bluuebunny/crossref_metadata_2025 huggingface dataset:
0901 An odd presentation of a hidden curse
Authors: Buntak Vesna , Chang Anna , Loutoo Ariane , Bham Zubin , Kwon Jeff
Published: May 2023

Introduction

Congenital central hypoventilation syndrome (CCHS) is a rare disorder of respiratory deficiency due to a mutation in the PHOX2B gene. Clinical presentation may be mild in certain individuals due to different levels of ventilatory dysregulation.

Methods

We present the findings of exogenous ventilatory challenge testing and polysomnography (PSG) performed on a normocapnic adult female with late-onset (LO) CCHS patient.

Results

The patient was exposed to four separate ventilatory challenges. During exposure to hyperoxia using 100% oxygen (O2) administration, patient showed an inconsistent ventilatory response with a blunted and delayed increase in regional tissue oxygen saturation (rSO2). During hyperoxic hypercapnia with 5% carbon dioxide (CO2) and 95% O2, she demonstrated a reduced ventilatory response based on respiratory rate and tidal volume. During hypoxic hypercapnia, 7% CO2 and 14% O2, patient demonstrated a delayed and markedly attenuated ventilatory response. Hypoxia; 100% nitrogen inhalation did not result in increased ventilation. Ve slope, change in minute ventilation/change in end-tidal CO2 (EtCO2), with hypercapnia challenges was 4.88, which is lower than normal. Ventilatory EtCO2 threshold was 36 mmHg. PSG showed apnea-hypopnea index 3.3 with hypoxemia during rapid eye movement (REM), with an oxygen saturation nadir of 84%. EtCO2 baseline was around 36, peak was 50 and was associated with REM-related apnea events. Arterial blood gas was unremarkable.

Conclusion

CCHS is characterized by abnormal respiratory response to exogenous ventilatory challenge testing. Hyperoxia silences peripheral chemoreceptors (PC) responsible for stimulating ventilation in normal individuals. Hyperoxic hypercapnia silences PC but stimulates central chemoreceptors (CC). Hypoxic hypercapnia stimulates hyperventilation via both PC and CC. Our patient demonstrated inconsistent and reduced ventilatory responses to all four challenges. As expected, the classic chemosensory parameter, Ve slope, for hypercarbia challenge was markedly reduced. However, the ventilatory EtCO2 threshold fell well below threshold typically observed in CCHS. PSG noted greater alveolar hypoventilation during REM compared to non-REM, which is also atypical for CCHS. In conclusion, exogenous ventilatory challenge testing demonstrated derangements in ventilatory control typical in CCHS. Despite this, our patient had no evidence of daytime hypoventilation with normal CO2 threshold. This case illustrates the phenotypic variability present in LO-CCHS.

Support (if any)
0903 CPAP adherence rate in patients with ischemic stroke
Authors: Kim Jee Hyun , Song Tae-Jin , Park Moo-Seok , Kim Hyung Jun , Kim Dong Yeop
Published: May 2023

Introduction

Although treatment of OSA in patients with ischemic stroke is important for secondary prevention of stroke and improving neurologic outcomes, patients with stroke often are not adherent to nasal CPAP. The aim of the study is to examine the adherence rate and explore the predictive factors for CPAP compliance in patients with a recent history of ischemic stroke.

Methods

We reviewed the medical records of patients with ischemic stroke who were diagnosed with OSA after the onset of stroke and those who were recommended to use nasal CPAP at a single university Hospital from March 2020 to November 2022. Demographic information, neurologic functional status, and polysomnographic data were reviewed. For patients who agreed to use CPAP, CPAP compliance data were analyzed using cloud data run by various CPAP companies.

Results

76 patients with cerebral infarction or transient ischemic attack were diagnosed with OSA and were recommended to use nasal CPAP (mean age, 60.8±12.6, male 60). Night PSG was performed after the onset of the stroke as the evaluation process for risk factors for stroke based on clinical symptoms such as snoring or apnea. The acceptance rate for nasal CPAP was 88.1% (67/76) at the first visit after the PSG. The adherence rate was 55.2% (37/67). No difference between the adherent and non-adherent groups was found in polysomnographic variables, including AHI, RDI, and subjective sleep scales such as PSQI, ISI, and ESS. No difference in the neurologic functional deficit was found between the groups. The adherent group was younger but not statistically significant (58.4±13.10 vs. 63.6±11.65, p=0.10). Female patients with ischemic stroke were more intolerant to CPAP (24.1% vs. 11.7%).

Conclusion

The patients in our study performed a PSG due to the risk evaluation of stroke rather than pursuing treatment for sleep apnea symptoms. Half of the patients were not adherent to CPAP, although they agreed to try CPAP. The proper screening of sleep apnea and education on sleep apnea and its impact on the neurologic outcome would be mandated to increase CPAP adherence in patients with ischemic stroke.

Support (if any)

Basic Science Research Program through NRF funded by the Ministry of Education(2021R1I1A1A01059791)
0905 Factors Associated with Sleep Quality among Men with Multiple Sclerosis
Authors: Lorenz Rebecca , Alanazi Nouf
Published: May 2023

Introduction

Multiple sclerosis (MS), a neurodegenerative disease with typical onset in young to middle adulthood, results in disrupted sleep more commonly than the general population. There are known sex differences in MS onset and clinical course. MS, however, affects approximately three times more women than men, resulting in less attention to the male experience. Thus, there is a lack of information on disrupted sleep among men with MS. The purpose of this study was to examine the relationships between personal factors, behaviors, and sleep quality among men with MS.

Methods

Men with MS aged 20 to 90 years participated in an online anonymous survey recruited through the National MS Society website. Pearson’s correlations and linear regression were used to examine relationships between personal factors (age (years), type of MS, years since MS was diagnosed by a physician and race), sleep promoting behaviors (Sleep Behavior Self-Rating Scale), and sleep quality (Sleep Impact Short-Form total score).

Results

Four hundred ninety-six men with MS (mean age=53 years; SD=12.8; range 22-81 years) completed the survey. The majority were white (n=428; 86%) and married (n=358; 72%), with relapsing-remitting MS (n=323; 65%). Sleep quality ranged widely (mean=43.2; SD=3; range 27.9-59.9) with 90% reporting poor sleep. Pearson correlation results indicated a significant positive association between sleep quality and sleep promoting behaviors (r=.339) and negative associations with age (r=-234) and race (r=-.148). Multiple regression showed that sleep promoting behaviors and age statistically significantly predicted sleep quality (F(5,399) =15.51,p<.001,R2=.152). MS type, years passed since MS diagnoses and race did not add significantly to the prediction.

Conclusion

These findings suggest that poor sleep quality was strongly associated with sleep promoting behaviors among in older men with MS. Improving sleep promoting behaviors may substantially improve sleep quality. Further qualitative research is required to address the lack of information on understanding factors that disturb sleep among men with MS.

Support (if any)

This study was supported by National Heart, Lung, and Blood Institute (NHLBI) UB Clinical Scholar Program in Implementation Science to Achieve Triple Aims -NIH K12 Faculty Scholar Program in Implementation Science (NHLBI) Award
0908 Multi-modal Recruitment of Individuals with REM Sleep Behavior Disorder into a Longitudinal Prodromal Parkinson’s Study
Authors: Dobkin Roseanne , Kuhl Maggie , Destro Christina , Brown Ethan , Chahine Lana , McMahon Bridget , Ricci Jillian , Videnovic Aleksandar , Kelliher Caitlin , Lynch Kimberly , Islam Natasha , Simuni Tanya , Siderowf Andrew , Tanner Caroline , Marek Ken
Published: May 2023

Introduction

In 2010, The Michael J. Fox Foundation launched the Parkinson’s Progression Markers Initiative (PPMI) to study how Parkinson’s disease (PD) starts and changes over time. Volunteers participate in clinic, online or both. PPMI is now prioritizing recruitment of individuals with possible or probable REM sleep behavior disorder (RBD) without a PD diagnosis (goal of 500 in clinic). As 30% of people with RBD and smell loss receive a PD diagnosis within four years, RBD may provide a model to understand the evolution of the prodromal phase of PD. This presentation will describe diverse recruitment strategies utilized since 2020 to enroll individuals with RBD, to inform best practices for engaging this population in research.

Methods

A key strategy for identifying individuals with possible RBD was the dissemination of educational content on the disorder and its connection to PD. Materials emphasized that not everyone with RBD develops PD but that, in some people, RBD is an early symptom of the disease. Educational materials and messages (with associated calls to actions) were shared via webinars, print and online publications, emails, animated videos, radio, TV, and paid social media ads. Materials included scientific, participant and influencer spokespeople and were targeted to both individuals with RBD and bed partners. PPMI study sites sought referrals from sleep physicians.

Results

More than 535 individuals with a self-reported diagnosis of RBD (without PD) have enrolled in the online PPMI platform (59.4% male, 68.1% aged ≥60). Nearly 185 have been screened for site enrollment; 111 are contributing data at a study site. Foundation-led emails (16.1%) and paid social media ads (9.3%) were highest drivers to online enrollments. The most common referral sources to a PPMI RBD information and screening phone line were email (38%), social media (19%), and family/friend referral (19%). Approximately one-fourth of clinic enrollments were from physician referrals.

Conclusion

Multi-modal recruitment strategies, linked to tailored educational content, are critical for enrollment of individuals with RBD in clinical research studies including, but not limited to, those investigating and aiming to prevent other neurologic disorders.

Support (if any)

PPMI – a public-private partnership – is funded by the Michael J. Fox Foundation for Parkinson’s Research.
0909 Pitolisant Pregnancy Registry: An Observational Study of the Safety of Pitolisant Exposure in Pregnant Women and Their Offspring
Authors: Adamkovic Anthony , Montgomery Padge , Roy Michele , Dayno Jeffrey , Veley Kristin
Published: May 2023

Introduction

WAKIX (pitolisant) is a potent and highly selective histamine 3 receptor antagonist/inverse agonist approved for the treatment of excessive daytime sleepiness or cataplexy in adult patients with narcolepsy. The safety of pitolisant in pregnant women has not been established. Available case reports from clinical trials and postmarketing experience have not demonstrated a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. The registry is a prospective, observational cohort study designed to evaluate the association between pitolisant exposure during pregnancy and subsequent maternal, fetal, and infant outcomes.

Methods

The primary study population consists of 3 cohorts: pregnant women with a diagnosis of narcolepsy who are exposed to pitolisant during pregnancy, pregnant women with narcolepsy who are unexposed to pitolisant but exposed to comparator products during pregnancy, and pregnant women with narcolepsy who are neither exposed to pitolisant nor comparator products. Comparator products include modafinil, armodafinil, sodium oxybate, oxybate mixed salts, solriamfetol, methylphenidate, and amphetamines. Outcomes of interest include major congenital malformation (primary outcome), minor congenital malformation, pre-eclampsia, eclampsia, spontaneous abortion, stillbirth, elective termination, small for gestational age, preterm birth, postnatal growth deficiency, and infant developmental deficiency. Data are collected from enrolled pregnant women and healthcare providers involved in their care or the care of their infants, if applicable. Only data that are routinely documented in patients' medical records during usual care are collected. Participation in the registry is voluntary and participants may withdraw their consent to participate at any time. The registry design follows current FDA guidance for designing and implementing pregnancy exposure registries.

Results

The registry was initiated in May 2021. Presently, data are insufficient to assess an association between pitolisant exposure and any endpoint of interest. Study completion is planned in 2030.

Conclusion

Healthcare providers are encouraged to discuss this voluntary pregnancy registry with their eligible patients and assist women who are interested in enrolling. The study is registered on Clinicaltrials.gov (ID# NCT05536011).

Support (if any)

This study is sponsored by Harmony Biosciences LLC.
0910 Potential Role of Physicians in Addressing the Needs of Those At-Risk of a Neurodegenerative Disorder – A Pilot Survey
Authors: Levendowski Daniel , Berka Chris , Neylan Thomas C , Mazeika Gandis , Walsh Christine , Boeve Bradley , St. Louis Erik
Published: May 2023

Introduction

In a recent study, most patients diagnosed with isolated REM sleep behavior disorder (iRBD) preferred their physician discussed their risk for developing a future neurodegenerative disorder (NDD) such as parkinsonism or dementia (PD). In the Mayo Clinic email survey, 75% would lose trust in their physician if PD-risk was not discussed following an iRBD diagnosis. For this survey, questions were designed to investigate preferences for how sleep physicians might communicate to community-based adults about risk of a NDD.

Methods

A survey was administered to Rotary Club attendees prior to a sleep and neurodegenerative disease presentation, with options for responses being either strongly disagree, disagree, neutral, agree, or strongly agree. Thirty-four surveys were obtained from approximately equal numbers of men and women with estimated ages above 50 years. Personal information were not obtained (i.e., sex and age).

Results

The vast majority of respondents wanted their physician to ask their preference prior to sharing NDD risk (86% strongly agreed or agreed), while virtually all would lose trust in their physician if he/she did not discuss their NDD risk (97% strongly agreed/agreed). If identified with NDD risk, responders would seek out information about medications and adaptive therapies that could delay onset (97% strongly agreed/agreed), while only about half currently had a good understanding of lifestyle patterns that might help delay onset (47% strongly agreed/agreed and 47% disagreed/strongly disagreed). Not knowing when memory problems might begin would cause most responders to feel anxious (85% strongly agreed/agreed).

Conclusion

Those surveyed wanted their physician to ask their preference prior to sharing NDD risk, but virtually all would lose trust in their health care provider if the information was known but not shared. There appears to be a role for physicians in educating those who may be at NDD risk about interventions that could delay onset of NDD, given approximately half have a limited understanding of lifestyle patterns that could help delay onset. Further, routine follow-up for changes in prodromal NDD biomarker severity might help to reduce anxiety in the 85% of those concerned about when memory problems might begin.

Support (if any)

NIA-R44AG050326
0919 EMR-Integrated Clinical Pathway Improves Familiarity with Obesity Hypoventilation Syndrome Among Inpatient Clinicians
Authors: Camacho Jessica , Andani Sameer , Drake Lauren , Green Katherine
Published: May 2023

Introduction

Obesity hypoventilation syndrome (OHS) is an underrecognized chronic respiratory condition characterized by obesity (BMI > 30kg/m2) and hypoventilation (PaCO2 > 45mmHg) in the absence of other causes of hypoventilation. In OHS, obesity causes mass loading on the respiratory system, leading to CO2 retention, diminished ventilatory response, progressive hypoxia/hypercapnia, and eventual cardiopulmonary arrest. OHS is typically diagnosed while inpatient, wherein 18-month mortality approaches 23%. Non-invasive ventilation (NIV) improves OHS symptoms & prognosis which subsequently decreases healthcare utilization and mortality. With the proper tools and training, inpatient providers can facilitate accurate diagnosis and prompt treatment of OHS. Our team developed an EMR-integrated clinical pathway to increase recognition and facilitate treatment of OHS in hospitalized patients on the general medicine service.

Methods

The OHS Pathway was implemented among a large group of hospitalists at a tertiary academic medical center. A multi-disciplinary team of physicians, respiratory therapists, and care coordinators designed the pathway structure and content. Prior to integrating the OHS pathway into the EMR, hospitalists were surveyed to assess existing knowledge and experiences caring for patients with OHS. Hospitalists then participated in an educational series on OHS with orientation to the pathway. 12-months into the intervention, hospitalists were re-surveyed.

Results

Survey data analysis revealed that providers were significantly more familiar with the diagnostic criteria for OHS after (n=40) the introduction of the clinical pathway rather than before the introduction (n=24) of the pathway (t (62) = 2.88, p = .0027). Subjective success rates for prescribing NIV to patients upon discharge did not significantly improve

Conclusion

OHS diagnosed in the inpatient setting carries significant morbidity and mortality. Proper detection and prompt treatment of OHS are essential to improving the care and prognosis of this high-risk population. We demonstrate that our multi-disciplinary based, EMR-integrated clinical pathway increased provider familiarity with the diagnostic criteria for OHS. While treatment success did not significantly improve, numerous systems factors were at play, and further investigations are needed to address access to treatment.

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0923 Poor sleep hygiene is widespread among first-year medical students
Authors: Marquardt Matthew , Fisher Fielding , Grandner Michael , Khan Meena
Published: May 2023

Introduction

Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Sleep hygiene is broadly defined as the sleep-adjacent behaviors and beliefs that significantly contribute to sleep quality. This study sought to determine the prevalence of various sleep hygiene related behaviors among first-year medical students.

Methods

A one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Mean bedtimes were grouped based on when students drank their last caffeinated beverage and compared using one-way analysis of variance (ANOVA) with the Turkey HSD test. Statistical significance was considered a p-value ≤0.05.

Results

138 of the 209 person (66%) first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. While only 15% of students reported pulling an all-nighter (obtaining less than 2 hours of sleep over 24 hours) during the current academic year, many other behaviors associated with poor sleep hygiene were prevalent. Large proportions of students reported using social media (78%), texting (68%), watching television (41%), and thinking (53%) in bed more than three times per week. Caffeine use was also high. Only 12 respondents (8.7%) reported never consuming caffeinated products, while just over 50% consumed caffeine at least once per day. Furthermore, of the 126 students who reported caffeine use at least once per month, 74 (59%) drank their last caffeinated beverage after 2:00 p.m. Intriguingly, average weekday bedtimes did not differ based on when students consumed their last caffeinated beverage (p=0.059), suggesting that caffeine consumption is driven by factors other than predicted bedtime.

Conclusion

Poor sleep hygiene is widespread among first-year medical students. Future interventions should seek to increase awareness among medical students about sleep hygiene and its importance while providing them with feasible tips for how to incorporate them into their lives.

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0926 Teaching Medical Students About Insomnia: Early Results of a Brief Lecture for Third Year Medical Students
Authors: Tubbs Andrew , Karp Jordan , Parthasarathy Sairam , Perlis Michael , Grandner Michael
Published: May 2023

Introduction

Insomnia affects 10 to 20 percent of Americans annually. Unfortunately, evidence-based training on the diagnosis and management of insomnia during U.S. undergraduate medical education is limited. This educational gap may promote use of off-label medications or supplements (e.g., melatonin) and contribute to the “medicalization of sleeplessness”. By contrast, cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation of the American Academy of Sleep Medicine and the American College of Physicians, and CBT-I is increasingly available in a digital format that can even be prescribed by primary care providers. Most physicians are not trained in how CBT-I works, however, and thus are ill-equipped to prescribe or refer this service. Therefore, this pilot study evaluated a brief educational intervention to improve medical student knowledge about insomnia.

Methods

The first author (AST) developed a 20-minute in-person lecture on insomnia which was delivered to 122 undergraduate medical students during their third-year medical curriculum. Topics included epidemiology, Spielman’s 3-P model of pathophysiology, and the treatment recommendations from the AASM with an emphasis on CBT-I. A total of 43 students (36%) provided informed consent and provided pre- and post-presentation ratings (0–100-point scale) of 1) their comfort in discussing insomnia with their patients, 2) the importance of insomnia for human health, 3) their familiarity with the pathophysiology of insomnia, and 4) their familiarity with treatments for insomnia. Participants were additionally asked to categorize a list of treatments as evidence-based or not.

Results

Following the presentation, students reported increased comfort in discussing insomnia with their patients, knowledge of the pathophysiology of insomnia, and knowledge of evidence-based treatments. In selecting treatments, more students chose CBT-I as an evidence-based treatment, while fewer students identified sleep hygiene, PAP therapy, diphenhydramine, hydroxyzine, melatonin, quetiapine, and trazodone.

Conclusion

A brief lecture on insomnia improved medical students’ knowledge of the disease process and evidence-based treatments for insomnia. Forthcoming analyses will determine whether students utilized this knowledge during subsequent clerkships. Future work will examine whether alternative formats (e.g., flipped-class, case-based instruction, interactive modules) are more effective for conveying this information.

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0929 The Social Determinants of Health and Sleep Health: A Latent Class Analysis
Authors: Narcisse Marie-Rachelle , Moise Rhoda , Locklear Clarence , Turner Arlener D , Grandner Michael , Seixas Azizi , Jean-Louis Girardin
Published: May 2023

Introduction

Social determinants of health (SDOH) have been linked to well-being, quality-of-life and health disparities. We aim to investigate, 1) To classify adults based on their SDOH characteristics, and 2) To examine association between SDOH classes and sleep health.

Methods

This study used 2020 National Health Interview Survey data (n=31,568). SDOH was captured by health insurance, well-visits, delayed medical care, neighborhood walkability, social support, food insecurity, food stamp, poverty, and education. Sleep health was captured by: 1) Sleep quantity (hours): very short (< 5), short (5-6), normal (7-8), and long (≥9); 2) Sleep quality: trouble falling asleep or staying asleep; 3) Sleep medication, 4) Feeling well-rested, and 5) Fatigue. Latent class analysis generated a 3-class model with a gradient on all SDOH characteristics. Generalized structural equation modeling was used to examine associations between adverse’ SDOH classes and sleep health, with Class 1 (lowest probability of adverse’ SDOH), as reference category.

Results

Adults in Class 3 were 36% more likely to have short sleep than normal sleep. Classes 2 and 3 were 16% and 24% more likely to have trouble falling asleep on “some days”; 26% and 40% more likely on “most days”; and 28% and 77% more likely every day than never. Classes 2 and 3 were 22% and 23% more likely to have trouble staying asleep on “some days”; 36% and 35% more likely on “most days”; and 48% and 77% more likely every day than never. Class 2 was 19% more likely to take sleep medications on “some days” and 25% more likely every day than never. Classes 2 and 3 were 26% and 86% more likely to never feel well-rested; 30% and 60% more likely to feel well-rested on “some days” than every day. Classes 2 and 3 were 17% and 49% more likely to feel fatigued on “some days”; 43% and 99% more likely on “most days”; 55% and twice as likely to feel fatigued every day than never.

Conclusion

Adverse SDOH are associated with worsened unhealthy sleep. Further research is needed for the implementation of interventions to improve sleep health among marginalized groups more impacted by adverse SDOH.

Support (if any)

G1-5524901
0930 What explains high self-reports of poor sleep quality in Native Hawaiian/Pacific Islanders?
Authors: Locke Brian , Situmeang Josiah , Anderson Nicholas , Sundar Krishna
Published: May 2023

Introduction

High rates of poor sleep quality have been reported among patients of Native Hawaiian/Pacific Islander (NHPI) race. Unrestful sleep might be attributable to short sleep times or to elevated rates of obstructive sleep apnea among NHPIs. We aimed to evaluate factors associated with self-reported poor sleep quality among NHPIs in a nationwide, representative community sample.

Methods

Using the 2014 National Health Interview Survey (NHIS), we used logistic regression to model the odds of individuals reporting that they did not awake feeling rested at least two out of the prior seven days. NHPIs from the NHPI-NHIS and non-NHPIs from the general sample were compared. Age, sex, BMI, smoking status, report of heavy drinking, employment status, marital status, and reported average hours of sleep time were evaluated in terms of their effects on self-reported sleep quality.

Results

Data from 36,697 non-NHPI and 2,590 NHPI individuals was available for analysis. There were significant differences in age, BMI, marital and current employment status between NHPIs vs. non-NHPIs. NHPI patients reported less sleep (mean 6.86±1.41 hours) in contrast to non-NHPIs (mean 7.12±1.42 hours) (P< 0.001). NHPIs were more likely to report two or more days awakening not feeling rested (Odds Ratio (OR) 1.22, 95% confidence interval (95CI) 1.12–1.32) as compared to non-NHPIs. After adjusting for demographics, BMI, alcohol, smoking, and marital and employment status, the relationship persisted (OR 1.17, 95CI 1.07-1.28). When additionally controlling for sleep time, which was strongly associated with the likelihood of awakening unrested (OR 3.1 95CI 2.9-3.2 for six or fewer average hours of sleep), there was no significant relationship between race and likelihood of awakening unrested (OR 1.02, 95CI 0.93-1.13). Findings were similar when evaluating different thresholds of unrestful nights per week.

Conclusion

NHPIs are more likely to awake feeling unrested than non-NHPIs. The higher rate of unrestful sleep is associated with higher reports of short (6 hours or less) sleep time. Therefore, future research to improve sleep quality in NHPIs should also investigate the cultural and social factors leading to short sleep time.

Support (if any)

BWL: NIH Ruth L. Kirschstein National Research Service Award 5T32HL105321 and the ATS ASPIRE Fellowship
0933 Sleep Specialists in Federally Qualified Health Centers: A Gap in Sleep Health Care Potentially Contributing to Sleep Disparities
Authors: Singh Rupsha , Juarez Paul , Redline Susan , Nápoles Anna , Jackson Chandra
Published: May 2023

Introduction

Poor sleep is associated with adverse cardiometabolic health outcomes and increased risk of mortality. Although primary care providers recognize the importance of sleep, they report low comfort levels in diagnosing, treating, and managing sleep disorders; lack of clinical knowledge and skills is the most common barrier to recognizing insomnia in family practice. Furthermore, minoritized racial/ethnic groups are disproportionately affected by poor sleep health, likely due in part to structural and other forms of racism that result in limited access to sleep healthcare. Health Resources & Services Administration (HRSA) has a variety of awards that support scholarships and loan repayment programs at colleges and universities to meet critical workforce shortages and diversify the health professions. We assessed the distribution of sleep specialists among clinicians who participated in a HRSA grant program because they tend to work for health care organizations that serve persons from lower socioeconomic and diverse racial-ethnic backgrounds.

Methods

Publicly available data were obtained from the HRSA data warehouse. Data were available for 44,199 clinicians (49% MD/DO and 16% Nurse Practitioner) who participated in a HRSA grant program between 2011 and 2021. We report data for those clinicians who endorsed sleep medicine as their subspecialty.

Results

Of the 44,199 clinicians, 27 (0.06%) physicians trained in a medical subspecialty of sleep medicine, and the majority (52%) were in Michigan. The remainder of sleep medicine specialists completed their program in Pennsylvania (33%), Ohio (7%), Minnesota (4%), and California (4%). Only the participants in the Children's Hospital Graduate Medical Education program designated their subspecialty as sleep medicine. None of the sleep medicine specialists currently practice in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas/Populations (MUA/P), and 1 physician currently practices in a rural area.

Conclusion

A marked paucity of trained sleep specialists in HRSA grant programs and an absence of such practitioners in HSPAs underscores the disparities in access to sleep specialty care. Initiatives are needed to incentivize sleep specialists to serve in under-resourced communities as well as to implement programs training primary care practitioners working in these areas to deliver sleep health care, supported by sleep specialists.

Support (if any)

Divisions of Intramural Research: NIMHD/NIEHS, NIH
0936 Characteristics and predictors of prescription sleep medication use in a national sample of Veterans with chronic pain
Authors: Li Y , Chen Claire , Donovan Lucas , Zeliadt Steven , Chen Jessica
Published: May 2023

Introduction

Insomnia and other sleep problems commonly occur in patients with chronic pain. While behavioral approaches are recommended first-line treatments for conditions such as insomnia, patients with sleep complaints often receive sleep medications. Thus, we aim to understand patterns of prescription sleep medication use in Veterans with chronic pain receiving care at the Veterans Health Administration (VHA).

Methods

We reviewed electronic medical records to identify patients with moderate/severe chronic pain receiving care at a VA hospital between FY2019—2021. Multivariate logistic regressions examined associations between 14 patient demographic and clinical variables on sleep medication prescription. Short-term prescriptions associated with upcoming procedures were excluded.

Results

Of the 1,706,214 moderate/severe patients with chronic pain (88% male, 66% White), 14% had comorbid diagnosis of insomnia, 30% sleep disordered breathing, and 19% were prescribed sleep medications. Trazodone (40%), melatonin (23%), and benzodiazepines (14%) were most commonly prescribed. Although 14% of patients without insomnia or sleep apnea diagnostic codes were prescribed medication, patients with insomnia were four times more likely to use sleep medication (odds ratio (OR) = 4.05, 95% CI [4.01-4.09]). Strongest predictors of medication use were insomnia (adjusted OR = 2.84, 95% CI [2.81-2.86]), PTSD (adjusted OR = 2.77, 95% CI [2.75-2.79]), depression (adjusted OR = 1.89, 95% CI [1.87-1.91]), bipolar disorder (adjusted OR = 1.84, 95% CI [1.81-1.87]), and ongoing opioid use (adjusted OR = 1.82, 95% CI [1.80-1.84]). Prevalence of medication use was similar across gender, age, and racial/ethnic groups.

Conclusion

Sleep medication use is common in Veterans with chronic pain, with highest rates among patients with insomnia diagnoses. Additionally, a large number of patients without a sleep disorder diagnosis also receive medications. Findings highlight need to connect chronic pain patients with behavioral sleep interventions. Notably, we observed a wide variety of medications without strong patterns across demographic characteristics.

Support (if any)

This work was conducted as a non-research quality improvement effort supported by Quality Enhancement Research Initiative (PEC 13-001) and the VA Office of Patient Centered Care and Cultural Transformation. YIL is supported by a VA MIRT Fellowship. JAC is supported by a VA HSR&D CDA (IK2 HX002866). LMD is supported by a VA HSR&D CDA (CDA 18-187).
0941 Sleep Apnea Testing in Hospitalized Patients: Are Patients Following Up?
Authors: Lam Nhi , Singh Monica , Lastra Alejandra
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) can often be recognized in an inpatient setting where patients are continuously monitored. Although an unattended portable sleep study can successfully diagnose OSA in many inpatients, allowing for earlier intervention, a loss to follow up can compromise effective treatment. This study aims to determine the rate of hospital follow-up in patients who are diagnosed with OSA on a portable inpatient sleep study.

Methods

We included adult inpatients who underwent portable sleep studies from 2013 to 2022. This is a retrospective study design. Individual charts were reviewed to determine demographics including age, gender, and race. Co-morbidities and length of stay were recorded. Sleep study data analyzed included total recording time, total estimated sleep time, overall apnea-hypopnea index (AHI) and nadir oxygen saturation. Primary outcome was percentage of patients with AHI 5/h with scheduled follow up visit. Secondary outcome was percentage of patients with AHI 5/h completed outpatient follow-up visit.

Results

104 patients were included for analysis. Majority were middle aged (55.2 SD15.9 years-old), black (n=71, 68.2%) and male gender (n=64, 62%). A minority identified as Hispanic (n=7, 6.7%). The total number of sleep studies with AHI 5/h was 95 (91.3%) and the mean AHI was in the severe range (42.8 SD31.4/h) with significant associated oxygen desaturations (mean nadir oxygen saturation 77.1 SD10.6%). Primary outcome: the number of patients with a positive sleep study for OSA (AHI 5/h) who had scheduled for follow-up at discharge was 57 (60%). Secondary outcome: 54.4% of patients with positive sleep study and scheduled follow-up completed the outpatient visit.

Conclusion

The percentage of patients lost to follow-up is high despite diagnosing OSA successfully with an inpatient portable sleep study. Close to half of the patients had no scheduled follow-up, and the “no show” rate remained high (close to 50%) in those who had a sleep medicine appointment. Future studies should explore effective interventions to improve the follow-up rate and overall adherence to treatment.

Support (if any)
0943 Sleep Medicine Tweet-by-Tweet, an Electronic Platform for Collaborative Medical Education
Authors: Liu Ran , Thomas Robert , Heckman Eric , Mak Michael
Published: May 2023

Introduction

Twitter is a novel and accessible platform for the dissemination of medical education, and it is used by many medical practitioners (1). Many physicians have used Twitter as a means of meeting continuing medical education needs. This can manifest as Twitter-based Journal Clubs, curated conference data and webinars (2).

Methods

I have created a Sleep Medicine Medical Education Twitter account @SleepyNeuroDoc to share complex cases in all areas of sleep medicine, including sleep-disordered breathing, movement disorders in sleep, circadian rhythm disorders and nocturnal epilepsy. I share notable images of polysomnogram outputs, home sleep apnea tests, compliance data, neuro-imaging, electroencephalogram, cardiopulmonary coupling and more. This digital education platform allows rapid circulation of unique cases and promotes in-depth scholarly discussion, with no geographical limit. Polls are conducted for complex topics to facilitate knowledge exchange and consumer engagement. This educational twitter is followed by the entire spectrum of professions within the sleep medicine care team, including physicians, allied health, and researchers. To date, there are 40 cases posted.

Results

We conducted online questionnaires with consumers of this Twitter account, and the results so far indicate greater practitioner comfort with management of various sleep medicine conditions. Some consumers report having changed their approach to practice.

Conclusion

Our work suggests that this unique use of a social medical platform is beneficial for continuing medical education and knowledge exchange in the field of Sleep Medicine. References: 1. Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011;305(6):566-568. 2. Thamman R, Gulati M, Narang A, et al. Twitter-based learning for continuing medical education? Eur Heart J. 2020;41(46):4376-4379.

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0945 A Robust Hybrid algorithm for automatic respiratory events scoring in adults
Authors: Kim Myeong Seok , Ha Tae Kyoung , Lee Ho Dong , Lee Young Jun
Published: May 2023

Introduction

Even though Polysomnography has many advantages, manual scoring is a labor intensive and time consuming. Therefore, automatic scoring system using a deep learning algorithm has been developed and commercialized for clinical sites. However, it is challenging to explain the results of respiratory events and to measure a precise event’s duration. To overcome these challenges, a new hybrid algorithm was proposed to explain why this event was categorized and provided the accurate duration of respiratory events.

Methods

In order to classify respiratory events - OSA, MSA, CSA, O-hypopnea, and C-hypopnea, the proposed algorithm consists of two algorithms – deep learning and post processing algorithms. Deep learning algorithm was used to detect candidates of respiratory events and post processing algorithm was used to determine the final classification and to measure duration of events. Deep learning model consisted of five layers: a perceptron layer, three consecutive layers of long short-term memory (LSTM) cells, and two more perceptron layers. A total of 1,000 case PSG data were enrolled to develop this algorithm. To classify respiratory events from the results provided by the deep learning algorithm, auto-correlation, peak detection, de-noise filtering and transition detection were used to obtain respiratory rate and measure signal amplitude. Using these algorithm’s results, amplitude and time of baseline breathing and respiratory events were calculated and classified based on the AASM’s guidelines.

Results

To evaluate the performance of proposed algorithm, 30 PSG data were selected and compared with the results of deep learning algorithm. The test dataset consisted of thirty subjects with 15 OSA, 5 PLMS, 2 insomnia and 8 healthy. The kappa value of deep learning algorithms showed 0.77 (0.759, 0.78) and that of proposed algorithm was 0.838 (0.832, 0.843). They showed better agreement by 0.068 than that of deep learning algorithm. In addition, the proposed algorithm provided the classification results such as OSA, MSA, CSA, O-hypopnea and C-hypopnea and explanations of the reason of event detection.

Conclusion

The proposed algorithm showed better agreement and versatile classified results. This algorithm will be adopted for new automatic sleep scoring solution and this solution will be very helpful to use in real clinical sites.

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0946 CIRCUL: VALIDATION OF A SMART RING FORM OXIMETER IN INDIVIDUALS WITH DARK SKIN PIGMENT
Authors: Cruz Miguel Meira e , Chen Enguo , Zhou Young , Shu Dengui , Zhou Congcong , Kryger Meir
Published: May 2023

Introduction

The potential impact of skin pigmentation on the accuracy of oximetric assessment has long been known to be a clinically relevant matter. During the COVID pandemic it became apparent that oximeters may underestimate oxyhemoglobin saturation in darkly pigmented individuals. Validation data for SaO2 is not generally available for the many consumer wearable oximeter devices. Circul® (Bodimetrics Corp, Los Angeles, CA), a wearable oximeter with a form factor of a ring, measures several variables for cardiorespiratory assessment (SpO2, movement, heart rate). We aimed to evaluate the accuracy this device in the measurement of SaO2 compared to a simultaneous values obtained by measurement of SaO2 by arterial blood gases.

Methods

24 subjects (8 Black, 16 Non-Black) participated in the validation of the Circul device. In an operating suite they had catheters inserted into their radial arteries. They were administered nitrogen rich air which made them hypoxic in steps to an SaO2 of 70%. Arterial blood was sampled at various levels of hypoxia and simultaneous readings were obtained from the Circul device. We compared SaO2 obtained by Circul vs measurement of ABGs by a medical grade blood gas analyzer.

Results

There was excellent correlation between SaO2 measured by the ring oximeter and ABGs in both Black (y = 1.0174x - 1.573; R² = 0.9414) and Non-Black (y = 1.0209x - 2.5607; R² = 0.9207) subjects. No significant differences were found in comparing the intercept and slopes of the regressions. At ABG of 70% and 100% the SaO2 measured by the ring was calculated to be 69.6% and 100.2% for the Black subjects and 68.9% and 99.5% for the non-Black subjects.

Conclusion

Results from this study confirmed that Circul oximetry accuracy seems to be independent of the skin tone.

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0952 A Long Winter’s Sleep: What Does Big Data From Consumer Sleep Technology Tell Us?
Authors: Gahan Luke , Wilson Samantha , Watson Nathaniel F , Gottlieb Elie
Published: May 2023

Introduction

Light is the most powerful zeitgeber influencing sleep-wake patterns, and winter’s shorter days have profound effects on mood, energy, and metabolic function. Here, we leverage big data from consumer sleep technology to examine the relationship between objectively measured sleep in winter versus summer months in the United States.

Methods

The dataset included 21,101 users residing in the US across 1,255,518 nights (age range: 17-90, mean age: 46.6 ± 16.7 years, 59% female). Data were extracted from 01 January 2019 until 31 August 2022. Seasons were defined according to the Northern Hemisphere’s meteorological calendar and included winter (December - February) and summer (June - August). USA public holidays were mapped and removed from the data. The relationships between objectively measured sleep and winter versus summer were examined using linear regression models, controlling for age and gender.

Results

A shift to later average monthly wake times were observed in both summer and winter, peaking in summer. Similarly, bedtimes shift later in summer and winter, yet the shift in summer was greater than winter (winter vs summer: waketime: 07:06 vs 07:07, ß = -0.46, SE = 0.023, p< 0.001, bedtime: 23:17 vs 23:23, ß = 0.12, SE = 0.006, p< 0.001). Although bedtime and wake times delay during the winter and summer seasons, measures of sleep health including sleep duration, sleep efficiency, and SleepScore peak in winter and slowly decline to their lowest point during the summer months (winter vs. summer: SleepScore 78.4 vs 77.6, ß = -0.89, SE = 0.17, p< 0.001; sleep duration 359.6 min vs 352.8 min, ß = -4.8, SE = 1.02, p< 0.001; sleep efficiency 77.5 vs 76.6, ß = 0.86, SE = 0.038, p< 0.001).

Conclusion

Bedtime and wake time delays were greater in summer than winter, likely contributing to small improvements to sleep quality, duration, and efficiency in winter compared to summer. These findings are generally supported by previous research examining sleep-wake patterns in locations with extreme seasonal differences, such as Northern Norway, where, despite midnight sun and polar nights, researchers have found little variation in sleep-wake timing.

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SleepScore Labs
0953 A Novel Active Humidifier for Non-Invasive Ventilated Patients
Authors: Moylan Melanie , Cunningham Helen , Grau-Bartual Sandra
Published: May 2023

Introduction

The RespirAq® humidifier is a novel, active heated humidifier that humidifies without the need for additional water. Within milliseconds, the humidifier switches between a super-hydrophilic state to capture moisture during expiration, and a super-hydrophobic state, returning moisture during inspiration. The device delivers gases at 37°C/100% relative humidity to individuals requiring humidification, including those with tracheostomies. We demonstrated the device meets EN ISO 80601 2 74:2020 during bench testing. This study aimed to compare the performance of the novel humidifier with a heated humidifier - HH (MR850™ Fisher & Paykel Healthcare) and a heat and moisture exchanger - HME (DAR™ Covidien) in healthy volunteers during non-invasive ventilation (NIV) using a non-vented full face mask.

Methods

Ten healthy volunteers were recruited. NIV was performed at different settings (inspiratory positive airway pressure (IPAP) range 5-20cmH20, expiratory positive airway pressure (EPAP) = 5cmH20) over a one-hour period. Humidity and temperature were collected continuously during the study.

Results

Sixty per cent of participants were female. Mean age of 35.6 ± 5.89 years (M±SD, n=10). Absolute humidity inside the face mask increased from 22.55 ± 2.41 mg/L without humidification to 30.18 ± 2.07 mg/L with an HME, and 39.09 ± 1.05 mg/L and 38.23 ± 1.78 mg/L when using a water-based heated humidifier and the novel humidifier, respectively. When comparing the performance of the humidification devices head-to-head, the two heated humidifiers significantly outperformed the HME (HME vs Novel = P < 0.0001, HME vs HH = p < 0.0001) and there was no significant difference seen between the two active humidifiers (p =0.2047).

Conclusion

Results show that the device meets the 12 mg/L absolute humidity established by the EN ISO 80601-2-74:2020 standards and that there is no significant difference in performance compared to traditional heated humidification. This suggests that the novel device can deliver the performance of a heater humidifier at the size, reliability and ease of use of a heat and moisture exchanger. Due to the mechanism of action, droplet/aerosol transmission of COVID-19 may also be mitigated. Further studies are warranted to confirm these findings.

Support (if any)

This research was supported by Tier 2 KiwiNet funding.