bluuebunny/crossref_metadata_2025 huggingface dataset:
0787 Autonomic Dysfunction and Phenoconversion in Idiopathic/Isolated REM Sleep Behavior Disorder
Authors: McCarter S , Gehrking T , St. Louis E , Suarez M , Boeve B , Silber M , Low P , Singer W
Published: May 2020

Introduction

REM-sleep behavior disorder (RBD) is a common finding among patients with synucleinopathies. We aimed to determine the degree of autonomic dysfunction in patients presenting with idiopathic RBD (iRBD), and the predictive value of autonomic dysfunction for phenoconversion to a defined neurodegenerative disease.

Methods

We searched our electronic medical record for patients diagnosed with iRBD who also underwent standardized autonomic function testing within 6 months of iRBD diagnosis, and who had clinical follow-up of at least 3 years following iRBD diagnosis. Patients who received a diagnosis of phenoconversion within 3 months of autonomic testing were excluded. The composite autonomic severity score (CASS) was derived and compared between phenoconverters and non-converters using chi-square and Wilcoxon rank-sum tests.

Results

We identified 18 patients who fulfilled in- and exclusion criteria. Average age at autonomic testing was 67 ± 6.6 years. Twelve (67%) patients phenoconverted during the follow-up period; 6 developed PD, the other 6 DLB. Fifteen (83%) patients had at least mild autonomic dysfunction. There were no significant differences between overall converters and non-converters in total CASS or CASS subscores. However, iRBD patients who developed DLB had significantly higher total and cardiovagal CASS scores compared with those who developed PD (p <0.05), and a trend for higher adrenergic CASS scores compared to those who developed PD and those who did not phenoconvert (p=0.08 for each).

Conclusion

Autonomic dysfunction was seen in 83% of iRBD patients, and more severe baseline cardiovagal and adrenergic autonomic dysfunction in iRBD was associated with phenoconversion to DLB but not PD. Prospective studies are needed to confirm the value of autonomic testing for predicting phenoconversion and disease phenotype in iRBD.

Support
0794 Reduction in Restless Legs Syndrome Symptoms with Non-Invasive Peripheral Nerve Stimulation
Authors: Charlesworth J D , Baker F C , Kolotovska V , Adlou B , de Zambotti M , Ismail M , Raghunathan S , Singh H , Buchfuhrer M J
Published: May 2020

Introduction

Restless Legs Syndrome (RLS) is a sensorimotor neurological condition characterized by an uncontrollable urge to move the legs that interferes with falling and staying asleep. For the over 5 million Americans with clinically significant RLS, these symptoms occur multiple nights per week, significantly impair quality of life, increase the prevalence of depression and anxiety, and increase suicide risk. FDA-approved medications for RLS are associated with progressively worsening RLS symptoms and numerous adverse events, whereas existing medical device treatments have limited efficacy.

Methods

We evaluated a novel neurostimulation intervention for RLS developed by Noctrix Health; electrical stimulation was applied non-invasively and bilaterally to the peroneal nerve of patients with moderate-to-severe primary RLS. Stimulation parameters were engineered to maximize therapeutic efficacy while minimizing interference with sleep. To assess the therapeutic efficacy of this technique, we conducted a multi-site randomized patient-blinded crossover trial comparing active neurostimulation treatment to a sham device. Following a lab visit for calibration, optimization, and training, each patient was instructed to self-administer each treatment - active and sham - for 14 consecutive nights at home.

Results

Active neurostimulation treatment resulted in a clinically significant reduction in RLS severity of 4.2 points on the International RLS Rating Scale (IRLS) relative to sham (P<0.01), comparable to FDA-approved medications. Moreover, 79% of patients demonstrated a clinically significant improvement on the Clinical Global Impressions-Improvement scale (CGI-I) compared to 7% for sham (P<0.01).

Conclusion

To our knowledge, this is the first sham-controlled study demonstrating a clinically significant reduction in RLS severity resulting from a non-pharmacological intervention. This therapeutic effect was sustained over 2-weeks of in-home patient-administered usage, indicating consistent efficacy. A medical device based on this technology could be a promising alternative or complement to medications.

Support

Funding was provided by Noctrix Health, Inc.
0798 “Uncovering My Feet Alleviates My Restless Legs”: Impact of Different Activities and Conditions on Restless Legs Symptoms
Authors: Karroum E G , Leu-Semenescu S , Amdur R , Arnulf I
Published: May 2020

Introduction

The restless legs syndrome (RLS) is a resting wake state disorder with inactivity/decreased movement as an aggravating factor and activity/increased movement as an alleviating factor. Other activities and conditions may impact RLS symptoms but have not been systematically studied.

Methods

Fifty-six patients with primary severe RLS (age: 64.1±11.3; 66% women) responded about the effect of 20 activities/conditions on their RLS symptoms. Responses were assigned a numerical value: Aggravation (-1), No effect/Don’t know (0), Alleviation (+1), with calculating a mean effect score for each activity/condition and using a sign test to determine if that score was significantly above or below zero (no effect). Responses were further analyzed based on age, age at RLS onset, duration of RLS, RLS severity, gender, Familial/Non-familial RLS, and Painful/Non-Painful RLS. Association of continuous variables and categorical variables with each activity/condition was examined using Spearman correlation test and Fisher exact test, respectively. Bonferroni p threshold was set at p=0.00036.

Results

Activities/conditions with significant (p<0.0001) positive mean effect scores were: Feet uncovering (0.70); Leg massaging (0.63); Cold showers (0.54); and Manual activities (0.46). Activities with significant negative mean effect scores were: Vehicle passenger (-0.80); Show attendance (-0.70); Bedsheets weight on legs (-0.57); Watching TV (-0.54); High ambient temperature (-0.45); During meals (-0.39) (all p<0.0001); and Bedsheets rubbing on legs (-0.34; p=0.0002). Activities/conditions with no significant (all p>0.00036) mean effect scores were: Driving (0.00); Gambling (0.02); Professional activities (0.13); Hot showers (0.13); Using computer (0.14); Low ambient temperature (0.21); Sexual activities (0.27); Mental activities (0.29); and Sports activities (0.34). There was no significant association between each activity/condition and age, age at RLS onset, duration of RLS, RLS severity, gender, Familial/Non-familial RLS, or Painful/Non-Painful RLS.

Conclusion

There is a wide range of impact of different activities/conditions on RLS symptoms. These could be further considered in the non-pharmacological treatment or prevention of RLS symptoms.

Support

This study was not funded.
0807 NREM Parasomnias: Retrospective Analysis Of Treatment And Outcomes
Authors: Limbekar N , Pham J , Yusuf H , Budhiraja R , Javaheri S , Epstein L J , Pavlova M
Published: May 2020

Introduction

NREM parasomnias are relatively common among children and sometimes persist in adulthood. These behaviors may result in injury or have negative impacts on functioning and quality of life thus necessitating treatment. The treatment is challenging given the lack of evidence for frequently used medications such as benzodiazepines (BDZ) or tricyclic antidepressants (TCA). The aim of this retrospective analysis is to determine the most frequently prescribed medications for treatment of NREM parasomnias and evaluate reported outcomes.

Methods

We performed a retrospective chart review of all patients with NREM parasomnia diagnosed within BWH clinics examining the date of diagnosis, date of starting therapy, comorbidities, type of medication prescribed, and the reported change in symptoms or side effects at the individual’s follow-up visits.

Results

From 2012 to 2019, 123 patients (64 females, 59 male) at BWH clinics received the diagnosis of NREM parasomnia, including sleepwalking and night terrors. Mean age was 44. Comorbidities included depression=16, anxiety=32, seizures=6, RLS=9, epilepsy=5, insomnia=29, and OSA=57. Initial treatment included safety counseling (72), BDZ (7), TCA (4), and treatment of comorbidity (23). Treatment of OSA only (n=15) was effective in 66% (n=10) and 33% were lost to follow up. Of those with OSA treatment plus BDZ (n=6), treatment was effective in 50% (n=3). Of those receiving BDZ only (n=7), treatment was effective in 43%. Of those receiving Melatonin (8),treatment was effective among 62.5% (n=5). TCAS (n=4) were effective in 3 patients (75%). Treatment of comorbid conditions without pharmacotherapy (23) was effective in 35% (n=8) while the remaining 65% (n=15) were lost to follow up.

Conclusion

Treating comorbid conditions such as OSA, insomnia, RLS, depression, and anxiety is a frequent treatment strategy. Additional pharmacologic treatment most commonly includes melatonin, BDZs, and TCAs.

Support

None
0808 High Density EEG Correlates Of NREM Sleep Parasomnia Episodes
Authors: Valomon A , Nakamura K P , De Cuntis I , Kummerow E , Bazalakova M , Plante D T , Riedner B A , Jones S G , Tononi G , Boly M
Published: May 2020

Introduction

Parasomnia episodes (PE) consist of abnormal behaviors during sleep. Using high-density EEG (HDEEG), we sought to quantify topographical differences in spectral power during PE in comparison to wake and sleep.

Methods

17 adult subjects with a history of NREM sleep parasomnia underwent 256-electrode HDEEG recordings during recovery sleep after 25h of sleep deprivation. PE occurred either spontaneously or when triggered by a sound. Data preprocessing of PE, sleep and wake data included filtering at 1-25 Hz, careful epoch and channel selection, and adaptive mixture independent component analysis (AMICA). We compared topographies of delta (slow wave activity, or SWA) and theta power, alpha power, and beta/delta ratio (a marker of cortical arousal) between states using paired t-tests. All results were thresholded at p<0.05 corrected for multiple comparison using statistical non parametric mapping (SNPM).

Results

Clean data were obtained in 26 PE arising out of N2/N3 sleep in 11 subjects. During PE, delta and theta power were significantly higher than during wake but lower than during sleep in central regions (at uncorrected p<0.05 for sleep vs. PE delta power). Occipital alpha was lower during PE compared to wake, but higher during PE compared to sleep. Finally, beta/delta ratio values during PE were globally higher than in wake, but globally lower than during sleep.

Conclusion

The present results confirm and extend our previous findings of decreased SWA in central areas during baseline sleep in patients with NREM sleep PE. They suggest that higher cortical arousal in central regions may precipitate motor behaviors during PE. Alpha power and beta-delta ratio during PE were intermediate between sleep and wake, suggesting that PE are transitional states with an admixture of cortical arousal and cortical sleep. Future analyses will use source reconstruction to identify the cortical generators of observed scalp differences.

Support

This work was funded by the Swiss National Science Foundation and the Tiny Blue Dot foundation.
0828 Descriptive Model of Sleep Quality in the Older Adults
Authors: Morelhao P K , Fernandes G L , Dokkedal-Silva V , Pires G N , Tufik S , Andersen M L
Published: May 2020

Introduction

Poor sleep quality is a health condition that impacts the quality of life of the older population. In the literature, there are questions about which objective sleep parameters should be considered to describe precisely the definition of sleep quality. There is ongoing debate with this term usually being used in relation to subjective sleep perception. This study aimed to investigate which objective and subjective sleep parameters contribute to a measurement of sleep quality in older adults.

Methods

A cross-sectional study using a representative sample of adults from the city of São Paulo, Brazil was performed. We used a dataset from the 2015 Epidemiological Study of Sleep from the City of São Paulo (EPISONO), including only individuals aged 60 years or more. We used exploratory factor analysis and structural equation modelling to identify relevant variables to a descriptive model of sleep quality.

Results

A total of 152 older adults were included. The final model consists of two factors, objective sleep quality which comprises sleep efficiency, total sleep time and sleep latency, and poor sleep perception, constituted by scores in the Pittsburgh Sleep Quality Index and Insomnia Severity Index.

Conclusion

The results suggested that sleep quality had both an objective (sleep efficiency, total sleep time, latency of sleep onset) and subjective dimensions (subjective questionnaires). These results may be useful in the clinical scenario, serving as leads for a better understanding of the sleep quality in aging patients. Future studies may also benefit from this descriptive model to further researches other associations, such as sleep and pain in this population.

Support

The study was supported by Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Nível Superior (CAPES). ST and MLA received support from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
0836 Self-Reported Difficulty Initiating Sleep and Early Morning Awakenings are Associated With Nocturnal Diastolic Non-Dipping in Older Men
Authors: Tan X , Benedict C
Published: May 2020

Introduction

Aging increases the risk of insomnia and elevated blood pressure (BP). Here, we examined in older men whether reports of difficulty falling asleep (DIS) and early morning awakenings (EMA) are associated with 24-h BP and heart rate.

Methods

We utilized variables from 995 men (mean age: 71 years) who participated in the Uppsala Longitudinal Study of Adult Men (ULSAM). BP and heart rate were measured over 24 hours.

Results

Non-dippers (night-to-day BP ratio > 0.90) had a higher risk of hypertension than dippers (systolic non-dippers vs. systolic dippers, OR [95%CI]: 1.64 [1.21, 2.21], P=0.001; diastolic non-dippers vs. diastolic dippers, 1.50 [1.10, 2.04], P=0.01). Compared to men without DIS, men who reported DIS (10% of the cohort) had a higher risk of diastolic non-dipping (1.85 [1.19, 2.87], P=0.006). Similarly, men who reported EMA (19% of the cohort) had a higher risk of diastolic non-dipping than those without EMA (1.59 [1.12, 2.24], P=0.009). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+1.4 mmHg, P=0.035), no other differences in BP and heart rate were found between men with and those without insomnia complaints.

Conclusion

Our findings uncover a link between disruption in nocturnal dipping of diastolic BP and insomnia symptoms related to difficulty initiating sleep and early morning awakening in older men.

Support

Authors’ work is funded by the Novo Nordisk Foundation (C.B., NNF19OC0056777), Swedish Brain Research Foundation (C.B., FO2019-0028), Swedish Research Council (C.B., 2015-03100), Åke Wiberg Foundation (X.T., M18-0169, M19-0266), Fredrik and Ingrid Thuring Foundation (X.T., 2018-00365), and the Swedish Medical Research Society (X.T., P18-0084).
0852 Geriatric Health Conditions And The Combined Outcome Of Poor Sleep Quality With Objective Short Sleep Duration
Authors: Miner B , Vaz Fragoso C A , Han L , Yaggi H K , Redeker N S , Stone K L
Published: May 2020

Introduction

Poor sleep quality with objective short sleep duration (≤6 hours) is a high-risk phenotype. The associations of geriatric health conditions with this sleep phenotype have not been described.

Methods

Using data on 3,127 older women from the Study of Osteoporotic Fractures (SOF), mean age 84 years, and 3,058 older men from the Osteoporotic Fractures in Men Sleep Study (MrOS), mean age 76 years, we evaluated cross-sectional associations between geriatric health conditions and the combined outcome of poor sleep quality with actigraphic short sleep duration. Geriatric health conditions included cognitive impairment (modified MMSE score 1.5SD below the cohort mean value), physical impairment (inability to do a chair stand), falls (≥2 in past year), and vision impairment (acuity ≤20/40). Poor sleep quality was defined by Pittsburgh Sleep Quality Index (PSQI) score >5 and short sleep duration by average total sleep time ≤6 hours from wrist actigraphy (averaged over ~5 days). Women (SOF) and men (MrOS) were evaluated separately and multivariate logistic regression models also included age, race, education, comorbidities (medical, psychiatric, and primary sleep disorders), and medication use.

Results

Poor sleep quality with actigraphic short sleep duration was present in 475 (15.6%) men and 400 (13.1%) women. In men, the unadjusted odds of having combined poor sleep quality with actigraphic short sleep duration were statistically higher with cognitive impairment (OR=1.45 [CI 1.05, 1.98]), physical impairment (2.90 [1.87, 4.51]), and falls (1.97 [1.48, 2.62]). In women, the unadjusted odds of having combined poor sleep quality with actigraphic short sleep duration were statistically higher with physical impairment (1.54 [1.16, 2.04]) and falls (1.63 [1.21, 2.20]). However, these associations were no longer statistically significant in adjusted models (men and women).

Conclusion

Older persons with geriatric health conditions are more likely to have the combined phenotype of poor sleep quality with actigraphic short sleep duration, but this association is likely explained by comorbidity and medication use.

Support

Dr. Miner is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine, and the National Institute on Aging T32AG019134.
0856 Relationship Between A Composite Measure Of Sleep Health And Bone Mineral Density In A Sample Of Older Women From The Study Of Osteoporotic Fractures
Authors: Kubala A G , Sullivan K J , Kline C E , Cauley J A
Published: May 2020

Introduction

Observational studies suggest poor sleep is related to lower bone mineral density (BMD) and increased osteoporosis risk. Yet, many studies focus on sleep duration and lack inclusion of other sleep characteristics. The sleep health construct simultaneously recognizes multiple dimensions of sleep and is operationalized as a composite score. Thus, we examined whether a composite measure of sleep health was related to BMD in a sample of older women.

Methods

The sample included 1968 older women (mean age: 83.6 ± 3.1 years) from the Study of Osteoporotic Fractures. Six sleep health domains (regularity, duration, satisfaction, timing, efficiency, sleepiness/alertness) were dichotomized into either “good” or “poor” categories. The number of “good” characteristics were summed into a score ranging from 0 (poor) to 6 (good). BMD (g/cm2) was measured at the femoral neck, total hip, and trochanter sites with dual energy x-ray absorptiometry. Multiple linear regression was used to explore the association between sleep health (composite score and the individual domains) with BMD (cross-sectional) and annualized percent change in BMD (longitudinal). All models were adjusted for age, body mass index, alcohol consumption, smoking, physical activity, education, diabetes, hyperthyroidism, fracture history, and cardiovascular disease.

Results

Average sleep health score was 3.8±1.2. Cross-sectionally, better sleep health was associated with higher BMD at the femoral neck (β=.04, p=.04) and trochanter (β=.05, p=.02). Sleep health was not cross-sectionally associated with BMD at the total hip (β=.03, p=.09) or with change in BMD at any region (Each p >.13). The individual domain of sleep regularity was cross-sectionally related to BMD at the total hip and trochanter, respectively (β=.04, P=.04; β=.05, P=.02).

Conclusion

A multi-dimensional measure of sleep health was related to greater BMD cross-sectionally at the femoral neck and trochanter regions in a sample of older women. Future studies should focus on associations between sleep health and osteoporotic-related fractures.

Support

The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576
0860 Sleep Disorders In Female Military Personnel
Authors: Villarreal B , Foster S , Hansen S , Brock M , Sanchez H , Gerwell K , Carrizales F , Peterson A , Pruiksma K , Mysliwiec V
Published: May 2020

Introduction

Sleep is an essential biological function and the disruption of sleep has deleterious consequences. Military personnel experience unique stressors related to their service, elevating the risk of developing sleep disorders. The etiologies and impact of sleep disorders on military women’s health is poorly understood. This study is the first to prospectively assess whether military women with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA) have different gender roles, military service-associated factors, and biological characteristics than military men with the same disorders.

Methods

This is a prospective observational study of military personnel with sleep disturbances. The study will evaluate women and men matched for sleep disorder. Participants will complete an evaluation to include polysomnography (PSG), sleep questionnaires and validated clinical assessments of associated disorders of interest. The baseline demographics, questionnaire, and PSG results will be analyzed to assess for commonalities or differences between genders.

Results

We have enrolled 45 patients (24% female). Males had a higher BMI (29.1) than females (26). Males were also older (38) than females (35). The leading diagnosis in males was OSA (44%) and insomnia in females (64%). In males, the apnea-hypopnea index (AHI) was 11.3/hr, arousal index (ARI) was 20/hr, and sleep efficiency (SE) was 86.5%. Total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL) were 364.6, 40.9, and 12.6 minutes, respectively. In females, the average AHI was 6.6/hr, ARI was 15/hr, and SE was 87.2%. Their TST, WASO, and SOL were 359, 44, and 12.6 minutes, respectively.

Conclusion

Military personnel are at increased risk of sleep disorders. Literature comparing male and female characteristics and sleep disorders is scarce. In this study, baseline demographics were similar in both groups but insomnia was the leading diagnosis for women. This emphasizes the importance of adequate recognition and treatment of insomnia in this group.

Support

This study is supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health.
0861 Age, Race, And Continuous Positive Airway Pressure (CPAP) Confidence Score At 1-week Predict 3-month CPAP Adherence In Older Adults With Amnestic Mild Cognitive Impairment And Moderate To Severe Obstructive Sleep Apnea
Authors: Richards K C , Vallabhaneni V , Moelter S , Davis E M , Morrison J , Lozano A , Hanlon A , Wang Y , Wolk D , Gooneratne N
Published: May 2020

Introduction

Adherence to continuous positive airway pressure (CPAP) may delay cognitive decline in older adults with obstructive sleep apnea (OSA) and amnestic mild cognitive impairment (MCI), defined as deficits in memory that do not significantly impact daily functioning. The aim of this analysis was to identify predictors of CPAP adherence in this population.

Methods

Data are from Memories 2, an ongoing multisite clinical trial on the effect of treatment of moderate to severe OSA on cognitive decline in older adults 65-85 years of age who have amnestic MCI. Unadjusted and adjusted linear models were used to examine predictors of mean hours of CPAP use at 3 months. Predictors were age, sex (male/female), race (White/Non-White), education (more than high school, less than high school), Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and CPAP Comfort and Confidence scores at 7 days. Collinearity in the adjusted model for CPAP use at 3 months was examined using the variance inflation factor.

Results

Of 57 participants, most were male (54%), White (72%), with a mean age of 66.3 years (SD: 6.1). Mean AHI in this sample was 35.1 (SD: 19.9), with mean daily hours of CPAP use at 3 months 5.3 hours (SD: 2.3). Adjusted linear model results demonstrated that younger age (β=-0.13, SE=0.04, p=0.0032), White race (β=2.56, SE=0.58, p<0.0001), and higher 7-day CPAP Confidence score (β=0.48, SE=0.17, p=0.0086) were significantly associated with CPAP use at 3 months. Sex, education, AHI, ESS, and CPAP comfort were not statistically significant predictors of adherence.

Conclusion

Tailored interventions to increase self-efficacy during the first 7 days of CPAP treatment, especially in Non-Whites and those older than 74 years, may improve long-term CPAP adherence in older adults with amnestic MCI.

Support

R01AG054435
0871 Air Pollution Exposure And Adverse Sleep Health Across The Life Course: A Systematic Review
Authors: Liu J , Wu T , Chen J
Published: May 2020

Introduction

An increasing number of epidemiologic studies have examined air pollution as a possible contributor to adverse sleep health, but the results were mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan.

Methods

PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining the direct epidemiological associations between air pollution exposures, both ambient and indoor, and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness.

Results

Twenty-two articles from 2010-2019 spanning a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other) were selected for inclusion. Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. Increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes in children and adolescents. In adults, air pollution exposure was most notably related to sleep disordered breathing severity.

Conclusion

Existing literature generally show negative relationships between exposure to air pollution and sleep health across different ages, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methodologies and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures an individual encounters may help ameliorate variability in the results reported by current published literature.

Support

yes
0880 A Pilot Study Evaluating the Effect of Head Elevation During Sleep on Obstructive Sleep Apnea in Pre-Pubertal Children with Down Syndrome
Authors: Kaplan K , Spielberg D , Petitto L , Musso M , Glaze D
Published: May 2020

Introduction

Children with down syndrome are at high risk for developing obstructive sleep apnea when compared to typically developing children. Treatment of obstructive sleep apnea is complicated as these children often struggle with traditional therapies such as positive airway pressure. In adult populations it has been shown that head elevation is successful in reducing the severity of OSA (AHI). The hypothesis of this study is that head elevation (30°) would improve OSA in a cohort of pre-pubertal children with down syndrome.

Methods

Children with down syndrome, aged 4-13, presenting to the sleep clinic at Texas Children’s Hospital were screened for enrollment into the study (n=21; 11 male). Subjects were randomized to begin a diagnostic polysomnogram with either the head of the bed flat (0°) or elevated (30°). Head position was alternated every 2 hours during the study. Studies were performed in an AASM pediatric sleep center by a registered PSG technologist. Studies were scored using AASM pediatric scoring rules. Data was analyzed using paired student t-tests. Each subject served as their own control.

Results

There was no significant difference in AHI (p=0.71), RDI (p=0.7), O2 nadir (p=0.17), total sleep time (p=0.34), sleep efficiency (p=0.28), time in REM sleep (p=0.94) or arousal index (p=0.14) when the head of the bed was flat (0°) versus elevated (30°). The study shows that head elevation is not successful in significantly reducing obstructive sleep apnea in a pre-pubertal pediatric population of children with down syndrome.

Conclusion

In children with down syndrome, aged 4-13, referred for a diagnostic sleep study, there is no improvement in OSA due to head elevation (30°) when compared to sleeping flat (0°). These findings were independent of if the subject started with the head of the bed flat or elevated. Other cofounders were eliminated as each subject served as their own control.

Support

No external funding was utilized for this study.
0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome
Authors: Yu Y A , Vaughn B V
Published: May 2020

Introduction

Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing.

Methods

This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed.

Results

Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen.

Conclusion

Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS.

Support

None.
0908 The Impact Of Adenotonsillectomy On Obstructive Sleep Apnea In Children With Trisomy 21: A Retrospective Cohort Study
Authors: Platt J , Adeleye A , Nettel-Aguirre A , Chugh A , Yunker W
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) has a prevalence of 1 - 5.7% in the general pediatric population. In children with Trisomy 21 (T21), OSA is estimated to be much higher, at 30-60%. The medical consequences of untreated OSA may be significant, therefore it is worthwhile to explore treatment options. Adenotonsillectomy (AT) is often the first line treatment in children, including those with T21. However, success rates of AT in patients with T21 is more variable, and postoperative complications can be higher. The aim of this study was to determine the impact of AT on the apnea hypopnea index (AHI) in patients with Trisomy 21.

Methods

A retrospective cohort study was conducted by reviewing children with T21 and the following criteria: 1) 0 to 18 years of age, 2) AT completed between January 2010 to December 2015, 3) pre- and post-operative polysomnogram (PSG). Data extraction included demographics, details of PSG both prior to and after surgery including severity of sleep apnea and oxygen levels, type of surgery, and surgical complications.

Results

Our sample consisted of 64 subjects. Mean pre-operative AHI was 32.2, while mean post-operative AHI was 8.0, for a difference of 21.7 (p = 0.0001). Mean pre-operative oxygen saturation was 92.5, while mean post-operative oxygen saturation was 93.7, for a difference of 1.2 (p = 0.01). There were 10 post-operative emergency room visits (15.3%), 2 admissions to hospital (3.1%) and 2 repeat surgeries for post-operative bleeding (3.1%).

Conclusion

Preliminary findings of this study show a statistically significant improvement in OSA severity as determined by change in AHI and mean oxygen saturations post AT in children with T21. Complication rates were low. Further data collection and analysis is underway.

Support

None.
0913 Ambulatory Blood Pressure Monitoring In Children With Obstructive Sleep Apnea Syndrome
Authors: Geng X , Wu Y , Ge W , Feng G , Zheng L , Xu Z , Ni X
Published: May 2020

Introduction

This study was performed to investigate the differences in blood pressure among different groups of snoring children and among different sleep stages.In recent years, the incidence of OSAS in children has increased year by year. Blood pressure research of OSAS children can better understand the occurrence of OSAS related complications. Early detection and intervention of blood pressure changes in children with OSAS can effectively reduce the incidence of cardiovascular disease in adulthood and lower the disease burden.

Methods

Habitually snoring children (snoring frequency of ≥3 nights per week) aged 3to 11 years were recruited from Beijing Children’s Hospital, Capital Medical University from 1 January 2017 to 30 June 2018. All children underwent polysomnography, and their blood pressure was monitored and calculated by the pulse transit time. The children were divided into those with primary snoring (PS), mild obstructive sleep apnea syndrome (OSAS), and moderate to severe OSAS according to their obstructive apnea-hypopnea index (OAHI).

Results

In total, 140 children were recruited. Ninety-seven had PS, 24 had mild OSAS, and 19 had moderate to severe OSAS. There were no differences in age, sex, or body mass index z-score among the groups. Statistically significant differences were found in the OAHI, oxygen desaturation index 3%, respiratory arousal index, and lowest oxygen saturation among the three groups. Children with moderate to severe OSAS had higher systolic and diastolic blood pressure than those with mild OSAS and PS (P < 0.001). In all children, systolic and diastolic blood pressure was higher in the rapid eye movement (REM) sleep stage than in the non-REM sleep stage (P < 0.05).

Conclusion

Children with moderate to severe OSAS had higher blood pressure than those with PS and mild OSAS. Blood pressure in the REM sleep stage was higher than that in other sleep stages in all groups of children.

Support

The Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority (XTYB201807);Capital Health Research and Development of Special Funding (2018-1-2091);National Key Research and Development Plan (2017YFC0112502)
0915 Sleep Patterns and the Effect of Late Bedtime on School-Age Children and Adolescents: Preliminary Results
Authors: Matsangas P , Gratsia S , Cocos A , Vastardis H , Shattuck N L
Published: May 2020

Introduction

School-age children (6-13yrs) and teenagers (14-17yrs) should receive 9-11hrs and 8-10hrs of sleep/day, respectively. Several studies have shown, however, that these age groups are chronically sleep deprived. Our study assessed the sleep patterns of a sample of children and teenagers in Athens, Greece. The study is part of a larger project investigating the association between orthodontic treatment and sleep disturbances.

Methods

Participants (N=27; 69% females; 21 school-age children 9-13yrs, 6 teenagers 14-17yrs) were under treatment in the Orthodontic Clinic of the National and Kapodistrian University. Sleep was assessed with actigraphy/logs for 59±19 days.

Results

Participants slept on average 7.36±0.42hrs/day. Nighttime sleep was on average 7.23±0.43hrs (percentage sleep: 87.3%±3.38%). Four (14.8%) participants napped at least once/week. Compared to the lowest sleep duration recommended for their age group, participants showed a chronic sleep deficit of 1.42±0.52hrs/day (range: 0.32-2.15hrs). The younger age group had an average sleep deficit of ~1.6hrs compared to ~0.8hrs for the teenagers (p=0.006). During the school year, daily sleep duration increased by ~0.73hrs on weekends (7.78±0.67hrs) compared to school nights (7.05±0.48hrs; p<0.001). On average, school-age participants slept from 23:13 (±31min) until 7:19 (±22min) on school nights and from 23:23 (±2:72hrs) until 8:49 (±39min) on weekends. Teenagers slept from 00:34 (±36min) until 7:40 (±14min) on school nights and from 01:34 (±41min) until 10:34 (±48min) on weekends.

Conclusion

Our findings verify earlier survey results showing that restricted sleep is a problem for children and adolescents in Greece. To our surprise, both age groups go to bed quite late. The impact of late bedtime on sleep duration, however, is larger in the younger group due to their larger sleep needs. In contrast to earlier research in rural areas, napping was not common in our urban sample, probably due to extracurricular activities and studying at home.

Support

N/A
0916 The Use of Immersive Virtual Reality and Slow Breathing to Enhance Relaxation and Sleep in Adolescents
Authors: Yüksel D , Goldstone A , Prouty D , Forouzanfar M , Claudatos S , Lee Q , Wang R , Dulai T , Arra N , Volpe L , Durley I , Baker F , de Zambotti M
Published: May 2020

Introduction

Sleep disturbances frequently emerge during adolescence amongst profound, normative, sleep maturation and biopsychosocial changes. Factors like stress, worry or rumination may make falling asleep and maintaining sleep more difficult. Here, we evaluate the efficacy of a novel intervention based on virtual reality (VR) and slow breathing to promote bedtime relaxation and facilitate sleep in high-school adolescents.

Methods

Twenty-nine 16-18 year-old adolescents with (N=9, 6 girls) and without (N=20, 11 girls) sleep difficulties underwent two counterbalanced in-lab relaxation and baseline polysomnography (PSG) nights. For the relaxation condition, immediately preceding bedtime, participants were engaged in slow diaphragmatic breathing (to promote physiological downregulation) whilst passively experiencing a relaxation immersive VR environment, designed to promote cognitive relaxation/distraction (20min). On the baseline night, participants engaged in quiet activities (e.g., reading a book) before bedtime (20min).

Results

The VR intervention resulted in a significant immediate increase in perceived relaxation and reduced worry (p<0.05). Also, heart rate dropped (~5bpm) in the pre-to-post intervention (p<0.05), while no significant change in heart rate was evident before and after the time spent in quiet activities on the baseline night. PSG-defined sleep onset latency was shorter (~6min reduction) and sleep efficiency was greater (~3% increase) on the VR relaxation night compared to the baseline night (p<0.05). In addition, baseline sleep onset latency was related to the magnitude of the baseline-to-relaxation reduction in sleep onset latency in participants (R2=0.70; p<0.01). There was no apparent difference in responses to the VR intervention between adolescents with or without insomnia.

Conclusion

Our data highlight the potential for combining cognitive relaxation/distraction strategies, using immersive VR technology and physiological downregulation, to promote bedtime relaxation and improve overall sleep quality in adolescents. Further research is needed to evaluate the feasibility and effectiveness of such interventions over time.

Support

National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)
0945 Adolescent Sleep Mediates Maternal Depression and Harsh Parenting
Authors: Stearns M , Wilkerson A , Speed K J
Published: May 2020

Introduction

Mothers dealing with depressive problems often report using more harsh parenting practices. This occurs, in part, due to a scarcity of effective coping mechanisms and increased irritability. In addition, depressed mothers are less likely to set consistent rules and expectations within the home, which may result in children who stay up late. Children who get inadequate levels of sleep also are more likely to have behavior problems, irritability, and defiance toward their parents, particularly in adolescence. However, no studies have examined the potential of adolescent sleep as a contributor to the association between maternal depression and the use of harsh parenting. The current study examined whether mothers’ perceptions of inadequate adolescent sleep duration mediated the relationship between maternal depression and harsh parenting, with child gender as a moderator.

Methods

The sample (N=318) consisted of mothers reporting on adolescents aged 16-18 (M=16.89, SD = .429; 53.4% female) from the 10th wave of the Schools and Families Educating Children Study (SAFE). The SAFE study was a randomized control trial conducted from 1997-2008 designed to investigate children and families living in inner-city Chicago, Il. Measures included the Child Behavior Checklist (CBCL), Center for Epidemiologic Studies Depression Scale (CESD), and the Parenting Practices Questionnaire (PPQ).

Results

Too little adolescent sleep mediated (β = .15) the relation between maternal depression and her reported use of harsh parenting. Mediation was further moderated by child gender, such that the mediation occurred for sons (β = .12) but not daughters.

Conclusion

These results suggest that too little adolescent sleep is the process through which mothers experiencing depressive problems engage in more harsh parenting. In addition, important child gender differences were apparent, such that sons’ lack of sleep may be more related to maternal depression and the use of harsh discipline.

Support

United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse (5 R01 DA020829)
0963 Perceived Sleep Need in Adolescents and Acceptability of a Morning Bright Light Intervention
Authors: Culnan E , Eastman C I , Crowley S J
Published: May 2020

Introduction

We are testing strategies to make fall asleep times earlier to extend sleep duration of sleep-deprived, delayed adolescents. We explored whether perceived sleep need was associated with the acceptability of an intervention which included earlier bedtimes on school nights and early morning bright light (BL) on one weekend.

Methods

Twenty-three participants (16.0±0.7 years; N=11 female) from the intervention group of a study of adolescents reporting ≤7 h sleep on school nights and late bedtimes (school-night≥23:00; non-school night≥midnight) were included. Participants estimated nightly sleep need during baseline. The intervention included shifting school-night bedtimes 1h earlier than each participant’s usual school night bedtime during the first week and 2h earlier than baseline during the second week. Evening time management goals were used to help participants get to bed earlier. Wake times remained stable because of early school start times. During the weekend in between these 2 weeks, participants lived in the laboratory and received very early morning BL on Saturday and Sunday from two light boxes (~6000 lux; three 50-minute exposures with 10-minute breaks). At the end of the study, an acceptability questionnaire asked about hypothetically engaging in different elements of the intervention (earlier bedtimes, morning BL) at home. Items were summed to create a composite acceptability score.

Results

Participants reported needing 7.8 h (SD=1.2; range=5-9.5h) of sleep. A linear regression demonstrated that needing more sleep was associated with less acceptability when controlling for age and sex, b=1.37, SEb=.60, p=.03.

Conclusion

Adolescents who felt they needed less sleep were more accepting of an intervention that required earlier bedtimes on school nights and waking up very early to receive BL on the weekend. Interventions that produce less weekend sleep deprivation, like including naps, might be more acceptable to all.

Support

R01HL105395 (S.J.C.)
0970 Longitudinal Study Of Infant Sleep Problems And Influencing Factors
Authors: Zhou Z , Wang N
Published: May 2020

Introduction

To investigate the sleep problems and influence factors in infants at the age of 1 month and 6 months through longitudinal questionnaire survey.

Methods

600 healthy infants aged 1 month were selected from May to August 2014 from Chongqing health center for women and children. A self-made sleep questionnaire was used to investigate the infants’s sleep at the age of 1 month and 6 months respectively. Logistic regression model was used to analyze the correlation between sleep problems and factors.

Results

The incidence of nigt-waking, difficulty in falling asleep and night crying at 1 month of age were 30%, 17% and 14.1%, respectively, and at 6 months were 7.3%, 9.3% and 13.1%, respectively. Results of the Logistic regression analysis model of sleep problems of infants at 1 month old were: 1. body length grade, baby touch, sleep alone, putting the infants back into bed after being picked up and quiet, night feeding were the protective factors of night-waking, while diaper changing is the risk factor; 2.body length grade, listening to music, orderly bedtime routine, comforting without holding and putting the infants back into bed after being picked up and quiet were protective factors for difficulty in falling asleep, while diaper changing is the risk factor; 3. listening to music, orderly bedtime routine, watching and waiting, holding until sleep were all protective factors of night-crying. Logistic regression model analysis results of sleep problems of infants aged 6 months were: 1. The risk factors of night-waking include putting the infants back into bed after being picked up and quiet, holding the infants until falling asleep, diapers changing, and parent-children interaction before bedtime. 2. Listening to music and sleeping alone in a bed were protective factors for difficulty in falling asleep. 3. Touching, orderly bedtime routine and comforting without holding are protective factors of night-crying.

Conclusion

Sleep problems in infants are common and decrease with age. The factors of sleep problems at the age of 1 and 6 months are different, Targeted prevention are beneficial to the prevention of infant sleep problems.

Support

Chinese center for disease control and prevention grant