bluuebunny/crossref_metadata_2025 huggingface dataset:
0688 Post-illumination Pupillary Response (PIPR) Is Attenuated in Patients with REM-sleep Behaviour Disorder
Authors: Chan Joey , Chau Steven WH , Huang Bei , Li Tim Man Ho , Chan Ngan Yin , Wing Yun Kwok
Published: April 2024

Introduction

Circadian disruptions are conspicuous in patients with Parkinson’s disease (PD). Previous study showed that melanopsin-mediated post-illumination pupillary response (PIPR) was attenuated in patients with PD. iRBD is often regarded as a prodromal phase of PD, but it remains unclear whether there is an early emergence of changes in PIPR in patients with iRBD.

Methods

This case-control study compared the PIPR, sleep and circadian parameters among controls and patients with iRBD. PIPR was measured by DP-2000 pupillometer (NeurOptics, Irvine, CA, USA). Post-stimulus continuous pupil size recording for 60s was conducted after a 1-second blue stimulus (467nm, 2.0log lux) and a 1-second red light stimulus (632nm, 2.0 log lux), respectively, with 2 minutes of dark adaptation in between. The PIPR was defined as the pupil size at 6s post-stimulus, normalized to the baseline pupil diameter. Net-PIPR is calculated by subtracting PIPR-red from PIPR-blue. One-week actigraphy, sleep diary data and an overnight urinary 6-sulfatoxymelatonin (aMT6s) sample (except those on exogenous melatonin) were also collected. Group difference was compared by Chi Square test or t-test where appropriate. Linear regression analyses were conducted to examine the relationship between PIPR and other circadian parameters.

Results

At present, 50 controls (Age, mean±standard deviation: 62.9±7.1 years) and 37 patients with iRBD (64.4±5.4 years) were recruited. The Net-PIPR was significantly attenuated in the iRBD group (19%±0.11 vs 26%±0.11, p=0.003). Net-PIPR has significant association with aMT6s (B=0.13, 95% Confidence interval (CI)=0.05-0.21, p=0.001), actigraphic M10 (B=2.6, CI:0.8,4.4, p=0.005), mesor (B=1.5, CI: 0.48-2.51, p=0.005), and amplitude (B=1.1, CI:0.2 - 2.1, p=0.02), while controlled for age, gender, photoperiod, time since awake, use of medication. A higher PIPR was associated with a lower odds for iRBD (Odd ratio=0.03, CI:0,89,0.99,p=0.014), adjusted for age, gender, photoperiod, and MOCA score.

Conclusion

Our results showed that PIPR is attenuated in patients with iRBD and is associated with other markers of circadian disruptions. The study supported the early emergence of circadian disruptions in iRBD patients and PIPR is a potential convenient non-invasive circadian marker. Further longitudinal study is needed on whether PIPR would predict circadian disruption and future neurodegeneration.

Support (if any)

Direct grant of The Chinese University of Hong Kong (Ref. 2021.054)
0691 High Prevalence of Periodic Limb Movements of Sleep While Using Hypoglossal Nerve Stimulation Therapy
Authors: Moon Hye-Jin , Lee Chang-Hoon , Cho Unjung , Im KyoungBin
Published: April 2024

Introduction

Periodic limb movements of Sleep (PLMS) often accompany obstructive sleep apnea (OSA) and significantly impact the quality of sleep and treatment adherence. As a novel treatment for OSA, it is crucial to understand the presence and potential impact of PLMS in patients undergoing hypoglossal nerve stimulation (HNS) therapy. Nevertheless, no study to date has investigated PLMS among those in HNS therapy.

Methods

Subjects receiving HNS therapy from December 2020 to August 2023 were consecutively included for this retrospective cohort analysis. PLMS diagnosis was based on periodic limb movement index (PLMI) ≥ 15. Prevalence of PLMS was the main outcome measure and then we compared biometric/ demographic data, comorbidities, medications, data from HNS fine-tune polysomnography (PSG), pre- and post-HNS Epworth Sleepiness Scale (ESS), and baseline OSA parameters between two groups: PLMS versus no PLMS. Statistical analyses were performed using STATA.

Results

One hundred subjects were included for the analysis. The average age was 66.7, with 75% being male, and 82% being non-Hispanic White. Significant PLMS was shown in 52 among 100 subjects receiving HNS treatment. The PLMS group was older (69.0 vs. 64.2 years old, P = 0.008); however, there was no difference observed in terms of sex, race, co-morbidities including depression and anxiety, use of selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors, dopamine agonists, or alpha-2-delta ligands. The PLMS group had lower pre-HNS ESS score (7.3 vs. 9.4, P = 0.018), and higher baseline non-supine apnea-hypopnea index (AHI) (22.5 vs. 12.9, P = 0.030); however, there were no differences of HNS fine-tune PSG parameters including non-supine AHI (6.6 vs 4.2, P = 0.505), maximum tolerated voltage, HNS usage, and subjective benefit.

Conclusion

The prevalence of PLMS among OSA patients with HNS therapy is notably high at 52%. This high prevalence of PLMS may be attributed to the negative impact of PLMS on CPAP adherence leading to the HNS therapy. Despite the high prevalence of PLMS, PLMS did not result in HNS treatment short-term outcome difference. Further study is needed to investigate the effect of HNS on PLMS and a longer-term impact of PLMS in HNS treatment outcome.

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0696 Slow-wave Sleep and REM Sleep Without Atonia Predict Motor Progression in Parkinson's Disease
Authors: Shen Yun , Tao Mengxing , Li Hanxing , Xie Weiye , Liu Chunfeng
Published: April 2024

Introduction

Growing evidence supports the potential role of sleep in the motor progression of Parkinson's disease (PD). Slow-wave sleep (SWS) and rapid eye movement (REM) sleep without atonia (RWA) are important sleep parameters. The association between SWS and RWA with PD motor progression and their predictive value have not yet been elucidated.

Methods

We retro-prospectively analyzed clinical and polysomnographic data of 136 patients with PD. The motor symptoms were assessed using Unified Parkinson’s Disease Rating Scale Part III (UPDRS III) at baseline and follow-up to determine its progression. Partial correlation analysis was used to explore the cross-sectional associations between slow-wave energy (SWE), RWA and clinical symptoms. Longitudinal analyses were performed using Cox regression and linear mixed-effects models.

Results

Among 136 PD participants, cross-sectional partial correlation analysis showed SWE decreased with the prolongation of the disease course (P = 0.046), RWA density was positively correlated with Hoehn & Yahr (H-Y) stage (tonic RWA, P < 0.001; phasic RWA, P = 0.002). Cox regression analysis confirmed that SWE (HR = 1.739, 95% CI = 1.038-2.914; P = 0.036) and tonic RWA (HR = 0.575, 95% CI = 0.343-0.963; P = 0.032) were predictors of motor symptom progression. Furthermore, we found that lower SWE predicted faster rate of axial motor progression (P < 0.001) while highertonic RWA density was associated with faster rate of rigidity progression (P = 0.006) using linear mixed-effects models.

Conclusion

These findings suggest that SWS and RWA might represent markers of different motor subtypes progression in PD.

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0698 Exploring Age- and Sex-Specific Changes in PLMS in RLS: An Emphasis on Postmenopausal Women
Authors: Mogavero Maria P , DelRosso Lourdes , Lanza Giuseppe , Lanuzza Bartolo , Bruni Oliviero , Strambi Luigi Ferini , Ferri Raffaele
Published: April 2024

Introduction

This study aimed to investigate whether women experiencing restless legs syndrome (RLS) undergo distinct changes in periodic leg movements during sleep (PLMS) during the post-menopausal period, using an age threshold of >50 years as a proxy, in comparison to men of the same age. The assessment of leg movement activity during sleep employed a method that utilized indexes specifically designed for evaluating leg movement periodicity.

Methods

We enrolled a total of 103 participants, 36 of them were aged 18-50 years, comprising 19 men (median age: 40 years) and 17 women (median age: 37 years). Additionally, 67 participants were >50 years old, including 24 men (median age: 66.6 years) and 43 women (median age: 60.0 years). Full night PSG were obtained in all subjects which were scored following standard criteria.

Results

Significant differences were not observed between men in the two age groups. However, in women, a noteworthy and statistically significant increase in the periodicity index was evident in the older group, accompanied by a decrease in isolated leg movements. The intermovement interval graphs revealed a clear age-related enhancement of PLMS in women, particularly in the 16-22 second range, surpassing the changes observed in men. These findings remained consistent when the analysis was replicated by comparing subjects aged 18-45 years with those aged >55 years.

Conclusion

Our results underscore the clinical relevance of evaluating PLMS in postmenopausal women, as these changes are likely associated with the hormonal fluctuations characteristic of this life stage. Translationally, recognizing and addressing PLMS in postmenopausal women is imperative for optimizing their sleep health and mitigating potential health risks associated with sleep disturbances. This study contributes to the broader understanding of RLS and emphasizes the need for targeted interventions in this specific demographic group.

Support (if any)

This study was partially supported by a fund from the Italian Ministry of Health “Ricerca Corrente” (RC n. 2779779) (Drs. Ferri, Lanza, and Lanuzza).
0699 Frequency of Sleep Paralysis as Related to Lifestyle Variables in a Nationwide Student Sample: Preliminary Findings
Authors: Spano Michael , Pace-Schott Edward
Published: April 2024

Introduction

Sleep Paralysis (SP) is a sleep-disturbing experience of muscle atonia while conscious, creating an in-between sensation of wakefulness and dissociation during REM sleep. During SP, one can experience hypnagogic and hypnopompic hallucinations, which may cause feelings of terror and fear. These feelings affect the overall well-being of the experiencers and may impact other aspects of their lives. We investigated factors that may influence the frequency of SP in university students.

Methods

Participants (N=158, 65.19% female, 5.7% non-binary/third gender, 64% white) completed a mixed method, retrospective nationwide survey including items querying demographic variables, lifestyle (i.e., substance use, technology use, social media use), sleeping behaviors (i.e., napping, habitual bedtime, sleep interruption), sleep quality, and frequency of SP.

Results

For questions relating to SP frequency among the 7 categories, most respondents experienced SP “Several” times (36%, N=45, while 14.4% (N=18) experienced SP “Once” and 3.2% (N=4) experienced SP “Daily.” When comparing daily SP experiencers (DSP) to one-time SP experiencers (OSP), 75% (N=3) of DSP napped 4-7 times per week, while half of the OSP (N=9) napped only 1-3 times per month. In our qualitative analysis, many respondents stated they experienced SP most during “napping.” Additionally, the majority of non-SP experiencers (N=18) answered “Never” or “Less than once a month” for napping. For alcohol use, 75% of DSP (N=3) answered “Yes” to “Do you drink alcohol?” while only 55% of OSP (N=10) answered “Yes.” This study could not find differences in caffeine or nicotine use.

Conclusion

Our results suggest that there is a difference in sleeping and lifestyle behaviors between students who experience SP frequently and students who experience SP once or not at all. The most significant difference in the sleeping behaviors is the frequency of napping. The direction of causation between the frequent napping behavior and the SP remains to be determined. Among lifestyle behaviors, SP frequency data suggests that drinking frequency may moderately predict SP. More research is needed regarding whether phone use and/or social media may influence SP frequency, as such behaviors have been shown to influence sleep timing, time duration, and quality.

Support (if any)

None
0700 Identifying Rapid Eye Movement Sleep Behavior Disorder in Veterans Administrative Databases: A Validation Study
Authors: Jones Melissa , Azarian Mehrnaz , Schenck Carlos , Sharafkhaneh Amir , Jorge Ricardo , Razjouyan Javad
Published: April 2024

Introduction

As a first step toward phenotyping large numbers of Veterans with rapid eye movement (REM) sleep behavior disorder (RBD), we investigated the ability of ICD-9 (327.42) and ICD-10 (G47.52) codes to detect Veterans with this clinical diagnosis.

Methods

Subjects were 150 randomly selected Veterans with relevant RBD ICD codes for at least 2 outpatient encounters or 1 inpatient discharge (+RBDcode). Notes from the date of the first ICD diagnosis were reviewed for any documentation of RBD, dream enactment behaviors (DEBs), and targeted pharmacotherapy. The nearest diagnostic, split night, or titration polysomnogram (PSG) report was also reviewed. To calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for probable RBD, a comparison group of 50 Veterans with at least 2 outpatient visits or 1 inpatient discharge summary with ICD-9/ICD-10 codes for OSA and no ICD codes for RBD (-RBDcode) were propensity-matched for age, sex, gender, race, ethnicity, and month-year of first diagnosis.

Results

The final sample consisted of 139 Veterans in +RBDcode (age 64.8±15.2, 94.6% male, 69.8% white, 10% Hispanic) and 47 Veterans in -RBDcode (age 69.6±2.7, 95.8% female, 77.1% white, 4.3% Hispanic) after excluding subjects with unavailable or restricted charts. In +RBDcode, a diagnosis of RBD, overt DEBs, and targeted pharmacotherapy were documented in 130 (93.5%), 103 (74.1%), and 71 (51.1%) of subjects, respectively. No PSGs were documented in 71 (51.5%), reports did not comment on REM sleep without atonia (RSWA) in 29 (20.9%), and REM did not occur in 8 (5.8%) subjects. Only 13 (9.3%) had documented DEBs and a PSG with RSWA. No subjects in -RBDcode had documentation of pRBD. The sensitivity, specificity, PPV, and NPV for pRBD was 100%, 83.9%, 93.5%, and 100%, respectively.

Conclusion

ICD-9 and ICD-10 codes accurately predicted the presence (or absence) of pRBD compared to manual chart review. Next steps are to phenotype Veterans with RBD diagnoses according to comorbidities and outcomes on a nation-wide scale.

Support (if any)

VA CSR&D CDA #IK2CX002363-01A1 [MJ]; NIH-NHLBI-K25 (#1K25HL152006-01) [JR]; seed funding by AHBPCE (#FY2024-002) [JR]; Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0702 Periodic Limb Movements in Sleep May Contribute to REM Parasomnia
Authors: Aleem Muhammad Saad , Saqib Fatima , Morris Bryn , Bikov Andras
Published: April 2024

Introduction

Parasomnias are characterised by increased number of arousals. Periodic limb movements in sleep may fragment the sleep; therefore, may trigger parasomnias. However, the association is poorly understood.

Methods

As part of a retrospective service evaluation project, we investigated 131 patients who underwent a full night attended polysomnography due to reported history of parasomnias. Patients were divided into two groups, depending on their periodic limb movements in sleep index (PLMI≥15/h).

Results

Forty-three patients (32%) had PLMS. They more commonly complained about dream enactment (51 vs. 26%, p< 0.01), abnormal movements (59 vs. 39%, p=0.04) and sleep paralysis (11 vs. 1%, p< 0.01) and less likely experienced sleep walking (22 vs. 40%, p=0.04). There was no difference in sleep eating (8 vs. 10%), sexsomnia (0 vs. 2%), nightmares (24 vs. 21%), night terrors (8 vs. 21%), or confusional arousals (17 vs. 30%). Overall, they more likely had a diagnosis of REM parasomnia (71 vs. 50%, p=0.03) and were less likely diagnosed with non-REM parasomnia (45 vs. 70%, p< 0.01). PLMI significantly related to arousal index (ρ=0.37, p< 0.01) and arousal index from NREM (ρ=0.38, p< 0.01); however interestingly, there was no relationship with arousal index from REM (ρ=0.13, p=0.13).

Conclusion

Periodic limb movements in sleep are common in patients with parasomnia and are associated with REM parasomnias. Further studies are necessary to investigate if treatment of PLMS could be beneficial in patients with REM parasomnias.

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0704 Comparative Efficacy of Tonic Motor Activation for Medication-Naïve and Dopaminergic-Treated Restless Legs Syndrome
Authors: Buchfuhrer Mark , Singh Haramandeep , Ojile Joseph , Baker Fiona , Charlesworth Jonathan
Published: April 2024

Introduction

Due to augmentation, exposure to dopaminergic treatment induces worsening of restless legs syndrome (RLS) and reduces response to gabapentinoid medications, frequently leading to refractory RLS. Tonic motor activation (TOMAC) is a noninvasive neurostimulation therapy indicated for refractory RLS. We tested if response to TOMAC is affected by dopaminergic treatment.

Methods

We retrospectively analyzed two clinical trials that each enrolled a mixture of adults with primary moderate-severe RLS who were medication-naïve (drug-naïve), treated with dopamine agonist medication (DA-treated), or other medication history (not analyzed here). There was no drug washout. Trial 1 (NCT04700683, mean age 55.6, 56% female) employed crossover design with 2-weeks of TOMAC and sham control in randomized order. Trial 2 (NCT05214963, mean age 56.0, 69% female) employed parallel design with participants randomized to 2-weeks of TOMAC or sham. Participants were instructed to self-administer 30-minutes of treatment when they experienced RLS symptoms. RLS severity was assessed based on change to mean International RLS Scale (IRLS) score. P-values were determined with two-factor ANOVA for treatment assignment and medication history.

Results

RLS severity improved similarly for drug-naïve and DA-treated RLS patients during TOMAC relative to sham treatment. In Trial 1, mean IRLS change during TOMAC was -4.2 points for drug-naïve (sham: 0.0 points; n=13) and -4.5 points for DA-treated (sham: -1.4; n=14) groups; treatment assignment main effect was significant (p=0.011) and there was no interaction between medication history and treatment assignment effects (p=0.679). In Trial 2, mean IRLS change during TOMAC was -6.3 points for drug-naïve (sham: -1.4; n=25) and -8.6 points for DA-treated (sham: -4.9; n=14); treatment assignment main effect was significant (p=0.010) and there was no interaction between medication history and treatment assignment effects (p=0.701). For all groups, IRLS change was >3 points different for TOMAC compared to sham, the minimal clinically significant difference.

Conclusion

There was no difference in TOMAC efficacy between DA-treated and medication-naïve RLS. TOMAC treatment consistently resulted in greater RLS improvement than sham control. This differs from gabapentinoids, which have reduced effectiveness following DA treatment. These results may indicate an advantage of TOMAC over gabapentinoids for refractory RLS.

Support (if any)

Sponsored by Noctrix Health. NCT05214963 supported by NIH/NINDS R44NS117294.
0705 Detection of Periodic Limb Movements During Sleep in RLS Using Tonic Motor Activation System and Machine Learning
Authors: Rigot Stephanie , Singh Haramandeep , Baker Fiona , Ojile Joseph , Adlou Bahman , Charlesworth Jonathan
Published: April 2024

Introduction

Periodic limb movements during sleep (PLMS) are the most important objective correlate of restless legs syndrome (RLS) and, thus, could be beneficial for long-term monitoring and management. We aimed to develop a machine learning (ML) model to detect PLMS based on inertial measurement unit (IMU) movement sensors within an existing therapeutic device for refractory RLS – the tonic motor activation (TOMAC) system.

Methods

Twenty-two individuals with RLS completed a total of 32 nights of polysomnography (PSG) while wearing bilateral TOMAC units externally on the lower legs at the head of the fibula. Each TOMAC unit continuously recorded accelerometer and gyroscope data from a 6-axis IMU. Features including signal statistics, frequency domain characteristics, and positions were extracted from each IMU sensor in 2-second epochs throughout the night. Features were aggregated into 60-minute windows, input into a random forest ML model, and evaluated using leave-one-out cross-validation. Ground truth PLMS assessment was based on tibialis anterior EMG collected as part of PSG and technician-scored without excluding movements related to respiratory events. Classification metrics, Pearson correlations, and Bland-Altman plots were used to evaluate agreement, variability, and bias between ML model predictions and ground truth, based on ability to estimate periodic limb movement index (PLMI) for each hour and ability to screen for pathological PLMS based on the diagnostic cutoff PLMI >15/hour.

Results

For calculating PLMI for each hour (n= 215 hours), ML model predictions were highly correlated with ground truth (r= 0.890) and showed minimal bias (mean ± SD= 0.11 ± 21.05). For classifying potential presence/absence of pathological PLMS, ML model predictions had high accuracy (0.907), specificity (0.958), and area under the curve (AUC, 0.841).

Conclusion

The TOMAC IMU feature-based ML model showed strong agreement with PSG-based ground truth for calculating PLMI and screening for pathological PLMS. This suggests that the therapeutic TOMAC system might also offer the possibility for long-term, in-home PLMS monitoring.

Support (if any)

Sponsored by Noctrix Health and supported by NIH/NINDS R44NS117294.
0706 Dextromethorphan for Restless Legs Syndrome: Testing the Glutamate Theory
Authors: Khalil Melissa , Dredla Brynn , Cheung Joseph , Castillo Pablo
Published: April 2024

Introduction

Restless legs syndrome (RLS) is a common disorder of unpleasant sensations during inactivity, an urge to move the legs, and hyperarousal. The pathophysiology is incompletely understood. Treatments are not always successful or carry side effects.

Methods

(Case Report)

Results

A 45-year-old woman presented with over a decade of RLS and sleep-onset insomnia. The diagnosis was based on the International RLS Study Group criteria. The severity was assessed by the nightly occurrence and Insomnia Severity Index (ISI) of 25. Interfering neurologic or sleep disorders, medications, and abnormal blood work were ruled out. Different dopamine agonists resulted in augmentation. Caffeine was stopped. Polysomnography revealed periodic limb movement with sleep fragmentation. Gabapentin was partially effective and poorly tolerated at high doses, but continued at 600 mg. While using Dextromethorphan (DXM) for an upper respiratory infection, the patient found dramatic improvement of her RLS symptoms. Independently, she discontinued Gabapentin, and continued DXM 30 mg for 6 months, with consistent improvement. ISI decreased to 10. Ultimately, considering its expense, DXM was tapered, and Tramadol initiated. The pathophysiology of RLS is partially understood. Studies showed abnormalities in iron regulation, low adenosine tone, enhanced glutamatergic activity, inflammation, and a genetic predisposition, as contributing factors. Alpha-2-delta calcium channel ligands inhibit the presynaptic glutamate release. Central nervous system iron deficiency may increase glutamatergic tone. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, inhibits the activation of NMDA receptor by glutamate and decreases glutamate presynaptic release. Ketamine was reported to effectively treat RLS. DXM, another NMDA receptor antagonist, has not been reported to treat RLS in the literature. Additionally, an association between inflammation and RLS was described, and limited data showed anti-inflammatory effect of DXM.

Conclusion

Patients with RLS suffer from their symptoms’ burden. Approved medications could carry side effects, or augmentation. We report a case of severe RLS with dramatic and sustained improvement with DXM.

Support (if any)
0709 Incidence, Determinants, and Impact of RLS During Pregnancy and Puerperium
Authors: Esteves Andrea , Hackethal Sandra , Riccardi Silvia , Garbazza Corrado , Manconi Mauro
Published: April 2024

Introduction

RLS is associated with a lower quality of life. During pregnancy, RLS is highly frequent and peaks in the third trimester. The main objective of the present study was to evaluate the impact of RLS on sleep during pregnancy and puerperium by using subjective and objective data.

Methods

This study was part of the multicenter study “Life-ON”, prospective, cohort investigation on sleep and mood changes during early pregnancy until 12 months after delivery. The presence of Restless legs Syndrome (RLS) was assessed in interview, according to essential criteria for diagnosis of RLS proposed by the International RLS Study Group (IRLSSG) during 11 visits (1 º, 2 º and 3 º trimester; and after delivery – 8 visits). Sleep was evaluated by PSG during the 2º trimester. Mood (MADRS, EPDS, HDRS-21), sleep quality (PSQI), insomnia (ISI), sleepiness (ESS) were also assessed at visits.

Results

Out of the 439 pregnant women recruited, 113 (26.037%) met the criteria for diagnosis of RLS. Together with the prevalence, the severity of RLS get worse in the third trimester. Pregnant women suffering from RLS had a worse sleep quality and insomnia then non-RLS women. A reduction in Sleep Efficiency and an increase in PLMS have also been demonstrated by polysomnography. Mood deflection was also associated with RLS; while RLS was not associated with adverse fetal outcomes and pregnancy related complications.

Conclusion

RLS is confirmed to be highly prevalent in late pregnancy. A negative impact of RLS on mood and sleep was evident from both subjective and objective tests.

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0711 REM Sleep Behavior Disorder Diagnostic Code Accuracy and Implications in the Outpatient Setting
Authors: Chahine Lana , Ratner Deena , Palmquist Aaron , Dholakia Gayatri , Boyce Richard , Rosano Caterina , Brooks Maria
Published: April 2024

Introduction

Isolated REM sleep behavior disorder (iRBD) carries increased risk for neurodegenerative parkinsonian disorders or dementia (NPD), but is difficult to accurately screen for in the community. Healthcare data offer the opportunity to identify large numbers of iRBD cases among outpatients. We aimed to determine the positive predictive value (PPV) of an RBD international classification of disorders (ICD) code for actual iRBD based on manual review of the electronic health record (EHR), examine risk of NPD diagnosis, and explore whether a statistical model developed using selected EHR data can identify individuals with RBD ICD code that have high probability for actual iRBD.

Methods

In this retrospective cohort study, an EHR search at a single healthcare system was conducted to identify outpatient cases who received ICD9 or ICD10 RBD code in 2011-2021. The EHR for each case was manually reviewed. Cases with secondary causes of RBD were excluded. Remaining cases were classified as no iRBD or actual iRBD. Incident cases of NPD were identified. PPV of presence of RBD ICD code for actual iRBD was calculated. Cumulative incidence of NPD with death as a competing event was compared in those with vs without iRBD. Least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for iRBD and the model was validated in an independent dataset.

Results

Among 1,130 cases with RBD ICD code, 499 had secondary causes of RBD. For the remaining 628 cases, determination based on EHR review was that 168 (26.8%) did not have iRBD; PPV of RBD ICD code was 73.25%. Compared to the no iRBD group, the iRBD group had a higher risk of NPD (sub-distribution hazard ratio=10.4 (95% CI 2.5-43.1)). The LASSO prediction model for iRBD had an Area Under the Receiver Operating Characteristic Curve of 0.844 (95%CI 0.806-0.880).

Conclusion

PPV of an RBD ICD code is moderate. In the real-world setting, patients with iRBD had a high risk of diagnosis of NPD. Results indicate feasibility of using statistical models developed using EHR data to accurately predict iRBD.

Support (if any)

This work was partially funded by the University of Pittsburgh Dean’s Faculty Advancement Award (Chahine PI).
0712 Tonic Motor Activation for Restless Legs Syndrome Is Compatible with Sleep Onset and Reduces Periodic Leg Movements
Authors: Rigot Stephanie , Adlou Bahman , Kolotovska Viktoriia , Tekchandani Jatin , Charlesworth Jonathan
Published: April 2024

Introduction

Tonic motor activation (TOMAC) is a noninvasive neurostimulation therapy indicated for refractory restless legs syndrome (RLS). Here, we characterized the acute response to TOMAC based on objective evidence from polysomnography (PSG).

Methods

Adults with primary moderate-severe refractory RLS (n=23) were enrolled in a clinical trial (NCT05214963) that included a night of PSG with TOMAC treatment. Participants were instructed to activate TOMAC sessions to address RLS symptoms before sleep onset (bedtime session, n=8) and/or awakenings during the sleep period (mid-sleep session, n=19). When activated, TOMAC bilaterally stimulated the peroneal nerve for 30-minutes and turned off automatically. For each 30-minute TOMAC session, periodic leg movements during sleep (PLMS) were compared between the last 15min of sleep before TOMAC activation and the first 15min of sleep after TOMAC activation.

Results

Sleep initiation occurred during 75% of bedtime TOMAC sessions and 84% of mid-sleep TOMAC sessions. Mean duration from TOMAC activation to sleep was 21.9 min for bedtime sessions (median 16.1, SD 15.7) and 13.6 minutes for mid-sleep sessions (median 7.4, SD 15.4). Mean TOMAC intensity at the time of sleep onset/re-initiation was 27.2mA (SD: 5.8), similar to previous clinical trials. For mid-sleep TOMAC sessions, mean PLMS frequency reduced by 75% from 36.7/hour (SD: 68.6) before TOMAC activation to 9.1/hour (SD: 37.5, p< 0.01) after TOMAC activation; this corresponded to 68% reduction relative to mean PLMS frequency during the full sleep period (28.6/hour).

Conclusion

TOMAC was compatible with sleep; both sleep onset and re-initiation were prevalent during TOMAC administration at therapeutic stimulation intensities. TOMAC was also associated with significant acute reduction in PLMS. These results motivate investigation of the longer-term effects of TOMAC on sleep architecture and PLMS.

Support (if any)

Sponsored by Noctrix Health and supported by NIH/NINDS R44NS117294.
0717 Ageism and Insomnia: Examining the Relationship Between Negative Aging Stereotypes and Insomnia in Older Adults
Authors: Boyle Julia , Fischer Ian , Bashian Hannah , Moye Jennifer , Pietrzak Robert
Published: April 2024

Introduction

Although insomnia symptoms (e.g., sleep disturbances, daytime complaints) are more prevalent in older age, poor sleep is not guaranteed in older adulthood. Preliminary research has found a relationship between an individual’s greater awareness of age-related changes and poor sleep; however, more research is needed to observe this relationship in insomnia and aging stereotypes. Using data from a nationally representative sample of U.S. veterans, the present study sought to characterize the relationship between negative aging stereotypes and clinical insomnia symptoms.

Methods

Participants (N=3,000) were older veterans (aged 60-99) who participated in the National Health and Resilience in Veterans Study (NHRVS). Participants reported their insomnia severity (Insomnia Severity Index [ISI]), sleep disturbance (ISI Factor 1 [items1,2,3]), and daytime dysfunction (ISI Factor 2 [items4,5,6,7]). Negative aging stereotypes were assessed using a 3-item Expectations Regarding Aging scale, which assessed negative stereotypes related to emotional, physical, and cognitive aging. Sociodemographic characteristics, mental health and medical conditions, traumatic life events, physical activity, disability, and psychotropic medication use were also assessed.

Results

Veterans who screened positive for clinical insomnia (n=213; weighted 7.1%) scored significantly higher on measures of negative stereotypes regarding emotional (p<.001), physical (p=.003), and cognitive (p=.013) aging. Multivariable regression analyses revealed that, after adjusting for a broad range of sociodemographic, trauma, and health covariates, greater endorsement of negative stereotypes regarding emotional aging was associated with significantly greater odds of screening positive for clinical insomnia (OR=1.57, 95%CI=1.24-1.99, p<.001), as well as higher rates of sleep disturbance (OR=1.54, 95%CI=1.28-1.86, p<.001) and daytime dysfunction (OR=1.67, 95%CI=1.40-2.00, p<.001). Relative to veterans who fully rejected aging stereotypes, those who somewhat and fully endorsed them were 3- and 6-times more likely to screen positive for clinical insomnia, respectively (predicted probabilities=0.10 and 0.18 vs. 0.03).

Conclusion

Negative aging stereotypes, especially emotional aging, were related to clinical insomnia symptoms in a nationally representative sample of U.S. veterans aged 60+. These findings suggest that efforts to modify aging stereotypes in older veterans may help improve overall sleep quality, or alternatively, that addressing clinical insomnia may help mitigate negative aging stereotypes. Longitudinal studies are needed to evaluate interrelationships between these measures over time.

Support (if any)
0720 A Cone Beam CT Study of Upper Airway Morphology in Perimenopausal and Postmenopausal Women
Authors: Zhang Wanxin , Gao Xuemei
Published: April 2024

Introduction

Menopause is accompanied by a decline in estrogen and progesterone. Several studies have demonstrated that upper airway patency decreases in women after menopause, while morphology changes are still a lack of evidence. This study aimed to explore upper airway morphology changes in perimenopausal and postmenopausal women.

Methods

This retrospective cross-sectional study included 367 consecutive Chinese female patients over 25 years old who had routinely taken large-field cone beam computed tomography in the imaging library of Peking University School and Hospital of Stomatology from October 2016 to September 2020. A total of 283 males were screened as sex controls according to the same age group. Upper airway morphology, hyoid position and facial pattern were measured. The association between perimenopausal and postmenopausal years and upper airway morphology in both sexes was analyzed.

Results

Perimenopausal women (aged 45–54 years) showed a significant decrease in the volume (3172.91mm3, 95% CI = 653.86–5691.96) and minimum cross-sectional area (37.08 mm2, 95% CI = 5.36–68.80), and a significant increase in the length (−1.96mm, 95% CI = −3.62 to −0.29) of upper airway compared to adjacent reproductive years (aged 35–44), while this difference was neither seen in other adjacent two reproductive age groups of females nor in the same age groups of males. In postmenopausal women (55 years and older), hyoid position was significantly lower (−2.74mm, 95% CI = −4.42 to −1.07) than either age group, while no similar changes were seen in men.

Conclusion

Women had smaller airway volume, reduced upper airway cross-sectional area and longer airway length in perimenopausal years, and a significantly lower hyoid position in postmenopausal years. These changes may be related to menopause itself and independent of the changes associated with aging.

Support (if any)

Clinical Research Foundation of Peking University School and Hospital of Stomatology (PKUSS-2023CRF203)
0725 Phenotyping Obstructive Sleep Apnea in Latin American Women: The Latin American Sleep Network (LATAM Sleep Net)
Authors: Labarca Gonzalo , Che Jose Luis , Henriquez-beltran Mario , Saldias Fernando , Retamal Eva , Nieto Joaquin , Perez-chada Daniel , Maquilon Cesar , Herrera Edwin , Vargas Leslie , de Castro Jorge Rey , Jorquera Jorge , Saad Romina , Bazuarto Maria Angelica , Bettancourt Eddy , Larrateguy Luis , Gutierrez Angela , Rojas Stephanie , Nunez Jimena , Zuniga Carlos
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) is a major cardiovascular risk factor and has worse health outcomes. Novel OSA-driven metrics have been associated with worse outcomes. However, data on women from unrepresentative groups, such as the Hispanic/Latino population outside the USA, is scant. This study aims to quantitatively describe the clinical and novel OSA-driven phenotypes among women from Latin America.

Methods

We performed a prospective, multicenter study including women with suspected OSA from 18 sleep clinics in 8 countries (Argentina, Bolivia, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay). We extracted the raw data from the baseline sleep study from October 2022 to December 2023. To determine 1). Sleep Apnea Specific hypoxic burden (SASHB) is defined as the total area under respiratory event-related desaturation curves; 2) Specific Heart Rate Response (ΔHR), defined as the difference between a maximum heart rate during a subject-specific search window and an event-related minimum heart rate; 3) Ventilatory burden, defined as the event-specific area under the ventilation signal, identified by amplitude changes in the nasal pressure signal; and 4) Desaturation sensitivity (i.e., the tendency to desaturate) was defined as a hypoxic burden divided by a ventilatory burden.

Results

A total of 318 women were included 26% non-OSA, 38% mild OSA, and 36% moderate to severe OSA). The average AHI3% was 16.5 ev/hr, SASHB was 43.4%min/hr; VB was 244.3 %eupnea*min/h; ΔHR was 8.2 bpm, and the desaturation sensitivity was 0.16. Among OSA patients, the AHI3% was 21.78 ev/hr; SASHB was 57.8 %min/hr; VB was 338.1 %eupnea*min/h; ΔHR was 8.14 bpm, and the desaturation sensitivity was 0.18. Based on high SASHB (≥ 60%min/hr) or high ΔHR (≥ 10 bpm), 19% and 26% of the sample are at risk of worse cardiovascular outcomes, respectively, and 7.4% of the sample reported both criteria associated with adverse outcomes.

Conclusion

Among OSA women from Latin America, OSA-physiologically driven metrics are reproducible and similar to previous publications. Further studies are needed to fully understand the clinical utility of these metrics in clinical practice. Study register ISRCTN11936746.

Support (if any)

The Chest /AASM (7868 ); NIH(1R21HL161766-01); SRS (07-SRG-22); Universidad de Concepcion(2022000589)
0727 Sleep Timing and Depression Risk in Pregnancy
Authors: Dunietz Liana , Olson Anna , Tittle Lucas , Kalmbach David , Pitts D'Angela , Yang Chia-Lun , Jansen Erica , Kerver Jean , Hirko Kelly , Burgess Helen , Swanson Leslie , O'Brien Louise
Published: April 2024

Introduction

There is growing evidence that sleep timing is linked to health outcomes. Poorly timed sleep has been associated with metabolic risk factors and mood problems although there is a lack of data in the pregnant population. Emerging data suggest that late sleep timing during pregnancy may be associated with gestational diabetes, gestational hypertension, and preterm birth. However, data on sleep timing and mood during pregnancy are lacking.

Methods

Pregnant women were recruited from prenatal clinics at a large Midwestern tertiary referral center. Women were eligible if they were at least 18 years old and pregnant in their second or third trimester with a single fetus. There were no other exclusion criteria. Participants were queried about their sleep including questions about the time they went to bed, the time they woke up and their typical nocturnal sleep duration. Sleep mid-point was calculated as the time midway between bedtime and wake time and a delayed midpoint was defined as being after 4:00am. Demographic information was abstracted from medical records. Women were considered to have depression with a score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) or a clinical diagnosis of depression.

Results

A total of 1349 women were included in the analysis, of which 15% were classified as having depression. Mean age was 30.7 years (SD 5.6 years) and mean gestational age was 33.8 weeks (SD 4.3 weeks). Overall, 26% of women had a sleep midpoint after 4:00am. In a regression model, women with a delayed sleep midpoint had a significantly increased odds ratio for depression (OR 1.4, 95%CI 1.1-1.8), which did not appreciably change after controlling for age, race, presence of hypertension or diabetes, first pregnancy, marital status, and sleep duration (aOR 1.5, 95%CI 1.1-2.2).

Conclusion

We provide initial evidence suggesting a link between self-reported late sleep midpoint and depressive symptoms in pregnancy. Assessment of sleep timing during pregnancy may have potential for identification of women at risk of depression.

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0730 Immigration Status and Acculturation Level Are Prospectively Associated with Sleep in a Diverse Population of Women
Authors: Benasi Giada , Cho Annabel , Aggarwal Brooke
Published: April 2024

Introduction

Sleep, diet, and physical activity are key to cardiovascular health (CVH). Recent immigrants have healthier habits than native-born US adults, and greater acculturation is linked to poorer diets, less physical activity, and worse CVH. However, little is known about sleep in immigrant women. We aimed to investigate prospective associations between immigration status, acculturation, and sleep in a diverse sample of women from a New York City community-based cohort.

Methods

This prospective cohort study of 447 women (60.4% racial/ethnic minority, mean age=36.37±15.43 y) evaluated whether immigration and/or acculturation predicted sleep patterns at 1y follow-up. Immigration status, region of origin (Asia, Caribbean, Latin America, other), and acculturation measures including language preference, length of US residency, and age at immigration were self-reported at baseline. Sleep duration, quality, and sleep-onset latency were measured using the Pittsburgh Sleep Quality Index at baseline and 1y follow-up. Linear and logistic regression models were adjusted for age, health insurance, education, BMI, and corresponding baseline sleep measure.

Results

Among all participants, being born in the US was associated with poorer sleep quality (β:0.57, SE:0.25, p=0.022) at 1y. Among immigrant women, longer residency in the US (β:-0.02, SE:0.01 p=0.008), younger age at immigration (β:0.02, SE:0.01, p=0.012), and being from the Caribbean (β:-0.46, SE:0.19 p=0.017) were associated with shorter sleep duration at 1y. In logistic regression models adjusted for confounders, women who were from the Caribbean vs. other regions (OR:3.09, CI:1.13-8.51, p=0.029) and who had a longer US residency (OR:1.06, CI:1.02-1.10, p=0.002) had higher odds of sleeping < 7h/night. A lower risk of short sleep (< 7h/night) was observed among those who had been in the US for < 10y vs. ≥10y (OR:0.33, CI:0.11-0.96, p=0.042) and with an older age at immigration (OR:0.94, CI:0.90-0.98, p=0.003).

Conclusion

Poorer sleep quality was reported by US born women, while shorter sleep was observed among immigrant women from the Caribbean compared to other regions, those with a younger age at immigration, and those with a longer residency in the US. These findings may help to identify women at greater risk for poor sleep and, consequently, at increased risk for poor CVH.

Support (if any)

American Heart Association (AHA16SFRN27960011).
0731 Bisexual Women Are More Prone to Nightmares and Insomnia Compared to Straight Women in a Sample of College Students
Authors: Virnoche Regan , Gratton Matthew , Baber Garrett , Hamilton Nancy
Published: April 2024

Introduction

Frequent nightmare and insomnia severity are associated with sequelae including increased risk of substance abuse, cardiovascular disease, and suicide. Women and sexual minorities report higher incidence of nightmares and insomnia and as such may be at greater risk for negative associated outcomes. However, most research has consolidated all sexual minority members into a heterogeneous group. To address this gap, we investigated the risk of nightmares and insomnia among women who identified as heterosexual, lesbian, and bisexual.

Methods

Using the Student Trauma and Nightmare Development (STAND) data set, we analyzed the differences in frequency of nightmares and insomnia between straight and bisexual women. The data were collected from a sample of women enrolled at an American midwestern university (N = 957). Insomnia was measured using the 7-item Insomnia Severity Index (ISI) questionnaire. The 5-item Nightmare Disorder Index (NDI) questionnaire was used to assess the severity and frequency of one’s nightmares. Sexual orientation could be endorsed as straight/heterosexual, gay/lesbian, bisexual, queer, asexual, prefer not to say, or prefer to self-describe. We fitted two general linear models using sexual orientation to predict insomnia and nightmare severity while controlling for age.

Results

Women who identified as bisexual reported significantly higher ISI and NDI scores compared to those identifying as a straight/heterosexual (NDI: β = -2.46, 95% CI: [-3.65, -1.26], p < 0.001; ISI: β = -2.52, 95% CI: [-4.00, -1.04], p < 0.001). There was no significant difference between straight/heterosexual women and lesbian women (NDI: β = 0.04, 95% CI: [-3.67, 3.76], p = .981; ISI: β = -2.85, 95% CI: [-7.464, 1.767], p = .226).

Conclusion

These results show that bisexual women in college may be at higher risk for insomnia and nightmares compared to heterosexual/straight college women. These findings highlight a significant sleep health disparity affecting bisexual women, a group with marginalized sexual identities. While these outcomes provide valuable insights, future studies should investigate the potential impact of trauma and utilize a larger and more diverse sample. This study may provide clinical utility for the treatment of bisexual women.

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0734 Early Life Trauma Impacts Adult’s Sleep Valuation in a Sample of African American Couples
Authors: Kay Daniel , Decker Andrea , Marquez Francisco , Cribbet Matthew , Nielson Spencer
Published: April 2024

Introduction

Sleep value is the worth placed on sleep. The Sleep Valuation Item Bank (SVIB) is a novel questionnaire designed to capture the basic dimensions of sleep. The latent structure of sleep value has been tested in several nationally representative samples and college students. Distinct patterns have emerged across demographic and sleep variables. This study sought to outline the factor structure of the updated SVIB in African American couples (97% married) and explore how early life trauma impacts sleep value in adulthood.

Methods

Participants (30+/-4 years of age) in a committed relationship (6.6+/-3 years in a relationship) completed an online survey that included demographic variables, the SVIB, and the Childhood Trauma Questionnaire (CTQ). The factor structure of the SVIB was determined using principal axis factoring with a Promax solution. Factors scores were extracted using the Barlett method and correlated with CTQ subscores: emotional, physical, and sexual abuse and emotional and physical neglect.

Results

The scree plot method, eigenvalues greater than 1, model fit indices (BIC=-2667, χ2=<.001, CVE=.44, TLI=.84, and RMSEA=.054), and conceptual considerations of item fit suggested the presence of 5 factors: sleep devaluing, wanting, prioritizing, preferring, and enjoyment/liking. With the exception of emotional abuse, early life trauma was related to an ambivalent sleep value pattern characterized by lower sleep devaluing (r=-.69), greater sleep wanting (r=.24), and preferring to go to sleep when sleepy at night (r=.22) on the one hand, while enjoying sleep less (r=-.33) on the other (p<.05, for all). Emotional abuse was unique in that they tended to prioritize sleep less (r=-.15) and had the highest negative correlation with sleep enjoyment (r=-.44, p<.05 and .01, respectively).

Conclusion

Our results generally support previous analyses in other samples suggesting the SVIB captures a 5-factor structure of sleep value. This study extends those findings to African American couples. These findings suggest that early life trauma has a highly significant impact on sleep value in adulthood making it more desirable but less enjoyable. Emotional abuse in particular may lead to less prioritizing of sleep and more negative experiences with sleep.

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