bluuebunny/crossref_metadata_2025 huggingface dataset:
0649 Objective and Subjective Sleep Patterns in Youth with Obsessive-Compulsive Disorder
Authors: Swisher Valerie , Rozenman Michelle , Peris Tara , Tan Patricia , Piacentini John , Ricketts Emily
Published: May 2022

Introduction

Sleep disturbance commonly presents in youth with obsessive-compulsive disorder (OCD). However, studies elucidating the nature of sleep problems in OCD are limited and pose discrepant findings. The present study examines objective and subjective sleep disturbance in youth with OCD relative to healthy controls, and investigates the relationship between sleep disturbance and OCD symptom severity.

Methods

Participants were 61 youth aged 8 to 17 years (M = 12.18, SD = 2.64) with OCD (n = 26), and healthy controls (n = 35). An evaluator assessed psychiatric diagnosis through a diagnostic interview and rated OCD symptom severity (Children’s Yale-Brown Obsessive-Compulsive Scale). Objective sleep patterns, including sleep onset latency, wake after sleep onset, duration and number of awakenings, total sleep time, and sleep efficiency were assessed through 7-day sleep monitoring using the wActiSleep-BT actigraph. Youth rated sleep using the Sleep Self-Report (SSR), and parents rated youth sleep using the Children’s Sleep Habits Questionnaire (CSHQ).

Results

Independent samples t-tests were performed to compare youth with OCD and healthy controls on sleep measures. Findings revealed no significant differences between youth with OCD and healthy controls on the actigraphy measures (i.e., total sleep time, wake after sleep onset, duration and number of awakenings, and sleep onset latency, sleep efficiency). Youth with OCD had significantly greater self-reported, t(24) = 3.29, p < 0.01, and parent-reported sleep disturbance, t(41) = 2.94, p < 0.01, relative to healthy controls. OCD symptom severity was positively correlated with SSR scores, r = .53, p < 0.01, and CSHQ scores, r = .47, p = 0.03. There were no significant correlations between actigraphy measures and OCD symptom severity.

Conclusion

Youth with OCD exhibit sleep disturbance on subjective but not objective sleep measures relative to healthy controls. Findings are discrepant from objective-subjective sleep patterns found in other studies of youth with OCD, but consistent with those found in youth with anxiety disorders. Findings may suggest subjective measures capture forms of sleep disturbance (e.g., bedtime resistance, nighttime anxiety, etc.) not measured by actigraphy.

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0650 Does pain related disability moderate the relationship between subjective insomnia and anxiety in comorbid fibromyalgia and insomnia?
Authors: Guandique Alan , Nair Neetu , McCrae Christina
Published: May 2022

Introduction

Fibromyalgia is a chronic widespread pain condition with up to 90% of patients experiencing comorbid sleep disorders (e.g., insomnia) and up to 64% experiencing comorbid anxiety disorders. Past research has shown: 1) a bidirectional relationship between insomnia and anxiety, 2) associations between pain and insomnia and 3) associations between pain and anxiety. However, research has yet to explore the role of pain, specifically pain related disability, in moderating the association between insomnia and anxiety. The present study evaluated the moderating impact of self-reported pain related disability on the relationship between subjective sleep variables and anxiety scores in adults with fibromyalgia and insomnia (FMI).

Methods

Two-hundred and nineteen adults with FMI (Mage=51.53, SD=1.89, 92.8% female) completed daily sleep diaries over fourteen days, the Pain Disability Index (PDI), and the State-Trait Anxiety Inventory Form Y-1 (STAI-Y1) as part of the baseline for a larger randomized clinical trial (SPIN, NCT#02001077). Moderation analyses included STAI-Y1 as the dependent variable, sleep variables averaged over 14 days (Sleep Onset Latency- SOL, Wake After Sleep Onset-WASO, Total Sleep Time-TST, Sleep Efficiency-%SE) as independent variables, PDI as the moderator, and age and years of education as covariates. For moderation at significance levels of p<0.05, significance of simple slopes at high (1 SD above), average, and low (1 SD below) PDI scores were examined.

Results

PDI moderated the relationship between SOL and STAI-Y1 (B=0.0052, SE=0.0019, p=0.01, R2=0.04). At high PDI scores (but not average), higher SOL was associated with higher STAI-Y1 scores (B=0.0748, SE=0.0310, p=0.02). At low PDI scores, higher SOL was associated with lower STAI-Y1 scores (B=-0.0844, SE=0.0453, p=0.06; trend).

Conclusion

Results indicate that at higher levels of perceived pain related disability, greater difficulty falling asleep is associated with increased levels of anxiety in FMI. At lower levels of pain related disability though, difficulty falling asleep and anxiety levels may have an inverse relationship. This points to a possible complex interplay between sleep difficulties, pain related disabilities and anxiety in the FMI population. Future research is warranted to examine potential causal relationships between pain, sleep, and anxiety.

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NIAMS-R01AR055160(PI-McCrae)
0652 Associations Between Anhedonia and Maladaptive Beliefs About Sleep in Middle Age and Older Adults with Insomnia Disorder
Authors: Tully Isabelle , Tutek Joshua , Gumport Nicole , Simpson Norah , Dietch Jessee , Palaniappan Latha , Manber Rachel
Published: May 2022

Introduction

Comorbid depression often exacerbates dysfunctional beliefs about sleep in those with insomnia disorder. Anhedonia, a core symptom of depression, may be mechanistic in this association. Previous research suggests that, when appraising potential decisions, individuals with anhedonia regularly overestimate the probability of negatively valenced outcomes and underestimate the likelihood of positive outcomes. This study explores the relationship between anhedonia and sleep-related cognitions in patients with insomnia disorder.

Methods

Adults 50 years and older (N = 241) who met DSM-5 criteria for insomnia disorder were enrolled in a randomized controlled trial assessing the effectiveness of a stepped care approach to delivering Cognitive Behavioral Therapy for Insomnia. At baseline, participants completed the Dysfunctional Beliefs and Attitudes about Sleep Scale, Pre-Sleep Arousal Scale (cognitive subscale), Beliefs about Medications Questionnaire (Subscales assess the belief that hypnotics are necessary and concern regarding consequences of use), and PROMIS sleep-related impairment short form. A t-test was used to compare participants who did and did not endorse anhedonia on the Geriatric Depression Scale (GDS). We also correlated the Patient Health Questionnaire-4 (PHQ-4) anhedonia item with sleep-related cognition measures.

Results

Participants reporting anhedonia (GDS) endorsed greater dysfunctional beliefs about sleep (p < .001, d = 0.44) and sleep-related impairment (p < .01, d = 0.39). Groups did not differ significantly regarding belief in the necessity of sleep medications and concern with hypnotic use, nor in pre-sleep arousal. Higher anhedonia (PHQ-4) was correlated with more severe dysfunctional beliefs about sleep (r = .20, p < .01), belief in the necessity of hypnotics to manage sleep disturbance (r = .22, p < .001), and greater pre-sleep arousal (r = .18, p < .01).

Conclusion

Endorsement of anhedonia was associated with stronger dysfunctional beliefs about sleep in this sample of middle age and older adults with insomnia disorder. Participants reporting anhedonia also reported greater sleep-related impairment. Exploring anhedonia as a transdiagnostic symptom that influences interpretation of sleep-related difficulties may elucidate underlying mechanisms that sustain maladaptive cognitions. Prospective, multi-method studies will be essential to clarify predictive interactions between reward system dysfunction and sleep-related beliefs in those with insomnia disorder.

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1R01AG057500
0673 Script-Driven Imagery in PTSD: Comparing Reactivity to Imagery of Trauma Memories to Imagery of Trauma-Nightmare Memories
Authors: Mendelsohn Augustus Kram , Orr Scott , Ivkovic Vladimir , Fortier Elizabeth , Kelly Anne , Cetinkaya Doga , Martinez Uriel , Bazer Oren , Tanev Kaloyan , Lasko Natasha , Pineles Suzanne , Pace-Schott Edward
Published: May 2022

Introduction

Prolonged Exposure (PE) therapy produces therapeutic fear extinction via imaginal exposure to trauma memories. However, traumatic events that occurred in the distant past and the associated memories may become distorted or habituated. Posttraumatic nightmares are more recent, potentially salient, and may better support extinction learning. Physiological responses to imagery of a trauma and nightmare related to this trauma were compared to each other and to neutral imagery.

Methods

Twelve participants (mean age=26.16, 11 female) with PTSD (mean CAPS-5=27.83) and frequent trauma-related nightmares wrote accounts of their trauma. Participants then completed a 14-day sleep-monitoring period with diaries, actigraphy and two nights of ambulatory PSG. Participants narrated a nightmare report into an audio recorder when awoken by a nightmare or when recalled upon awakening. Two pairs of short narratives were created from the written account of the trauma and recording of a nightmare most similar to the trauma. These narratives (scripts) were audio-recorded by an investigator. Participants then underwent two script-driven imagery (SDI) sessions, one hour apart, during which they listened to either their two trauma-memory or their two nightmare-memory scripts (counterbalanced across participants) with 3 interspersed neutral scripts. Each script in an SDI session included baseline, listening, and imagery periods (approximately 30 sec apiece). Skin conductance (SC), heart rate (HR), and corrugator electromyography (EMG) biosignals were continuously recorded throughout each SDI session. For each script, HR, SC, and EMG means during the baseline period were subtracted from their respective imagery-period means. These difference scores were square-root transformed and analyzed by ANOVA with Type (trauma vs. nightmare) and Valence (trauma/nightmare vs. neutral) factors.

Results

Biosignals from scripts of both Types (trauma and nightmare) significantly exceeded those from their respective neutral scripts [HR:F(1,11)=23.42, p=0.0005; SC:F(1,11)=9.53, p=0.01; EMG:F(1,10)=8.0, p=0.018]. However, biosignals from trauma and nightmare scripts did not differ (p’s>0.39) nor did the Type x Valence interactions (p’s>0.10).

Conclusion

Physiological reactivity during imagery of a trauma memory and a trauma-related nightmare both significantly exceeded reactivity to neutral scenarios. Nightmare-memory and trauma-memory imagery produced similar reactivity. Thus, imagery of nightmares have potential utility as alternative PE stimuli.

Support (If Any)

This project was supported by NIMH grant 1R21MH121832-01A1 to E.P.S.
0678 Slow Wave Sleep Recovery Correlates with Brain Functional and Structural Changes in Alcohol Use Disorder
Authors: Zhang Rui , Tomasi Dardo , Shokri-Kojori Ehsan , Manza Peter , Feldman Dana , Kroll Danielle , Biesecker Caterine , McPherson Katherine , Wang Gene-Jack , Wiers Corinde , Volkow Nora
Published: May 2022

Introduction

Sleep disturbances are very common in alcohol use disorder (AUD) and contribute to relapse. Recovery of N3 sleep within the first 30 days of abstinence is limited. Brain mechanisms associated with N3 sleep recovery in AUD are still poorly understood.

Methods

We examined brain functional and structural changes associated with inter-individual differences in N3 recovery in 30 AUD patients (9 Females, mean age: 41 years) undergoing a 3-week inpatient detoxification. We measured patients’ N3 sleep, resting state functional connectivity (RSFC), grey matter volume (GMV) and negative mood on week 1 and week 3.

Results

AUD patients had shorter N3 sleep than healthy controls on week 1 and showed a trend towards N3 sleep recovery after 3-week detoxification. Inter-individual differences in N3 recovery were observed. Larger increases in N3 sleep were associated with greater improvement in negative mood. Inter-individual variations in N3 recovery were associated with increases in midline default mode network (DMN) RSFC and anterior DMN GMV. Exploratory analyses revealed significant sex effects on N3 sleep and N3 recovery such that AUD females had greater N3 impairments on week 1 and greater N3 recovery after detoxification than AUD males.

Conclusion

We show a significant relationship between N3 recovery and structural and functional changes in DMN in AUD patients during detoxification. Combining nighttime and daytime interventions that target N3 sleep and DMN might have a complementary therapeutic effect on AUD recovery including mood improvement. Future investigations on sex differences with a larger sample and with longitudinal data for a longer period of abstinence are needed.

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0691 Examining the Associations between Insomnia and Adult-ADHD Diagnosis in Army Soldiers
Authors: Kautzmann Jeremie , Goldschmied Jennifer , Miller Katherine , Klingaman Elizabeth , Gehrman Philip
Published: May 2022

Introduction

Most research on the association between insomnia and attention deficit hyperactivity disorder (ADHD) has been conducted in children. It has been established that insomnia and ADHD are frequently comorbid, but less is known about whether the association extends to individual ADHD symptoms, or any possible moderators of the association. This study aims to understand whether sex plays a key role in the moderation between insomnia and ADHD in adult military servicemembers, as well as to investigate the relationship between insomnia diagnosis and ADHD symptomology.

Methods

Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21292; age 18-61, 88.24% male). Participants completed a survey that included items assessing insomnia and ADHD status based on DSM-5 criteria. Chi-squares and logistic regression, including interactions with sex, were used to examine the relationship between insomnia diagnosis and ADHD symptomology.

Results

There is a significant association between insomnia and ADHD diagnoses (r = 0.30; <.0001), consistent with prior literature. There was a small but statistically significant moderation by sex of the relationship between insomnia and ADHD diagnosis (Chi square = 9.43; p = .002). There was also a strong association between insomnia diagnosis and certain symptoms of ADHD: keeping attention on repetitive work (Chi square = 3687.75; <.0001), remembering appointments (Chi square = 3186.735; <.0001), and getting things in order (Chi square = 2756.28; <.0001).

Conclusion

Insomnia diagnosis was associated with both ADHD diagnosis and symptomology in a nationwide sample of army servicemembers, with the relationships being stronger in males compared to females. These findings highlight the importance of assessment and treatment of insomnia in patients with ADHD given their interrelationships.

Support (If Any)

This publication is based on data obtained from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1). KEM’s time was supported by the U.S. Department of Veterans Affairs, Clinical Science Research and Development Service - IK2 CX001874. EAK’s time was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2 RX001836.
0692 Physical activity and sleep patterns before and during the COVID-19-pandemic – results from a cross-sectional and retrospective study
Authors: Sadeghi-Bahmani Dena , O’Hora Kathleen , Osorno Raquel , Lopez Mateo , Morehouse Allison , Krause Adam , Goldstein-Piekarski Andrea
Published: May 2022

Introduction

In general, higher physical activity is related to lower symptoms of insomnia, depression, and anxiety. The COVID-19-pandemic and its related restrictions unfavorably impacted both physical activity and sleep patterns. However, it remains unknown how better sleep and physical activity prior to the pandemic confer resilience to psychological and health-related disturbances during the pandemic. We investigated whether people with higher physical activity and lower insomnia scores before the COVID-19-pandemic also reported higher physical activity, lower insomnia scores, and lower symptoms of depression and anxiety during COVID-19-pandemic-related restrictions.

Methods

A total of 826 adults (mean age: 34.58±12.37 years) completed self-rating questionnaires covering physical activity, and symptoms of insomnia, depression, and anxiety during the COVID-19-pandemic. Further, participants retrospectively rated their physical activity and insomnia before the COVID-19-pandemic. Hypotheses were tested using Pearson’s correlations and paired t-tests with significance at p < 0.05.

Results

Retrospectively assessed higher physical activity levels before the COVID-19-pandemic were associated with lower symptoms of depression (r = 0.84, p = 0.041), but neither insomnia (r = 0.02, p = 0.67) nor anxiety scores during the COVID-19-pandemic (r = 0.05, p = 0.20). Retrospectively assessed lower insomnia scores before the COVID-19-pandemic were associated with lower symptoms of insomnia (r = 0.57, p < 0.001), depression (r = 0.30, p < 0.001) and anxiety (r = 0.31, p < 0.001) during the COVID-19-pandemic. Consistent with other studies both insomnia and physical activity worsened; insomnia scores increased (p < 0.001, d = 0.66) and physical activity decreased (p < 0.001, d = 0.19) from before to during the COVID-19 pandemic.

Conclusion

These results suggest that those with lower levels of insomnia prior to the pandemic may be resilient to the psychological and health-related consequences of the COVID-19-pandemic and its related restrictions in everyday life, while those with higher physical activity prior to the pandemic were more resilient specifically to depression during the pandemic).

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0712 Cluster analysis for the association between obstructive sleep apnea phenotypes: a population-based longitudinal study
Authors: Tempaku Priscila , Silva Luciana , Guimarães Thaís , Vidigal Tatiana , D'Almeida Vânia , Andersen Monica , Bittencourt Lia , Tufik Sergio
Published: May 2022

Introduction

The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.

Methods

We used data derived from the São Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to AHI≥ 15 events/hour. Cluster analysis was performed using latent class analysis (LCA).

Results

Of the 1,042 individuals in the EPISONO cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.3% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 cluster for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).

Conclusion

The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.

Support (If Any)

This work was supported by grants from AFIP and FAPESP.
0715 Diagnosis of Sleep Disordered Breathing in Patients with Interstitial Lung Disease: A Retrospective Evaluation of Polysomnogram and Home Sleep Apnea Testing Using Peripheral Arterial Tonometry
Authors: Kelly Bryan , Moua Teng , Escalante Patricio
Published: May 2022

Introduction

Previous studies have shown that sleep disordered breathing (SDB) is common in patients with Interstitial Lung Disease (ILD), and oximetry is often used for screening prior to further diagnostic testing. Current guidelines recommend polysomnography (PSG) for diagnosis of SDB in patients with significant pulmonary disease, however, home sleep apnea tests (HSAT) are increasingly used in clinical practice for a variety of reasons despite lack of evidence regarding accuracy in this population. In this study, we evaluate the correlation between screening oximetry, a commercial brand HSAT (WatchPAT®) and PSG to examine the diagnostic accuracy of this HSAT technology in patients with ILD.

Methods

The institution electronic medical record was screened for patients with a diagnosis code for ILD who underwent screening oximetry followed by PSG or HSAT using peripheral arterial tonometry from July 1, 2012 to present. Clinical review confirmed presence of ILD according to American Thoracic Society guidelines. Among the respective cohorts, Paired Wilcoxon Test was used to compare the oximetry 4% oxygen desaturation index (ODI) to the HSAT ODI and PSG apnea-hypopnea index (AHI) as well as percent time spent below oxyhemoglobin saturation of 89%. Spearman correlation was used to correlate the oximetry ODI and parameters of SDB on HSAT and PSG.

Results

Data was analyzed for 25 patients who had undergone oximetry/HSAT and for 25 patients who had undergone oximetry/PSG. Oximetry ODI showed no significant difference from PSG AHI (p = 0.2635) or between HSAT ODI (p = 0.0755), and no difference was seen in hypoxic time between oximetry and PSG (p = 0.9789). Hypoxic time on HSAT was significantly longer than that on oximetry (p < 0.001). Using HSAT ODI as the standard, HSAT AHI and respiratory disturbance index (RDI) showed rs of 0.9638 and 0.8913 respectively, while oximetry ODI was 0.3893. Compared to PSG AHI, the PSG RDI and oximetry ODI rs were 0.9759 and 0.7407 respectively.

Conclusion

Among patients with ILD, screening oximetry appears to correlate more strongly with indices of SDB and hypoxic time on PSG rather than HSAT. Further studies are warranted to evaluate efficacy of additional HSAT testing modalities in this patient population.

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0725 Five-year Transitions of Symptom Subtypes in Untreated Obstructive Sleep Apnea
Authors: Morris Jonna , Scott Paul , Mazzotti Diego
Published: May 2022

Introduction

Symptom subtypes have been consistently identified in mild and moderate-severe OSA in cross-sectional studies. The objectives of this study were to determine how often participants transition between symptom subtypes over 5 years and whether baseline clinical factors were associated with observed transitions.

Methods

We analyzed demographic, clinical, polysomnographic and symptom data from 2,643 participants of the Sleep Heart Health Study (53.7% women; mean age 62.4 years) with complete baseline and follow-up visits (5.2 years between visits). Latent transition analysis was conducted using 14 daytime and nighttime symptom items in individuals with OSA diagnosis (apnea-hypopnea index [AHI]≥5) to determine symptom subtypes at baseline and follow-up as well as their transition probabilities over time. Individuals without OSA (AHI<5) were incorporated as a known class at each time point. Multinomial logistic regression was conducted to assess the effect of age and sex on class transitions between baseline and follow-up visits.

Results

We identified four OSA symptom subtypes at both baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy. Most participants did not transition subtypes between visits (55.8%). Of participants whose subtype remained the same between visits, 54.1% had minimal symptoms at baseline; 48.5% were in moderately sleepy; 31.5% were excessively sleepy and 34.6% were in disturbed sleep. A transition to moderately sleepy was the most common. Excessively sleepy participants transitioned most often to moderately sleepy (37.9%). One-year increase in baseline age was associated with a 7% increase in odds to transition from excessively sleepy to disturbed sleep (OR=1.07; 95%CI=1.01-1.15) and about 6% increase in odds to transit from excessively sleepy to moderately sleepy (OR=1.06 (95% CI=1.02-1.12). Women had higher odds to transit from moderately sleepy to minimal symptoms (OR=2.35; 95%CI: 1.27-3.27) and to transit from minimal symptoms to no longer having an OSA diagnosis (OR = 2.30; 95%CI=1.40-3.80).

Conclusion

Approximately half of the participants transitioned their symptom subtypes over a period of 5 years, with most transitioning to minimal symptoms. Increasing age and sex may affect the transitions.

Support (If Any)

National Institutes of Health: U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL53938, U01HL53940, U01HL53941, U01HL64360
0727 Age-related association of visceral adiposity with cardiometabolic disorders in mild-to-moderate sleep apnea
Authors: Karagkouni Efthalia , Vgontzas Alexandros , Fernandez-Mendoza Julio , Lenker Kristina , Basta Maria , Krishnamurthy Venkatesh , Bixler Edward
Published: May 2022

Introduction

Visceral adiposity is a key predictor of both metabolic syndrome and obstructive sleep apnea (OSA). Both metabolic syndrome and OSA are associated with cardiometabolic disorders, however, the association of OSA with these disorders weakens in older adults. We compared the relative strength of the association between visceral adiposity vs. OSA with hypertension and diabetes and whether this association is stronger in middle-aged vs. older adults.

Methods

A clinical sample of 148 adults (53.79±12.45y, 36,5% female) with mild-to-moderate OSA (5≤AHI<30) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure and fasting glucose. Hypertension was defined as blood pressure ≥140/90mmHg or use of anti-hypertensive medication. Diabetes was defined as fasting glucose ≥100mg/dL or receiving treatment for diabetes, except insulin. Visceral Adiposity Index (VAI) was calculated within each sex using Amato et al (2010) standardized formulas based on waist, BMI, triglycerides and HDL cholesterol. Logistic regression models examined the association between VAI and AHI with hypertension and diabetes, while simultaneously adjusting for sex and stratifying by age. We also generated under the receiver-operating characteristics (ROC) curves (AUC) having hypertension and diabetes as outcomes and gender, age, BMI, AHI and VAI as independent variables.

Results

VAI was associated with greater odds of having hypertension (OR=1.57, 95%CI=1.20-2.06, P=0.001) and diabetes (OR=1.27, 95%CI=1.02-1.57, p=0.031) compared to AHI (OR=1.05, 95%CI=0.98-1.13, p=0.185; and OR=1.07, 95% CI=1.00-1.14, p=0.690, respectively) in adults aged <60y. There was no association between VAI or AHI with hypertension and diabetes in adults aged ≥60y. Adding VAI to standard clinical factors (age, sex, and BMI) yielded moderately-good risk models for hypertension (AUC=0.73) and diabetes (AUC=0.70) in adults aged <60y, while suboptimal risk models (AUC=0.61 and 0.68, respectively) in adults aged ≥60y.

Conclusion

These data indicate that visceral adiposity, but not AHI, is associated with cardiometabolic disorders in patients with mild-to-moderate OSA, an association that is stronger in middle-aged adults. Visceral obesity should be a priority in preventive/therapeutic interventions in young and middle-aged patients with OSA. These findings also further support that OSA in older adults is a distinctly different phenotype.

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0736 Mandibular Movements Are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome
Authors: Martinot Jean-Benoit , Le Dong Nhat Nam , Cuthbert Valérie , Coumans Nathalie , Tamisier Renaud , Malhotra Atul , Pépin Jean-Louis
Published: May 2022

Introduction

Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA).

Methods

In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed. PSGs were scored manually using AASM 2012 rules. Data blocks (n=8042) were randomly sampled during normal breathing (NB), obstructive or central apnea/hypopnea (OA/OH/CA/CH), respiratory effort-related arousal (RERA), and mixed apnea (MxA). Analyses were: evaluation of the similarity and linear correlation between PES and MM using the longest common subsequence (LCSS) algorithm and Pearson’s coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from NB to a respiratory disturbance for a given change in MM signal using a mixed linear-regression.

Results

Participants (n=38) had mild to severe OSA (median AH index 28.9/h; median arousal index 23.2/h). MM showed a high level of synchronization with concurrent PES signals. Distribution of gyroscope MM signal amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.17–2.43) for CA, 0.83 (0.23–4.71) for CH, 1.93 (0.54–5.57) for MxA, 3.23 (0.72–18.09) for OH, and 6.42 (0.88–26.81) units for OA. Mixed regression indicated that crossing from NB to central events would decrease gyroscope MM signal amplitude by –1.23 (CH) and –2.04 (CA) units, while obstructive events would increase gyroscope MM signal amplitude by +3.27 (OH) and +6.79 (OA) units (all p<10-6).

Conclusion

In OSA patients, MM signals facilitated the measurement of specific levels of RE associated with obstructive, central or mixed apneas and/or hypopneas. A high degree of similarity was observed with the PES gold-standard signal.

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0764 Evaluation of cloud-connected home sensors of apnea-hypopnea index versus polysomnography and home sleep test during upper airway stimulation home titration
Authors: Huyett Phillip , Yu Phoebe , Kent David , Stahl Stephanie , Manchanda Shalini , Mehra Reena , Rundo Jessica , Roy Asim
Published: May 2022

Introduction

A growing number of cloud-connected sensors can longitudinally record apnea hypopnea index (AHI) at home. The Ectosense NightOwl is an FDA-approved peripheral arterial tomography device; the Withings Sleep Analyzer mat is an under-mattress sensor with AHI data for retrospective research use (CE marked, not FDA approved). We used these sensors to monitor patients with upper airway stimulation (UAS) therapy during therapy acclimatization and post-titration follow-up and compared sensor AHI to polysomnography (PSG) and home sleep test (HST) AHIs.

Methods

Enrolled patients underwent UAS implantation as part of regular clinical care and were required to have a smartphone. The Ectosense and Withings sensors were distributed at UAS device activation. Patients were asked to use NightOwl weekly, and Withings provided nightly AHI. Sleep studies (PSG & HST) occurred at 3 and 6-mo post implant. Ectosense & Withings AHI were averaged and correlated against the nearest 3- and 6-month sleep study AHIs.

Results

Patients were 67% male, aged 57 ± 10 years. Smartphone platforms were 59% Apple iOS, 24% Google Android, and 17% Unknown. As of October 2021, 45 patients have had near-simultaneous Withings and PSG/HST AHI, 35 have had near-simultaneous NightOwl and PSG/HST AHI. The Withings AHI was fairly linear against PSG/HST AHI, adjusted R2 = 0.47, p < 0.0001, (y=10 + 0.82x). Withings AHI < 15 (n=18) had a 90% positive predictive value for a PSG/HST AHI less than 15 (n=20). Ectosense data was less linear and more scattered, adjusted R2 = 0.15, p=0.01, (y=14 + 0.47x). Ectosense AHI < 15 (n=12) had an 80% positive predictive value of a PSG/HST AHI less than 15 (n=15).

Conclusion

Home-based sensors provide longitudinal SDB data in a home setting and may adequately classify patients with mild sleep apnea, and may have utility for home-based management of UAS patients in the post-implantation period.

Support (If Any)

Inspire Medical Systems
0812 Periodic Limb Movements in the Setting of Pediatric Traumatic Brain Injury
Authors: Willis Aaron , Petitto Lacie , Revana Amee
Published: May 2022

Introduction

Sleep disturbances following traumatic brain injury (TBI) are commonly diagnosed and can affect up to 70% of individuals, with many occurring after mild injuries such as concussions.1 Patients can experience a variety of sleep problems such as sleep-wake disturbances, infrequent parasomnias, and periodic limb movement disorders. While periodic limb movements (PLMs) can occur in pediatric patients, they are rare compared to their adult counterparts. Literature is limited regarding the presence of PLMs post-concussion in the pediatric population. We describe an unusual case of PLMs in the setting of mild TBI in a pediatric patient.

Report of Cases: A 6-year-old male with a past medical history significant for adeno-tonsillar hypertrophy and chronic cough was brought to the emergency department by ambulance after being found facedown secondary to a fall at school. Physical examination findings were significant for dried blood at the nares with an abrasion to the anterior nasal bridge. No other signs of trauma were noted, and his Glasgow Coma Scale (GCS) was 15. Computerized Tomography (CT) scan of the head was negative for any acute intracranial abnormality. He was diagnosed with a mild TBI and sent home with concussion precautions. Prior to his concussion, at the age of 4, he was diagnosed with obstructive sleep apnea (OSA) via polysomnography (PSG). Moderate OSA was noted with an apnea hypopnea index (AHI) of 8.1 per hour leading to adenotonsillectomy. Five weeks after his concussion, an evaluation by the pediatrician revealed complaints of restless sleep and worsened emotional lability prompting a referral to the sleep clinic. By comparison, the patient’s post-TBI PSG at age 6 showed no evidence of sleep-disordered breathing (AHI of 1.48 per hour) but with new periodic limb movements and an elevated PLM index of 6.56 per hour. An iron panel is pending.

Conclusion

PLMs in the setting of pediatric TBI is a rarely diagnosed entity and, to our knowledge, has never been reported in the literature. Our case suggests that clinicians should have a high level of suspicion for sleep problems post-TBI and consider PSG to assess for PLMs which can affect recovery and the overall quality-of-life of the pediatric patient.

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Viola-Saltzman M, Watson NF. Traumatic brain injury and sleep disorders. Neurol Clin. 2012;30(4):1299-1312. doi:10.1016/j.ncl.2012.08.008
0822 Caffeine as a treatment option for primary central sleep apnea of infancy in term infants
Authors: Shah Amit , Kasi Ajay , Shah Samar , Martinez Fran , Leu Roberta
Published: May 2022

Introduction

Primary central sleep apnea of infancy tends to improve over weeks with supportive care. No established treatments exist; however, infants with this condition remain at risk from sequelae of intermittent hypoxemia. We present a term infant with primary central sleep apnea of infancy treated with caffeine citrate resulting in clinical and polysomnographic improvement.

Report of Cases: A 7-day-old male infant born at 37 weeks gestation (gestational age confirmed by early first trimester prenatal ultrasound) was hospitalized following an episode of hypotonia and decreased responsiveness. Infectious studies, chest radiograph, and echocardiogram were

normal. During the hospitalization, oxygen desaturations during sleep were observed and

capillary blood gas during sleep showed a pH of 7.36 and a partial pressure of carbon dioxide of

54 mmHg. Polysomnography on room air showed central sleep apnea [central apnea hypopnea

index (AHI) of 58, obstructive AHI of 4, hypoxemia, hypoventilation with transcutaneous carbon

dioxide greater than 50 mmHg for 89% of sleep time, and periodic breathing for 21.7% of

sleep time]. Brain MRI and paired-like homeobox2B (PHOX2B) genetic testing were normal. A

trial of caffeine citrate was initiated with prompt resolution of oxygen desaturations during

sleep. Serial capillary blood gases showed improvement with partial pressure of carbon dioxide

between 39-44 mmHg. Polysomnography on room air three days after caffeine initiation

demonstrated resolved hypoxemia, hypoventilation, periodic breathing, obstructive sleep

apnea, and central sleep apnea (central AHI of 6.8). The patient was discharged home on

caffeine and continuous pulse oximetry during sleep. At follow-up six weeks later, the patient

had no oxygen desaturations and was successfully weaned off caffeine.

Conclusion

To our knowledge, there are no prior reports of term infants being treated with caffeine citrate for primary central sleep apnea of infancy. While caffeine is an established therapy for apnea of prematurity, it is typically discontinued at a postmenstrual age of 32 - 34 weeks. Our case demonstrates that in term infants with no underlying medical conditions and primary central sleep apnea of infancy, immature regulation of respiration should be suspected, and a trial of caffeine may be considered.

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None.
0827 Obstructive Sleep Apnea in a Congenital Central Hypoventilation Syndrome Patient Post-Tracheostomy Ventilated with Diaphragmatic Pacing
Authors: Cocozza Victoria , Kim David , Hansen Shana , Frey William
Published: May 2022

Introduction

Congenital central hypoventilation syndrome (CCHS) is a rare, autosomal dominant disorder associated with a genetic mutation in the PHOX2B gene. While the treatment of CCHS requires lifelong ventilatory support, advancements in management have allowed for life expectancies comparable to healthy individuals. Prolonged lifespan of CCHS patients presents new challenges with regards to the chronic management of the disease, including the concurrence of obstructive sleep apnea (OSA) in patients ventilated with diaphragmatic pacing post decannulation.

Report of Cases: A 23-year-old female with a past medical history of adenotonsillectomy and CCHS with nocturnal ventilatory support via diaphragmatic pacer (DP) was referred to sleep clinic by her pulmonologist for an evaluation of increased obstructive events and worsening nocturnal hypoxia. The patient did not require daytime ventilatory support and did not complain of any sleep-related symptoms. The DP was implanted at age 17 and the patient previously had a

tracheostomy from age 3 months until decannulation at 18 years. She had a surgical closure a

year later. The DP settings were titrated by her pulmonologist and monitored with repeat home

sleep apnea testing (HSAT) to achieve optimal control of central hypoventilation. After an initial

period of response, however, subsequent HSATs showed a progressive increase in obstructive

breathing events associated with hypoxia. Further adjustments in the DP settings did not successfully correct the findings. An in laboratory polysomnography (PSG) confirmed moderate

OSA with significant hypercapnia. At clinic follow-up, the patient was offered positive airway

pressure therapy but chose to defer decision-making until pulmonary follow-up. The patient

was also referred to ENT for an anatomic evaluation to look for potential causes contributing to

upper airway obstruction.

Conclusion

DP remains a treatment option for select patients with CCHS. Limited studies have shown that OSA can occur in patients with CCHS using DP as their primary management modality. Our case demonstrates the importance of keeping a broad differential in evaluating the development of concurrent OSA in these patients. Potential contributors to developing OSA include weight gain, tracheomalacia or tracheal stenosis resulting from longstanding tracheostomy status, and effects of increased DP amplitude settings.

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0828 Positional Central Sleep Apnea
Authors: Mempin Roberto , Sarrami Kayvon , Thomas Aaron , Zeidler Michelle
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is well known to often improve with non-supine positioning as opposed to supine positioning. The prevalence of OSA that may improve on proper positioning is 50-60% and the prevalence of OSA that appears when supine and disappears when non-supine is 25-30%. Sleeping in a lateral positioning is thought to reduce pressure on the airway, shift the directional effect of gravity on airway structures, and counteract physiologic genioglossus collapse that occurs when supine. On the other hand, the effect of positional changes on the severity of central sleep apnea (CSA) is not well documented aside from Cheyne-stokes breathing in congestive heart failure.

Report of Cases: We present two cases of positional CSA. One patient is a 52-year-old male with a history of traumatic brain injury, hypogonadism, hypothyroidism and Parkinson’s Disease. He underwent split-polysomnography (PSG) for dream enactment behavior, was found to have severe CSA, which occurred almost exclusively supine (Supine Apnea-Hypopnea Index (AHI) 66/hr, Non-Supine 0.8/hr). A positional belt was recommended to the patient. The second patient is an 89-year-old male with history of chronic obstructive pulmonary disease and chronic kidney disease who underwent PSG for symptoms of sleep apnea. He was found to have severe obstructive and central sleep apnea with periods of Cheyne-stokes breathing. This also occurred almost exclusively supine (Supine AHI 69/hr, Non-Supine 0/hr) and improved on continuous positive airway pressure (CPAP) independent of position (AHI 6/hr). CPAP or positional belt was recommended to the patient.

Conclusion

Positional CSA unrelated to congestive heart failure is an uncommon phenomenon with poorly understood pathophysiology. Treatment of CSA is often challenging and based on elucidating and addressing the underlying cause such as optimizing treatment of heart failure. Positional therapy is characteristically thought of as a potential treatment option for OSA. However, our findings further support the presence of a phenotype of central sleep apnea that may respond to positional therapy.

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0839 Complex Sleep Apnea Improved with Decompression of a Chiari I Malformation in a Pediatric Patient
Authors: McKee Matthew , Petitto Lacie , Kaplan Kevin
Published: May 2022

Introduction

Chiari malformation (CM) occurs when a portion of the cerebellum herniates through the foramen magnum. CM is categorized as two types. Type 1 involves the cerebellar tonsils and type 2 involves the cerebellum and brain stem. Those with CM can be asymptomatic to having debilitating neurologic symptoms such as dysphagia, tinnitus, emesis, balance difficulty, muscle weakness, and/or headache. Central sleep apnea (CSA) and obstructive sleep apnea (OSA) have been associated with CM. It is postulated that the sleep disordered breathing (SDB) is due to compression of the medulla which houses the breathing center and cranial nerves that play a role in nocturnal breathing. OSA has been thought to be related to muscle weakness of the lower airway in those with CM. After resolving CM with surgical decompression, residual OSA is common requiring treatment with positive airway pressure therapy.

Report of Cases: A 3-year-old male with a history of OSA and tonsillar hypertrophy. Polysomnography (PSG) was performed after tonsillectomy and adenoidectomy indicating severe OSA (oAHI 17.7/hr) and CSA (CSAI 29.9/hr). A titration study was conducted and bilevel positive airway pressure spontaneous/timed (BPAP ST) 10/6 cmH2O with a backup rate of 12 breaths per minute was utilized further resolving his SDB and daytime sleepiness. After months of BPAP ST therapy, he presented to an urgent care with symptoms of somnolence, emesis, and nystagmus of the left eye. Magnetic resonance imaging of the brain revealed a 2 cm herniation of the cerebellar tonsils indicating CM type 1. Neurosurgery performed surgical decompression without complication. Post-operative PSG indicated significant improvement of OSA (oAHI of 3.45/hr) and resolution of CSA (0.9/hr). BPAP ST therapy was discontinued with the resolution of his daytime sleepiness and SDB.

Conclusion

This case demonstrates a patient with severe OSA and CSA due to an undiagnosed CM type 1. OSA and CSA are associated with CM; however, residual OSA typically exists status post decompression and can require positive airway pressure therapy for treatment. Our case demonstrates the need for consideration of CM in patients with complex sleep apnea and that surgical decompression can improve both OSA and CSA in these patients.

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0856 Correcting Sleep/Wake Cycle and Reducing Combativeness in an 84-year-old Patient
Authors: Bell Alexa , Capaldi Vincent
Published: May 2022

Introduction

Sleep disruption is a common occurrence in hospitalized geriatric patients. Such patients frequently arrive at the emergency department for behavioral changes due to delirium, which can often be mistaken for, or compounded by, underlying dementia. Behavioral symptoms may vary, including disinhibition, aggression, distress during care, mood disturbance, and paranoia, affecting approximately 90% of patients. Effectively treating these patients is challenging; antipsychotic use is a commonly implemented treatment in hospitalized settings, but is complicated by adverse side effects and an increased risk of CVA. In this case report, we discuss the use of an antipsychotic, olanzapine, to treat an 84 year old hospitalized patient presenting with sleep disruption and changes in mental status.

Report of Cases: An 84 year old gentleman with a history of Alzheimer’s dementia with worsening behavioral changes was admitted for urinary tract infection, humeral fracture secondary to mechanical fall, and increasing aggression toward his caretaker. At home the patient was sleeping during the day and more was active and combative at night. While hospitalized, he had become aggressive with hospital staff due to his distress and was minimally oriented at baseline. We trialed the patient on olanzapine 5mg at night to facilitate sleep and reduce his aggression, in addition to environmental changes to reorient day and night. After a few days of this treatment, this patient was much more pleasant and oriented, able to hold conversation, and no longer aggressive. His initial disposition was to be transferred to a memory care facility, given increasing safety concerns expressed by the caretaker. However, following these changes, he was able to return home in the comfort of his family and caretaker.

Conclusion

Antipsychotic use in the elderly for sleep disruption and behavioral disturbances is heavily debated, though there may be some benefit to their use. The CATIE-AD trial and a Cochrane Review suggest Olanzapine may reduce aggression, particularly in Alzheimer’s disease, and has the added benefit of sedation which aids in establishing sleep cycles. However, many patients discontinue antipsychotic treatment due to side effects and routine use is discouraged. When in use, regular monitoring should take place to evaluate for side effects associated with pharmacotherapy and continued therapeutic benefit should be reassessed.

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