bluuebunny/crossref_metadata_2025 huggingface dataset:
0533 Age-related changes in sleep disordered breathing in pediatric Prader Willi Syndrome patients
Authors: Patel Neha , Gustavo Nino , Lew Jenny , Weiss Miriam , Aziz Julia
Published: May 2022

Introduction

Prader Willi Syndrome (PWS) is a rare genetic disorder characterized by infantile hypotonia, hyperphagia leading to early childhood obesity, and multiple sleep abnormalities including increased risk of obstructive sleep apnea, central sleep apnea, and excessive daytime sleepiness. PWS patients have been reported to have a shorter lifespan with respiratory related causes as a common cause of death. Limited data exists on PSGs in pediatric PWS patients. Our aim was to compare respiratory parameters in different age groups.

Methods

We conducted a retrospective chart review of pediatric patients with a genetically confirmed diagnosis of Prader Willi Syndrome from 2007 to 2015. In lab polysomnograms were scored using the AASM criteria for pediatric sleep studies. As central apneas are more commonly seen in infancy with PWS, we categorized patients into < 1 years old and 1-19 years old for comparison.

Results

Fifty-one PSGs were reviewed of which 31 (60.7%) were males and 20 (39.3%) were females. Forty-one PSGs were initial studies and 11 were repeat studies. Age at time of sleep study ranged from 11 days-19 years old. 8 (15%) subjects were < 1 years old and 44 (84%) were 1-19 years old. For patients < 1 year old, mean obstructive hypopnea index (OAHI) was 5.65±3.7, central index (CI)2.2±2.5, mean SpO2(%) 98±.4, SpO2 nadir 86±5.8, and % of time with SpO2 < 90% .16±.314. For patients 1-19 years old, mean (OAHI) was 8.7±13.4, (CI) 0.8±1.25, mean SpO2 96±3.0, SpO2 nadir 81±.10, and % of time with SpO2 < 90% .03±.10. The OAHI trended up in the 1-19 year old group but results were not significant, CI decreased in the 1-19 year old group 2.2 vs 0.8 p < .04.

Conclusion

Our study demonstrated similar results to prior studies in pediatric PWS with an increase in OAHI and decrease in CI with age. SPO2 nadir decreased in the 1-19 year old group but these results were not significant. Ongoing research at our center is looking at possible contributing factors including BMI percentile, GH therapy, and adenotonsillectomy to better understand our findings.

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0536 Association of a Novel EEG Biomarker of Sleep Depth with Sleep Disordered Breathing in Adolescents
Authors: Ricci Anna , He Fan , Calhoun Susan , Fang Jidong , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Younes Magdy , Fernandez-Mendoza Julio
Published: May 2022

Introduction

The odds ratio product (ORP) provides a standardized, continuous measure of sleep depth that ranges from 0 (deep sleep) to 2.5 (full wakefulness). ORP has been shown to increase during adolescence, representing the decline in sleep depth that occurs during this developmental period. In adults, higher ORP has been associated with sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), while there have been no studies in youth. We aimed to determine the association of ORP with SDB in adolescents.

Methods

We extracted ORP from the sleep EEG of 261 typically developing adolescents aged 12-23y (median 16y) from the Penn State Child Cohort. Higher ORP during rapid eye movement (REM) and non-REM sleep indicates less deep sleep, while higher ORP-9 (i.e., average ORP in the 9-seconds following non-REM cortical arousals) indicates greater arousability. We used general linear models, adjusted for sex, age and race/ethnicity, to examine mean differences in ORP metrics among clinically meaningful groups of SDB based on the apnea/hypopnea index (AHI) consisting of no SDB (AHI<2 and no snoring, n=100), primary snoring (AHI<2 and snoring, n=75), 2≤AHI<5 (n=64), and AHI≥5 (n=22).

Results

Adolescents with primary snoring or 2≤AHI<5 did not significantly differ in ORP metrics from those without SDB (all p≥0.12). Adolescents with AHI≥5 had higher ORP-NREM compared to those without SDB, with primary snoring or with 2≤AHI<5 (all p≤0.01), while ORP-REM was significantly higher compared to those without SDB (p=0.02). ORP-9 was significantly greater in adolescents with AHI≥5 compared to those with no SDB (p<0.01) and those with primary snoring (p=0.02), but not when compared to those with 2≤AHI<5 (p=0.07).

Conclusion

Our data suggest that adolescents with OSA experience lower REM and non-REM sleep depth/intensity (higher ORP) compared to those without SDB. In addition, these adolescents experience a slower progression back to deep sleep following cortical arousals (higher ORP-9), which suggests they remain in a high arousability state and, thus, are more likely to repeat arousals. Commensurate with previous studies in adults, our data show that ORP is a useful sleep EEG biomarker able to capture decreased sleep depth in adolescents with OSA.

Support (If Any)

National Institutes of Health (R01MH118308, UL1TR000127)
0544 Polysomnography characteristics of children with obesity: A single center retrospective study
Authors: Rao Harish , Bandyopadhyay Anuja , Slaven James , Saliba Gabriel , Jalou Hasnaa
Published: May 2022

Introduction

The constellations of symptoms known as obstructive sleep apnea (OSA) results from either partial or complete airway obstruction during sleep. This affects effective gas exchange and disrupts sleep architecture resulting in sleep fragmentation with downstream immediate and long-term adverse effects. Obesity is a significant risk factor in childhood OSA, especially in post-pubertal children. Obese/overweight children have been found to have significantly higher rates of OSA than their normal-weight counterparts, independent of tonsillar size. Polysomnography characteristics (PSG) comparing children with obesity with and without comorbidities (Hypertension, Diabetes or Pre-diabetes) has not been previously described.

Methods

Retrospective analysis of 190 obese children (BMI>95th centile), age between 7-18 years with AHI ≥5/hour met the criteria for the data analysis. Clinical, demographic and PSG parameters of children with obesity with and without co-morbidities were compared using Wilcoxon rank sum test. Correlation (Spearman non-parametric) and regression model was employed to explore associations between demographic and PSG characteristics.

Results

Majority of the obese children (mean BMI 33.2) had mild OSA, with no significant difference in AHI between the two groups. Children with obesity and comorbidities were older with higher BMI. There was no difference in BMI between the two groups after adjusting for BMI z scores. AHI increased with increasing BMI centiles. In our regression model, peak ETCO2 was associated with Black race, AHI, rhinitis and inversely associated with asthma. Peak ETCO2 increased with BMI. Oxygen at baseline, nadir and desaturation duration inversely correlated with BMI-centiles. Older children had lower O2 nadir. Black race was associated with higher desaturation, supine AHI, and arousal index. Supine AHI was higher with rhinitis. Average heart rate when awake, NREM and REM increased with higher BMI.

Conclusion

In our study, majority of the children had mild OSA with no significant difference in AHI between obese children with and without comorbidities. AHI, average heart rate and peak ETCO2 increased with BMI. O2 nadir was lower in older children and with higher BMI. Black race was associated with higher peak ETCO2, higher desaturation and supine AHI. Children with obesity and comorbidities were older with higher BMI suggesting synergistic effect of BMI and duration of obesity.

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0545 Metabolic Variables and the severity of Obstructive Sleep Apnea in non-obese children
Authors: Bhushan Bharat , Maddalozzo John , Johnston Douglas , Yasuda Mayuri , Billings Kathleen
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) can be associated with abnormal metabolic variables that may impact the overall health of the child into adulthood. Prior studies have focused on understanding the relationship of obesity, OSA, and metabolic alterations. Understanding the relationship of OSA and metabolic alterations in normal-weight children would improve understanding of the health impact of OSA in and of itself. The Objective of this study was to evaluate the association of OSA and metabolic variables, including lipid levels, blood glucose, and HbA1c in normal-weight children with OSA.

Methods

Prospective, case-control study performed at a tertiary care children’s hospital. Normal-weight children, aged 2-12 years, undergoing overnight polysomnography (PSG) for assessment of sleep disordered breathing were selected for participation in the study. Laboratory testing for lipid levels, fasting glucose, HbA1c were completed and analyzed relative to the PSG findings.

Results

A total of 61 patients with a mean age of 4.7±2.5 years were analyzed. Thirty-four (55.7%) patients were male, and 27 (44.3%) were female. The mean body mass index (BMI) z score was 0.5±1.2, and all patients were non-obese (BMI z score <85th percentile). Total cholesterol, fasting blood glucose, HbA1c levels were significantly higher in patients with OSA when compared to those with No-OSA (p<0.01). There was incremental worsening of blood glucose and HbA1c levels with greater severity of OSA. The apnea-hypopnea index (AHI) was positively and significantly correlated with blood glucose and HbA1c (p<0.001). Multiple linear regression analysis showed that the AHI was a predictor of blood glucose (p<0.001) and HbA1c (p<0.001) levels independent of age, gender, total sleep time, and BMI z score.

Conclusion

Increasing severity of OSA in non-obese children was associated with worsening levels of cholesterol, blood glucose, and HbA1c. This points to the importance of addressing the issue of OSA in children given the potential impact of these elevated levels on the overall health of the child.

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None
0549 Prevalence and Impact of Muscle Cramps in Patients with Restless Legs
Authors: Albazli Khaled , Walters Arthur S , Karroum Elias G
Published: May 2022

Introduction

Recent studies have shown alterations in Vitamin D binding protein in RLS, and Vitamin D is intimately related to calcium metabolism, while hypocalcemia is a well-known trigger for muscle cramps. The presence and consequences of muscle cramps in RLS has never been systematically studied. Therefore, the aim of this study was to determine the prevalence and impact of muscle cramps in RLS patients.

Methods

An email was sent to 4222 active members of the RLS foundation (RLSF) with a link to survey adult RLS patients. The survey included demographic information, questions on muscle cramps (including a visual analogue scale rating intensity), the Pittsburgh Sleep Quality Index assessing sleep disturbances, the 36-Item Short Form Survey Instrument (SF-36) evaluating health status, the 13-item short-form Cambridge-Hopkins diagnostic questionnaire (CH-RLSq13) for diagnosing RLS, and the International RLS Severity Scale measuring RLS severity. Patients who answered “yes” to the question “In the last 3 months have you experienced muscle cramps (defined as involuntary painful muscle contraction occurring at rest, not associated with exercise)?” were considered to have muscle cramps.

Results

A total of 509 RLSF members completed the whole electronic survey, while 317 participants (Age: 68.9±10.2; 73.1% Women; 97.8% White/Caucasian; BMI: 27.4±5.8) qualified as RLS patients and were included in further analysis. The prevalence of muscle cramps in RLS patients was 60.3%. RLS patients with (versus without) muscle cramps were more overweight (p=0.0119) and had lower scores (more disability) on several SF-36 health concepts including physical functioning (p=0.0093), role limitations due to emotional problems (p=0.0429), social functioning (p=0.0017), and more pain (p=0.0387). In addition, there was a weak (Spearman coefficient ρ=0.253) but significant positive correlation (p=0.0004) between intensity of muscle cramps and severity of RLS symptoms.

Conclusion

Muscle cramps were present in almost two-third of RLS patients and were associated with a negative impact on health status and severity of RLS. Therefore, from a clinical practice point of view, it seems warranted to screen for muscle cramps in RLS patients. RLS and leg cramps may theoretically be related to each other through calcium metabolism and/or through inflammatory mechanisms.

Support (If Any)

This study was not funded.
0550 Health-Economic Implications of Defined Improvements in Restless Leg Syndrome Severity: A Model-Based Exploratory Analysis based on Prior Publication Data
Authors: Cao Khoa , Winkelman John , Pietzsch Jan
Published: May 2022

Introduction

Restless leg syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for changes in symptom severity.

Methods

We identified two health-economic studies which reported severity-specific quality-of-life and resource utilization. Happe et al. 2009 reported HRQoL using EQ-5D measurements stratified by International Restless Legs Scale (IRLS) severity (n=519, 63.6% female, 64.2 years) and Durgin et al. 2015 reported healthcare utilization stratified by RLS severity (no/mild/moderate/severe RLS) (n=2,392, 56.9% female, 56.0 years). We fitted regression models to support IRLS-specific estimates of EQ-5D and healthcare resource utilization. These models (polynomial for EQ-5D, linear for resource utilization) were applied to calculate QALY gain, and events avoided for ER visits, hospitalizations, and healthcare provider (HCP) visits over 5 years for IRLS improvement of 1-10 points, from a baseline of 30, 25, and 20.

Results

At five years, a 1, 3, 5, 7, and 10-point IRLS reduction corresponded to a QALY gain of 0.09, 0.25, 0.40, 0.52, and 0.69 for a baseline of 30, 0.07, 0.19, 0.29, 0.37, and 0.47 for a baseline of 25, and 0.04, 0.12, 0.18, 0.22, and 0.26 for a baseline of 20. The events avoided over 5 years with an IRLS reduction of 1, 3, 5, 7, and 10 points respectively were 1.12, 3.37, 5.62, 7.87, and 11.25 HCP visits, 0.09, 0.26, 0.43, 0.61, and 0.87 ER visits, and 0.04, 0.11, 0.18, 0.26, and 0.36 hospitalizations.

Conclusion

This exploratory analysis based on two health-economic studies confirms the substantial quality-of-life and healthcare cost burden associated with RLS. The data provide guidance on the magnitude of potential quality-of-life improvement and cost reduction that might be associated with defined improvement in RLS severity. Further investigation may be warranted for the factors that link change in IRLS and healthcare resource utilization, such as sleep deficits or cardiovascular risks.

Support (If Any)

Funding was provided by Noctrix Health
0555 Isolated REM Sleep Without Atonia Following COVID-19 Infection: A Case-Control Study
Authors: Steele Tyler , Bauer David , Cesarone Olivia , Lovold Kevin , Paule Gwen , Bibi Noor , Strainis Emma , Williams Jacob , Jagielski Jack , Feemster John , Vissoneau Laurene LeClair , Boeve Bradley , Silber Michael , McCarter Stuart , Louis Erik St
Published: May 2022

Introduction

REM sleep without atonia (RSWA) is the neurophysiological substrate of REM sleep behavior disorder (RBD), a form of prodromal parkinsonism in most older adults. Isolated RSWA (without clinical RBD) elevation was demonstrated recently in older adults following SARS-CoV2 (COVID-19) infection, but comparison to controls was not reported. We aimed to comparatively analyze RSWA between patients with previous COVID-19 infection and COVID-19 negative controls.

Methods

25 patients with previous COVID-19 infection were compared to 25 age-sex matched controls who tested negative for COVID-19 prior to polysomnography. Patients receiving medications known to increase RSWA were excluded. We reviewed medical records to determine clinical features and quantitatively analyzed RSWA in the submentalis (SM) and anterior tibialis (AT) muscles for phasic, tonic, and “any” muscle activity, phasic burst duration, and the automated REM atonia index. Non-parametric analyses compared clinical and polysomnographic features between groups, with combined SM and AT RSWA as the defined primary outcome. The comparative frequency of COVID-19 positive cases and COVID-19 negative controls who met or exceeded proposed isolated RSWA thresholds was also determined.

Results

COVID-19 patients had significantly greater RSWA than COVID-19 negative controls in the combined SM and AT muscles (p = 0.00076). Most other RSWA metrics were also higher in COVID-19 patients than controls (p<0.03), except tonic muscle activity, phasic burst durations, and RAI. Isolated RSWA occurred more frequently in COVID-19 (9 patients, 36%) than controls (3, 12%; p>0.05). No patients had a clinical history or polysomnographic evidence for parasomnia behavior or a primary neurological condition.

Conclusion

Quantitative RSWA amounts were comparatively greater in COVID-19 patients than in COVID-19 tested-negative controls, suggesting association of previous COVID-19 infection with central nervous system brainstem dysfunction in the region of the dorsal pons and/or ventromedial medulla. Further prospective studies are needed to determine whether RSWA is a predisposing influence to, or consequence of, COVID-19 infection in these patients, and whether COVID-19 survivors might harbor neurodegenerative risk or disease markers.

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0556 Prevalence and Incidence of Hypnagogic Hallucinations In A Longitudinal Study Of The American General Population
Authors: Ohayon Maurice , Pakpour Amir , Cote Marie Lise
Published: May 2022

Introduction

Hypnagogic hallucinations are vivid hallucinations that occur at sleep onset, during the transition between wakefulness and REM sleep. The hallucinations can be visual, auditory, tactile or kinetic and can be terrifying for the individual who experience them. Hypnagogic hallucinations are a common symptom of narcolepsy, a disorder characterized by excessive sleepiness, cataplexy and disturbed sleep. The evolution of hypnagogic hallucinations remains seldomly investigated. There is no data regarding its incidence and its chronicity. This study examines the predictive factors for chronic hypnagogic hallucinations in the general population.

Methods

This longitudinal study had two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the general population based on US Census. Analyses included subjects participating to both waves (N=10,931). Logistic regression models were used to determine the predictive variables for persistent hypnagogic hallucinations.

Results

At W1, 11.7% (95% CI:11.1%-12.3%) reported having experienced hypnagogic hallucinations in the previous year. At W2, 9.3% (95% CI: 8.8%-9.8%) reported hypnagogic hallucinations. A total of 22.8% of subjects with hypnagogic hallucinations at W1 still reported these hallucinations at W2 (2.1% of the sample). The 3-year incidence was 5.7% (95% CI: 5.3%-6.1%). After adjusting for age, sex, alcohol intake and medical conditions, persistence of hypnagogic hallucinations (i.e., present at both interviews) was predicted by the following factors: persistent pain (RR: 3.2 [95% CI:1.9-35.3] p<0.0001), persistent hypersomnolence (RR: 5.8 [95% CI:3.8-8.8] p<0.0001); persistent sleep paralysis (RR: 2.4 [95% CI:1.3-4.2] p=0.003); and persistent cataplexy-like symptoms (RR: 11.6 [95% CI:6.5-20.6] p<0.0001).

Conclusion

Hypnagogic hallucinations are frequent in the general population. Its chronicity is predicted mostly by factors associated with narcolepsy such as hypersomnolence, cataplexy and sleep paralysis.

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0557 Diagnostic Visual and Automated Polysomnagraphic REM Sleep Without Atonia Thresholds in Isolated REM Sleep Behavior Disorder 2.0
Authors: LaClair-Visonneau Laurene , Feemster John , Bibi Noor , Gossard Thomas , Jagielski Jack , Strainis Emma , Steele Tyler , Carvalho Diego , Timm Paul , Boeve Bradley , Silber Michael , McCarter Stuart , Louis Erik St
Published: May 2022

Introduction

Accurate, early diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial given its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds in a current cohort of iRBD patients using submentalis (SM) and individual four limb electromyography (EMG) recordings, including bilateral flexor digitorum superificialis (FDS) and anterior tibialis (AT) during polysomnography.

Methods

We analyzed RSWA in 20 iRBD patients and 20 age-sex-AHI matched controls who underwent polysomnography between 2017-2021 for phasic burst durations, phasic, tonic, and "any" muscle activity, and automated REM atonia index (RAI). Group RSWA metrics were analyzed with non-parametric comparisons, logistic regression, and receiver operating characteristic (ROC) curves to determine optimal diagnostic cutoff thresholds for iRBD. Correlation explored associative relationships between RSWA metrics, and principal components analysis (PCA) defined determinants of RSWA metric variance.

Results

All mean RSWA metrics were higher in iRBD patients than controls (p<0.05), except for left and bilateral AT phasic density and duration. RSWA(phasic%, AUC; "any"%, AUC) cutoffs were: SM (6.5%, AUC=90.2; 6.5%, AUC=92.5); L FDS (7.3%, AUC=95.8; 7.3%, AUC=95.8%); R FDS (5.4%, AUC=93.5; 5.8%, AUC=93.2%); Bilateral FDS (10.7%, AUC=96; 15.3%, AUC=95.8); L AT (6.7%, AUC=74.5; 6.7%, AUC=74.8%); R AT (4.7%, AUC=76.8; 4.7%, AUC=76.8%); Bilateral AT (7.5%, AUC=77.5; 7.5%, AUC=77.5%), combined SM/FDS (15.0%, AUC=95.5; 15.1%; AUC=95.8), combined SM/AT (16.5%, AUC=85.8; 21.0%; AUC=88.8),tonic (0.5%; AUC=85.9), and RAI (0.90; AUC=91.4). Phasic burst duration cutoffs were: SM=0.7s (AUC=90.2), L FDS=0.5 s (AUC=83.2), R FDS=0.6 (AUC=85.2), L AT=0.3 s (AUC=65.0) and R AT=0.4 s (AUC=77.0). PCA demonstrated that FDS and combined SM/FDS and SM/AT RSWA metrics best explained RSWA variance and differentiated controls from RBD, while SM and AT alone were less explanatory.

Conclusion

This study provides evidence for quantitative RSWA diagnostic thresholds applicable in current iRBD populations, and confirms the key importance of FDS to assure accurate iRBD diagnosis. Interestingly, these RSWA diagnostic thresholds are lower than previously determined thresholds, suggesting secular trends toward earlier iRBD detection and heterogeneous disease duration relative to polysomnography acquisition, underscoring the necessity of future large scale prospective, multicenter polysomnographic analyses to determine definitive iRBD diagnostic RSWA thresholds.

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0558 Emergence of Restless Legs Syndrome During Opioid Withdrawal
Authors: McCarter Stuart , Labott Joshua , Mazumder Mridul , Gebhard Judy , Cunningham Julie , Loukianova Larissa , Gilliam Wesley , Lipford Melissa
Published: May 2022

Introduction

Discontinuation of opioid medications may be associated with emergence of restless legs syndrome (RLS), which may complicate opioid withdrawal. However, this has not been systematically studied. We aimed to prospectively determine the frequency of the occurrence and severity of RLS symptoms in patients undergoing physician supervised opioid tapering during a 3-week interdisciplinary pain rehabilitation program.

Methods

Adult patients undergoing prescription opioid taper were prospectively recruited during their participation in the Mayo Pain Rehabilitation Center from 2016 to 2021. Subjects completed the Cambridge-Hopkins RLS Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Scale (IRLS) at baseline, midpoint, and dismissal from the program as well as 2 weeks, 1 and 3 months after dismissal from the program.

Results

101 patients participated with 61% being female taking a mean morphine equivalent dose of 46.6 ± 49.0 mg. Baseline prevalence of RLS symptoms was 29% (29/101), increasing to 32% (32/101) at midpoint of treatment and further to 35% (34/97) at dismissal from the program. Frequency of RLS symptoms peaked 2 weeks after dismissal at 38% (30/78) and steadily declined to 35% (28/80) and 31% (21/68) at 1 month and 3 months after dismissal, respectively. Thirty-five percent of patients without baseline RLS symptoms reported de novo RLS symptoms at some point during their opioid taper. RLS severity score followed a similar trend as the presence of symptoms with a baseline of 16.6 ± 10.0. RLS severity score was maximum at 19.1 ± 7.3 one month following dismissal and decreased but remained elevated above baseline at 3 months following dismissal.

Conclusion

Symptoms of RLS occurred in over a third of patients on chronic opioids and increased during opioid withdrawal, appearing to peak in frequency and severity 2-4 weeks after discontinuation and gradually improved 3 months after discontinuation. Over one-third of patients in our cohort developed de novo symptoms of RLS at some point during their opioid withdrawal. Physicians supervising individuals undergoing opioid withdrawal should be aware of the potential development of RLS symptoms which may hinder successful opioid withdrawal.

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0561 Sleep Disturbance Among COVID-19 Post-hospitalized Patients
Authors: Satashia Parthkumar , Castellanos Paula , Aleger Chary , Yin Mingyuan , Cheung Joseph
Published: May 2022

Introduction

COVID-19 primarily affects the respiratory system, however, a number of clinical sequela have emerged in patients recovered from COVID-19. Besides the most commonly reported symptoms of fatigue and dyspnea, early studies have found that sleep disturbance is also a common complaint. The aim of this study is to survey for sleep disturbance, degree of fatigue and daytime sleepiness in a group of post-hospitalized COVID-19 patients.

Methods

Patients who were discharged from Mayo Clinic hospitals after COVID-19 hospitalization were recruited in this study. Patients who have an existing diagnosis of sleep apnea or other sleep disorders were excluded from this study. Mayo Clinic patients who never had COVID-19 infection, nor a history of sleep disorders or other sleep disorders were also recruited as controls. Patients completed Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) questionnaires via REDCap. Wilcoxon rank sum test was used to evaluate the difference between cases and controls in continuous variables and Fisher’s exact test was used to compare categorical variables. Multivariable linear regression model was used to evaluate the difference in sleep and fatigue scores between cases and controls with baseline characters adjusted. All tests were two-sided with p value <0.05 considered statistically significant.

Results

A total of 62 patients who completed the questionnaires were included in the analysis. Among them, 33 had COVID-19. Cases were significantly older with higher BMI compared to controls. Global PSQI score (median=10 vs 6, p=0.015), ESS total score (median=8 vs 5, p=0.018) and FSS total score (median=30 vs 22, p=0.009) were all significantly higher for cases compared to control patients. After adjusting for age and BMI, the difference stayed statistically significant. The mean difference between cases vs controls was found to be 2.7 (95%CI:0.2-5.2, p=0.038), 2.93 (95% CI: 0.66-5.2, p=0.014), and 12.62 (95% CI:5.22-20.03, p=0.001) for PSQI, ESS, and FSS scores, respectively.

Conclusion

Preliminary results showed that sleep disturbance (PSQI) and daytime symptoms (measured by ESS and FSS) are found to be significantly higher among post COVID-19 hospitalized patients compared to controls.

Support (If Any)

This work is supported by the Mayo Clinic in Florida Department of Medicine Catalyst for Advancing in Academics award and the Mayo Clinic in Florida Research Accelerator for Clinicians Engaged in Research Program.
0573 Daytime and Nighttime Sleep and Symptoms of Depression and Anxiety in Adults with Inflammatory Bowel Disease
Authors: Conley Samantha , Proctor Deborah , Jeon Sangchoon , Redeker Nancy
Published: May 2022

Introduction

Inadequate sleep duration and daytime napping are associated with symptoms of depression and anxiety in the general population. People with autoimmune diseases frequently experience poor sleep and depressive and anxious symptoms; however, little is known about how sleep might contribute to depressive and anxious symptoms in this population. The purpose of this study was to explore the associations between nighttime sleep and naps and depressive and anxious symptoms in adults with inflammatory bowel disease (IBD).

Methods

We conducted a cross-sectional feasibility study of adults with IBD (Crohn’s disease and ulcerative colitis) ages 18 to 60 years recruited from a single academic IBD center. We measured depressive and anxious symptoms using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures. We elicited nighttime sleep [sleep duration, efficiency, and wake after sleep onset (WASO)] using wrist-worn actigraphs (Philips Spectrum Plus) and elicited naps and perceived sleep quality (analog scale 0-100) with sleep diaries over 10 days.

Results

We included 35 adults [age M = 37.8 (14.0); female N = 21 (60.0%); Crohn’s disease N = 18 (51.4%); clinical remission N= 22 (63.9%)]. Mean depression (51.4 SD= 9.1) and anxiety (52.6 SD = 9.9) were over the population-based cut-offs. Additionally, nightly sleep duration was short (M = 391.9 minutes SD = 52.5). Sleep efficiency (M = 83.0% SD = 5.5) was low, and WASO (M = 41.8 minutes SD = 19.9) was high. Twenty-one (60%) participants reported taking at least one nap (median = 2, range 1-7) over the 10 days. Depressive and anxious symptoms were higher in people who napped than those who did not nap with a moderate effect size (Cohen’s d = -.309, -.466 respectively). Sleep quality was correlated with symptoms of depression (r = .622, p < .001) and anxiety (r = .638, p < .001). No other sleep characteristics were associated with depressive and anxious symptoms (r < .1, p > .59).

Conclusion

Health care providers should assess for the presence of depression and anxiety in people with IBD who regularly nap and report poor sleep quality. Future research regarding the treatment of sleep, depression, and anxiety is needed in this population.

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American Nurses Foundation
0578 Clinical Patterns of Obstructive Sleep Apnea patients in COVID 19
Authors: Mechineni Ashesha , Gardner Jessica , Gordon Howard , Prasad Bharati
Published: May 2022

Introduction

Recent studies indicate Obstructive Sleep Apnea (OSA) patients have higher severity of respiratory compromise after COVID19 infection due to their sleep related hypoxemic burden. The pro-inflammatory state associated with OSA, sympathetic excitation, and recurrent hypoxemia may predispose to poorer post-COVID19 outcomes. We compared COVID19 infection outcomes in a cohort of hospitalized Veterans with and without OSA.

Methods

We used Jesse Brown Veteran Affairs Medical Center (JBVAMC) Registry for Research on Risk Factors and Outcomes of Veterans Evaluated for COVID19. The registry includes all patients who received a test for COVID19 at JBVAMC through November 8th,2021. Data are from the VA COVID19 Shared Data Resource and chart review, and include demographic data, pharmacological and non-pharmacological interventions, clinical outcomes, and pre-existing conditions. The study was approved by the Institutional review board (IRB). STATA v16 was used for data analysis.

Results

Of the 13,385 patients included in the registry, 1890 patients were found to have a positive COVID19 test, of which 625 were hospitalized and included in our study. The sample was older (mean age of 66.8 years), predominantly men (583, 93.3%) and African Americans (461, 73.8%). 18.7% (117, 18.7%) were European American, and (47, 7.5%) were of other race categories. The group with OSA was 37.8% (n=236) and without OSA was 62.2% (n=389) of the total sample. Elixhauser comorbidity index was higher in OSA group compared to those without OSA (p:0.00001, mean (SD): 16.73(14.6) vs. 12.03 (13.1)). Univariate analysis demonstrated a higher rate of readmission at 60 days (p=0.02, Odds ratio (95% CI): 1.69 (1.1-2.6)) and use of mechanical ventilation (p=0.05, Odds ratio (95% CI): 1.65 (0.99-2.75) in OSA vs. without OSA. These associations were attenuated in multivariate logistic regression models including age, gender, race, Elixhauser index and body mass index. OSA did not affect the length of stay or inpatient mortality.

Conclusion

In hospitalized COVID19 patients, OSA increases the probability of readmission and risk of mechanical ventilation, but this effect is likely due to higher comorbidity and obesity rates in OSA. In the future, we plan to examine larger samples of Veterans hospitalized with COVID19 and assess the effect of positive airway pressure treatment to understand the impact of OSA on COVID19 outcomes.

Support (If Any)

no conflicting or financial interests to disclose
0580 Sleep Attitudes as a Predictor of Risk for Metabolic Syndrome in College Freshman
Authors: Hirsch Sophie , Ruggiero Aria , Zendels Philip , Peach Hannah , Gaultney Jane
Published: May 2022

Introduction

Transitions into adulthood and starting higher education can be a challenge in habit formation of first-year students. Unhealthy habits related to eating, exercise, substance consumption and sleep can lead to rapid weight gain and conditions such as metabolic syndrome. Research has suggested that regardless of sleep knowledge, favorable sleep attitudes predict better sleep. Thus, our aim was to investigate whether sleep attitudes directly predicted risk for metabolic syndrome or indirectly via subjective and objective sleep measures.

Methods

First year college students (N=165) completed self-report measures and were brought into the lab for height, weight, body fat, blood sugar and fats, and blood pressure analyses. Participants wore FitBit Flex wristwatches to collect sleep data for seven consecutive days. Preliminary correlational analyses were conducted on sleep and obesity measures. Two separate path analyses were conducted to investigate whether there was a direct effect of sleep attitude on risk for metabolic syndrome or indirect via subjective sleep (sleep quality, duration and apnea) and objective sleep (sleep efficiency, duration and apnea). Two moderated mediations were conducted to investigate the effects of gender and age.

Results

The average age was 18.66 (SD=3.33) with the majority of the sample being female (63%) and White (55.9%). In our subjective sleep analysis, we found that sleep attitudes predicted quality and duration, but not apnea, and that the overall model yielded significance. In our objective model, only apnea was a significant predictor, as well as the overall model. The indirect relationships were not moderated by gender or age.

Conclusion

Poor sleep attitudes are related to risk for metabolic syndrome in college aged individuals. Future studies should further examine sleep attitudes as a modifiable risk factor to prevent disease.

Support (If Any)

NA
0581 Sleep Patterns and “OFF”-Time in Patients with Parkinson’s Disease and Motor Fluctuations
Authors: Hauser Robert , Videnovic Aleksandar , Soares-da-Silva Patrício , Liang Grace , Olson Kurt , Jen Eric , Rocha José-Francisco , Klepitskaya Olga
Published: May 2022

Introduction

Sleep disruptions in patients with Parkinson’s disease (PD) include difficulty falling/staying asleep, which can contribute to daytime sleepiness and overall worsening of health, mood, and quality of life. Although sleep disturbances in PD are multifactorial, nighttime motor symptoms can negatively affect sleep. To better understand how “OFF”-episodes affect sleep, post-hoc analyses were conducted using baseline data from two phase 3 studies of opicapone, an approved once-daily adjunctive treatment to levodopa/carbidopa (LD/CD) in patients with PD experiencing motor fluctuations.

Methods

In BIPARK-1 and BIPARK-2, participants recorded sleep/awake periods, “OFF”-time, and “ON”-time in 24-hour PD diaries. Sleep metrics included sleep duration, awakenings after sleep onset, and percent of sleep time spent awake. “OFF”-times included “OFF” before sleep (OBS), nighttime “OFF” (NTO), and early morning “OFF” (EMO). Data at baseline were pooled across treatment groups and analyzed descriptively. Mean values are presented with standard deviations (±SD).

Results

Baseline data from 1010 participants were pooled for analysis. Among 964 participants with available sleep metrics, mean total sleep duration was 7.6 (±1.5) hours and longest duration of uninterrupted sleep was 7.2 (±1.9) hours. 332/964 (34.4%) participants experienced an “OFF”-episode before going to sleep and the mean duration of this OBS was 1.8±1.2 hours. 158/964 (16.4%) participants awoke after sleep onset; of these, 128/158 (81.0%) awoke in an “OFF”-state and the mean duration of this NTO was 1.0 (±0.5) hours. Among these 128 participants, the mean number of awakenings was 1.3 (±0.7) and percent of sleep time spent awake was 15.4% (±9.6%). 898/1005 (89.4%) participants experienced an “OFF”-episode upon waking up in the morning and the mean duration of this EMO was 1.5 (±0.9) hours.

Conclusion

Results from this pooled analysis indicate that 34.4% of participants experienced an “OFF”-episode before going to sleep. Moreover, 81.0% of participants who woke up during the night were in an “OFF”-state upon awakening. Reducing “OFF”-episodes before and during the nighttime may help improve sleep in patients with PD, in turn potentially improving quality of life and daytime motor performance.

Support (If Any)

Neurocrine Biosciences, Inc.
0584 Impact of Obstructive Sleep Apnea on Chronic obstructive pulmonary disease Hospitalizations
Authors: Al Khateeb Mohannad , Yusuf Mubarak , Horoub Ali , aldiabat Mohammad , Jabiri Yazan Al
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is a sleep disorder that has been linked to increase the risk for hypertension, ischemic heart failure, arrhythmia and heart failure. There are multiple similarities between OSA and Chronic Obstructive Pulmonary Disease (COPD); both are associated with hypoxia and hypercapnia, with different mechanisms of hypoxia; in COPD its chronic and slow progression, whereas it is suddenly intermittent hypoxia in OSA. Intermittent hypoxia was hypothesized to enhance the protective effect on subsequent hypoxia resulting in cardioprotective effect [1]. There is little data on rates of in-hospital mortality on patients with OSA and COPD using a nationwide study. In this study, we aim to analyze the impact on mortality and length of hospital stay of obstructive sleep apnea in patients with COPD.

Methods

Adults with principal diagnosis of COPD were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis on discharge. We queried the 2019 National Inpatient Sample for OSA, and other secondary diagnoses (hyperlipidemia, hypertension, heart failure, smoking, CKD, electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses.

Results

In a total of 520,624 adult hospitalizations with COPD primary diagnosis on discharge were included from the 2019 national inpatient sample. 73,705 patients had concomitant secondary diagnosis with OSA. On weighted analysis, hospitalizations with primary diagnosis of COPD and secondary diagnosis of OSA had lower in-hospital mortality rates compared to hospitalizations with COPD alone (0.6% vs 1.08%, p= 0.000), .COPD hospitalizations with OSA had statistically significant lower odds for mortality compared to COPD patients without OSA (adjusted OR 0.73, 95% CI 0.57-0.93; p= 0.009).However, COPD hospitalizations with OSA showed increased in the mean length of stay by 0.21 days (95% CI 0.12-0.30, p=0.000) compared to patients without OSA.

Conclusion

Our analysis showed better mortality outcomes for COPD patients with OSA , supporting the protective effect hypothesis of intermittent hypoxia. COPD patients with concomitant secondary OSA diagnosis have increased in-hospital length of stay.

Support (If Any)

1- Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136
0592 Hybrid Closed Loop Insulin Delivery Systems Reduce Perceived Hypoglycemia During Sleep in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness
Authors: Matus Austin , Malone Susan Kohl , Flatt Anneliese , Peleckis Amy , Dalton-Bakes Cornelia , Rickels Michael , Goel Namni
Published: May 2022

Introduction

Sleep-associated hypoglycemia is a major concern for individuals with type 1 diabetes (T1D). Hybrid closed loop insulin delivery systems with continuous glucose monitoring (HCL-CGM) may reduce the perceived frequency, severity, and impact of sleep-associated hypoglycemia. This analysis assessed changes in perceived sleep-associated hypoglycemia in individuals with T1D at high risk for hypoglycemia after initiating HCL-CGM.

Methods

Seven adults (median age=53y) with long-standing T1D (median duration=41y) and hypoglycemia unawareness participated in an ongoing 18-month clinical trial assessing effectiveness of HCL-CGM. At baseline and every 6 months thereafter, participants completed the validated Hypoglycemia Awareness Questionnaire (HypoA-Q), a 33-item tool consisting of three subscales (impaired awareness, symptom level, and symptom frequency), and 16 conceptually distinct items, including six items that relate to the frequency, severity, and impact of sleep-associated hypoglycemia, each which is scored and assessed individually. Friedman Tests assessed changes in items over the 18-month interval and Kendall’s W determined effect sizes.

Results

HCL-CGM significantly reduced the reported frequency of the following questions: (a) “How often you have had a hypo during your sleep?” (χ2(3)=8.4, p<0.05; moderate effect size, W=0.40) and (b) “…and were unable treat yourself when you woke up?” (χ2(3)=12.1, p<0.05; large effect size, W=0.57). HCL-CGM also reduced the reported frequency to: (c) “…and someone else gave you sugar by mouth?” (χ2(3)=7.2, p<0.07; moderate effect size, W=0.34). By contrast, HCL-CGM did not affect reported frequency to the questions: (d) “…which led to a major problem?” (p>0.05; moderate effect size, W=0.26)”; (e) “…and someone else gave you a glucagon injection?” (p>0.05; small effect size, W=0.14); and (f) “…where you stayed asleep and only later realized that you had been hypo?” (p>0.05; small effect size, W=0.19).

Conclusion

HCL-CGM improved various critical aspects of perceived sleep-associated hypoglycemic events in individuals most at-risk for hypoglycemia. Our results have important implications for self-care and patient treatment in this population.

Support (If Any)

NIH R01DK117488 (NG), R01DK091331 (MRR), K99NR017416 (SKM), and UL1TR001878 (University of Pennsylvania Center for Human Phenomic Science); NASA NNX14AN49G and 80NSSC20K0243 (NG); Pennsylvania Department of Health SAP 4100079750 (IL).
0597 The Relationship Between Sleep Quality and Functional Outcomes Following Acute Stroke and Inpatient Rehabilitation
Authors: Chen Pin-Wei , O’Brien Megan , Nguyen Amy , Prokup Sara , Knutson Kristen , Yang Hyun Sik , Hucker Alejandro , Byron Max , Goyal Swati , Adcock Emma , Morris Linda , Mokhlesi Babak , Zee Phyllis , Arora Vineet , Jyaraman Arun
Published: May 2022

Introduction

There is mounting evidence that sleep plays an important role in the rehabilitation and recovery process following acute stroke. Following acute care, many patients with stroke are admitted to inpatient rehabilitation facilities (IRFs), where they undergo intensive, interdisciplinary therapy to recover or relearn functional skills to minimize long-term disability. The role and impact of sleep in this early stage of stroke rehabilitation, however, is poorly understood. The purpose of this study is to investigate the relationship between sleep quality and clinical outcomes in the IRF setting following acute stroke.

Methods

Patients wore a collection of wearable sensors to measure sleep and wake throughout their IRF stay. Linear mixed-effect models (LMEMs) were built to determine the relationship between functional outcomes and sleep quality. Independent variables were total sleep time (TST) and sleep efficiency (SE) derived from wearable sensors, calculated between two clinical measures. Dependent variables included scores from repeated measures of the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), Berg Balance Scale (BBS), and Action Research Arm Test (ARAT). Covariates included demographics such as age and stroke type.

Results

Fifty-three individuals with stroke (age: 58.26±15.57 years; BMI: 28.27±6.16 kg/m2) consented to participate during their IRF program within 7 days of admission. All individuals were recruited from a single-site IRF between July 2020 and August 2021. The average length of stay was 17.85±6.99 days. There were no significant differences in TST between the first three nights and the last three nights (5.1±1.9 hours vs. 5.2±2.0 hours) or SE (67.8±17.7% vs. 69.0±17.8%). The greater standard deviation of TST was associated with lower 6MWT scores (R2=0.77, beta=−0.48, p=0.06), while the greater standard deviation of SE was associated with lower 10MWT scores (R2=0.80, beta=−0.20, p=0.18).

Conclusion

Our preliminary findings indicate that greater variability in TST and SE are associated with walking endurance and mobility recovery. Future analyses will investigate additional measures of sleep and activity in IRF settings and their relationship with patient outcomes. This work can inform novel sleep interventions to optimize post-stroke recovery.

Support (If Any)

This work is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NIH R01HD097786-01A1).
0609 Sleep Stabilization in Prehypertensive/Hypertensive Patients
Authors: Stokes Alicia , Yang Huan , Buraks Olivia , Vazquez Michael , Pandeya Sarbesh , Haack Monika , Mullington Janet
Published: May 2022

Introduction

Variable sleep/wake patterns have been linked to increased cardiometabolic risk. The current project investigates the effects of using sleep hygiene interventions to stabilize sleep timing in prehypertensive/hypertensive patients. Growing evidence supports the importance of regularizing sleep timing in improving cardiovascular health, and we believe that using sleep hygiene techniques to stabilize sleep may reduce these risks.

Methods

As part of a larger study, fifty-three participants (55.5 ± 1.4 years; 51% male) completed sleep diaries during 3 study periods. The first period (S1) was a baseline control, the second period (S2) was a 4-week wait-list control condition, and the third period (S3) was an 8-week randomly assigned intervention that used sleep hygiene approaches and scheduling to stabilize sleep timing or stabilize and lengthen sleep. Currently, we are still blind to condition; however, because both conditions involve sleep stabilization, an analysis using linear mixed models was used to assess change in the variability of total sleep time (SDTST), wake up time (SDWUT), and fall asleep time (SDFAT) across the 3 study periods.

Results

There was a significant decrease in SDTST variability (standard deviation) at post-intervention (S3) compared to S2 (p<0.01) and S1 (p<0.01). There was also a significant decrease in SDWUT variability at post-intervention (S3) compared to S2 (p<0.01) and S1 (p<0.01). There was a trend towards a significantly decreased SDFAT at S3 compared to S2 (p=0.057), but there was a significant decrease in SDFAT variability during S3 compared to S1 (p<0.01).

Conclusion

These data suggest that we were able to utilize sleep hygiene interventions to decrease the variability in total sleep time, wake-up time and fall asleep time. When we unblind we will report on if we were able to increase and lengthen the sleep period for those in the sleep extension condition.

Support (If Any)

NIH (R01HL125379 to Dr. Janet Mullington), Harvard Catalyst, Harvard Clinical and Translational Science Center (UL1TR001102)