bluuebunny/crossref_metadata_2025 huggingface dataset:
0795 The Relationship Between Restless Legs Syndrome and Hypothyroidism
Authors: Ahmed N , Kandil M , Elfil M , Jamal A , Koo B
Published: May 2020

Introduction

The diurnal nature of RLS and its response to dopamine hint that hormones may be central in RLS pathophysiology. Hypothyroidism has been linked to RLS, but studies are few and limited in scope. We sought to determine whether restless legs syndrome (RLS) is more prevalent in persons with hypothyroidism and whether hypothyroidism is more prevalent in persons with RLS.

Methods

Persons with hypothyroidism and controls without hypothyroidism were recruited through Research Match, an on-line registry of potential clinical research participants, and assessed for RLS using the Cambridge Hopkins questionnaire. Persons with RLS and controls without RLS were recruited through the RLS Foundation and Research Match and assessed for hypothyroidism by self-report of physician diagnosis. RLS severity was assessed using the International RLS Study Group Severity Scale and cause of hypothyroidism was assessed by self-report.

Results

266 hypothyroid subjects and 321 controls were comparable in age (52.3±13.4 vs. 53.9±11.7; p=0.14) and gender (91.7% vs. 91.3% women; p=0.85). 354 RLS and 313 control subjects were comparable in age (59.1±13.2 vs. 58.2±13.6; p=0.41) and gender (80.8% vs. 78.3%; p=0.42). Hypothyroid participants compared to controls had significantly higher RLS prevalence (14.3% vs. 8.1%; p=0.02). RLS participants compared to non-RLS controls had significantly higher hypothyroidism prevalence (22.3% vs. 13.8%; p=0.005). RLS severity was similar in persons with and those without hypothyroidism. Among 73 persons with RLS and comorbid hypothyroidism, 14 previously were hyperthyroid compared to 0 out of 37 persons with hypothyroidism without RLS (p=0.004).

Conclusion

RLS prevalence is increased in individuals with hypothyroidism and hypothyroidism prevalence is increased in individuals with RLS. Persons with comorbid hypothyroidism and RLS are significantly more likely than those with hypothyroidism alone to have had hyperthyroidism prior to hypothyroidism. The association between RLS and thyroid disease is likely to shed light on the complex biological mechanisms underlying RLS pathophysiology.

Support

None
0809 A Randomized Double-blind, Placebo Controlled Trial With Cross-over, To Assess The Efficacy Of Correcting Vitamin D Deficiency In Improving The Symptoms Of Restless Legs Syndrome (RLS)
Authors: Wong J , Gupta D , Nadhim A , Bhat S , Polos P
Published: May 2020

Introduction

Recent studies have shown an association of low Vitamin D levels and severity of RLS symptoms. However, effect of treatment of Vit D deficiency on RLS symptoms was not reported, nor were other exacerbating factors for RLS such as iron deficiency or OSA addressed in prior studies, but have been addressed in our study.

Methods

This is an ongoing study at the JFKMC Sleep Clinic. Eligible Patients with RLS include those with vitamin D 25,hydroxy deficiency (<20 ng/ml), or insufficiency (<30 ng/ml). Such patients will be enrolled in the study after comorbid conditions like iron deficiency and OSA have been adequately corrected. Randomization of the patients will be done by the JFK pharmacy so the patient and provider are blinded to the substance. Substance A or B could be either Vitamin D3 Capsule 50,000 IU, or placebo. Each patient takes A for 6 weeks and then crosses over to B for 6 weeks. Weekly iRLS questionnaires will be collected. Actiwatch Device, to assess activity count per minute, will be worn on the ankle at night for one week time periods: at baseline, at end of 6 weeks of taking A and then at the end of 6 weeks of taking B. Vitamin D levels will also be assessed after each course of supplementation and correlated with subjective and objective findings.

Results

Between July 7, 2019 to current, 50 consecutive patients seen in sleep clinic with RLS were assessed for vitamin D levels. Ages ranged from 23-86 years. 27 patients were female (54%). Two patients met inclusion criteria and have started their 13-week study.

Conclusion

This study will help to establish the role of Vitamin D deficiency as a risk factor for RLS, independent of ferritin levels, and comorbid OSA, in affected individuals. This may help to discover a potentially treatable form of RLS.

Support

No financial support.
0810 Sleep Disturbances In Returning Veterans That Are Homeless And Combat-exposed
Authors: Speed K J , Crean H J , Bishop T J , Hoff R , Pigeon W J
Published: May 2020

Introduction

Challenges with sleep (i.e., nightmares and insomnia) impact military service members both during and following deployment, but may occur more frequently in combat-exposed individuals. In addition, among the challenges faced following the transition from active duty to Veteran status are periods of homelessness, which may further contribute to sleep disturbances.

Methods

The present analyses utilized data from the Survey of Experiences of Returning Veterans, a national survey of recently returning combat Veterans focused on the examination of sex differences following exposure to traumatic events. The sample (n = 793) consisted of 58% males; females were oversampled and all branches were represented. Ordinal and multiple linear regressions were used to investigate the role of combat exposure and homelessness in predicting nightmare distress and insomnia severity.

Results

An ordinal regression found that combat exposure (b = -.02, p <0.001), homelessness (b = -.31, p = 0.010), and insomnia severity (b = -.10, p <0.001) each significantly predicted nightmare distress. These variables increased risk (SAS parameterizes these models so that negative coefficients are associated with increased risk). Demographic variables were not significantly related to nightmare distress. Similarly, combat exposure (β = .100, p = .002) was associated with insomnia severity, as was nightmare distress (β = .522, p < .001). The moderational role of gender and homeless in the above models are also tested.

Conclusion

For those who have been combat exposed, have a history of homelessness, and report insomnia symptoms there is an increased odds of reporting nightmare distress, sleep disturbance is even more likely to occur. Although combat exposure and nightmare distress were predictive of insomnia severity, history of homelessness was not. These findings suggest that nightmare distress and insomnia symptoms are a significant concern in our returning combat-exposed Veterans, with nightmares being even more problematic for those at risk of homelessness.

Support

This study was funded by VHA CSR&D grant ZDA-01. Dr. Speed is supported, in part, by the VA Advanced Fellowship Program in Mental Health Illness Research and Treatment, the VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC.
0819 Objective Sleep Efficiency is Associated with Longitudinal Risk of High Depressive Symptoms in Pregnant Women
Authors: Tsai S , Lee P , Gordon C , Cayanan E , Lee C
Published: May 2020

Introduction

Sleep disturbances are one of the most frequent complaints identified during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide. The purpose of this study was to examine the predictive association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.

Methods

We recruited 204 first-trimester pregnant women from a large university-affiliated hospital. They provided baseline socio-demographic and health information, wore a wrist actigraph for 7 days, and completed the Pittsburgh Sleep Quality Index and Center for Epidemiologic Studies - Depression Scale and repeated this again in the second and third trimesters. Each data collection was scheduled at least 8 weeks apart. Unadjusted and multivariable adjusted odds ratios with 95% confidence intervals were used to evaluate sleep disturbances at 1st trimester and risk of high depressive symptoms at follow-up.

Results

A total of 121 (59.3%) women had actigraphic sleep efficiency of < 85% and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.65-, 3.86-, and 5.27-fold increased odds having risk of high depressive symptoms at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. No subjective sleep disturbance variables were significantly associated with risk of high depressive symptoms in multivariate adjusted models.

Conclusion

Objectively assessed poor sleep efficiency in the 1st trimester plays a crucial role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether early interventions to improve sleep may help reduce high depressive symptom risk and lower depression rates in women during pregnancy.

Support

This study was funded by the Ministry of Science and Technology, Taiwan (MOST-101-2314-B-002-049-MY3).
0821 Gender Differences in Sailor Well-Being, Sleep-Related Behaviors, and Psychomotor Vigilance Performance in the United States Navy
Authors: Shattuck N L , Matsangas P
Published: May 2020

Introduction

Approximately 18% of US Navy sailors are females. Research has shown gender-related differences in the prevalence of sleep disorders in active duty personnel (Foster et al., 2017). Specifically, insomnia, depression, and anxiety are more prevalent in females, while obstructive sleep apnea is more prevalent in males. We have studied the sleep patterns and fatigue levels of crew members on more than 30 US Navy ships. The current study focuses on gender differences in well-being, sleep-related behaviors, and psychomotor vigilance performance of sailors in the US Navy.

Methods

Using a longitudinal, naturalistic observation paradigm, data were collected from crewmembers on nine USN ships while performing their normal underway duties. Participants (N=1,056) tended to be young (on average 27 years of age), predominantly male (80.6%), and enlisted (84.8%). We assessed average daytime alertness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), mood (Profile of Mood States), and sleep quality (Pittsburgh Sleep Quality Index). Sleep was assessed with actigraphy and logbooks. Sailors performed a 3-minute version of the Psychomotor Vigilance Task (PVT), which was built into their wrist-worn actigraph.

Results

Compared to males, female sailors reported more depressive symptoms (p=0.042) and less vigor (p<0.001). Females slept more (daily sleep duration: p<0.001) but their sleep was split into more episodes than their male counterparts (p=0.029). Fewer females reported a regular exercise routine (p=0.033). In addition, females report consuming fewer energy drinks (p=0.007), and using fewer nicotine products (p=0.013). Lastly, consistent with findings from civilian populations, female sailors had slower reaction times on the PVT (p<0.001) and experienced more lapses combined with false starts (p<0.001) than their male counterparts.

Conclusion

Compared to their male peers, female sailors tend to report higher levels of depression and lower levels of vigor. They experience more pronounced split sleep, are less likely to report having an exercise routine, and have poorer performance on the PVT. Fewer females report using energy drinks and nicotine products.

Support

This research was supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.
0833 Midlife Sleep Health is Associated With Later-Life Depression and Anxiety
Authors: Hagen E W , Barnet J H , Sprecher K E , Peppard P E
Published: May 2020

Introduction

Several aspects of sleep - collectively conceptualized as ‘sleep health’ - are associated with anxiety and depression. This study investigated whether specific components of sleep health experienced during midlife are associated with depression and anxiety symptoms in later life.

Methods

A subset of Wisconsin Sleep Cohort participants (n=616; 45% female; mean [SD] baseline age=55 [8] years) completed 4 study visits at 4-year intervals. Visits included polysomnography and questionnaires about sleep, mood, and health. Outcomes (Zung depression score, State and Trait Anxiety) were regressed on sleep health characteristics (AHI, %N3 sleep, %REM sleep, sleep efficiency, sleep latency, sleep duration, sleep debt, nap duration, insomnia symptoms, circadian preference, excessive daytime sleepiness [EDS], Epworth Sleepiness Scale [ESS]) using 2 types of linear models adjusting for age, sex, BMI, education, exercise, smoking, and caffeine consumption: 1) longitudinal models in which baseline sleep health predicted mood outcomes 12 years later (adjusting for baseline levels of the outcome variable), and 2) models in which 12-year change in sleep health predicted 12-year change in outcomes.

Results

Longer nap duration, evening circadian preference, and EDS during midlife were associated with worse depression scores in later life. 12-year increases in nap duration, EDS, and ESS were associated with 12-year worsening of depression. Longer sleep duration and greater EDS during midlife were associated with worse trait anxiety in later life. 12-year increases in sleep duration, nap duration, insomnia symptoms, EDS and ESS were associated with 12-year worsening of trait anxiety. Greater AHI and EDS during midlife were associated with worse state anxiety in later life. 12-year increases in ESS were associated with worsening state anxiety. (P<0.05 for all reported results.)

Conclusion

Multiple aspects of sleep health experienced during midlife are associated with greater depression and anxiety in later life.

Support

NIH grants: National Institutes of Aging (R01AG058680; R01AG036838); National Heart, Lung, and Blood Institute (R01HL62252); National Center for Research Resources (1UL1RR025011)
0853 Fetal Heart Rate Variability Increases During Maternal Sleep Apnea Events
Authors: Pien G , Bei J , Watson H , Sgambati F , Raghunathan R , Henderson J , DiPietro J M
Published: May 2020

Introduction

While studies have established that SDB during pregnancy increases the risk of adverse maternal outcomes, fetal effects are less well studied. Evidence suggests that fetal heart rate decelerations, an indicator of fetal distress, may be elicited by SDB. We examined the relationship between maternal SDB events and fetal heart rate (FHR) and fetal heart rate variability (FHRV).

Methods

Obese (BMI≥30kg/m2) non-smoking women carrying singleton fetuses underwent overnight polysomnography (34-37 weeks gestational age), with simultaneous fetal heart rate monitoring. Standard methods were used to score sleep, SDB events (apneas/hypopneas) and to analyze fetal heart rate parameters. Using linear mixed effect models, we examined changes in mean FHR and FHR variability (expressed by FHR SD) between the 10-second period immediately before individual SDB events, during events to the end of the associated oxygen desaturation period, and the 10-second period immediately following the SDB event.

Results

Valid PSG and FHR data were obtained from 85 third trimester maternal-fetal dyads. Across all participants, there were 2779 maternal SDB events (apneas or hypopneas). Mean AHI for individual subjects was 9.04 (SD 13.75). 39 women had OSA (AHI≥5), which was mostly mild. Mean FHR did not change significantly during and after episodes of SDB episodes compared to pre-event FHR, and did not change afterwards compared to during events, in unadjusted or adjusted (sleep stage, apnea type, degree of desaturation, age) analyses. In unadjusted analyses, FHRV significantly increased during SDB episodes compared to pre-SDB FHRV. After SDB events, FHRV was significantly lower than during SDB events. In fully adjusted models, these findings remained highly significant. FHRV was not significantly different after SDB events compared to pre-SDB event FHRV in unadjusted or adjusted models.

Conclusion

We observed consistent changes in FHR variability during and after maternal SDB events. Mean FHRV significantly increased during maternal SDB episodes compared to baseline FHRV, and decreased after SDB episodes. In contrast, mean FHR did not change significantly before, during and after SDB episodes. These data demonstrate that the fetus reacts to maternal SDB events, and raise questions about persistent effects of maternal SDB on the developing fetus.

Support

NIH HD079411
0864 Race/ethnicity And Sex-dependent Effects Of Metabolic Burden Across Different Age-categories On Trends In Self-reported Sleep Duration: Findings From The National Health Interview Survey, 2004-2013
Authors: Eirene O , Bubu O M , Donley T , Blanc J , Madera C , Turner A , Mbah A K , Williams N J , Youngstedt S , Shochat T , Seixas A A , Osorio R S , Jean-Louis G
Published: May 2020

Introduction

We examined race and sex-dependent effects of metabolic burden across different age-categories on trends in self-reported sleep duration for the U.S. non-institutionalized civilian population.

Methods

We analyzed data from the National Health Interview Survey (NHIS) adults aged 18-85 from 2004 to 2013 (N=258,158). Metabolic burden was characterized by obesity (BMI>30), dyslipidemia, diabetes, and hypertension morbidity burden levels. Racial/ethnic categories included non-Hispanic Whites (NHW), Blacks/African Americans (AAs) and Hispanics. Sleep duration within a 24-hour period on average was categorized as short sleep (≤ 6hrs), adequate sleep (7-8 hrs.), and long sleep (≥ 9hrs). Age was categorized as 18 - <26, 26 - <65 and 65 - 85. Adjusted multinomial logistic regression models stratified by race, sex and age-categories examined effects of metabolic burden on trends in self-reported sleep duration.

Results

The prevalence of short sleep duration was relatively stable from 2004-2012 for NHW and all females. However, AA and Hispanic males showed consistent increase in the rates of short sleepers beginning in 2007 through 2013 especially for ages 18 - <26, and 26 - <65 (P <.001 for trend). For all racial/ethnic categories, compared to individuals aged 18 - <26, individuals aged 26 - <65 were more likely to report short sleep (aOR: 1.55, 95% CI: 1.50-1.61) and individuals aged 65 - 85 were more likely to be long sleepers (aOR: 1.95, 95% CI: 1.86-2.05). Interestingly, the rate of short sleep increased as the metabolic burden increased (P <.001 for trend). This trend was more pronounced among AA and Hispanic males aged 65 - 85 with ≥ 2 metabolic conditions who were more likely to report short sleep (aOR: 1.77, 95% CI: 1.44-2.19 and aOR: 1.45, 95% CI: 1.17-1.93 respectively), compared to NHW males.

Conclusion

Increased metabolic burden among minority populations and especially in the elderly male, affect sleep and may have consequences for treating these populations.

Support

NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01AG056531, R25HL105444, R25NS094093, K07AG05268503, R01HL142066, K23HL125939)
0867 Gender Differences In The Relationship Between Exercise And Sleep In Young Adults
Authors: Glavin E , Spaeth A M
Published: May 2020

Introduction

Exercise is widely prescribed as a behavioral treatment for sleep health, but generalizations about the benefits of exercise for sleep do not typically consider gender differences. The present study examined relationships between exercise frequency and self-reported sleep outcomes in undergraduate men and women.

Methods

Students were recruited from campus fitness facilities immediately after they finished a workout (N=829, 19.5±1.4 y, 38.5% Female) and completed demographic, Pittsburgh Sleep Quality Index (PSQI) and exercise questionnaires. Department of Health and Human Services Physical Activity Guidelines for Americans were used to dichotomize students into those who met recommendations for weekly aerobic and strength training exercise and those who did not. Multiple regression was used to examine the relationships between exercise frequency and PSQI outcomes and analysis of variance was used to compare PSQI outcomes by gender and exercise guideline groups.

Results

Compared to women, men reported more days of exercise, fewer days of aerobic exercise, more days of strength training, better sleep efficiency and later bedtimes (ps<0.05). Among all participants, exercise frequency associated with an earlier bedtime, higher sleep efficiency, less daytime dysfunction and better sleep quality (ps<0.05). When divided by gender, exercise frequency associated with an earlier bedtime and better sleep quality in women (ps<0.05) but not men and associated with less daytime dysfunction in men (p=0.012) but not women. Approximately 47% of participants met exercise guidelines for both aerobic and strength training. Participants who met the guidelines exhibited an earlier bedtime (p=0.01) and higher sleep efficiency (p=0.08) than those who did not. There was also a significant interaction effect for sleep latency (p=0.042) such that meeting the guidelines associated with a shorter sleep latency in men (p=0.006) but not women.

Conclusion

These findings highlight the importance of taking an individual’s gender and specific sleep issue into account when implementing an exercise prescription to improve sleep.

Support

Rutgers University Aresty Foundation
0872 Correlates Of Restless Sleep Among Female Sex Workers In Baltimore, MD
Authors: Urquhart G J , Spira A P , Park J N , Sherman S G
Published: May 2020

Introduction

Sleep quality is understudied among street-based female sex workers (FSW), a population characterized by high rates of structural vulnerability. FSW may be at higher risk for poor sleep due to food and housing insecurity, violence, substance use and irregular work hours. We studied correlates of restless sleep in an urban, street-based risk environment.

Methods

Data are from a year-long observational prospective cohort study of street-based FSW (n=250) in Baltimore, MD. Baseline survey data, collected April 2016 to February 2017, included topics such as structural vulnerability, mental and physical health, substance use and lifetime violence. Sleep was measured with item 7 on the CES-D-10 Scale; respondents indicated how many days in the past week their sleep was restless (< 1 day, 1-2 days, 3-4 days, 5-7 days). We conducted bivariate and multivariable logistic analysis to identify correlates of experiencing 5-7 days of restless sleep vs. fewer.

Results

Median age was 35 years. Most (66%) were Non-Hispanic White, 62% were homeless, 61% reported food insecurity, and 65% injected heroin. We documented a high prevalence of trauma; 81% reported lifetime sexual or physical violence by family members, intimate partners, paying clients, or police officers, and 62% screened positive for PTSD on the PCL-5 Checklist. 54% reported 5-7 days of restless sleep in the past week. Independent associations with frequent restless sleep included older age (age 35+ aOR: 2.67 [1.64-4.36]), food insecurity (aOR: 2.02 [1.42-2.88]), self-reported poor health (aOR: 3.98 [1.99-7.96]), and lifetime violence: a greater number of violent experiences corresponded with higher odds of restless sleep (1-2 vs. 0 experiences aOR: 2.38 [1.43-3.99], 3-4 vs. 0 experiences aOR: 3.67 [2.22-6.05]).

Conclusion

These data demonstrate high prevalence of restless sleep among street-based FSW with higher risk among those who experience intersecting vulnerabilities and multiple exposures to violence. Trauma-informed structural interventions may improve sleep quality among this population.

Support

This work was supported by the National Institute of Drug Research (R01DA038499-01).
0874 Patients with Congenital Central Hypoventilation Syndrome Do Not Wake Up to Ventilator Alarms
Authors: Mathur S K , Kun S , Keens T G , Perez I A
Published: May 2020

Introduction

Congenital Central Hypoventilation Syndrome (CCHS) requires lifelong ventilatory support during sleep. CCHS patients are vulnerable to sleep disturbances associated with treatments, monitoring alarms, and care they receive. We hypothesized that sleep would be disrupted in CCHS patient’s due to ventilatory support and other treatments at night.

Methods

An anonymous survey of CCHS patients aged 0-17 years was conducted through REDCAP. Patients were recruited in person, by flyer, email, and social media. Data collected included demographics, PHOX2B genotype, ventilatory support, treatments, nursing, and sleep parameters.

Results

We received 22 responses (27% Female, 8.1 years ± 5.7). PHOX2B genotypes were 20/27 PARM (8), 20/26 PARM (2), 20/24 PARM (2), 20/25 PARM (4), ≥ 20/28 PARM (2), and 2 NPARM (2). Two respondents did not indicate the PHOX2B genotype. 13/22 were ventilated by PPV via tracheostomy, 7/22 by BPAP, and 2/22 by diaphragm pacing. Additional treatments received at night included suctioning (8), aerosol (1), G-tube feeding (2), and none (11). Only 9 received nursing at night. 13 used pulse oximetry for monitoring, and 9 used both pulse oximetry and end tidal CO2 monitor. 16/22 rarely woke up due to ventilator or monitor alarms. 15/22 slept within 20 minutes after going to bed. Sleep latency was not affected by mode of ventilation. 11/22 reported night waking ≥ 2 nights/week and 10/22 returned to sleep without help after night waking. 6/7 BPAP dependent patients reported low frequency of night waking (0-1 time/week). Of the PPV + trach group, 7/13 reported high frequency of night wakings, mostly 5-7 times/week.

Conclusion

Most CCHS patients do not awaken in response to ventilator alarms. Sleep is rarely disrupted by nursing or feeding intervention. We speculate that CCHS patients contemplating to live independently should be tested to see if they awaken in response to ventilator alarms.

Support

None
0879 Outcomes of Adenotonsillectomy in Children with Down Syndrome and Obstructive Sleep Apnea
Authors: Morello Gearhart A , Gunaratnam B , Senthilvel E
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is highly prevalent in children with Down Syndrome (DS). The aim of this study was to assess the effectiveness of adenotonsillectomy (T&A) on polysomnographic parameters of children with DS.

Methods

Retrospective chart review of children with DS who underwent T&A between 2012-2019 was performed. Preoperative OSA severity was categorized by obstructive apnea-hypopnea index (OAHI): mild = 1-4.9 events/h; moderate = 5-9.9 events/h; severe ≥ 10 events/h.

Results

We identified 43 DS children with pre and post T&A polysomnographic data in a population of 162 DS patients. A total of 25 were male, mean age 5.1 years (± 3.8 years) and 56% Caucasians. Preoperative data showed 19% mild OSA, 30% moderate and 51% severe. Postoperatively, apnea-hypopnea index (AHI) normalized in 9.3%, 37.2% had mild OSA, 18.6% moderate and 34.9% severe. Overall, T&A resulted in significant improvement (p-value <0.05) in mean AHI, (18.51 ± 28.05 vs 11.72 ± 16.43), SaO2 nadir (80.00 ± 14.82 vs 85.51 ± 5.94), sleep efficiency (81.97 ± 11.15 vs 85.9 ± 8.28), arousal index (16.14 ± 10.23 vs 14.45 ± 12.34), and wake after sleep onset (67.19 ± 46.89 vs 50.55 ± 40.83) and no statistical difference (p-value >0.05) in end-tidal carbon dioxide (43.86 ± 9.56 vs 44.17 ± 3.78), Rapid Eye Movement (REM)% (15.86 ± 7.75 vs 15.92 ± 7.41), sleep latency (24.03 ± 34.39 vs 22.55 ± 21.11), and central apnea index (0.86 ± 1.38 vs 0.66 ± 0.82) in pre and post T&A data. There was no statistically significant difference in pre and post T&A polysomnographic parameters between 17 DS and 17 age and gender-matched non-DS control subjects.

Conclusion

Adenotonsillectomy resulted in improvement in AHI, oxygen desaturation nadir, sleep efficiency, arousal index and wake after sleep onset. However, a significant portion of children with DS continued to have moderate to severe OSA after T&A.

Support

None.
0881 Clinical Evaluation of Adeno-Tonsillar Hyperplasia in Non-Syndromic Children and Adolescents During Growth Hormone Treatment
Authors: Nasser R , Vervloet T , Eckley C A , Amade S , Dokkedal-Silva V , Pires G N , Andersen M L , Tufik S , Longui C , Xavier S D
Published: May 2020

Introduction

Recombinant human Growth Hormone (rhGH) is an important pharmacological agent for linear growth stimulation and body composition in children with growth hormone deficiency (GHD). However, reports indicate that treatment with rhGH can be associated with adeno-tonsillar hyperplasia. This condition can lead to occurrence of obstructive sleep apnea (OSA) and worsening of sleep and life quality. Nonetheless, studies assessing this outcome in non-syndromic children are scarce.

Methods

We evaluated the difference in size of pharyngeal and palatine tonsils in patients aged between 5 and 17 being treated with recombinant human Growth Hormone (rhGH). We conducted a prospective longitudinal observational study. Twelve patients in treatment with rhGH were evaluated by otorhinolaryngological physical examination, nasofibrolaryngoscopy and obstructive sleep apnea (OSA)-18 questionnaire in two different time-points: when selected (T0) and after 6 months (T1).

Results

No significant associations were found regarding palatine and pharyngeal tonsil size with rhGH treatment. In relation to OSA 18 questionnaires, there was no statistically significant result in the absence of covariables for the general score as well as for the five domains that it comprises. When covariables were included in the analyses, controlled by the patients age, we observed statistically significant increases in the general score and in the domains relating to sleep disorders, emotional suffering, diurnal problems and the caretaker′s concerns.

Conclusion

In the present study, pharyngeal or palatine tonsils hyperplasia were infrequent during treatment with rhGH in the non-syndromic children and adolescents. However, the impact on sleep and quality of life that may arise warrant careful monitoring during therapy.

Support

Associação Fundo de Incentivo à Pesquisa (AFIP).
0885 Reduction in Emergency Department and Inpatient Hospitalization Visits and Length of Stay in a Cohort of Pediatric Patients Initiated on Positive Airway Pressure for Obstructive Sleep Apnea Syndrome
Authors: Xanthopoulos M S , Williamson A A , Tapia I E , Cielo C M , Ku H , Smith J , Matthews E , Beck S E
Published: May 2020

Introduction

Positive Airway Pressure (PAP) is an efficacious treatment of pediatric obstructive sleep apnea syndrome (OSAS). However, it is unknown whether PAP initiation is associated with reduced healthcare utilization, an important metric of care management. We hypothesized that healthcare utilization would be reduced after initiation of PAP in a cohort of pediatric patients prescribed PAP for OSAS.

Methods

Data were extracted from electronic medical records of 475 patients (Mean±SD age at PAP initiation=7.7±5.7 years; 58.7% male; 40.6% White; 38.3% Black; 18.1% multiracial/other; 12.1% Hispanic/Latinx) prescribed PAP for OSAS and followed in our Sleep Center quality improvement program. We extracted the total number of emergency department (ED) visits and hospitalizations and computed the related average length of stay (LOS) in hours for these visits in the 18 months prior to and 18 months following PAP initiation.

Results

Paired samples t-tests showed that number of ED visits and hospitalizations, and the related visit LOS, were significantly reduced following PAP initiation. The average number of visits reduced from 2.20 pre-PAP to 1.77 post-PAP initiation [t(474) = 3.48, p<.001, effect size = 0.16], while average LOS reduced from 185.14 hours pre-PAP to 42.94 hours post-PAP initiation [t(474) = 4.81, p<.001, effect size = 0.29]. Findings for the significant reduction in LOS held after adjusting for the number of pre and post-PAP ED visits and hospitalizations, average pre-PAP LOS, and patient demographics (age at the time of initiation; sex; race/ethnicity) using multiple linear regression.

Conclusion

PAP initiation was associated with fewer and shorter ED visits and hospitalizations in a large sample of pediatric patients. We speculate that PAP initiation could help reduce morbidity associated with pediatric OSAS, as well as improve healthcare utilization, capacity management and care in this population.

Support

K23HD094905 and Sleep Research Foundation (AAW)
0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis
Authors: Bandyopadhyay A , Kaneshiro K N , Camacho M
Published: May 2020

Introduction

OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data.

Methods

Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.

Results

Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P <0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes.

Conclusion

Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.

Support

None
0898 The Accuracy Of Split-night Study In Assessing Obstructive Sleep Apnea (OSA) In Children And Adolescents
Authors: Bedoya M , Chini B , Armoni-Domany K , Boh M , Huang G , Md Hossain M , Simakajornboon N
Published: May 2020

Introduction

Split-night polysomnography (PSG) can be used for the diagnosis of OSA, if clinically appropriate, per AASM recommendation based on adult data. However, there are limited data in pediatric population. The aim of our study is to assess the accuracy of split-night-PSG compared with a full-night-PSG in children with OSA.

Methods

A retrospective review was performed in children and adolescents who were diagnosed with OSA during a diagnostic PSG (oAHI >1). Sleep and respiratory parameters from the full-night-PSG(F) were compared with the first three hours of the same PSG(S). Subgroup analysis was performed for age and OSA severity. The results were reported as mean±SD. All variables were compared with paired T-test.

Results

226 met the criteria for entry into analysis. The mean age was 7.8y±5.8. For the whole cohort, there were no significant differences in the mean AHI and oAHI [7.3±11.7(F)vs6.9±13.9(S),p=0.26] between full-night and split-night studies. Subgroup analysis revealed that children aged 2-12 yo (n=120) had significant differences in the mean AHI [6.1±7.1(F)vs4.8±6.4(S)p=0.002] and the mean oAHI [4.8±5.6(F)vs3.9±5.4(S)p=0.03]. In addition, subgroup analysis of mild OSA (n=137) showed a significant difference in the mean AHI (p=0.006), but not in the mean oAHI (p=0.08). There were no significant differences in the mean AHI and oAHI in the moderate to severe OSA group. Based on the first 3 hours of PSG, 16.8%(n=38) of patients were inaccurately classified to have no OSA, while the severity was misclassified in 37.6%(n=85) of patients (underestimated in 30%(n=68) and overestimated in 7.5%(n=17)).

Conclusion

Although there were no differences in the mean AHI and oAHI, split-night-PSG misclassified diagnosis and severity in a significant proportion of our pediatric cohort. In addition, the accuracy of split-night-PSG is influenced by age and severity of OSA. Further studies are needed to identify factors that play a role in these differences.

Support

Cincinnati Children’s Hospital, Children’s Foundation
0905 Obstructive Sleep Apnea In Pediatric Patients With Early Onset Scoliosis
Authors: Panek D , MacKintosh E , DelRosso L , Ruth C , White K , Redding G
Published: May 2020

Introduction

Early onset scoliosis (EOS), defined as curvature of the spine >10 degrees with onset before 10 years of age, is associated with increased rates of restrictive lung disease, pain, and other factors that increase risk of poor sleep. We compared the polysomnographic findings of children with EOS to those of children without EOS. We postulated that children with EOS would have a higher rate of OSA than patients without EOS, and differences in sleep stage distribution, arousals, and limb movements.

Methods

Single-center retrospective chart review performed on 58 subjects with EOS (ages 1-17yr) who underwent PSG from 2003-2019; comparison group of 58 subjects without scoliosis who underwent diagnostic PSG was chosen consecutively (ages 1-18yr). Polysomnographic parameters compared include: sleep stage distribution, arousal index (AI), obstructive/central AHI, mean and nadir oxygen saturation in REM/NREM, and periodic leg movement index. All p-values were adjusted for multiple comparisons.

Results

There was no difference in age or sex distribution between the two groups, though subjects with EOS had lower BMI than those without EOS (median 16.3 (IQR 14.7-19.3) vs. 17.5 (IQR 16.2-21.6), p=0.019). 84% of subjects with EOS had OSA, compared to 66% without EOS. Subjects with EOS and OSA had higher obstructive AHI than the OSA group without EOS, and longer duration of hypopneas. There was no significant difference in sleep stage distribution, AI, or PLMI.

Conclusion

Of pediatric patients referred for polysomnography at our institution, those with EOS had a higher rate of OSA, more severe OSA where present, and lower BMI. We advocate for routine polysomnography for children with EOS due to the high risk of OSA amongst those tested, and further study to better understand the pathophysiology of sleep disordered breathing in this population.

Support

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services under grant #T72MC00007/University of Washington Pediatric Pulmonary Center/PI: Redding. The content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
0906 Identification Of Physical Exam Findings With High Predictive Value For Moderate To Severe Pediatric Obstructive Sleep Apnea(osa) In Overweight/obese Children
Authors: Ajisebutu A , Kak I , Thompson N , Honomichl R , Moul D , Mehra R , Shah V
Published: May 2020

Introduction

Obstructive sleep apnea(OSA) is highly prevalent and under-diagnosed in the overweight/obese pediatric population largely due to limitations of existing pediatric OSA screening instruments including lack of efficiency and practical implementation and lack of careful consideration of physical examination(PE) findings with high predictive value for OSA. We sought to identify PE finding(s) predictive of pediatric OSA in overweight/obese patients to inform development of an OSA screening tool.

Methods

Overweight/obese patients presenting to the Cleveland Clinic weight-management clinic between 2013-2018 with polysomnogram (PSG) data were included. The association of PE predictors: age, sex, race (white, black, other), neck (NC), waist circumference (WC), tonsil size (TS), height, systolic and diastolic blood pressure (BP) percentiles) in relation to OSA defined by apnea-hypopnea index (AHI)≥5,i.e. clinically significant pediatric OSA, were assessed using univariate and multivariate logistic regression models (OR,95%CI).

Results

Retrospective analysis of 180 overweight/obese patients (BMI percentile>85th for age and sex) and age 12.5±3.7 years were included. The multivariate model showed that only WC was significantly associated (1.03, 1.00 - 1.07, p=0.038) with OSA defined as AHI≥5. A statistically significant interaction of age and sex was observed such that the likelihood of OSA increased in males with older age and conversely decreased in females with older age. (1.26,1.04 -1.52, p=0.038) The reduced multivariate model, which included age, sex, WC, and age*sex interaction term, correctly discriminated AHI <5 vs. ≥ 5 66.5% of the time.

Conclusion

In this large clinic-based overweight/obese pediatric sample, males, older age and WC were significant predictors of OSA and TS was not. A significant interaction of age and sex was observed supporting increased OSA with increasing age in males. Data generated supports value of PE findings of age, sex and WC to incorporate in development of an OSA screening tool for overweight/obese children.

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0935 Association Between Chronotype, Sleep Duration, Weekend Catch-Up Sleep, and Depression Among Korean High School Students
Authors: Yang K , Jee Hyun K , Hwangbo Y , Koo D , Kim D , Sunwoo J , Hong S
Published: May 2020

Introduction

The present study aimed to examine the association between chronotype, sleep duration, weekend catch-up sleep (CUS) duration, and depression among Korean high school students.

Methods

A total of 8,565 high school students who were analyzed from 15 nationwide districts in South Korea completed an online self-report questionnaire. Depressive mood was assessed using the Korean version of the Beck Depression Inventory. The following sleep characteristics were assessed: weekday and weekend sleep durations, weekend CUS duration, chronotype, perceived sufficiency of sleep, self-reported snoring and sleep apnea, daytime sleepiness, and sleep environment. Age, sex, body mass index, number of private classes, and proneness to internet addiction were also measured. Logistic regression analysis was conducted to compute odds ratios for the association between depression and sleep characteristics, after controlling for relevant covariates.

Results

The prevalence of depression (BDI ≥ 16) was 1,794 (20.9%). In the analyses of multivariate logistic regression, the late chronotype (odds ratio [OR], 1.71; 95% CI, 1.47-1.99), female (OR, 2.24; 95% CI, 1.99-2.53), underweight (OR, 1.27; 95% CI, 1.02-1.57) and obesity (OR, 1.41; 95% CI, 1.13-1.75), weekday sleep duration (OR, 0.86; 95% CI, 0.81-0.91), weekend CUS duration ≥ 2 hours (OR, 0.68; 95% CI, 0.55-0.85), ESS (OR, 1.08; 95% CI, 1.07-1.10), much (OR, 2.15; 95% CI, 1.63-2.84) and insufficient (OR, 1.71; 95% CI, 1.46-2.01) perceived sleep, snoring (OR, 1.27; 95% CI, 1.11-1.46) and witnessed apnea (OR, 2.10; 95% CI, 1.75-2.52), increased internet addiction (OR, 1.06; 95% CI, 1.05-1.06), high number of private education (OR, 0.76; 95% CI, 0.60-0.95), and poor sleep environment (OR, 1.86; 95% CI, 1.56-2.21) were associated with depression.

Conclusion

Eveningness preference, insufficient weekday sleep duration, short weekend CUS duration, and self-reported snoring and sleep apnea were associated with an increased risk for depression.

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0936 Cardiometabolic Disorders are Independently Associated with Excessive Daytime Sleepiness in Young Adults
Authors: Fernandez-Mendoza J , Puzino K , Calhoun S L , Qureshi M , He F , Liao J , Vgontzas A N , Liao D , Bixler E O
Published: May 2020

Introduction

Cardiometabolic risk factors (CMR), including obesity, hypertension, diabetes and hypercholesterolemia, have been associated with sleep apnea and insufficient sleep, both of which can lead to excessive daytime sleepiness (EDS). We hypothesized that CMR are associated with EDS in young adults independent of sleep apnea, sleep duration and mental health disorders (MHD).

Methods

The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) and 425 another 7.0 years later during young adulthood (24.4±2.6y). Subjects underwent a 9-h in-lab polysomnography in childhood and adolescence and parent- or self-reported standardized surveys at all time points. Self-reports in young adulthood and in-lab measurements in childhood were used to ascertain CMR and sleep apnea. Parent-reports in childhood and self-reports in young adulthood were used to ascertain the presence of MHD and EDS. Logistic regression models adjusted for age, race, sex, snoring/observed apneas, insomnia symptoms, and sleep duration in young adulthood as well as mean arterial blood pressure, body mass index percentile and apnea/hypopnea index in childhood.

Results

CMR (OR=2.71, 95%CI=1.69-4.36) and MHD (OR=4.61, 95%CI=2.79-7.62) were associated with EDS in univariate models. After adjusting for covariates in childhood and young adulthood, CMR and MHD remained independently associated with EDS (OR=2.32, 95%CI=1.29-4.16 and OR=2.78, 95%CI=1.59-4.87, respectively).

Conclusion

EDS in young adults with CMR or MHD does not solely arise from sleep apnea, insufficient sleep or other sleep disturbances. EDS may be the result of central pathophysiologic mechanisms or the functional impairment associated with cardiovascular, metabolic and mental health disorders. These data further support that youth with these disorders should be screened for EDS and appropriately managed.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0937 The Evaluation of Brain Maturation by REM Sleep Analyses During Puberty Using Fast Fourier Transform
Authors: Lopes M , Roizenblatt S
Published: May 2020

Introduction

Brain maturation has been associated with electroencephalogram (EEG) changes during rapid eye movement (REM) sleep. There is a higher delta power during sleep in the first decade of the human EEG and this fact might be related to puberty period. Most studies assessed EEG during wakefulness and NREM sleep. The aim of this study was to evaluate changes in the REM sleep EEG spectral analysis across puberty.

Methods

Twenty healthy children were studied. They were divided into two groups: early puberty (n=10, ageranging from 6 to 12) and late puberty (n=10, age= ranging from 13 to 18). Polysomnography was performed in 2 nights, one for adaptation purpose. The Tanner scales were obtained and exclusion criteria were the presence of sleep and daytime complaints at least 14 days before recruitment. Fast Fourier Transform (FFT) was performed in C3-A2 derivation throughout all night. The FFT was calculated in 4s windows and the mean of delta (0.5-2.0 Hz), delta 2 (2.0-4.0 Hz), theta (4.0-8.0 Hz), alpha (8.0 - 12.0 Hz), sigma (12.0-16.0 Hz) and beta (16.0 - 20.0 Hz) were obtained.

Results

We found differences during NREM and REM sleep between two groups (U-test, p<0.05). In REM sleep, the delta 2 (U-test, p=0.02)and theta power were higher in early puberty group (U-test p=0.04). The delta power correlated negatively with the duration in minutes of stage 1 (rs=-0.46 p<0.05), and the wake time after sleep onset (rs=-0.48, p<0.05) and correlated positively with sleep efficiency (rs=0.45, p<0.05). Theta power during REM sleep also correlated positively with N3 sleep stage (rs=0.45, p<0.05).

Conclusion

The REM sleep can be an extremely useful biomarker of brain function for future therapeutic protocols. The present results suggest that there are changes in REM sleep EEG throughout puberty, and that they may be related to puberty brain maturation. The hormone therapy may have an action in the REM behavioral Sleep Disorder. Future studies are need to evaluate this hypothesis.

Support

N/A