bluuebunny/crossref_metadata_2025 huggingface dataset:
0754 Cognitive Behavioral Therapy for Hypersomnia (CBT-H): A Feasibility Study for Improving Health-Related Quality of Life
Authors: Ong J C , Dawson S C , Mundt J M , Adkins E , Moore C
Published: May 2020

Introduction

The purpose of this study was to conduct a feasibility trial for a novel cognitive behavioral therapy (CBT-H) aimed at improving health-related quality of life (HRQoL) in people with hypersomnia.

Methods

Participants were 35 adults (32 female, mean age=32.0 years, SD=12.9) with an established diagnosis of Narcolepsy Type 1 (n=12), Type 2 (n=11), or Idiopathic Hypersomnia (n=12). Participants were assigned to individual (n=19) or group (n=16, 3-5 per group) format of a 6-session, manualized CBT-H, delivered using live videoconferencing. Key components of CBT-H included structuring daytime behaviors (e.g., planned naps), emotion regulation techniques, and energy management strategies. Outcome measures for HRQoL included PROMIS measures for depression, anxiety, self-efficacy, and social isolation. Other clinical outcome measures included the Patient Health Questionnaire (PHQ) and Epworth Sleepiness Scale (ESS). Exit interviews were used to collect qualitative data to inform acceptability of the intervention.

Results

Intent-to-treat analyses were conducted on the entire sample with the last observation carried forward for 3 participants who did not provide post-treatment data. Paired-samples t-test revealed a significant reduction on PROMIS depression (t[34]=2.05, p=0.0486, d=-0.35), and significant increases on PROMIS general self-efficacy (t[34]=3.64, p=0.0009, d=0.62) and self-efficacy managing social interactions (t[34]=2.14, p=0.0396, d=0.36). Significant reductions were also observed on the ESS (t[34]=2.07, p=0.0458, d=-0.35) and PHQ (t[34]=4.42, p<.0001, d=-0.75). Mixed-design ANOVAs revealed no significant differences on hypersomnia diagnosis or treatment format. Qualitative data supported the acceptability of telehealth delivery with mixed opinions regarding the format and number of sessions.

Conclusion

These findings support the acceptability of a novel CBT-H delivered using a telehealth model and the feasibility of reducing excessive sleepiness and improving HRQoL, particularly in the domains of self-efficacy and depression, in people with narcolepsy and idiopathic hypersomnia.

Support

This study was supported by grant 185-SR-17 from the American Sleep Medicine Foundation.
0782 Duration Of Sun Exposure In Medical Students Impactschronotype
Authors: Geoca A , Dowling M , Jain V
Published: May 2020

Introduction

Timing of the human sleep-wake cycle is determined by social constraints, biological processes (sleep homeostasis and circadian rhythmicity) and environmental factors, particularly natural and electrical light exposure. However the effect of environmental factors, especially duration of sun exposure, on circadian rhythmicity remains unknown. We aimed to study the relationship between duration of sun exposure and chronotype among medical students.

Methods

Eighty-six GW medical students (62 F [71%], 24 M [29%]; ages 21-33 y [mean 24.4 y]) completed the Munich Chronotype Questionnaire (MCTQ). Mid points, the middle of the participants reported bedtime and wake time on workdays, were used to determine chronotype. Two independent groups based on the mean split (mean = 45) of the distribution of minutes of sun exposure were created: 45 minutes or more (n=31) vs less than 45 minutes (n = 55) of sun exposure. Independent samples t-test was performed to compare the measured midpoint with the following pairs of groups of reported work day sunlight exposure (in minutes): less than 45 min (n = 55) versus 45 min or more (n = 31).

Results

In the total sample (n = 86), no significant association between duration of sun exposure and midpoints was found using Pearson correlation. However, medical students with reported sun exposure of greater than or equal to 45 minutes a day had a significantly earlier chronotype compared to students reporting a sun exposure of less than 45 minutes a day [mid point 2.196 (SD 0.085) versus a mid point 3.386 (SD 1.084); t(69) = 2.021; p = .047].

Conclusion

We found that, in GW medical students, greater amounts of sun exposure during the day was advancing the circadian rhythm. This may have implications on sleep duration and quality.

Support

NA
0813 Circadian Rest-activity Rhythm In Isolated Rem Sleep Behavior Disorder
Authors: Stefani A
Published: May 2020

Introduction

Isolated REM sleep behavior disorder (iRBD) is a parasomnia characterized by abnormal behaviours occurring during REM sleep. Several studies showed that iRBD is a prodromal stage of synucleinopathies. Therefore identifying iRBD in the general population is of utmost importance. Aim of this study was to explore whether the assessment of circadian rest-activity rhythm features, measured by actigraphy, can distinguish iRBD patients from patients suffering from disorders characterized by other pathological motor activity during sleep and healthy controls.

Methods

Nineteen subjects with video-polysomnographic (v-PSG) diagnosis of iRBD, 39 subjects with other disorders with motor activity during sleep (19 restless leg syndrome -RLS- and 20 untreated sleep apnea syndrome patients -SAS) and 16 healthy controls underwent 2-week actigraphy, v-PSG, and completed RBD screening questionnaires. Nonparametric analyses were applied to assess rest-activity rhythm features; daytime napping was also evaluated. The diagnostic value of nonparametric measures has been assessed through ROC curve.

Results

iRBD patient showed lower sleep efficiency, increased WASO and increased frequency of prolonged activity bouts compared to RLS and controls, while no difference emerged with SAS patients. Moreover, iRBD patients presented increased occurrence of estimated nap in comparison to RLS, SAS and controls. The nonparametric measure I<O distinguished iRBD patients from RLS, SAS and controls with an area under the curve greater than that of RBD screening questionnaires.

Conclusion

The nonparametric index I<O is able to distinguish iRBD patients from patients with other pathological motor activity during sleep and controls, confirming its potential use as an objective measure suitable to screen large at-risk populations.

Support

This study was supported by a grant from the Austrian Science Fund (FWF) to Birgit Högl, I 2120-B27.
0816 Sleep Correlates Of Nightmares Among Veterans
Authors: Patel R K , Schwartz S W , Sebastiao Y V , Andrews A , Foulis P R , Anderson W M
Published: May 2020

Introduction

There is an increased prevalence of Nightmare disorder (ND) among patients with obstructive sleep apnea (OSA). A further investigation of objectively measured sleep parameters among patients with and without ND could inform on potential comorbidities. We hypothesize ND correlates with Epworth sleepiness scale (ESS), apnea hypopnea index (AHI), Trough 02% (Sp02 nadir), and periodic limb movement (PLM) index.

Methods

Data presented herein are interim results from an IRB approved study to determine correlates and sequelae of nightmares. A cohort of all patients with ND visiting James A Haley Veterans Hospital between 2007 and 2011 was defined along with a random cohort of control patients. Demographic and outpatient visit data between January 2006 and April 2016 was pulled from VISTA for both the ND and control cohorts, and patients who had undergone a sleep study were identified. To date, sleep summary data has been individually extracted for 111 ND patients and 835 control patients. Logistic regression (SAS 9.4) was used to compare ESS, AHI, Sp02 nadir, and PLM Index.

Results

Mean age for ND was significantly lower at 49.7 ± 14, compared to 58.4 ± 12 for controls. Other demographic measures were similar including gender, race, and marital status. PLM index was significantly lower in ND compared to controls, however this relationship disappeared after adjusting for age. There were neither significant differences between other polysomnographic (PSG) variables, specifically AHI and Sp02 nadir, nor did OSA severity significantly different between ND and controls.

Conclusion

Among veterans undergoing a PSG, there were no significant differences between measured sleep parameters. Our results contradict our hypothesis that ND correlates with ESS, AHI, Sp02 nadir, and PLM index.

Support

This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
0823 Age-Related Changes in Nocturnal Urine Composition
Authors: Bliwise D L , Monaghan T F , Lazar J M , Epstein M R , Agudelo C W , Weiss J P , Weedon J , Everaert K
Published: May 2020

Introduction

In humans sleeping nocturnally, nocturnal polyuria (NP) refers to high rate of overnight urine production. NP is a heterogeneous condition that may reflect both free water and/or sodium diuresis, but the influence of age on differential fluid handling remains poorly understood. This study examined diuresis rate, sodium clearance, and free water clearance (FWC) by age, time of day (nighttime vs. daytime) and NP status (positive/negative) in subjects under entrained conditions sleeping nocturnally.

Methods

Convenience samples (age range 18-91; 82 men, 148 women) recruited from a urology ambulatory care unit (n=135) or continence clinic (n=95) collected 8 urine samples at 3-hour intervals over a single 24-hr period. Three separate mixed linear models were constructed for diuresis rate, sodium clearance, and FWC using four predictors: NP status (present [>90mL/h] vs. absent), time of day (night = 0100, 0400, 0700), age (as a continuous measure), and study source.

Results

Subjects with NP experienced both higher nighttime vs. daytime diuresis rate (1.89 vs. 1.44 mL/min, p<0.001), sodium clearance (0.91 vs. 0.74 mL/min, p<0.001), and FWC (-0.38 vs. -0.71 mL/min, p<0.001), whereas subjects without NP demonstrated lower nighttime vs. daytime diuresis rate (0.94 vs. 1.06, p=0.004) and no difference in sodium clearance (0.59 vs. 0.64, p=0.120) or FWC (-0.80 vs. -0.86, p=0.268). Regardless of NP status, FWC increased with age (p=0.039), and older age (>70) was accompanied by an increase in the ratio of nighttime/daytime diuresis rate and both nighttime and daytime sodium clearance.

Conclusion

Irrespective of NP, older adults experience proportionally greater nocturnal sodium clearance, as well as a complex surge in both daytime and nighttime FWC. The data imply that both nocturnal sodium clearance and FWC may reflect the relevant substrate underlying excess nocturnal urine production in elderly persons.

Support

N/A
0827 The Association Among Diagnosed and Suspected Sleep Disorders and Pain
Authors: Ravyts S , Dzierzewski J
Published: May 2020

Introduction

Poor sleep has increasingly been linked to adverse pain outcomes. Yet, the complex interplay between sleep apnea, insomnia, or comorbid sleep apnea and insomnia (COMISA), and pain are less well understood. The purpose of the present study was twofold: 1) assess pain intensity in individuals with diagnoses of insomnia, sleep apnea, and COMISA, and 2) examine pain intensity in individuals who are at a high risk for having either sleep apnea, insomnia, or both sleep disorders.

Methods

Participants included 3401 adults (mean age= 42.77, male= 45.6%) who participated in an online study investigating sleep across the lifespan. Sleep apnea and insomnia diagnoses were self-reported while participant risk profiles for these disorders were assessed via the Insomnia Severity Index and the STOP-BANG questionnaire respectively. Average pain intensity over the last two weeks was rated from 0 (no pain) to 100 (very severe).

Results

Participants with self-reported comorbid sleep disorders reported higher pain scores than individuals with one or no sleep disorder (F(2,3398) = 71.61, p < .001). Among individuals with no previously diagnosed sleep disorder, participants with more insomnia symptoms reported greater pain intensity (F(3,3100) = 201.64, p < .001), as did those with higher scores on the STOP-BANG (F(2,3125) = 46.79, p < .001). Participants with suspected comorbid sleep disorders reported higher pain scores than individuals with either sleep apnea or no sleep disorder, but not insomnia (F(3,2887) = 110.15, p < .001).

Conclusion

Results suggest that individuals with known sleep disorders report high levels of pain particularly in the context of comorbid sleep apnea and insomnia. Additionally, individuals with suspected, but untreated, sleep disorders also report increased pain. Future research should examine whether treating one of more sleep disorders can improve pain outcomes.

Support

This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).
0838 Sex Specific Changes in Sleep Macro-Structure With Obstructive Sleep Apnea in a Large Clinical Population of Older Adults
Authors: Mullins A E , Bagchi N , Parekh A , Kam K , Wang J , Williams M K , Rapoport D M , Ayappa I , Burschtin O E , Varga A W
Published: May 2020

Introduction

Sleep architecture is influenced by age and sex and is disrupted by obstructive sleep apnea (OSA) and periodic limb movements (PLM) of sleep. Although increasing OSA severity is thought to decrease both REM and slow wave sleep (SWS), it may do so in non-linear ways. Here, we aim to 1) compare sleep macrostructure between older men and women, 2) compare metrics of total and REM-specific OSA severity between older men and women, and 3) examine associations between metrics of OSA severity and REM sleep and SWS in a clinical sample.

Methods

Clinical in-lab diagnostic polysomnography (PSG) in adults ≥64 years of age from the greater New York area recorded between 2006- 2016 were collated including demographic and traditional sleep scoring metrics. Studies where TST < 4 hours were removed. Demographic, sleep macrostructure, OSA (AHI4% & AHI3A criteria), pulse oximetry (SpO2) nadir and PLM measures were compared according to sex.

Results

PSGs from 1282 older adults (average age 70 years in both sexes, 41% female) were included in the analyses. Women had a significantly greater SWS% (14.5 vs 7.9, p<0.001) and less N1% (18.2 vs 24.4, p<0.001), without significant differences in TST, N2%, REM%, sleep efficiency or SpO2 nadir. Men had significantly higher all-sleep OSA (median AHI4% 8.8 vs 11.1, p=0.0004; median AHI3A 24.4 vs 27.9, p=0.003) and PLM’s (4.0 vs 7.6/hour, p=0.008) but women had significantly more OSA during REM sleep (median REM AHI4% 16.7 vs 14.0, p=0.01; median REM AHI3A 32.6 vs 27.4, p=0.0002). Inverse non-linear associations were observed between OSA severity and %SWS and %REM with a unique pattern for each sleep stage. The pattern between men and women within each stage appeared similar.

Conclusion

In this clinical sample of older adults, women exhibit a greater proportion of SWS and worse REM-related OSA then men. Increasing OSA severity is associated with non-linear reductions in %SWS and %REM, and we plan to further investigate these relationships and sexual dimorphism by using quantitative analysis of PSG signals for more precise measures of slow wave activity and breathing physiology than traditional sleep scoring metrics.

Support

R01AG056682
0841 Trajectories of Sleep Quality During the Perinatal Period in the “Life-ON” Study
Authors: Garbazza C , Castronovo V , Sforza M , Manconi M
Published: May 2020

Introduction

The perinatal period is characterized by poor sleep quality, with a worsening trend across pregnancy, peaking in the first month after delivery and often persisting during the postpartum. Consequences of perinatal sleep problems range from negative obstetric outcomes, to mood disturbances in the mothers and neurobehavioral deficits in the infants. Therefore, an early identification of at-risk women is highly relevant.

Methods

As part of the “Life-ON” project, a multicenter study on sleep and mood changes during the perinatal period, 120 women (aged 36.31±4.21 years) were repeatedly evaluated with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Edinburgh Postnatal Depression Scale (EPDS) and Montgomery-Åsberg Depression Rating Scale (MADRS), from the first gestational trimester (baseline) to 12-months postpartum. Using latent class analysis (LCA) we identified different subtypes according to baseline evaluation and analyzed their distinct trajectories of sleep quality based on PSQI.

Results

We chose 3 latent classes that were statistically different in all scales at baseline (p<0.05), with lowest values in the stable-low class, followed closely by a mild class and highest values in the stable-high class (mean±SD for each class, respectively: EPDS 2.58±2.34 vs. 3.54±2.87 vs. 7.22±3.1, MADRS 1.75±1.83 vs. 4.08±2.67 vs. 7.17±3.74, PSQI 2.50±1.26 vs. 4.89±1.73 vs. 8.00±3.26, ISI 1.40±1.58 vs. 6.46±2.90 vs. 11.13±4.28). This trend remained significant for the whole observation period. Focusing on PSQI, the mild (n=37) and stable-low class (n=60) maintained a mean score below 5, only peaking above 5 around delivery. In contrast, the stable-high class (n=23) showed a constant mean PSQI>5 throughout the perinatal period (first trimester=8.00±3.26; second trimester=8.26±3.41; third trimester=8.39±3.90; 20-days postpartum=8.39±3.33; 3-months postpartum=7.96±3.6; 6-months postpartum=7.35±3.79; 12-months postpartum=6.83±3.35).

Conclusion

We identified a latent class of women with a stable-high poor sleep quality (PSQI>5) across the perinatal period. Determining baseline sleep and mood characteristics in early pregnancy can help predicting distinct sleep trajectory subgroups in the perinatal period and detecting at-risk women, who should be targeted by early preventive and therapeutic interventions.

Support

The “Life-ON” project is supported by the Swiss National Science Foundation (grant: 320030_160250/1) and the Italian Ministry of Health and Emilia-Romagna Region (grant: PE-2011-02348727).
0842 The Moderating Effects of Sleep and Sex on Physical Activity and Cognitive Functioning in African Americans
Authors: Beard B , Ramirez-Ruiz M , Mwendwa D T , Sims Wright R
Published: May 2020

Introduction

Research suggests modifiable lifestyle behaviors are associated with delayed cognitive decline. Identifying modifiable lifestyle behaviors in African Americans is critical because they are more likely to be diagnosed with Alzheimer’s disease and other related dementias. Evidence shows the positive effects of physical activity (PA) on cognitive functioning. Sleep quality also impacts cognitive functioning. Therefore, the purpose of this study examined how sleep quality and sex moderated the relationship between PA and cognitive functioning in African Americans.

Methods

A sample of 147 African Americans (mean age 59) completed the Pittsburgh Sleep Quality Inventory (PSQI) and a battery of cognitive tests (The Delis-Kaplan Executive Function System (DKEFS) Verbal Fluency Test, The Stroop Color Word Test and Trail Making Test). Participants completed a participant screener to determine PA frequency and intensity. Anthropomorphic measures were also obtained. A moderated moderation analysis was conducted.

Results

Poor sleep quality was associated with poorer performance on a verbal fluency task after controlling for age, BMI and years of education (B=-1.37, p=.012). There was a significant interaction between PA frequency and sleep quality on verbal fluency performance (B=0.42, p=.047). Additionally, there was a significant interaction between sleep quality and sex on verbal fluency performance (B=0.80, p=.016). Further adjustments revealed significant conditional effects such that more frequent PA per week improved verbal fluency performance among women, who reported better sleep quality (B=0.20, p=0.03).

Conclusion

The current study suggests sleep quality strengthens the relationship between PA and cognitive performance, specifically in African-American women. Consistent with previous studies, our findings support the need to target sleep quality and PA in women as modifiable lifestyle factors that may delay cognitive decline.

Support

This research was funded by the Office of the Provost at Howard University.
0846 Reports of Sleep Symptoms in Young Adults of College Age
Authors: Thatipelli S , Abbasi A A
Published: May 2020

Introduction

Young adults of college age in the United States often report inadequate sleep. The objectives of this study were to identify a) how often young adults of college age report symptoms of insomnia, fatigue and mood disorder and b) identify differences in symptom reporting based on their sleep duration.

Methods

This is a cross-sectional study, using data from 2013 through 2018 of the National Health Interview Survey (NHIS). 11,028 subjects, ages 18-22 years, for whom information was available on duration of sleep were included. We analyzed reports of trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder. Subjects were divided into 2 groups: ≤7 hours and > 7 hours of sleep. Data was analyzed using Complex Sample Analysis of IBM SPSS version 26.

Results

Out of the 11,028 subjects 50.7% were male and 49.3% were female. Mean sleep duration for all subjects was 7.44 ± 0.02 hours (mean± SE). 13.5% subjects reported trouble falling asleep while 10.6% reported trouble staying asleep for ≥4 nights per week. Non-restorative sleep and frequent fatigue were reported by 33.8% and 12.4% respectively. Daily/weekly symptoms of anxiety and depression were reported by 23.9% and 8.6% respectively. There were 48.4% subjects with ≤7 hours and 51.6 % with >7 hours of sleep. When compared to subjects with ≤7 hours to >7 hours of sleep, trouble falling asleep, trouble staying asleep and non-restorative sleep were reported by 19.9% vs. 7.5%, 14.8% vs. 6.6% and 45.9% vs. 22.4% respectively. Symptoms of fatigue, anxiety and depression reported by subjects with ≤7 hours vs. >7 hours of sleep were: 18.6% vs. 6.6%, 26.9% vs. 21% and 10.2% vs.7% respectively.

Conclusion

Young adults with ≤ 7 hours of sleep are more likely to report trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder.

Support

None
0866 A Comparison Of Resting Cerebral Blood Flow And Sleep Quality In Older Adults
Authors: Hays C C , Almklov E A , Orff H J , Wierenga C E
Published: May 2020

Introduction

Sleep disturbances have been linked to a variety of health-related consequences, including clinically significant cognitive alterations. Older adults represent a particularly vulnerable population given that advanced age is associated with an increased risk for both sleep disorders, such as insomnia, and cognitive decline. Examining the relationship between resting cerebral blood flow (rCBF) and sleep quality in older adults will better our understanding of the neurophysiologic implications of poor sleep in aging adults.

Methods

Thirty-three cognitively normal older adults (15 males) between the ages of 65-85 (mean age=73) were administered the Pittsburg Sleep Quality Index (PSQI) and underwent assessment of rCBF using arterial spin labeling (ASL). Those who scored above 5 on the PSQI were defined as poor sleepers (n=17) and those who scored 5 or below were defined as good sleepers (n=16). Groups were then compared on voxel-wise whole-brain rCBF using independent samples t-tests statistically adjusting for age, sex, and the time interval between neuroimaging and sleep assessment.

Results

Compared to good sleepers, poor sleepers exhibited higher rCBF within bilateral thalamus and the left precuneus and lower rCBF within the left putamen (all ps<.01, uncorrected).

Conclusion

In this preliminary investigation, poor sleepers exhibited a differential pattern of rCBF in several brain regions, including those involved in consciousness and other important cognitive abilities such as attention. Future research is needed to determine the short- and long-term implications of poor sleep on the aging brain.

Support

U.S. Department of Veterans Affairs Clinical Sciences Research and Development Service Merit Award 5I01CX000565 (CEW) & VA Rehabilitation Research & Development - Career Development Award - RX001512-01A2 (HJO)
0883 Impact of Implementation of a Comprehensive Positive Airway Pressure Program
Authors: Oppy K , Huffman B , Kalra M
Published: May 2020

Introduction

The American Academy of Sleep Medicine (AASM) guidelines for treatment of Obstructive Sleep Apnea (OSA) with Positive Airway Pressure (PAP) state good practice standards involve adequate follow up with a clinician tele-monitoring efficacy through objective usage data to ensure acceptable treatment and compliance is met, and provide education, behavioral and/or troubleshooting interventions. In 2016, Dayton Children’s Hospital’s pap compliance was 29% due to limited staff support.

Methods

To efficiently implement the AASM guidelines, one dedicated Respiratory Therapist (RT) was assigned to help manage OSA patients at Dayton Children’s Sleep Medicine. The RT responsibilities include, PAP therapy education, arranging home PAP system, and a follow-up call within 7 days of setup. Through the tele-monitoring system, the RT assesses compliance and addresses equipment issues and mask fitting at the 4 to 6 week clinic visit. To enhance compliance, a welcome postcard and gift card were implemented. Monthly clinic visits occur until compliance is met, wearing device greater than 4 hours 60% of the time, then appointments are scheduled every 6 months to 1 year.

Results

Since 2016, compliance rate increased from 29% to 58%. There was a year over year growth of number of patients starting therapy from 2017 to 2019, 86 patients were added to the PAP program. In 2019, 60% of 6 to 12 years old met compliance and 51% of 13 to 18 years old.

Conclusion

A comprehensive PAP program resulted in improved compliance and substantial growth. Referring providers and families are more likely to accept PAP therapy when made aware of extensive education and follow up by RT staff. To further improve compliance, especially in the 13 to 18 age range, a desensitization program has recently been implemented.

Support

No support provided.
0886 Changes in Parent Knowledge and Self-Efficacy and Association With Adherence Following the Steps Towards Achieving Restful Sleep (STARS) Pediatric PAP Therapy Desensitization Program
Authors: Crane S C , Taylor A , Wesley K L , Simon S L
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) presents in 2-5 % of youth and has been consistently linked to sleepiness, cognitive deficits, behavior difficulties, and cardiovascular morbidity. PAP effectively treats OSA, however, nonadherence is the most common cause of PAP treatment failure in children. Few adherence interventions have been empirically studied for youth with OSA. The STARS (Steps Towards Achieving Restful Sleep) Clinic is a behavioral program to optimize child tolerance to PAP therapy through a parent class, and in vivo practice. The goal of the study was to examine parent knowledge and self-efficacy following participation in STARS, and associations with subsequent PAP adherence.

Methods

A retrospective chart review was conducted for patients in the STARS program. Items queried included patient demographics, diagnostic and treatment characteristics, pre- and post- STARS responses to a parent self-efficacy and knowledge questionnaire, and polysomnography and PAP adherence data. Paired-samples t-tests examined changes in parent self-efficacy and knowledge pre- to post STARS, and regression analyses examined associations between self-efficacy and knowledge with demographics, treatment-related characteristics, and PAP adherence.

Results

130 patients completed the STARS program from October 2016 to February 2019. Participants were 8.3 years old ±6.3, 63% male, 57% white, 33% Hispanic, with severe OSA (OAHI =22 ±33). Most participants (87%) had at least one medical comorbidity (e.g, Down Syndrome, 41%). Both parent knowledge and self-efficacy increased significantly from pre- to post- STARS. Approximately 60% of patients were adherent following STARS (defined as ≥4 h use and ≥70% of days used). Higher post- knowledge, but not efficacy score, was significantly associated with better PAP adherence.

Conclusion

Parent knowledge and self-efficacy for PAP improved following the STARS program, and greater knowledge was associated with better adherence. Future research evaluating the efficacy and effectiveness of the STARS program is needed but preliminary evidence suggests it may be a promising model for improving youth PAP adherence.

Support

None
0888 A Peer-Based Social Media Intervention to Promote Continuous Positive Airway Pressure Adherence in Adolescents With Obstructive Sleep Apnea
Authors: Watach A J , Bishop-Gilyard C T , Ku H , Afolabi-Brown O , Parks Prout E , Xanthopoulos M
Published: May 2020

Introduction

Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive sleep apnea (OSA) is suboptimal. This study evaluated an innovative CPAP adherence intervention for adolescents and their caregivers delivered via private Facebook groups. Study aims: (1) determine feasibility and acceptability of the intervention and (2) assess CPAP use pre- and post-intervention.

Methods

A pilot cohort study design was employed (N=6 dyads). Intervention included psychoeducation, CPAP use downloads/feedback, promoting peer-engagement through posts, videos, and polls. Adolescent and caregiver groups ran separately and simultaneously over 4-weeks. Measures: demographics, engagement/participation data, CPAP use, semi-structured interviews. Analysis: descriptive statistics and thematic content analysis.

Results

Adolescents were Black/African American (100%), males (100%) with a median age of 16 years (range 13-17). Caregivers (n=6) were mothers (67%) and fathers (33%) with a median age of 47 years (range 38-55). Caregivers were more engaged with the intervention than adolescents, viewing content 65%, 75%, 85%, 90%, and 100% (n=2) of days versus adolescents who viewed content 0%, 20% (n=2), 40%, 75% and 100%. Semi-structured interviews revealed the intervention was perceived positively; learning/expanded knowledge, gaining a sense of community, and enjoyment in the opportunity to help others were commonly identified. Interview feedback revealed utilizing a different social media platform may be more beneficial for adolescent engagement. Participants noted the intervention promoted conversations between the adolescent and caregiver, and 4/6 teens cited increased motivation to use CPAP. Average CPAP use increased in 50% of participants (n=3); 33% (n=2) sustained their use, and one decreased use.

Conclusion

Participants consistently noted appreciation for knowledge gained and sense of community derived from the intervention. This study supports the potential utilization of social media platforms to not only provide reliable OSA/CPAP education but to also promote peer-engagement. Given the acceptability and increased CPAP use in this small sample, a larger trial is indicated.

Support

Lead author receives support from NIH/NHLBI Award T32 HL07953. Videos included in intervention supported by The Children’s Hospital of Philadelphia Metabolism, Nutrition and Development Research Affinity Group Pilot and Feasibility Grant.
0903 Screening Of Pediatric Obstructive Sleep Apnea Using Video Monitoring
Authors: Ikeda K , Yagi T , Chiba S
Published: May 2020

Introduction

In Japan, the many of the patients are not able to access the specialized sleep medical facilities for overnight polysomnography(PSG) due to less availability and cost issues. Purpose of the study is to examine whether combination of video monitoring and other clinical examinations can reliably predict the severity of pediatric OSA compared with PSG.

Methods

Between April 1, 2012 and March 31, 2019, total of 175 children (3-12 years of age, boy 122, girl 53) with SDB were enrolled in this individual prospective-cohort study. In-laboratory based PSG were performed for all patients and sleep stages and respiratory events were manually scored. Video monitoring was performed during PSG. Modified video-recording test scoring system (based on Sivan et al 1996), were scored by laboratory technicians. Other clinical examinations were extracted from each PSG with ENT examinations, cephalogram, and rhinomanometry for all patient

Results

Multiple linear regression analyses was performed with a forward stepwise approach in which independent predictors that were significantly related to severity of OSA (AHI: 5/hr and 10/hr). Applying the multiple logistic regression analysis, the independent predictors for AHI 5/hr were ODI 3% >3/hr, rhinomanometry (NR>0.5 Pa/cm3/sec), enlargement of tonsils (Brodsky classification more than 2), two video monitoring items and total score, with an accuracy of predictive statistic model was 88.0% (sensitivity 78.3%, and specificity 93.0%). For the severity above AHI 10/hr, the independent predictors were Cephalogram parameter (Fx>84°), Oximetry (ODI 3% >5/hr) and BMI<15 with the video monitoring parameters of whole night inspiratory noise (loud) and chest retraction contribute to predict with the sensitivity 91.5%, the specificity 82.6% and the accuracy 88.0%.

Conclusion

Video monitor scoring parameters contributed to predict both AHI 5/hr and 10/hr with good overall sensitivity, specificity and overall accuracy compare with the combination of objective results alone. Instead of PSG, the combination of video scoring system and multiple clinical examinations could potentially provide reliable diagnostic approach for pediatric OSA with high accuracy. These results will support to establish more efficient diagnostic strategy for both patients and physicians

Support

N/A
0912 Central Sleep Apnea Patterns On Pediatric Polysomnograms
Authors: Rao H S
Published: May 2020

Introduction

Central sleep apneas (CA) are frequently seen on pediatric polysomnograms (PPSG) independently or in conjunction with obstructive sleep apnea (OSA). In the pediatric population, the AASM defines CA as the absence of chest and/or abdominal movement associated with a cessation of airflow of more than 20s or longer than 2 baseline respiratory cycles if associated with an arousal, an awakening or oxygen desaturation ≥ 3%. Scoring CAs on PPSG based on AASM definition can cause confusion among providers as CAs are generally associated with central nervous disorders causing reduced or absent respiratory drive.

Methods

Retrospective review of 71 consecutive diagnostic PPSGs to analyze patterns of CAs scored per AASM definition was performed. None of the children had a disorder causing reduced respiratory drive. Data on age, obstructive AHI (Apnea Hypopnea Index), CO2, Oxygen saturation, Central AHI and diagnosis were collected.

Results

68 of 71 children had varying degree of OSA and CAs. Three main patterns of CAs were observed: occurring in NREM, following sigh breaths or arousals and CAs seen in REM sleep. CO2 and oxygen saturation were in the normal range.

Conclusion

In our study, CAs were more often seen in young children related to reduced functional residual capacity and immaturity of chest wall. CAs in REM sleep was seen more often in children with lung disorders and gastroesophageal reflux. CAs associated with arousals/awakenings were seen in conjunction with OSA or periodic limb movement disorder (PLMD). Though a finding of CAs >5/hour is considered significant, the minimum number of events required to cause a specific disorder or syndrome remains elusive and may be different in different patient populations. As such, there is no threshold of the number of central apneas associated with disease. CAs associated with disorders causing reduced or absent respiratory drive are mostly seen in NREM sleep and associated with abnormal gas exchange. The context in which the CAs are seen on PPSGs should be clearly described to avoid confusion among ordering providers. In CAs associated with arousals/awakenings, it is important to target the cause of arousals such as OSA or PLMD.

Support

None
0918 Quebec Adolescents’ Insomnia Symptoms, Mental Health & Access to Sleep Care
Authors: Gruber R , Somerville G , Finn C , Boursier J
Published: May 2020

Introduction

Our school boards are part of the Quebec Center Of Excellence For Mental Health, and are thus mandated to identify and then prevent/treat factors that could negatively affect the mental health of their students. As part of this mission, we conducted a study that aimed 1) to examine the prevalence of insomnia in typically developing students in Quebec and their associations with students’ mental health, and; 2) to assess student access to behavioral sleep interventions in Quebec.

Methods

145 (Age 15.53+1; 75 Girls, 70 Boys) typically developing students. Insomnia symptoms were measured using the Insomnia Severity Index. Sleep was measured by Actigraphy. The Youth Self Report was used to measure students mental health. Access to care was measured using a detailed questionnaire.

Results

The key findings were: 1) 45% of the students reported poor sleep quality, dysfunction during the day due to sleepiness, difficulty falling or staying asleep, and excessive daytime sleepiness. Total scores on self-reports sleep measures were positively significantly correlated with Actigraphy measures of sleep duration and quality and with each other; 2) Robust positive associations were found between insomnia and psychiatric symptoms after adjusting for common risk factors, including age, socioeconomic status, and gender; 3) None of the students had access to sleep care and 25% of them reported using over-the counter sleep aids with minimal success.

Conclusion

These findings are alarming because they show that: 1) insomnia symptoms are prevalent in Quebec students and are strongly associated with the symptomatology of mental distress in students who do not meet the diagnostic criteria of a psychological disorder, and; 2) these students do not have access to insomnia care. These findings suggest that treatment of insomnia could offer an incredible opportunity to protect and improve the sleep and the mental health of these students.

Support

Canadian Institute of Health Research grant to Reut Gruber
0919 Health Disparities in the Persistence of Childhood Insomnia Symptoms in the Transition to Adolescence: The Penn State Child Cohort
Authors: Bourchtein E , Puzino K , Calhoun S L , Criley C , He F , Vgontzas A N , Liao D , Bixler E O , Fernandez-Mendoza J
Published: May 2020

Introduction

A strong body of cross-sectional evidence indicates that social determinants of health (SDH), such as race, ethnicity, socioeconomic status, and sex/gender, are linked to sleep problems, including insomnia symptoms. Few studies have examined the longitudinal association between SDH and the persistence and remission of insomnia symptoms in the transition between childhood and adolescence, a critical period for sleep health.

Methods

The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y at baseline), of whom 421 were followed up as adolescents (12-23y at follow-up). All subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Childhood insomnia symptoms were defined as a parent- and/or self-report of difficulty falling and/or staying asleep. All subjects or their parents identified the subject’s sex, race, and ethnicity, and reported on socioeconomic status (SES) of the household.

Results

Females (32.7%) and racial/ethnic minorities (25.0%) were associated with a significantly lower remission rate as compared to males (53.3%) and non-Hispanic whites (48.3%), respectively. Non-Hispanic whites of low SES were associated with a significantly lower full remission rate (26.3%) as compared to non-Hispanic whites of higher SES (42.0%), while racial/ethnic minorities were associated with the lowest full remission rates regardless of whether they were of low (9.1%) or higher (11.1%) SES.

Conclusion

Our novel data indicate that gender-, racial/ethnic- and socioeconomic-related disparities in insomnia not only occur as early as childhood but are important determinants of insomnia’s chronic course throughout development.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0931 Parenting Stress Can Be Predicted by Parent and Child Sleep, and Can Be Reduced by an Intervention Targeting Child Sleep in Vulnerable Families
Authors: Potvin J , Mercier K , Bérubé A , Raymond N , Forest G
Published: May 2020

Introduction

Studies suggest that family intervention programs should consider different sources of parenting stress (PS). Knowing that child sleep has an impact on PS, this study aimed to examine if a child sleep intervention can affect PS in vulnerable families.

Methods

In a first study, parent and child sleep habits along with PS were assessed using Parenting Stress Index-Short Form, Pittsburgh Sleep Quality Index and homemade questions assessing child sleep. Measures were administered to 138 community mothers (children 3-79 months). Multiple linear regression analyses examined mothers and child sleep associations to PS, controlled by family income. Following results of this first study, 11 vulnerable mothers (children 39-68 months) participated in a child sleep intervention specifically developed for vulnerable families. Measures administered were the same as for study 1, but in this study, the Child Sleep Habits Questionnaire was used to assess the child sleep. Wilcoxon’s t-test compared pre and post-intervention measures.

Results

In the first study, sleep onset latency (SOL; β= -.25; p= .003), waketime (β= -.28; p= .003) and sleep aids (β= -.19; p= .048) explained 23.6% of PS variance. When child sleep variables were added to the model, only bedtime resistance was significant (β= -.23; p= .023) and increased the explained variance to 30.6%. Following the child sleep intervention, no significant changes in parent sleep were observed. However, results show improvement of child bedtime resistance (Mpre=10.73; Mpost=8.36; p= .027) and PS (Mpre=3.50; Mpost=3.82; p= .05).

Conclusion

Our results suggest that higher PS is explained by greater struggles in parents sleep (higher SOL, later waketime and higher use of sleep aids) as well as bedtime resistance behaviors in children. Furthermore, PS can be reduced by an intervention improving child bedtime resistance, even if parent sleep is not improved.

Support
0943 Increased Non-REM Sleep Instability in Children with Restless Sleep Disorder
Authors: DelRosso L M , Hartmann S , Baumert M , Bruni O , Ferri R
Published: May 2020

Introduction

Restless sleep disorder (RSD) is a newly recognized condition characterized by motor movements involving large muscle groups with frequent repositioning or bed sheets disruption. We analyzed cyclic alternating pattern (CAP) in these children, a marker of sleep instability that might be associated with the motor episodes of RSD and may play a role in their daytime symptoms.

Methods

Polysomnographic recordings from thirty-eight children who fulfilled RSD diagnostic criteria (23 boys and 15 girls), 23 children with restless legs syndrome (RLS, 18 boys and 5 girls) and 19 controls (10 boys and 9 girls) were included. For CAP analysis, a previously developed, highly precise automated system, based on a deep learning recurrent neural network, was used.

Results

Age and gender were not statistically different between groups. RSD patients showed a lower percentage of A3 CAP subtypes than controls (median 9.8 vs. 18.2, p=0.0089), accompanied by shorter duration of the B phase of the CAP cycle (median 28.2 vs. 29.8 in controls, 30.2 in RLS, p=0.005) and shorter CAP cycle duration than both controls and RLS subjects (median 33.8 vs. 35.0 in controls, 35.8 in RLS, p=0.002). Finally, RSD children also showed a longer duration of CAP cycle sequences, when compared to controls (median 172.7 vs. 141.9, p=0.0063).

Conclusion

In conclusion, our study indicates that NREM sleep EEG shows an increased instability in RSD; these findings add to the current knowledge on the mechanisms of this newly recognized sleep disorder and suggest that sleep instability might be a favoring mechanism for the emergence of the motor episodes characterizing RSD.

Support

Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)
0944 Shhh! Initiative: Sleep Health Practices In Pediatric Hospitals
Authors: Benoit K M , Harkins E , Olsen S , Sterni L , Wolfson A R
Published: May 2020

Introduction

Hospitalizations often result in significant sleep disruption, despite the importance of sleep in healing (Cmiel, et al., 2004). Research-to-date has focused primarily on adult intensive care (ICU) with minimal focus on pediatric patients. The aim of this study was to assess pediatric inpatient healthcare providers’ understanding of and attitudes towards sleep in the hospital environment with the goal of developing a sleep health educational intervention as well as modifications to standards of care that unnecessarily interrupt sleep of pediatric inpatients.

Methods

An online survey was administered to pediatric inpatient staff (nurses, physicians, residents) at a Mid-Atlantic children’s hospital focused on assessing their understanding of sleep in the context of inpatient care (N = 316). Respondents were 30-50 years old (54%), primarily identified as female (88%), and most (60%) reported being in a nursing position.

Results

Quantitative findings (N = 316) revealed that 65% reported patients were sometimes, rarely, or never allowed to sleep without being awakened from administration of non-critical medications. A majority (63.8%) reported that sometimes, rarely, or never do they consider interruption of sleep in decisions on when to give medications, while 54.9% reported the quantity and quality of sleep is rarely/never considered in a patient’s treatment. Qualitative responses (N = 248) confirmed these findings with 34.3% reporting that they considered re-scheduling medications to minimize sleep interruptions. Despite this finding, only 15.7% reported they would assess or give attention to sleep in the context of patient recovery and treatment.

Conclusion

Pediatric healthcare providers are aware of the importance of sleep for their patients; however, they are not prioritizing sleep as a part of treatment in their behaviors and decisions. Next steps include developing and implementing an intervention for pediatric healthcare providers to follow through on limiting sleep interruptions as well as focusing on sleep in the treatment process.

Support

N/A