bluuebunny/crossref_metadata_2025 huggingface dataset:
0878 Particulate Matter Exposure Is a Driving Factor of Oxygen Desaturation in Blacks with Central Sleep Apnea
Authors: Gallop Erin-Leigh , Blanc Judite , Oliveira Bruno , Elvariste Stessie , Chung Debbie , Scott Sadeaqua , Thompson Michelle , Seixas Azizi , Jean-Louis Girardin
Published: April 2024

Introduction

Exposure to particulate matter (PM) in the home environment is a modifiable risk factor for oxidative stress, a common and burdensome symptom of Central Sleep Apnea (CSA), a condition characterized by the brain temporarily not sending signals to the muscles that control breathing during sleep. Although previous research has established a greater likelihood of adverse health outcomes given environmental exposure, the effects of specific air pollutants have not been distinguished from other neighborhood factors. Moreover, recommendations to reduce exposure to PM have not been included in CSA treatment. This study aims to contribute to the development of predictive models that account for the impact of environment on severity of CSA symptoms among Black Americans.

Methods

Data were collected from 168 Blacks (69% female and 31% male, Mage 47.60 ±16.459yrs) that were enrolled in two NIH-funded community-based sleep studies, ESSENTIAL and MOSAIC. Sleep environment PM levels were assessed objectively with the IQAir device for a period of 7 days. During the same period, SleepImage ring devices were used to measure the number of paused breathing events during a sleep period and a score was generated based on the qualifying events of oxygen desaturation. Analyses of correlation matrices were conducted to explore the associations between CSA and PM exposure. Descriptive statistics were analyzed, and a regression analysis was performed to understand the association between CSA and PM. Analyses were performed using SPSS29.

Results

Exposure to PM 2.5 (fine inhalable particles with diameters measuring 2.5 micrometers and smaller) was highly correlated with Central Sleep Apnea (sAHI Central), with at least 10 qualifying events of 3% oxygen desaturation (r(165)=.465,p<.001) and 4% oxygen desaturation (r(165)=.473,p=<.001) during a sleep period. Regression analysis further revealed significant association between PM 2.5 and sAHI Central [β= .032; p< .001]. The model adjusted for age, sex, and an existing Sleep Apnea diagnosis.

Conclusion

Findings suggest that exposure to PM is a driving factor in oxygen desaturation in Blacks. These findings present an opportunity to influence population health by contextualizing the relationship between CSA and environmental factors among Black Americans.

Support (if any)

R01AG067523, R01HL142066, and T32HL166609-02
0879 Investigating Family Sleep Health in Native Hawaiian and Pacific Islander Communities
Authors: Gilles Allyson , Kavapalu Olivia
Published: April 2024

Introduction

Native Hawaiian/Pacific Islander (NHPI) populations have significantly elevated risk for cardiometabolic diseases, which are linked mechanistically to sleep deficiencies. Research suggests that sleep deficiencies are highly prevalent among NHPI adults, including short sleep, insomnia symptoms, and elevated risk factors for OSA (obesity). Although adult sleep practices often begin during childhood, little research has examined sleep among NHPI families. As sleep significantly relates to sociocultural factors (stress, socioeconomics, family dynamics), this study aimed to identify sleep health parameters that affect family members’ sleep and determine community methods to improve sleep.

Methods

NHPI adolescents and adults(N=34; 33.3% female) from Utah and Hawaii participated in six online focus groups. Discussed sleep-related topics were duration, sufficiency, environment, routines, household rules/dynamics, beliefs/practices, and disorders. Health-related topics discussed included cardiometabolic disease, stress, technology use, work schedules, and health attitudes/goals. Mixed method data were analyzed using constant comparison approach.

Results

Participants (adolescent mean age of 15.3 years; adult mean age of 39.4 years) reported an average household of 5.5 members(73.3% included children). Few participants regularly slept in a different home from family members(13.3%). Reported annual household income was $75,000+ by 48% of participants. Education level was 53.3% GED/high school, 43.3% some college/bachelor's degree, and 3.3% master’s degree. Adolescents reported adverse sleep-related factors, including sleep timing, chores, shared sleeping space and noise, sport/school schedules, and sleep insufficiency from homework and sleep onset worry. Adult-focused adverse sleep health repercussions included childcare, temperature, technology use in bed, community/extended family event frequency, financial strain, working multiple jobs, dietary challenges, and social beliefs/practices related to Polynesian culture. Community members identified religious practices, family-driven efforts, changing cultural perception of sleep, and targeting youth as ways to address intergenerational transmission of sleep health values and behaviors.

Conclusion

Findings reveal feasible areas that community members of all ages can utilize to improve sleep health across generations like limit setting at bedtime, utilizing strong community-driven ties (Polynesian cultural values, religious practices), and enhancing existing familial structure. Future research should address significant barriers to improving sleep health (socioeconomics, environmental influences, extracurricular events, sleep perception) that seem unsurmountable.

Support (if any)

Health Studies Fund, Department of Family and Preventive Medicine, University of Utah
0883 Sleep and Circadian Health, Insulin Sensitivity, and Glycemic Control in Adolescents with Type 1 Diabetes
Authors: Simon Stacey , Cooper Emily , Brinton John , Bernard Angel , Bowen Anne , Snell-Bergeon Janet , Cree Melanie , Wright Kenneth , Nadeau Kristen
Published: April 2024

Introduction

Insulin resistance and poor glycemic control are significant risk factors for cardiovascular disease for individuals with type 1 diabetes (T1D). Adolescents with T1D are at heightened risk for poor sleep and circadian health due to behavioral and physiologic aspects of T1D in combination with biological, psychosocial, and environmental factors of adolescence. Emerging evidence suggests an association between sleep and circadian health with insulin sensitivity (SI) and glycemic control among adults with T1D and healthy adolescents, but this has not been explored in adolescents with T1D.

Methods

Twenty-three adolescents with T1D underwent a cross-sectional assessment during the academic year with one week of in-home actigraphy and continuous glucose monitoring (CGM) followed by in-laboratory serial salivary melatonin sampling and hyperinsulinemic-euglycemic clamp. BodPod assessed free-fat mass (FFM). SI was expressed as steady-state glucose infusion rate (“M”) in mg/kg/FFM/min. Sleep variability was calculated as the standard deviation of weekday actigraphy-estimated sleep metrics. Duration between dim-light melatonin onset (DLMO) and bedtime was calculated to determine circadian phase angle. Pearson correlations examined associations between sleep and circadian variables with SI and glycemic control.

Results

Adolescents with T1D (age=15.9±1.1 years, 48% female, 91% non-Hispanic White, HbA1c=7.6±1.1%) obtained 6.7±0.8h sleep on weeknights. Greater nightly variability of time in bed (TIB) and sleep midpoint timing across the monitoring period were associated with worse SI (M mg/kg FFM/min; r=-0.43, p=0.045; and r=-0.44, p=0.04, respectively). Greater nightly variability in the duration of wake after sleep onset (WASO) was associated with poorer CGM metrics, including higher mean sensor glucose (r=0.62, p=0.006), less time in range (70-180mg/dL, r=-0.56, p=0.016), and higher standard deviation (r=0.51, p=0.031). A longer duration (wider phase angle) between DLMO and bedtime was associated with a higher CGM coefficient of variation (r=0.91, p=0.002).

Conclusion

Nightly variability in TIB, sleep timing, and WASO, and circadian phase angle may represent contributing mechanisms of poorer SI and glycemic control in adolescents with T1D. Further research is warranted examining the health impact of sleep and circadian health interventions in adolescents with T1D.

Support (if any)

Ludeman Center for Women’s Health Research; JDRF 2-SRA-2019-848-S-B and 2-SRA-2022-1144-M-B; CCTSI Maternal & Child Health Pilot Award; NIH NCATS UM1TR004399.
0889 Association of U.S. Military Burn Pit Smoke Exposure with Objective Sleep Parameters Among Smoking Veterans
Authors: Nowakowski Sara , Kokonda Manasa , Razjouyan Javad , Sharafkhaneh Amir , Helmer Drew
Published: April 2024

Introduction

Burn pits (BPs) have been widely used by the U.S. military for waste disposal. Due to the obviously toxic nature of the BP emissions exposure (BPe) may contribute to diverse adverse health conditions, including sleep apnea. This study aimed to examine the association between self-estimated amount of BPe and objective sleep problems among smoking veterans.

Methods

Using polysomnography reports in the Veteran Affairs electronic medical records, sleep measures were extracted for 4940 Veterans and active-duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. Objective sleep parameters included Total Sleep Time (TST) and Sleep Efficiency (SE). Cumulative BPe variable was calculated by multiplying the response (in hours) to a question about BPe by number of deployment days, summing across deployments, and categorized into quartiles by ranking. Inverse probability treatment weighing method was used to adjust the imbalances of covariates age, BMI, sex, race, ethnicity, military branch, and duty status between treatment groups. We employed separate weighted logistic regression models to determine the association between cumulative BPe days and sleep outcomes among smoking veterans.

Results

Current smokers in prolonged BPe quartile predicted higher odds of shorter TST (OR:1.43, 95%CI: 1.08-1.89, p=0.02, with reference to never smokers), whereas no significance shown in SE (OR:0.97, 95%CI: 0.75-1.27, p=0.89).

Conclusion

Higher levels of self-estimated BPe was associated with shorter objective TST in current smoking veterans. Smoking may exert synergistic effect to BP emission exposure on sleep problems. Further research is needed to define the effects of BP emission exposure on sleep among deployed and non-deployed Veterans.

Support (if any)

This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E DeBakey Veteran Affairs Medical Center Bridge Grant, and the VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant.
0890 Polysomnography Extracted Sleep Health Disparities Among Burn Pit Registered U.S. Military Veterans
Authors: Kokonda Manasa , Razjouyan Javad , Sharafkhaneh Amir , Helmer Drew , Nowakowski Sara
Published: April 2024

Introduction

Disparities are under-recognized factors for sleep health. Additionally, there are concerns about sleep health among Veterans with exposure to burn pit emissions during deployment. This study aimed to examine the association between age, sex, and race and objective sleep related problems in veterans and active duty personnel.

Methods

Using polysomnography reports between April 2000 and September 2022 in the Veteran Affairs electronic medical records, objective sleep problems were extracted to 4940 Veterans and active duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. We examined the association between sociodemographic variables (age, sex, and race) and objective sleep related problems (Total Sleep Time (TST), Sleep Efficiency (SE), Minimum SAO2, and Apnea-Hypopnea Index (AHI)) in separate logistic regression models.

Results

Middle age Veterans (41 - 50 y) predicted greater odds of shorter TST, lower SE, (ORs:1.26-1.36, p’s< 0.03), and older age Veterans (>50 y) predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.29-1.71, p’s< 0.01). Male sex predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.22-1.97, p’s< 0.04). African American race predicted greater odds of shorter TST (OR:1.25, p=0.04).

Conclusion

We observed a higher prevalence of objective sleep problems and sleep-disordered breathing problems among middle age compared to young Veterans and males compared to females. We also found a higher prevalence of shorter TST in Black compared to White Veterans and active duty personnel who completed the burn pit registry. This research address the importance of sleep health disparities of objective sleep related problems among Veterans with burn pit emission exposure.

Support (if any)

This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); Michael E DeBakey VAMC Bridge Grant, and VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).
0891 Sleep Quality Among Post-9/11 Veterans with Exposure to Airborne Hazards
Authors: Glick Danielle , Konikkara John , Sotolongo Anays , Alexander Thomas , Diaz-Abad Montserrat , So Jennifer , Arjomandi Mehrdad , Krefft Silpa , Osterholzer John , Richmond Bradley , Falvo Michael
Published: April 2024

Introduction

Disordered sleep, including insomnia and obstructive sleep apnea, is common among post-9/11 veterans returning from Southwest Asia and Afghanistan. Environmental exposures, such as elevated respirable particulate matter, may contribute to the development of sleep apnea. Additional occupational exposures sustained during military service may contribute to poor sleep, for example hyperarousal and resultant insomnia. We sought to describe sleep quality and prevalence of sleep disorders among a veteran population exposed to airborne hazards with unexplained dyspnea.

Methods

Veterans from across five sites of the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN) completed, as part of a more comprehensive evaluation, questionnaires inclusive of demographic information and the Pittsburgh Sleep Quality Index (PSQI). Limited polysomnography data was also available through chart review at the Baltimore site. Descriptive statistical analysis was performed, with means and standard deviations or medians and interquartile ranges reported for all questionnaire and PSG outcomes, as appropriate.

Results

In total, 168 veterans completed the PSQI and demographic questionnaires. The majority of respondents were aged 45±9 years, male (82%), and white (73%). Approximately half had served in the Army branch of the military. BMI was available for only 127 veterans, with mean 31.9±5.9 kg/m2. The group overall reported prolonged sleep onset latency (56±51 minutes) and reduced total sleep time (5±1 hours). Overall PSQI scores were elevated at 13±5. In Baltimore (N=38), PSQI data was similar. Sleep study data was available for 30/38 veterans, of whom 27 had a diagnosis of obstructive sleep apnea (OSA). Among those with OSA, the median AHI was 13.5 (IQR 14.5) events/hour and the mean BMI was 31.0±5.2 kg/m2.

Conclusion

Among a cohort of post-9/11 veterans with exposure to airborne hazards, insufficient and disturbed sleep was common. In a limited subset with sleep study data, the majority had at least mild OSA. Future work will evaluate the presence of comorbid medical and mental health conditions. This early descriptive data is consistent with prior reports among similar veteran populations, and highlights the need for further research to elucidate causes of sleep disturbances and possible relation to exposure to airborne hazards.

Support (if any)

Supported by the VA’s Airborne Hazards and Burn Pits Center of Excellence
0892 Roles of Pain Interference, Pain Intensity, and Sleep-partner in Insomnia and Daytime Sleepiness Among Veterans
Authors: Tsai Thomas , Krueger Mason , Wallace Douglas , Wohlgemuth William
Published: April 2024

Introduction

Insomnia and daytime sleepiness are prevalent in Veterans, many of whom have co-morbid pain. Although ample evidence suggests an association between sleep and pain, the differential roles of pain-related daytime dysfunction (hereafter, “pain interference”) and pain intensity in insomnia and daytime sleepiness are less known. These associations may also be influenced by the presence of a sleep-partner, who has been shown to provide psychological comfort but may also interfere with the physical comfort of one’s sleep environment. Thus, this study examined the unique associations of pain interference and pain intensity, as well as the moderating effects of sleep-partner, with symptoms of insomnia and daytime sleepiness among Veterans presenting to a sleep clinic.

Methods

Veterans presenting to the Miami VA sleep clinic for sleep apnea assessment (N=405, M age=50.3 years, 84.3% male) completed the PROMIS-29 (pain interference, pain intensity), Insomnia Severity Index, and Epworth Sleepiness Scale, and reported whether they sleep with a partner or not. Structural equation modeling was used to examine the study aims while controlling for age, gender, and apnea-hypopnea index.

Results

On average, Veterans reported moderate levels of pain interference, pain intensity, and insomnia severity, as well as mild levels of daytime sleepiness. Over half (59.0%) of the Veterans endorsed sleeping with a partner. Among Veterans who slept without a partner, greater pain intensity was associated with greater insomnia severity (b=.14, p=.002). Among Veterans who have a sleep-partner, greater pain intensity was associated with both greater insomnia severity (b=.09, p=.017) and greater daytime sleepiness (b=.53, p=.038). Pain interference was not associated with insomnia or daytime sleepiness in either group (b<=.02, p>=.084).

Conclusion

Findings indicated the unique and deleterious role of pain intensity in insomnia and daytime sleepiness in Veterans, particularly among those who sleep with a partner. Such evidence highlights the interdependent nature of sleep and suggests considerations of dyad-level factors in sleep interventions. Further investigations are warranted to elucidate the biopsychosocial factors underlying the current findings.

Support (if any)
0893 Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Comorbid Chronic Obstructive
Authors: Greig Danny , Rastogi Ruchi , Diaz Teresa , Johnston Ian , Mishra Poonam , Tovar-Torres Maria , Kushida Clete , Axelrod Bradley , Zhao Lili , Shamim-Uzzaman Qurratul , Chowdhuri Susmita
Published: April 2024

Introduction

Cognitive impairment in older Veterans is an independent predictor of subsequent mortality and disability. Pilot data indicate that patients with OSA-COPD Overlap Syndrome (OVS) have reduced sleep quality and quality of life (QoL). However, there are no prior systematic studies evaluating treatment paradigms in patients with OVS. Our ongoing clinical trial is investigating whether, compared with usual care, positive airway pressure (PAP) therapy alleviates sleep disturbances, sleepiness, and improves cognitive function and QoL in older adults with OVS.

Methods

The design is a prospective parallel group randomized controlled trial in Veterans 60 years and older, with moderate-to-severe OSA with concomitant COPD (OVS). 225 eligible participants will be randomized to two treatment groups (PAP and conservative care) in 2:1 ratio for a duration of 6 months. Participants on the conservative care arm are required to follow good sleep habits and sleep hygiene, and on the PAP arm, in addition, are required to be adherent to PAP treatment (CPAP or Bilevel PAP, as required). Sleep questionnaires are administered to evaluate sleepiness, sleep quality, and general and disease specific QoL. Cognitive function is evaluated using Trail Making Test Part A and B, Paced Auditory Serial Addition Test, Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R, Weschler Abbreviated Scale Intelligence II, Weschler Memory Scale IV, and Psychomotor Vigilance Test, respectively. All tests are administered at baseline visit, 3 months, and 6 months.

Results

We have enrolled 222 participants between Detroit and Ann Arbor VAMC locations, randomized 50 participants (48 males, 5 females; age: 70.5±6.5 years, BMI: 29.2±6.3kg/m2, AHI: 44.4±20.9events/hr, spirometry FEV1: 61.6±14.9% predicted, arterial blood gas (n=37) PaCO2:41.3±3.7 mmHg, ESS: 7.6±4.3, Six Minute Walk Test Total Distance Walked: 389.6±105.7 meters, FOSQ Total Score: 17.0±3.5, SGRQ Total Score: 45.6±22.6;30 participants have completed the study per the protocol. Group analysis will be available at the end of the trial. COVID pandemic has negatively impacted enrollment targets.

Conclusion

Final results from our study will determine the effects of treating a novel target (OVS) to maximize daytime function and QoL, while also providing a framework for early treatment of mild cognitive impairment in vulnerable older Veterans.

Support (if any)

VHA RR&D # 1I01RX003124-01
0895 Greater Sleep Reactivity and Poorer Sleep Efficiency Are Associated with Increased Medical Expenditures
Authors: Slavish Danica , Kotov Roman , Ruggero Camilo , Luft Benjamin
Published: April 2024

Introduction

Insufficient sleep costs the U.S. economy over $411 billion per year in lost productivity. However, most studies investigating the economic costs of sleep rely on flawed retrospective measures of sleep (e.g., typical sleep patterns in the past month). These measures are prone to recall bias and do not accurately capture daily variability in sleep patterns. To address these gaps, we examined how sleep metrics captured from prospective sleep diaries were associated with medical claims approximately one year later.

Methods

Participants were 452 World Trade Center 9/11 responders enrolled in the World Trade Center Health Program in 2017 (mean age = 52.22 years, SD = 8.73, 10.6% female). At baseline, participants completed 14 days of self-reported sleep and stress measures each morning. Mean sleep efficiency, variability in sleep efficiency, as well as a novel measure of sleep reactivity (i.e., how much people’s sleep efficiency changes in response to previous-day stressors) were used to predict total yearly medical claims, physical health claims, and mental health claims approximately one year later , covarying for participant age and sex.

Results

Greater sleep reactivity to stress was associated with more total medical claims (b = $7,742.63, p < .001), more physical health claims (b = $1,421.87, p < .001), and more mental health claims (b = $2,682.81, p < .001). Lower mean sleep efficiency was associated with more total medical claims (b = -$7,669.63, p = .018), more physical health claims (b = -$2,103.42, p = .026), and more mental health claims (b = -$2,494.76, p = .011). Greater variability in sleep efficiency was associated with more total medical claims (b = $14,020.82, p = .010) and more mental health claims (b = $7,035.91, p < .001).

Conclusion

Individuals with greater sleep disturbances engage in more healthcare utilization. Given the steep costs of insufficient sleep, it may be important to proactively address sleep problems to prevent downstream social and economic consequences.

Support (if any)

NIOSH U01OH011321 (PI: Kotov)
0900 Comparing a Lifestyle Plus Sleep Extension to a Lifestyle Intervention in Adults with Short Sleep and Prediabetes
Authors: Malone Susan , Patterson Freda , Grunin Laura , Goel Chitvan , Hu Jinyu , Sclafani Michelle , Saini Sara , Melkus Gail D'Eramo
Published: April 2024

Introduction

The purpose of this study was to evaluate the extent to which a sleep extension intervention optimized the well-established effects of a diet and physical activity lifestyle intervention on improved metabolic outcomes in adults with prediabetes (hemoglobin A1c ≥5.7% and ≤6.4%) and short sleep duration (≤6.5 hours/night actigraphy-estimated sleep).

Methods

157 eligible adults (mean age=52.16 years, 69% female, 66% White, 36% Black, 11% Asian, 7% other race) were randomized to an 8-week lifestyle plus sleep extension (n=88) versus lifestyle control (n=69) condition. Participants completed pre and post assessments of device-estimated glucose, sleep, and waist circumference. Self-reported sleep quality and daytime sleepiness were also assessed. Paired sample t-tests modeled pre to post-intervention changes in these measures.

Results

Device-estimated sleep duration increased significantly in both conditions [intervention condition 17.04 (SD=42.98) minutes; control condition 24.18 (SD=38.10) minutes]. Sleep onset time, sleep midpoint, and weekend sleep midpoint advanced in the intervention condition only [-16.71 (SD=52.48) minutes, -9.40 (SD=38.82) minutes, -20.83 (SD=54.30) minutes, respectively]. Sleep quality improved clinically and significantly in the intervention condition; mean Pittsburg Sleep Quality Index score decreased from 8.32 (SD=2.82) to 4.77 (SD=2.55). Sleep quality improved significantly in the control condition from 7.75 (SD=2.97) to 6.35 (SD=2.88). Between group differences in sleep quality change scores showed greater improvement in intervention versus control participants (p< 0.001). Daytime sleepiness decreased significantly in both conditions (-3.15 intervention versus -1.18 control). Between group differences in daytime sleepiness showed greater improvement in intervention versus control participants (p< 0.001). On average, waist circumference decreased by -0.74 (SD=5.19) cm. in the intervention and -1.56 (SD=5.21) cm. in the control condition; these changes scores did not differ significantly between conditions. There were no statistically significant improvements in devise-estimated glucose measures.

Conclusion

Adding sleep extension to a lifestyle change intervention improved several dimensions of sleep, beyond sleep duration, that have been associated with poor metabolic health (e.g. sleep times, sleep quality). The two conditions did not differentiate in terms of increasing sleep duration or decreasing waist circumference suggesting that individuals should at least have lifestyle interventions as a component of care. Neither condition improved glycemic outcomes.

Support (if any)

NIH (R00NR017416)
0904 The Prevalence of Insomnia and Fatigue in Cancer Patients Pre-Post Radiation Treatment
Authors: Lampe Elizabeth , Park April , Seewald Mark , Freedman Gary , Boyle Julia , Perlis Michael , Muench Alexandria
Published: April 2024

Introduction

Insomnia and Cancer-related fatigue (CRF) are highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing at least one of these at some point during treatment. Concerningly, insomnia and CRF have long-term effects on quality of life, daytime function, and are associated with medical and psychiatric morbidity. No studies to date have assessed concurrent change in CRF and insomnia with radiation therapy. Thus, the present analysis aimed to characterize insomnia & CRF prevalence and severity pre- and post-radiation.

Methods

Insomnia and fatigue were assessed pre- and post-radiation among 32 adults diagnosed with cancer (Mage=58.22 years, SDage=10.54, 46.9% female, 62.5% White). Subjects were asked to complete the Insomnia Severity Index, Functional Assessment of Chronic Illness Therapy – Fatigue Scale (FACIT-F), Brief Fatigue Inventory (BFI) and PROMIS-SF Fatigue 7A at each timepoint. Descriptive statistics are used characterize the severity of insomnia and CRF at each timepoint and exploratory t-tests examined whether sex was associated with change in insomnia and fatigue severity from pre- to post-radiation.

Results

The mean ISI total score was 8.25 (SD=5.01) pre-radiation, and 8.50 (SD=3.46) post-radiation. The mean FACIT-F total score was 40.34 (SD=9.01) pre-radiation and 34.67 (SD=8.69) post-radiation. There was one (3.12%) case of new-onset clinical insomnia and five (15.63%) cases of new-onset clinical fatigue from pre- to post-radiation. Females reported greater increases in fatigue from pre- to post-radiation compared to males (t(31)=-4.612, p < 0.001, d=-1.44).

Conclusion

Insomnia and fatigue are highly prevalent in patients diagnosed with cancer at both pre- and post-radiation. Overall, insomnia stayed relatively stable while fatigue increased over treatment. This suggests that separate mechanisms may drive cancer-related fatigue and insomnia. Fatigue increased over treatment for both men and women, however this effect was stronger for women. A better understanding of mechanisms of insomnia and CRF may allow for earlier detection of insomnia and CRF as well as the use of targeted interventions for individuals struggling with CRF and/or insomnia during cancer treatment and recovery, especially among women.

Support (if any)

University of Pennsylvania, Radiation Oncology, Chair's Summer Research Grant
0906 Free-text Documentation of Sleep Disturbance in Acute Myeloid Leukemia: A Natural Language Processing Study
Authors: Jeon Bomin , Chae Sena
Published: April 2024

Introduction

Sleep disturbance in acute myeloid leukemia (AML) patients is usually linked to cancer-related fatigue, affecting quality of life. Although addressing sleep disturbance might prevent fatigue, it is often overlooked. Limited knowledge about healthcare clinician’s observations of sleep disturbance in AML patients hampers evidence-based interventions. To address this gap, this study identified sleep disturbance documentation in patients with AML from free-text narrative notes in electronic health record (EHR) using a natural language processing (NLP).

Methods

The sample consisted of 692 patients with AML, who received 2,064 encounters at Midwestern academic hospital. We followed a stepwise process using NLP. 1) Identify a preliminary list of synonyms based on (a) 57 common symptoms from a previous study; (b) relevant literature; and (c) “synonyms” category of the Unified Medical Language System. We developed and validated algorithms using the publicly available NLP system, NimbleMiner, then an NLP algorithm was applied to extract sleep disturbance documentation using 316,038 EHR narrative notes of AML patients. The overall accuracy to identify documentation of sleep disturbance was high, with F score = 0.97.

Results

In general, this study involves older AML patients (average age, 59 years) and male (57%). When applying the NLP algorithm, 543/692 (78.5%) patients and 1,255/2,064 (60.8%) encounters in this sample were identified as having notes with language describing sleep disturbance. The most common language describing sleep disturbance was sleeping medication (40.5%), such as melatonin, olanzapine, zolpidem. Additionally, around 30% of languages mentioned sleep disorders including insomnia and obstructive sleep apnea (OSA).

Conclusion

We have demonstrated the feasibility of identifying sleep disturbance from EHR narrative notes with NLP in AML patients. While using sleeping pills are found as a common treatment option for sleep disturbance, it is important to consider the established first-line treatment for insomnia (cognitive behavioral therapy) and OSA (continuous positive airway pressure). Utilizing NLP-generated symptom indicators can assist in identifying high-risk patients for targeted sleep interventions. The impact of sleep disturbance on health outcome in AML patients should be further evaluated.

Support (if any)

This study was funded by Center for Advancing Multimorbidity Science: NIH/NINR 1 P20 NR018081-01 (MPI: Gardner & Rakel)
0908 Pain in OSA Patients Is Modulated by Chronic Pain History and Sex
Authors: Guttmann Maxine , Dubrovsky Boris , Weingarten Jeremy , Miryala Nandini , Cunningham John
Published: April 2024

Introduction

Altered pain perception was found in OSA. However, the relationship remains unclear, possibly due to differential effects on pain of apnea-related sleep disturbance and hypoxemia, or other factors. This study examines the relationship between retrospective pain reports and PSG variables, sex, age, BMI, depression and insomnia questionnaires in patients referred for OSA evaluation.

Methods

From all in-lab patients between 08/2017 and 04/2021, 420 (259 women) were selected without significant cardiac, pulmonary, neurological, endocrine or psychiatric conditions; 136 had chronic pain conditions (CPC, e.g., fibromyalgia, arthritis, sciatica, musculoskeletal pain and similar). Patients filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Chronic Pain Grade Scale measuring pain intensity (CPGS-PI) and functional disability (CPGS-FD) in the preceding 6 months. CPGS-PI and CPGS-FD were outcomes in hierarchical backward regression models. Blocks of explanatory variables were: (1) age, sex, BMI; (2) AHI, SpO2-nadir, time below SpO2-90%, respiratory-related arousal index, (3) total sleep time, sleep latency, sleep efficiency, #awakenings, (4) CESDR, ISI, ESS, (5) OSA(AHI≥5), CPC presence, and sex-OSA-CPC interactions.

Results

Higher CPGS-PI was unrelated to the presence of OSA (AHI≥5, n=248), but was predicted by higher BMI (p=0.008), higher CESD (p< 0.001), higher ISI (p=0.006), CPC presence (p< 0.001), and CPC-by-sex interaction (p=0.005). Higher CPGS-FD was unrelated to OSA, but was predicted by higher BMI (p< 0.001), higher CESD (p< 0.001), higher ISI (p< 0.011), CPC presence (p< 0.001), and interactions CPC-by-OSA (p=0.017), CPC-by-OSA-by-sex (p=0.002). Analyzing the interaction terms, in the absence of CPCs OSA was unrelated to CPGS-FD, although women reported higher CPGS-FD (M=2.5±3.1) than men (M=1.4±2.3). Among patients with CPC, OSA had a differential effect on pain: women with OSA reported higher CPGS-FD (M=5.3±3.5) than women without OSA (M=4.2±3.5), while men with OSA reported lower CPGS-FD (M=2.7±3.1) than men without OSA (M=4.2±4.0).

Conclusion

Demographic, mood and insomnia variables affect pain experience in OSA patients. Pain experience in men and women with CPC appears to be differentially affected by OSA.

Support (if any)

none
0910 Examining Relationships of Pain Chronicity and Sleep Disturbances in Adults with Skin Problems
Authors: Hogue Sarah , Gilles Allyson
Published: April 2024

Introduction

Patients with chronic pain report comorbid sleep challenges (sleep fragmentation/reduced duration). Research suggests sleep disturbance in individuals with skin/subcutaneous conditions, notably insomnia. Psychological/physiological symptomology with poor disease management can lead to self-medication, possibly exacerbated from compromised sleep. The objective of this study was to examine relationships between sleep, skin conditions, and pain chronicity relative to demographics and substance use.

Methods

Adult self-reported data (N=34,525; mean age 48; 55.8% female) from 2012 National Health Interview Survey(NHIS) were used. Sleep disturbance was categorized as < 7hr sleep, insomnia/trouble sleeping, or excessive sleepiness in the past year. Skin problem type was classified as eczema/skin allergy only(n=1908), non-specified skin problem only(n=1517), eczema/skin allergy and non-specified skin problem(n=569), and none(n=30531). Chi-square test for association, Kruskal-Wallis H test, and logistic regression were performed.

Results

Individuals with skin problems(n=3994) reported chronic pain(21.5%) and sleep issues (insomnia(35.4%); excessive sleepiness(27.1%); sleep duration < 7hr(33.7%) and >9hr(5.3%)). There were significant relationships between skin problem type and chronic pain X2(3,N=34525)=564.87,p<.001) and sleep disturbance (< 7hr nightly, insomnia, or excessive sleepiness) X2(3,N=34,525)=391.04,p<.001). Pain and sleep disturbance were significantly associated X2(1,N=34,525)=1184.84,p<.001). Multinomial logistic regression was performed to examine effects of age, sex, race, smoking initiation age, excessive tobacco/alcohol use, skin problem type, and sleep disturbance on the likelihood that participants have chronic pain. The model was significant, X2(9)=816.14,p=.0001 and explained 10% (Nagelkerke R2) of the variance in chronic pain. Predictor variables of sex, excessive tobacco/alcohol use, sleep disturbance, and skin problem type were statistically significant. Individuals of increasing age, female, and having any skin problem type, especially multiple, were more likely to report chronic pain. Sleep disturbance didn’t predict chronic pain, even when duration, insomnia, and excessive sleepiness were replaced separately for sleep disturbance in the model.

Conclusion

Although adults with skin problems report various sleep disturbances and substance use, pain chronicity is better predicted by sex, comorbid skin issues, and age. The relationships between sleep and chronic pain in individuals with skin/subcutaneous disorders need further exploration to focus prevention efforts/treatments. Understanding whether various sleep issues, comorbid with pain, possibly signal development/presence of skin cancer is important, as research links melanoma with obstructive sleep apnea.

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0911 Characterizing Sleep, Pain, and Opioid Craving in People with Chronic Low Back Pain on Long Term Opioid Therapy
Authors: Abraham Liza , Giagtzis Alexandros , Wejbrandt Julia Camacho , Reid Matthew , Ellis Jennifer , Smith Michael , Finan Patrick
Published: April 2024

Introduction

Previous studies have demonstrated that long-term opioid use alters sleep architecture and continuity. Long-term opioid therapy (LTOT) is common amongst people with chronic pain, yet the interrelations of sleep and pain among patients on LTOT are poorly understood.

Methods

We characterized sleep amongst people with chronic low back pain (CLBP) on LTOT (n=53) using wireless sleep-electroencephalography (EEG), and ecological momentary assessment (EMA) in a naturalistic remote study. The relationships amongst the duration and percentages of rapid eye movement (REM) and slow wave sleep (SWS), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), pain, and opioid craving, measured using 14 days of EMA assessments were explored. Opioid craving was assessed through two questions which asked participants to rate how much they wanted to use opioids and the strength of their urge to use opioids. These items were averaged into one craving measure. Sleep-EEG data were averaged across two nights (when available) and separate linear regression analyses were used to determine the relationships between sleep predictors (architecture and continuity metrics) and 14-day averages of pain and opioid craving.

Results

Participants demonstrated poor sleep continuity, with substantial WASO (mean=148, SD=101 mins), short TSTs (mean=5.40, SD=2.16 hours), and low SE (mean=61.35%, SD=19.98%). However, REM% (mean=15.16%, SD=9.23%) and SWS% (mean=20.99%, SD=15.36%) were generally within normative ranges. Regression models demonstrated no significant relationship between the sleep architecture variables and pain or opioid craving. However, a strong positive correlation between pain and opioid craving (r=0.57, p< 0.01) was present.

Conclusion

Participants with CLBP on LTOT demonstrate poor sleep continuity, despite sleep architecture within normative ranges. Although we observed no relationship between sleep and pain or opioid craving, there was a strong relationship between pain and craving. Future studies should evaluate the temporal dynamics of sleep, pain, and opioid craving in this population, as well as the potential role of opioid dose and use patterns.

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NIH/NIDA R01DA048206
0912 The Association Between Somatization and Sleep
Authors: Abdalla Marwah , Shurovi Sumayya , David Michelle , Cornelius Talea , Shechter Ari , Schwartz Joseph
Published: April 2024

Introduction

Somatization, the experience of having somatic symptoms (e.g., pain, fatigue, dizziness) with resultant psychological distress, has been described among working adults and contributes to work-related absences. Whether somatization affects employees’ sleep quality and sleep duration is unclear. We examined the association of somatization with sleep quality and duration.

Methods

Data came from the 4th wave of the multi-site Worksite Blood Pressure Study, which assessed psychological factors and ambulatory blood pressure. A total of 472 participants without major cardiovascular disease from 10 worksites in NYC were recruited across 4 waves and ~11 years. At Wave 4, participants completed the Brief Symptom Inventory (BSI) and a sleep questionnaire derived from the Sleep Heart Health Study. Items from the BSI were averaged and T-scored (normed to mean=50, SD=10). Items assessing sleep quality were averaged (higher scores indicated worse sleep quality). Weekday sleep duration was also reported using a one-time sleep diary. Analyses were restricted to participants providing complete data (N= 238). Linear regression models were specified predicting (1) sleep quality and, separately (2) sleep duration from somatization. Covariates were age, sex, race/ethnicity, body mass index, marital status, years of education, family income, employment status, and average work hours per week.

Results

Of the 238 participants, 79.8% were male, 11.8% were Black, 5.9% were Hispanic/Latinx, and 76.5% were married. Median family income was $70,000-$79,999. Mean age was 52.4 years (SD=8.1), mean years of education was 17.9 (SD=3.1), mean body mass index was 27.9 kg/m2 (SD=3.8), and mean hours worked per week (among those currently employed; n=191) was 42.0 (SD=10.9). Mean somatization score was 49.5 (SD=9.3), mean sleep quality was 8.4 (SD=4.3), and mean sleep duration was 6.5 hours/night (SD=1.1). Higher somatization scores were significantly associated with worse sleep quality, B=0.15, 95% CI 0.09, 0.20, p< 0.001. The association of somatization with sleep duration was not significant, B= 0.01, 95% CI -0.00, 0.02, p=0.18.

Conclusion

There was an association between somatization and sleep quality but not with sleep duration. Future research should examine whether treatment modalities for somatization among working adults improve sleep quality and overall occupational health.

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P01HL47540, NIH/NHLBI K23HL141682
0913 Interaction Between Sleep Duration and Trouble Sleeping on Depression Among U.S. Adults, NHANES 2015-2018
Authors: Wang Shanshan , Rossheim Matthew , Nandy Rajesh , Nguyen Uyen-Sa
Published: April 2024

Introduction

To examine the interaction effects of sleep duration and trouble sleeping on depression among U.S. adults.

Methods

We used data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 (N=10,044). Trouble sleeping was self-reported. Sleep duration was determined as short (≤ 6 hours) or long (≥ 9 hours), compared with normal (>6 and < 9 hours). Depressive symptoms were defined as the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were assessed.

Results

A significant positive additive interaction between short sleep duration and trouble sleeping on depression was observed in the fully adjusted model (Relative excess risk due to interaction, RERIOR=4.42, 95% CI: 1.12, 7.73), with 43% of the association with depression attributed to the interaction (attributable proportion of interaction, AP=0.43, 95% CI: 0.22, 0.64). Similarly, there was a significant positive additive interaction between long sleep duration and trouble sleeping on depression after adjustment (RERIOR= 4.17, 95% CI: 0.96, 7.38), with 41% of the association with depression attributed to the interaction (AP=0.41, 95% CI: 0.21, 0.60). No multiplicative interaction between short or long sleep duration and trouble sleeping was detected.

Conclusion

Different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depression. It is crucial to simultaneously consider multiple dimensions of sleep health when examining their relationship with depression.

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0914 Retrospective Review of Sedative Use on Hospitalized Patients at Risk for OSA
Authors: Rojas Edward , Srinivasan Priyanka , Mudgal Mayuri , Olgers Kassandra , Knollinger Scott , Ecker Zachary , Seol Calvin , Stansbury Robert , Sharma Sunil
Published: April 2024

Introduction

There has been prevalent usage of sedatives and narcotics in the United States, specifically in the Appalachia. Obstructive sleep apnea (OSA) has proved to be associated with significant cardiopulmonary consequences. This study aimed to examine the effects that sedatives and/or narcotics have on the length of stay (LOS) and 6-month mortality rates of patients screened and diagnosed with OSA.

Methods

A retrospective analysis was conducted on hospitalized patients who were screened positive for OSA and had used some form of sedative. The patients were divided into three groups: patients with OSA and on sedatives chronically at home or in the hospital; patients with OSA not on sedatives; and controls with no OSA or use of sedatives. The variables studied included 6-month mortality rate and LOS. Demographics, comorbidity and medication information were also recorded for these patients.

Results

Of the patients screened from August 2019 to May 2021, 156 patients were with OSA and used sedatives, while 278 were diagnosed with OSA but no use of sedatives. There were 88 patients negative for OSA or sedatives. The patients who had OSA and used sedatives had the highest 6-month mortality rate of the three groups. Specifically, these patients had a 6-month mortality rate of 14%, compared to the other two groups, which both had 6-month mortality rates of 3%. Moreover, the patients who used sedatives had significantly longer LOS (10.06 days versus 5.97 days) than those who were diagnosed with OSA but did not use any sedative. Those without OSA had a LOS of 5.23 days. Both age-unadjusted and age-adjusted Charlson comorbidity were similar amongst all groups.

Conclusion

Hospitalized patients’ high risk for OSA and on sedatives have significantly higher 6-month mortality rates and LOS. To improve quality of care and healthcare utilization, practitioners should take caution when providing sedatives to patients with OSA and consider alternative therapies. To elucidate underlying mechanisms, further prospective studies would be necessary.

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