bluuebunny/crossref_metadata_2025 huggingface dataset:
0105 The Impact of Lifetime Trauma Exposure Among Law-Enforcement on Actigraphically-Recorded Sleep
Authors: Krizan Zlatan , Strauel Caroline , Miller Anthony
Published: April 2024

Introduction

Law-enforcement officers have a critical mission to ensure public safety and investigate crime, yet frequently report sleep disturbances and mental health challenges. Exposure to trauma common during police duties may contribute to officers’ poor sleep, although research is lacking. Moreover, whether trauma exposure influences objective sleep characteristics and which ones may be especially vulnerable is unclear. To this end, this study examined whether cumulative exposure to traumatic events predicted multiple parameters of sleep health derived from actigraphically-recorded sleep among a sample of police officers during daily duties.

Methods

A sample of mostly day-shift police officers (n=77, 73% male, average age 42) participated in a two-week study where they reported trauma exposure (Life-Event-Checklist for DSM-5), sleep quality (PSQI), including other indicators of health (e.g., Berlin OSA Questionnaire). Subsequently, officers wore the Fatigue Science Readiband for two weeks, which yielded actigraphic estimates of sleep duration, wake-after-sleep-onset, sleep latency, and sleep quality, also producing biomathematical estimates of alertness. Analyses included correlations and regressions controlling for demographic covariates.

Results

In general, 36% of officers reported at least one traumatic event, 25% were at high risk for obstructive sleep apnea, and most officers reported significant sleep complaints. Critically, cumulative exposure to trauma was significantly associated with shorter sleep duration, lower sleep quality, and more frequent awakenings (marginally with PSQI reports). For example, officers who reported trauma slept on average around 20 minutes less per night. These effects were robust amid inclusion of critical covariates (age, sex, height, weight, sleep apnea risk, and generalized anxiety).

Conclusion

The findings provide novel and much needed evidence on the impact of trauma exposure on objectively-recorded sleep among police officers. Trauma exposure was found to impact multiple dimensions of everyday sleep including duration and continuity. Moreover, these effects could not be attributed to demographic differences or currently reported mental distress. The results underscore the presence and impact of trauma on sleep among law-enforcement (even day-shift). They also highlight the need for assessing sleep and fatigue more objectively, as well as sleep and fatigue management intervention efforts.

Support (if any)

This work was funded by a Federal Bureau of Investigation contract #15F06718C000253 to the first author.
1050 Supporting Patient Safety with Oxybate Therapy: A Survey of Patients and Prescribers
Authors: Macfadden Wayne , Whalen Marisa , Patodiya Vandana , Ward Danytza , Bronson Stefanie , Measey Thomas , Candler Shawn
Published: April 2024

Introduction

Low-sodium oxybate (LXB; Xywav®) and high-sodium oxybate (SXB; Xyrem®) are approved to treat cataplexy or excessive daytime sleepiness in patients ≥7 years of age with narcolepsy; LXB is also approved for idiopathic hypersomnia in adults. Both are available through the same manufacturer’s Risk Evaluation and Mitigation Strategy (REMS) program under the US Food and Drug Administration, where prescribers and patients receive training and educational materials containing important information about the significant risks, safe handling, and storage of LXB and SXB. The Knowledge, Attitude, and Behavior survey was conducted to document and assess their level of awareness regarding important information about LXB and SXB communicated through the REMS.

Methods

Internet, telephone, and paper surveys were conducted between October 27, 2022 and February 26, 2023. Survey questions and statements tested each group’s understanding of REMS Key Risk messages (risks associated with LXB and SXB, risk of abuse, dosing and safe handling). Surveys considered LXB and SXB jointly.

Results

Surveys were completed by 3152 patients and 273 prescribers. Most patient respondents correctly identified risks related to taking LXB and SXB at recommended doses (81.5%); most knew there is a risk of abusing LXB and SXB (89.6%) and correctly identified risks of taking too much of either (93.4%). Most prescriber respondents correctly recognized central nervous system depression (91.6%) and respiratory depression (79.5%) as risks associated with LXB and SXB; most were aware of patterns of misuse (99.3%) and drug-seeking behaviors (96.7%). For twice-nightly regimens, nearly all patients and prescribers, respectively, understood the first dose should be taken at bedtime (99.5%, 98.9%), the second dose should be taken 2.5–4 hours following the first dose (99.0%, 98.9%), and patients should remain in bed for both doses (99.4%, 95.9%). Most patients and prescribers responded correctly regarding proper storage (99.8%, 83.8%), reporting loss or theft (89.6%, 87.5%), and the legality of giving or selling LXB and SXB (98.9%, 99.6%).

Conclusion

Most patients and prescribers surveyed demonstrated understanding of the risks, dosing instructions, and safe handling of LXB and SXB communicated through the REMS to support safe and effective use.

Support (if any)

Jazz Pharmaceuticals
1051 A Novel Sleep Pilot Program to Streamline Care in Patients Undergoing Joint Replacement
Authors: Goldenberg Daniella , Rojas Edward , Devabhaktuni Sirisha , Santer Matthew , Matyus Valerie , Pincavitch Jami , Richmond Nathan , Battung Francis , Stansbury Robert , Sharma Sunil
Published: April 2024

Introduction

The presence of sleep disordered breathing can have a significant impact on a patient’s perioperative risk. Diagnosis and treatment of obstructive sleep apnea (OSA) with positive air pressure (PAP) may help prevent post-operative complications. In this pilot program we hope to identify high risk patients early to help mitigate these risks.

Methods

We created a pilot program to help streamline patients undergoing joint replacement. In this program we identified high risk OSA patients, set them up with evaluation with our sleep medicine team and had them undergo standard of care sleep apnea testing. Once testing was completed patients received treatment if indicated.

Results

A total of 49 patients were evaluated 53% (26) of patients completed evaluation with the sleep medicine team. 8 out of the 49 patients completed their perioperative sleep apnea testing and had undergone their surgery. 9 out of the 49 patients did not complete their perioperative testing and had undergone surgery. Of the 9 that did not complete testing 4(44%) had readmission/visit to the emergency department (ED) post-surgery. 1 out of 8 (12%) who did complete testing had a readmission/visit to the ED. The average AHI of patients who completed testing was 14.67.

Conclusion

Early identification and intervention of patients with OSA may lead to less post operative readmissions/ED visits in patients undergoing joint replacement. Of note only 53% of patients completed evaluation with the sleep medicine team. This further identifies the importance of discussing with patients the risks that certain comorbidities may have when undergoing procedures. Although the sample size was small due to this being a pilot study, there was a 44% readmission/ED visit rate in patients who did not undergo testing or treatment for OSA. Further studies are needed to see if we can identify which patients with high suspicion for OSA are at greater risk for developing post operative complications to help streamline care and reduce hospital costs.

Support (if any)
1053 Patients’ Sleep Perception and Its Correlation with Unattended Ambulatory Testing in the Inpatient Setting
Authors: Devabhaktuni Sirisha , Rojas Edward , Srinivasan Priyanka , Richmond Nathan , Goldenberg Daniella , Battung Francis , Knollinger Scott , Olgers Kassandra , Stansbury Robert , Sharma Sunil
Published: April 2024

Introduction

Obstructive sleep apnea is an increasingly prevalent condition today, with many cardiopulmonary consequences. In the ambulatory setting when a patient reports poor sleep quality on the night of the study, repeat testing is usually sought out. Here, we examine the differences in AHI, ODI and comorbidities among patients who perceived they slept well versus patients who perceived they slept poorly and compare it to outpatient PSG follow up.

Methods

A retrospective chart review of 1351 patients enrolled in a formal hospital sleep medicine program between September 2019 and October 2022, was conducted. The sleep medicine team asked each patient how they perceived they slept that night, using three options: slept well, slept but not well, or slept very poorly. Patients who slept but not well and patients who slept very poorly were combined to make a category of slept poorly. From there, each patient’s AHI, ODI, Stop-Bang score, ESS score and comorbidities were monitored.

Results

Of the 1351 patients 304 of these patients had outpatient follow up with PSG. The STOP-BANG score for patients who slept well and slept poorly was 5.17 and 5.48, respectively. In the patients who slept poorly, 73% had a mean AHI >5 on confirmatory PSG compared to 79% while inpatient. The patients who slept well, 79% had a mean AHI >5 on confirmatory PSG compared to 73% while inpatient.

Conclusion

The variables used to measure sleep apnea were not significantly different among patients who believed they slept well versus patients who believed they slept poorly. Current thought is that inpatient sleep medicine can lead to false positive results, as patients are sicker in the inpatient setting, leading to poorer sleep quality and disruption that could alter their unattended sleep study. In this retrospective chart review, there seemed to be little difference when comparing patients’ hospital sleep studies to their outpatient ones. Only 22% of patients completed outpatient follow up. This needs further evaluation to see if streamlined care for the patients leads to better outcomes and cost-effective care.

Support (if any)
1055 Development of a Provider and Patient-Based Sleep Improvement Resource for Inpatient Setting
Authors: Claudatos Stephanie , Simpson Norah , Eisen Katherine , Ma Flora , Manber Rachel
Published: April 2024

Introduction

Insomnia is common among hospitalized psychiatric patients and environmental challenges often increase the severity of sleep disturbances. Pharmacotherapy is often used to treat insomnia symptoms. Few studies have investigated ways to adapt CBT-I to inpatient populations.

Methods

A preliminary needs assessment was conducted at Stanford Hospital and Clinics Acute Inpatient Psychiatric units to identify barriers related to the use of non-pharmacological approaches to improve patients’ sleep. We conducted unstructured interviews with staff members, including nurses, occupational therapists, psychologists, and psychiatrists. Based on themes that emerged from the interviews, we developed sleep improvement resources and subsequently refined them based on input from behavioral sleep medicine providers and the inpatient team.

Results

We developed the following three resources (1) a provider training and education resource, (2) a patient-facing handout, and (3) recommendations on the environment in the inpatient unit. Both the provider- and patient-facing resource consisted of context-sensitive CBT-I recommendations: psychoeducation about sleep regulation, counter control, alerting strategies, strategic napping, daytime activities that support sleep, developing a wind down and morning routine, and optimizing the sleep environment (e.g., utilizing earplugs, eye masks or extra blankets). Additionally, several recommendations were included to address modifiable environmental factors at the unit-level. These included increasing consistency with unit light and wake time schedule, nursing staff to perform visual checks to minimize disrupting patients’ sleep, designated quiet time, dimmable lights in bedrooms, and additional unit-safe sitting areas in bedroom (e.g., bean bag chair).

Conclusion

Adapting CBT-I principles to specifically target sleep difficulties unique to psychiatric inpatients at all three levels (i.e., patient, staff, and environment) has the potential to support sleep in this vulnerable population. Future research is needed to test efficacy of this comprehensive approach.

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1058 Experience of VA Telesleep Medicine Following the COVID Pandemic
Authors: Atwood Charles , Boudreau Eilis , Sarmiento Kathleen , Williams Katherine , Totten Annette , Folmer Robert , Wholey Mary
Published: April 2024

Introduction

The VA Telesleep Enterprise Wide Initiative (EWI) operated from 2017 through 2023 and focused on increasing sleep medicine care to rural Veterans. Part of the Telesleep EWI was promotion of telehealth visits to improve access to sleep medicine care for rural Veterans. This report examines the significant growth of telesleep visits during the COVID-19 pandemic and the strong sustainment in Telesleep care in EWI sites post-pandemic. EWI sites participated in weekly clinical support meetings and best practices sharing to foster uptake and improvement of telesleep clinical work. Non EWI sites did not have access this support network.

Methods

Data regarding clinical visits for sleep medicine at a national level were obtained from the VA Corporate Data Warehouse by trained and experienced data analysts. Data from 2019 through fiscal year 2023 were obtained which spans the pre-pandemic to the post-pandemic time frame. The data were analyzed by medical center based on whether the site was part of the Telesleep EWI or not part of the EWI. In this report only rural Veterans were analyzed.

Results

From 2019 to 2023, for rural Veterans, the proportion of total sleep medicine visits performed using telehealth modalities increased from 25% to 56% for sites in the Telesleep EWI compared to 16% to 36% in the non EWI sites. Comparing Telesleep visits at the peak of pandemic in 2021-22 to post-pandemic 2023, Telesleep visits peaked at 61% and decreased to 56% in 2023 for the EWI sites and peaked at 52% and decreased to 36% in non EWI sites.

Conclusion

The COVID -19 pandemic resulted in rapid changes in healthcare delivery for many clinical services including sleep medicine. Post-COVID-19 many clinicians returned to previous care delivery models. In VA, where telesleep medicine virtual care was strongly supported in the EWI, sites showed greater sustainment of virtual care compared to non EWI sites. We speculate that ongoing support of clinicians through training and expert support in the EWI accounted for this better sustainment of virtual care.

Support (if any)

VA Office of Rural Health; VA Office of Connected Care; VA HSR&D Merit Review
1067 Increasing Access to Behavioral Insomnia Care: A Hybrid Implementation-Effectiveness Trial
Authors: Bramoweth Adam , Hough Caroline , Boudreaux-Kelly Monique , McCoy Jennifer , Youk Ada
Published: April 2024

Introduction

Chronic insomnia is common among Veterans and contributes to poor health and quality of life. To improve access to care, Brief Behavioral Treatment for Insomnia (BBTI) was developed for delivery outside of specialty care settings. BBTI is a brief, flexible, and effective adaptation of CBT-I. However, training alone is rarely sufficient for sustainable change and implementation strategies are needed for successful uptake and adoption.

Methods

This was a stepped wedge, hybrid 3 implementation-effectiveness trial at 4 VA Medical Centers. Primary Care Mental Health Integration (PCMHI) providers attended a 3-hour live online BBTI training followed by a pre-implementation phase prior to receiving implementation support. During the 12-month implementation phase, strategies and support were provided by the hub-site and assisted by each site’s implementation champion. After 12-months, support was withdrawn. Data from the VA Corporate Data Warehouse were extracted across four phases (pre-training, pre-implementation, implementation, post-implementation) and compared within and between sites. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework informed outcomes; reach data is presented here from pre-training to pre-implementation and pre-implementation to implementation. Analyses were conducted using logistic regression with a fixed effect for study phase.

Results

Sites 2, 3, and 4 saw significant increases in the proportion of Veterans engaging in BBTI from post-training to pre-implementation (8.37% - 24.16%; ps< 0.00001); site 1 did not have a pre-implementation phase. From pre-implementation to implementation, sites 1 and 3 saw significant increases in Veterans engaged in BBTI (7.32% - 22.3%; ps< 0.0001), site 2 had a non-significant increase in BBTI (4.14%; p=0.21), and site 4 had a non-significant decrease in BBTI (-0.89%; p=0.82). All four sites also saw significant reductions in sleep medications prescribed in Primary Care (-0.60% - -1.43%; ps< 0.0001) from pre-implementation to implementation.

Conclusion

BBTI training alone plus implementation support resulted in mixed findings across the four sites. However, BBTI in PCMHI increased over time across the study phases. BBTI plus implementation support also contributed to sleep medication reductions in Primary Care. Contextual barriers and facilitators also need to be evaluated to determine their impact on efforts to implement BBTI in VA PCMHI clinics.

Support (if any)

VA HSR&D I01HX003096
1070 Awakening Insights: Increasing Sleep Medicine Education for Psychiatry Residents
Authors: Shaffer Nicholas , Peterson Telyn , Hentschel-Franks Karen
Published: April 2024

Introduction

Sleep is integral to mental health. For example, it is estimated that 40 to 50% of individuals with insomnia have co-occurring mental illness. Despite this, only ~3.31% of current sleep medicine fellows enter from a psychiatry residency, ~4.89% of sleep medicine fellowship alumni are psychiatrists, and 4.25% of sleep faculty members have a psychiatry background. At the present time, the Accreditation Council of Graduate Medical Education has no curriculum requirement for sleep education within psychiatry residency programs. A past study has shown that less than 40% of psychiatry programs have faculty with training in sleep medicine. If sleep medicine is not prioritized amongst psychiatry residents, psychiatry is at risk of losing representation in the field.

Methods

From November to December 2023, a voluntary & anonymous online 15-minute, 32 question survey was given to psychiatry residents in the third largest psychiatry residency program in the country. The survey evaluated psychiatry residents' knowledge on guidelines from the American Academy of Sleep Medicine, as well as attitudes, behaviors, and barriers towards sleep medicine.

Results

A total of 31 psychiatry residents completed the survey. Results show perceived and objective opportunities to improve sleep education amongst psychiatry residents. Residents demonstrated discomfort in counseling patients regarding topics including sleep related breathing disorders (43%), non-REM parasomnias (53%), and REM behavior disorders (45%). Barriers were identified regarding discussing sleep with patients included limited training (43%), lack of time (37%), and decreased prioritization (17%).

Conclusion

More can be done to promote sleep medication education for psychiatry residents. While analysis is ongoing, it is the hope that the results of this survey will lead to the development of applicable curricula with expected completion within 12 months. We anticipate identifying specific educational needs to inform the development of a standardized sleep medicine training protocol for residents in hopes of increasing the number of psychiatry residents willing to consider sleep medicine as a possible future career. With research establishing a bidirectional relationship between sleep and psychiatric disorders, it is imperative that curricular improvements are targeted, so that psychiatrists can continue to contribute to the field of sleep medicine.

Support (if any)

UT Health San Antonio Department of Psychiatry
1071 Knowledge and Attitudes Regarding Obstructive Sleep Apnea Among Pulmonologists in South Korea: A Survey Study
Authors: Park Sunmin , Kim Seiwon
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) has known associations with cardiovascular and metabolic conditions and is increasingly recognized in chronic lung diseases like COPD and IPF. In South Korea, OSA patients receive care from various specialties, but pulmonologists' involvement is limited. This study aimed to assess the knowledge and attitudes of pulmonologists in South Korea regarding OSA.

Methods

An online survey was conducted in February 2023, targeting all registered respiratory specialists listed in the online directory of the Korean Academy of Tuberculosis and Respiratory Diseases. The survey utilized the "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA), a previously validated instrument. Three email invitations were sent to potential participants to encourage survey participation.

Results

A total of 127 pulmonologists (20.0%) completed and returned the questionnaires. The mean age of respondents was 45.4 ± 8.6 years, with 68.5% being male. Additionally, 71.7% of respondents were affiliated with university hospitals, and 79.5% were working in hospitals with more than 500 beds. The median total knowledge score was 15.0 [13.0;16.0], and the overall proportion of correct answers was 0.8 [0.7;0.9]. Notably, pulmonologists who had experience in managing OSA patients exhibited significantly higher knowledge and attitude scores than their counterparts without such experience. Furthermore, those with OSA treatment experience demonstrated more confidence in OSA screening, OSA diagnosis, and continuous positive airway pressure (CPAP) therapy management. Interestingly, attitude scores tended to be higher among older respondents and those who graduated from medical school and completed pulmonology specialist training earlier in their careers.

Conclusion

The knowledge levels of South Korean pulmonologists regarding OSA were found to be comparable to or better than those reported in previous studies. Nevertheless, there remains a need for targeted education and practical exposure to OSA management, especially for younger respiratory physicians, to enhance their proficiency in treating OSA patients effectively.

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1076 Feasibility of Sleep Staging EEG Acquired by a Dry-electrode Wearable Device Using a PSG-trained Algorithm
Authors: Cakir Ahmet , Josephs David , Kleinschmidt Dave , Guillot Antoine , Pathmanathan Jay , Donoghue Jacob , Chan Alexander
Published: April 2024

Introduction

Sleep monitoring hardware that allows for accurate sleep staging while also being unobtrusive and self-administered has the potential to make reliable EEG-based assessment of sleep quality at home widely accessible. However, for novel hardware utilizing dry EEG electrodes, a question remains regarding the similarity of these signals to traditional polysomnography (PSG), especially when used for therapy development. Here, we investigate how well EEG signals from a wearable dry electrode system can be sleep staged by an algorithm trained on traditional PSG.

Methods

The Dreem 3 headband, a low-profile sleep monitoring device with dry electrode EEG sensors, was used simultaneously with overnight PSG in 75 individuals. A machine learning model that was trained to stage sleep from the EEG signals of PSG, SleepStageML™, was run without modification on both the PSG and headband EEG signals. Each PSG recording was independently staged by 3 registered polysomnographic technologists to generate consensus ground-truth sleep stage labels. We compared the algorithmic performance of the sleep stages generated from the PSG signals to that of the sleep stages generated from the synchronously recorded headband data.

Results

Staging of PSG signals resulted in per-stage positive-percent-agreements (PPAs) of 92.4% for W, 58.4% for N1, 90.7% for N2, 76.0% for N3, and 92.9% for R. Negative-percent-agreements (NPAs) for these stages were 98.6%, 98.1%, 88.4%, 97.5%, and 98.4% respectively. When staging the headband recordings, performance remained high with PPAs for W, N1, N2, N3, and R of 94.4%, 34.7%, 88.2%, 78.6%, and 83.7% and NPAs of 96.2%, 98.9%, 86.5%, 96.3%, and 98.4% respectively. Cohen's Kappa on PSG signals was 0.82, and 0.77 on headband data.

Conclusion

We demonstrate that the EEG signals from a dry-electrode sleep monitoring system are similar enough to the EEG signals of a traditional PSG that an algorithm trained to stage PSG can also stage these dry-electrode signals. These results suggest that dry electrodes configured in a comfortable headband montage can capture clinical grade EEG useful for sleep staging with existing paradigms. These findings are promising for the broader investigation of cerebral functioning in sleep pathology, and could simplify the development of sleep biomarkers of neuropsychiatric disease.

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1078 Performance of USleep Algorithm to a Better Than “Gold-Standard” Polysomnogram Validation Data Set
Authors: Hanif Umaer , Jubien Guillaume , Cairns Alyssa , Radke Tammie , Mysliwiec Vincent
Published: April 2024

Introduction

Algorithm based PSG scoring is increasingly used in clinical practice and research. Currently, there is no accepted PSG validation data set to ensure algorithms are developed from an accepted standard; thus algorithm-based scoring has inherent inaccuracies. The purpose of this study was to evaluate the inter-rater agreement between three experienced sleep technicians to develop a PSG validation data set with a high interscorer reliability and compare performance of the USleep algorithm to the PSG validation data set.

Methods

One-hundred de-identified PSGs from a clinical database with 55 males and 45 females were independently scored by three different technicians and each record was quality controlled by a lead technician. The data set encompassed all sleep-related events: sleep stages, apneas, hypopneas, desaturations, arousals, and PLMs. Consensus annotations were computed when at least two technicians agreed upon a given event. The performance of each technician was compared against the consensus annotations. USleep was evaluated on the validation data set and the performance with respect to sleep stages was compared against the consensus annotations.

Results

The inter-rater agreement was 96.0% for sleep stages across all epochs, which did not greatly differ between N1 (88.3%), N2 (97.3%), N3 (94.2%) and REM sleep (98.1%). The inter-rater agreement across all records was 88.9% for arousals, 84.0% for obstructive apneas, 80.2% for central apneas, 76.4% for mixed apneas, 89.4% for hypopneas, 94.9% for desaturations, and 81.3% for PLMs. Comparing USleep to the consensus yielded an accuracy of 78.3%, with differences between N1 (46.2%) and N2 (76.8%), but not N3 (99.3%) and REM sleep (92.1%).

Conclusion

This data set has high accuracy for sleep stages. The USleep algorithm showed poor performance for N1 and moderate for N2, but high for N3 and REM. Frequently scored PSG measures to include arousals, hypopneas and obstructive apneas had high degrees of accuracy; however, this decreased for central and mixed apneas. This dataset can serve as a benchmark for developing and validating algorithms in PSG scoring for sleep stages and certain PSG measures. Further development is required to provide basis for a comprehensive PSG validation data set.

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1080 The Sleep Physiological Change with Light Interventions in Adolescents - A Magnetic Resonance Spectroscopy Study
Authors: Lu Tsung-Hua , Yang Ya-Ting , Yang Yen-Kuang , Wang Jeen-Shing , Lin Shih-Hsien
Published: April 2024

Introduction

The good sleep quality contributes to the better emotion and cognitive functions. A significant portion of adolescents in Asia shows insufficient sleep quality, which impacts the emotion such as depression and anxiety. The bright light exposure could regulate sleep and mood. The aim of this study was to figure out the sleep and emotion change after artificial bright light intervention in female senior high students, by the measurements of salivary melatonin, polysomnography and magnetic resonance spectroscopy.

Methods

There were two classes of the same senior-high school enrolled in and assigned to the control group and experimental group. During the middle to the end of semester, the students in the control group received basic sleep education. The students in the experimental group received artificial bright light exposure (500 LUX, 5000K) in the classroom from 8:00 AM to 12:00AM every morning for total 58 days. The students in the two classes had the same persistent academic stresses during this period. We randomly selected eight students from the control group and seven students from the experimental group without any diagnosis of mental disorders. Before and after the interventions, Pittsburgh Sleep Quality Index(PSQI), Hospital Anxiety and Depression Scale(HADS) were measured for sleep quality and emotion, salivary melatonin for the dim-light melatonin onset, polysomnography for sleep parameters, and brain magnetic resonance spectroscopy for excitatory/inhibitory ratio(E/I ratio). Correlation analysis was conducted to probe the association between these variables. ANOVA tests were used to examine group differences before and after the intervention.

Results

Before the intervention, these two groups showed no significant difference in the above variables. The scales for anxiety showed significantly negative correlation with sleep phase angle from all these participants. After the bright light intervention, the change of HADS showed no significant difference between groups. However, only in the control group, the sleep phase angle became longer and the E/I ratio became higher significantly, but no change in experimental group.

Conclusion

During persistent academic stress, the daytime artificial bright light exposure might have buffering effects for the adolescent students, preventing them from delaying sleep onset and over-activating the arousal system in brain.

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1082 Accreditation of Home Sleep Apnea Testing in British Columbia, Canada: The Types of Nonconformance
Authors: Markin Aleksei , Rakhra Nav , Homewood Laura , Manship Sharan
Published: April 2024

Introduction

Accreditation of Home Sleep Apnea Testing (HSAT) has been conducted in British Columbia (BC) since 2021. BC is one of only two provinces in Canada that require accreditation for HSAT facilities. In this study, we analyzed the types of nonconformance cited, based on the first facilities completing on-site assessments.

Methods

The accreditation process was divided into three phases: an initial attestation, a desktop audit, and an on-site assessment. In 2022-2023, we analyzed data from 46 HSAT facilities who have completed an onsite assessment based on 329 standards. The assessment approach included reviewing evidence, interviewing staff, and observing patient practices. All assessment questions were categorized and included a complete set of HSAT Accreditation Standards (1). The outcomes of these assessment activities highlighted nonconformance for the facilities to meet to obtain full accreditation.

Results

By December 2023, 46 out of 172 facilities in BC (26.7%) had completed on-site assessments, and 480 nonconformance were cited. The nonconformance identified in the on-site assessments was analyzed. Among the nonconformance, we found 105 (21.9%) in procedural and documentation areas, 78 citations (16.3%) in human resources standards, 54 (11.3%) in the medical director’s duties, 38 (7.9%) in HSAT equipment evaluation and maintenance aspects, 32 (6.7%) in reporting, 29 (6.0%) nonconformance were identified in ethical standards, 28 (5.8%) in complaint and feedback processes, 22 (4.6%) were related to technical HSAT issues, 18 (3.7%) in safety and privacy and the same number 18 (3.7%) were associated with patients communication problems, 13 (5.0%) nonconformance were in scoring and interpretation area, and 34 (7.1%) in referral process, infection prevention and control, and information management groups of standards.

Conclusion

Standalone HSAT facilities will continue to play a significant role in providing diagnostic sleep services. HSAT facilities have welcomed the accreditation process to facilitate continuous patient care and safety improvement. Our study, showing the first experience of the HSAT accreditation process, strives to create a path for further research on the positive influences of accreditation programs on public health indicators.

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1084 Association of Social Determinants of Health and Sleep Study Completion Rates in a Large Cohort
Authors: Okoli Chimuanya , Bena James , Sulaj Holta , Dalton Jarrod , Mehra Reena , Pena-Orbea Cinthya
Published: April 2024

Introduction

The effects of social determinants of health (SDH) on health outcomes are well documented. However, the extent to which SDH influences sleep study completion is unknown.

Methods

A retrospective cohort study was conducted utilizing sleep study referrals at the Cleveland Clinic Sleep Center from 1/3/2017 to 8/5/2023. Adult patients who underwent sleep testing and completed at least one SDH screening questionnaire including food insecurity, financial strain, housing stability were included. A comparison between sleep study and SDH completion was conducted using Pearson chi-squared tests and Wilcoxon rank sum tests for unordered and ordered variables respectively. Continuous measures were summarized and compared with two-sample t-tests or ANOVA. Univariate logistic regression was used to measure associations between sleep testing completion rates, with SDH measures and demographic variables.

Results

Of 113,843 patients referred for sleep testing, 55% (n=62,569) patients completed at least one SDH screening questionnaire. Of these, 40% (n=25,003) completed a sleep study and 60% (n=37,556) did not. Patients who completed at least one SDH screening questionnaire were older (55.0±15.6 vs 53.5±15.8), of White race (77.7%vs76.3%, p< 0.001), non-Hispanic (95.9%vs94.9%, p< 0.001) and more likely to complete their sleep study (40.0%vs29.6%, p< 0.001) compared to those who did not complete any SDH screening questionnaire. On the other hand, the subset of patients who completed at least one SDH measure and sleep testing were older (56.0±15.65 vs 54.4±15.5, p=< 0.001), had a higher BMI 34.4±8.8vs33.8±8.3, p< 0.001) and were of Hispanic origin (4.4%vs3.8%, p< 0.001) compared to patients who did not complete sleep testing. Likewise, completers reported medium to high financial strain (15.8%vs13.7%, p< 0.001), high risk for housing stability (11.5%vs10.3%, p< 0.001) and food insecurity (9.9%vs8.9%, p=0.027) versus the subset of patients who did not complete sleep testing.

Conclusion

SDH screening questionnaires are not routinely completed by patients referred for sleep testing. However, patients who completed SDH screening questionnaires and sleep testing reported higher risk for food insecurity, housing stability and financial strain. Systematic efforts are needed to investigate the feasibility and acceptability of implementing SDH screening in sleep clinics to understand the relationship between social needs, access and utilization for sleep testing.

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1085 Evaluating Different Message Strategies from the AASM “Count on Sleep” Campaign to Promote Awareness About OSA
Authors: Robbins Rebecca , Honaker Sarah , Morkous Sameh , DelRosso Lourdes
Published: April 2024

Introduction

The American Academy of Sleep Medicine (AASM) initiated “Count on Sleep” in 2023, a public health campaign that was awarded to the AASM by the Centers for Disease Control (CDC) ) and Prevention of the U.S. Department of Health and Human Services (HHS) in 2021, with the goal of raising the awareness of Obstructive sleep apnea (OSA) among general practitioners and the public. Three campaign messages were developed and disseminated via social media. We examine the impact of these campaign messages using back-end analytics from the social media platform Meta.

Methods

We downloaded impressions (number of times the message was displayed on a screen), clicks, and shares for each of three public health messages from Meta, including demographic information for users (age, gender). Three message strategies were tested: positive outcome expectations (e.g., “improve your health”); negative outcome expectations (e.g., “increase your risk of health problems”); and partner-focus (e.g., “have you heard your partner snore?”).

Results

The campaign received a total of 142,607 impressions, divided into positive outcome expectation (n=120,062), negative outcome expectation (n=12,286) and partner-focus (n=10,259) messages. The campaign yielded a total of 3038 link clicks, with the highest number for positive outcome expectation (n=3,006), followed by negative outcome expectation (n=21) and partner-focus (n=11) messages. The total shares were 276, with most shares (165) for the negative outcome post. Female users were more likely to engage with the positive outcome (39% v.28%) and negative outcome (34% v.25%) messages; engagement did not vary by sex for the partner-focus message (36% v.36%). Those 65 years and older had the highest engagement of all age groups (negative outcome: 54%; positive outcome expectation: 47%; and partner-focus: 40%).

Conclusion

Although the positive outcome message strategy received the most engagement and clicks to the website for more information, the message using a negative outcome approach was the most frequently shared message. Females and older adults were more likely to engage with OSA messaging. These results provide information about the reach and uptake of OSA messages with different frames (e.g., negative/positive outcomes, partner-focus).

Support (if any)

This project was funded by the CDC. Additional support from the NIH (K01HL150339).
1086 Literacy Profile of Digital Education on Positive Airway Pressure Interventions Generated by Machine Learning
Authors: Shreekumar Shreevarsha , Ramprasad Aarya , Singh Som
Published: April 2024

Introduction

Sleep apnea affects over 30 million individuals in the United States and contributes to a multitude of comorbidities among patients. Let alone, there has been a bibliometric increase in clinical research development on understanding and innovating the treatment of sleep apnea. One of the most common sleep interventions is using positive airway pressure (PAP) devices which play a key role in maintaining the oxygen saturation of a patient during sleep. As these devices continue to be used among individuals, it is imperative to ensure patients receive appropriate education on the management of these devices. However, few clinical studies have evaluated the quality of the most commonly used digital educational materials that are designated to specifically answer questions asked by patients regarding PAP devices. This study aimed to evaluate the comprehension and readability of digital patient education materials regarding PAP modalities.

Methods

To address the primary objective of this study, a cross-sectional methodology was employed. It extracted the most frequently asked questions from the Google RankBrain machine learning algorithm and each associated educational article regarding continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices. Following, two independent raters evaluated questions for JAMA Benchmark Criteria and Rothwell’s Classification of Questions. Additionally, these raters also utilized the Flesh Reading Ease scale and Brief DISCERN for each article to evaluate the quality, readability, and understanding of each educational material.

Results

This study extracted the first 200 frequently asked questions and educational articles on CPAP and BiPAP devices using the algorithm. Rothwell’s Classification revealed 93.0% of questions were classified as “Fact” (n= 186). Within this cohort, digital patient education materials that met grade-reading level recommendations (Flesh Reading Ease ≥ 60) were found in a tighter distribution for CPAP vs. BiPAP. Brief DISCERN scores were not found to be statistically significantly associated with Flesh Reading Ease when scores met grade-reading level recommendations (p = 0.13).

Conclusion

The findings of this study indicate that a majority of education materials on PAP devices do not meet US grade-reading level recommendations. These results encourage healthcare providers and educators to integrate techniques that improve healthcare literacy regarding PAP modalities.

Support (if any)

None
1090 Utilization of Advanced Practice Providers in a Pediatric Sleep Program: A Strategy for Expansion and Outcomes
Authors: Petitto Lacie , Spear Jinae , Revana Amee , Kancherla Binal
Published: April 2024

Introduction

With the increasing demand for sleep services and a declining number of board-certified sleep physicians, pediatric sleep centers are seeking ways to meet the demand of managing sleep disorders identified by polysomnography. Employment of advanced practice providers (APPs) is a strategy to bridge this gap in healthcare access. Currently, there is no literature describing expansion of a pediatric sleep program with APPs including orientation, utilization, and outcomes. Objectives: 1: Describe the curriculum/orientation and clinic scheduling; 2. Report patient satisfaction and access to care outcomes; 3. Explain how utilization of APPs has led to program expansion and community outreach.

Methods

Narrative review of the curriculum and program expansion. Retrospective review of Press Ganey scores and clinic volumes including third next available appointment (TNAA) data.

Results

The sleep laboratory expanded from 14 to 23 beds; therefore, 3 APPs were hired between December 2018 and August 2019 with one having sleep medicine experience. Orientation included reading assignments, didactic lectures, and ~450 clinical hours in sleep, otolaryngology, pulmonary, neurology, craniofacial surgery, and psychology clinics. Clinic schedules after orientation started at 25% of the expected patient volume and increased quarterly by 25%. 3,358 patients were seen by the APP team in the first fiscal year which was an ~92% clinic volume increase. TNAA decreased from 34 to 5 (-29 days). According to Press Ganey survey metrics, APPs’ top box scores were 1.28 points higher (86.6) than the collective physician and clinic scores increased by 5 percentile ranks (86.1). APPs have also been involved in multidisciplinary clinics including the Bariatric Surgery Program and Multidisciplinary Obstructive Sleep Apnea Clinic. Blog publications and community talks have been given regarding sleep training and sleep disorders in school age children. Performance evaluations have not indicated safety or quality concerns related to care delivery. Two APPs were onboarded in 2023 with another position pending approval.

Conclusion

We identify a detailed strategy using various metrics to help meet the demand of sleep services for pediatric sleep centers. Utilizing APPs can potentially increase patient satisfaction and access to care while maintaining high reliability and quality care of the institution’s sleep medicine practice.

Support (if any)
1094 Who Gets the Stim?: A Demographic Analysis of Hypoglossal Nerve Stimulator Patients
Authors: Magana Linda , Soose Ryan , Kurland Kristen , Harrison Tina , Mazul Angela
Published: April 2024

Introduction

In addition to traditional demographic analysis, Geographic Information System (GIS) tools, provides a unique methodology that allows us to spatially analyze data and capture geographic data related to HNS patients. This study seeks to create geographic maps related to socioeconomic attributes of HNS patients in addition to relevant demographic and clinical data to better understand potential barriers to care for those seeking treatment for obstructive sleep apnea (OSA).

Methods

A retrospective study was performed of patients who underwent HNS implantation at a tertiary care academic hospital from August 2011 to October 2021. Relevant demographic and clinical characteristics were captured for each patient, both pre- and post-operatively. GIS was used to geocode patient addresses and perform spatial analyses to capture socioeconomic dynamics that may produce barriers to care for vulnerable populations. Maps were produced identifying distribution of patients relative to median household income, Area Deprivation Index (ADI), and drive times to the hospital.

Results

229 patients were included in this study. 167 patients were male and 62 were female. 222 patients implanted during this period identified as Caucasian. When considering median home value, median household income, and Area Deprivation Index, the cluster of patients within Pittsburgh most often lived in more affluent areas. However, more than 50% of patients lived greater than a 30-minute drive from the hospital where surgery and clinic appointments occurred. 90% of patients lived within 60 minutes of the hospital.

Conclusion

As hypoglossal nerve stimulation (HNS) continues to expand its footprint in the treatment of patients with obstructive sleep apnea (OSA), there is a dearth of demographic studies related to the populations currently being served by this treatment modality. This study uniquely seeks to meld clinical data with socioeconomic information to better understand recipients of HNS.

Support (if any)
1096 Attitudes Towards Mental Health Service for Sleep Scale (AMHSUS): Development and Psychometric Evaluation
Authors: LoBrutto Lara , Clark Maraya , Nagle Kerensa , Williams Claire , Nielson Spencer , Reid Morgan , Dautovich Natalie
Published: April 2024

Introduction

Poor sleep health is prevalent at the population level and is especially high among college students. There are numerous evidenced-based mental health treatments for sleep disturbance [e.g., Cognitive Behavioral Therapy for Insomnia (CBT-I) and mindfulness-based therapies], but mental health care for sleep continues to be underutilized. The novel Attitudes Towards Mental Health Service Utilization for Sleep (AMHSUS) scale was developed to assess attitudes towards the use of mental health services for sleep disturbance to gain a fuller picture of individual and population-level barriers and facilitators.

Methods

An initial 20-item scale covering four hypothesized dimensions was developed via team consensus, then refined and reduced to 16 items in response to feedback from a graduate student panel. The scale was tested using a sample (n=367) of university students (Mage= 19.0; female= 71.1%; white=43.1%; Black= 31.3%) in the southern region of the United States.

Results

An exploratory factor analysis yielded four factors: “Severity,” “Facilitators,” “Barriers,” and “Priority.” All but one of the original items were retained. The total scale demonstrated good internal consistency, with a Cronbach’s alpha of .71. Reliability was appropriate for two of the four factors, “Severity” (∝=.83) and “Facilitators” (∝=.82), but questionable for “Barriers” (∝=.63) and poor for “Priority” (∝=.46).

Conclusion

Future directions include testing the scale for convergent and discriminant validity, revising the “Barriers” and “Priority” subscales, and removing items as needed. AMHSUS shows strong psychometric potential and, with some modifications, will be a valuable tool for sleep health research.

Support (if any)