bluuebunny/crossref_metadata_2025 huggingface dataset:
0306 Corticotropin-Releasing Hormone Receptor 1 Gene Polymorphism Modulates Cognitive Flexibility Following Acute Stress and Total Sleep Deprivation
Authors: Satterfield B C , Anlap I , Esbit S L , Killgore W D
Published: May 2020

Introduction

Dynamic decision processes requiring flexible updating of information are impaired by stress and sleep loss, both of which activate the hypothalamic-pituitary-adrenal (HPA) stress response. Corticotropin-releasing hormone (CRH) initiates the HPA pathway. The CRH receptor (CRHR1) gene contains a single nucleotide polymorphism that modulates this response. We investigated whether cognitive flexibility is affected by CRHR1 polymorphism following a night of acute stress and total sleep deprivation (TSD).

Methods

N=46 healthy, young adults (21.8±3.4y; 21 females) participated in an in-laboratory 31h sleep deprivation study. Beginning at 19:30 until 07:30, the Maastricht Acute Stress Test (MAST) was administered every 4h. The MAST alternates a cold pressor task with an oral subtraction task five times in a single bout. At 29h wakefulness, subjects performed a novel go/no-go reversal learning task. Stimulus-response rules were presented at the beginning of the task, and subjects were asked to either respond or withhold a response to the presented stimuli while receiving accuracy feedback. Halfway through the task, the stimulus-response rules were reversed. Performance was assessed by discriminability index (d’), hit rate (HR), and false alarm rate (FAR). Saliva samples were collected immediately prior, immediately after, and 30min after each MAST and assayed for cortisol. One saliva sample from each subject was assayed for CRHR1 genotype.

Results

CRHR1 genotypes were in Hardy-Weinberg equilibrium (χ 2=2.97, p=0.08). Mixed effects ANOVA with fixed effects of CRHR1 genotype, pre/post-reversal, and their interaction found a significant CRHR1 by reversal interaction for d’ (F2,319=3.88, p=0.022) and HR (F2,319=3.16, p=0.044) following a night of stress and TSD. No such interaction was found at well-rested baseline (d’: F2,319=2.51, p=0.083; HR: F2,319=1.55, p=0.213). Subjects homozygous for the T allele had higher mean post-MAST cortisol levels (0.40±0.06 µg/dL) with better pre-reversal performance, but worse post-reversal performance compared to heterozygous and homozygous G allele carriers.

Conclusion

CRHR1 genotype modulates dynamic decision making following a night of acute stress and TSD. A higher cortisol stress response (T/T genotype) is beneficial to maintaining task relevant information (stability), but significantly impairs the ability to update task-relevant information following a change in situational demands (flexibility).

Support

CDMRP grant W81XWH-17-C-0088
0317 Impact of Recurrent Partial Sleep Loss Combined with Acute Exercise on Circulating and Adipose Tissue Levels of Leptin, Adiponectin and Ghrelin in Healthy Young Individuals
Authors: Schéle E , Dickson S , Benedict C , Cedernaes J
Published: May 2020

Introduction

Chronic sleep loss and aerobic exercise have opposing effects on body weight maintenance. The effects of sleep loss on circulating levels of the orexigenic hormone ghrelin and the anorexigenic hormone leptin have been extensively studied. In contrast, how these changes interact with acute exercise, and whether these changes are reflected at the tissue level, remains poorly understood.

Methods

In a randomized, 2 session, crossover design, 16 normal-weight young men were studied following three nights of partial sleep deprivation (4.25 hr sleep opportunity each night) and three nights of normal sleep (8.5-h sleep opportunity), monitored in a sleep laboratory. Each condition was followed by 30 min of intense morning ergometer cycling. Plasma levels of leptin and ghrelin, as well adipose tissue mRNA levels of leptin and adiponectin, were measured before and after each exercise intervention.

Results

In response to acute exercise, circulating levels of both leptin (ANOVA time effect: P<0.001) and ghrelin (time: P<0.001) decreased immediately (+15 min), and remained significantly lower +30, +60 and +240 min post exercise for leptin (all P<0.05), and up until +30 min post exercise for ghrelin. These effects were seen regardless of sleep condition (ANOVA sleep condition: P>0.10). In adipose tissue, mRNA expression of leptin and adiponectin was not different between the sleep conditions (ANOVA sleep condition: P>0.10). In contrast, mRNA levels of leptin decreased (P=0.017), whereas adiponectin mRNA increased (P=0.010) 3.5 hours post vs. pre exercise. The decrease in leptin in response to exercise appeared to mainly occur following sleep loss (P=0.066) and not after normal sleep (P=0.38).

Conclusion

Our results suggest that both circulating and adipose tissue levels of appetite-regulating hormones are altered in response to acute aerobic exercise, in a manner that does not depend on prior sleep history. Whether these findings apply to older, female, or metabolically ill individuals - and whether they may differ in response to circadian misalignment, or evening exercise - remains to be established.

Support

The Swedish Society for Medical Research, the Swedish Society of Medicine, the Swedish Research Council and the Göran Gustafsson; Swedish Brain; Åke Wiberg and NovoNordisk Foundations.
0336 The Relationship Between Chronotype, Sleep and Sport Motivation in Adolescents
Authors: Bourgon V , Forest G
Published: May 2020

Introduction

Studies have shown that sleep affects physical performance and certain aspects of motivation in general. Even though it is well known that adolescents are generally sleep deprived, very few studies have investigated the impact of sleep on the inactivity of teens. The aim of this study was to determine the association between sleep and sport motivation in teenagers.

Methods

176 young, physically active participants (10-18y; 86 male) completed an online survey comprised of questions extracted from the Adolescents Sleep Habits Survey, the Pediatric Daytime Sleepiness Scale, the Morningness Eveningness Questionnaire, and the Sports Motivation Scale-28. The self-determination theory of motivation was used to determine the different types of motivation, from the most autonomous motivation (intrinsic motivation) to the least autonomous (extrinsic motivation-externally regulated). Amotivation represent an absence of motivation. Pearson correlations were computed between the sleep variables (sleep habits, daytime sleepiness, chronotype score) and the motivation variables (different types of motivation, and amotivation scores).

Results

Results show that amotivation is significantly associated with daytime sleepiness (r=.16, p =.03). The external regulated form of extrinsic motivation score is significantly associated with daytime sleepiness (r=.157, p=.037), chronotype score (r=-.164, p=.03), and bedtimes on weekends (r=.156, p=.042). The intrinsic motivation score is significantly associated with wake times on weekdays (r=-189, p=.012).

Conclusion

These results suggest that eveningness, higher daytime sleepiness, and later bedtimes on weekends are associated with amotivation and external regulation of sport motivation. Research has shown that teens who present those two characteristics are more likely to drop out of sports teams or leagues. This could have important implications when addressing inactivity and sport motivation problems in adolescents.

Support

N/A
0373 Blacks with Obstructive Sleep Apnea Report Greater Nighttime Insomnia Symptoms than Whites, but Don’t Endorse Daytime Impairment
Authors: Williams N J , Butler M , Roseus J , Barnes A , Blanc J , Bubu O M , Ebben M , Grandner M A , Krieger A C , Jean-Louis G , Perlis M
Published: May 2020

Introduction

Few studies have assessed insomnia severity in racial/ethnic minority patients with OSA. In recognition of the burden of OSA in blacks compared to whites, the current study sought to examine insomnia symptoms in a sample of black and white patients newly diagnosed with OSA, prior to treatment, at 3 and 6 months.

Methods

94 patients newly diagnosed with OSA provided demographics (age, sex, race/ethnicity), socioeconomic status, and completed the well-known and validated Insomnia Severity Index (ISI). To assess insomnia complaints, we ascertained total ISI score, nighttime sleep complaints, and daytime impairment. Linear regression and repeated measures analysis were conducted.

Results

Mean age was 57.43 years ±13.55; 63.8% were men and 35% were black. Mean BMI was 32.35±7.04and 35% were diagnosed with hypertension. The mean ISI score for the total sample was 13.06±7.06. The total ISI was significantly higher in blacks than whites, respectively (M=15.00±7.17; M=12.02±6.83, p<0.05) indicating moderate clinical insomnia in blacks, but not whites. In covariate-adjusted linear regression, nighttime complaints were statistically more pronounced in blacks (b=1.71, SE=0.82, p<0.05) and women (b=2.05, SE=0.72, p<0.01). There were no significant racial/ethnic differences with daytime impairment, but gender differences in daytime impairment remained (b=2.93, SE=1.04 p<0.01). Results from repeated measures effects of race over time revealed that blacks had higher nighttime complaints across all time-points (b=2.51, SE=1.10, p<0.05), but we did not observe a race-by-time interaction effect (b=-0.89, SE=0.50).

Conclusion

For the first time, we observed that overall ISI score and nighttime complaints are more pronounced in blacks than whites. Notably, only women endorsed complaints of daytime impairment. Findings from the study may contribute to understanding who will need treatment for relief of insomnia complaints.

Support

K23HL125939
0386 Identification of Sleep Complaints Using Social Media: Effect of the Daylight Savings Time to Standard Time Transition
Authors: Veatch O J , Mazzotti D R
Published: May 2020

Introduction

Transitions to and from daylight savings time (DST) are natural experiments of circadian disruption and are associated with negative health consequences. Yet, the majority of the United States and several other countries still adopt these changes. Large observational studies focused on understanding the impact of DST transitions on sleep are difficult to conduct. Social media platforms, like Twitter, are powerful sources of human behavior data. We used machine learning to identify tweets reporting sleep complaints (TRSC) during the week of the standard time (ST)-DST transition. Next, we evaluated the circadian patterns of TRSC and compared their prevalence before and after the transition.

Methods

Using data publicly available via the Twitter API, we collected 500 tweets with evidence of sleep complaints, and manually annotated each tweet to validate true sleep complaints. Next, we calculated term frequency-inverse document frequency of each word in each tweet and trained a random forest to classify TRSC using a 3-fold cross-validation design. The trained model was then used to annotate a collection of tweets captured between Oct. 30, 2019-Nov. 6, 2019, overlapping with the DST-ST transition, which occurred on Nov. 3, 2019.

Results

Random forest demonstrated good performance in classifying TRSC (AUC[95%CI]=0.85[0.82-0.89]). This model was applied to 3,738,383 tweets collected around the DST-ST transition, and identified 11,044 TRSC. Posting of these tweets had a circadian pattern, with peak during nighttime. We found a higher frequency of TRSC after the DST-ST transition (0.33% vs. 0.27%, p<0.00001), corresponding to a ~20% increase in the odds of reporting sleep complaints (OR[95%CI]=1.21[1.16-1.25]).

Conclusion

Using machine learning and Twitter data, we identified tweets reporting sleep complaints, described their circadian patterns and demonstrated that the prevalence of these types of tweets is significantly increased after the transition from DST to ST. These results demonstrate the applicability of social media data mining for public health in sleep medicine.

Support

NIH (K01LM012870); AASM Foundation (194-SR-18)
0391 Gateways, Disparities, and Finals Week, Oh My! Translating Sleep Science from the Laboratory to the Classroom
Authors: Scullin M K , Gao C , Bermudez V , Diaz J , Zinke P , George C
Published: May 2020

Introduction

Organic chemistry can be an insurmountable “gateway” course for otherwise-qualified students in pre-health pathways. Recent data indicate that organic chemistry increases drop-out risk for females and underrepresented minority students (URMs), raising the provocative possibility that sleep disparities are an underrecognized contributor to achievement gaps in gateway STEM courses.

Methods

In Study 1, 481 students enrolled in organic chemistry courses completed sleep questionnaires at the beginning, midpoint, and end of the semester. In Study 2, non-chemistry majors were randomly assigned to normal sleep (8 hours) or sleep restriction (5.5 hours) before taking an organic chemistry virtual lecture and test. In Study 3, 35 students wore actigraphy for five nights and could earn extra credit on a mid-semester test by averaging ≥8 hours of sleep; actigraphy sleep durations were compared to 40 active-control students who only received sleep education.

Results

In Study 1 (classroom), URM and female students earned lower organic chemistry grades than comparison students, p<.001. Baseline weekday sleep duration predicted test grades across the semester, and students who improved their weekday sleep subsequently improved their organic chemistry grades. In Study 2 (laboratory), mild sleep loss impaired meta-cognitive judgments of organic chemistry learning, a potential causal mechanism for reduced persistence in chemistry courses. In Study 3 (classroom), when better sleep behaviors were incentivized by extra credit, students slept an hour longer/night than control groups (7.8 vs 6.8 hours, p<.001). These benefits persisted 1 month later into finals week when sleep behaviors were not externally incentivized (7.3 vs 6.3 hours, p=.001). Improving sleep improved performance on difficult short answer questions after correcting for pre-final grades (Madjusted=78% vs 72%, p=.04).

Conclusion

Sleep disparities contribute to achievement gaps in gateway STEM courses, but incentives can reverse poor sleep habits. University administrators should develop and implement behavioral change programs to reduce sleep disparities.

Support

National Science Foundation (DRL 1920730)
0402 Impact of Various Actigraphic Editing Approaches on Sleep/Wake Outputs in Adults with Insomnia and Healthy Sleepers
Authors: Kline C E , Egeler M E , Kubala A G , Patel S R , Lehrer H M , Duggan K A , Hall M H
Published: May 2020

Introduction

Actigraphy data can be edited using a variety of approaches. However, whether time-intensive manual editing provides different sleep/wake estimates compared to other approaches is unknown. The purpose of this study was to compare sleep/wake data obtained from a standardized editing approach that incorporates multiple inputs versus three other common approaches.

Methods

72 adults (33.8±11.1 y, 74% female, 71% white) provided 1022 nights of data for analysis; 45 were healthy sleepers (678 nights) and 27 met DSM-5 criteria for insomnia. Participants wore an Actiwatch Spectrum on their nondominant wrist and completed a sleep diary for 3-24 nights. Each night’s rest interval was set using four different approaches: (1) a standardized process based upon published guidelines (Patel et al., Sleep 2015) that incorporates a hierarchical order of multiple inputs (event marker, light, diary, activity; STANDARD); (2) software-provided automated algorithm (AUTO); (3) automated algorithm with incorporation of event markers (AUTOE); and (4) sleep diary (DIARY). We used linear mixed-effects models to evaluate whether sleep/wake parameters differed between the STANDARD and other editing approaches, accounting for patient status (healthy sleeper, insomnia) and the possibility that differences among editing approaches may be dependent on patient status.

Results

All results are expressed relative to the STANDARD approach. Bedtime was 36.1±5.1 min earlier (P<.0001) and morning out-of-bed time was 13.6±5.7 min later (P=.02) using the AUTO (P<.0001) approach. Time in bed was 42.3±4.7 min longer with AUTO (P<.0001). Sleep onset latency was 11.7±1.4 min and 2.8±1.4 min longer for AUTO (P<.0001) and DIARY (P=.05), respectively. Sleep duration was 22.5±4.4 min longer with AUTO (P<.0001). Wake after sleep onset was 6.8±1.2 min greater with AUTO (P<.0001). Similar patterns were observed for all sleep/wake measures among healthy sleepers and adults with insomnia.

Conclusion

A standardized approach to editing actigraphy data leads to different sleep/wake estimates compared to other common approaches, though the differences were often small in magnitude and not dependent upon sleep status. Most notably, reliance upon the automated algorithm yielded longer time in bed, sleep duration, sleep onset latency, and wake after sleep onset compared to the standardized approach.

Support

NIH K23HL118318
0417 Associations Between Rest-Activity Patterns and Resting-State Networks in Older Adults
Authors: Moon C , Cole R A , Xiao Q , Voss M W
Published: May 2020

Introduction

Resting-state functional connectivity is coherent brain activity in a task-free state that strongly correlates to task-evoked sensory, motor, and higher-order cognitive systems. Certain networks show decreased functional connectivity with aging. Aging is associated with changes in circadian rhythms and sleep-wake cycles. Limited research has been conducted on how circadian activity and sleep are related to markers of functional brain aging. The purpose of this study was to explore whether rest-activity patterns and shorter sleep duration are related to functional connectivity of specific resting-state networks in older adults.

Methods

A total of 124 cognitively normal participants (mean age (SD) = 67.2 (5.7), 42% men) underwent 3.0 T MRI and week-long wrist actigraphy protocols. Rest-activity pattern was analyzed using an extended cosine model calculating acrophase (time of peak activity) and pseudo-F statistics of goodness-of-fit (a measure of overall rhythmicity). We used resting-state fMRI scans to measure functional connectivity in association and sensory networks as defined by the Schaefer 17 network functional atlas. Multiple linear regression analysis was used to investigate how rest-activity pattern parameters and sleep duration are associated with resting-state functional connectivity, adjusting for age, sex, and sleep apnea.

Results

We found that the average acrophase was 2:30 PM (SD = 54 min), and delayed acrophase (average vs. delayed [+1SD]) was associated with lower functional connectivity of the right-lateralized default mode network A (p=0.02), and higher pseudo-F statistics was associated with higher functional connectivity in networks including left dorsal attention B (p=0.001), right somatomotor A (p = 0.05), and somatomotor B (both p=0.02). Longer sleep duration was associated with higher right executive control B (p=0.03).

Conclusion

The overall rhythmicity of diurnal rest-activity patterns and longer sleep duration are associated with some resting-state functional networks. Further investigation is needed to understand the mechanisms between circadian rhythm and brain function.

Support

National Institute of Health, U of Iowa Aging Mind Brain Initiative, Center on Aging
0444 Examining Sleep Duration and Social Jetlag From a Popular Wearable Sleep Tracker in France and Canada
Authors: Elbaz M , Robbins R , Bouchequet P , Czeisler C , Leger D
Published: May 2020

Introduction

Many population estimates of sleep duration and quality rely primarily on self-reported data. Passive and ubiquitous digital tracking and wearable devices may provide more accurate estimates of sleep duration and quality.

Our objective was to identify trends in sleep duration and social jetlag using data from a popular mobile sleep application (app) in France and Canada ‘iSommeil.’

Methods

We examined sleep using 8,207 nights from iSommeil, a popular sleep-tracking app in France and Canada. In this analysis, we explored sleep data collected from this app from 2,126 users. We examine sleep parameters by sex and between week and weekend. Specifically, we explore social jetlag, as calculated by the midpoint of sleep during the weekend, subtracted from the midpoint of sleep during the week.

Results

Women represented 1,254 (59.7%) of the sample and men represented 857 (40.3%) of the sample. Among women, 16.4% of the sample averaged <6 hours of sleep; 51.9% averaged 6-7.99 hours of sleep, and 31.7% averaged >=8 hours of sleep. Among men, 17.4% averaged <6 hours of sleep; 58.4% averaged 6-7.99 hours of sleep, and 24.2% averaged >=8 hours of sleep. Social jetlag scores among all users averaged 31.4, yet the average for men was 27.1 while that for women was 36.4.

Conclusion

Our study of data from a popular sleep tracker in France and Canada showed that sleep duration of 6-7.99 hours was most observed among the majority of participants. Our results also showed that women had higher social jetlag scores than men. Future research may compare sleep measures obtained via wearable sleep trackers with validated research-grade measures of sleep.

Support
0465 Association Between Physical or Sexual Abuse and Sleep Reactivity in Patients with Insomnia
Authors: Drake C L , Cheng P , Kalmbach D , Roth T , Sagong C , Arnett L
Published: May 2020

Introduction

Physical and sexual abuse are common and have demonstrated associations with insomnia. A common factor predisposing individuals to the development of insomnia is sleep reactivity, yet no studies have determined the relationship between sleep reactivity and physical and/or sexual abuse.

Methods

Patients with DSM-5 insomnia disorder (N = 658; 519 F; mean age = 45.03) participated in an online randomized controlled trial of behavioral treatment of insomnia. Participants completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress Test (FIRST), and demographic information at baseline. Abuse history was assessed with a single 4-choice item asking participants if they had a history of physical or sexual abuse. One-way analysis of variance was used to determine the level of sleep reactivity in each of the 4 abuse groups (none, physical, sexual, both) controlling for insomnia (ISI). Post-hoc analyses also compared differences in self-reported difficulties falling and staying asleep.

Results

Compared to those with no abuse history (n = 465), patients who reported both physical and sexual abuse (n = 50) had significantly elevated FIRST scores (p < .001). Results remained significant after controlling for severity of insomnia, age, and gender. Post-hoc analyses showed group differences in sleep onset latency but not wake after sleep onset.

Conclusion

Combined physical and sexual abuse are associated with higher levels of sleep reactivity to stress, and that the effects may be most prominent for difficulties falling asleep and not sleep maintenance. Prospective studies are needed to determine the potential effects of abuse on sleep reactivity, and whether sensitization of the sleep system to stress constitutes an etiological pathway in the development of insomnia disorder in survivors of abuse. Future work should also investigate potential overlapping biological markers of abuse and sleep reactivity.

Support

This study was funded by the Robert Wood Johnson Foundation (PI: Drake).
0471 24-Month Post Marketing Safety Surveillance Data of a Novel Continuous Release and Absorption Melatonin (CRA-Melatonin) Delivery System, Confirms Favorable Safety Profile
Authors: Brodner D , Corsino P
Published: May 2020

Introduction

The awareness of sleep disorders having negative health consequences, including hypertension, diabetes, obesity, depression, heart attack and stroke, has sharply escalated in recent years. Traditional treatments, including benzodiazepenes, non-benzodiazepenes, anti-depressants and non-prescription first-generation antihistamines, come with limitations in efficacy, safety and tolerability. The search for non-drug alternatives continues. The novel, well tolerated CRA-melatonin was shown in a randomized, crossover, pharmacokinetic (PK) study versus the leading marketed melatonin to achieve quick uptake and then continuous release and absorption for up to 7 hours. No safety or tolerability issues were observed. The Remfresh Safety Update at 24 months (REMSU24), a real-world safety surveillance study was conducted to confirm the previously observed safety profile of CRA-melatonin.

Methods

An independent call center with pharmacovigilance-trained health care personnel in accordance with FDA guidelines on properly reporting events, was retained to receive and record customer questions, product issues and adverse events (AEs). The study was conducted from March 9, 2017 to March 9, 2019.

Results

An estimated 320,255 patients used CRA-melatonin during the surveillance period. There were no serious AEs. The self-reporting rates of non-serious AEs were low with only 51 events recorded, a 0.016% event rate. The two most frequent AEs, headaches and nightmares are known comorbidities of insomnia. As background, there had been no treatment emergent adverse events for CRA-melatonin in the PK trial.

Conclusion

CRA-melatonin’s extended 7-hour PK profile may be an effective and well-tolerated baseline therapy to improve sleep. These results confirm the favorable safety and tolerability trend observed in the PK study. In REMSU24, the scatter of reported adverse events could not be separated from what could be expected in the untreated general population.

Support

This study was supported by Physician’s Seal LLC
0495 Auricular Acupuncture Treatment Associated with Improved Self-Reported Sleep and Emotional Distress in Hispanic and Latino Immigrants: A Preliminary Report
Authors: Hockmeyer T R , Rupp H R
Published: May 2020

Introduction

Hispanic and Latino immigrants face sociocultural stressors that may contribute to sleep disturbance. We investigated: 1. Whether Hispanic/ Latino immigrants with self-reported sleep disturbance showed improvements in sleep with auricular acupuncture; 2. If sleep effects were associated with emotional distress.

Methods

Emotional distress and sleep responses to auriculotherapy in Hispanic/ Latino adult immigrants were measured using Emotional Distress (ED), Athens Insomnia (AI), and Pittsburgh Sleep Quality Index (PSQI) scales completed Baseline, Mid (4 treatments), and Follow-up (8 treatments). Randomly assigned intervention was bi-weekly for 8 treatment sessions of 5 needles inserted bilaterally: Active Intervention [NADA protocol (Shen men, sympathetic autonomic, lung, liver and kidney points)] OR Sham Control (outer ear helix with no active points). Scores were compared between Groups (NADA or SHAM) and within (Pre-, Mid- and Post-treatment) sessions using Mixed-Model ANOVA; multiple linear regression assessed ED scores association with sleep.

Results

Ten Hispanic/ Latino female participants [NADA, N=5, mean (SD) age = 41 (14); SHAM, N =5; mean (SD) age = 42 (17)]. Anovas for the ASI, PSQI, and ED showed significant within-subjects effects (p’s < .05). Baseline; Mid; Follow-up Mean (SD) = AIS: 12.3 (8.9); 8.5 (6.9); 7.1 (12.8); PSQI: 10.9 (5.4); 8.9 (2.8); 7.6 (3.4); ED: 25.6 (50.4); 17.6 (26.7); 16.9 (29.8). Post-hoc t-tests were significant between Baseline/ Mid and Baseline/ Final for all measures (p’s < .05). Linear Regression showed significant association between ED and PSQI (R square = 0.25; p < .05): lower Emotional Distress associated with lower PSQI.

Conclusion

Auriculotherapy may improve sleep in Hispanic/ Latino immigrants after 4 treatments suggesting a novel, low-cost, easily implemented group treatment option for improving sleep in this community. Better sleep was associated with decreases in emotional distress supporting our hypothesis. Data collection continues and larger sample size will allow for increased power to detect between group differences.

Support

This research was made possible with thanks to the American Academy of Sleep Medicine (AASM) Humanitarian Award#:197-FP-18.
0498 Effect of Lavender Essential Oil on Sleep in Postmenopausal Women with Insomnia: Double-Blind Randomized Controlled Trial
Authors: Lucena L R , Santos-Junior J G , Tufik S , Hachul H
Published: May 2020

Introduction

Sleep is essential for women’s health and its deprivation leads to serious physiological consequences. In addition, insomnia is a common complaint in postmenopausal women. Thus, the present study aimed to evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia.

Methods

Experimental, double-blind, randomized controlled trial composed by 33 women (48 - 65 years) with clinical diagnosis of insomnia divided in two groups that inhaled different oils before sleep during 29 days: Placebo Group - PG (sunflower oil) and Aroma Group - AG (Lavandula angustifolia essential oil). Both groups received sleep hygiene guidelines and were followed weekly. To assess the effect of the intervention on menopausal symptoms the Menopause Rating Scale (MRS) and the Hospital Anxiety and Depression Scale (HADS) were used and for sleep evaluation the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) were used. Additionally, polysomnography were used to assess sleep pattern. All outcomes were evaluated before and after intervention. Statistical analysis was performed using SPSS 22 through Generalized Estimed Equations test with significance set at p≤ 0.05.

Results

Comparing the pre and post-intervention periods, AG participants had a significant decrease in sleep onset latency, depression level, hot flashes, menopausal symptoms and a significant increase in sleep quality. Polysomnography data showed increased sleep efficiency and decreased wakefulness after sleep onset on AG participants. After the intervention, all volunteers presented improvement in all outcomes of sleep and menopausal symptoms measured by questionnaires.

Conclusion

The intervention was effective in improving the sleep pattern of AG participants, but was not significant when compared to PG participants. In addition, sleep hygiene instructions were essential to improve the sleep pattern of all volunteers. Therefore, inhalation of lavender essential oil is a safe, low-cost practice that should be considered as a complementary option to conventional treatments, whether medical, psychological or other integrative and complementary practices.

Support

This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001 and Conselho Nacional de Pesquisa (CNPq).
0501 Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia “Nitecapp” in Rural Dementia Caregivers: A Mixed-Methods Study
Authors: McCrae C , Curtis A F , Nair N , Deroche C B , Shenker J , Rowe M
Published: May 2020

Introduction

Informal caregivers (CGs) of persons with dementia frequently experience insomnia. The time consuming and unpredictable schedule of CGs, and associated emotional/physical exhaustion emphasize the need for brief, easily accessible interventions to treat insomnia. Internet-based behavioral insomnia interventions hold promise, particularly for rural CGs who have limited access to traditional in-person treatments. This study aimed to 1) translate an efficacious 4 session cognitive behavioral therapy for insomnia (CBT-I) to web-based “NiteCAPP” for dementia caregivers, and 2) conduct NiteCAPP usability testing/evaluate acceptability of content and features.

Methods

NiteCAPP is an online CBT-I that incorporates guided delivery through weekly therapist moderator feedback. A stepwise approach was implemented in order to explore user needs and validate NiteCAPP content in a focus group of rural dementia caregivers (n=5) and primary care providers (PCPs; n=5). Participants conducted usability testing and provided ratings of program content (1-least favorable to 5-most favorable) regarding ease of use, amount of information, website maintaining interest, adequate font size, videos maintaining interest/easy to understand/helpful. Participants also indicated whether they had at home internet access, method of internet access, and provided open ended feedback on NiteCAPP. Feedback transcripts were compiled and analyzed independently (C.S.M., A.F.C.) through deductive content analysis. Topics mentioned frequently were categorized and merged into common themes during consensus meeting, and NiteCAPP was subsequently adapted.

Results

Average ratings for NiteCAPP features were high, ranging from 4.1/5 to 4.7/5 across all items. All participants had access to internet through both phone and computer. No barriers to use identified. Feedback themes were largely positive (e.g., comprehensive written material, promotes independence, excellent visual tools for therapy moderator feedback, good pacing, use of visual contrast). Negative themes for improvement/adaptation included adding font size options, a light/dark mode, tab with all videos, reducing amount of scrolling, adding a glossary of terms.

Conclusion

Rural dementia CGs and PCPs evaluated NiteCAPP as easy to use with acceptable features and program content and no barriers to access. Improvement themes were used to adapt NiteCAPP. Next steps are to evaluate feasibility and preliminary efficacy of NiteCAPP in rural dementia CGs with insomnia.

Support

none
0593 Hypoxemia During Sleep Disordered Breathing and Cardiovascular Disease: A Comparison of Different Oxygen Desaturation Measures
Authors: Mazzotti D R , Leppänen T , Sands S , Töyräs J , Wellman A , Kulkas A , Redline S , Karhu T , Azarbarzin A
Published: May 2020

Introduction

The apnea-hypopnea index has been used to characterize obstructive sleep apnea (OSA) severity. However, this metric is limited in providing information about cardiovascular disease (CVD) risk. Recent studies proposed alternative metrics that capture frequency, duration, depth, and combinations of duration and depth of hypoxemia. This study provides a systematic evaluation of the association between conventional or novel nocturnal hypoxemia metrics and the incidence of CVD and CV mortality in the Sleep Heart Health Study (SHHS).

Methods

We used data from 5,042 participants of the SHHS. Over 10.7 years, there were 1,312 (26.0%) incident CVD events and 359 (7.1%) CV deaths. We calculated standardized (z-scored) values of eight nocturnal hypoxemia indices, including conventional (e.g., oxygen desaturation index) and novel metrics (e.g., hypoxic burden, respiratory event-related area under desaturation curve and desaturation severity, corresponding to alternative quantitative measurements looking at the shape of each desaturation event). The association between each metric and incidence of CVD or CV mortality was evaluated using Cox proportional hazards models. Age, sex, body mass index, race, ethnicity, smoking, total sleep time, number of respiratory events, and prevalent CVD at baseline were used as covariates. Hazard ratios (HR) are presented as the effect of one standard deviation increase in each correponding metric.

Results

In unadjusted models, all nocturnal hypoxemia indices were associated with increased incidence of CVD and CV mortality. In adjusted models, longer average desaturation duration was associated with lower CVD incidence (HR[95%CI]=0.93[0.86-0.99];p=0.034), higher hypoxic burden with increased CV mortality (HR[95%CI]=1.22[1.04-1.43];p=0.017), and higher % sleep time with oxygen saturation less than 90% (Tlt90%) with increased CV mortality (HR[95%CI]=1.12[1.00-1.26];p=0.040).

Conclusion

Different metrics of nocturnal hypoxemia derived from polysomnography were associated with CV risk in the SHHS. However, after covariate adjustment, only shorter average desaturation duration, and higher hypoxic burden and Tlt90% were independent CV risk factors.

Support

AASM Foundation (194-SR-18,188-SR-17); American Heart Association (19CDA34660137); NIH (U01HL53940,U01HL53941,U01HL63463,U01HL53937, U01HL53938,U01HL53916,U01HL53934,U01HL63429,U01HL53931,HL114473, P01HL094307,HL134015,R35HL135818,1R21HL145492-01,R01HL102321,R01HL128658); The State Research Funding (KUH: 5041767, 5041768; TUH: VTR3242, VTR3228, EVO2089), Academy of Finland (313697, 323536), Business Finland (5133/31/2018), Respiratory Foundation of Kuopio Region, Tampere Tuberculosis Foundation, Research Foundation of Pulmonary Diseases, Foundation of Finnish Anti-Tuberculosis Association.
0604 Comorbidities and Admission Rates in Inpatients Undergoing Sleep Studies
Authors: Johnson K G , Ravikumar N , Scuderi N , Sharma A , Rastegar V , Visintainer P
Published: May 2020

Introduction

Uncontrolled sleep-disordered breathing (SDB) and hypoventilation, which are common in COPD, CHF and obesity hypoventilation patients can lead to death and readmissions. It is unknown whether inpatient sleep studies to diagnose and optimize treatment improve care and prevent readmissions.

Methods

All patients > 18 years old with sleep studies while inpatient at Baystate Medical Center between October 2015 and September 2017 were included. Patient characteristics, comorbidities, sleep study diagnoses, and treatment recommendations were evaluated. Admission (inpatient or observation) and death rates were determined for 1-year before admit date and 1-year after discharge date of index admission.

Results

326 adult inpatients had 120 portable and 304 in-laboratory tests performed. Average age was 62.9±14.4, mean BMI was 37.2±12.3 and 56% were male. Principal diagnoses were CHF (50%), COPD (39%), both COPD and CHF (20%) and obesity hypoventilation (27%). 31 used PAP and 71 used oxygen prior to admission. Sleep diagnoses included OSA (73%), central sleep apnea (CSA) (29%), treatment emergent CSA (8%), hypoxia (48%), hypoventilation (41%), and normal or non-diagnostic (6%). Treatment recommendations included CPAP (25%), BiPAP (18%), BiPAP ST (3%), ASV (4%), iVAPS (22%), oxygen only (5%) and further titration (20%). The average length of stay was 11.6 ± 9.6 days. There was no difference in the percentage of patients who had an admission before or after their sleep study (53% vs 56%, respectively). In addition, no difference was seen in the median number of admissions before and after the sleep study (median=1.0, IQI=0-2, p=0.77). 90-day readmission rate was 19%. 14% died.

Conclusion

SDB, hypoxia and hypoventilation were common in inpatients evaluated with sleep studies with PAP therapy recommended in most patients. Further research is needed to determine whether inpatient testing and subsequent treatment can result in decreased readmissions and death.

Support

None
0612 Validation of NEMS-BG Score in Screening of Patients with Obstructive Sleep Apnea
Authors: Gharraf H , Baess A
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is one of the most prevalent diseases worldwide. Diagnosis of OSA is still a dilemma despite our well known disease-related impact on human body health. Under-diagnosis of OSA is still a problem despite the well-established clinical and laboratory criteria of diagnosis. Over-diagnosis may lead to exhaustion of our limited health-care resources. Therefore, an efficient screening tool that is well validated and easily applied, will be an ideal solution for the over or under-diagnosis of OSA. NAMES-BG score was suggested to efficiently screen for OSA depending on neck circumference, airway classification, comorbidities, Epworth sleepiness scale, snoring score, body mass index and gender

Methods

The aim of the work was to validate NEMS-BG score in screening of patients with obstructive sleep apnea (OSA).

Patients and Methods

This is a retrospective single center clinical study. Records of patients with documented obstructive sleep apnea were collected. Those records were collected from the database of department of chest diseases in Alexandria Main University Hospital (AMUH). The records of included patients included demographic data, clinical findings, anthropometric measures and polysomnographic records. Statistics were formulated to validate the sensitivity and specificity of this score in our cohort of patients. The significance of the results were at the 5% level of significance.

Results

The cutoff value for the composite NAMES tool was calculated at ≥3 points. In the validation group, NAMES demonstrated similar test characteristics to the Berlin questionnaire, and sensitivity was statistically significantly better than that seen with the Epworth scale. The addition of BMI and gender to the tool improved screening characteristics

Conclusion

The NAMES assessment is an effective, inexpensive screening strategy for moderate to severe OSA.

Support

no support
0615 The Prevalence of Common Sleep Disorders In Young Adults: A Population-Based Study
Authors: Eastwood P R , Ward S V , Bucks R S , Maddison K , Smith A , Huang R , Pennell C E , Hillman D R , McArdle N
Published: May 2020

Introduction

Adult sleep disorders are associated with adverse health effects including reduced quality of life and increased mortality. However, there is a paucity of data on sleep disorders in young adulthood.

Methods

We undertook a cross-sectional observational study of 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012-2014) to describe the prevalence of common sleep disorders in young adults. We used in-laboratory polysomnography (PSG) and validated survey methods, including the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Symptom Questionnaire-Insomnia and International Restless Legs Syndrome Study Group criteria. 1,146 completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analysable PSG data.

Results

Participants had a mean age of 22.2 years and male to female ratio of 1 to 1.1. The prevalence of OSA [apnoea hypopnoea index (AHI): ≥5events/hour] was 20.8% (95%CI: 18.2 to 23.6) and this was usually of mild severity (AHI:≥5 to<15events/hour, 17.1%). OSA syndrome (AHI≥5 events/hour and ESS≥11) was found in 2.8% (95%CI: 1.9 to 4.1). Chronic insomnia was present in 16.6% (95%CI: 14.7 to 19.4). Restless legs syndrome was present in 2.9% (95%CI: 2.0 to 4.0) and abnormal periodic leg movements during sleep (>5 movements/hour) in 9.1% (95%CI: 7.3 to 11.1). In those participants who had complete data on all sleep-related assessments (n=841), at least one sleep disorder was present in 42.6%.

Conclusion

Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.

Support
0658 The Effect of Text Message Reminders on Positive Airway Pressure Adherence in Veterans With Obstructive Sleep Apnea
Authors: Al Saleh Q , Kim D , Jordan K , Balish M , Kataria L
Published: May 2020

Introduction

Adherence to positive airway pressure (PAP) therapy continues to be a challenge. The main objective of this study was to determine whether mobile text-message reminders increased PAP adherence in veterans with obstructive sleep apnea.

Methods

This is a retrospective study of 25 patients with poor adherence to PAP therapy who used the Veterans Affairs ANNIE app to receive nightly mobile text message reminders. PAP adherence was measured at baseline, 1,and 3 months. A one-way repeated measures ANOVA was used to compare the effect of time on PAP adherence, specifically the percentage of overall days used and percentage use >4 hours. A two-way repeated measures ANOVA without replication was used to determine the effects of AHI severity and time on PAP adherence.

Results

Our sample demographics included a mean age of 59 ±12 years, mean BMI of 33.5% ±5.4, and mean AHI of 26.3 ±25.4. The mean PAP overall percentage use and mean use >4 hours respectively were 32% ± 27 and 18% ± 19 at baseline, 66% ± 27 and 45% ± 30 at 1 month, and 54% ±32 and 37% ± 30 at 3 months. After three months of receiving nightly text-message reminders, there was a statistically significant effect of time on percentage overall PAP use, F (2, 48)=21.54, p=2.10E-07, as well as in the percentage PAP use >4 hours, F (2, 48)=22.05, p=1.61E-07. A two-way repeated measures ANOVA without replication yielded a main effect of the interaction of time with PAP adherence, F (2, 48)=22, p=<0.0001. AHI severity was not a significant factor.

Conclusion

Nightly text message reminders significantly improved PAP adherence from baseline to 3 months. Though PAP adherence was not optimal, it doubled initially in our sample. Further studies are warranted to determine how text-messages can be used long term to improve adherence.

Support

Nil
0668 Identifying Risk Of Positive Airway Pressure Therapy Non-Adherence Before Beginning Therapy: The Importance Of First Impressions
Authors: Shaughnessy G F , Morgenthaler T I
Published: May 2020

Introduction

Prior studies established that compliance during the early days of positive airway pressure (PAP) therapy predicts long-term adherence, which in turn relates to outcomes. However, patient impressions gathered immediately after PAP titration may be the earliest indication of adherence and could help focus efforts at improving compliance. The aim of this study was to examine whether a survey on PAP experience during polysomnography predicts adherence.

Methods

This prospective cohort study included PAP naïve adults with obstructive sleep apnea who had PAP titration during polysomnography and had 30 day adherence data available. Patients answered a pre-existing 5-question survey with dichotomous answers (yes/no) regarding their PAP experience (improved sleep, general discomfort, PAP related discomfort, mask discomfort, willingness to use PAP). Primary outcome was 30 day adherence (average time used per night, percent of nights used, percent of nights with >4 hours use).

Results

We enrolled 47 patients (68% male) with average age of 62.4 years, body mass index 32.6 kg/m2, and apnea-hypopnea index 27.8/hr. Patients answered an average of 3.4±1.3 survey questions favorably. The number of favorable answers correlated with percent of nights used and percent of nights with >4 hours use (P<0.05). Patients with improved sleep during PAP titration had a greater percent of nights with >4 hours use (82.4% vs 60.3%; P <0.05). In addition, successful titration during polysomnography (less than 5 events per hour) correlated with improved adherence and less leak after 30 days.

Conclusion

Initial PAP titration experience influences future PAP adherence. Although there was a correlation between answers on our pre-existing questionnaire and outcomes, some questions did not contribute much for this use. We believe a next step would be to develop questions that help predict future usage and better guide therapy.

Support

None