bluuebunny/crossref_metadata_2025 huggingface dataset:
311 Can a Brief Sleep Education Training Improve Sleep Quality Among Shipboard Sailors?
Authors: Harrison Elizabeth , Schmied Emily , Perez Vanessa , Hurtado Suzanne , Glickman Gena
Published: May 2021

Introduction

Sleep disturbance is pervasive among active duty military service members (ADSM) and has serious adverse effects on performance and health. Interventions designed to improve sleep in operational settings are critical to maintain the health and readiness of this at-risk population. The objective of this study is to evaluate a novel sleep education program developed for ADSM.

Methods

Participants were U.S. Sailors (N=150; 82.7% male, 35.3% <25 years old) assigned to either an intervention (44.7%) or control (55.3%) condition. Intervention participants attended the Circadian, Light, and Sleep Skills program for military personnel (“CLASS-M”). The 30-minute education program was designed to teach ADSM how to maximize sleep quality in operational environments. All participants completed a questionnaire at both baseline and 2 months post-intervention assessing demographics, sleep quality (Pittsburgh Sleep Quality Index; PSQI), sleep-related behaviors, knowledge and motivation. During the follow-up period, participants went underway for 2–8 weeks.

Results

At baseline, scores were comparable for the PSQI (Control: 8.58±0.35 vs. Intervention: 8.58±0.38), sleep behaviors (12.26±0.35 vs. 11.32±0.38; Range: 0–17), sleep-related knowledge (0.48±0.21 vs. 0.50±0.24; Range: 0–1), and sleep motivation (4.12±0.35 vs. 4.07±0.34; Range: 0–5). A significant group x time interaction indicating benefits for the intervention group were observed on PSQI (F (1,139) = 7.99, p=0.005), knowledge (F (1,139) = 36.54, p<0.001), and behaviors (F (1,139) = 4.75, p=0.03), but not motivation (p>.05). Main effects of group were observed (p<0.05) on PSQI and sleep knowledge only.

Conclusion

Study results indicate that participation in a brief, educational program prior to deploying may improve ADSM’s sleep quality. Future research is needed to explore mechanisms of intervention effect, and to determine best practices for disseminating such programs force-wide.

Support (if any)

This work was supported by Defense Health Program 6.7 under work unit no. N1634. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
317 Sleep-wake survival dynamics in people with insomnia
Authors: Hermans Lieke , Regis Marta , Fonseca Pedro , Hoondert Bertram , Leufkens Tim , Overeem Sebastiaan , van Gilst Merel
Published: May 2021

Introduction

Assessing objective measures of sleep fragmentation could yield important features reflecting impaired sleep quality in people with insomnia. Survival analysis allows the specific examination of the stability of NREM sleep, REM sleep and wake. The objective of this study was to assess the differences between survival dynamics of NREM sleep, REM sleep and wake between people with insomnia and healthy controls.

Methods

We analyzed polysomnography recordings from 88 people with insomnia and 92 healthy controls. For each participant, survival dynamics of REM sleep, NREM sleep and wake were represented using Weibull distributions. We used lasso penalized linear regression to analyze the difference between participant groups with respect to the Weibull scale and shape parameters, while correcting for age, sex, total sleep time and relevant interaction effects. Because comparisons were done for scale and shape parameters of REM sleep, NREM sleep and wake, a Bonferroni correction was applied, resulting in an alpha value of 0.05/6 = 0.0083.

Results

Significant effects of group were found for the NREM scale parameter (unstandardized model coefficient B=-0.79, t=-3.0, p=0.0035), and for the scale and shape parameters of wake (scale parameter B=7.6, t=2.8, p=0.0065; shape parameter B=0.20, t=2.9, p=0.0048). Results indicated that people with insomnia had less stable NREM sleep and more stable wake after sleep onset compared to healthy controls. Additionally, the altered distribution of wake segment lengths indicated an increased difficulty to fall asleep after longer awakenings in the insomnia group. However, these differences were mainly observed in younger participants. Significant effects of group for the survival parameters of REM sleep were not found.

Conclusion

As illustrated by our results, survival analysis can be very useful for disentangling different types of sleep fragmentation in people with insomnia. For instance, the current findings suggest that people with insomnia have an increased fragmentation of NREM sleep, but not necessarily of REM sleep. Additional research into the underlying mechanisms of NREM sleep fragmentation could possibly lead to a better understanding of impaired sleep quality in people with insomnia, and consequently to improved treatment.

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320 Effect of accumulated unhealthy behaviors on insomniaâ€•lifestyle-related disease differences in a Japanese community population
Authors: Kato Suzuka , Harada Sei , Iida Miho , Kuwabara Kazuyo , Sugiyama Daisuke , Takeuchi Ayano , Hirata Aya , Sata Mizuki , Matsumoto Minako , Kurihara Ayako , Okamura Tomonori , Takebayashi Toru
Published: May 2021

Introduction

Some studies reported that health behaviors and lifestyles are related to sleep disorder; obesity, drinking, smoking and lack of physical exercise are risk factors for insomnia. However, it’s unclear the association between accumulated unhealthy behaviors and insomnia in consideration of lifestyle-related diseases. Therefore, this study was to examine the effect of accumulated unhealthy behaviors on insomnia in a Japanese community population.

Methods

The subjects included 1,1002 participants aged 35–74 years. Sleep quality was assessed by the Athens Insomnia Scale. Unhealthy behaviors were classified into smoking, drinking, no habit of exercising, obesity, and skipping breakfast. We examined the impact of unhealthy behaviors accumulation, which was stratified into three categories, i.e., 0-1,2-3,4 or more, on insomnia. The association between accumulated unhealthy behaviors and insomnia was estimated by logistic regression analysis. Further analysis after stratification by lifestyle-related diseases was also performed.

Results

The overall prevalence of insomnia was 14.6% for men and19.3% for women. Men with unhealthy behaviors were more likely to have insomnia after adjusting for potential confounders, compared with the least unhealthy groups (trend p=0.017). Women with 4 or more unhealthy behavior factors were more likely to have the suspected insomnia, compared with the lowest groups (ORs 1.176 95% CI 1.079–1.282). Then, we analyzed to stratify by lifestyle-related disease. Insomnia has an association with unhealthy behaviors among men with the absence of diabetes (trend p=0.015) and dyslipidemia (trend p=0.032). Women without hypertension were more likely to have the suspected insomnia, compared with the lowest groups (ORs 1.215 95% CI 1.102–1.340), but the odd for those with the hypertension was 1.031(95%CI 0.855–1.243).

Conclusion

Accumulated unhealthy behaviors were associated with increased rates of insomnia in the Japanese community population. According to stratification by lifestyle-related disease, men showed the associations by the presence or absence of diabetes. Women showed the associations by the absence of hypertension. These associations were nearly similar regardless of the presence or absence of lifestyle-related disease.

Support (if any)

This research was supported by research funds from the Yamagata Prefectural Government and the city of Tsuruoka and the Grant-in-Aid for Scientific Research (JP24390168, JP15H04778 and JP19K19441) from the Japan Society for the Promotion of Science.
321 Subjective Sleep and NEO Five Factor Personality Domains in Individuals with Primary Insomnia Compared to Good Sleeper Controls
Authors: Orff Henry , Rivera Guadalupe , Almklov Erin
Published: May 2021

Introduction

Insomnia is a common sleep disorder in adults. Primary Insomnia (PI) can be specified in cases where the insomnia symptoms cannot be overtly attributed to medical, psychiatric, or environmental reasons. Although the underlying predisposing causes of insomnia are unclear, one possible contributing factor may be personality traits. To date no consensus on the relationship between insomnia and personality has been determined, although many studies have found a general association with neuroticism. To better explore these associations, this study compared NEO Five Factor Model (FFM) personality traits with measures of subjective sleep in PIs and Good Sleeper (GS) controls.

Methods

Nine PI and nine GS matched for age, sex, and education were studied. Each participant was administered the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and NEO FFM. Participants also completed a sleep diary for 1-week. ANOVAs compared PI vs GS on ISI, PSQI, NEO FFM, and 7-day averaged data from the sleep diary. Lastly, sleep variables were collapsed across groups and Pearson correlations were run to explore the relationship between sleep and personality.

Results

PIs (4M/5F, age=39.6+/-10.1, education=16.0+/-1.7) and GSs (4M/5F, age=38.6+/-7, education=15.1+/-1.5) showed significant differences in ISI (p<.001) and PSQI (p<.001) total scores. Additionally, the groups differed on diary measures of total sleep (p=.001), sleep efficiency (SE: p<.001), sleep latency (p=.005), and wake after sleep onset (p<.001). On the NEO FFM only the Agreeableness domain was found to differentiate the two groups (p=.004). Pearson correlations found significant negative relationships for Agreeableness with ISI (r= -.625/p=.006), PSQI (r= -.611/p=.007), and a significant positive relationship with SE from the sleep diary (r=.602/p=.008).

Conclusion

In a small but well-matched study of PI and GS, significant differences in Agreeableness on the NEO FFM were observed. Lower levels of agreeableness were associated with poorer sleep on the ISI and PSQI, and lower SE on the sleep diaries. Unlike other published reports this study did not find a relationship between insomnia and neuroticism, which may reflect the use of a well-screened Primary Insomnia sample with limited comorbidities. Future research should determine if other insomnia subtypes (e.g., psychophysiological, paradoxical insomnia) are associated with different personality profiles.

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327 Developmental Trajectories of Insomnia and Risk of Internalizing Disorders in Young Adulthood
Authors: Fernandez-Mendoza Julio , Puzino Kristina , Qureshi Myra , Calhoun Susan , Toth Savannah , Liao Jiangang , He Fan , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: May 2021

Introduction

Internalizing disorders (ID) are the most common form of psychopathology and a large proportion of individuals experience their first onset after the age of 18. Childhood insomnia symptoms, i.e., difficulties initiating or maintaining sleep (DIMS), have been shown to be associated with ID. However, little is known about the developmental trajectories of insomnia symptoms and their associated risk of ID as the child transitions into adulthood. The present study examined the risk of ID in young adulthood associated with the longitudinal trajectories of insomnia symptoms across three developmental stages.

Methods

The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence and young adulthood) moderate-to-severe DIMS. The developmental trajectories of insomnia symptoms across the three time-points were identified as never, remitted, waxing-and-waning, persistent and incident. The presence of ID was defined as a self-report of a diagnosis or treatment for mood and/or anxiety disorders. Cox regression models were adjusted for sex, race/ethnicity, age and childhood/adolescent history of ID or psychoactive medication use.

Results

A persistent developmental trajectory was associated with a 2.8-fold increased risk of adult ID (HR=2.83, 95%CI=1.79–4.49) and an incident trajectory with a 1.9-fold risk (HR=1.88, 95%CI=1.10–3.20), while a waxing-and-waning trajectory was marginally associated with adult ID (HR=1.70, 95%CI=0.99–2.91). A remitting trajectory was not associated with an increased risk of adult ID (HR=0.92, 95%CI=0.38–2.24).

Conclusion

This 15-year longitudinal study with three developmental stages shows that childhood-onset insomnia symptoms that persist across the life-course are strong determinants of ID in young adulthood, independent of past diagnosis or medication use. In contrast, childhood insomnia symptoms that remit in the transition to adolescence do not confer increased risk of ID in young adulthood. Given that insomnia symptoms may precipitate and/or maintain ID, these data further reinforce the need for early sleep interventions to prevent mental health disorders.

Support (if any)

NIH Awards Number R01HL136587, R01MH118308, R01HL97165, R01HL63772, UL1TR000127
328 Insomnia in older HIV patients: a systematic review
Authors: Freire Igor , Meira e Cruz Miguel , Salles Cristina
Published: May 2021

Introduction

Insomnia is a common sleep disorder in elderly. Although the HIV-positive population have a similar life expectancy when compared to the general population, some factors may interact with immunity conditions and therefore contribute to a worse prognosis. Little is known however, about the frequency of insomnia in older HIV-positive patients. OBJECTIVE: To systematic review the prevalence of insomnia in older HIV-positive patients.

Methods

Systematic Review. Several databases were consulted (MEDLINE-PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, SciELO, LILACS, and VHL) and manual searches were performed. The terms used for the search were related to prevalence, HIV, insomnia, and advanced age. The inclusion criteria were: cross-sectional, cohort, and longitudinal studies. The accepted data were in patients with the previous diagnosis of HIV in advanced age, those over 50 years; studies that report the frequency of insomnia or insomnia symptoms (accepted symptoms: difficulty in starting sleep, difficulty in maintaining sleep, multiple awakenings during sleep and early awakening). The criteria for exclusion were: clinical trials, animal studies, letters, abstracts, conference proceedings, studies with other sleep scales that did not include insomnia.

Results

There were 2805 publications found in the database and a further 10 articles were included manually. Of this total, four were included in this review, resulting in a total of 2,227 participants. The prevalence of insomnia in HIV-positive patients over 50 years varied from 12.5% to 76.5%.

Conclusion

The frequency of insomnia was higher in the profile of the population studied than in the general population. This should be clinically relevant in order to adequately treat and impact on the prognosis of those patient.

Support (if any):
330 Characteristics Associated with Napping Among Pregnant Women with Insomnia
Authors: Badon Sylvia , Dietch Jessica , Tutek Joshua , Solomon Natalie , Simpson Norah , Manber Rachel
Published: May 2021

Introduction

Napping is common in pregnant women; however, characteristics associated with napping in pregnant women with insomnia have not been studied.

Methods

We used baseline data from a randomized controlled trial of insomnia treatment during pregnancy for this cross-sectional analysis (n=159). Women self-reported sociodemographic characteristics (age, race/ethnicity, education, income, employment), pregnancy-related characteristics (parity, trimester), sleep-related characteristics (7-day sleep diary including total napping time per day, Insomnia Severity Index), and depression symptoms (Edinburgh Postnatal Depression Scale). Women were categorized as non-nappers (0 days with napping), infrequent nappers (1–3 days with napping), and frequent nappers (≥4 days with napping). Characteristics were compared across napping categories using descriptive statistics and multinomial logistic regression.

Results

Eighteen percent of women were frequent nappers, 53% were infrequent nappers, and 30% were non-nappers. Average time spent napping on days with naps was 67 minutes (SD=35). In unadjusted analyses, frequent nappers were more likely to have a high school diploma or less (36% vs 19%), be unemployed (57% vs 41%), and be nulliparous (21% vs 13%) than non-nappers. Infrequent nappers were more likely to have a 4-year college degree (32% vs 11%), have a household income $100k or more (58% vs 45%), be working full time (51% vs 39%), and be nulliparous (26% vs 13%) than non-nappers. Age, race/ethnicity, trimester, sleep-related characteristics, and depression symptoms were similar across napping categories. In analyses adjusted for education and trimester, being unemployed (OR=3.6; 95% CI: 0.8, 15.4), working part time (OR=2.3; 95% CI: 0.5, 11.2), and nulliparity (OR=2.4; 95% CI: 0.4, 14.6) were most strongly associated with frequent napping (though confidence intervals were wide) but were not associated with infrequent napping. Sleep-related characteristics were not associated with frequent or infrequent napping in adjusted analyses.

Conclusion

Among pregnant women with insomnia, frequent napping was associated with characteristics that suggest greater feasibility of napping (not working, working part time, pregnant with first child), but was not associated with nocturnal sleep parameters or insomnia severity. Given napping can reduce homeostatic sleep drive at bedtime, it should be addressed during insomnia treatment in pregnant women, particularly among women with greater opportunity to nap.

Support (if any)

National Institutes of Health (K99HD100585, R01NR013662)
349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis
Authors: Selvanathan Janannii , Pham Chi , Nagappa Mahesh , Peng Philip , Englesakis Marina , Espie Colin , Morin Charles , Chung Frances
Published: May 2021

Introduction

Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain.

Methods

A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs).

Results

The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue.

Conclusion

This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes.

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350 Opioid Use and Abuse are Associated with Use of Sedative Hypnotic Medications
Authors: Tubbs Andrew , Naps Michelle , Grandner Michael , Rivera Louis
Published: May 2021

Introduction

The Department of Health and Human Services recently reported that 10.3 million people misused opioid drugs in 2018. Recent research attributed 21% of the deaths from opioid overdose to benzodiazepines. The overdose data and clinical experience show that opioid misusers commonly complain of insomnia and use hypnotic medications to self-medicate their sleep disturbance. At the same time, it remains unclear from a scientific perspective whether those who use/abuse opioids are more likely to use drugs in the sedative-hypnotic medication category. Consequently, the present study explores the relationship between comorbid use of opioids and sedative-hypnotic medications.

Methods

We extracted data from the 2015–2018 waves of the National Survey on Drug Use and Health (N=171,766). The primary outcome was the use of sedative-hypnotic medications, either in the z-class (zaleplon, zolpidem, eszopiclone) or sedating benzodiazepines (temazepam, flurazepam, triazolam). The primary exposures were prescription use of an opioid or abuse of an opioid (i.e., use of an illegal opioid such as heroin or misuse of a prescription opioid). Covariates included age, sex, race, income, education, and predicted mental illness category (none, mild, moderate, severe). Exposures were balanced on covariates using inverse probability of treatment weighting. Sequential binomial logistic regression estimated the association between opioid use/abuse and sedative-hypnotic use after adjusting for covariates.

Results

Opioid use and abuse varied by age, sex, race, education, and income (all p < 0.001). When adjusted for age, sex, and race (Model 1), sedative benzodiazepine use was more common among opioid users (OR 4.4 [4.04–4.79] and opioid abusers (OR 11.9 [9.72–14.5]). The use of z-class drugs was also more prevalent in opioid users (OR 3.69 [3.48–3.89]) and abusers (OR 7.74 [6.97–8.60]). Further adjusting for income and education (Model 2) and mental illness category (Model 3) attenuated but did not eliminate these associations.

Conclusion

Individuals who use or abuse opioids are significantly more likely to receive a sedative-hypnotic medication, a finding that is of concern and one that also suggests that sleep disturbance is common in this population. Further research is needed to determine the underlying nature and prevalence of sleep continuity disturbances in this population.

Support (if any)

VA grant IK2CX000855 and I01 CX001957 (S.C.).
370 Depressive symptoms in the context of Cognitive-Behavioral Therapy for Insomnia, a long-term follow-up study
Authors: Sforza Marco , Salibba Andrea , Scarpellino Alessandro , Galbiati Andrea , Zucconi Marco , Casoni Francesca , Ferini-Strambi Luigi , Castronovo Vincenza
Published: May 2021

Introduction

Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice treatment for Insomnia Disease (ID). The bi-directional causal relationship between insomnia and depression is recognized. Aim of our study is to investigate the role of depressive symptoms in predicting CBT-I outcomes, and the effectiveness of the treatment both on insomnia and depression.

Methods

77 ID patients (mean age 38.2±10.4 years, 69.2% females) underwent 7-sessions group CBT-I and were assessed pre- (T0) post- (T1) and at long-term after CBT-I (T2=7.6±1.6 years after treatment). The primary outcomes are Insomnia Severity Index (ISI) and Sleep Diary parameters. The secondary outcome is Beck Depression Inventory-II (BDI). Patients were divided in two groups according to BDI baseline score (≥14): depressive (D) vs non-depressive (ND).

Results

All patients showed significant improvements at ISI score at T1 that were maintained at T2 (T0=16.2±4.8 vs T1=8.2±4.5 vs T2=10.0±6.1;p<0.001). Also Sleep Diary parameters (sleep latency, wake after sleep onset and sleep efficiency) showed significant improvement at T1 (p<0.001). Moreover all patients showed improvements of depressive symptoms at T1 that were maintained at T2 (T0=10.8±6.8 vs T1=6.2±5.5 vs T2=8.2±6.6; p<0.001). Indeed, if 29.3% if ID patients at T0 presented clinically significant depressive symptoms (BDI≥14), only 9.7% at T1 and 20.5% at T2. Nevertheless, we found an interaction between ISI along time (T0-T1-T2) and D vs ND group membership (ISI_TREAT*BDI_BL_GROUP Sig=p<0.05). In other words, group D patients at baseline showed a worsening of insomnia symptoms at the long-term evaluation (T2).

Conclusion

CBT-I showed improvements both in insomnia and in depressive symptoms at the end of treatment that are maintained at long-term (7.6yrs after treatment). Nevertheless, clinically significant depressive symptoms at the baseline predicted a worsening of insomnia at the long-term evaluation. This could suggest the need of a more frequent follow-up evaluation of CBT-I efficacy in those patients presenting depressive symptoms at the baseline.

Support (if any)

None
382 Measuring Daytime Sleepiness in Insomnia Disorder
Authors: Manber Rachel , Simpson Norah , Dietch Jessica , Tutek Joshua , Tully Isabelle
Published: May 2021

Introduction

The EPWORTH Sleepiness Scale (ESS) is correlated with clinical parameters among patients with obstructive sleep apnea. However, its clinical relevance among patients with insomnia disorder is not clear. These patients often do not report daytime sleepiness nor have abnormal MSLT scores, but many do experience sleepiness in the evening. As a result, the ESS may not be the most appropriate measure for assessing daytime sleepiness among insomnia patients. This study aimed to evaluate clinical correlates of ESS among patients with insomnia. It also examined correlates of two items from the PROMIS item bank that specifically probe daytime sleepiness.

Methods

We used baseline data from 141 participants with insomnia disorder (mean age = 63.1y [SD 8.2]; 72% female) in the RESTING study (RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice). Clinical measures: the Insomnia Severity Index (ISI), the Geriatric Depression Scale (GDS), and the Morningness Eveningness Questionnaire (MEQ). ESS>10 defined excessive sleepiness. Two PROMIS items assessed frequency of being sleepy and of having trouble staying awake during the day, with ratings of ‘quite a bit’ and ‘very much’ classified as excessively sleepy.

Results

The ESS did not correlate with any of the clinical variables (ISI, GDS, MEQ). Correlations with these three variables with the PROMIS Sleepiness were .36, .22, and -.24 and with the PROMIS Excessive Sleepiness .28, .31, and -.17. Of the 38 participants with ESS>10, 80% were not excessively sleepy per PROMIS. PROMIS Excessive Sleepiness classified only 9 participants as excessively sleepy, of which 7 (78%) were not classified by the ESS as excessively sleepy.

Conclusion

These results suggest that the ESS might not be a clinically relevant measure among people with insomnia disorder and that the PROMIS items may better capture sleepiness and excessive sleepiness during the daytime in this patient group. The divergence of the two measures might relate to whether instructions specify daytime as the period assessed, since people with insomnia may be more likely to experience evening, rather than daytime, sleepiness. It might also relate to differences in item wording (i.e., struggling to stay awake [PROMIS] versus likelihood of falling asleep [ESS]).

Support (if any)

1R01AG057500
396 Ethnicity modifies the association between central sleep apnea and atrial fibrillation in older men: Kuakini HAAS and Mr.OS
Authors: Anzai Tagayasu , Grandinetti Andrew , Katz Alan , Hurwitz Eric , Wu Yan Yan , Masaki Kamal
Published: May 2021

Introduction

Several studies indicated there is an association between central sleep apnea (CSA) and atrial fibrillation (AF) in older populations. However, few studies assessed the impact of ethnicity on the association. We assessed the hypothesis that ethnicity modifies the association between CSA and AF in older men.

Methods

We did a cross-sectional analysis using two population studies of Japanese-American (JA) and White-American (WA) men. The Kuakini Honolulu-Asia Aging Study (HAAS) is a longitudinal cohort study of JA men living in Hawaii. Sleep data were collected between 1999–2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003–2005 on the continental U.S. The majority of Mr.OS participants were WA. We selected 79–90 year old males, who had overnight polysomnography from both studies. Total participants were 690 JA and 871 WA men. Obstructive apnea-hypopnea index (OAHI) was the measure of the number of obstructive apneas and hypopneas with >4% oxygen desaturation. Additionally, the central apnea index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI <5), mild (OAHI 5–14), moderate (OAHI 15–29), and severe (OAHI>=30). CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5–10 minute period of a crescendo-decrescendo respiratory pattern associated with CSA. A board-certified physician confirmed AF by single lead electrocardiography of polysomnography.

Results

The prevalence of AF was 5.7% in JA and 9.1% in WA. The prevalence of CSA and CSB in WA were higher than in JA (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). Conversely, the prevalence of severe OSA in JA (20.7%) was higher than in WA (11.8%). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in JA [Odds Ratio (OR)=4.77, 95% confidence interval (CI): 1.95–11.64] than in WA (OR=2.05, 95% CI: 1.07–3.94). CSB showed similar trends as CSA. In contrast, the severity of OSA was not significantly associated with AF in either ethnicity.

Conclusion

Ethnicity modifies the association between CSA and AF. In older JA and WA men, screening for CSA might be important to prevent AF.

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403 Comparative Study of Wireless Sensors Versus Type III Home Sleep Apnea Test for Home-based Diagnosis of Obstructive Sleep Apnea
Authors: Lee Jong Yoon , Kim Donghyun , Blake Stefanida , Kalluri Lakshmi , Walter Jessica , Davies Charles , Zee Phyllis , Xu Shuai , Power Thomas
Published: May 2021

Introduction

More than 22 million Americans are estimated to have obstructive sleep apnea (OSA), though this disease remains perpetually underdiagnosed. Undiagnosed OSA contributes to poor clinical outcomes, large healthcare costs and an economic burden in excess of $150 billion dollars annually. While polysomnography (PSG) is considered the gold standard to diagnose OSA home sleep apnea testing (HSAT) is now used for most patient cohorts. Wireless sensors may offer a lower cost and less burdensome approach to home testing than traditional HSAT.

Methods

We performed a fully remote, national, single-arm, open-label, prospective clinical study to evaluate the performance of a wireless, two sensor experimental system (ANNETM One, Sibel Health) against a Type III HST system. A total of 154 individuals completed screening with 62 screening in as high risk for OSA using the STOP-BANG questionnaire. Ultimately 60 participants were enrolled, and 46 completed a successful home testing night wearing both the commercially available HSAT (Philips Alice NightOne Home Sleep, Koninklijke Philips N.V) and the wireless experimental system. A board-certified sleep medicine physician determined the apnea-hypopnea index (AHI) for the HSAT defined by American Academy of Sleep Medicine v2.6 guidelines. Two study investigators, blinded to the HSAT results, scored the experimental system to determine AHI based on similar guidelines. An independent study investigator conducted the final analysis of comparative performance. Participants completed a psychometric survey of their preferences, experience, and usability of the two testing systems.

Results

We demonstrated a high level of agreement between the HSAT and experimental system for AHI (r2=0.81, p<0.0001). The sensitivity and specificity of the experimental system to diagnose moderate and severe OSA (AHI>15) was 85% and 95%, respectively. The experimental system had a significantly higher Systems Usability Scale score compared to HSAT (61 vs 48, p<0.0001) and more than 85% of participants preferred the experimental system.

Conclusion

This study provides compelling evidence that the experimental system was highly acceptable and comparable to a currently used HSAT. Continued innovation in reliable, cost-effective, low profile technologies will be critical to address the unmet needs of sleep diagnostic testing.

Support (if any)

Anthem and Sibel Inc.
412 Prevalence of pulmonary hypertension in patients referred for sleep apnea diagnostics
Authors: Elfimova Eugeniya , Mikhailova Oxana , Danilov Nikolai , Litvin Alexander , Pevzner Alexander , Chazova Irina
Published: May 2021

Introduction

The aim to evaluate the prevalence of pulmonary hypertension according to echocardiography in patients referred for sleep apnea diagnostics.

Methods

We included 145 patients referred to Sleep laboratory for sleep apnea diagnostics. Mean age 63,8 ± 10,4 years, BMI 34,0 ± 5,7 kg/m2, AHI 31,3 ± 20,3/h, ODI 3% 28,2 ± 19,5/h, min SpO2 77,4 ± 9,8%, systolic pulmonary artery pressure (systolic PAP) 25,9 ± 16,4 mmHg. All patients underwent cardiorespiratory and respiratory diagnostics for sleep apnea and echocardiography.

Results

From the random sample of patients referred to Sleep laboratory 14,5% (21) had systolic PAP > 40 mmHg (by echocardiography). Patients with higher levels of systolic PAP (Systolic PAP, mmHg 49,9 [43,6; 56,2] vs 20,7 [19,9; 23,5],p=0.000) had more severe OSA (AHI 35,7 [27,1; 44,3] vs 26,6 [22,6; 30,6], p = 0.029, ODI 3%, /h 35,8 [25,1; 46,4] vs 23,8 [19,8; 27,8], p= 0.017) and were more obese (BMI 37,1 [33,8; 40,4] vs 33,4 [32,4; 34,5], p=0.024). Prevalence of AHI > 30 /h was 62% in group with systolic PAP > 40 mmHg vs 23% in the group with systolic PAP < 40 mmHg. We observed differences in echocardiography, in group with systolic PAP > 40 mmHg: left atrium (4.6 ± 0,5 vs 4,2 ± 0,4 cm, p=0.012), left atrium volume (94.0 ± 23.6 vs 71.7 ± 16.5 ml, p=0.001) and right atrium area (24.5 ± 4.9 vs 18.4 ± 3.8cm2, p=0.000) were higher. Though ejection fraction (58.2 ± 3.8 vs 59.0 ± 3.8%, p=0.268), interventricular septum thickness (1,13 ± 0,2 vs 1,06 ± 0,3 cm, p=0,654) and left ventricular posterior wall thickness (1,05 ± 0,08 vs 1,00 ± 0,13 cm, p=0,117) didn’t differ. In terms of excessive daytime sleepiness, snoring and nocturia groups didn’t differ, as well as for the prevalence of arterial hypertension, coronary artery disease, chronic heart failure, diabetes mellitus and chronic obstructive pulmonary disease.

Conclusion

Pulmonary hypertension is frequently observed in patients with OSA and appears to be related to the severity of sleep apnea and obesity. PH should be considered in the regular clinical assessment of all patients with sleep apnea, especially with severe form.

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414 Deep Neural Networks: A Survey Tool for Obstructive Sleep Apnea Prediction
Authors: Taweesedt Pahnwat , Kim JungYoon , Park Jaehyun , Park Jangwoon , Sharma Munish , Surani Salim
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder with an estimation of one billion people. Full-night polysomnography is considered the gold standard for OSA diagnosis. However, it is time-consuming, expensive and is not readily available in many parts of the world. Many screening questionnaires and scores have been proposed for OSA prediction with high sensitivity and low specificity. The present study is intended to develop models with various machine learning techniques to predict the severity of OSA by incorporating features from multiple questionnaires.

Methods

Subjects who underwent full-night polysomnography in Torr sleep center, Texas and completed 5 OSA screening questionnaires/scores were included. OSA was diagnosed by using Apnea-Hypopnea Index ≥ 5. We trained five different machine learning models including Deep Neural Networks with the scaled principal component analysis (DNN-PCA), Random Forest (RF), Adaptive Boosting classifier (ABC), and K-Nearest Neighbors classifier (KNC) and Support Vector Machine Classifier (SVMC). Training:Testing subject ratio of 65:35 was used. All features including demographic data, body measurement, snoring and sleepiness history were obtained from 5 OSA screening questionnaires/scores (STOP-BANG questionnaires, Berlin questionnaires, NoSAS score, NAMES score and No-Apnea score). Performance parametrics were used to compare between machine learning models.

Results

Of 180 subjects, 51.5 % of subjects were male with mean (SD) age of 53.6 (15.1). One hundred and nineteen subjects were diagnosed with OSA. Area Under the Receiver Operating Characteristic Curve (AUROC) of DNN-PCA, RF, ABC, KNC, SVMC, STOP-BANG questionnaire, Berlin questionnaire, NoSAS score, NAMES score, and No-Apnea score were 0.85, 0.68, 0.52, 0.74, 0.75, 0.61, 0.63, 0,61, 0.58 and 0,58 respectively. DNN-PCA showed the highest AUROC with sensitivity of 0.79, specificity of 0.67, positive-predictivity of 0.93, F1 score of 0.86, and accuracy of 0.77.

Conclusion

Our result showed that DNN-PCA outperforms OSA screening questionnaires, scores and other machine learning models.

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441 Influence Of Chronotype On CPAP Adherence
Authors: Adekolu Olurotimi , Xu Zhichao , Chu Jen-hwa , Kushida Clete , Yaggi Henry , Knauert Melissa , Zinchuk Andrey
Published: May 2021

Introduction

Continuous positive airway pressure therapy (CPAP) is an efficacious treatment for obstructive sleep apnea (OSA). However, despite interventions targeting established determinants of CPAP use, adherence to CPAP remains poor. An Individual’s chronotype can influence behavior including adherence to dietary changes and alcohol abstinence. We hypothesized that chronotype will be associated with CPAP adherence and aimed to identify the mechanisms of this association.

Methods

Secondary data analysis of the active CPAP arm (n=469) from the Apnea Positive Pressure Long-term Efficacy Study, a multicenter randomized controlled trial of CPAP therapy in a sleep clinic population was performed. The Morningness-Eveningness Questionnaire (MEQ) was used to identify three chronotype categories: Evening (MEQ score: 16–41), Neither (42–58) and Morning (59–86) types. CPAP adherence over 6-months (hours/night) was objectively measured using smart-card downloads. Linear mixed modelling evaluated the association between the chronotype and CPAP adherence, adjusting for confounders (e.g., age). Mechanisms of this association were examined by change in beta estimates for the chronotype with addition of a potential mediator (e.g., sleep duration).

Results

There were 206(44%), 38(8%) and 219(47%) Morning, Evening and Neither chronotype patients respectively. Evening types were youngest (48.0±13.4 vs. 50.3±11.3 and 56.3±11.4 years, p<0.001) with highest body mass index (BMI, 34.9±10.5 vs. 31.2±10.5 and 32.7±10.5 kg/m2, p=0.006) and longest sleep on weekends (7.9±2.0 vs. 7.3±1.3 and 7.6±1.5 hours, p=0.017) compared to Morning and Neither types. A higher proportion of Evening types also reported symptoms of insomnia and fatigue (p-values 0.017 and 0.048 respectively). CPAP adherence, however, did not differ between Evening and Neither types (p=0.276). Compared to the Neither types, Morning types exhibited significantly higher CPAP adherence (β= 40mins/night, p=0.001) with a slight decrease after adjusting for age, sex, race, marital status, education, and OSA severity (β= 33mins/night, p=0.012). Sleep duration, insomnia, BMI and fatigue mediated a minimal proportion of this effect (0.7–3.7%).

Conclusion

In this cohort of sleep clinic patients, the Morning chronotype was associated with better CPAP adherence. Only a small proportion of this association was mediated by observed clinical differences between the chronotypes. Understanding the influence of chronotype on CPAP use may provide novel insight for improving OSA therapy effectiveness.

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451 Change of sleep disordered breathing severity in obese patients receiving Laparoscopic sleeve gastrectomy
Authors: Hsu Tzu-Chien , Lee Pei-Lin , Yang Po-Jen , Lee Po-Chu , Lee Pei-Jung , Lai Shang-Ru , Chang Yi-Cheng , Chen Chiung-Nien , Yang Wei-Shiung
Published: May 2021

Introduction

Bariatric surgery via laparoscopic sleeve gastrectomy (LSG) was proved to alleviate significantly in apnea hypopnea index (AHI) in obesity patients. We aimed to investigate LSG effects on AHI in different sleep stage (REM vs NREM) and in position (supine vs non-supine) and on CO2 reduction and to identify the factors associated of AHI reduction.

Methods

From April 2016 to December 2020, 22 obese patients who underwent PSG before and after bariatric surgery at National Taiwan university Hospital were retrospectively studied. The simultaneously nocturnal percutaneous transcutaneous CO2 (PtcCO2) monitoring was applied. Demographic, anthropometric characteristics, Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), PSG parameters were reviewed. Responsive to treatment was defined as AHI reduction ≥50% and residual AHI< 10/hour.

Results

Postoperative PSG was performed in 22 patients [13 men and 9 women, median age 38 years (interquartile range, 32.8–46.5), median body mass index (BMI) 44.5 kg/m2 (39–52.5)] and median follow up days of 535 days (440–687) after LSG. The median post-op BMI was 32.4 kg/m2 (28.3–37.1). The AHI decreased from 51.9/h (27–85.9) to 10.7/h (2–16.3) (p<0.01). The AHINREM decreased from 49.9/h (31.8–91.5) to 5.8/h (1.1–17.3) while the AHIREM decreased from 63.7/h (52.5–83.2) to 19.6/h (4.4–49.7) /h. The AHIsupine decreased from 64.1/h (40.1–88.8) to 11.9/h (2.3–18.7) while the AHInon-supine decreased from 27.5 /h (17.6–78.3) to 1 /h (0–2). The average PtcCO2 decreased from 51.6 mmHg (39.3–54.7) to 46 mmHg (36.6–49.3) while %PtcCO2-total sleep time>50mmHg decreased from 84.5% (0.1–99.1) to 0% (0–44.6). Logistic regression showed baseline higher AHI was independently associated with less treatment responsive [odds ratio, 0.909 (0.84–0.985)].

Conclusion

The AHI and PtcCO2 marked decreased via LSG where the residual AHI was lower in NREM than REM sleep; and in non-supine than supine. Baseline AHI is inversely associated with the residual AHI

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Ministry of Science and Technology (MOST 109-2314-B-002-252)
459 The Effect of Upper Airway Stimulation Therapy on Blood Pressure
Authors: McKinlay Alex , Scalzitti Nick , Walters Ben
Published: May 2021

Introduction

Upper airway stimulation (UAS) therapy is a novel technique in the treatment of Obstructive Sleep Apnea (OSA). UAS therapy is indicated for patients with moderate to severe OSA who fail therapy with Continuous Positive Airway Pressure (CPAP) and/or the use of a dental appliance. Although research suggests that CPAP can modestly improve patients’ Blood Pressure (BP), little is known about the effect of UAS on BP.

Methods

Via a retrospective cross-sectional cohort study, we identified all patients undergoing UAS surgery at Brook Army Medical Center from July 2015 through July 2020. We captured pre-operative and post-operative data from a structured electronic medical record review, including Polysomnographic data and BP measurements at designated time points. We measured UAS therapy compliance in hours of usage per week. Statistical analysis includes paired T-tests to determine whether changes in BP and AHI were significant when comparing preoperative and postoperative values.

Results

We report data for 12 patients treated with Upper Airway Stimulation therapy in our cohort. The mean pre-operative Systolic Blood Pressure (SBP) is 128.3±7 mmHg, the mean post-operative SBP is 122.8±10 mmHg with a mean difference of -5.4mmHg (standard error for difference 2.9mmHg). The mean pre-operative Diastolic Blood Pressure (DBP) is 80.0±6 mmHg, the mean post-op DBP is 76.4±8 mmHg, with a mean difference of -3.6mmHg (standard error for difference 1.9 mmHg). Neither of these are statistically significant, with P values of 0.09 and 0.08 respectively. The mean pre-operative Mean Arterial Pressure (MAP) is 96.1±6 mmHg, the mean post-op MAP is 91.9± 8 mmHg, with a mean difference of -4.2 mmHg (standard error for difference 1.7 mmHg). This represents a statistically significant difference with a P value of 0.03. Seven patients carried a pre-operative diagnosis of Hypertension whereas five did not. There is not a statistical difference in BP changes between these subgroups.

Conclusion

Upper Airway Stimulation surgery appears to decrease SBP, DBP, and MAP measurements with a similar magnitude as Positive Airway Pressure Therapy. In our cohort, only MAP changes appear to reach statistically significance. Further studies are warranted to elucidate the clinical significance of UAS on physiologic parameters such as blood pressure.

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463 The Effect of Intervention of Medical Staff on the Adherence of CPAP and Heart Rate in Patients with Obstructive Sleep Apnea
Authors: Shirahama Ryutaro , Ishimaru Rie , Takagiwa Jun , Mitsukura Yasue
Published: May 2021

Introduction

Recent studies have indicated that obstructive sleep apnea syndrome (OSAS) is associated with hypertension. OSA is a common cause of sympathetic nervous activity. Increase of sympathetic nervous activity causes hypertension. Continuous positive airway pressure (CPAP) is the most useful treatment for OSAS. Good CPAP adherence treatment improve the risk of hypertension. This study examined the effect of intervention of medical staff on the adherence of CPAP, heart rate and sleep stages in patients with OSA.

Methods

All patients diagnosed with OSA and undergoing subsequent CPAP were clinically followed for 12 months to examine CPAP adherence, as well as longitudinal changes in blood pressure, average heartrate of 24 hours and sleep stages. They were divided into 2 groups, Group A: patients who had individual consulted in person by sleep physician and technicians before start using CPAP and Group B: patents who did not have individual consulted. Patients in both groups were consulted by sleep physician and technicians after start CPAP with utilizing tele-monitoring. If the adherence were poor, the patients were recommended to stop CPAP. We provided 3D accelerometer and an optical pulse photoplethysmography to all the patients and analyzed the data of heart rate and sleep stages.

Results

A total of 30 OSA patients underwent CPAP, were enrolled in the study and assessed for changes in mean heart rate and body weight during the study period. We found a significant reduction in mean heart rate in both group A and B compared with baseline (p<-0.05). The patients aged under 50 years old and whose AHI<20 times/hour have higher ratio of dropout CPAP therapy. There was no significant difference between Group A and Group B on the persistency rate of CPAP therapy. Also, no significant association was found between group A and B on the adherence of CPAP.

Conclusion

We showed the importance of the effect of intervention of medical staff on the adherence of CPAP and heart rate in patients with OSA the consultation after starting CPAP for a while with utilizing tele-monitoring data would be more effective compared with that in person before start using CPAP.

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