bluuebunny/crossref_metadata_2025 huggingface dataset:
0735 A Preliminary Comorbidity Profile for Patients with Insomnia and Daytime Sleepiness in VA Subacute Rehabilitation
Authors: Boeve Angelica , O'Malley Kelly , Moye Jennifer , Ruopp Marcus , Boyle Julia
Published: April 2024

Introduction

Insomnia symptoms during inpatient rehabilitation are associated with slower recovery progression and longer lengths of stay. In addition to addressing environmental and behavioral factors, understanding medical and psychiatric comorbidities may help clinicians identify patients in most need of insomnia-related assessment, monitoring, or treatment. The present preliminary analysis aimed to characterize the comorbidity profiles of patients with insomnia symptoms and daytime sleepiness newly admitted to a VA subacute rehabilitation neighborhood.

Methods

48 Veterans (Mage=72.8±12.1; 97.9%male; 79.2%white) were admitted to the neighborhood following hospital discharge during a 6-month period. Reasons for admission included short-term rehabilitation following acute illness or injury or worsening of an existing medical condition. Within 7 days of admission, Veterans completed the Insomnia Severity Index(ISI) and Epworth Sleepiness Scale(ESS). Medical and psychiatric diagnoses were obtained from electronic medical records. Comorbidity profiling was determined through frequency analyses.

Results

52.1%(n=25) of Veterans endorsed at least subthreshold insomnia (ISI≥8), and 33.3% (n=16) of Veterans endorsed excessive daytime sleepiness (ESS>10). For Veterans with at least subthreshold insomnia OR excessive daytime sleepiness, the following medical comorbidities were most prevalent: circulatory disease (e.g., coronary artery disease, hypertension) (80%;93.8%) and pain disorder (e.g., spinal stenosis) (76%;75%), respectively. For Veterans with at least subthreshold insomnia OR excessive daytime sleepiness, the following psychiatric comorbidities were most prevalent: anxiety disorder (44%;68.8%), and history of substance use disorder (e.g., alcohol use disorder) (44%;43.8%), respectively. Prevalence of circulatory disease (89%) and pain disorder (90.1%) were more pronounced among Veterans with clinical insomnia (n=11)(ISI ≥ 15), though these findings were not significant.

Conclusion

While this work is preliminary, the findings support that it may be beneficial for clinicians to assess sleep difficulties upon admission to subacute rehabilitation settings. This may be especially important for patients with medical comorbidities, such as circulatory disease and pain disorders, and/or psychiatric comorbidities, such as anxiety disorder and substance use disorder. Future evaluations should include larger, more diverse samples and longitudinal designs to identify which comorbidities are primary risk factors for greater insomnia severity and daytime sleepiness during subacute rehabilitation. Understanding these risk factors would be essential to addressing insomnia and daytime sleepiness during rehabilitation in order to optimize recovery.

Support (if any)
0741 Effects of Light Exposure on Sleep, Rest-Activity Rhythms, and Cognitive Function in Adults with Heart Failure
Authors: Wang Zequan , Jeon Sangchoon , Conley Samantha , LaFleur Kelley , Redeker Nancy
Published: April 2024

Introduction

Sleep disturbance and circadian rhythm disruptions are common among adults with chronic heart failure (HF), and are related to cognitive impairment. Although light levels are known to influence sleep quality, cognition, and the circadian system, little is known about the role of light among adults with HF. The purpose of this study is to investigate the association between light exposure and sleep, diurnal rest-activity rhythms (RAR), and cognitive function among adults with HF.

Methods

We retrospectively analyzed baseline data from a randomized controlled trial of cognitive behavioral therapy for insomnia for adults with HF and insomnia. We measured light levels and sleep with 24-hour wrist actigraphy and computed the circadian quotient, inter-daily stability, and intra-daily variability (strength of the RAR) using cosinor and non-parametric methods. We computed time above threshold (TAT) (100, 500, and 1000 lux), ratio of light exposure in daytime to evening (AUC ratio), and light regularity index (LRI) (20, 50, and 100 lux) to assess the intensity and consistency of light exposure patterns. Lapses in performance on the Psychomotor Vigilance Task (PVT lapse) measured cognitive function. Multiple linear regressions tested if the light exposure metrics could predict the RAR, sleep efficiency, and PVT lapses after adjusting for age, sex, and comorbidities.

Results

The sample included 167 participants (M age=63.8 (SD =12.9) years; 45.5%female). The AUC ratio and TAT500 were associated with a stronger circadian quotient in males (0.339 ± 0.095, p=.0005; 0.296 ± 0.085, p=.0006) compared to females (0.058 ± 0.106, p=.5800; -0.061 ± 0.128, p=.6364), after controlling for age and comorbidities. TAT500 was associated with better inter-daily stability (0.221 ± 0.077, p=.0044) than the other thresholds. Higher light exposure intensity (TAT100) (0.129 ± 0.065, p=.0492) and a greater circadian quotient (0.267±0.076, p=.0006) were associated with improved sleep efficiency. TAT100 was associated with fewer PVT lapses (-0.229 ± 0.082, p=.0061), after controlling for total sleep time, circadian quotient, and demographics.

Conclusion

Light exposure, particularly at certain intensities and regularity, predicted RARs, sleep efficiency, and cognitive function in adults with HF. Future tailored light interventions with varying intensities and regularity may improve HF outcomes.

Support (if any)
0744 Metrics of Sleep Apnea Severity and Sleep-Dependent Memory Consolidation
Authors: Holloway Breanna , Harding Christian , DeYoung Pamela , Kwan Crystal , Ancoli-Israel Sonia , Banks Sarah , Malhotra Atul
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is common in older adults and has recently been implicated in the pathogenesis of Alzheimer’s disease (AD). Sleep disruption is a possible reversible cause of memory impairment. Furthermore, quality of sleep has been determined to be one of the most important variables affecting overnight memory consolidation. As part of a larger study, data are presented evaluating correlations between markers of sleep apnea severity and sleep-dependent memory consolidation.

Methods

Seventy-one older adults ages 65-83 (M=70, SD=4.1) with normal cognition underwent polysomnography (PSG) and completed sleep questionnaires as part of a larger study. The sample was 54.9% women, 83.1% White, and 91.5% Non-Hispanic. Severity of sleep apnea was assessed using several metrics: Daytime sleepiness measured by the Epworth Sleepiness Scale (ESS), apnea-hypopnea index (AHI) based on American Academy of Sleep Medicine recommended, Total Sleep Time with Oxygen Saturation below 90% (T90), the lowest level of oxygen saturation reached during sleep (SPO2 Nadir), and hypoxic burden. Sleep-dependent memory consolidation was assessed using the Word-pairs Association (WPA) task, which shows semantically related word pairs for 5 seconds for the participant to learn, and the next morning, post-sleep, the delayed recognition test is performed.

Results

Descriptive analyses showed a median daytime sleepiness of 7 (SD=3.1), AHI of 28 (SD=24.3), and body mass index of 27 (SD=7.1). Nonparametric correlations were performed to assess markers of sleep apnea severity as correlates of sleep-dependent memory consolidation. There were no significant associations between objective measures of OSA severity, particularly AHI, hypoxic burden, T90, and SPO2 Nadir. However, there was a significant negative association between subjective daytime sleepiness (ESS) and sleep-dependent memory consolidation (r=-0.30, p=0.01).

Conclusion

This study provides preliminary insights into the association between daytime sleepiness and sleep-dependent memory consolidation. The observed finding that lower daytime sleepiness is related to better sleep-dependent memory consolidation warrants further investigation into the underlying mechanisms and to assess whether alternate cognitive measures may be associated with objective severity metrics. Future research should assess relations with psychological factors, such as mood and coping, as these factors can impact memory and are not captured by PSG.

Support (if any)

1R01AG063925-01A1 and T32MH018399
0749 A Social Ecological Perspective on Sleep Hygiene Habits in Older Adults with HIV
Authors: Davey Christine Horvat , Webel Allison , Ruksakulpiwat Suebsarn , Foradori Megan , Griggs Stephanie , Ward Teresa , Anthony Donald , Gripshover Barbara , Erlandson Kristine
Published: April 2024

Introduction

Nearly 75% of people with HIV (PWH) report poor sleep quality, a risk factor for impairment in daily activities, poorer quality of life, and declines in physical and mental health. However, little is known about the multifactorial causes of poor sleep, rendering it difficult to treat. We examined sleep hygiene habits in PWH through qualitative and quantitative methods.

Methods

Using qualitative analyses, we examined sleep hygiene habits in older virally suppressed PWH on antiretroviral therapy who enrolled from December 2021 to September 2022 in this cross-sectional study. Individuals participated in semi-structured telephone interviews regarding sleep hygiene habits. Interviews were recorded, transcribed verbatim, and coded by three independent coders, codes were adjudicated and analyzed for common themes using Dedoose 9.0.82 software. The Social Ecological Model constructed with five levels: individual, interpersonal, organization, community, and policy served as the framework. Self-reported sleep quality data was measured with the Pittsburgh Sleep Quality Index (PSQI).

Results

Among 50 PWH, the mean age was 54 years, 32% were female (n=16), and 62% identified as African American/Black (n=31). The mean PSQI was 9 (median: 9, interquartile range: 5-14). The individual level themes identified were: 1) Shorter Sleep Duration and the Ripple Effect; 2) Poor Bedtime Habits; 3) The Sleep and Physical Activity Connection; and 4) Late Night Bites. The interpersonal level themes identified were: 1) Family Ties: The Impact of Family on Sleep; 2) Balancing Act: The Interplay between Work and Sleep; and 3) The Impact of Aging and Stimuli on Sleep. The theme at the organizational level identified was Sleep Health Neglect, that refers to a lack of adherence and continuity of sleep health care.

Conclusion

Poor sleep habits including lack of physical activity and late-night eating, family, work, aging, internal and external stimuli compete with the opportunity to sleep and contribute to inadequate amounts of sleep and/or poor quality sleep. Moreover, the lack of adherence and continuity of sleep health care also negatively impacts the perceived sleep quality of aging PWH. Future studies should consider a multimodal intervention approach to mitigating poor sleep quality in this population.

Support (if any)

National Institutes of Nursing Research grants: K23NR019744 and R01NR018391.
0751 Comparability of Self-Reported & Wearable-Measured Sleep & Predictors of Agreement in a Preconception Cohort
Authors: Coleman Chad , Wesselink Amelia , Bethea Traci , Rothman Kenneth , Kuriyama Andrea , Pothen Jacob , Kossowsky Joe , Bertisch Suzanne , Wise Lauren
Published: April 2024

Introduction

Agreement between self-reported and device-estimated sleep duration has not been well studied among pregnancy planners. As data from wearables provide complementary information to self-reported sleep, assessment via wearable devices may improve characterization of sleep in naturalistic settings and better inform research on sleep health and reproductive outcomes.

Methods

We analyzed data from Pregnancy Study Online, an Internet-based prospective preconception cohort study. From 2021-2023, we invited U.S. residents aged 21-45 years with pregnancy attempt times ≤6 months at enrollment to participate in a study of wearable sleep-tracking devices. Enrolled participants wore a study-issued Fitbit Inspire 2/3 for 24 hours/day for up to two months and completed all other parent study activities. We examined agreement between self-reported sleep duration in the month before enrollment and device-estimated 30-day average sleep duration (hours/day) within two months after enrollment using Bland-Altman plots and Kappa statistics (one-hour intervals). We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for predictors of agreement.

Results

Of the 1,523 invited participants (1,178 females and 345 males), 948 (62%) consented to participate (females: 67% vs. males: 47%). Self-reported sleep duration (median: 7.5; interquartile range [IQR]: 7.0-8.0 hours/day) was longer than wearable-measured (median: 7.2, IQR: 6.3-8.0 hours/day). Self-reported and wearable-measured sleep duration showed poor agreement (weighted Kappa: 0.12; 95% CI: 0.07-0.17). Comparing self-reported to wearable-measured sleep duration, the Bland-Altman plot yielded a mean difference of 0.2 hour/day (95% CI: -3.3-3.8). Outliers from the Bland-Altman plot indicate that participants with shorter wearable-estimated mean sleep duration overestimated their self-reported sleep duration, while participants with longer wearable-estimated mean sleep duration underestimated this measure. Among females, predictors of poorer agreement in short sleep duration (< 7 hours/day) included older age (≥35 years, PR: 0.71; 95% CI: 0.50-1.00), rural residence (PR: 0.64; 95% CI: 0.35-1.16), menstrual irregularity (PR: 0.80, 95% CI: 0.54-1.18), and shift work (PR: 0.83; 95% CI: 0.56-1.23). There were no strong predictors in agreement among males.

Conclusion

Self-reported and wearable-measured sleep duration showed poor agreement in a preconception cohort. Age, rurality, menstrual irregularity, and shift work predicted poor agreement in short sleep duration among females.

Support (if any)

R01-HD086742, R01-HD105863
0752 Regional Cerebrovascular Pathology Is Associated with Local Disruptions in Non-rapid Eye Movement Sleep Expression
Authors: Berisha Destiny , Rizvi Batool , Chappel-Farley Miranda G , Dave Abhishek , Meza Novelle , Sattari Negin , Lui Kitty K , Chen Ivy Y , Tustison Nicholas , Neikrug Ariel , Benca Ruth , Yassa Michael , Mander Bryce
Published: April 2024

Introduction

Aging is associated with disruptions in non-rapid eye movement (NREM) sleep expression, but the mechanisms driving this effect remain unclear. Cerebral small vessel disease (CSVD) burden increases with age and is associated with clinical sleep disturbance, but little is known about its relationship with local expression of oscillatory activity during NREM sleep. Here, we explore associations between CSVD burden and local electroencephalography (EEG) measures during NREM sleep in older adults.

Methods

Fifteen cognitively intact older adults (mean age 71.8±6.3 years, 10 female, Apnea Hypopnea Index (AHI)=7.82±7.95) completed T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging on a 3T scanner to quantify total and lobar white matter hyperintensity (WMH) volumes using a validated semi-automated toolbox and an in-lab overnight polysomnography with 128-channel EEG, separated by 1.95±1.02 years. EEG was preprocessed and multi-tapered to derive absolute spectral power. Topographical correlations between NREM multi-tapered absolute spectra bands were run with 5000-permutation threshold free cluster enhancement.

Results

Older age was associated with lower absolute posterior total (all p< 0.016, r>-0.61) and slow sigma power (all p< 0.018, r>-0.60) and slow wave activity (SWA) (all p< 0.017, r>-0.61) over centro-posterior EEG derivations. Age was also positively associated with frontal (τ=0.51, p< 0.01) and parietal (τ=0.49, p< 0.01) but not occipital (τ=0.33, p=0.092) or temporal (τ=0.36, p=0.064) WMH burden. Occipital WMH burden was also not associated with AHI (τ=0.038, p=0.843). Occipital WMH burden was associated with global reductions in alpha activity (all p< 0.043, τ>-0.78), centro-posterior reductions in SWA (all p< 0.043, τ>-0.63) and Delta (all p< 0.009, τ>-0.63), frontal reductions in total (all p< 0.043, τ>-0.71) and fast sigma power (all p< 0.004, τ>-0.57), global reductions in slow sigma power (all p< 0.043, τ>-0.71), and central reductions in theta activity (all p< 0.042, τ>-0.57).

Conclusion

Collectively, these findings indicate that WMH burden in older adults is associated with local disruptions in NREM sleep expression in multiple frequency bands associated with sleep-dependent cognitive functions. Future studies should examine the role of NREM sleep expression in cognitive decline associated with CSVD burden.

Support (if any)

Supported by NIH grants R01AG053555, R21AG079552, K01AG068353, F31AG074703, P30AG066519, and the AASM Foundation SRA-1818
0755 Sleep Strategies and Sleep-related Adverse Events Experienced by Runners in 200-mile Ultramarathons
Authors: Lynch William , Ginell Keara , Whibley Daniel
Published: April 2024

Introduction

Sufficient sleep is essential for the athletic recovery process and is considered foundational for optimal sports performance. Participation in ultramarathons taking place over multiple days may benefit from specific sleep strategies to avoid sleep-related adverse events and injury. This study aimed to identify if and which types of sleep strategies were used by ultramarathon runners, whether these were associated with sleep-related adverse events or injury, and the types of sleep-related adverse events experienced during these races.

Methods

This cross-sectional study comprised an electronic survey distributed to ultramarathoners aged 18 years or above who had recently completed a 200-plus mile race. Survey distribution was facilitated by race directors between June and September 2023. The survey included questions about demographics, ultramarathon experience, training habits, sleep-related factors, sleep-related adverse events experienced during the race, and whether an injury was sustained. Continuous variables were summarized as mean (standard deviation) and categorical variables as N (%). Logistic regression was used to quantify associations between sleep strategies and sleep-related adverse events and injury.

Results

Of 115 survey respondents who competed in a 200-plus mile ultramarathon, mean (standard deviation) age was 47.5 (10.8) and 67.0% were men. Among 71 respondents (61.7%) who reported using a sleep strategy during the race, the most common was ‘sleeping when exhausted’ (N=31; 43.7%) and the least common was sleeping for 6-8 hours (N=3; 4.2%). Using a strategy of ‘sleeping when exhausted’ was significantly associated with having a sleep-related adverse event (odds ratio 3.5, 95% confidence interval 1.3-9.5, p=0.01) but was not associated with sustaining an injury during the race (odds ratio 0.7, 95% confidence interval 0.2-2.1, p=0.5). Of 42 people who reported experiencing a sleep-related adverse event, the most common was experiencing hallucinations (N=40; 95.2%).

Conclusion

Sleeping when exhausted during an ultramarathon was a common strategy associated with experiencing hallucinations during the race. Further investigation should determine whether this is perceived as problematic for runners or if this is an integral part of their ultramarathon experience. Longitudinal research into acute, sub-acute and chronic downstream sequalae of sleep deprivation in this athletic population is warranted.

Support (if any)
0760 Sleep Health Profiles Across Six Harmonized Cohorts and Their Association with Future Depressive Symptoms
Authors: Wallace Meredith , Hoepel Sanne , Oryshkewych Nina , Luik Annemarie , Butters Meryl , Buysse Daniel , Redline Susan , Stone Katie , Yaffe Kristine , Barnes Lisa , Lim Andrew , Ensrud Kristine
Published: April 2024

Introduction

Depression is a leading cause of disability in older adults, yet it remains underdiagnosed and undertreated. Establishing common multivariable sleep health profiles may eventually help to identify at-risk older adults and match them with appropriate treatments. However, profiles identified across cohorts often differ because of inconsistent measures and methods, hampering progress towards large-scale initiatives. We aimed to overcome this challenge using harmonized data across six cohorts.

Methods

We harmonized five self-report sleep health indicators across six epidemiologic cohorts of adults aged >60 from the United States and Netherlands (N=613 - 3,123). We performed latent class analysis in each cohort. Generalizability and comparability of findings were assessed using several indices, including cluster stability and novel distance metrics. Generalized linear mixed-effects modeling was used to relate sleep health profiles to the risk of increased depressive symptoms over time in each cohort.

Results

Two sleep health profiles were common across all cohorts: ‘Good Sleep’ (GS; average sleep duration, high quality and efficiency) and ‘Poor Sleep’ (PS; short sleep duration, low quality and efficiency, high daytime sleepiness). Three cohorts indicated an ‘Inefficient Sleep’ profile (IS) and three cohorts indicated a ‘Long Sleep’ profile (LS). PS had high and sustained depressive symptoms over 3-15 years of follow-up, especially relative to GS and IS (Risk Ratios [RRs]=1.47-3.44 for PS vs.GS; 1.75-2.32 for PS vs. IS; and 1.10-1.15 for PS vs. LS).

Conclusion

GS and PS profiles were generalizable across cohorts. Older adults with the PS profile had heightened depressive symptoms over multiple years of follow-up, especially relative to GS and IS profiles. Next steps involve quantifying the impact of screening using sleep health profiles and gathering evidence that interventions targeting sleep health profiles reduce onset or severity of depression.

Support (if any)

Wallace (RF1AG056331); Rush Alzheimer’s Disease Center (R01AG017917, R01AG022018); Osteoporotic Fractures in Men Study (U01AG027810, U01AG042124, U01AG042139, U01AG042140, U01AG042143, U01AG042145, U01AG042168, U01AR066160, UL1TR000128, R01HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, R01HL070839); Study of Osteoporotic Fractures (R01AG005407, R01AR35582, R01AR35583, R01AR35584, R01AG005394, R01AG027574, R01AG027576, and R01AG026720); Rotterdam Study (Erasmus Medical Center and Erasmus University, Netherlands Organization for the Health Research and Development, Ministries of Education and Health, European Commission, Rotterdam Municipality).
0763 Association of Chronotype and Sleep Characteristics with Obesity Indexes in Korean Adults
Authors: Baek Younghwa , Kim Hoseok , Kim Jeonggyun , Lee Siwoo
Published: April 2024

Introduction

Insufficient sleep and circadian disruption are known modifiable risk factors for obesity. Chronotype reflects an individual's preferences in sleep timing and behaviors. This study examined the association between sleep characteristics and common obesity indicators, body mass index (BMI) and waist circumference (WC), according to chronotype in Korean adults.

Methods

This study used data from the Korean Medicine Daejeon Citizen Cohort study of 2,000 participants in their 30s to 50s from 2017 to 2019. The survey examined several sociodemographic and lifestyle factors. Sleep characteristics including time, quality, latency, and efficiency were investigated using the Pittsburgh Sleep Quality Index questionnaire. Chronotype was classified into morning (M), evening (E), and intermediate types based on single nucleotide polymorphisms in insomnia-related genes such as SYCE1L, IP6K3, PLCL1, APOE, and DPP3. Anthropometric measurements of BMI and WC were performed to assess obesity indices. General linear model adjusted for sex and age was performed to determine association between sleep and obesity index according to morning and evening types.

Results

Among the total 2,000 participants, the chronotype distribution was 5.3% morning type, 9.5% evening type, and 85.2% intermediate type. The evening type tended to have shorter sleep time (M: 6.75, E: 6.66 hr), poor sleep quality (M: 4.55, E: 4.68 score), longer sleep latency (M 19.7, E: 22.5 min), and low sleep efficiency(M: 95.1, E: 94.7%) than the morning type, but there was no statistically significant difference. The WC and BMI of the morning and evening types were similar. Morning type was associated with long sleep latency and increased WC (B= 0.12, 95% CI= 0.01 – 0.22, p=0.01). However, there was no association between them in the evening type. Additionally, morning types, being married and having less physical activity were associated with increased WC. Male was associated with increased WC and BMI, regardless of morning and evening types.

Conclusion

This study has demonstrated that the associations between sleep status and obesity indicators may vary in Korean middle-aged adults depending on chronotype, especially morning type. Future study will be needed on the causality between obesity considering chronotype, sleep status, and general characteristics.

Support (if any)
0764 Clinical Phenotypes of Patients with Obstructive Sleep Apnoea: A Retrospective Study
Authors: Wali Siraj , Alshumrani Ranya , Alhejaili Faris , Alghamdi Khalid , Alalwani Tariq , Halawani Ammar , Nowailaty Fares , Seiql Omar , Alshali Sultan , Fida Moufag
Published: April 2024

Introduction

The various clinical manifestations of Obstructive Sleep Apnoea (OSA) have not been officially depicted in clinical practise. The lack of clinical knowledge on the heterogeneity of OSA may present fundamental difficulties in its clinical recognition, resulting in missed conclusions for diagnosis. OSA symptoms frequently include higher airway narrowing, excessive sleepiness, sleep disturbances, and general fatigue. It is well known that the aetiology, symptoms, and consequences of OSA vary between patients.

Methods

Retrospective chart review of all patients who were evaluated at SMRC from 2017 to 2022. Data about patients' demographics, chief complaint (Excessive day time sleepiness (EDS), Insomnia, Co- morbidities with no symptoms), chronic diseases, STOP-Bang risk, CPAP adherence and values of ESS, RLS, ODI and AHI. The CPAP adherence was defined as using CPAP < 4 hours per day at least for 5 nights per week or ≥ 70% of all recorded days.

Results

shows that participants whose chief complaint was EDS had a significant higher mean BMI, higher ESS value and a significant higher percent of having a high-risk STOP-Bang (p=< 0.05). Participants whose chief complaint was insomnia had a significant older age (p=< 0.05). While those patients had a significant lower BMI, lower ESS and lower ODI levels (p=< 0.05). Participants whose chief complaint was referral from other services due to co- morbidities with no symptoms had a significant younger age and a significant lower value of ESS (p=< 0.05). participants with poor CPAP adherence had a significant older age, higher BMI, and higher ESS (p=< 0.05).

Conclusion

Different OSA phenotypes have different characteristics . Clustering OSA patients may lead to more individualized therapy with better compliance.

Support (if any)
0767 ICSD-3 TR Criteria for Nocturia: Is 3+ Nightly Episodes Too High a Bar?
Authors: Gupta Shalini , Mitchell Michael , Alessi Cathy , Martin Jennifer , Dzierzewski Joseph , Josephson Karen , Naeem Saadia , Der-Mcleod Erin , Ghadimi Sara , Zeidler Michelle , Badr M Safwan , Moore Alison , Fung Constance H
Published: April 2024

Introduction

Prior studies suggest that nocturia negatively affects sleep quality and daytime function. In the new ICSD-3 TR, nocturia is defined as three or more nightly episodes of urination arising from sleep. Previous studies suggest that two or more nightly episodes are bothersome and clinically meaningful. This study investigated the relationship between frequency of nocturia and symptoms of reported bother and sleep disturbance in a sample of middle-aged and older adults using hypnotics.

Methods

We performed secondary analysis of baseline assessment data collected for a multi-site trial testing hypnotic deprescribing programs. Participants aged >=55 years who use hypnotics completed self-reported assessments of nighttime urination frequency, bother from nocturia (not at all [0] to a lot [3]), and sleep outcomes (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and Epworth Sleepiness Scale [ESS]). Adjusting for age, gender, and site, we regressed each outcome on nocturia frequency (one vs 0, two vs 0, three vs 0, four+ vs 0 episodes) and estimated differences in adjusted means.

Results

Among participants (n=335;72% male, 76% white, mean age 68.9 years, 21% diabetes, 26% enlarged prostate, 48% depression), the estimated differences (#nightly urination episodes versus 0 episodes) in adjusted means for each outcome were: bother (one episode of nocturia: 0.77, two: 1.07, three: 2.08, four+: 2.02; all P<.001), worse PSQI (two: 1.64, three: 2.61, four+: 3.14; all P<.05; one episode was not significant [NS]), and worse ISI (three: 3.38, four+: 5.36, all P< .01; one, two episodes were NS). Only four+ episodes were associated with a difference in mean ESS (2.71, p<.05).

Conclusion

As episodes of nocturia increased, bother from nighttime urination and sleep disturbance increased. When compared to zero nocturia episodes, nocturia at a threshold of two or more nightly episodes was associated with more bother and worse overall sleep quality. Only insomnia severity worsened at a threshold of 3 nightly episodes. These findings may not apply to women and minority populations, who were underrepresented. A nocturia frequency threshold requiring 3 or more nightly episodes may miss individuals suffering from significant adverse effects of nocturia on their overall sleep quality.

Support (if any)

NIAR01AG057929, VAIIR17-234, UL1TR001881
0770 The Impact of Acute Sleep Extension on Blood Pressure Is Dependent on Sleep Quality
Authors: Gonzales Joaquin , Clark Cayla , Dellinger Jacob
Published: April 2024

Introduction

About 30% of the U.S. population sleep less than 7-hours per night, with this proportion of adults having a greater prevalence of hypertension than adults that meet the recommended amount of sleep. Middle-aged to older adults are of particular interest as they have lower sleep durations than younger adults, and suffer from higher rates of cardiovascular disease. Therefore, more research is needed in this population to understand the impact of sleep duration on vascular health. The aim of this study was to determine the impact of one night of sleep extension on blood pressure and microvascular function in middle-aged to older adults.

Methods

Sleep and daily physical activity were objectively measured at home for two weeks using wrist actigraphy in 22 adults (60 ± 15y). Vascular measurements were made in the morning on the 8th and 15th day. Participants spent at least 10h in bed on the night prior to one of these testing days to extend sleep. Mean arterial blood pressure (MAP) and peak reactive hyperemia in the forearm were measured on each testing day.

Results

Reactive hyperemia and MAP were unaltered (P>0.05) by sleep extension in the total sample. However, adults that experienced improved sleep efficiency during extended sleep (n=10, 4.2 ± 1.4%) exhibited reduced MAP (-5.5 ± 4.6 mm Hg, P=0.005) while adults that had little change or decreased sleep efficiency (n=12, -1.7 ± 2.9%) showed no change in MAP. The reduction in MAP was significantly different between sleep efficiency groups (P=0.005, Hedges’ g = 1.21) after adjustment for sex and moderate-to-vigorous physical activity.

Conclusion

These results suggest that one night of sleep extension has the potential to reduce blood pressure in midlife to older adults when the additional sleep time improves quality of sleep.

Support (if any)

This study was funded by the American Heart Association (19IPLOI34760579; J.U. Gonzales).
0772 OSA Improvement Due to Ato-oxy in Children with down Syndrome Predicts Improved Quality of Life
Authors: Combs Daniel , Edgin Jamie , Hsu Chiu-Hsieh , Bottrill Kenneth , Maxfield Kate , Gerken Blake , Matloff Daniel , La Rue Sicily , Dean Adam , Provencio-Dean Natalie , Parthasarathy Sairam
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS). Current OSA treatments for children with DS have limited effectiveness, as positive airway pressure therapy is poorly tolerated and adenotonsillectomy is not curative in most children with DS. We recently showed that the combination of atomoxetine and oxybutynin (ato-oxy) reduced OSA severity by 51% in a small trial of children with DS. Health-related quality of life (HRQOL) scores improved with ato-oxy, but the improvement was not statistically significant when examined across all trial participants. Therefore we evaluated if HRQOL improvements were greater in participants with more significant improvement in OSA.

Methods

We compared baseline characteristics and changes in HR-QOL in children with DS age 7-17 years old who had a response (defined as obstructive apnea-hypopnea index [oAHI] improvement of >50% and reduction of oAHI to < 5 events/hour) vs. those who did not respond to ato-oxy. Participants received 4 weeks of ato-oxy (0.5 mg/kg atomoxetine and 5 mg oxybutynin) with polysomnography and assessment of HR-QOL using the PedsQL along with behavioral assessment using the Conners at baseline and after 4 weeks of treatment. Paired t-tests or chi square tests were used to compare baseline participant characteristics and linear regression with adjustment for baseline was used to compare treatment outcomes.

Results

12 participants had data at both baseline and on ato-oxy. 42% of participants had a significant response to ato-oxy. There were no significant differences at baseline between treatment responders and non-responders in demographics, body mass index or OSA severity. Quality of life was significantly higher in ato-oxy responders compared to non-responders. Adjusted mean total PedsQL score was 75 (95% confidence interval: 64, 87) in responders compared to 61 (51, 70) in non-responders, p=0.048. Responders had better scores across Conners domains including attention and behavior, but these were not statistically significant compared to non-responders.

Conclusion

No characteristics predicted ato-oxy response for OSA treatment in children with DS. Children who had a significant response to ato-oxy had significant improvement in their quality of life.

Support (if any)

Funding provided by NIH (HL151254 and HD109777) as well as the Lumind-IDSC foundation.
0773 Anthropometric and Polysomnogram Findings in a Pediatric Cohort of Night Eaters and Non-night Eaters
Authors: Rani Seema , Strang Abigail , Chidekel Aaron , Levenbrown Aryeh
Published: April 2024

Introduction

As the prevalence of pediatric obesity increases, it is important to understand the relationship between chronotype, daytime sleepiness, eating times, sleep disorders and obesity. The objective of this study is to describe chronotype, eating timings, daytime sleepiness, and PSG findings in pediatric patients presenting for sleep evaluation and to investigate relationships between eating times on chronotype, daytime sleepiness, obesity, and PSG parameters (both respiratory and non-respiratory).

Methods

IRB-approved cross-sectional, survey-based study completed, between May-August, 2023 during sleep clinic visit, at Nemours Children's Hospital, Delaware. Eligibility criteria included age 11-17 years, English-speaking and developmentally appropriate. Validated surveys included: The Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), The Morningness Eveningness Questionnaire (MEQ), and the Night Eating Diagnostic Questionnaire (NEDQ). Demographic and PSG parameters were obtained from EMR. Descriptive and comparative statistics were performed to compare surveys, PSG findings and anthropometrics between night-eaters and non-night eaters.

Results

Study participants (n=35) were 60% male, mean age 14.9 years (1.8). The mean BMI was 37.8 kg/m2 (9.8), mean BMI Z-score was 4.3 (3.1), 89% were obese, 63% had increased daytime sleepiness, 71% had an intermediate chronotype, and 31% were night eaters. The cohort was split into night eating and non-night eating group. Among the night eating group (n=11), mean BMI was 39.8 (5.8), BMI Z-score 3.89 (2.1), 100% were obese, 55% were abnormally sleepy, and 55% had a moderate evening chronotype. Among the non-night eating group (n=25) mean BMI was 36.9 (11.1), and mean BMI Z-score was 4.6 (3.4), 83% were obese, 67% were abnormally sleepy, and 83% had an intermediate chronotype. PSG parameters were similar in both groups except duration of N2 sleep, which was significantly higher in night eaters 60.5% (7.5) compared with non-night eaters 54.3% (9.6), p=0.05.

Conclusion

Night eating is associated with evening chronotype in this unexpectedly obese pediatric population. There were no observed differences in daytime sleepiness, or respiratory parameters between night eaters and non-night eaters. Further studies with a more varied BMI are necessary. Night eaters had significantly higher duration of light (N2) sleep compared to non-night eaters.

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0775 Polysomnography Characteristics of Infants Presenting with BRUE: A Single Center Experience
Authors: Rao Harish , Bandyopadhyay Anuja , Jalou Hasnaa
Published: April 2024

Introduction

Brief resolved unexplained events (BRUE) commonly seen in infants, is not a specific diagnosis but a description of a sudden, brief, and now resolved episode. It includes one or more of the following presenting features: Cyanosis or pallor; absent, decreased, or irregular breathing, marked change in tone or altered level of responsiveness. Polysomnograms (PSG) are often performed as part of workup for infants presenting with BRUE. But the utility of PSGs in BRUE workup algorithm has not been well studied.

Methods

In this single center retrospective study, we reviewed clinical data from 100 consecutive infants (0-1 years) presenting with BRUE, of which 32 infants had PSG performed as part of workup.

Results

Age ranged from 12 days to 7 months: median age being 3 months. 23 out of 32 infants presented with apnea while 6 infants presented with change in color. 24 infants had obstructive sleep apnea (OSA); 3 infants had mixed sleep apnea; 3 infants had central sleep apnea (CSA) and 2 were normal. 10 infants had severe OSA, 9 had moderate OSA while 5 had mild OSA. Most common clinical diagnoses in our cohort were gastro-esophageal reflux disease (GERD) (17 infants) and laryngomalacia (8 infants). In our cohort, infants with GERD and laryngomalacia had higher AHI overall.

Conclusion

Though BRUE is a transient event, it is frightening to the observer leading to significant anxiety to parents. Because of the diverse presentations, causes, and prognoses of infants presenting with acute events, evaluation and management should be individualized. The clinical challenge is to identify the infants who may benefit from further testing and prolonged observation, while avoiding unnecessary testing. In our cohort, most of the infants presenting with BRUE did not undergo PSG. But among those who had PSG, it showed significant findings in infants which led to further intervention. PSG can be a useful non-invasive tool in the workup of selected infants with BRUE combined with clinical judgement. A normal PSG can also allay anxiety and be extremely reassuring for parents.

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0780 Pediatric OSA Assessment Tool to Predict Severity of Sleep Disordered Breathing
Authors: Bertschy Calli , Abdallah Tarek , Majid Ruckshanda , Sargsyan Lilit , Mathew Reeba
Published: April 2024

Introduction

In the general pediatric population, the prevalence of obstructive sleep apnea (OSA) varies between 2% and 5% with several well-established consequences, including learning disability and behavioral difficulties. Resources for evaluation are limited often with long wait times. The STOP-BANG questionnaire has facilitated OSA screening (in adults) and can also predict OSA severity. We developed a pediatric “Severe OSA Score” (SOS), for patients referred for polysomnography to predict severity of the OSA, hence facilitating appropriate triaging of available sleep studies.

Methods

An 8-item (10-point) SOS questionnaire was developed consisting of: snoring (+1), witnessed apneas (+2), restless sleep (+1), speech/developmental delay (+1), tonsillar hypertrophy (+1), craniofacial abnormality (+2), and body mass index (BMI) percentile < 5% or >95% (+1). This was administered prospectively to parents of consecutive patients between 2–12 years, scheduled for a polysomnography (PSG), at the Memorial Hermann Sleep Disorders Center - Texas Medical Center, between December 2022 to February 2023. The obstructive apnea hypopnea index (OAHI) was calculated on PSG (using the American Academy Sleep Medicine scoring manual version 3.0). An OAHI cut-off of 1.5 events/hour was used as diagnostic for OSA. A comparison was made between SOS severity (Group 1: >5 and Group 2: ≤5) and the mean OAHI.

Results

45 subjects were included with a M:F gender distribution of 2:1, a mean age of 6.5 years (SD +/- 2.9), and a mean BMI percentile of 74.8 (SD +/- 28.3). All patients were diagnosed with OSA. The mean OAHI was 19.6 events/hour (SD +/- 20.1) with an average SOS score of 4.6 (SD +/- 1.2). When comparing Groups 1 and 2, the difference in the mean OAHI was statistically significant with a mean of OAHI 29.9 versus 14.3 events/hour respectively (p-value of 0.01).

Conclusion

We were able to prospectively show a strong correlation between a score of >5 on the SOS risk tool and the mean OAHI in this pediatric cohort. This tool hence may be used to identify those children at higher risk for more severe OSA, thereby allowing us to select those patients for more urgent referral when resources are limited.

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0781 Perioperative Delta Weight and Pediatric Obstructive Sleep Apnea Resolution After Adenotonsillectomy
Authors: Dang Quynh-Chi , Johnson Romaine , Mitchell Ron , Ulualp Seckin
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients and has detrimental effects on childhood growth and development. Adenotonsillectomy (AT) is the most effective treatment for pediatric OSA but is correlated with postoperative weight gain in children. We hypothesized that higher perioperative weight gain correlates with lower rates of OSA resolution in pediatric patients.

Methods

We conducted a retrospective cohort study at a tertiary academic medical center analyzing demographic, weight, and polysomnography (PSG) data for 250 patients from 2-17 years of age between January 2021 and December 2022. We performed univariate and multivariate logistical regression analyses.

Results

Following AT, 27.7% (n=68/250) of patients had residual OSA (AHI>5). Compared to patients without residual OSA, those with residual OSA were predominately male (77.9% vs 60.2%, p=0.007), had a higher median age (7.5 years vs 6.2 years; p=0.04), a higher median weight (41.8 vs 27.7 kg; p=0.01), and a higher median preoperative BMI (27.7 vs 20.9; p=0.001). Logistic regression showed that for every one-unit (1 kg) increase in perioperative weight, the odds of residual OSA increase by 6.0% (OR=1.06, 95% CI=1.02-1.10). For every one unit increase in baseline AHI correlated to 2% increase in the odds of residual OSA (OR=1.02, 95% CI=1.01-1.03, P=0.001). The odds of having residual OSA increased by 92% for Black or African American patients (OR=1.92, 95% CI=1.04-3.55, P=0.037).

Conclusion

Perioperative weight gain around the time of AT is correlated to higher rates of residual severe OSA in children. Weight loss and/or control is an important adjunctive treatment to ensure OSA resolution.

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0788 Effect of Sleep State and Position on Obstructive Respiratory Events in 12 - 24-month-old Toddlers
Authors: Shah Charmi , Sivaram Ganeshraj , El-Kersh Karim , Kluthe Theresa , Betz Kelly , Senthilvel Egambaram
Published: April 2024

Introduction

As per our knowledge, very limited number of studies have investigated the effect of sleep states and body positions on respiratory events distribution in toddlers aged 12-24 months. We aimed to investigate this relationship in this specific age group.

Methods

This was a single center, retrospective study that included normal toddlers between the ages of 12 and 24 months diagnosed with OSA with overnight polysomnography. Toddlers with obstructive apnea hypopnea index (OAHI) of 2 or greater were included. Patients with Down syndrome, neuromuscular disease were excluded. REM, NREM and different body positions AHI were collected, in addition to REM and NREM mean end-tidal carbon dioxide level (EtCO2) and mean oxygen saturation (SaO2).

Results

A total of 95 toddlers (68 males, 27 females) between 12 and 24 months old met the criteria. 48.4% of patients were Caucasian, 37.9% were African American and 4.2% were Hispanic. Median times (%) spent in REM and NREM were 21 and 79.1, respectively. Median time (minutes) in different body positions were supine 147, right side 53.4, left side 58.5, and prone 42.35. Median REM AHI was 8.45, higher than median NREM AHI of 1.1 (p< 0.001, IQR: 3.475-24.875 and IQR: 0.3-4.5, respectively). Median REM SaO2 was 98% (IQR: 97-99) and median NREM SaO2 was 98 %( IQR: 97-99), with no statistical difference. REM EtCO2 median was 41 (IQR: 40-44) and median NREM was 42 (IQR: 40-44), with no statistical difference. Median AHI while supine was 2.15 (IQR: 0.4-9.1), on right side was 0.8 (IQR: 0-7.25), on left side was 1.1(IQR: 0-8.8), and while prone was 0 (IQR: 0-5.2). The median supine AHI compared to off-supine AHI showed no significant difference (p=0.6252).

Conclusion

Toddlers suffering from OSA have worsening AHI during REM sleep, however their SaO2 and EtCO2 does not significantly change compared to NREM sleep. Additionally, sleep position does not affect AHI distribution this population.

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