blood draw period. False discovery rate (FDR) to control for multiple testing was applied with an a-priori p-value of 0.05 for identifying significant associations.

Results

PLMI was significantly associated with 253 proteins (219 positive,34 negative). The inclusion of RLS in the model mitigated the significance of most proteins, and only 8 proteins remained significant. Negatively associated proteins (LEAP-1, Ferritin, SELH, Caspase-8) included functions related to iron storage, absorption, and delivery and negative regulation of inflammatory/immune responses. Positively associated proteins (SFRP4, RANTES, CathepsinA, DKK1) included proteins with functions related to immune response, inflammatory response, bone formation, and protein stability. RLS without PLMs was associated with 7 upregulated proteins (megalin, RUFY1, TADBP, ANGL7, LRTM2, SNAPN, STOM) with functions related to vitamin D metabolism, calcium and zinc binding, circadian rhythm regulation, and calcium-dependent neurotransmitter secretion.

Conclusion

These large proteomic analyses identified independent differential protein expressions for PLMs and RLS that suggest different pathophysiological contributions.

Support (If Any)

This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952] and the Klarman Family Foundation.
0560 Rest-Activity Rhythms are Associated with Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults
Authors: Makarem Nour , German Charles , Zhang Zhanhao , Diaz Keith , Palta Priya , Duncan Dustin , Castro-Diehl Cecilia , Shechter Ari
Published: May 2022

Introduction

Prior studies have linked rest-activity rhythms (RAR), a measure of circadian rhythmicity in the free-living setting, to morbidity and mortality. However, evidence is limited on the associations of RAR with adiposity, hypertension, and cardiovascular disease (CVD) in a nationally representative sample of US adults.

Methods

Participants were 4,822 adults (age:≥20y) from the 2013-2014 National Health and Nutrition Examination Survey, who participated in the physical activity monitoring examination. Data from a wrist-worn ActiGraph GT3X+ accelerometer were used to estimate non-parametric 24-h RAR variables. Logistic models adjusted for age, sex, race/ethnicity, education, marital status, smoking, and alcohol use were used to evaluate associations of RARs with prevalent CVD (self-reported), hypertension (blood pressure≥130/80mmHg or medication use), obesity (BMI≥30kg/m2), and central adiposity (waist circumference>102cm for men and >88cm for women).

Results

Participants (mean age: 48y, 53% female, 33% racial/ethnic minority) in the highest vs. lowest tertile of relative amplitude, indicative of more robust RAR, had lower odds of prevalent CVD (OR(95%CI):0.47(0.25-0.87)), hypertension (OR(95%CI):0.63(0.40-0.99)), obesity (OR(95%CI):0.50(0.36-0.69)), and central adiposity (OR(95%CI):0.50(0.36-0.69)). Those in the highest vs. lowest tertile of M10 counts, indicating a more active wake period, had 66%, 54%, and 39% lower odds of CVD, obesity, and central adiposity, respectively. In contrast, participants in the highest vs. lowest tertile of intradaily variability, indicative of more fragmented RARs, had >2-fold (OR(95%CI):2.40(1.23-4.70)) and 40% (OR(95%CI):1.40(95%CI:1.04-1.88)) higher CVD and obesity odds, respectively. Further, those in the highest vs. lowest tertile of L5 midpoint, indicative of a later sleep period, had 68% and 41% higher odds for CVD and hypertension, while those with higher L5 counts, indicative of less efficient sleep, had 72%, 57%, and 79% higher hypertension, obesity, and central adiposity odds, respectively. A statistically significant linear trend was observed across RAR tertiles for all associations (p-trend<0.05).

Conclusion

Robust RAR, an active wake period, and an earlier and more efficient sleep period are associated with lower odds for CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The timing, regularity, and periodicity of sleep-wake and rest-activity patterns may represent an important target for reducing cardiovascular risk in adults.

Support (If Any)

NHLBI R00-HL148511; AHA grant #855050
0564 Sleep patterns of patients on home parenteral nutrition: a home-based observational study
Authors: Dashti Hassan , Godbole Meghna , Chen Angela , Mogensen Kris , Leong Aaron , Burns David , Winkler Marion , Saxena Richa , Compher Charlene
Published: May 2022

Introduction

Whereas home parenteral nutrition (HPN), a form of nutrition administered through a central venous catheter for patients with intestinal failure, is necessary for survival, the current standard practice for HPN is to administer infusions for approximately 12-hour periods overnight, coinciding with nighttime sleep. Patients supported with HPN often report poor sleep, however limited research has been conducted to objectively measure sleep patterns of HPN-dependent patients.

Methods

We aimed to characterize the sleep patterns of patients on HPN through 7-day actigraphy in a remote, home-based observational study. Sleep measures of clinical importance were derived from actigraphy including sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset. Participants also completed validated sleep surveys electronically.

Results

20 participants completed all study procedures [mean (standard deviation): age =51.6 (13.9), BMI =21.4 kg/m2 (4.6), 80% female]. The population median (interquartile range) for sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset was 6.9 (1.1) hours, 83.3 (7.8) %, 11.8 (7.1) minutes and 57.2 (39.9) minutes, respectively, and 55%, 60%, 35%, and 100% of participants did not meet the recommendations for these measures from the National Sleep Foundation. 65% of participants reported napping at least once during the 7-day period. Based on the Insomnia Severity Index, 70% of participants were classified as having sub-threshold or more severe insomnia. Based on the Pittsburgh sleep quality index, 85% were classified as having significant sleep disturbance.

Conclusion

Most HPN-dependent patients likely have disrupted sleep largely driven by difficulty maintaining sleep. The extent to which overnight HPN infusions contributed to poor sleep cannot be elucidated from this observational study. Addressing known factors that contribute to poor sleep and encouraging sleep hygiene and sleep interventions are imperative to improve the overall quality of life of patients requiring HPN.

Support (If Any)

Research reported in this publication was supported by the American Society for Parenteral and Enteral Nutrition (ASPEN) Rhoads Research Foundation.
0590 Factors Associated with Sleep Health in Young Women After Breast Cancer Treatment
Authors: Hwang Youri , Conley Samantha , Jeon Sangchoon , Redeker Nancy , Sanft Tara , Knobf Mary
Published: May 2022

Introduction

Poor sleep health adversely affects quality of life and prognosis in cancer survivors, yet there is limited evidence on sleep health in young women with breast cancer (YWBC). The purpose of this study was to identify sociodemographic, clinical, and psychosocial factors associated with sleep health.

Methods

We conducted a cross-sectional study. Eligible participants were women diagnosed with stage I-III breast cancer ≤ 50 years of age and within 5 years from primary cancer treatment. Sociodemographic, clinical, and psychosocial data were collected through an online survey. Sleep health and psychosocial data were assessed by the Pittsburgh Sleep Quality Index (PSQI), PROMIS depression and anxiety, and the McMaster Family Device General Functioning subscale. Data were analyzed with logistic regression. A PSQI cut-off score of >8 was used to define poor sleep health based on the study data and the cancer sleep literature.

Results

The sample included 159 YWBC with a mean age of 43.6 years (SD=6.8), the majority of whom were non-Hispanic White (84%) and completed chemotherapy or radiotherapy (>70%). Half of the participants were premenopausal at diagnosis and became peri- or postmenopausal after treatment. The mean global PSQI was 9.3 (SD=3.6) and 55% reported poor sleep health. About half of the participants slept <7 hours per night, 87% spent >15 minutes falling asleep, and 58% reported taking medication to sleep. Non-White underrepresented groups (OR=7.56, p<.01), more severe night sweats (OR=9.00, p<.001), no history of endocrine therapy (OR=2.73, p<.05), more severe anxiety (OR=1.08, p<.01) and depression (OR=1.06, p<.05), and poorer family functioning (OR=3.78, p<.001) were associated with poor sleep health.

Conclusion

The findings suggest that poor sleep health is a significant clinical problem in YWBC. Sleep assessment, education, and appropriate referrals should be part of routine survivorship care. Social determinants of health such as race and ethnicity and family functioning warrant further investigation related to sleep health. Future studies are needed to confirm the relationships of sociodemographic and clinical factors, psychological symptoms, and family functioning with sleep health.

Support (If Any)

The Global Korean Nursing Foundation.
0600 The moderating effect of comorbid insomnia on the association of obstructive sleep apnea with mood, and with diabetes-related distress in adults with type 2 diabetes
Authors: Jeon Bomin , Luyster Faith , Sereika Susan , DiNardo Monica , Callan Judith , Chasens Eileen
Published: May 2022

Introduction

Previous findings showed that insomnia in persons with type 2 diabetes (T2D) may have a greater impact on mood disturbances than obstructive sleep apnea (OSA) and that insomnia contributed to the severity of diabetes-related distress. This study examined insomnia severity as a moderator of the association between OSA severity with mood, and with diabetes-related distress in adults with OSA and T2D.

Methods

This secondary analysis used pooled baseline data (N=240) from two independent randomized controlled trials that evaluating the efficacy of OSA and insomnia treatment in persons with T2D. OSA (apnea-hypopnea index [AHI] ≥ 5 events per hour) was determined by in-home ApneaLinkPlus®. Insomnia severity was measured by the Insomnia Severity Index, mood by the Profile of Mood States, and diabetes-related distress by the Problem Areas in Diabetes Scale. Possible moderator effect of insomnia severity was examined using hierarchical multiple linear regression analysis, controlling for demographic characteristics and restless leg syndrome (RLS).

Results

Participants were middle-aged (mean age ± SD [years] = 57.80 ± 10.17), White (65%), educated post high school (56.3%), evenly distributed by gender (49.6% female) and marital status (47.9%), with 34.3% reporting financial difficulty. Participants had poorly controlled diabetes (mean HbA1c ± SD [%] = 7.93 ± 1.62) and 15.5% reported symptoms of RLS. Insomnia severity had a moderating effect on the association between OSA severity and mood states (b = -.048, p = .017). Insomnia severity had no significant moderating effect on the relationship between OSA severity and diabetes-related distress (b = -.009, p = .458), but independently increased the level of diabetes-related distress (b =1.133, p < .001).

Conclusion

Insomnia severity moderated the association between OSA severity and mood states in adults with OSA and T2DM. Counterintuitively, as OSA severity increased, the level of mood disturbances decreased depending on insomnia severity. In addition, insomnia was independently associated with diabetes-related distress. These findings suggest that insomnia may be the primary underlying sleep disorder which is associated with psychological factors in persons with T2D. Findings need further investigation because psychological factors are known to be associated with worse glycemic control.

Support (If Any)

The NIH funded the parent studies (R01-DK0960281; K24-NR016685) and the CTSI grants (UL1-RR024153; UL1-TR000005)
0607 Prevalence and Correlates of Sleep Disorders Among Users of a Consumer Sleep Technology
Authors: Gahan Luke , Gottlieb Elie , Aman Aman , Watson Nathaniel , Raymann Roy
Published: May 2022

Introduction

Sleep disorders constitute a major public health burden yet remain widely undiagnosed and untreated. The prevalence of diagnosed sleep disorders and associations with objectively measured sleep-wake dysfunction vary widely across populations. Here, we examined the self-reported prevalence and objective sleep architectural correlates of four sleep disorders in a large sample of individuals using a consumer sleep technology.

Methods

Data from 33,429 users (mean age: 44.6, 55.1% female) across 1,842,282 nights were included in the analysis from the PSG-validated SleepScore Mobile Application, which uses a non-contact, sonar-based method to objectively capture sleep-related metrics, and questionnaires to capture self-reported data. Subjective sleep disorder information was ascertained by asking users, “Which of the following sleep disorders has a healthcare professional diagnosed you with?” Linear regression was used for analysis, while age and gender were used as confounding variables, with the cohort reporting “None of the above” were used reference group for research purposes.

Results

The prevalence of reported disorders were “None of the above” (n=23,732,71.0%), sleep apnea/SDB (n=5,309, 15.9%), insomnia (n=3,968, 11.9%), RLS/PLM (n=2,295, 6.87%), or narcolepsy (n=266, 0.8%). Narcolepsy was associated with the greatest reduction in TST (ß=-23.6 mins, SE=3.475, p<0.001) while insomnia was associated with smallest (ß=-5.7mins, SE=0.979, p<0.001). Narcolepsy was associated with the greatest increase in WASO (ß=7.0 mins, SE=1.815, p<0.001) while insomnia was associated with smallest (ß=2.2 mins, SE=0.511, p<0.001). RLS/PLM was associated with the greatest increase in SOL (ß=3.9mins, SE=0.302, p<0.001) while sleep apnea/SDB was associated with the smallest (ß=2.171 mins, SE=0.22, p<0.001). Narcolepsy was associated with the greatest decrease in SE (ß=-3.05%, SE=0.5, p<0.001) while insomnia was associated with smallest (ß=-1.42%, SE=0.1, p<0.001).

Conclusion

Self-reported sleep disorders were associated with objectively poor sleep in a big data consumer sleep technology analysis. These findings suggest consumer sleep technologies may have value in screening for sleep disorders in the general population and may motivate these individuals to seek care in clinical sleep medicine settings.

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0627 The Effects of Insomnia Therapy on Depression, Anxiety, and Daily Functioning in Individuals with Insomnia and Mild Cognitive Impairment
Authors: Morehouse Allison , O'Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Goldstein-Piekarski Andrea
Published: May 2022

Introduction

Insomnia is common in older adults with and without mild cognitive impairment (MCI), and is associated with worse neuropsychiatric symptoms (NPS) and impaired daily functioning. Evidence suggests treating insomnia may resolve some of these difficulties in cognitively normal adults. However, little is known about the effects of improving sleep on these domains in older adults with MCI.

Methods

We examined whether MCI status moderates the improvements of a behavioral intervention for insomnia on NPS and daily functioning. 125 adults (mean age=69.18, 34.4% male) with insomnia (38 with MCI as determined by a Montreal Cognitive Assessment; MoCA score < 26) completed the Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and five domains (activity, vigilance, intimacy, productivity, and social) of the Functional Outcomes of Sleep Questionnaire (FOSQ) before (BL) and after (ETX) completing either the behavioral, cognitive, or combined components of Cognitive Behavioral Therapy for Insomnia (CBT-I). Linear mixed effects models were used to determine the effect of MCI status, time, and an MCI-by-time interaction on NPS and daily functioning while covarying for sex.

Results

Treatment improved BDI (p<0.001), BAI (p<0.001), ISI (p<0.001), productivity (p<0.008), activity (p<0.001), social functioning (p=0.014), and FOSQ total score (p=0.015) regardless of MCI status at ETX compared to BL. Treatment did not significantly improve vigilance (p=0.154) or intimacy (p=0.439). There was a significant MCI-by-time interaction for the FOSQ social domain (p=0.041) with MCI participants showing greater improvements in social functioning compared to non-MCI participants. There were no other significant MCI-by-time interactions.

Conclusion

These findings suggest insomnia therapy can similarly improve aspects of sleep-related daily functioning, insomnia severity, and NPS regardless of MCI. However, insomnia therapy may be more beneficial in improving social functioning for individuals with MCI.

Support (If Any)

NIMHR01MH101468-01; Mental Illness Research, Education, and Clinical Center (MIRECC) at the VAPAHCS
0641 Automated Detection of Isolated REM Sleep Behavior Disorder (iRBD) During Single Night In-Lab Video-Polysomnography (PSG) Using Computer Vision
Authors: Adaimi George , Gupta Niraj , Mottaghi Ali , Yeung Serena , Mignot Emmanuel , Alahi Alexandre , During Emmanuel
Published: May 2022

Introduction

At least 1% of adults aged 45 and above have isolated REM sleep behavior disorder (iRBD), a prodromal stage of a synucleinopathy, however a majority remains undiagnosed until they develop irreversible neuropathology. The gold-standard diagnostic procedure, the in-lab video-polysomnography (PSG), relies on complex rules for sleep staging and electromyography quantification which potentially lead to incorrect diagnoses. We tested a computer vision classifier for RBD versus other sleep conditions based on automated video analysis of body movements during a single-night in-lab PSG.

Methods

Raw PSG video recordings of 60 iRBD patients (mean 67 years, 78% males) and 100 controls (mean 65, 65% males) were selected from the Stanford Sleep Center database. Our pipeline involved three main steps: movement detection, feature extraction, and RBD recognition. The recordings between lights off and lights on were 7 to X hours in duration with some interspersed short movements. For every recording, short video segments that contain movements were first extracted using background subtraction. Additional features, such as sleep-onset time and wake-up time, were used to filter out noisy segments that did not involve patients being asleep. Next, I3D, a state-of-the-art method for action recognition, was used to derive a feature vector of 2048 features from every extracted segment. RBD diagnosis could be considered as an action recognition task in which ‘RBD’ was the action category to be classified. For every recording, the feature vectors for every segments were averaged, resulting in one feature vector per subject. With 160 PSG video recordings, this resulted in a dataset of 160 feature vectors that were used to train a multi-layer perceptron (MLP) for RBD recognition.

Results

Leave-one-out cross-validation (LOOC) procedure was used for evaluation achieving 91.9% accuracy, with a 78.3% sensitivity and 100% precision.

Conclusion

We tested the feasibility and performance of a new diagnostic paradigm for RBD solely based on single-night video analysis of PSG. Our results suggest that a machine learning model can detect and distinguish the characteristics of movements related to RBD versus other sleep disorders and normal sleep. Larger studies in heterogeneous datasets are needed to validate these findings.

Support (If Any)

Google
0648 Decreased Slow-Wave Sleep May Exacerbate Anxiety in Individuals with Low Anxiety
Authors: Games Margaux , Goldstein Elena , Palermo Emma , Costello Samantha , Owens Kendall , Goldschmied Jennifer
Published: May 2022

Introduction

Evidence suggests that individuals with generalized anxiety disorder exhibit decreases in slow-wave sleep (SWS). Because SWS has been shown to be modifiable, it is imperative to better understand the relationship between symptoms of anxiety and amount of SWS to inform treatment development. This study aimed to explore the relationship between anxiety and SWS, and to investigate the impact of slow-wave sleep disruption on state anxiety.

Methods

Twenty-seven participants’ (mean age 30.9) were recruited as part of an ongoing study examining the relationship between SWS and depression. Participants spent two nights in the laboratory: baseline (BL) and slow-wave disruption (SWD), where SWS was disrupted using auditory stimulation. Anxiety was measured using the State-Trait Anxiety Inventory (STAI). Both trait and state anxiety (BL, SWD) measures were collected. Repeated measures ANOVA was used to determine the impact of SWD on state anxiety.

Results

Participants’ trait anxiety scores were significantly correlated with percent N3, such that greater anxiety was associated with less N3 (r = -0.43; p<0.05). Individuals were then categorized as either high-anxiety (HA) or low-anxiety (LA) by median split (M=46.5). Results of the repeated measures showed a significant main effect of group (F=43.963; p<0.001), with HA individuals showing greater state anxiety than LA individuals. A significant interaction of group*condition was also found (F(1,24)=4.703; p=0.40). LA participants showed a significant increase in state anxiety following SWD (t=-2.539; p=0.028), while HA participants showed no change.

Conclusion

The current findings replicate previous research showing that anxious individuals have a reduced amount of SWS and demonstrate that decreases in SWS may exacerbate anxiety in individuals with low anxiety. Further, this work suggests that individuals with high anxiety may be more resilient to changes in anxiety state than individuals with low anxiety when SWS is reduced.

Support (If Any)

Goldschmied: K23MH118580 (NIMH)
0669 The Role Of Hypersomnolence In Depression: Results From A Longitudinal Study Of The American General Population
Authors: Ohayon Maurice , Pakpour Amir , Cote Marie Lise
Published: May 2022

Introduction

Insomnia symptoms have often been pointed out as an important factor for the relapse and/or the maintenance of depression. However, the contribution of hypersomnolence in depression is less studied and the conclusions are unclear. Our aim is to examine the association between hypersomnolence and depression in the US general population.

Methods

This longitudinal study was carried out in eight states in the U.S. A total of 12,218 subjects were interviewed by phone during the first wave (W1) and 10,931 at the second wave (W2) three years apart. The analyses included only the subjects who participated in the 2 waves (N=10,931). Hypersomnolence symptoms and Major Depressive Disorder (MDD) were assessed according to DSM-5 criteria.

Results

At W1, 27.2% (95% CI 26.4%-28.0%) of the sample had at least one hypersomnolence symptoms listed in the DSM5 occurring at least 3 days per week. This prevalence at W2 was 26.4% (95% CI 25.6%-27.2%). The incidence of DSM5 hypersomnolence symptoms was 20.5% which represents a yearly incidence of 5.8%. For MDD, the prevalence was 5.1% (95% CI 4.7%-5.5%) and 4.2% (95% CI 3.8%-4.6%) in W1 and W2, respectively. At W1, 54.2% of participants with a MDD also had hypersomnolence. At W2, 50.7% of MDD subjects also reported hypersomnolence. After adjusting for age, gender and medical conditions, persistent hypersomnolence (i.e., reported at both interviews) predicted incident MDD (i.e., absent at the first interview but present at the follow-up) with a relative risk of 2.0 (95% CI 1.5-2.8). Similarly, persistent hypersomnolence predicted persistent MDD with a relative risk of 3.8 (95% CI 2.5-5.8). After adjusting for the presence of insomnia, persistent hypersomnolence remained a strong predictor for persistent MDD (RR: 2.4) but not for incident MDD.

Conclusion

Hypersomnolence, especially when it is persistent, is an important contributing factor for persistent MDD. While the presence of insomnia mitigates the predictive value of hypersomnolence in incident MDD, it had little effect on the association between persistent hypersomnolence and persistent MDD.

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0685 Sleep, mental health and socioeconomic factors concomitantly influence the risk in tobacco consumption
Authors: Dokkedal-Silva Vinícius , Fernandes Guilherme , Morelhão Priscila , Pires Gabriel , Rowlett James , Galduróz José Carlos , La Berro ís , Tufik Sergio , Andersen Monica
Published: May 2022

Introduction

Extensive evidence points that sleep, psychiatric symptoms and sociodemographic factors separately affect the risk involved in substance use. Due to the well-known relationship between these 3 pillars, an investigation of the combined effect of this factors on substance use is necessary. The objective of this study was to build a model including the 3 factors simultaneously and their effect on risk in substance use.

Methods

Volunteers of the EPISONO (2007) study underwent assessment through validated questionnaires concerning their general health and a night of polysomnographic examination. For this study, scores in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were evaluated considering responses to questionnaires concerning sleep, psychiatric symptoms, and socioeconomic parameters, as well as polysomnographic findings. A structured equation modelling (SEM) protocol was conducted to build a theoretical model in which variables pertaining to the 3 factors of interest (sleep, mental health and socioeconomic influence) could have their simultaneous effect on substance use measured.

Results

793 participants of the EPISONO were included (mean age=43.4 years; 452 women). Significant effects were found for the tobacco consumption model. Subjective sleep quality (SSQ), psychiatric symptoms (PS) and socioeconomic status (SES) influenced the ASSIST score for tobacco consumption. Influence of PS on tobacco consumption was also mediated by SSQ. Models for other substances assessed in the ASSIST questionnaire, such as alcohol, did not find any statistically significant effect.

Conclusion

The lack of significance of models for alcohol and other substances may be related to the nature of our sample, in which not many individuals presented a substantial risk of substance involvement that could be detected by the ASSIST questionnaire. However, in the model for tobacco consumption, subjective sleep quality, socioeconomic status and psychiatric symptoms exerted an effect on tobacco consumption risk, with psychiatric symptoms having their influence mediated by self-perceived sleep quality.

Support (If Any)

Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.
0702 Real World Characteristics of Central Sleep Apnea: Experience at One Academic Medical Center
Authors: An Liudan , Genuardi Michael , Fudim Marat , Lund Lars , Mehra Reena , McKane Scott , Meyer Timothy , DeSensi Rebecca , Patel Sanjay
Published: May 2022

Introduction

Despite growing recognition of sleep disordered breathing, the prevalence and clinical characteristics of central sleep apnea (CSA) in real-world sleep referral populations remain poorly understood. We used historical data from the University of Pittsburgh Medical Center (UPMC) to assess the differences in patients with CSA compared to obstructive sleep apnea (OSA).

Methods

We retrospectively reviewed the medical records of 29,803 patients who underwent in-lab diagnostic polysomnography at six UPMC sleep labs between 2004 and 2018. Baseline clinical characteristics and polysomnography results 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≥5, patients were categorized as CSA if CAI≥5 and CAI>OAI or OSA if OAI≥5 and OAI>CAI.

Results

CSA and OSA were identified in 2% (583/29,803) and 34% (10,090/29,803) of patients, respectively, while 32% had AHI≥5 but didn’t meet either CSA or OSA criteria (CAI and OAI<5 or CAI=OAI) and the remaining 32% had AHI<5. Median AHI was 41 events/hr for CSA vs. 36 events/hr for OSA (p<0.01). The median percentage of apneas being central was 78% for CSA vs. 0% for OSA (p<0.01). Compared to patients with OSA, those with CSA were more likely to be male (78% vs. 66%), older (58 vs. 54 yrs), have lower body mass index (32 vs. 35 kg/m2), have heart failure (23% vs. 13%), atrial fibrillation (19% vs. 8%), stroke (5% vs. 2%), myocardial infarction (7% vs. 2%), diabetes (27% vs. 22%) and have received a prescription for methadone (1.5% vs. 0.3%) [all p<0.01]. In multivariable logistic regression, all factors except stroke remained independently associated with CSA. The strongest predictors of CSA (compared to OSA) were methadone prescription (adjusted odds ratio=4.9, 95% CI [2.3-10.6]) and myocardial infarction (1.9, [1.3-2.8]). In contrast, the prevalence of CSA and OSA were similar across races.

Conclusion

CSA was identified in 2% of patients undergoing polysomnography in everyday clinical practice and independently associated with a variety of clinical characteristics. Recognition of characteristics associated with CSA can lead to more targeted screening and treatment in a broader population beyond just heart failure patients.

Support (If Any)

ZOLL Respicardia, Inc.