bluuebunny/crossref_metadata_2025 huggingface dataset:
0113 Sleep Moderates Depression and Quality of Life in People with Chronic Illnesses in South Africa & the United States
Authors: Diallo Idiatou , Musci Rashelle , Spira Adam , Bass Judy
Published: April 2024

Introduction

In the era of global health challenges, escalating chronic physical and mental health issues, coupled with sleep problems, threaten individual well-being and burden healthcare systems. This study evaluated the moderating role of sleep on the depression-quality of life (QOL) association in individuals aged 50+ with chronic illnesses in South Africa (SA) and the United States (US).

Methods

We studied 16,556 participants with at least one chronic illness (i.e., hypertension, diabetes, or cardiovascular disease). Data were drawn from the Health and Retirement International Family of Studies (N=3,379 in SA; N=13,177 in the US). To generate a sleep disturbance score, we averaged responses to three items: 'my sleep is restless' (no=0/yes=1), 'waking up too early' (rarely or never=0/sometimes=1/most of the times=2), and 'feeling rested' (most of the times=0/sometimes=1/rarely or never=2). To generate a QOL score, we summed responses to two questions about ‘life satisfaction as a whole’ (coded 2-10) and ‘position on the life satisfaction ladder’ (coded 0-10). Depressive symptoms were assessed via the 8-item Center for Epidemiological Studies-Depression scale. Pre-statistical harmonization aligned common items across the datasets, and country-specific regression analyses were conducted due to measurement non-invariance.

Results

After adjusting for demographic and health-related confounders, greater sleep disturbance was associated with lower QOL in SA (B=-0.52, 95% confidence interval (CI) =-0.55, -0.48) and the US (B=-0.48, 95% CI =-0.49, -0.47). Higher depression symptoms were associated with lower QOL in both SA (B=-0.26, 95% CI =-0.28, -0.25) and the US (B=-0.42, 95% CI =-0.42, -0.41). Sleep disturbance moderated the depression–QOL association in both countries, such that the negative association between depression symptoms and QOL was stronger among those with greater sleep disturbances, but moderation was much stronger in SA (B=-0.35, 95% CI =-0.38, -0.33) than in the US (B=-0.02, 95% CI =-0.02, -0.01).

Conclusion

The interaction of depression symptoms and sleep disturbances on lower QOL emphasizes the need to integrate routine depression/sleep disturbance screening and treatment in populations with chronic illnesses. Policy recommendations include culturally tailored sleep and depression interventions while future research recommendations include exploring the temporal interrelationships among depression symptoms, sleep disturbance, and quality of life.

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1131 : A Novel Sensor to Track Transient Blood Pressure Changes During Sleep
Authors: Khayat Rami , Kim Joshua , Lee Eugene , Chaudhari Akhil
Published: April 2024

Introduction

Sleep disordered breathing is associated with poor cardiovascular outcomes. However, measurements like blood pressure (BP) using ambulatory BP monitoring (ABPM) are not commonly utilized in sleep assessments because of its difficulty, discomfort, and interference with sleep. ABPM is intermittent and lacks the temporal resolution to identify rapid BP changes. A novel, wearable sensor that captures beat-by-beat BP changes, has been validated against the arterial line. We sought to adapt this device to measure BP changes continuously during sleep.

Methods

We developed a technique that measures transient BP changes during sleep using the novel sensor. The calibration-free technique measures BP changes based on evaluating the sympathetic and vascular tones during steady state breathing and comparing those with that of respiratory events like apneas, hypopneas, and arousals. We developed a machine learning classifier to automatically detect steady state breathing and validated this approach of measuring transient BP changes within twenty-seven patients’ arterial line. For each patient, we compared a total of 50 points that were 30 seconds apart exhibiting at least 15 mmHg systolic or 10 mmHg diastolic change for each point.

Results

In twenty-seven patients undergoing surgery, the 50th percentile and 85th percentile of error rate between the arterial line and our approach for estimating BP change was 23.8 and 42, respectively, meeting ISO 81060-3 (< 25% and < 50% error for the 50th and 85th percentiles, respectively). Using our calibration-free technique, we measured transient BP changes induced by sleep events in twenty-eight patients undergoing polysomnography. We observed BP surges in response to events such as EEG arousals (up to 72 mmHg) and obstructive hypopnea events (up to 84.6 mmHg).

Conclusion

This method leveraging a novel, flexible, and sleep-compatible beat-to-beat BP monitoring device accurately and non-invasively tracks transient BP changes during sleep. Applications of this hemodynamic monitoring include the ability to provide stratification of severity of sleep disordered breathing (SDB) events. Additionally, this device can be worn comfortably throughout the night, enabling real-time monitoring of cardiovascular disorders during sleep. Lastly, this device could allow for titration of SDB therapies using real time BP information and objective evaluation of treatment efficacy.

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1132 Analyzing Spectral Density of EEG During Sleep in COVID-19 Survivors
Authors: Bohra Arwa , Goyal Manish , Mishra Priyadarshini , Goyal Abhishek
Published: April 2024

Introduction

- Long COVID19 patients exhibit persistent symptoms, including dyspnea, anxiety, and neurological issues. - Acute COVID-19 infection is linked to neuropsychiatric complications; 62% had cerebrovascular accidents, and 31% had altered mental status. - Depression (33%), anxiety (36%), and insomnia (41%) are common during acute infections, but COVID- 19's impact on sleep architecture is unknown. - Previous study reported EEG changes in COVID19 survivors; alpha intrusion (78%), cyclical alternating pattern (59%), and increased REM density (38%).

Methods

- Sub-analysis of a prospective study with COVID-19 survivors undergoing Level I Polysomnography. - PSG data compared with pre-COVID era healthy volunteers. - EEG analysis was done in MATLAB and included artifact detection, power spectral densities, and REM analysis. - Statistical analysis was done using JASP 0.16.4.

Results

- 132 participants underwent Level I PSG. - Baseline characteristics showed mean age 43.9±14.6 years, mean BMI 24.31±6.54 Kg/m2. - Sleep characteristics: Total sleep time 359.78±70.29 minutes, sleep efficiency 81.53±12.02%, AHI 19.6±18.2. - Spectral wave percentages in REM and NREM sleep varied significantly between COVID and control groups. -Logistic Regression: Factors like age, REM C3 delta, REM C3 theta, NREM C3 alpha, NREM C3 theta, total AHI predict outcome variable (presence in COVID patients). -Multivariate Logistic Regression: Best fit model includes Age, C3 alpha wave percentage of NREM Sleep, and AHI. McFadden R² value is 0.56, indicating a good fit; AUC value is 0.94, indicating high predictive ability.

Conclusion

- Significantly high alpha frequency was seen in COVID19 survivors. REM density was also significantly elevated in patients with COVID19. - Presence of these abnormal PSG-EEG waves hints that COVID19 might have similar effects as depression, insomnia on these subjects, at least in the short run. - Whether these changes are temporary or permanent needs to be evaluated by performing serial polysomnography in patients with COVID19 ARDS.

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1134 Post-acute Sequelae SARS CoV-2 Related Sleep Study and Symptom-based Factors Associated with Sleep Disturbances
Authors: Zia Zahra , Li Yadi , Lapin Brittany , Mehra Reena
Published: April 2024

Introduction

Post-Acute Sequelae of SARS-CoV-2 (PASC) poses a global public health challenge, manifesting in persistent sleep disturbances beyond four weeks post-acute infection Despite the high prevalence of PASC-related sleep symptoms, there is a critical lack of objective evidence, particularly in sleep study characterization and symptom-based PASC contributors to reported sleep disturbances(SD). We sought to identify distinct sleep study features and PASC-related symptoms associated with patient-reported SD.

Methods

This cross-sectional ReCOVER cohort involved patients presenting with PASC from February 2021-May 2023 who underwent sleep studies following a positive COVID test with PROMIS-Sleep Disturbance(PROMIS-SD) collected within 6 months. Sleep study variables (sleep apnea and sleep architectural indices) and PASC-specific symptoms were stratified by PROMIS-SD score. A dichotomized T-score ≥60 defined moderate-severe SD. Multivariable logistic regression models adjusted for age, sex, race, and COVID hospitalization, assessed the association of sleep study indices and PASC symptom status (never, resolved,recurrent or new) across SD severity group. Statistical interaction of sleep study indices by sex and race were examined.

Results

The sample included 494 patients(age:49.5±12 years,BMI:35±9 kg/m²,73.1% female,82.5% vaccinated). Of 365 patients completing PROMIS-SD,166(45.5%) reported moderate/severe SD. Of all sleep study indices examined, only lower REM % was associated with higher SD, OR=0.95, 95% CI=0.92-0.99, p=0.01. Notably, males and black patients with moderate-severe SD exhibited higher average heart rate during sleep(statistical interaction p-values=0.01). Recurrent PASC symptoms were more common in moderate to severe vs normal/mild SD respectively: dyspnea(75.2 vs 60.9%,p=0.008),joint aches/pains(47.7 vs 31.1%,p=0.04) and headaches(47.7 vs 33.1%,p=0.03).

Conclusion

The sleep architectural alteration of lower percentage of REM sleep is associated with greater degree or patient-reported sleep disruption in PASC. Males and black individuals experiencing moderate-severe SD showed elevated heart rate during sleep, potentially reflecting sleep-related autonomic dysfunction in PASC. PASC-specific symptoms of dyspnea,joint pain and headaches appear to be clinically relevant sleep disruptors in recurrent PASC. Future investigation should focus on enhanced understanding of REM sleep-specific neural circuitry and memory consolidation in PASC as well as sleep-related autonomic fluctuations in predisposed subgroups. Moreover, targeting treatment of specific PASC symptoms such as dyspnea and pain may mitigate compromise in sleep and improve clinical outcomes.

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1135 Predictors of Post-COVID Clinical and Cognitive Consequences
Authors: Greig Danny , Rastogi Ruchi , Diaz Teresa , Tovar-Torres Maria , Axelrod Bradley , Zhao Lili , Badr M Safwan , Chowdhuri Susmita
Published: April 2024

Introduction

“Post-acute sequelae of SARS-COV-2 infection (PASC)” is a condition with a wide range of physical and mental health consequences that are present or persist four or more weeks after SARS-COV-2 infection. Fatigue is one of the most common PASC symptoms. It is not known whether underlying OSA and sleep disturbances may influence the persistence of chronic physical, mental health and neurocognitive dysfunction post-COVID. This pilot study will systematically examine whether sleep disturbances and severity of OSA comprise modifiable facets of PASC.

Methods

We prospectively collected sleep quality, sleepiness, quality of life (QoL) and neurocognitive data in patients with post-COVID fatigue (PASC) and OSA, and compared with control patients with OSA but without prior COVID infection. Questionnaires were administered at baseline and after 3 months to evaluate sleep disturbances, sleepiness, and general and disease specific QoL. Cognitive testing included Trail Making Test Part A and B, Paced Auditory Serial Addition Test (PASAT), Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R (HVLT-R), Weschler Abbreviated Scale Intelligence II (WASI), Weschler Memory Scale IV (WSM), and Psychomotor Vigilance Test (PVT), respectively. 6-minute walk test and COVID-infection related medical data were also collected.

Results

Thus far, we have enrolled 26 total participants, 16 controls (13 males, 3 females; age: 65.4±11.7 years, BMI: 35.4±12.8 kg/m2, AHI: 49.2±34.6/hr, Education:14.4±3.0 years), and10 patients with PASC (7 males, 3 females; age: 59.3±12.8 years, BMI: 31.7±8.4 kg/m2, AHI: 44.2±33.6/hr, Education:16±2.3 years).Baseline data in controls vs. PASC patients are given as: FSS Total Score: 29.8±16.7 vs. 37.9±11.2, ESS: 8.6±4.7 vs. 8.5±5.6, PROMISE Sleep Disturbance Score: 20.2±10.1 vs. 22.9±11.2, 6-Minute Walk Test Total Distance Walked: 415.5±56.8 vs. 389.1±47.2 meters, FOSQ Total Score: 16.7±3.9 vs. 17.17±3.2, HVLTR Total Recall: 88.2±14.5 vs. 83.2±16.2, WMSIV Visual Reproduction Delayed Recall: 109.2±19.8 vs. 106.2±27.7, TMT-B: 94.2±21.1 vs. 93.0±25.6, Stroop Color-Word Score: 88.7±10.7 vs. 94.5±20.1, WASI-II FISQ4 Score: 97.6±11.2 vs. 96.2±17.2, PASAT Rate 2 Correct: 38.8±25.4% vs. 33.3±33.3%, PVT Mean Reaction Time: 319.2±65.2 vs. 324.7±149.5 ms.

Conclusion

Our study provides preliminary data on important clinical metrics in patients with post-COVID sequelae. Additional data will allow us to determine future targets for management of PASC.

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VHA RR&D # RX004396 (SPiRE)
1137 Sleep Quality of Undergraduate Medical Students During and Post Lockdown: A Cross Sectional Study
Authors: Sebastian Loana , Fathima Farah
Published: April 2024

Introduction

The global upheaval caused by the COVID-19 pandemic significantly influenced healthcare and medical education. Faced with in-person learning restrictions, institutions globally adopted online platforms, disrupting the daily routines and sleep patterns of medical students. This study aims on the assessment of sleep quality among undergraduate medical students affiliated with the National Medical Council in India, exploring effects of COVID-19 lockdown measures on their sleep patterns both in the short and long term.

Methods

Conducting a cross-sectional survey, participants included undergraduate medical students from NMC-registered colleges, encompassing all genders. Ethical approval and written consent were obtained, employing respondent-driven sampling to recruit 165 participants over six months (October 2021 to March 2022). The study utilized the Pittsburgh Sleep Quality Index (PSQI), a validated questionnaire with 19 self-rated questions and five partner-rated items, if available. Statistical analysis involved SPSSv2021 for descriptive analysis, PSQI score calculations, and tests examining associations between PSQI components and sociodemographic variables.

Results

Among the 171 participants, 9.4% reported poor sleep quality during the lockdown, decreasing to 4.7% post-lockdown—a substantial 50% improvement. Noteworthy changes were observed in specific PSQI components, such as sleep quality and habitual sleep efficiency, with sleep duration decreasing by 23.4% during lockdown and increasing by 45.6% post-lockdown. Weak correlations between PSQI scores during and post-lockdown suggested persistent sleep challenges for those initially affected. Sociodemographic factors showed no significant associations with PSQI score changes.

Conclusion

This study accentuates the pandemic's impact on the sleep quality of undergraduate medical students, revealing a significant 50% enhancement post-lockdown. It underscores the importance of addressing reduced sleep quality among this demographic and emphasizes the need for strategies promoting good sleep hygiene and offline study habits. Future research should delve into the academic consequences of poor sleep during the pandemic and assess students' readiness to seek advice or treatment for sleep-related issues. In summary, the study highlights the critical significance of sleep quality among undergraduate medical students and underscores the imperative for interventions supporting their well-being amid and beyond the COVID-19 pandemic.

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1138 The Association Between Racial Discrimination During COVID-19 and Sleep Quality Among Asian Americans
Authors: Giorgio Luciana , Lee Hee Yun
Published: April 2024

Introduction

The positive association between racial/ethnic discrimination and poor sleep health has been well documented among racial/ethnic minoritized populations in the US. Although Asian Americans experienced a rise in anti-Asian discrimination during the COVID-19 pandemic, they remain underrepresented in sleep studies. Studies suggest that the positive association between discrimination and poor health outcomes is stronger with increased levels of acculturation among Asian Americans, however, this modifying effect has not been tested in sleep studies. Our aims were to examine the association between racial discrimination experienced during COVID-19 (COVID discrimination) and poor sleep quality(SQ) and test differences in this association by English proficiency, a proxy for acculturation, among a sample of Asian Americans.

Methods

Using survey data from a sample of Korean American adults living in the Southeastern US (n=360), we conducted logistic regression analyses to test the association between COVID discrimination and poor SQ. We progressively adjusted for age, gender, education, nativity status, and English proficiency. We conducted moderation analyses (COVID discrimination*English proficiency) in fully adjusted models. COVID discrimination was assessed using a count of discriminatory experiences reported during the COVID-19 pandemic. Self-reported English proficiency was dichotomized into high and low proficiency. Poor SQ was determined using Pittsburgh Sleep Quality Index scores >5.

Results

Most participants were immigrants (98.61%) and highly educated (79.17%). About half of the sample identified as women (49.33%) and had high English proficiency (55.28%). Mage=40.67 years (SD=12.18). On average, participants reported < 1 experience of COVID discrimination and the majority reported good SQ (68.33%). Every additional COVID discrimination experience was associated with 33% increased odds of poor SQ (OR=1.33, 95%CI: 1.10-1.61, p< 0.001) in fully adjusted models. English language fluency did not moderate this association.

Conclusion

Although the height of COVID-19 pandemic has subsided, these findings shed significant light on the persistent impact of racial discrimination, specifically its adverse effects on the sleep quality of Asian Americans. There is urgent need to advocate for a proactive approach in tackling anti-Asian discrimination. If replicated through larger-scale studies, the findings may suggest that addressing anti-Asian discrimination is essential to supporting good sleep quality among members of the Asian American community.

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1139 The Association Between Sleep and Coronavirus disease-19 Severity
Authors: Yeh An-Yun , Chao Ying-Yu , Strauss Shiela
Published: April 2024

Introduction

Sleep disturbances are key symptoms of long-COVID syndrome, particularly in patients with severe COVID-19. It is therefore critical to understand the sleep characteristics and the association between sleep and COVID-19 severity in patients diagnosed with COVID-19. The study’s purpose is to investigate 1) self-reported sleep characteristics in patients diagnosed with COVID-19 and 2) the association between sleep characteristics and COVID-19 severity after controlling for depressive symptoms and age.

Methods

In this correlational and cross-sectional study, data were collected via an online survey posted on social media. The sample included 90 patients diagnosed with COVID-19 (female: 47.8%; mean age= 36.6 ± 10.1 years). The survey was completed by participants 308.95 ± 164.7 days after their COVID-19 infection. Self-reported sleep characteristics were measured by the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). COVID-19 severity was measured by hospitalization, use of oxygen therapy, and use of ventilation. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). Descriptive statistics and multiple regression were used to analyze the data.

Results

A total of 66.7% were hospitalized; 57.8% used oxygen therapy, and 66.7% used ventilation. In all, 6.7% and 4.4% had sleep time < 6 hours and > 9 hours, respectively; 17.8% had sleep efficiency < 85%; 54.4% had poor sleep quality (total score of PSQI > 5); and 38.9% had excessive daytime sleepiness (total score of ESS >10). After controlling for depressive symptoms and age, COVID-19 severity (i.e., hospitalization, use of oxygen therapy, and use of ventilation) significantly predicted self-reported sleep time [F(5, 84)= 4.16, p= 0.002, Δ R2= 0.1], self-reported sleep efficiency [F(5, 84)= 2.5, p= 0.037, Δ R2= 0.09], sleep quality [F(5, 84)= 9.23, p < 0.001, Δ R2= 0.04], and daytime sleepiness [F(5, 84)= 14.41, p < 0.001, Δ R2= 0.03].

Conclusion

Poor sleep quality and excessive daytime sleepiness are common in patients diagnosed with COVID-19. COVID-19 severity was significantly associated with self-reported sleep characteristics, but the effect size is small. A further understanding of sleep problems and the relationship between COVID-19 severity and sleep in patients diagnosed with COVID-19 is required to design interventions to improve sleep.

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1140 The Influence of Daily Rest and Activity on Mental Health Among Japanese Adults During the COVID-19 Pandemic
Authors: Miyata Seiko , Iwamoto Kunihiro , Kawai Keita , Fujishiro Hiroshige , Ozaki Norio , Ikeda Masashi
Published: April 2024

Introduction

The global COVID-19 pandemic has not only presented an unprecedented threat to physical health but has also cast a shadow over the mental well-being of individuals worldwide. Various sleep disturbance symptoms have been reported, including a sense of nonrestorative sleep and poor sleep quality. Promoting the mental health of community residents is critical in their lives. This study examined the relationship between sleep habits, activities of daily living, and mental health symptoms in young to middle-aged Japanese adults.

Methods

The participants were 76 adults not currently attending a psychiatric clinic. Participants kept a sleep diary for at least five days (including two days off), recorded daily activity using Fitbit Sense, and answered questionnaires regarding psychiatric symptoms and sleep. The Patient Health Questionnaire-9 (PHQ-9), State-Trait Anxiety Inventory-S (STAI-S), Beck Depression Inventory (BDI), and Temperament and Character Inventory Harm Avoidance (HA) were used to assess psychiatric symptoms. The Insomnia Severity Index (ISI), Hyperarousal Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were used to assess subjective symptoms. Sleep diary records were averaged over five days and rated for bedtime, waking time, time in bed, sleep duration, sleep satisfaction, and sleepiness upon awakening. The study was approved by the Bioethics Review Committee of Nagoya University School of Medicine.

Results

Daily wakefulness, sleepiness, and subjective sleep efficiency were significantly related to psychiatric symptoms such as PHQ-9, STAI-S, BDI, and HA (Fatigability). Participants with a higher total HA score and HA (Fatigability) score had a significantly lower amount of active time in their daily lives, as recorded by Fitbit.

Conclusion

Daily rest and activity levels have an impact on mental health during the COVID-19 pandemic in Japanese community residents.

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1141 Long-Term Efficacy of Acetazolamide in Treating Central Sleep Apnea After Traumatic Brain Injury
Authors: Manahil Naila , Shukri Ghaith , Mayo Meagan , Agudelo Christian , Dib Salim , Ramos Alberto , Geil Eric
Published: April 2024

Introduction

Central sleep apnea (CSA) is characterized by recurrent cessation of breathing during sleep due to a failure of the physiological mechanisms responsible for the respiratory drive. Risk factors include congestive heart failure, high altitude, opioids, and traumatic brain injury (TBI), particularly brainstem injury. Current mainstay treatments are positive airway pressure (PAP) and oxygen therapy. Medications such as acetazolamide are presumed to enhance respiratory drive or modulate chemosensitivity. Given the high degree of nonadherence to PAP therapy, medications are an appealing alternative treatment for CSA.

Report of case(s)

A non-verbal 39-year-old man with spastic quadriplegia, intractable epilepsy, and static encephalopathy secondary to a TBI from a motor vehicle accident at age 10 was evaluated in the sleep clinic due to his caregiver’s concern for loud snoring, witnessed apneas, and daytime hypersomnolence. The caregiver denied the use of opioids, sleep aids or a history of parasomnias. Overnight home oximetry results demonstrated nocturnal hypoxemia with a SpO2 nadir of 71%. The initial in-laboratory polysomnography showed an apnea-hypopnea index (AHI) of 144.2 with a central apnea index (CAI) of 131.6 and no Cheyne-Stokes respiration. A subsequent in-laboratory PAP titration was difficult due to the patient’s inability to follow commands. He was then started on treatment with auto-titrating CPAP 5-10 cmH2O with a full facemask. However, the therapy was ineffective due to the patient chewing on several different masks, so he was transitioned to supplemental oxygen therapy. Due to the potential choking hazard, other options such as tracheostomy and medications were considered. Because a tracheostomy would only address the obstructive component of his sleep apnea, the patient was started on acetazolamide 250 mg per G-tube daily. Reevaluation at two months with a repeat in-laboratory polysomnography demonstrated complete resolution of sleep-related respiratory events with an AHI of 0.0 and the caregiver reported improvement in daytime hypersomnolence. Repeat polysomnography 9 months later showed continued efficacy of the therapy with an AHI of 1.7 and CAI of 0.0.

Conclusion

Current literature demonstrates improvement of CSA with short-term use of acetazolamide. This case highlights the potential long-term efficacy of acetazolamide for chronic management of CSA in patients with TBI.

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1142 Atypical Cataplexy and Post LP Headaches in POTS with Features of Narcolepsy Type I
Authors: Kewalramani Anjali , Molina Courtney , Avidan Alon
Published: April 2024

Introduction

Postural Orthostatic Tachycardia Syndrome (POTS) consists of orthostatic intolerance upon standing resulting in lightheadedness or fainting. Narcolepsy type I (Narcolepsy with cataplexy) is a disorder of hypersomnolence categorized by cataplexy and impaired hypocretin levels in the hypothalamus. The diagnostic criteria for type 1 narcolepsy include the presence of cataplexy or cerebrospinal fluid orexin-A/hypocretin-1 ≤ 110 pg/mL. Recent data reveals the increased prevalence of POTS in narcolepsy, particularly NT1 phenotype. We present two patients with POTS and features of cataplexy with a normal orexin level.

Report of case(s)

Patient 1: A 19-y/o Caucasian female presented with excessive daytime sleepiness with the onset of symptoms occurring 5 years before her initial evaluation. The patient describes episodes of “feeling weak” and experiencing symptoms of lightheadedness when “laughing a lot.” A lumber puncture (LP) was conducted by an experienced neurologist using a 22G spinal needle drawing 15cc of CSF The patient described severe headaches lasting for 4 days following the LP, which improved with caffeine, hydration, and analgesics. CSF Orexin= 248 pg/mL. Patient 2: A 22 y/o female presented with severe fatigue, EDS, and POTS against a history of Ehlers-Danlos Syndrome despite a total sleep time of 7-8 hours per night. The patient noted a “loss of coordination” and “sudden muscle weakness when she felt excited and upset while standing, Due to the presence of serotonergic agents and suicidality, a CSF orexin level was drawn using a 24G spinal needle drawing 15cc of CSF. The patient also described severe headaches lasting for a week following the LP, which improved with a blood patch. CSF Orexin= 281 pg/mL.

Conclusion

Our experience illustrates two important findings about patients with POTS who presented for narcolepsy evaluation: (1) reports of atypical cataplexy may be related to autonomic intolerance compared to cataplexy triggers and is positional in nature, and (2) The prevalence of post-LP headaches in POTS might require prophylactic blood patch and conservative measure to prevent CSF leak/spontaneous intracranial hypotension.

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1143 Nuclear Narcolepsy
Authors: Jordan Melissa , Bliton Kyle , Patterson Patricia , Aulakh Puneet
Published: April 2024

Introduction

The sleep -wake mechanism is a complex network of structures of the brain and numerous neurotransmitters. Notably, the hypothalamus produces a powerful wake promoting peptide, orexin, which lack thereof results in narcolepsy. Moreover, studies have demonstrated that the thalamus,although not fully elucidated, plays a dichotomous role in the sleep -wake cycle. This case highlights an interesting iatrogenic cause of hypersomnia.

Report of case(s)

Patient is a 49 year old male who presents for evaluation of hypersomnia. He had some sleepiness throughout his adult life but worsened significantly in the recent years prior to presentation. His Epworth Sleepiness Scale is 21. No hypnagogic/hypnopompic hallucinations, cataplexy, sleep attacks, sleep paralysis reported. Mild snoring is present. His BMI is 24kg/m2. His PMH is notable for essential tremor treated with stereotactic radiosurgery thalamotomy four years prior to presentation. He underwent polysomnography that was overall unremarkable with no evidence of sleep disordered breathing or periodic limb movements, but the study had sleep onset REM of 13 minutes. The following day, an MSLT was performed and demonstrated sleep latency of 3 minutes and 26 seconds and one sleep onset REM. He was diagnosed with secondary narcolepsy and started on pharmacotherapy with modafinil.

Conclusion

The patient in this case underwent stereotactic radiosurgery to the thalamus for treatment of essential tremor. Given the proximity of the thalamus to the hypothalamus, it is thought that damage to this structure resulted in loss of orexin causing secondary narcolepsy. Furthermore, excessive daytime sleepiness is a consequence of thalamic lesions such as thalamic stroke further demonstrating the role of the thalamus in the sleep -wake mechanism.

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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis. 2021 Apr 1;12(2):570-585. doi: 10.14336/AD.2020.0707. PMID: 33815883; PMCID: PMC7990374. Cheng P, Roehrs T, Roth T. Daytime Sleepiness and Alertness. Principles and Practice of Sleep Medicine. 7th Edition. Elsevier. 2022. Chapter 4, 35-45.e5.
1144 Unique Use of PAP Download Data to Identify Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD) in Sighted Individual
Authors: Usman Abira , Irfan Muna
Published: April 2024

Introduction

N24SWD is a circadian rhythm sleep disorder (CRSD) in which there is misalignment between the 24-hour light dark cycle and the non-entrained endogenous circadian rhythm of sleep wake propensity. We present case of a sighted individual, incidentally noted to have FN24SWD upon review of his PAP download data.

Report of case(s)

A 75-year-old sighted, single male with major depressive disorder (MDD), generalized anxiety disorder (GAD), obstructive sleep apnea (OSA), restless leg syndrome (RLS), insomnia and hypertension presented to sleep clinic. Patient after retirement spent most of his time working on small engineering projects and programming. He reported regular use of PAP with average daily use of 7 hours and 11 minutes. PAP data review revealed well controlled OSA with residual apnea-hypopnea index of 3.1/ hour. His time in bed delayed approximately 1 to 2 hours each night and would cycle around every 20 days with 1 to 2 days in a month without any sleep. His Epworth Sleepiness Scale score was 3/24. Medications included gabapentin and ropinirole for RLS, trazodone, melatonin for insomnia, buspirone, citalopram. Based on the patient’s history, corroborated by PAP device data, diagnosis of behaviorally induced Non24SWD was made. Patient reported intermittent insomnia managed by above stated medications and thus reported no impact on his social life. Thus, he deferred treatment to entrain the rhythm.

Conclusion

Treatment for CSRDs comprises of melatonin in sighted individuals and melatonin receptor agonists in blind. In our patient, melatonin was used ad lib as a sleep promoting agent. Lack of regular daytime bright light exposure and light exposure from screens at night contributed to lack of entrainment . It is usually noted in blind individuals due to lack of photic input to circadian pacemaker. In sighted individuals, delayed sleep phase, decrease light exposure, psychiatric disorders, TBI or dementia is noted. In our case anxiety and depression were noted. This case highlights the unexpected discovery of Non 24SWD on detailed review of PAP download data in case of good PAP adherence, essentially replacing actigraphy. Thus, in CPAP compliant patient, detailed PAP review can help identify circadian disorders especially where actigraphy may be difficult to obtain.

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1145 Stride Along with Stridor in the Setting of CSA: An Unusual Presentation of Pediatric Cervicomedullary Ganglioma
Authors: Wasim Alina , Musso Mary , Petitto Lacie , Revana Amee
Published: April 2024

Introduction

We describe an unusual presentation of a cervicomedullary ganglioglioma secondary to findings of stridor despite positive airway pressure (PAP) therapy and the presence of treatment emergent central sleep apnea in a pediatric patient.

Report of case(s)

Patient is an 8 year old male with a history of congenital subglottic stenosis and no history of neurologic problems who presented to the sleep clinic for stridor despite adequate adherence to CPAP. Split night polysomnogram (PSG) showed moderate OSA (OHI 8.3/h) and treatment emergent central sleep apnea. Patient was unable to tolerate BPAP ST and wanted to go back to CPAP. Drug induced sleep endoscopy findings were significant for mild collapse of upper airway with no snoring. Repeat PSG - 6 months later - was significant for severe obstructive and central sleep apnea (OAHI 10.4, CAI 19, REM CAI 54, AHI of 30). MRI of the brain showed cervicomedullary tumor with marked effacement of the foramen magnum. Further workup showed right vocal cord paralysis. Biopsy confirmed ganglioglioma. Tumor was not amenable for surgical resection hence proton radiation therapy was pursued. Repeat titration study was performed which showed BPAP ST settings of 12/6 with BUR of 12 to be effective with residual AHI of 0.7. Patient developed radiation induced tumor psuedoprogression and tumor necrosis with worsening ataxia and recurrence of central and mixed apneas requiring AVAPS for further respiratory support due to progressive neuromuscular weakness. Stridor resolved after AVAPS support.

Conclusion

Stidor in a pediatric patient can involve various anatomical abnormalities of the upper airway. However, in the setting of central sleep apnea, abnormalities of the brain stem can lead to stridor. We present a patient with a prolonged period of central sleep apnea of unknown etiology and persistent stridor despite adequate adherence to PAP therapy that ultimately led to a diagnosis of a cervicomedullary ganglioma before neurologic symptoms developed.

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1146 Polysomnographic Description of Hemifacial Spasm
Authors: Aristy Catherine Fernandez , Greenough Glen
Published: April 2024

Introduction

Hemifacial spasm is characterized by sudden, involuntary, irregular, tonic or clonic motor discharge of the facial nerve (seventh cranial nerve), leading to muscular contraction. Its etiology may be idiopathic or secondary to an irritation of the facial nerve. Possible sources of irritation include vascular malformations, infections, trauma, and tumors. Hemifacial spasms may be a temporary or a permanent sequela from Bell’s palsy. This disorder typically presents unilaterally, although it may be seen bilaterally in about 5% of the cases. This condition affects women more often than men in a 2:1 ratio. To this day, there is minimal information describing hemifacial spasms during sleep using a polysomnogram (Incirli et al. 2019, Montagna et al. 1986 article). The previous studies documented the persistence of hemifacial spasms in sleep but did not offer illustrative polysomnographic images. In this case report, we illustrate the polysomnographic characteristics of hemifacial spasms in order to improve a sleep medicine provider’s ability to identify and recognize these events.

Report of case(s)

We are able to provide polysomnographic images demonstrating both sustained and intermittent paroxysmal left-sided facial muscle activity in the left mastoid, left EOG, as well as left central and left frontal EEG leads. The occipital EEG leads bilaterally did not demonstrate this finding. Chin EMG also revealed this activity. The muscle activity was most notable during wake but persisted during both NREM and REM sleep (Images will be provided in the poster).

Conclusion

We were able to document paroxysmal left-sided facial muscle activity during wake and sleep in a patient who carries a diagnosis of left hemifacial spasm. This description can be used as a visual reference for sleep medicine providers when encountering this unusual polysomnographic appearance.

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1148 Narcolepsy with Cataplexy in a Pediatric Patient with a Thalamic Mass: A Case Report
Authors: Pietrapiana Stefano , Sabogal Carlos
Published: April 2024

Introduction

A female adolescent patient with gradual hypersomnolence.

Report of case(s)

The patient is a 16-year-old with gradual onset of parasomnias, leg cramps, headaches and history of gastroesophageal reflux, and asthma. Her ferritin was low, and a diagnosis of restless legs was made, the patient was started on oral iron supplements without improvement. Intravenous iron replacement therapy was tried with laboratory improvement (>50 ng/ml) but not clinical. Clonazepam and gabapentin were tried without success. Over time, she developed more tiredness and started to fall asleep in class. A sleep study was done which showed primary snoring without evidence of sleep disorder breathing, PLMD index was 4.4, and REM sleep latency was 120 minutes. The headaches got worse, and she was seen by neurology, MRI showed a hyperintense 6mm rounded lesion on the left side of the thalamus. She started pregabalin and remained stable for almost a year. Sleepiness got worse with sleep attacks. She was sleeping 12-14 hours at night with a 1–2-hour nap in the afternoon. A Multiple sleep latency test (MSLT) showed no evidence of sleep-onset rapid eye movement periods (SOREMPs), and the mean sleep latency was 9.6 minutes. She was diagnosed with primary hypersomnolence. Modafinil and methylphenidate were tried for hypersomnolence and added duloxetine for headaches without improvement. A repeated sleep study and MSLT, showed a mean sleep latency of 4.9 minutes without SOREMPs, Epworth Sleepiness Scale (EPS) of 20. Later she started with jerky legs and tripping/falling in gymnastics practice, diagnosis of narcolepsy with cataplexy was made. Sodium oxybate was started with improvement of hypersomnolence (EPS: 8) and cataplexy.

Conclusion

The patient presented with insidious onset of restless legs, migraines, and hypersomnia. In pediatric patients classic narcoleptic symptoms are not always present. Interestingly restless legs and migraines can precede the diagnosis of narcolepsy. Our patient had no SOREMPs on the MSLT on two different occasions but in her last MSLT her mean sleep latency was 4.4 minutes and soon after developed cataplexy. Due to the presence of a thalamic mass, we conclude that this patient has secondary narcolepsy type 1.

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1149 Unravelling the Mysteries of Pediatric Central Sleep Apnea (CSA): A Unique Case Report
Authors: Phanthok Tenzing , Yori Tiffany , Malhotra Sonal
Published: April 2024

Introduction

CSA in pediatric patients is characterized by pauses in breathing during sleep that result from a lack of drive to breathe. It is estimated to be about 10% of all pediatric sleep-disordered breathing cases. The most common type is primary, also known as idiopathic CSA, unrelated to another medical cause. Other causes include, CSA of prematurity, CSA in certain medical conditions such as congenital heart defects or neurological disorders, and CSA related to medications. We report a case of CSA in the setting of an acute neurological impairment secondary to atypical hemolytic uremic syndrome (HUS) in a pediatric patient.

Report of case(s)

A 3-year-old female with chromosome 3p deletion syndrome presents after a recent hospitalization with acute hypoxic respiratory failure status post tracheostomy, for a baseline PSG with capped tracheostomy to evaluate for decannulation. During this hospitalization, the patient developed acute neurological impairment with brain swelling and abnormal signaling in bilateral basal ganglia and thalami, findings consistent with HUS. A baseline PSG (table 1) with capped tracheostomy showed an AHI of 16 events per hour of sleep. She was uncapped per protocol but continued to have worsening AHI of 128 events per hour, predominantly central apneas. An interval brain imaging showed evolving parenchymal injury with encephalomalacia and some resolution of prior swelling, indicating the cause of her CSA to be neurological. She was placed on BIPAP ST with set rate 12, IPAP 10 cm H2O and EPAP 5 cm H2O during sleep. Tracheostomy remained capped during the day but decannulation was deferred due to intolerance of BIPAP via nasal mask on further attempts.

Conclusion

The prognosis for pediatric patients with CSA depends on the underlying cause and how well the patient responds to treatment. Mild CSA may require just observation or medications such as acetazolamide or specific respiratory stimulants to stimulate breathing during sleep. In severe cases, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy may be used to provide mechanical support for breathing during sleep. A multidisciplinary approach involving Pulmonary and Sleep specialists would thus be ideal to manage the complex nature of pediatric CSA.

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0115 How Pre-Sleep Negative Affect and Rumination Impact Sleep Onset
Authors: Strauel Caroline , Krizan Zlatan
Published: April 2024

Introduction

Getting a good night’s sleep is critical to several aspects of daily functioning and health, but many choices may hinder an individual’s onset of sleep. The impact of negative emotion on subsequent sleep has received limited attention and causal claims require strong experimental methodology. One contributor to delayed sleep onset may be rumination, as ruminating individuals’ may negative emotions may persevere longer. The current study aimed to examine the impact of emotions on sleep immediately after experiencing an emotionally disturbing video and the role of individual differences, specifically rumination tendencies.

Methods

Using a within-subjects, at-home design, participants (N=149) encountered two nights of control videos and two nights of emotionally distressing videos immediately before their normal sleep time. Rumination tendencies were measured at baseline using the Rumination-Reflection Questionnaire by Trapnell and Campbell. Mood and negative affect were recorded before and after watching the videos and their subsequent sleep was recorded using actigraphy. Participants self-reported sleep-onset latency (SOL) in minutes.

Results

The manipulation was effective at inducing negative emotions including anger (d = 0.596, p< 0.001), disgust (d = 1.513, p< 0.001), and fear (d = 1.058, p< 0.001). A paired samples t-test showed no meaningful differences on self-reported SOL between control and experimental nights (p=.596). While control nights did have a slightly higher average SOL than experimental, the averages differed by 1.1 minutes. Preliminary analysis revealed no significant correlations of rumination on experimental or control SOL, with rumination correlated to overall SOL 0.05.

Conclusion

Despite effective induction of pre-sleep negative affect, preliminary analyses showed there were no substantive differences between control and experimental conditions in participants’ self-reported SOL (despite adequate statistical power), although the reports may be inaccurate due to self-report biases. Future analyses of actigraphic data will evaluate more objective aspects of sleep and roles of other individual differences.

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1151 Pharmacological Treatment of Pediatric Insomnia--A Successful Trial of Doxepin
Authors: Tu Xinhang , Matarese Christine , Lloyd Robin , Sorensen Channing , Schmidt Scott , Baughn Julie
Published: April 2024

Introduction

Insomnia is a common sleep disorder in pediatric patients with neurodevelopmental disabilities. There are no FDA approved medications for insomnia in the pediatric population, and treatment can be challenging. We present a case of successful treatment of sleep maintenance insomnia in a 15-year-old male with doxepin with supportive actigraphy data.

Report of case(s)

A 15-year-old male with a past history pertinent for a genetic neurodevelopmental disorder, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) was evaluated in Pediatric Sleep Medicine Clinic for long standing difficulties with sleep maintenance. He experienced frequent, prolonged nocturnal awakenings and early morning awakenings. Previous polysomnogram was negative for sleep disordered breathing. He previously trialed clonidine, guanfacine, trazodone, melatonin, and mirtazapine without significant benefit. Baseline actigraphy demonstrated frequent and prolonged nocturnal awakenings and early morning awakenings. He was initiated on doxepin 3 mg at bedtime, and it was subsequently increased to 6 mg at bedtime. Parental report and repeat actigraphy 4 months later (on doxepin 6 mg) demonstrated improvement in nocturnal awakenings and early morning awakenings.

Conclusion

Up to now, there are no FDA approved medications for the treatment of insomnia in the pediatric population. A prior study of patients with ASD and ADHD demonstrated the use of doxepin provided clinical improvement in sleep onset and maintenance insomnia based on subjective evidence with parental report. In this case, doxepin improved subjective report of insomnia and correlated with objective findings on actigraphy.

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