bluuebunny/crossref_metadata_2025 huggingface dataset:
474 Phenotyping of patients with Moderate to Severe OSA on Polysomnography after Negative Home Sleep Apnea Testing
Authors: Sarfraz Sarah , McCullough Lindsay , Arantes Henry , Lastra Alejandra
Published: May 2021

Introduction

Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients.

Methods

We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index <5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis.

Results

The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h.

Conclusion

A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient.

Support (if any):
481 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with narcolepsy and solriamfetol prescriber rationale
Authors: Thorpy Michael , Hyman Danielle , Parks Gregory , Chen Abby , Foley Catherine , Ito Diane , Singh Haramandeep
Published: May 2021

Introduction

Pharmacotherapy for excessive daytime sleepiness (EDS) associated with narcolepsy is diverse, with factors such as efficacy, side effects, and tolerance influencing treatment decisions. Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor, is approved (US and EU) to treat EDS in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnea (OSA) (37.5–150 mg/day). This study characterized real-world patients with narcolepsy starting solriamfetol and prescribers’ rationales for initiating treatment.

Methods

This virtual, descriptive study included a quantitative retrospective patient chart review among US-based physicians prescribing solriamfetol. Target enrollment was 25 physicians treating patients with EDS associated with OSA or narcolepsy. Treatment initiation was classified as de novo (no EDS medication prior to solriamfetol), transition (switched/switching from existing EDS medications onto solriamfetol), or add-on (adding solriamfetol to current EDS medication).

Results

Twenty-six physicians participated. Seventy patients with narcolepsy were analyzed (type 1, n=24; type 2, n=46; mean±SD age, 40±11 years; 57% female; 6 also had OSA); EDS was primarily moderate (59%) or severe (36%). Twenty-two patients (31%) were obese (BMI≥30); other common physician-reported comorbidities were migraine headaches (n=12, 17%), depression (n=10, 14%), and cardiovascular disorders (n=10, 14%). Solriamfetol initiation was de novo for 19 (27%) patients, transition for 31 (44%), and add-on for 20 (29%). Patients transitioning to solriamfetol were taking 1 (29/31, 94%) or 2 (2/31, 7%) prior EDS medications; patients adding solriamfetol were taking 1 (16/20, 80%), 2 (3/20, 15%) or 3 (1/20, 5%). Most patients transitioning to solriamfetol were taking wake-promoting agents (22/31, 71%); patients adding solriamfetol were most frequently taking sodium oxybate (11/20, 55%). Solriamfetol’s efficacy profile was the primary reason prompting the discussion to prescribe solriamfetol de novo (12/19, 63%); need for better efficacy/augmenting effects of other medications was the primary reason for transitioning (18/31, 58%) and add-on therapy (19/20, 95%). At data collection, 63 (90%) patients were still on a stable solriamfetol dose. The most common reasons for discontinuing solriamfetol were lack of efficacy (n=3) and side effects (n=3).

Conclusion

Efficacy and the need for improved efficacy over existing medication(s) were key considerations for physicians prescribing solriamfetol treatment to patients with narcolepsy in clinical practice.

Support (if any)

Jazz Pharmaceuticals
502 Idiopathic hypersomnia and co-occurring psychopathology among veterans
Authors: Bishop Todd , Ashrafioun Lisham , Pigeon Wilfred
Published: May 2021

Introduction

Idiopathic hypersomnia (IH) is relatively rare and characterized by excessive daytime sleepiness despite prolonged and undisturbed sleep as well as the absence of cataplexy and other causes of hypersomnolence. The etiology of IH is largely unknown. The present study capitalized on electronic medical record (EMR) data from the Veterans Health Administration (VHA) to create a cohort of veterans diagnosed with IH in order to: 1) estimate the prevalence of IH diagnosis in the VHA, and 2) identify co-occurring physical and behavioral health conditions to characterize IH in the sample.

Methods

Using 2009–19 VHA EMR data, we created two cohorts: those with an IH diagnosis (N = 3,674) or a hypersomnia diagnosis (e.g., primary hypersomnia) other than IH (N = 110,530). Diagnostic data (i.e., ICD 9 and 10 codes) were extracted for the 6-months prior to index diagnosis to examine group differences in the prevalence of physical and behavioral health conditions.

Results

Veterans diagnosed with IH, as compared to veterans with another hypersomnia disorder, were more likely to be female (30.1% vs 12.3%) and less likely to be obese (16% vs 28.3%; chi-squared = 79.27, p <.001), or carry diagnoses of diabetes (type 1 or 2; 9.7% vs 24.4%; chi-squared = 123.02, p <.001), or anxiety disorders (5.8% vs 9.5%; chi-squared = 16.83, p <.001). Individuals with IH were more likely to carry diagnoses of chronic fatigue syndrome (4.2% vs 1.6%; chi-squared = 45.91, p <.001), depression (31.3% vs 23.4%; chi-squared = 36.04, p <.001), and posttraumatic stress disorder (29.5% vs 26.5%; chi-squared = 5.79, p = .02).

Conclusion

Data suggest that veterans diagnosed with idiopathic hypersomnia may present with different diagnostic profiles than veterans with other hypersomnia disorders. Far more basic and clinical research is needed in IH.

Support (if any)

This work was supported by the Hypersomnia Foundation and in part by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.
511 Pathological sleep prolongation and sleep onset REM period
Authors: Honda Makoto , Kimura Shinya , Sasaki Kaori , Wada Masataka , Ito Wakako
Published: May 2021

Introduction

ICSD-3 employs two definitions of pathological sleepiness: sleep prolongation with 24-hour total sleep time (24hrPSG TST) ≥660 and high sleep propensity with mean sleep latency(mSL) ≤8 min on MSLT. Multiple SOREMPs on MSLT reflects the pathophysiology (sleep instability) of narcolepsy, but it is not clear whether the lack of SOREMPs is associated with the pathophysiology of idiopathic hypersomnia. We performed 24hr PSG and PSG-MSLT sequentially to understand the meaning of SOREMP in those with pathological sleep prolongation.

Methods

Fifty-six consecutive patients visiting Seiwa Hospital or Koishikawa Tokyo Hospital affiliated to Institute of Neuropsychiatry with suspected idiopathic hypersomnia with habitually long sleep time were evaluated by 3-day sleep studies: unattended 24hr PSG followed by PSG and MSLT from January 2017 to November 2020. After excluding inadequate recordings or other sleep pathologies, we analyzed 52 data and found that 39 patients (23 females, 21.8 ± 7.9 years old, BMI 20.4 ± 2.5 kg/m2) exhibited pathological sleep prolongation.

Results

We divided 39 patients with pathological sleep prolongation into those with at least one SOREMP(n=9) and those without SOREMP(n=30) and explored differences in clinical symptoms and PSG variables. There were no differences in conventional sleep variables except for PSG sleep latency, shorter in those with SOREMP (20.8min vs 43.8min, p=0.032). Also 24hr PSG sleep variables showed no differences except for the number of NREM-REM cycles, more in those with SOREMP (10.4 vs 8.1, p=0.037). Frequency of clinical symptoms such as REM related phenomena and various symptoms characteristic for idiopathic hypersomnia did not differ between groups except for less frequency of general malaise p=0.003 and orthostatic hypotension p=0.049 in those with SOREMP. We had similar results when we compared 5 patients with multiple SOREMPs and 30 patients without SOREMP.

Conclusion

Our results indicated that sleep variables and clinical characteristics of idiopathic hypersomnia in those with pathological sleep prolongation were mostly the same regardless of the status of SOREMP on MSLT, suggesting that the absence of SOREMPs on MSLT were not fundamentally related to the pathophysiology of those with pathological sleep prolongation (idiopathic hypersomnia with long sleep time).

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516 Impacts of Chronic Nausea and Vomiting on Daytime Sleepiness and Fatigue
Authors: Ohayon Maurice , Chen Y J , Cote Marie-Lise
Published: May 2021

Introduction

Chronic nausea and vomiting (CNV), common symptoms in patients with GI disorders like gastroparesis, can be a debilitating health problem with considerable impact on patients’ health-related quality of life during daytime. Yet, little is known about how CNV may impact on sleepiness and fatigue during the daytime. Our aim was to examine the impact of CNV on daytime sleepiness and fatigue based on the data from a longitudinal study.

Methods

Prospective longitudinal study with two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the US general population. Analyses included subjects participating to both waves (N=10,931). CNV was defined as episodes of nausea and vomiting occurring at least twice a month for at least 1 month (outside pregnancy). Logistic regression models were employed to determine whether CNV is a predictive variable for excessive sleepiness or fatigue.

Results

Out of all W1 participants, 9.8% (95% CI: 9.2%-10.4%) reported nausea only while 3% (95% CI: 2.7%-3.3%) reported CNV. In W2, 7.7% (95% CI: 7.2%-8.2%) reported nausea only and 2.5% (95% CI: 2.2%-2.8%) reported having CNV. Of the subjects who participated in both W1 and W2, 25.7% of them reported CNV in W1. CNV subjects reported more frequently excessive daytime sleepiness (53.5% vs. 25.9%) and being moderately or severely fatigued (38.6% vs, 5.4%) compared with the participants without nausea or vomiting. After controlling for age, sex, BMI, health status, alcohol intake, sleep disorders and psychiatric disorders that might impact on daytime sleepiness or fatigue, it was found that subjects with CNV at both W1 and W2 had a significantly higher relative risk of reporting daytime sleepiness (RR: 2.7 (95% CI:1.9–3.9) p<0.0001) and fatigue (RR: 4.9 (95% CI:3.2–7.5) p<0.0001) at W2, compared with the participants without nausea or vomiting.

Conclusion

Many factors are likely to influence daytime sleepiness. CNV appears to be an important contributor even after controlling for several factors that can explain the sleepiness. This underlines the extent to which alertness could be disturbed and impacted by chronicity of nausea/vomiting symptoms.

Support (if any)

This analysis study was funded by Takeda Pharmaceutical Company
531 Efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: A pilot RCT
Authors: Cederberg Katie , Motl Robert
Published: May 2021

Introduction

Restless legs syndrome (RLS) occurs in approximately 26% of persons with multiple sclerosis (MS) and can worsen other symptoms of MS, including sleep quality. Physical activity represents a promising approach for managing RLS and its secondary effects in MS. This pilot randomized controlled trial examined the feasibility and efficacy of a physical activity intervention for improving RLS severity and secondary sleep outcomes among a sample of adults with MS.

Methods

Participants with MS (N=15) were randomly assigned into intervention (n=8) or waitlist control (n=7) conditions. The physical activity behavioral intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions.

Results

There was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), RLS severity during the night (p=.03,ηρ2=.35), RLS severity during the day while resting (p=.01,ηρ2=.44), and RLS severity during the day while active (p<.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction (p<.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality (p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed (p=.03,ηρ2=.37) and total sleep time (p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency (p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04; p=.35,ηρ2=.08; p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality.

Conclusion

This study provides initial evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and possibly self-reported sleep quality outcomes in persons with MS. These preliminary results should inform a future, fully-powered randomized controlled trial that further establishes the efficacy of physical activity for reducing symptoms of RLS and secondary outcomes in a larger sample of adults with MS and RLS.

Support (if any)

This work was supported, in part, by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health [F31HD097903]. ClinicalTrials.gov Identification Number: NCT0406168.
544 Burden of Sleep Disturbance in Black Pregnant Women
Authors: White Kaylin , Dunietz Liana , Pitts D’Angela , Kalmbach David , O’Brien Louise
Published: May 2021

Introduction

Black women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Poor sleep has emerged as a strong contributor to adverse pregnancy outcomes and, in the non-pregnant population, sleep-wake disturbances have a high prevalence with often greater severity among Blacks. Nonetheless, the majority of studies have included largely White populations which has restricted our understanding of race-specific burdens and morbidities of sleep disturbance. The goal was to describe the burden of sleep-wake disturbance in Black pregnant women and associations with pregnancy outcomes.

Methods

Black women at least 18years and >28 weeks pregnant were recruited from prenatal clinics. All women completed questionnaires about their sleep including the presence and timing of habitual-snoring (pre-pregnancy or pregnancy-onset), the Epworth Sleepiness Scale (ESS), and the General Sleep Disturbances Scale (GSDS) to determine poor sleep quality and poor daytime function as well as symptoms of insomnia. We also analyzed three commonly-reported sleep problems as individual question items (difficulty getting to sleep, wake up during sleep period, and wake up too early at the end of a sleep period). Demographic information and diagnoses were abstracted from medical records.

Results

Overall, 235 women enrolled; mean age was 27.6 + 6.2 years, mean BMI 31.7 + 9.8kg/m2, and 64% were in receipt of Medicaid. Eighty-percent of women reported >three sleep-wake disturbances, and almost half experienced a burden of >five disturbances. Women with pregnancy-onset habitual-snoring (but not those with pre-pregnancy habitual-snoring) had increased odds of poor sleep quality aOR 8.2 (95% CI 1.9, 35.9), trouble staying asleep aOR 3.6 (95% CI 1.0, 12.5), waking up too early aOR 2.7 (95% CI 1.1, 6.2), excessive daytime sleepiness aOR 2.3 (95% CI 1.1, 4.7), and poor daytime function aOR 8.7 (95% CI 2.5, 29.9). In contrast, women with pre-pregnancy habitual-snoring had increased odds for chronic hypertension, preterm delivery and fetal growth restriction; aOR 2.6 (95% CI 1.1, 6.3), aOR 2.8 (95% CI 1.1, 6.9), and aOR 5.1 (95% CI 1.7, 15.2), respectively.

Conclusion

Black women have a significant burden of sleep-wake disturbances. These findings highlight the excess risk that habitual-snoring confers to sleep-wake disturbances and perinatal outcomes in an infrequently studied yet highly vulnerable population.

Support (if any)

NIH NHLB-IHL089918
547 Earlier-life sleep patterns and risk for delirium in elderly hospitalized patients from a 14-year longitudinal cohort
Authors: Ulsa Ma Cherrysse , Zheng Xi , Li Peng , Hu Kun , Gao Lei
Published: May 2021

Introduction

Delirium is an acute decline in attention and cognition that is associated with cognitive dysfunction in elderly patients. While accumulating evidence points to associations between sleep disturbances and neurocognitive disorders, the temporal relationship between sleep patterns and delirium remains unclear. We tested whether earlier-life sleep duration, daytime dozing, insomnia, and sleep apnea predict incident delirium during hospitalization.

Methods

We studied 315,989 participants (mean age 58.3±7.9; range 37.4–73.7) from the UK Biobank with up to 14 years follow-up, and at least one hospitalization episode. Delirium diagnosis was derived using ICD-10 coding from hospitalization records. Multivariate logistic regression models examined the associations of self-reported baseline sleep duration (less than 6h/6-9h/more than 9h), daytime dozing (often/rarely), insomnia (often/rarely), and presence of prior sleep apnea (ICD-10), with incident delirium. Models were adjusted for age, sex, education, Townsend deprivation index, and major confounders (including number of hospitalizations during follow-up, BMI, neurological/cardiovascular/respiratory diseases, depression/anxiety, chronotype, and sedatives).

Results

4,025 developed delirium (12.7/1,000). There was a U-shaped association between sleep duration and delirium, where short [17.3/1,000; OR 1.18, 95% CI: 1.05–1.33, p=0.006] and long (28.8/1,000; OR 1.49, 95% CI: 1.30–1.70, p<0.001) sleepers had elevated risk compared to regular 6-9h sleepers. Often daytime dozing (25.3/1,000; OR 1.38, 95% CI: 1.20–1.58, p<0.001) and sleep apnea (21.7/1,000; OR 1.21, 95% CI: 1.03–1.42 p=0.02) also had increased the risk for delirium, but the latter was attenuated by the inclusion of BMI and hypertension. However, we did observe further risk when two or more of the above traits were present (OR 1.59, 95% CI: 1.29–1.95 p<0.001). No effects on incident delirium were observed from insomnia.

Conclusion

Earlier-life sleep patterns, in particular longer sleep and daytime dozing, are associated with an increased risk for delirium. Sleep patterns may reflect unmeasured health status; further work is warranted to confirm the associations using objective sleep/circadian measures, examine underlying mechanisms, and test whether optimizing sleep patterns can reduce the risk of developing delirium.

Support (if any)

NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.
558 A Surface Electrode Adjacent to Vagal Nerve Stimulator Lead Can Aid in Characterizing VNS Mediated Sleep Disordered Breathing
Authors: Chan Jeremy , Wrede Joanna
Published: May 2021

Introduction

Vagal nerve stimulators (VNS) are a nonpharmacological treatment for patients with refractory epilepsy. The VNS can decrease seizure frequency by over 75% in 40% of pediatric patients with refractory epilepsy. An underrecognized side effect is sleep disordered breathing (SDB). The purpose of this study was to demonstrate how a sensor placed adjacent to the VNS lead can distinguish whether SDB is due to VNS discharge.

Methods

Five pediatric patients (ages: 5–8) with refractory epilepsy with VNS were referred to our sleep center for concern for SDB. Each patient underwent a polysomnogram (PSG) that included a standard PSG montage with a surface electrode placed adjacent to their left lateral neck to detect VNS discharge. VNS associated apnea hypopnea index (vAHI) was calculated by determining the number of hypopneas and obstructive apneas occurring during VNS discharge.

Results

Of the 5 patients, three met pediatric criteria for obstructive sleep apnea (OSA). Patient 1 had an obstructive AHI (oAHI) of 21.3 events/hr with a vAHI accounting for 79% of the total (16.8 events/hr), patient 2 had an oAHI of 16.6 events/hr with a vAHI accounting for 57% of the total (9.5 events/hr), and patient 3 had an oAHI of 1.9 events/hr with vAHI accounting for 68% of the total (1.3 events/hr). Because of these findings, the VNS settings of all 3 patients were changed with the goal of reducing SDB due to VNS discharge. Upon repeat PSG, patient 2 had reduced OSA with an oAHI of 3 events/hr, with no events associated with VNS discharge. The remaining 2 patients did not exhibit VNS associated SDB, however, both experienced increased respiratory rate during VNS discharge.

Conclusion

We demonstrated that a surface electrode adjacent to the VNS is able to temporally co-register VNS discharges and enabled us to directly correlate SDB to VNS stimulation in 3 patients with refractory epilepsy. Because of our findings, we titrated the VNS parameters in all 3 patients, with one showing resolution of VNS associated SDB on repeat PSG. We propose that an added surface electrode to detect VNS discharge be considered as standard practice in PSG studies of patients with VNS.

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567 Validity of Sleep Related Breathing Disorder Scale and Anthropometrics in Obese/Overweight Children with Obstructive Sleep Apnea
Authors: Jimenez Leyden Lozada , Brubaker Jennifer , Thompson Nicolas , Honomichl Ryan , Mehra Reena , Shah Vaishal
Published: May 2021

Introduction

Prevalence of OSA, a multifactorial disorder associated with significant morbidity, has increased due to the pediatric obesity epidemic. A key existing gap is lack of a valid OSA screening tool in overweight/obese pediatric patients incorporating anthropometrics. Our aim is to examine the validity of inclusion of anthropometrics to the existing SRBD scale to detect moderate (apnea hypopnea index-AHI≥5) or severe OSA(AHI≥10).

Methods

Consecutive obese/overweight(n=89) patients(body mass index-BMI percentile>85th for age/gender) in obesity management clinic with SRBD scale, polysomnogram(PSG) and anthropometrics (neck circumference (NC),waist circumferences(WC), height), systolic and diastolic blood pressure(BP) percentiles are included. Receiver operating characteristic(ROC) analysis with AHI as the outcome variable, sensitivity, specificity, positive(PPV), negative predictive values(NPV) for an SRBD cutoff score of 8 and SRBD score found using Youden’s index in ROC and 95% confidence intervals using the exact binomial method are presented. Prediction model, interaction and discrimination (Outcome:AHI; Independent: age, sex, WC, NC, SRBD) were analyzed.

Results

Study population characteristics: age 12.6±3.4years, 55% female, 62% non-white and AHI=13.0±20.7,AHI>5=65.1% and AHI>10=37.1%. No significant differences were noted in item endorsement or SRBD total score using either AHI≥5 or AHI≥10 (all P>0.10). The area under the ROC curve for SRBD detecting AHI≥5 and 10 was 0.491(95%CI=0.352–0.630) and 0.559(95%CI=0.439–0.679). SRBD≥8 had sensitivity 0.759(0.628–0.861), specificity 0.387(0.218–0.578), PPV 0.698(0.570–0.808), NPV 0.462(0.266–0.666), for AHI≥5 and for AHI≥10, 0.848(0.681–0.949), 0.375(0.249–0.515), 0.444(0.319–0.575), 0.808(0.606–0.934) respectively. The SRBD cutoff score for Youden’s index was 7 for both AHI cutoffs of 5 and 10 and produced similar results to using SRBD cutoff score of 8. The prediction models including age, sex and WC (NC was not significant) had optimism-corrected c-statistics of 0.724 and 0.627 for AHI≥5 and 10, respectively. Adding SRBD total score to the models actually reduced these values to 0.702 and 0.614.

Conclusion

SRBD alone has fair sensitivity, but poor specificity for significant OSA in overweight/obese. The addition of anthropometrics to SRBD decreased discrimination of OSA in prediction models. Anthropometrics may differ in pre pubertal and post pubertal phenotypes of OSA and may or may not aid in increasing predictability of OSA with SRBD.

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574 Sleep-disordered breathing symptoms in children who co-sleep: Are caregivers better reporters?
Authors: Alvi Nimra , Clarke Allison , Patwari Pallavi
Published: May 2021

Introduction

Medical consensus advises against co-sleeping for infants to protect against SIDS, but co-sleeping in older children is often dismissed if not associated with caregiver distress. While some families may choose to co-sleep due to cultural, circumstantial, or psychosocial factors, this choice can also be due to medical concerns warranting greater caregiver attention. We aimed to explore characteristics of co-sleeping children referred for sleep disordered breathing and hypothesized that children with polysomnogram confirmed obstructive sleep apnea (OSA) would have higher caregiver-reported sleep disordered breathing symptoms as compared to children without confirmed OSA.

Methods

Caregivers who accompanied their child for polysomnogram were asked to complete a questionnaire that included sleep-related symptoms of sleep-disordered breathing (snoring, apnea, gasping/choking), restlessness, and parasomnias. Inclusion criteria are age >1.0 years and <18 years, baseline study for sleep disordered breathing, and completed questionnaire. Retrospective chart review included demographic information, BMI, co-morbid conditions, and polysomnogram results. The cohort was divided into 2 groups based on polysomnogram confirmed diagnosis of “snoring” or “OSA”.

Results

Of 75 co-sleeping children, 27 (36%) had a diagnosis of snoring and 48 (64%) of OSA. The cohort was similar in age, gender, and insurance type for snoring and OSA groups (Average 5.7 +/- 2.6 yrs and 5.4 +/- 2.9 yrs, respectively; 41% and 35% female, respectively; 44% and 50% Medicaid, respectively). Notable differences in the snoring and OSA groups were found with BMI z-score (1.6 +/- 4.6 and 1.0 +/- 1.5, respectively) and absence of co-morbid conditions (44% and 63%, respectively). Regarding reported symptoms, the snoring-group compared to OSA-group had lower report of gasping/choking (19% vs 29%), bedwetting (7% vs 13%), and nightmares (7% vs 15%); and had higher report of movement (74% vs 60%), kicking (48% vs 31%), and startle/jump (30% vs 19%).

Conclusion

Although we predicted that co-sleeping would be associated with increased caregiver vigilance, witnessed sleep-disordered-breathing symptoms was only higher for report of gasping/choking and did not differ significantly for report of snoring and apnea in children with and without OSA. Interestingly, co-sleeping in children without OSA appeared to be more strongly related to report of sleep disruption in the form of restless sleep.

Support (if any):
575 Sleep Duration in American Children with Autism Spectrum Disorder and the Role of Physical Activity
Authors: Smidt Stacey Elkhatib , Gooneratne Nalaka , Brodkin Edward , Bucan Maja , Mitchell Jonathan
Published: May 2021

Introduction

Sleep dysfunction is prevalent in autism spectrum disorder (ASD) and can have major daytime behavioral consequences. Emerging evidence suggests that physical activity may be associated with improved sleep in children, including those with ASD. We aimed to determine if there was an association between physical activity and sleep duration in American youth and if the association was consistent in children with and without ASD.

Methods

We analyzed data from children ages 6–17 years whose caregivers completed the 2018 National Survey of Children’s Health (N=20,980). ASD was self-reported (N=687), and we determined if reported ASD was mild, moderate, or severe, and if reported ASD occurred with intellectual disability (ID). Participants self-reported their weekday sleep duration and days of physical activity in the past week. We classified children as sleep sufficient or insufficient based on age-specific recommendations. Logistic regression was used to determine if physical activity and ASD were associated with sleep sufficiency. Physical activity-by-ASD interaction terms were used to determine if any physical activity association was modified by ASD status. Covariates included: age, sex, race, Hispanic ethnicity, highest caregiver education level, and overweight status.

Results

Compared to children without ASD, children with ASD were 29% less likely to have sufficient sleep (OR=0.71; 95% CI: 0.52–0.99), but this association attenuated to the null after adjusting for physical activity (OR=0.77; 95% CI: 0.55–1.07). Compared to zero days, being physically active for 1–3, 4–6 or 7 days in the past week was associated with increased odds of sufficient sleep, even with adjustment for ASD status (e.g., 4–6 days: OR=1.85; 95% CI: 1.48–2.32). We did not observe a statistically significant interaction between physical activity and ASD status with respect to sleep sufficiency (P-interaction=0.571), which remained consistent when using ASD severity and ASD with ID exposure variables.

Conclusion

Physical activity was associated with increased odds of meeting age-specific sleep duration recommendations in children with and without ASD. Our observations support pursuing physical activity in future studies as a potential intervention target to improve sleep duration in children, including those with ASD.

Support (if any)

NIH T32HL07713 and University of Pennsylvania’s Institute for Translational Medicine and Therapeutics
576 Clinical characterization of insomnia disorder in adolescence
Authors: Yuksel Dilara , Prouty Devin , Kiss Orsolya , Volpe Laila , Arra Nicole , Dulai Teji , Durley Ingrid , Obilor Todd , Baker Fiona , de Zambotti Massimiliano
Published: May 2021

Introduction

Insomnia is common in adolescence, particularly in older girls, with an overall prevalence comparable to major depression. Despite being associated with adverse outcomes such as an increased risk for substance dependence and suicidality, insomnia in adolescence is still under-recognized, under-diagnosed, and under-treated, and poorly described in the literature. This study aims to investigate the clinical features of insomnia in adolescence, in both boys and girls.

Methods

Eighty-five post-pubertal adolescents (16–18 years) with (N=39, 26 girls) and without (N=46, 28 girls) DSM-5 insomnia symptoms underwent a detailed clinical evaluation, including a clinical interview with a trained clinician and an extensive questionnaire battery investigating sleep behaviors, stress, coping skills, emotion regulation, mood, and personality traits.

Results

Adolescents with insomnia symptoms exhibit poorer sleep and sleep-related behaviors, such as higher insomnia severity scores, lower sleep hygiene, higher dysfunctional beliefs and attitudes about sleep, and higher pre-sleep negative thought content compared with controls (p<0.05). They also indicated higher stress levels associated with school performance and peer pressure, higher susceptibility to work overload and greater depressive symptoms than controls (p<0.05). Insomnia girls reported a lower perceived sleep quality, higher perceived stress levels, and a higher sleep vulnerability to stress than insomnia boys (p<0.05). Exploratory network analyses unveiled profound group differences in the extent of multi-symptoms’ interconnection, with network complexity being lower in adolescents with insomnia symptoms and showing distinct symptoms’ centrality and clustering.

Conclusion

Insomnia in adolescence needs to be considered in the context of both classical insomnia-related features, as well as adolescence-specific factors, such as school and peer stress. Network analysis may be a promising approach to unveil hidden relationships and patterns among insomnia symptoms and behaviors, and to better characterize insomnia, possibly advancing early recognition and treatment of the disorder.

Support (if any)

National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)
583 Treating Insomnia in Youth Depression: A Randomized Controlled Trial of CBT for Depression vs. CBT for Insomnia
Authors: Li Shirley Xin , chan Ngan Yin , Lam Siu Ping , Lui Tsz Ting , Chan Joey W , Tam Barry Ka-Hang , Zhang J , Li Albert Martin , Espie Colin , Wing Y K
Published: May 2021

Introduction

Insomnia is often comorbid with depression in youths and both may reciprocally exacerbate clinical outcomes and lead to a constellation of detrimental consequences. The present study aimed to test the efficacy of cognitive behavioral therapy (CBT) for insomnia (CBT-I) and CBT for depression (CBT-D), when compared with waitlist control, in youths with comorbid insomnia and depression.

Methods

112 participants aged 12–24 years old (67.9% female) with insomnia and depression according to DSM-5 diagnostic criteria were randomised to one of the following conditions: 8-week group CBT-I (n=33), 8-week group CBT-D (n=39), or waiting-list control (n=40). Insomnia (Insomnia Severity Index, ISI) and depressive symptoms (Hamilton Rating Scale for Depression, HAMD) were assessed at baseline and post-intervention. The two active treatment groups were additionally followed up at post-treatment one-month.

Results

Linear mixed model showed that both treatment groups (CBT-D: Cohen’s d = -0.44, p<.001; CBT-I: Cohen’s d =-0.56, p<.001) had significantly lower ISI scores at post-intervention follow-up, as compared to the waitlist group. There was a significant difference in clinically meaningful improvement in insomnia (a reduction of ISI score ≥ 6 from baseline to post-intervention follow-up) between the groups (CBT-I: 73.1%; CBT-D: 40.0%; WL: 28.6%; p=.002). Moreover, there was a significant difference in remission of depression (HAMD≤7) at post-intervention follow-up (CBT-D: 75.9%; CBT-I: 81.5%; WL: 22.9%) (p <.001). Both CBT-D and CBT-I resulted in comparable improvements in insomnia and depressive symptoms at one-month follow-up (p>.05).

Conclusion

Preliminary evidence from this study supports the efficacy of CBT-I for improving both sleep and mood in youths with comorbid insomnia and depression.

Support (if any)

This work was supported by Early Career Scheme, Research Grants Council, Hong Kong SAR (Ref. 27613017).
590 Neighborhood Safety and Sleep During Childhood
Authors: Gaston Symielle , Riley Nyree , Gullett Lauren , Harmon Quaker , Baird Donna , Jackson Chandra
Published: May 2021

Introduction

Neighborhood safety has been associated with sleep health among adults; however, few studies have investigated its association with sleep characteristics during childhood.

Methods

Using data from 1,693 Black/African-American women enrolled in the Study of Environment, Lifestyle and Fibroids from 2010 to 2012, we investigated associations between neighborhood safety and sleep at age 5 years. Participants, aged 23–35 years, reported childhood neighborhood safety (unsafe, somewhat safe, very safe) and light sleep (yes/no). Participants, with assistance from their mothers or others, provided information on participants’ frequency of good sleep hygiene as a child (i.e., to bed by 8 p.m. in a quiet, dark room) as always/most of the time, sometimes, or rarely/never. Adjusting for relative childhood household income and both mother’s and father’s age at participant’s birth, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to compare sleep characteristics for participants who reported unsafe vs. very safe neighborhoods.

Results

While 20% of participants reported living in an unsafe neighborhood, 41% reported a somewhat safe neighborhood and 39% reported a very safe neighborhood at age 5 years. The unadjusted prevalence of always/most of the time going to bed by 8 p.m. in a quiet, dark room was highest among participants who reported very safe neighborhoods. After adjustment, participants in unsafe neighborhoods were substantially more likely than those in very safe neighborhoods to only sometimes (vs. always/most of the time) go to bed: by 8 p.m. (PR=1.57 [95% CI:1.21–2.03]), in a quiet room (PR=2.11 [1.43–3.11]), and in dark room (PR=1.44 [1.09–1.90]). Patterns were similar for frequencies of rarely/never and often practicing good sleep hygiene. Light sleep was not associated with neighborhood safety.

Conclusion

Perceived neighborhood safety was associated with multiple sleep dimensions in childhood.

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602 Sleep Moderates Improvements in Mental Health Outcomes in Youth: Building Resilience for Healthy Kids
Authors: Kaar Jill , Ware Meredith , Bowen Anne , Chandrasekhar Jessica , Lee Joey , Shomaker Lauren , Simon Stacey
Published: May 2021

Introduction

To examine the role of sleep health in a school-based health coaching resiliency intervention for 6th grade students. We hypothesized that participants with insufficient sleep would have poorer mental health outcomes and that the intervention would be less successful for youth with poor sleep health.

Methods

A total of 285, 11-12-year-old students (72% white, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth completed electronic surveys at baseline and 6-week follow-up assessing mental health parameters and self-reported bed and wake time. Participants were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night. General linear models examined differences between groups for each mental health parameter, as well as change in mental health parameters from baseline to follow-up.

Results

A third of participants (31%) reported time in bed <9 hours per night. Youth with insufficient sleep were less often white (58% vs 73%; p<0.001) or Hispanic (26% vs 15%; p=0.04) and were more likely to be classified with mild to severe depression and anxiety (55% vs 35%; p=0.004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.

Conclusion

Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency and mental health interventions. Addressing sleep health may be an important consideration for future school-based mental health interventions.

Support (if any):
611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome
Authors: Patel Nisha , Morgenthaler Timothy , Baughn Julie
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS.

Methods

A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded.

Results

94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis.

Conclusion

Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs.

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621 Association of E-cigarette and Tobacco Use with Adolescent Sleep Quality
Authors: Malhotra Clare , Gunge Deepti , Advani Ira , Boddu Shreyes , Nilaad Sedtavut , Crotty-Alexander Laura
Published: May 2021

Introduction

Recently, targeted marketing has encouraged teen e-cigarette vaping. Although e-cigarettes are often presented as a safe alternative to conventional tobacco, their toxicity is unclear. In adults, we have previously observed a link between dual usage of e-cigarettes and tobacco with increased sleep latency. We hypothesized an association between dual usage and increased sleep latency.

Methods

Participants were recruited to complete social media surveys. We performed three surveys: Survey 1 (n=47) in 2018, Survey 2 (n=1198) in 2019, and Survey 3 (n=564) in 2020. Surveys 1 and 2 had three sections: past and current inhalant use, the Pittsburgh Sleep Quality Index (PSQI), and the Leicester Cough Questionnaire (LCQ). Survey 3 did not include the LCQ, instead including the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ9). The adolescent data (aged 13–20 years; n=609) were isolated.

Results

Adolescents reported an increase in sleep duration with increasing age by one-way ANOVA. Males reported no change with increasing age, while, by Tukey’s multiple comparisons test, females got significantly more sleep at ages 19 and 20 than at age 14(p<0.01). There was no significant correlation between inhalant use and sleep duration. When broken down by gender, female dual users slept more than female nonsmokers,(p=0.01; mean difference=43.8 minutes; CI=0.11 to 1.36), while there was no difference in males. We observed a significant association between inhalant use and sleep(p=0.0008), with dual use correlated with a longer sleep latency than nonsmokers (mean difference=6.27 minutes; CI=1.40 to 11.13. We saw no correlation between inhalant use and anxiety or depression, nor between inhalant use and cough severity and prevalence.

Conclusion

In female adolescents, we observed a peak in sleep hours at age 19 but significantly less sleep in fourteen-year olds. College-aged females may have a later wake time relative to middle-school and high-school aged females. Dual inhalant use in females was associated with a long sleep duration, raising concern for sleep disruption caused by dual use. Dual use’s association with increased sleep latency raises concern for nicotine-induced wakefulness. Further data are required in order to define public health strategies.

Support (if any)

LCA is supported by NIH.
642 A School-Based Health and Mindfulness Curriculum Improves Children’s Objectively Measured Sleep
Authors: Chick Christina , Anker Lauren , Singh Anisha , Buck Casey , Kawai Makoto , Gould Christine , Cotto Isabelle , Schneider Logan , Linkovski Omer , Matlow Ryan , Bradley Travis , Carrion Victor , O’Hara Ruth
Published: May 2021

Introduction

Children of low socioeconomic status (SES) experience shorter sleep duration and poorer sleep quality, as well as more daytime sleepiness, compared to children of higher SES. Early interventions teaching skills for managing stress may mitigate the effects of SES-associated stress on trajectories of physical and mental health. We examined effects of a school-based health and mindfulness curriculum, teaching stress management skills such as paced breathing, on sleep and stress in school-aged children. We hypothesized curriculum exposure would improve children’s ability to manage stress, and that this would improve objectively measured sleep (i.e., increase duration of total and REM sleep).

Methods

Using a prospective observational cohort design, we recruited 115 children (49 girls, ages eight to 11) from two Northern California school districts. Of these, 58 children attended a school district that delivered a health and mindfulness curriculum twice weekly during their physical education time. 57 children attended an SES-matched school district that delivered a traditional physical education curriculum. Ambulatory polysomnography and perceived social stress were measured at baseline (before curriculum exposure) and at one- and two-year follow-ups.

Results

Children receiving the curriculum gained an average of 74 minutes of total sleep and 24 minutes of rapid eye movement (REM) sleep per night during the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep of 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure. Children who reported higher curriculum engagement (e.g., using the breathing exercises at home) experienced larger changes in sleep architecture and perceived social stress. Social stress did not mediate effects of the curriculum on sleep.

Conclusion

We conducted the first study to examine effects of a school-based health and mindfulness curriculum on children’s objectively measured sleep. Children from a low-SES community who received the curriculum experienced increased total and REM sleep, compared to an SES-matched cohort not receiving the curriculum. Mindfulness training may have increased awareness of stress, while developing tools to reduce stress vulnerability. These results warrant additional investigation to assess whether benefits persist after curriculum cessation and/or generalize to other populations.

Support (if any):