bluuebunny/crossref_metadata_2025 huggingface dataset:
1097 Education Intervention Improves Sedative Use for Healthy Sleep & Insomnia Management
Authors: Chang Fong-Ching , Wu Ching-Ying , Chen You-An , Hu Youwun , Liu Chun-Lung , Cheng Ning , Hsieh Yow-Wen , Shiue Ya-Ming , Tseng Chi-Ting , Chang Jungchen , Chi Hsueh-Yun
Published: April 2024

Introduction

Individuals with higher self-efficacy in managing their hypnotics and sedatives use are more likely to adhere to prescribed dosages, follow recommended guidelines, and make necessary behavioral changes. Self-efficacy also influences an individual's decision-making regarding their health and treatment regimen. Misuse or improper use of sedatives and hypnotics poses risks such as dependency, adverse effects, and potential addiction. Enhancing patients' self-efficacy in handling their medication intake could potentially mitigate these risks and promote safer usage.

Methods

The study was a single-arm interventional pre-and post-assessment study conducted nationwide in eight counties. The intervention was a well-consensus health education program. A self-report five-item questionnaire with good psychometrics (0.8 expert content validity and 0.9 internal consistency reliability) assessed the self-efficacy of proper use of hypnotics and sedatives.

Results

Eight institutions across different regions recruited 875 participants comprising elderly (n=337, 38.5%), workers from high-risk workplaces (n=415, 47.4%), native aborigines (n=95, 10.9%), youths (n=117, 13.4%) and others. The participants aged 58.3 ± 17.6 years and half were male (n=447, 51.1%). The self-efficacy of using hypnotics and sedatives was significantly improved after the educational interventions (the changed scores 0.16 ± 0.45, p <.001). After the educational intervention, the participants could re-establish their bedtime routine (e.g., a calmy environment, no 3Cs use), express their sleep disturbance to the physician, learn the medications comprehensively, and keep adherent to the treatment regions, etc.

Conclusion

The intervention, which focused on improving the self-efficacy of proper use of hypnotics and sedatives, resulted in a notable enhancement in participants' abilities. A statistically significant improvement was observed in their self-efficacy scores post-intervention, indicating a positive impact of the educational program. Notably, participants exhibited an improved capacity to re-establish healthy bedtime routines. Additionally, they demonstrated better communication with healthcare professionals regarding sleep disturbances, a comprehensive understanding of medications, and increased adherence to prescribed treatment regimens.

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1100 Innovative Skills Based Workshop on Advanced Positive Airway Pressure Devices for Sleep
Authors: Usman Abira , Woo Emily , Khalil Wajahat , Pusalavidyasagar Snigdhasmrithi , Akpa Bimaje , Khan Anees , Satovich Maria , Rana Izaan , Irfan Rayyan , Irfan Muna
Published: April 2024

Introduction

Chronic advanced respiratory assist device (RAD) management for complex sleep related breathing disorders is an overlooked area in sleep and pulmonary medicine education. Robust educational curriculum on practical management of advanced PAP therapies in sleep medicine fellowship programs is lacking. This void led our team to design innovative practical hands-on skills workshop to help facilitate learning.

Methods

Sleep faculty with area of expertise in education, sleep, medicine, and pulmonary fields designed a practical skills workshop titled “NIV skills workshop” consisting of introductory briefing, 3 clinical vignettes and post session debriefing. Cases were developed to highlight strategies on empiric use, PAP mode selection, setting adjustment and troubleshooting for complicated sleep related breathing disorders including neuromuscular disorders and hypoventilation to improve knowledge and comfort with prescription and management of the devices. RPSGTs helped with conduction of workshop with 3 stations, each dedicated to a clinical case with devices available to practice adjustments based on clinical scenarios. The learners rotated through these stations with a faculty moderating each case. Pre and post session surveys were conducted to assess workshop effectiveness in improving participants' level of comfort in modality selection, empiric settings, adjustment, and troubleshooting. Participants responded with numerical values based on Likert scale. A paired t-test was conducted to assess pre and post workshop skills gain. The workshop was conducted for 2 consecutive sleep fellowship batches and thus survey results were obtained from all the leaners(n=6)

Results

Improvement in mean scores was noted in level of confidence in PAP modality selection (3.3 vs. 4, p= 0.05), empiric device settings (2.3 vs. 3.7, p=0.0007), complex PAP therapy adjustment (2.6 vs. 3.7, p=0.006) and dyssynchrony troubleshooting (2 vs. 3.8, p=0.0009). High mean scores of 4.5 and 4.8 (scale of 0-5) were noted for confidence in RAD management skills and impact on clinical practice from workshop.

Conclusion

In addition to conventional didactic teaching on advanced PAP management, a practical hands-on workshop is a highly effective tool to improve trainees’ knowledge and confidence in chronic advanced device management and should be incorporated as integral part of curriculum. Such workshops should be extended to learners across the spectrum of training.

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1101 Long-term Trends in Utilization of Sleep Diagnostic Tests Among Medicare Beneficiaries
Authors: Braun Marcel , Coughlin Steven , Schneider Hartmut
Published: April 2024

Introduction

Evidence underlines the association between disordered sleep and adverse health outcomes such as, hypertension, cardiovascular and cerebrovascular disease, and metabolic disorders. A variety of sleep test modalities are available, ranging from ambulatory single-channel sleep tests to in-lab technician-supervised polysomnography (PSG). These tests are selected by the clinician based on the patients overall health profile, which sleep disorders are being investigated, and which tests are covered by insurance providers. The aim of this research was to evaluate trends in utilization of different sleep diagnostic tests among Medicare beneficiaries.

Methods

A retrospective analysis of sleep test utilization was conducted using a public data set curated by the Center of Medicare and Medicaid Services. Available data included information on services, categorized by HCPCS or CPT code, submitted and paid charges, beneficiary demographics and health characteristics for the years 2011 to 2021.

Results

From 2011 to 2021, sleep service utilization among Medicare beneficiaries decreased from 803,280 to 694,375 with a peak of 963,780 procedures in 2018 (-13.6%; Compound Annual Growth Rate (CAGR) = -1.4%). Despite a slight decline in overall sleep studies, unattended type 3 studies / Home Sleep Apnea Tests (HSAT) grew by 632.6% (CAGR = 22.0%), and replaced attended sleep studies as the main diagnostic test for sleep disorders. Attended sleep studies and split-night study utilization almost halved over the period analyzed (-44.9% and -45.6%, CAGR = -5.8% and -5.9%), while the share of unattended studies / HSAT grew from 4.7% in 2011 to 34.5% in 2021. When excluding the pandemic years 2020 and 2021, overall sleep study utilization grew by 18.0%. This development was entirely driven by increased use of unattended type 3 studies / HSAT (+616.5%; CAGR 25.2%), while attended sleep studies and split-night studies decreased by -15.5 and -7.3% respectively (CAGR -2.4% and -1.7%).

Conclusion

Utilization of sleep diagnostic tests among Medicare beneficiaries underwent significant changes since 2011, with a large shift occurring from in-lab sleep studies to simpler unattended at-home tests. While attended sleep studies, such as in-lab PSG, split-night titrations and vigilance tests were already declining before the pandemic, this event accelerated the transition towards at-home diagnostic testing.

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1102 Museum-Based Sleep Education: Development and Evaluation of Pop-Up Exhibits for Children and Families
Authors: LeBlanc Claire , Cruz Andri , Scullin Michael
Published: April 2024

Introduction

Museums are highly credible communal spaces where people can come together to learn. This immersive environment offers opportunities to engage briefly but meaningfully with the public about sleep health. We developed interactive pop-up exhibits with activities that introduced children to sleep science and encouraged families to change sleep behaviors. We evaluated their efficacy via observational data and visitor survey responses.

Methods

We held 11 pop-up exhibits in a medium-sized children’s museum from June to December 2023. Each exhibit lasted two hours and was designed to communicate three learning objectives: sleep is good, the sleeping brain is active, and changing nighttime behaviors can improve sleep. Pop-up exhibits included professional signage; take home sleep tips and stickers; videos to display sleep laboratory activities and interesting sleep facts; magnetic “electrodes” and a 3D-printed brain for learning about polysomnography; brain maze coloring sheets, and an inflatable dinosaur fitted to a CPAP mask (REM-ee the dino-snore-us). Each exhibit was staffed by 3-4 trainees (undergraduate to post-doctoral level) and observational data were collected by museum staff. Post-visit survey data in adults assessed participant demographics, meeting of learning outcomes, interest in recommending the exhibit to a friend, prioritization of sleep (0 to 100 scale), and changes in one’s perception of what a scientist looks like.

Results

1,336 people visited the sleep exhibits (32% of total museum visitors). Adult visitors (18+) were invited to complete a post-visit survey (N=102; M=37.25 years; 63.7% female; 37.25% non-white). Survey responses indicated that most learning objectives were met (89.2%), that most visitors would recommend the exhibit to a friend (91.2%), that visitors’ prioritization of sleep changed from 67.9% before the exhibit to 87.5% after the exhibit (p<.001), and that many visitors intended to change their sleep habits (73.5%). More than half of visitors (62.2%) reported that their perception of a scientist had changed (e.g., demographically diverse, friendlier).

Conclusion

Pop-up museum exhibits are a feasible and effective method for communicating sleep information in local communities. Additional work is needed to determine whether permanent installations of sleep exhibits retain their efficacy when sleep experts are not actively staffing the exhibit.

Support (if any)

National Science Foundation (1920730 and 1943323).
1104 Personalisation of Breathing Comfort for CPAP Users Through a Machine-Learning Algorithm
Authors: Pongrass Sarah , Liu Nathan , Nguyen Chinh , Tran Vinh , Emami Hussein , Armistead Jeff , Wimms Alison
Published: April 2024

Introduction

Many factors impact CPAP adherence, some common issues include trouble falling asleep, difficulty breathing against pressure, and being disturbed by high pressures. Various settings to address breathing comfort have been developed, such as ramp time, reducing pressure during exhalation, and APAP response rate, though evidence of their impact is minimal. We sought to develop a machine-learning model to recommend personalised combinations of comfort settings at setup with the goal of improving CPAP adherence in patients newly starting CPAP therapy.

Methods

Data sets from 718,421 anonymous OSA patients (myAir, ResMed) were used to create the machine-learning model (MLM). The model was developed using a causal inference approach to control for bias from observational data and utilised features such as age, sex, diagnostic AHI, mask type and start pressure to predict optimal comfort settings for various patient types. These comfort settings can then be applied on an individual level. A proof-of-concept, double-blinded, randomised controlled study was conducted with people newly diagnosed with OSA (AHI≥5) and indicated for CPAP therapy attending a sleep clinic. The primary outcome was treatment continuance after 30 days comparing those set up on MLM vs default comfort settings (control).

Results

58 patients (26% female, mean age 49.9±14.9, 46.6% non-white, mean diagnostic AHI 43.6±30.4) were included in the study analysis. At 30 days the MLM group had greater treatment continuance vs control (96% vs 80%) though not statistically significant. All other endpoints were also not statistically significant. 54% of MLM group had zero setting changes vs 37% control. In this subgroup, MLM showed increased average daily usage (+46.9min), number of days used (+2.9days), and number reaching CMS compliance (+11%), however these endpoints did not reach statistical significance.

Conclusion

This program developed a machine-learning model to predict optimal comfort setting combinations for individual CPAP patients to improve CPAP adherence. The proof-of-concept study did not reveal any harm to patients assigned personalised settings and showed some trends towards positive outcomes. Personalising comfort settings may benefit new CPAP patients, however a larger study is required to fully validate the machine-learning model.

Support (if any)

Funded by ResMed
1113 A Personalized Smartphone App Improves Sleep and Stress in Poor Sleepers: A Randomized Wait-List Controlled Trial
Authors: Gottlieb Elie , Gahan Luke , Munt Oliver , Fischer Susanne , Schredl Michael , Christoph Schoebel
Published: April 2024

Introduction

Smartphone applications (Apps) offer a highly scalable, engaging, and cost-effective approach to improving sleep-promoting behaviors and attitudes. In this randomized wait-list controlled trial, we evaluated the efficacy of a novel smartphone app, the Dein Schlaf Dein Tag app from SleepScore Labs, designed to objectively measure sleep via PSG-validated sonar methods and improve sleep by providing personalized, dynamic, and evidenced-based sleep and circadian advice and education founded in the principles of sleep hygiene and cognitive-behavioral skills.

Methods

A preliminary analysis of 412 participants with subclinical poor sleep (Regensburg Insomnia Scale score 13-24) randomized to either an App/intervention group (n=128) or a waitlist control group (n=298) was conducted. Changes in subjective sleep quality, perceived stress, and quality of life were measured using validated questionnaires at baseline, 6-weeks, and 12-week time-points. Statistical significance was tested via the interaction of an ANOVA (factor 1: app group vs. waitlist control; factor 2: baseline vs. 6 and 12 weeks).

Results

At both 6 and 12-week follow-up assessments, perceived sleep quality as measured by the sleep quality component of the Schlaffragebogen-B (SF-B) significantly improved among the App/intervention group when compared with controls (12-week effect size 0.646 App vs. 0.250 control group, F: 11.7, p=0.0007). Overall sleep problems as measured by the PSQI also significantly improved at 6 and 12-weeks among the App group when compared with controls (12-week effect size -0.448 app vs. -0.172 control, F: 7.5, p=0.0065). Feelings of being refreshed after sleep significantly improved among the App/intervention group after both 6 and 12-week assessments as measured by the GES component of the SF-B (12-week effect size 0.429 app vs. 0.143 control, F: 5.4, p=0.002). At 12-weeks, perceived stress significantly improved among the App/intervention group as measured using the Perceived Stress Scale (12-week effect size -0.526 app vs. -0.235 control, F: 4.1, p=0.0436), but not at 6-weeks (p=0.08). No significant differences in quality of life as measured using the SF-12 were observed between groups.

Conclusion

This randomized controlled trial demonstrated that a personalized and dynamic sleep improvement and measurement App can improve perceived sleep and stress in individuals with poor sleep.

Support (if any)

SleepScore Labs and ResMed Science Center
1114 Evidence for Deep Sleep Homeostasis in Real World Sleep Tracking Data
Authors: Goparaju Balaji , Bianchi Matt
Published: April 2024

Introduction

Investigations of sleep homeostasis often involve tightly controlled experimental sleep deprivation in service of understanding mechanistic physiology. The extent to which the deep sleep response to recent sleep loss occurs in naturalistic settings remains under-studied. We tested the hypothesis that a homeostatic increase in deep sleep occurs on the first recovery night following occasional short duration nights that arise in naturalistic settings.

Methods

We analyzed sleep staging data in participants who provided informed consent to participate in the Apple Heart and Movement Study and elected to contribute sleep data. The analysis group included n=33,358 participants with at least 30 nights of sleep staging data from Apple Watch.

Results

Short nights of sleep that were >=2 hours shorter than each participant’s median sleep duration occurred at least once in 65.1% of the cohort, most often in isolation (< 5% of instances were consecutive short nights). Assessing the amount of deep sleep on the recovery night revealed that deep sleep increased in proportion to the amount of sleep loss on the preceding short night, for short night definitions ranging from 30 minutes to >3 hours below the within-participant median sleep duration. Focusing on short nights that were at least 2 hours below median, we found that 64.9% of participants showed any increase in deep sleep on the recovery nights, with a median increase of 23.9% (absolute increase: median 11 minutes, interquartile range 5 to 19). Among participants with at least three short nights at any time in a 6-month window (28.6%), the percentage of recovery nights having >=5 minutes extra deep sleep showed small but significant Spearman correlations with two measures of sleep consistency, the standard deviation of sleep duration (r = -0.16), and the standard deviation of sleep start time (r = -0.12).

Conclusion

The results provide evidence for homeostatic responses in a naturalistic setting. Although the deep sleep recovery amounts are modest, naturalistic short nights are a lesser perturbation compared to experimental conditions of greater restriction or total deprivation. The findings illustrate the utility of longitudinal sleep tracking to assess real-world correlates of sleep phenomenology established in controlled experimental settings.

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n/a
1116 Naturalistic Sleep Tracking in a Longitudinal Cohort: How Long Is Long Enough?
Authors: Goparaju Balaji , DePalma Glen , Bianchi Matt
Published: April 2024

Introduction

Objective sleep tracking in health research, often via polysomnography or actigraphy, typically involves a small number of nights per person. Given the nightly variability of sleep duration, it remains unclear the extent to which relatively short observation windows may impact inferences in sleep research.

Methods

We attempt to quantify potential limitations of shorter duration sleep tracking research by sub-sampling from longer-term observation windows using both simulated data from known distributions and real-world Apple Watch sleep tracking data (30-365 nights) from over 35 thousand participants who provided informed consent to participate in the Apple Heart and Movement Study and elected to contribute sleep data to the study.

Results

Simulations demonstrate that the magnitude of deviation from truth defined using all available observations per individual, and the direction of bias depended on the sub-sample size, the type of simulated distribution (gaussian vs skewed), and the summary statistics of interest, such as centrality (mean, median) and dispersion (standard deviation (SD), interquartile range (IQR)). For example, n=7 longitdunal observations from a realistic normal distribution (7 + 1 hours) showed a 6.7% median under-estimation bias (IQR 24% under- to 14.7% over-estimation) compared to the true SD value (1 hour). Real-world sleep duration and sleep stage data, when under-sampled and compared to longer observations within-participant, showed similar SD bias at 7 nights, and similar convergence rates approaching the true value as longitdunal samples increase from 7 to 30 or more nights. Shapiro-Wilk tests for normality and log-normality show that 64% of simulated log-normal (skew) distributions fail to reject normality at n=7 samples, while real-world sleep duration data most commonly failed both normality and log-normality tests even using larger samples (180 nights per participant). Finally, simulating cohorts with 7 + 1 hours plus a subset of 6 + 1 hours shows that a single-night observation of “short sleep” (6 hours) is more likely from random variation of a 7-hour sleeper than from a 6-hour sleeper. Extending the observation to n=7 nights mitigates this mis-classification risk.

Conclusion

The results suggest that longer duration tracking provides important benefits to reduce bias and uncertainty in sleep health research that historically relies on small observation windows.

Support (if any)

n/a
1118 Smart Goggles Used Before Bed to Induce Relaxation Improve Objective Sleep and Reduce Self-Reported Stress
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Carmon Kiara , Mertz Catalina , Ledesma Duvia Lara
Published: April 2024

Introduction

Previous research has shown that gentle, rhythmic vibrations can help induce relaxation and support sleep. This study examined the effects of smart goggles used before bed to deliver gentle vibration and heat to the eyes and temples. Objective sleep, perceived sleep, and self-reported stress, anxiety, and relaxation were measured.

Methods

Healthy adults (40% female; ages 26-75, mean=50) participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants tracked their sleep at home. During the 3-week intervention period, participants used Therabody SmartGoggles before bed. The goggles deliver gentle eye and temple massage through vibrating motors and heat for relaxation. Sleep was measured objectively using a PSG-validated non-contact biomotion device, SleepScore Max, every night and by daily, nightly, and pre-post self-report. Relaxation, stress, and anxiety were measured using visual analog scales. Anxiety also was measured with a validated short form of the State-Trait Anxiety Inventory. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were over 676 nights of tracked sleep across 20 participants. Objective sleep measurements showed multiple improvements: increased sleep duration (+12 minutes, p=.014); increased deep sleep, in duration (+6 minutes, p=.002), proportion of the night (7% relative increase, p=.020), and BodyScore (4% increase, p=.002); fewer awakenings (7% decrease, p=.021) and decreased wake after sleep onset (-6 minutes, p=.047); and improved SleepScore, a measure of overall sleep quality (3% increase, p=.020). Immediately after using the goggles each night, compared to immediately before using the goggles, participants felt sleepier, less stressed, less anxious, and more relaxed (all ps<.05). At the end of the 3-week intervention period, compared to baseline, participants felt they had better sleep quality; felt more well-rested in the mornings; and showed reduced anxiety, confirming the nightly analysis (all ps<.05).

Conclusion

Objectively measured sleep quality and duration, as well as perceived sleep, improved when using the goggles before bed compared to baseline. Users also experienced increased feelings of relaxation along with reduced stress and anxiety.

Support (if any)

Therabody
0112 Ethnoracial Differences in the Association Between Witnessing Violence and Sleep Duration Among Young Adults
Authors: Dadzie Adwoa , Master Lindsay , Reichenberger David , Collie Angel , Mathew Gina , Hale Lauren , Chang Anne-Marie , Buxton Orfeu
Published: April 2024

Introduction

Experiences of interpersonal violence negatively influence sleep and health. Prior research has also shown that being aware of interpersonal violence experienced by friends and family is associated with short sleep duration. We seek to understand whether sleep is disrupted by witnessing or experiencing physical violence.

Methods

Data were from the age 22 wave of the Future of Families and Child Wellbeing Study (N=444). Young adults wore a wrist actigraphy device for 14 days and self-reported their experiences with physical violence over the prior year. Witnessing and experiencing violence were classified in four ways: witnessing/experiencing violence by someone not close and witnessing/ experiencing violence by someone close. Separate linear regression models assessed the cross-sectional associations of experiences of violence with nighttime total sleep time (TST), adjusting for race/ethnicity, gender, and educational level. Secondary analyses assessed race/ethnicity as a moderator of violence on night sleep duration.

Results

33% of young adults witnessed violence perpetrated by someone not close to them, 13% experienced violence by someone not close to them, 16% witnessed violence by someone close to them, and 8% experienced violence by someone close to them. There were no significant main effects of any type of violence on TST. There were interaction effects of witnessing violence (not close AND close) and race on mean TST. Post-hoc tests on witnessing violence by someone not close revealed White young adults had lower TST (42 minutes, p< 0.009) compared to White young adults who had not witnessed violence by someone not close to them. In addition, post hoc tests on witnessing violence by someone close revealed Black young adults had higher TST (20 minutes, p< 0.046) compared to Black young adults who had not witnessed violence by someone close to them, whereas White young adults had lower TST (43 minutes, p=< 0.037) compared to White young adults who had not witnessed violence by someone close to them.

Conclusion

We observed ethnoracial differences in associations between witnessing physical violence and sleep. More research is needed to further explain these interactions.

Support (if any)

R25-HL147668, R01HD073352, R01HD36916, R01HD39135, R01HD40421.
1128 Use of a Recliner Designed for Sleep Improves Perceived Sleep Outcomes
Authors: Ledesma Duvia Lara , Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Carmon Kiara , Mertz Catalina
Published: April 2024

Introduction

The positional adjustment of the sleep surface, such as inclining the upper body and/or legs, can potentially contribute to better sleep and alleviation of discomfort associated with a variety of physical problems. This study compared sleep on a recliner designed for sleep to participants’ prior sleep on their original sleeping surface.

Methods

Adults (78% female, ages 29-73, mean age=47) who reported already sleeping at least part of the night on a recliner, chair, or sofa, participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants slept at home in their usual environment. During the 3-week intervention period, they slept on the Zecliner at home. This recliner enables users to tailor the sleep surface to their preferences by adjusting the position of the upper body and legs. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were 708 nights of data across 23 participants. While objectively measured sleep did not improve, pre-post analyses revealed increases in self-reported sleep quality (+121%) and feeling well rested in the morning (+119%) compared to baseline (all ps<.001). Satisfaction with sleep and feeling well-rested in the morning increased from 1 to 4 days per week on average (all ps<.001). Also, increases in ratings of comfort (+107%), pressure relief (+240%), sense of weightlessness (+327%), and feeling cool (+180%) were observed compared to baseline (all ps<.001).

Conclusion

Perceived sleep quality at night and feeling well-rested in the morning improved when sleeping on the recliner compared to baseline, likely because the intervention was perceived as more comfortable. Findings highlight the importance of adjustable sleep surfaces in promoting satisfaction with sleep.

Support (if any)

Flexsteel
1129 Effects of a Mattress Protector Designed to Help Sleepers Feel Cool
Authors: Ledesma Duvia Lara , Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Upadhyaya Devanshi , Carmon Kiara
Published: April 2024

Introduction

Previous research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, temperature regulation plays an important role in sleep quality. This study compared sleep on a mattress protector designed to help keep the sleeper cool to participants’ prior sleep on their original bedding.

Methods

Healthy adults (69% female, ages 21-76; mean age=44) who reported sleeping hot or night sweats, as well as difficulties with frequent awakenings or time spent awake during the night, participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants used their regular bedding at home. During the 3-week intervention period, they used Sleepy’s Cooling Knit Protector. This mattress protector includes breathable materials designed to draw heat away from the body. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were 973 nights of tracked sleep across 33 participants. Objective sleep measurements showed decreased sleep onset latency (-7 minutes, p=.010) when using the mattress protector compared to baseline. Self-report measures revealed that participants felt cooler and more comfortable, perceived a reduction in sleeping too hot or experiencing night sweats, felt they had better overall sleep quality, and felt more well-rested in the morning (all ps<.05).

Conclusion

Objectively measured sleep onset latency and many aspects of self-reported sleep improved when using the cooling knit protector compared to the original bedding, suggesting that a comfortable and cool sleep surface can lead to improvements in sleep.

Support (if any)

Mattress Firm INC
1130 Use of a Mattress Designed to Help Sleepers Feel Cool Improves Objective and Perceived Sleep Quality
Authors: Weaver Morgan , Danoff-Burg Sharon , Rus Holly , Carmon Kiara , Mertz Catalina , Ledesma Duvia Lara
Published: April 2024

Introduction

Previous research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, temperature regulation plays an important role in sleep quality. This study compared sleep on a mattress designed to help the sleeper feel cool to participants’ prior sleep on their original mattress.

Methods

Healthy adults (72% female; ages 24-73, mean age=42) who reported sleeping hot or night sweats, as well as difficulties with frequent awakenings or time spent awake at night, participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, participants slept on a TEMPUR-LuxeBreeze Medium Hybrid mattress. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were 1,331 nights of tracked sleep across 32 participants. Compared to baseline, objective sleep measurements showed increased time spent in bed (+8 minutes, p=.029) and improved SleepScore, an overall sleep quality metric (+1%, p=.044). Self-report measures revealed improvements in perceived coolness, comfort, support, pressure relief, sleep quality, amount of tossing and turning, satisfaction with sleep, and feeling well-rested in the morning (all ps<.001).

Conclusion

Participants reported a more comfortable sleep, in numerous ways, when using the mattress being tested compared to baseline. In turn, they spent more time in bed, and objective measurements showed improved sleep quality.

Support (if any)

Mattress Firm INC.
1133 IoT and Sleep Health Dynamics: Evaluating Policy Impacts in the COVID-19 Era
Authors: Kaur Jasleen , Oetomo Arlene , Chauhan Vivek , Morita Plinio
Published: April 2024

Introduction

The political determination to prioritize public health can significantly influence disease outcomes. In the United States of America, the partisan divide has notably affected the enactment and adherence to public health policies, particularly during the COVID-19 pandemic. This study examines the impact of politically driven public health initiatives on sleep duration in the US population during the COVID-19 pandemic. Leveraging zero-effort technology and IoT device data, the research identifies variations in sleep patterns associated with political climates, providing the intricate relationship between politics and health outcomes during a global health crisis.

Methods

Data from 4,405 households in politically distinct cities within California and Texas are sourced from the ecobee ‘Donate Your Data’ (DYD) initiative. The dataset was preprocessed for clarity and consistency and stratified into two periods: pre-pandemic (March 2019 to February 2020) and during the pandemic (March 2020 to February 2021). Sleep duration is quantified using motion sensor inactivity as an indicator of rest periods. A Gaussian mixture model is used to identify the sleep cycle clusters, and inferential statistical methods are applied to evaluate the impact of public health policies on sleep duration across different political affiliations.

Results

A significant decrease in average sleep duration was observed post-pandemic onset, from 8.0±3.71 hours to 7.75±3.87 hours. Different sleep patterns were observed between political affiliations, with Democratic regions showing a consistent decline in sleep duration while Republican regions experienced varied changes.

Conclusion

This study highlights how political leanings and consequent health policies significantly impacted sleep health during the COVID-19 pandemic. The integration of IoT data and advanced analytics offers a novel approach to continuously monitor and enhance population health behaviours. The methodologies applied in this approach could inform public health strategies in future emergencies, with political leanings considered as a key factor in sleep health. The findings set a framework for future studies to explore the relationship between political climates and sleep health and to develop demographic- and politics-sensitive predictive tools for sleep health risks. This research supports more robust public health systems capable of sustaining sleep health despite political and societal shifts.

Support (if any)
0114 “My Mother Doesn't Sleep When It Rains at Night”: Assessing the Impacts of a Climate-Related Flood on Sleep
Authors: Moloney Mairead , Quinkert Ellie , PhD Caitlyn Hood , PhD Christal Badour
Published: April 2024

Introduction

Climate change and climate-sensitive disasters pose a serious threat to sleep health. Populations with pre-existing sleep and health disparities are particularly vulnerable to disaster related stress. In 2022 Eastern Kentucky, home to some of the nation’s largest “hotspots” of insufficient sleep, experienced thunderstorms resulting in 14-16 inches of rain. Subsequent catastrophic flooding and landslides claimed more than 40 lives and left thousands homeless. The present study used mixed methods to investigate the impacts of this flood disaster on the sleep and health of flood survivors.

Methods

We collected two waves of qualitative and quantitative data from 25 participants (18+) living in five flood-impacted counties in Eastern KY. Data were collected at 9- and 15-months post-flood. Semi-structured qualitative interviews at both waves explored perceived flood impacts on sleep and health. Quantitative surveys assessed sleep, stress, trauma symptoms, and other health outcomes via well-validated scales. Interviews were professionally transcribed and coded using an inductive process and NVIVO software. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI).

Results

At 9 months post-flood 77% of participants’ ISI scores were ◻15 suggesting clinically significant insomnia. Fifteen months post-flood, 68% of participants reported ISI scores ◻15. Most (72%) participants reported that the flood event and its aftermath directly impacted their sleep. Sixty-one percent reported delays in falling asleep and increased nighttime awakening; 22% woke up too early. Over half (56%) had racing or recurring thoughts related to the flood and 44% had nightmares. In interviews participants specifically linked increased anxiety to their difficulties with sleep. Many said that the sound of rain triggered an inability to fall or stay asleep in themselves or a family member. Changes in sleep environment also disrupted sleep; issues included destroyed or damaged housing, temporary housing, and mold problems.

Conclusion

Flood survivors in Eastern KY, a region already rife with sleep and health disparities, reported disturbed sleep at 9- and 15-months post flood. The sound of rain and/or changes in sleep environment impacted survivors’ sleep long after the flood event. As climate-sensitive disasters increase, sleep health in vulnerable populations must remain a focus of research and intervention.

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R01MD016236, UL1TR001998 and ES026529
1153 Many Reasons for Restless Legs, Not to Rest
Authors: Adesina Joyce , Patel Abha , Khan Safia
Published: April 2024

Introduction

Restless leg syndrome (RLS) involves an urge to move the legs that is exacerbated by rest, relieved by movement, and most prominent in the evening. While RLS is commonly associated with low ferritin, here we present a complex case in a patient requiring phlebotomy for symptom control related to elevated ferritin levels.

Report of case(s)

A 52 year-old male presented with uncontrolled RLS diagnosed 12 years prior. Sleep history included obstructive sleep apnea (OSA) on CPAP and hypersomnolence. Diagnostic polysomnogram was notable for an AHI 36.4 events/hr with associated hypoxia. Ferritin was 374ng/mL. He presented to our clinic on melatonin and wearing socks with bars of soap atop his feet. On exam, he was obese and plethoric with significant hypersomnolence despite excellent CPAP compliance. He was previously treated unsuccessfully with a combination of phenobarbital, trazodone, and ropinirole, which exacerbated his hypersomnia. He drank 4-5 liters (L) of soda daily. In the 5 years after initial presentation, he went through periods of total cessation to drinking up to 12L a day. He eventually developed uncontrolled diabetes, hypertension, hyperlipidemia, and NASH with advanced fibrosis. He was referred to Hematology and underwent therapeutic phlebotomy every 2-4 months. He was found to have HFE-C282Y Heterozygous mutation and NASH fibrosis without iron overload on MRI. His RLS was eventually controlled with a combination of pramipexole 1.5 mg, gabapentin 1800 mg, alprazolam 0.5 mg along with therapeutic phlebotomy to maintain a ferritin level less than 250 ng/mL. His hypersomnia was managed with amphetamine-dextroamphetamine.

Conclusion

RLS has been associated with high serum ferritin, iron, and saturation transferrin index levels with a low transferrin level due to impaired mobilization of stored iron. Iron deposits can be seen on MRI in the globus pallidus, dentate, red nuclei and substantia nigra. In this patient, soda cessation would help improve his diabetes, thereby decreasing chronic inflammation and lowering ferritin levels. Chronic liver disease, HFE C282Y mutations, and hypoxia from OSA can also contribute to increased ferritin levels. Abstaining from caffeine can likewise improve symptoms of RLS as caffeine is known to heighten proprioceptive awareness and increase neuromuscular reactivity which may include myoclonus.

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1158 Sleep Disorders in a Female with Hypermobility Spectrum Disorder Inclusive of Hypermobile Ehlers Danlos Syndrome
Authors: Damia Carla , Koothirezhi Rupa , Bhamrah Paul , Hall Catherine , Monceaux Brittany , Liendo Cesar , Ho Minh Tam , Ghildiyal Naomi , Chernyshev Oleg
Published: April 2024

Introduction

Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are conditions characterized by joint hypermobility and musculoskeletal complications including pain, atraumatic joint dislocations and joint instability. They are often associated with other comorbidities including but not limited to dysautonomia, GI disturbances, anxiety, depression, sleep disorders and chronic fatigue. There are no known genetic markers for HSD/hEDS, they are clinical diagnoses. The nomenclature for these conditions has evolved recently and there are ongoing discussions regarding the best way to characterize these populations. Data on the prevalence of HSD and hEDS are still limited. We are reporting a case describing multiple, long-standing sleep concerns in a young woman with recent evaluation by a geneticist.

Report of case(s)

Patient is a 25-year-old Caucasian female with initial past medical history notable for anxiety, depression, asthma, irritable bowel syndrome, POTS, scoliosis and vasovagal syncope. On presentation at age 24, the patient reported a family history of hEDS in an aunt and reported multiple family members with joint hypermobility. She had not seen a geneticist for evaluation but reported symptoms concerning for HSD/hEDS. Patient presented to clinic with multiple sleep concerns including sleep paralysis that had started in childhood, sleep-related hallucinations, snoring, witnessed apneas, unrefreshing sleep, fatigue and crawling sensations in legs that improved with movement. Patient had a home sleep study and was diagnosed with mild obstructive sleep apnea. Patient was initiated on PAP therapy but did not tolerate the mask. She reported some benefit to sleep concerns when she was able to utilize therapy. Lab work showed low ferritin. Patient has not been initiated on iron therapy yet. Patient established care with a geneticist and was informed that her past medical history, symptoms and exam were consistent with HSD inclusive of hEDS.

Conclusion

This case focuses on sleep disorders and sleep concerns in a patient with a clinical diagnosis of HSD/hEDS. Diagnosis of these hypermobility joint disorders is evolving and with that sleep disorders in these patients are becoming better characterized. Management of HSD/hEDS is symptomatic at this time and patients would benefit from thorough evaluation so as to improve their sleep and overall quality of life.

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0116 Multidimensional Perfectionism and Sleep: The Role of Self-Compassion
Authors: Assar Arash , Diaz Anjolii , Lee Tayla , Fletcher Kathryn
Published: April 2024

Introduction

Prior studies have indicated that perfectionistic behavior among college students is linked to sleep difficulties. However, there is currently limited research on conditions and protective factors that might help elucidate this association. The current study examined whether self-compassion moderated the association between the two higher-order dimensions of perfectionism and sleep difficulties in a sample of college students.

Methods

A total of 178 college students (M = 19.88, SD = 1.50) completed self-report measures assessing perfectionism, self-compassion (Self-Compassion Scale), and sleep (Pittsburgh Sleep Quality Index). This study took a multi-measure approach to capture the two higher-order dimensions of perfectionism – perfectionistic strivings (PS) and perfectionistic concerns (PC). Specifically, subscales from the three most common measures of multidimensional perfectionism (Frost Multidimensional Perfectionism Scale, the Hewitt-Flett Multidimensional Perfectionism Scale, and the Revised Almost Perfect Scale) were combined to form composite scores of PS and PC. Sleep was also measured objectively via wrist-actigraphy (ActiGraph GT3X+), which participants wore for three continuous weekday nights. Sleep diary data were collected to score and validate the actigraphy data.

Results

Moderation analyses were performed to examine the interaction of perfectionism and self-compassion on sleep outcomes. Findings indicated a significant and moderate interaction between PS and self-compassion when predicting poor sleep quality. Simple slope analyses indicated that the negative association between PS and poor sleep quality was significant at high levels of self-compassion (β = -.29, SE = .10, 95 % CI [-.49, -.09], t = -2.82, p = .005) followed by average levels of self-compassion (β = -.17, SE = .07, 95 % CI [-.31, -.02], t = -2.24, p = .026). Findings also indicated that college students with higher PC or lower self-compassion tendencies self-reported sleep difficulties despite having observable actigraphic sleep disturbances.

Conclusion

This study expands the current perfectionism and sleep literature by examining whether the moderating role of self-compassion can explain previous heterogeneous findings. Furthermore, the discrepancies between sleep methods observed in the current study highlight the importance of incorporating objective sleep measures as an adjunct to subjective and self-report measures of sleep to provide a more comprehensive assessment of sleep in relation to perfectionism and self-compassion.

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1160 Examining Criteria in Hypoglossal Nerve Stimulation: A Case Insight
Authors: Bean Steven , Mukkavilli Venkata
Published: April 2024

Introduction

Introduced in 2001, the hypoglossal nerve stimulator (HGNS) is an implantable device designed to treat moderate to severe obstructive sleep apnea (OSA). FDA-approved on May 1, 2014, it offers an alternative for patients unable to benefit from continuous positive airway pressure (CPAP) therapy. However, not all patients may benefit, leading to the establishment of exclusion criteria based on factors such as body mass index, central and/or mixed apnea index >25%, complete concentric palatal collapse, patient age, and certain comorbidities such as neuromuscular and cardiac diseases. It is important to consider these criteria when screening patients to ensure the appropriate use of the device. Here, we present a case illustrating a patient who received a HGNS device according to established criteria but may not have been an ideal candidate.123

Report of case(s)

A 55-year-old male with a history of hyperlipidemia, depression, and hypothyroidism status post (s/p) thyroidectomy to treat multinodular goiter, moderate OSA (AHI 16.2 events/hr) s/p uvulopalatopharyngoplasty and failed CPAP tolerance, underwent HGNS implantation. Post-procedure, an abnormal electrocardiogram led to a referral to cardiology, where he was found to have heart failure with a reduced ejection fraction of 20%. A follow-up titration polysomnography showed central events, presumed treatment emergent, following HGNS implantation. He is currently being monitored by cardiology for the optimization of his heart failure. Upon re-evaluation of his initial pre-implantation study, we felt that several of the hypopnea events may have been central hypopneas. Although his OSA is controlled with the HGNS, the patient still has central sleep apnea that is not being treated.

Conclusion

There is a lack of routine differentiation between central and obstructive hypopneas in current assessments, which poses a potential oversight in patient selection, impacting treatment planning. Central hypopneas should be included when assessing the 25% threshold of central events that would otherwise exclude a patient from receiving treatment. This case highlights the need for more stringent scoring criteria, specifically incorporating central hypopneas, to better screen high-risk patients and identify optimal candidates for hypoglossal nerve stimulation.

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