bluuebunny/crossref_metadata_2025 huggingface dataset:
1019 Obstructive Sleep Apnea and Cognitive Functioning 2 Years After Injury in Adults with Traumatic Brain Injury
Authors: Sudolcan Benjamin , Babicz-Boston Michelle , Ketchum Jessica , Calero Karel , O’Connor Kristen Dams , Silva Marc
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is associated with structural and functional brain changes and reduced cognition. Persons with traumatic brain injury (TBI) show disproportionately higher risk of OSA compared to community samples. Moderate-to-severe TBI often results in disabling cognitive sequelae, although the impact of OSA on cognitive outcome after TBI is poorly understood. The purpose of this study was to examine the degree to which OSA features predict cognitive performance during early TBI recovery. We hypothesized that greater obstructions, oxygen saturation, and cortical arousals would predict poorer cognition.

Methods

This was a secondary analysis of participants co-enrolled in the TBI Model Systems (TBIMS) and Comparison of Sleep Apnea Screening and Diagnostic Tools (CSAS) studies. Participants underwent attended PSG while admitted for neurorehabilitation following moderate-to-severe TBI. Telephone follow-up interviews were conducted 2 years ± 3 months from injury date and included the Brief Test of Adult Cognition by Telephone (BTACT). Spearman correlations were calculated between PSG metrics and BTACT performance.

Results

Of 184 participants co-enrolled in the CSAS and TBIMS studies, 123 had valid BTACT data and compromised the analytical sample. There was a negative correlation between the total Apnea-Hypopnea Index (AHI) and the BTACT Executive Function composite (ρ=-0.189, p=0.040), working memory (ρ=-0.199, p=0.029), and reasoning (ρ=-0.192, p=0.035). Cortical arousals was negatively correlated with reasoning (ρ=0.211, p=0.021). Correlations between PSG metrics of oxygen desaturation (nadir, desaturation index, percent sleep time below 90% peripheral oxygen saturation) and BTACT performance were statistically nonsignificant.

Conclusion

This study provides evidence that PSG metrics of OSA are associated with decreased cognitive performance during early recovery from moderate-to-severe TBI. Future studies should examine the degree to which OSA treatment can ameliorate cognitive deficits following TBI.

Support (if any)

PCORI (CER-1511-33005), NIDILRR (90DPTB0007, 90DP0084, 90DPTB0013, 90DPTB0008, 90DPT80004, 90DPTB0001, 90DPTB0024), and DHA Contract HT0014-22-C-0016 (For information, contact dha.TBICOEinfo@health.mil. UNCLASSIFIED). Defined as U.S. Government work under Title 17 U.S.C.§101. Supported with resources and use of facilities at the James A Haley Veterans’ Hospital. Views presented are of the authors and do not necessarily represent official policy or position of any U.S. government agency.
0102 Effects of Daytime Ambient Temperature on Actigraphy-derived Sleep Parameters in Men and Women
Authors: Ishihara Asuka , Brychta Robert , LaMunion Samuel , Chen Kong
Published: April 2024

Introduction

Evening and nocturnal exposure to cold and warm temperature can respectively blunt or enhance vasodilation needed to initiate sleep. However, the effects of temperature exposure several hours prior to bedtime on sleep have not been well studied. We examined the impact of colder and warmer daytime temperatures on nighttime sleep in men and women.

Methods

In a 7 to 13-day inpatient study (NCT01568671), the metabolism of twelve men (23.2 ± 4.9 yrs; 23.4 ± 1.6 kg/m2) and fifteen women (25.5 ± 4.0 yrs; 22.1 ± 2.2 kg/m2) was measured in a room calorimeter during exposure to a randomly assigned temperature between 16-31˚C from 0800-1300 each day while wearing standardized clothing. Thereafter, ambient temperature was controlled at a thermal neutral temperature (23-25˚C), including during nighttime sleep. Diet and physical activity each day were also standardized. Sleep parameters were assessed using the wrist actigraphy on the non-dominant hand (ActiGraph wGT3X-BT; 80Hz) and compared amongst thermal neutral (24.3 ± 0.4˚C), coldest (19.1 ± 1.2˚C), and warmest (30.4 ± 0.7˚C) daytime temperatures. Whole-body thermal insulation was calculated as the inverse of the slope of metabolism versus ambient temperature below the thermal neutral zone. Linear mixed effects models were used to predict each sleep parameter with sex and temperature as fixed effects and each subject as a random effect.

Results

Over all temperatures, women spent longer time in bed (460.1 ± 58.6 vs. 405.1 ± 68.9 min, p=0.01) and slept longer (427.3 ± 54.1 vs. 372.3 ± 62.0 min p=0.007). No significant interaction was observed between sex and temperature for the sleep parameters. Sleep efficiency after cold exposure was significantly correlated with insulation (R=0.45, p=0.03), which was greater for women than men (0.38 ± 0.04 vs. 0.34 ± 0.04°C/W/m2, p< 0.04). No differences in sleep parameters were observed after warm exposure.

Conclusion

Our findings suggest that daytime cold exposure may influence nocturnal sleep in a relationship mediated by individual thermal insulation. Future studies will need to assess sleep architecture and skin and core temperature regulations of men and women in response to daytime ambient temperature.

Support (if any)
1020 ◻Rest-activity Rhythm Linked to Parkinsonism in Older Adults: Results from the Rush Memory and Aging Project
Authors: Sugg Elizabeth , Gao Lei , Bennett David , Buchman Aron , Li Peng , Hu Kun , Haghayegh Shahab
Published: April 2024

Introduction

While the inter-relationship between parkinsonism and Parkinson’s disease (PD) in older adults remains unclear, both phenotypes are related to PD pathology. Adults with PD commonly exhibit nonmotor symptoms such as disturbances in sleep-wake cycles or rest-activity rhythm (RAR). In a previous study of older men, RAR disturbances preceded the development of PD. This current study examines whether RAR disturbances are associated with incident parkinsonism in a cohort of older community-dwelling men and women.

Methods

We examined 999 older adults (age=80.1; 76% female) in the Rush Memory and Aging Project who were free from parkinsonian symptoms (i.e., bradykinesia, rigidity, tremor, postural instability) during their baseline actigraphy assessment. Participants completed annual motor tests to identify parkinsonian symptoms during follow-up. Incident parkinsonism was rendered when ≥2 parkinsonian symptoms were present. Parametric and nonparametric RAR measures were derived from actigraphy including amplitude (representing the strength of the ~24-h RAR rhythms); acrophase (representing the peak activity time); the most active 10-hour (M10) and least active 5-hour (L5) period over 24-hours; intradaily stability (IS; estimated regularity of a 24-hour pattern); and interdaily variability (IV; fragmentation across 24-hour patterns). Cox proportional hazards models were performed to examine the associations between RAR measures and incident Parkinsonism. Models were adjusted for age, sex, and education.

Results

Parkinsonism was observed in 448 participants after an average of 6.62 years. Risk for parkinsonism was significantly higher in participants with lower amplitude (Hazard Ratio [HR] per 1-SD decrease: 1.36, 95% CI: 1.21-1.53), lower M10 (HR per 1-SD decrease: 1.33, 95% CI: 1.19-1.48), and higher IV (HR per 1-SD increase: 1.23, 95% CI: 1.13-1.34). The observed associations were similar in men and women. There was no significant association between the risk of parkinsonism and acrophase, L5, or IS.

Conclusion

Perturbed RAR were associated with an increased risk of incident parkinsonism in older men and women, suggesting parkinsonism could be a prodromal manifestation of PD in both genders. Further analysis should explore the underlying mechanisms of this relationship.

Support (if any)

5T32HL007901-25, NIH RF1AG064312, and BrightFocus A2020886S.
1021 Samelisant: Clinician and Patient Global Impression from a Double-Blind, Phase-2 Study in Patients with Narcolepsy
Authors: Nirogi Ramakrishna , Jayarajan Pradeep , Goyal Vinod Kumar , Ravula Jyothsna , Jetta Satish , Shinde Anil , Benade Vijay , Abraham Renny , Palacharla Veera Raghava Chowdary , Pandey Santosh Kumar , Mohammed Abdul Rasheed , Jasti Venkat
Published: April 2024

Introduction

Samelisant (SUVN-G3031) is a potent and selective histamine 3 receptor (H3R) inverse agonist. Samelisant exhibited desired pharmacokinetic properties in rodents and healthy human volunteers. Preclinical studies in orexin knockout mice demonstrated wake promoting and anticataplectic effects of samelisant. To confirm the preclinical findings, Samelisant was evaluated as monotherapy for the treatment of excessive daytime sleepiness (EDS) in patients with narcolepsy with or without cataplexy. The primary endpoint was changes in the Epworth Sleepiness Scale (ESS) scores. Clinician and Patient Global Impression for EDS were assessed as secondary and exploratory endpoints.

Methods

Two doses of samelisant (2 and 4 mg) were evaluated as a monotherapy in a Phase-2 study for the treatment of EDS in subjects with narcolepsy (ClinicalTrials.gov Identifier: NCT04072380). Subjects diagnosed with narcolepsy as per ICSD-3 criteria, aged between 18 to 65 years with an ESS score of ≥12 and mean Maintenance of Wakefulness Test (MWT) time of < 12 min were recruited in the study. A total of 190 subjects were randomized into 3 treatment arms (placebo, samelisant 2 mg and samelisant 4 mg) in 1:1:1 ratio and received either placebo or samelisant once daily for 2 weeks. The primary efficacy endpoint was the change in ESS score from baseline to week 2. Clinical Global Impression – Severity (CGI-S) was a secondary endpoint, whereas change in Patient Global Impression – Change (PGI-C) and Clinical Global Impression of Change (CGI-C) scores related to EDS were exploratory endpoints.

Results

At the end of the double-blind period, the samelisant treated groups demonstrated clinically and statistically significant improvements in CGI-S (p< 0.01), PGI-C (p< 0.001) and CGI-C (p< 0.0001) with regards to EDS. The proportion of patients reporting improvement in EDS was significantly higher in the samelisant treatment arms compared to placebo arm.

Conclusion

Treatment with samelisant as monotherapy resulted in significant improvement in excessive day time sleepiness as assessed by both clinicians and patients. These outcomes support the efficacy of samelisant observed in the primary endpoint, ESS, in patients with narcolepsy with or without cataplexy.

Support (if any)
1022 Sleep in Duchenne Muscular Dystrophy
Authors: Low Dominique , MD Partha Ghosh
Published: April 2024

Introduction

Duchenne Muscular Dystrophy (DMD), the prevalent childhood-onset muscular dystrophy, affects 1 in 3500 males due to a mutation in the DMD gene, leading to compromised dystrophin production and resultant muscle weakness. Steroid therapies, including prednisolone and deflazacort, commonly used in DMD treatment, may contribute to weight gain. Patients with DMD frequently experience sleep symptoms or disorders, particularly sleep-disordered breathing, impacting their quality of life.

Methods

The objective of this chart review of DMD patients in a multi-disciplinary DMD clinic at a tertiary referral center over a 3-month period is to estimate from the most recent notes, particularly the neurology and pulmonary notes, the prevalence of sleep symptoms and disorders in our multidisciplinary clinic. Clinical observations were also made and recorded by the investigators in the neuromuscular division of the DMD multidisciplinary clinic.

Results

Of the 29 patients reviewed, the average age was 13.3 (SD 3.8) years. All of the patients were male. The racial groups the patients identified as were: 11 (37.9%) “White,” 3 (10.3%) “Black or African American,” 2 (6.9%) “Asian,” 8 (27.6%) “Other,” and 5 (17.2%) “Declined to Answer.” The average BMI was 24.7 (SD 5.3). Of the 29 patients reviewed, 18 (62.1%) exhibited sleep symptoms or disorders. Of these 18 patients, 6 (33.3%) were treated with CPAP or BiPAP.

Conclusion

Our findings align with existing literature, emphasizing the prevalence of sleep-related symptoms and disorders in DMD patients. As DMD management progresses and treatment options expand, resulting in increased life expectancy, addressing sleep-related challenges becomes imperative to enhance the overall quality of life for these individuals. Further research is essential to delve into the intricate relationship between DMD and potential sleep co-morbidities, guiding interventions that can positively influence clinical trajectories and improve overall quality of life.

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1024 SURWEY: Treatment of Excessive Daytime Sleepiness with Solriamfetol: Initiation, Titration, and Outcomes
Authors: Parks Gregory , Burghaus Lothar , Eglit Graham , Abeynayake Iresha , Floam Samantha , Winter Yaroslav
Published: April 2024

Introduction

Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor with agonistic properties at TAAR1 and 5HT1A receptors, is a wake-promoting agent approved to treat excessive daytime sleepiness (EDS) associated with narcolepsy (75–150 mg/day) or obstructive sleep apnea (OSA; 37.5–150 mg/day). Real world data on solriamfetol safety and efficacy remains limited. Here we review real-world survey results to evaluate dosing/titration strategies and outcomes on EDS in patients with OSA, narcolepsy, and the pooled (OSA + narcolepsy) population.

Methods

Data from a retrospective chart review (SURWEY) by German physicians who prescribed solriamfetol for EDS associated with narcolepsy or OSA were analyzed. Inclusion criteria have been previously reported. Initiation and titration strategies (new-to-therapy, changeover, add-on) and Epworth Sleepiness Scale (ESS) scores are reported for each diagnosis and the pooled population to examine EDS as a symptom independent of etiology.

Results

Differences in baseline age, sex, and body mass index were observed for OSA (n=83) and narcolepsy (n=71) patients. Most common initiation strategy was new-to-therapy (n=63/83; 74.7%) for OSA and changeover (n=44/71; 62.0%) for narcolepsy. Patients with a final dose ≥150 mg/day were n=16 (19.5%), n=31 (45.6%), and n=47 (26.1%) for OSA, narcolepsy, and pooled, respectively. At initiation, mean±SD ESS scores were similar: 16.0±3.2 (OSA), 17.6±3.1 (narcolepsy), 16.7±3.2 (pooled). Mean±SD change from baseline in ESS scores at final follow-up were –5.4±3.6 (OSA), –4.5±3.2 (narcolepsy), –5.0±3. 5 (pooled). In the pooled analysis, ESS scores improved by 5.5, 4.7, and 4.4 in new-to-therapy, changeover, and add-on groups, respectively. In the changeover group, ESS scores improved by 5.7, 4.7, 4.6, and 4.0 points in patients who switched to solriamfetol from modafinil (n=13), stimulants (n=3), pitolisant (n=16), or unknown medication (n=21), respectively, while patients who added solriamfetol to pitolisant (n=13) or modafinil (n=3) improved by 4.4 and 3.3 points, respectively. Common adverse effects were headache, insomnia, and decreased appetite.

Conclusion

These real-world data describe the use of solriamfetol in patients with EDS in OSA or narcolepsy. Titration strategies differed by primary etiology but changes in ESS scores were similar. Although sample size was limited, clinically meaningful improvements in ESS scores were observed with solriamfetol regardless of switch/add-on medication.

Support (if any)

Axsome Therapeutics, Jazz Pharmaceuticals, Pharmanovia
1027 Valproic Acid and Central Sleep Apnea: A Retrospective Study
Authors: Martin Kari , Ruoff Chad , Carvalho Diego , Goswami Umesh , Ashley Garrett , Louis Erik St
Published: April 2024

Introduction

Central sleep apnea (CSA) is associated with several medical conditions (e.g., heart failure, atrial fibrillation) and medications (e.g., opioids, ticagrelor, sodium oxybate and valproic acid). We report a case of a 31-year-old female with bipolar disorder treated with valproic acid diagnosed with central sleep apnea on polysomnography, which revealed an apnea-hypopnea index of 150/hour, central apnea index of 112/hour, nadir oxygen saturation of 78%, and 38.6 minutes with oxygen saturation ≤ 88%. Echocardiogram, electrocardiogram, brain magnetic resonance imaging, serum acylcarnitine and serum ammonia levels were unremarkable. Total and free serum valproic acid level was 33 and < 3 mcg/mL, respectively. Two cases of central sleep apnea associated with valproic acid use, both of which improved upon discontinuation of valproic acid, have been reported in the literature. We started the patient on positive airway pressure and suggested she taper off valproic acid and then repeat polysomnography. Given the possible association between central sleep apnea and valproic acid use, we retrospectively analyzed patients receiving valproic acid at time of polysomnography.

Methods

We retrospectively identified patients between 2005-2017 who were prescribed valproic acid (n=6,169), and of these 72 received valproic acid within 90 days of polysomnography. After chart review, we were able to confirm that 29 received valproic acid at time of polysomnography via blood levels or clear chart documentation.

Results

Four patients (13.8 %) demonstrated a central apnea index ≥ 5 per hour (mean apnea-hypopnea index 39.2/hour +/- 32.2/ hour including a central apnea index 11.7 +/- 6.6/hour) during polysomnography. Although one patient (3.4 %), a 2-year-old child with Dravet syndrome and refractory/drug resistant generalized epilepsy, was diagnosed clinically with central sleep apnea, the other three patients were diagnosed with obstructive sleep apnea and had other potential reason(s) for the elevated central apnea index (e.g., opioid use as needed for migraines).

Conclusion

Our case describes a third report of central sleep apnea possibly associated with valproic acid, and our retrospective study indicates that this association is rare. Prospective sleep studies on patients before and after receiving valproic acid are warranted to determine if valproic acid causes central sleep apnea.

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1029 Actigraphy-informed Poor Sleep Health Is Associated with Worse Cognitive Performance Among Older Adults
Authors: Blankenship Anneka , Bock Karen , Watts Amber , Mahnken Jonathan , Hunt Suzanne , Siengsukon Catherine , Mazzotti Diego
Published: April 2024

Introduction

Sleep quality is a modifiable risk factor for Alzheimer’s Disease and other dementias due to the role it plays in removal of beta-amyloid and tau from the brain during sleep. The aim of this retrospective observational study was to examine the association between cognition and domains of sleep health in older adults at baseline and over time.

Methods

Older adults (≥60 years) underwent comprehensive sleep and cognition assessments as part of annual evaluations for a longitudinal cohort study about dementia risk factors. Participants completed self-reported (Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index) and objective (wrist-worn actigraphy) sleep assessments. Definitions for poor, moderate, and good sleep health were established based on composite scores derived from self-report only and from self-report plus actigraphy data using the RuSATED model. Verbal memory, attention, and executive function factors were measured annually. The relationship between composite sleep health scores and cognition factors at baseline and follow-up visits were assessed using linear mixed models adjusted for age, sex, and education.

Results

Among participants with available self-reported sleep health at baseline (N=174), 44.3% and 6.9% had moderate and poor sleep health, respectively. For those with actigraphy-informed sleep health at baseline (N=177), 56.5% and 11.9% had moderate and poor sleep health, respectively. Cross-sectional analyses revealed that participants with actigraphy-informed poor sleep health had lower performance on verbal memory (β [SE] = -0.58 [0.29], p = 0.045) and on executive function (β [SE] = -0.48 [0.18], p = 0.009). No significant relationships between self-reported or actigraphy-informed sleep health and cognition factors were found in longitudinal analyses.

Conclusion

Participants with actigraphy-informed poor sleep health exhibited worse verbal memory and executive function at baseline. These findings underscore the potential influence of sleep health on specific cognitive functions, offering valuable insights for future research and clinical implications in the intersection of sleep health and prevention of Alzheimer's disease and other dementias.

Support (if any)

NIA P30AG035982; General Faculty Research Fund (University of Kansas)
1032 Association of Sleep Duration and APOE ε4 Status on Brain Regional Tau Deposition in Clinically Normal Older Adults
Authors: Murali Komal , Gills Joshua L , Briggs Anthony , Cesar Justin Oliver , Kovbasyuk Zanetta , Valkanova Elena , Mbah Alfred , Figueredo Luisa , Kam Korey , Mullins Anna , Parekh Ankit , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo , Bubu Omonigho
Published: April 2024

Introduction

We examined interactive associations of sleep duration on regional tau-PET deposition in clinically-normal individuals, as a function of β-amyloid (Aβ), and apolipoprotein E (APOE) ε4 status.

Methods

This cross-sectional study analyzed preliminary data from 26 community-dwelling cognitively normal older-adults with baseline tau ([18F] PI2620) and Aβ ([11C] PiB) PET scans participating in NYU studies on sleep, aging and memory. Sleep duration was characterized as total sleep time (TST) using data from polysomnography (NPSG). Linear mixed effects models controlling for Aβ, age, sex, race, BMI and other sleep variables, examined a main association of TST with regional tau and a meta-region of interest, which was a composite of regions in the temporal lobe. Interactions between TST*Aβ, and TST*APOE ε4 on these regions were also examined

Results

Of the 26 subjects, 16 (61.5%) were females, 10 [38.5%] were Black/African-American, 14 [53.8%], APOE ε4 carriers, and 3 [11.5%] individuals were Aβ+. The mean (SD) age was 66.5 (4.6) years, BMI was 26.0 (10.6) kg/m**2, and education was 16.4 (2.5) years. There was no clear association of TST with cortical tau in the combined meta-region involving the entorhinal and inferior temporal lobe (meta-analytic estimate: β = −0.01[0.01]; 95% CI, −0.04 to 0.03, P =.16). However, TST by APOE ε4 interaction was significant for the combined meta-region (meta-analytic estimate: β = −0.06[0.02]; 95% CI, −0.11 to -0.01, P =.03), right inferior temporal β [right] = −0.02[0.01]; 95% CI, −0.04 to −0.00, P=.02), and bilaterally in the superior parietal β [left] = −0.20[0.08]; 95% CI, −0.37 to −0.02, P=.03), β [right] = −0.03[0.01]; 95% CI,−0.04 to −0.00, P=.04), cortical regions, suggesting a synergistic effect. TST by APOE ε4 interaction with regional tau trended in the left precuneus (β [left] = −0.01[0.01]; 95% CI, −0.02 to 0.00, P=.07) and the left inferior temporal β [left] = −0.02[0.01]; 95% CI, −0.03 to 0.00, P=.08) cortical regions. TST by Aβ interaction was not associated with regional tau.

Conclusion

APOE ε4 and sleep duration exhibited synergism in association with higher regional tau in cognitively-normal older adults. Larger studies are needed to delineate mechanisms and strata specific estimates.

Support (if any)

AASM[BS-231-20], NIAK23AG068534, R01AG082278, AARG-D- 21-848397, BrightFocus[A2022033S]
1036 Beyond Brain Fog: A Social Listening Analysis of Impaired Cognitive Functioning in Sleep Disorders
Authors: Flurie Maurice , Cline Zachary , Morse Anne Marie , Horsnell Matthew , Gudeman Jennifer , Craine Lauryn , Ortiz Luis , Ascencion Frederik , Kimmel Diana , Shah Puja , Burkoth Shannon , Neves Juliana Angelim , Mundt Jennifer , Picone Maria , DeFelice Christopher
Published: April 2024

Introduction

To best support a rare-disease community, it is imperative to understand the unique symptoms and challenges associated with their condition. In recent years, the experience of “brain fog” has been discussed across sleep-disorder communities, including narcolepsy and idiopathic hypersomnia (IH); however, the term “brain fog” is a vague descriptor that might represent several experiences. Here, we explored experiences with brain fog across sleep communities. The primary goal was to identify cognitive challenges associated with brain fog. Impacts on daily living were also characterized.

Methods

We analyzed conversations in 2 online sleep disorder communities: narcolepsy (a private Facebook group, PWN4PWN; and a public subreddit, r/narcolepsy) and IH (a public subreddit, r/idiopathichypersomnia). Posts/comments were explored using a natural language processing (NLP) engine designed to recognize and categorize clinical language on social media. Conversations mentioning brain fog across communities were isolated for analysis. Odds ratios were calculated to identify clinical concepts associated with brain fog conversations (vs other conversations). Last, conversations were subjected to topic modeling, a process which reveals common conversational themes in community discussions.

Results

Narcolepsy and IH communities contributed 355,028 posts/comments from 2011-2023. The NLP engine extracted concept mentions across communities. Brain fog mentions experienced the largest increase from 2014-2017. The concept most associated with brain fog was “memory impairment”. Another strongly associated cognitive concept included “inattention”. Sleep-related concepts (e.g., “difficulty sleeping”) were also associated with brain fog. Topic analysis showed converging support for these findings by identifying topics such as “memory issues” and “ADHD”. Topics related to daily living included “school” and “workplace”.

Conclusion

The experience of brain fog is shared across multiple sleep communities. In both narcolepsy and IH groups, brain fog experiences preceded the COVID-19 pandemic, with a substantial increase in mentions before 2020. Brain fog conversations were significantly associated with memory and attention difficulties, similar to other disorders. The association with sleep-related concepts appears to be unique in this patient group. These findings suggest brain fog may impact certain mental processes more than others and may be exacerbated by poor sleep quality. The daily impact of brain fog was illustrated by conversations centering around school and workplace experiences.

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1037 Comorbid Insomnia and Sleep Apnea in Epilepsy Patients
Authors: Deepak Vishal , Grayson Kammi , Scott Rebecca , Rodriguez Alcibiades
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) is very common in patients with epilepsy disorders, especially in refractory cases. Both epilepsy patients and OSA patients can have complaints of insomnia as a prevalent symptom. Additionally, about 30% of patients with chronic insomnia have OSA, and nearly 40% of people with OSA also have insomnia symptoms. This is known as Comorbid Insomnia and Sleep Apnea (COMISA). The objective of this study was to describe COMISA in patients with epilepsy.

Methods

We performed a retrospective observational study of adult patients with epilepsy with a concomitant diagnosis of OSA who presented for clinical visits between 10/01/2022 and 09/30/2023 at a sleep center. 57 patients were identified with either seizures or an epilepsy disorder. Among those patients, 9 patients were found to have concurrent OSA and met study criteria. Electronic medical records were reviewed to identify those with insomnia complaints.

Results

Preliminary results of the study are presented. Most patients were female (n=6, 66.7%%), with a mean age of 36.33 + 0.7 years. On review of the patients’ polysomnography, the mean apnea hypopnea index (AHI) was 15.63 + 10.74/hour, total sleep time (TST) was 342.05 + 104 minutes, and sleep efficiency was 64.92 + 0.21%. Four patients (44.4%) had COMISA. Among the patients with COMISA, the mean AHI was 16.65 + 10.74%. The mean TST (239 + 104.65 minutes) and mean sleep efficiency (45.78 + 21.6%) were significantly reduced and mean sleep latency was high (37.65 + 0.42 minutes).

Conclusion

Based on our retrospective screening, the prevalence of insomnia in patients with OSA and seizure disorders is quite high. Further large retrospective and longitudinal studies are required to identify the patients at risk of COMISA in epilepsy with the help of clinical and polysomnographic evaluation.

Support (if any)

n/a
1039 Diffusion Imaging Markers of Glymphatic Function in Veterans with Sleep Dysfunction and Mild Traumatic Brain Injury
Authors: Bhatti Gursimrat , Robinson Meghan , Li Ruosha , Jones Melissa , Jorge Ricardo
Published: April 2024

Introduction

We investigated the impact of sleep disturbances and past mild traumatic brain injuries on the glymphatic system (GS), an essential cerebral network responsible for fluid exchange and solute balance, by employing a novel, non-invasive imaging technique, Diffusion Tensor Imaging Along Perivascular Spaces (DTI-ALPS).

Methods

Participants were 148 Veterans of post-911 conflicts enrolled in the Houston Translational Research Center for TBI and Stress Disorders (TRACTS) who completed MRIs, the Pittsburgh Sleep Quality Index, Boston Assessment of TBI-Lifetime, and Clinician-Administered PTSD scale for DSM-5. Individuals with moderate or severe TBI were excluded. We analyzed potential relationships between the DTI-ALPS index, a ratio of diffusion measures at a priori regions of interest, and sleep parameters derived from the PSQI, concussion severity (grades I-III), demographic factors, and PTSD severity.

Results

Participants were aged 36.5±7.4 years, 8.6% were females, 55% were white, and 82.1% had mild TBI. DTI-ALPS negatively correlated with age (r=-0.189, p=0.021); correlations with PSQI global score, sleep efficiency, and total hours asleep were not significant. DTI-ALPS was significantly associated with concussion severity (p=0.042) and time to bed after 12:30 AM (p=0.038). After adjusting for age, grade III concussion severity and time to bed after 12:30 AM remained significant, but the interaction between them was not. There were no significant associations with components of the PSQI, PTSD, and other demographic variables.

Conclusion

Glymphatic flow is known to be affected by sleep, however, we found relatively modest effects of sleep on DTI-ALPS, which may mean that it may not be sensitive to detect cross-sectional measures of subjective sleep quality in awake participants. We observed both brain injury and time to bed to influence DTI-ALPs. Although brain injury is often associated with impaired sleep, these appear to be independent predictors of GS function in our cohort. Large-scale studies focusing on diurnal fluctuations of GS may advance our understanding of its role in long-term brain health.

Support (if any)

This work was funded by the Translational Research Center for TBI and Stress Disorders (B9268-X) from VA RR&D; Career Development Award # IK2CX002363-01A1 from VA CSR&D (MJ); MR is now a full-time employee of KBR, Inc.
1042 Influence of OSA Severity on the Association of Global Amyloid and Regional Tau-PET Burden
Authors: Bubu Omonigho , Gills Joshua L , Cesar Justin Oliver , Kovbasyuk Zanetta , Dharmapuri Anhiti , McBride Julian , Valkanova Elena , Mbah Alfred , Dominguez Joanna , Browne Laurel , Figueredo Luisa , Kam Korey , Mullins Anna , Parekh Ankit , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo
Published: April 2024

Introduction

We examined the association of OSA severity with regional tau-PET deposition in clinically normal individuals, as a function of β-amyloid (Aβ), race and apolipoprotein E (APOE) ε4 status.

Methods

Cross-sectional analysis of preliminary data from 26 (16 Whites and 10 Blacks matched on AHI4%, age, BMI and educational level) community-dwelling cognitively normal older-adults with baseline tau ([18F] PI2620) and Aβ ([11C] PiB) PET scans. OSA severity was characterized using AHI4%. Linear mixed effects models controlling for Aβ, age, sex, race, BMI and other sleep variables, examined a main association of OSA with regional tau and a meta-region of interest, which was a composite of regions in the temporal lobe. Interactions between OSA*Aβ, OSA*Race, and OSA*APOE ε4 on these regions were also examined.

Results

Of the 26 subjects, 16 (61.5%) were females, 14 APOE ε4 carriers [53.8%], and 3 individuals [11.5%] were Aβ+. The mean (SD) age was 66.5 (4.6) years, BMI was 26.0 (10.6) kg/m**2, and education was 16.4 (2.5) years. OSA severity was associated with cortical tau in the combined meta-region involving the entorhinal and inferior temporal lobe (meta-analytic estimate: β = −0.12[0.05]; 95% CI,−0.23 to −0.00), and regional tau in the superior parietal (β [left] = −0.05[0.02]; 95% CI,−0.10 to −0.01; β [right] = −0.05[0.02]; 95% CI,−0.09 to −0.00), left parahippocampal (β = −0.05[0.02]; 95% CI,−0.09 to −0.00), and right precuneus (β = −0.04[0.01]; 95% CI,−0.06 to −0.01) cortical regions, P <= .04 for all. A race by OSA severity interaction was significant for the left superior parietal (β [White, AHI4%] = −0.06[0.01]; 95% CI,−0.12 to −0.00), and left parahippocampal (β [White, AHI4%] = −0.01[0.03]; 95% CI, −0.03 to −0.00) and (β [Black, AHI4%] = −0.04[0.01]; 95% CI,−0.06 to −0.00) regions, P <= .05 for all. OSA severity by APOE ε4 interaction was not associated with regional tau.

Conclusion

OSA severity is associated with regional tau-PET deposition in clinically normal individuals, regardless of APOE ε4 status, and this association differed by race in certain brain regions. These findings highlight OSA as a unique disease model for examining racial differences in Alzheimer disease risk.

Support (if any)

AASM[BS-231-20], NIAK23AG068534, L30-AG064670, R01AG082278, RF1AG083975, AARG-D- 21-848397, BrightFocus[A2022033S]
1043 Prevalence of Sleep Paralysis in Medical Students Across India- a Cross Sectional Study
Authors: Shah Urmil , Abhishek Kumar , Shukla Rushikesh , Kumar Pratyush , Srikumar Shabarini , Panchawagh Suhrud , Sheth Aryan , Singh Shailja , Acharya Sourya
Published: April 2024

Introduction

Sleep paralysis is a condition that has been on the rise in recent years, occurring during the pre or post sleep stages. While there is no known direct cause of sleep paralysis, studies have shown a number of potential causes, including poor quality of sleep, alcohol use, exposure to stressful events, anxiety disorders, and a family history of the illness. The purpose of this study was to assess the prevalence of sleep paralysis among medical college students in India and identify factors associated with the condition.

Methods

A cross-sectional study involving 155 medical students was done involving the students to fill the questionnaire anonymously. The questionnaire was made using data from the Unusual Sleep Experiences Questionnaire (USEQ) and distributed nation-wide among medical students using an online Google Form. Power analysis is done using CDC EpiInfo software, Version 7.2.5. Statistical analysis is done using StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.

Results

Out of 155 students, 145 students (93.55%) participants consented to participate in the study. 76 medical students (52.4 %) reported having an episode of sleep paralysis in their lifetime. Out of those students, 39 (51.3%) were males, while 37 (48.6%) were females. A statistically significant association between medical students suffering from psychological illness and sleep paralysis was established, with 32.4 % of students suffering from anxiety and 22.1 % of individuals reporting concurrent depression. 46% of the individuals had only one or two episodes of sleep paralysis episodes in their lifetime while 54% had recurrent episodes of sleep paralysis. Majority (76%) of the participants do not indulge in recreational drug usage. Terror (56%) and Paralysis (54%) were the most commonly reported sensations by the individuals.

Conclusion

This study divulges that more than half of the medical students have suffered from sleep paralysis. In addition to it, students suffering from psychological illnesses were at increased risk of having sleep paralysis. In conclusion, this study highlights the need for increased awareness and education about sleep paralysis, especially among medical students. It also emphasizes the importance of addressing psychological issues and sleep-related disorders to reduce the risk of sleep paralysis.

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1046 Sleep Problems Predict Pain One Month After Diagnosis and Twelve Months Later Among People with Multiple Sclerosis
Authors: Whibley Daniel , Abou Libak , Kratz Anna , Ehde Dawn , Fritz Nora , Alschuler Kevin
Published: April 2024

Introduction

Sleep problems and pain are commonly experienced by people with multiple sclerosis (PwMS). This study aimed to determine whether sleep problems assessed one month after receiving an MS diagnosis associated with pain intensity and/or pain interference at this time or predicted these pain outcomes 12 months after diagnosis.

Methods

This secondary analysis used data from the prospective observational LAND (‘Life After New Diagnosis’) study and was restricted to those with an MS diagnosis who provided complete Medical Outcomes Study (MOS) Sleep Scale questionnaire data. Linear regression was used to quantify associations between sleep variables (MOS-Sleep problems index and dimension scores ‘sleep disturbance’, ‘sleep adequacy’, and ‘awaken short of breath or headache’) and pain intensity (past-week average, 0-10 Numeric Rating Scale) and pain interference (PROMIS Short Form 6a), adjusted for age, sex, number of years of education, comorbidities, and, in longitudinal models, baseline level of the outcome (pain intensity or pain interference). A p value < 0.05 was used to determine statistical significance.

Results

The sample (N=174) was predominantly female (69.5%) and white (86.2%), with a mean age of 39.8 years (standard deviation 11.2). The most common MS disease course was relapsing/remitting (52.3%); 35.6% were yet to be categorized. One month after diagnosis, there was a significant, cross-sectional association between MOS-Sleep problems index score and pain intensity (B=0.04, 95% confidence interval (CI): 0.02-0.05, p< 0.001) and pain interference (B=0.17, 95% CI: 0.11-0.24, p< 0.001). Dimension scores for ‘sleep disturbance’, ‘sleep adequacy’, and ‘awaken short of breath or headache’ were also significantly associated with the pain outcomes at this time. In longitudinal analyses, MOS-Sleep problems index score one month after diagnosis predicted pain intensity (B=0.02, 95 %CI: 0.007-0.04, p=0.003) and pain interference (B=0.11, 95% CI: 0.05-0.17, p< 0.001) 12 months after diagnosis. Higher scores for ‘sleep disturbance’ and ‘sleep adequacy’ one month after diagnosis also predicted both pain outcomes 12 months after diagnosis.

Conclusion

As a modifiable factor, sleep presents a viable constituent of multicomponent pain management for PwMS. Research is needed to determine whether improving sleep reduces pain in this population.

Support (if any)

The LAND study was funded by the National Multiple Sclerosis Society (RG4986A1/1).
1047 Sleep Fragmentation Predicts Diminished Processing Speed in Non-demented Elderly from the Cretan Aging Cohort
Authors: Skourti Eleni , Basta Maria , Simos Panagiotis , Zampetakis Alexandros , Alexopoulou Christina , Aligizaki Marina , Ganiaris Andronikos , Zaganas Ioannis , Vgontzas Alexandros
Published: April 2024

Introduction

Processing speed is an early index of cognitive decline in elderly. Also, sleep quality predicts memory deficits in this age group. However, the relationship between sleep fragmentation and processing speed remains controversial. Our aim was examine the longitudinal associations between sleep quality and processing speed in non-demented community dwelling elderly.

Methods

A sub-sample of 148 participants diagnosed with Mild Cognitive Impairment (MCI;n=79) or cognitively non-impaired (CNI;n=69) from the Cretan Aging Cohort, a large population-based cohort of 3,140 older adults (>60 years; baseline) were followed-up 8 years later (follow-up). Mean age at baseline was 74.9±6.33 and 70.4 ±6.24 years for MCI and CNI persons. Processing speed was assessed based on age and education adjusted z-scores of the Symbol Digit Modality Test. Sleep fragmentation (wake after sleep onset; WASO) was assessed using a 3-day actigraphy at baseline and follow-up. Change between the two time points was calculated using paired sample t-tests. The direct and indirect effects of baseline WASO on subsequent processing speed after controlling for sociodemographic covariates were estimated using panel models in AMOS.

Results

Average WASO among MCI and CNI participants was 80.6±41min and 72.3±31.2min; p=0.1 and 75.7±34.8min and 59.3±20.6min; p< 0.001 at baseline and follow-up, respectively. Average processing speed decreased between the two measurement points (CNI: 0.23±0.97 and -0.40±1.04; p< 0.001 and MCI: -0.75±0.60 and -1.09±0.72; p< 0.001 at baseline and follow-up, respectively). Baseline WASO directly predicted processing speed (β=-0.201; p=0.04) among MCI persons, while WASO at follow-up fully mediated the relationship between baseline WASO and subsequent processing speed (β=-0.098; p=0.004) in the CNI group.

Conclusion

Sleep fragmentation predicts diminished processing speed among non-demented elderly. Given the significance of processing speed on cognitive function, interventions improving sleep quality in elderly may prevent/delay cognitive decline.

Support (if any)

National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFRI-FM17-4397
1052 Impact of CPAP Adherence on Hospitalized Patients Diagnosed with OSA on Healthcare Utilization in Rural Settings
Authors: Srinivasan Priyanka , Rojas Edward , Olgers Kassandra , Knollinger Scott , Seol Calvin , Stansbury Robert , Sharma Sunil
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) is an increasingly prevalent condition with significant implications for cardiopulmonary health. Data suggests that early detection of OSA in hospitalized patients may improve outcomes. However, the effects of CPAP therapy have not been studied for hospitalized patients in a rural population. The primary purpose of this study is to examine the 1-year readmission, ED visit rate, and associated healthcare costs in hospitalized patients screened as high-risk for OSA, diagnosed, and started on CPAP therapy.

Methods

Through a retrospective review of 2042 patients from 08/2019 to 06/2023 in a registry of a hospital-based sleep medicine program, 786 patients were determined as high risk based on their results from apnea link. From there, 341 patients were selected based on their completion of an outpatient polysomnography (PSG), of which 293 were assessed for adherence of CPAP therapy. Composite end point of combined number of hospitalization and emergency department (ED) visits for 1-year were recorded, further separating the outcomes that were cardiopulmonary in nature due to the CPAP’s focus on those organs. Moreover, cost analysis was performed.

Results

Of the 293 assessed for adherence of CPAP therapy, 108 patients were adherent, while 185 were non-adherent. The mean age of patients evaluated was 58 years (12.82) and 57% were males. The average BMI of these patients was 39.7 (10.7). The mean AHI was 25.49 (26). Analyses showed that 1-year composite end point of hospital readmissions and ED visits were significantly higher in non-adherent patients compared to adherent patients. The hazard ratio was determined to be 1.24 with 95%CI 1-1.54(p=0.03). In the multivariate Cox model, adjusting for age and gender, the adjusted HR was 1.27 with 95%CI: 1.02 – 1.58 (p = 0.033). The one-year total cost of healthcare was significantly higher among non-adherent patients (p< 0.001).

Conclusion

Early detection of OSA in hospitalized patients in Appalachia and successful treatment may significantly lower healthcare utilization. These may have practical impact on quality of life and cost of healthcare delivery in rural hospitals.

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1056 Medical Record Alert to Increase PAP Use in Hospitalized Patients on Home PAP for Sleep Disordered Breathing
Authors: Grom Jennifer , Johnson Karin , Rastegar Vida
Published: April 2024

Introduction

Many patients with sleep disordered breathing (SDB) on home positive airway pressure (PAP) therapy are not ordered for PAP treatment when hospitalized. Our quality improvement project evaluated whether establishing an electronic medical (EMR) alert to place PAP orders on patients with home PAP for SDB, could be successfully implemented and lead to an increase in PAP ordering in hospitalized patients.

Methods

In April 2021 the nursing intake assessment was changed to ask if patients had SDB and used PAP at home. In September 2021, an EMR alert was implemented and triggered when a physician or advanced practice provider opened the chart of a patient on home PAP use if PAP therapy was not already ordered. We conducted a retrospective chart review to compare rates of PAP ordering for hospitalized patients with SDB on domiciliary PAP before (August 2021), during (9/7/2021-9/11/2021), and after (October 2021) implementation of an EMR alert. We included all patients admitted to medical and surgical wards of Baystate Medical Center. We excluded patients admitted to ICU and patients who had contraindications to PAP therapy including encephalopathy or vomiting.

Results

The alert was discontinued after 4 days due to hospitalist feedback that receiving the alert when the chart was first opened was disruptive to workflow. We were unable to link the alert to later steps in the workflow. Rates of PAP orders were 61.4% (148/241, 95% CI: 54.9, 67.6), 66.7% (28/42, 95% CI: 50.5, 80.4), and 65.6% (168/256, 95% CI 59.4, 71.4), respectively. Patients admitted to observation unit were prescribed PAP 46.7% (21/45), 71.4%(5/7) and 55.6% (25/45), respectively. Patients on surgical units were prescribed PAP 63.0% (29/46), 75% (6/8), 70.2% (40/57), respectively. Patients on medical units were prescribed PAP 65,3% (98/150), 63.0% (17/27), 66.9% (103/154), respectively.

Conclusion

An EMR alert for providers to prescribe in-hospital PAP therapy for patients on home PAP therapy may increase rates of PAP ordering, but implementation must be congruent with provider workflow. Although surgical and observation units had larger increases in PAP ordering with the alert, variability may due to small sample size so further evaluation is needed. Further studies are needed to optimize alert type and timing and assess utility.

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