bluuebunny/crossref_metadata_2025 huggingface dataset:
526 Characteristics of Augmented RLS Patients on Dopamine Agonists at a Tertiary Referral Center: Where Do We Go From Here?
Authors: Laiwah Jonathan Yeung , Winkelman John
Published: May 2021

Introduction

Augmentation is a management dilemma in RLS patients on dopaminergic therapy. Understanding the clinical characteristics of such patients may assist in better management strategies.

Methods

Consecutive new consultations for RLS from 4/2016-6/2020 were identified from a single tertiary referral center in Boston, USA. Patients were included in this analysis if they had augmentation and current treatment with a dopamine agonist. Clinical information from initial consultation was collected. RLS severity at time of consultation was determined retrospectively with a modified IRLSSG severity score (0–12), assessing RLS symptom frequency (0–4), duration (0–4), and severity (0–4).

Results

Out of 209 referrals with RLS, 105 patients had augmentation, of whom 88 were on dopamine agonists at initial evaluation. Average age was 67 years (SD 11 years, range 39–88); 62 were female (59%). Mean duration of RLS symptoms was 27 years (SD 20), and 91% had symptoms > 10 years. Mean duration of dopamine agonist therapy was 11 years; 72% had previously been treated with pramipexole, 65% with ropinirole, 73% with rotigotine, and 16% with levodopa; 72% of patients had been treated with alpha-2-delta ligands, and 28% with opioids. Common comorbidities included obstructive sleep apnea (47%), obesity (49%), and depression (44%). Serotonergic medications were currently used by 25%. Of the 88 augmented patients on dopamine agonist therapy, 97% had earlier onset of symptoms and 33% had symptoms in both morning and afternoon; 53% reported anatomical extension. The mean modified IRLSSG score was 8.4 (SD 3.2). 66% of patients had either ferritin <75 mcg/L or transferrin saturation <20%. At the time of initial assessment, 49% were on pramipexole, 47% on rotigotine, 5% on rotigotine and 7% on levodopa: mean daily dopamine agonist dose was 1.23 mg (SD 1.20) of pramipexole equivalent. 37% were on alpha-2-delta ligands: mean daily dose 1014 mg (SD 830, median 700 mg) of gabapentin equivalent.

Conclusion

Higher than FDA-recommended dopamine agonist dosing and high prevalence of iron deficiency in patients with augmented RLS represent a treatment gap in the care of RLS patients in the community. Controlled studies of guideline-based therapy are indicated to determine optimal management of augmented RLS.

Support (if any)

Baszucki Brain Research Fund
528 REM Sleep Without Atonia in Idiopathic REM Sleep Behavior Disorder in the North American Prodromal Synucleinopathy Cohort
Authors: Feemster John , Timm Paul , Teigen Luke , Faber Sarah , Steele Tyler , McCarter Stuart , Boeve Bradley , Hedtkamp Kristina , Ju Yo-El , McCleland Jennifer , Postuma Ronald , Pelletier Amelie , Avidan Alon , Bliwise Donald , St. Louis Erik
Published: May 2021

Introduction

Idiopathic/isolated REM sleep behavior disorder (iRBD) is a prodromal alpha-synucleinopathy characterized by dream enactment behavior and REM sleep without atonia (RSWA). We sought to define quantitative RSWA diagnostic thresholds in the North American Prodromal Synucleinopathy (NAPS) Consortium cohort. We analyzed RSWA between iRBD patients across participating NAPS sleep centers, compared to normative controls, and hypothesized that previous diagnostic RSWA thresholds were overestimates.

Methods

All digital polysomnography files were converted to European Data Format and scored at a central laboratory (Mayo Clinic) which standardized display scoring montages, channel sensitivities, and filtering, and scripted computational analyses for visual scoring. RSWA was quantitatively analyzed in the submentalis (SM) and anterior tibialis (AT) muscles in iRBD (n=86) patients and controls (n=118) utilizing well validated visual (Mayo) and automated (RAI) methods. Parametric statistics were used to compare RSWA metrics, and RSWA thresholds were developed using receiver operating characteristic curves.

Results

RSWA was significantly higher for the RAI and all visual individual and combined muscle activity metrics in iRBD compared to controls (all p<0.001). Average SM phasic measures were: 14.2% (Mayo), 17.9% (McGill), 18.5% (UCLA), and 9.4% (Washington University). Average AT phasic measures at each site were: 26.7% (Mayo), 17.1% (McGill), 23.3% (UCLA), and 17.4% (Washington University). Average SM/AT ‘any’ measures at each site were: 45.4% (Mayo), 35.9% (McGill), 53.4% (UCLA), and 23.5% (Washington University). Overall cohort RBD diagnostic thresholds (AUC, specificity/sensitivity) were: SM phasic 4.9% (90.0, 82.2%/83.7%); AT phasic 7.6% (88.7%, 82.2%/81.4%) and combined SM/AT ‘any’ 13% (94.6, 83.9%/96.5%).

Conclusion

RSWA thresholds in the NAPS cohort were substantially lower than previously reported, suggesting previously overestimated diagnostic RSWA thresholds due to smaller, enriched patient samples and overfit statistical modeling. Confirmation of these findings in the complete NAPS cohort (n=300 iRBD patients across all 10 NAPS centers) is planned.

Support (if any):
535 Associations between Multiple Stressors (Including Racism) and Sleep Health among Young African-American Women
Authors: Jackson Chandra , LaPorte Frankie , Gaston Symielle , Vines Anissa , McGrath John , Jackson W Braxton , Kubzansky Laura , Harmon Quaker , Baird Donna
Published: May 2021

Introduction

Stress contributes to poor sleep, and both are associated with adverse mental and physical health outcomes. African-American women are disproportionately burdened by multiple forms of stress as well as poor sleep, but few studies have investigated the stressor-sleep relationship in this population.

Methods

We investigated associations between multiple measures of both stressors and sleep among African American women participating in the Study of Environment, Lifestyle and Fibroids. Using principal components analysis, we summarized 43 items ascertaining self-reported stressors (e.g., racism) and potential mitigators (e.g., resilience). Components were extracted and factor scores generated. Self-reported sleep included short (<7 hours) versus recommended (7–9 hours) sleep, waking unrested 4+ days/week, and insomnia symptoms (>4 nights per month). Adjusting for demographics, health behaviors, and body mass index, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) for each factor score dichotomized at the median.

Results

Among 1,672 women, mean age was 29.2 ± 3.4 years and 45% had a household income <$20,000. We extracted 9 stress factors accounting for 57% of the variance across the 43 items. In order of contribution to explaining the variance, stress factors included emotional distress (e.g., frequency of anger suppression and rumination); racism; social/emotional support; financial strain; medical/crime/family problems; faith/spirituality; resilience; job/home changes; and intimate partner changes/problems. Emotional distress (PR=1.52 [1.35–1.72]), racism (PR=1.28 [1.13, 1.44]), and financial strain (PR=1.14 [1.01–1.29]) were associated with insomnia symptoms. Emotional distress was also related to waking unrested (PR=1.36 [1.26–1.47]) while social/emotional support (PR=0.85 [0.79–0.92]) and resilience (PR=0.88 [0.82–0.95]) were protective. Short sleep was associated with a higher prevalence of emotional distress (PR=1.15 [1.06–1.25]) as well as medical/crime/family problems (PR=1.21 [1.03–1.42]); however, there was a protective association between resilience and short sleep (PR=0.88 [0.82–0.96]).

Conclusion

Multiple stressors were associated with sleep disturbances, but social/emotional support and resilience were associated with more favorable sleep.

Support (if any):
539 Interactions Between Cardiorespiratory Fitness and Sleep Apnea in Predicting Risk of Alzheimer’s Disease
Authors: Hagen Erika , Barnet Jodi , Ravelo Laurel , Plante David , Driscoll Ira , Edmunds Kyle , Gaitán Julian , Lose Sarah , Motovylyak Alice , Okonkwo Ozioma , Peppard Paul
Published: May 2021

Introduction

Several studies suggest a link between obstructive sleep apnea (OSA) and Alzheimer’s disease (AD). Additionally, frequent exercise is associated with more favorable AD biomarker profiles, and emerging evidence suggests greater cardiorespiratory fitness levels may be associated with lower risk of cognitive decline. We investigated whether cardiorespiratory fitness modifies the association of OSA and risk of AD.

Methods

A subset of the Wisconsin Sleep Cohort study participants with study visits starting in 2000 (n=1182, 46% female, mean [range] age at baseline=57 [37–82] years) completed multiple [range, 1–5] in-laboratory protocols that included overnight polysomnography, anthropometric measurements, and questionnaires. Additionally, the National Death Index was searched to determine cause of death among decedents. Cox proportional hazards models estimated relative hazards of AD (self-reported physician diagnosis or indication of AD on the death certificate) associated with the joint effects and the interaction of OSA – characterized by the base 10 logarithm of the apnea-hypopnea index (log10(AHI+1)) – and cardiorespiratory fitness (an index based on age, sex, BMI, self-reported physical activity, and resting heart rate). Additionally, the sample was stratified by fitness level at the 3rd quartile (>75th percentile compared to <75th percentile) and the hazard ratio for log10(AHI+1) was estimated for the lower and higher fitness-level groups. Results were adjusted for age, sex, BMI, and education.

Results

There were 10 incident cases of AD. The mean [range] fitness level was 7.1 [0–12.3]. 28% of the sample had moderate OSA (AHI 5–15); and 26% had severe OSA (AHI>15). Higher log10(AHI+1) was associated with greater hazards (p=0.03) of AD and there was a significant interaction between log10(AHI) and fitness (p=0.04), such that at greater fitness levels, the effect of log10(AHI) on AD was mitigated. In stratified analysis, among the less fit, the hazard ratio for an increment of 1 in log10(AHI) was 12.8 (95% CI, 1.1–153.8, p=0.04); among those who were more fit, the hazard ratio was not significant.

Conclusion

More severe OSA is associated with higher risk of AD, and this risk is greater among those with lower levels of cardiorespiratory fitness.

Support (if any)

This work was supported by US NIH grants R01AG058680, R01AG062167, R01HL62252, 1R01AG036838 and 1UL1RR025011.
555 Role of X-Ray Soft Tissue Neck in Children with Obstructive Sleep Apnea with a Previous History of Adenotonsillectomy
Authors: Nguyen Quang , El-Kersh Karim , Gunaratnam Bakeerathan , Senthilvel Egambaram
Published: May 2021

Introduction

Adenoid recurrence in children after adenotonsillectomy can be an etiology for obstructive sleep apnea (OSA). The aim of this study was to assess the role of x-ray soft tissue neck (XR-STN) in evaluating adenoid recurrence from a sleep physician perspective and to assess the polysomnographic findings of pre and post revision adenoidectomy.

Methods

This was a single center retrospective study that included children <18 years old with a history of adenotonsillectomy who underwent sleep study that confirmed the diagnosis of OSA and had XR- STN to evaluate for adenoidal tissue recurrence at the University of Louisville/Norton Pediatric Sleep Disorders clinic from July 2012 to September 2020. XR-STN level of adenoidal obliteration, baseline and post revision adenoidectomy PSG data were analyzed.

Results

A total of 160 subjects were included in the study with a mean age of 9.71±3.5 years, 59.4% were male, 54.4% were Caucasians, and the mean z-score was 1.77±1.15. XR-STN was normal in 39.4% of the subjects and it showed mild, moderate, and complete adenoidal obliteration in 20.6%, 32.5% and 7.5% of the subjects, respectively. Multiple regression analysis showed that the total AHI, the mean for the moderate and complete adenoidal obliteration are significantly higher than children with no obstruction (p-value=000). However, mild obliteration, Z score, age, gender, and race were not significantly associated with an increased total AHI. Pre- and post- adenoid revision PSGs were available in 20 subjects and they showed significant improvement in AHI (10.4±12.9 vs. 21.1±23.9, p=0.04), arousal index (15.4 ±10.6 vs. 21.1± 14.9, p=0.04), and nadir SaO2 (86.7%±8.1 vs. 76.58% ±18.44, p=0.04).

Conclusion

Soft tissue neck x-ray was useful in assessing adenoid recurrence in our study. Revision adenoidectomy resulted in an overall improvement in several PSGs parameters of OSA. Pediatric sleep physicians may consider XR-STN in the evaluation of children with OSA with a previous history of adenotonsillectomy.

Support (if any)

None
569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia
Authors: Araji Fayruz , Mujuruki Cephas , Ku Brian , Basora-Rovira Elisa , Wani Anna
Published: May 2021

Introduction

Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH.

Methods

The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected.

Results

Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed.

Conclusion

Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing.

Support (if any):
579 Child Sleep Onset Latency Mediates Parental Depression and Non-Compliance in Children with Autism Spectrum Disorder
Authors: Stearns Melanie , Hayse Braden , Nair Neetu , Mazurek Micah , Curtis Ashley , Beversdorf David , Deroche Chelsea , Sohl Kristin , Ner Zarah , Davis Beth , Takahashi Nicole , Muckerman Julie , McCrae Christina S
Published: May 2021

Introduction

Parents who have been diagnosed with depression often report that their children are not compliant and have difficulty falling asleep. Parents with depression are less likely to be consistent or enforce bedtimes resulting in the child having less bedtime rules and getting less sleep. Overtime this may mean the child develops poor sleep habits and difficulty falling asleep. Although these relationships have yet to be studied in children with Autism Spectrum Disorder (ASD), it is an important area given the high prevalence of children with ASD who have sleep difficulties. The current study examined whether parent-reported child sleep onset latency mediated the relationship between parental depression and child non-compliance.

Methods

The sample (N=50) consisted of parents (81% female) reporting on their children aged 6–12 (M=8.63, SD = 2.00; 76% male). All children were diagnosed with ASD and had parent reported sleep complaints. Children and their parents were recruited because they expressed interest in a behavioral treatment sleep study and these data come from the baseline data collection associated with that study. Measures included sleep onset latency on the Child Sleep Health Questionnaire (CSHQ), an item on the Pediatric Symptom Checklist (PSC) which asked if a child follows rules, and a question asking if the parent had been diagnosed with depression.

Results

Analyses were conducting using AMOS 27.0. Slightly less than half (45%) of parents reported having been diagnosed with depression. Parent-reported child sleep onset latency significantly mediated (β =.13) the relation between parental depression and non-compliance. Parents who had been diagnosed with depression were associated with greater child sleep onset latency (β =.32, p = .04) and greater child sleep onset latency was associated with greater non-compliance (β =.40, p = .01). The direct effect between parental depression and non-compliance was not significant.

Conclusion

These results suggest that difficulty falling asleep may help to explain why children of parents who have depression are not compliant. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships.

Support (if any)

University of Missouri Research Board Grant (McCrae, PI); United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA AR190047).
582 Insomnia-related cognitive and behavioural factors in adolescents with delayed sleep-wake phase disorder
Authors: Cheung Forrest Tin Wai , Chan Joey W , Chan Ngan Yin , Li Xiao , Zhang J , Wing Y K , Li Shirley Xin
Published: May 2021

Introduction

Although delayed sleep-wake phase disorder (DSWPD) shares phenomenological experiences with chronic insomnia disorder, previous research on the conceptual understanding of DSWPD has been limited, with a predominant focus on its chronobiological basis. The present study examined several insomnia-related cognitive and behavioural factors in adolescents with DSWPD.

Methods

Twenty-five adolescents with DSWPD (age = 19.9 ± 1.6; female = 28%), 28 with chronic insomnia disorder (age = 20.4 ± 2.0; female = 61%), diagnosed according to the ICSD-3 criteria, and 25 healthy control (age = 20.4 ± 1.5; female = 68%) were included in the present study. Participants completed 7-day prospective sleep diary and actigraphy monitoring, and a battery of questionnaires on sleep and chronotype measures. Participants were also measured on hyperarousal (Pre-Sleep Arousal Scale, PSAS), sleep reactivity (Ford Insomnia Response to Stress Test, FIRST), sleep-related beliefs (Dysfunctional Beliefs and Attitudes about Sleep, DBAS-16), and sleep hygiene practices (Sleep Hygiene Practices Scale, SHPS). Analysis of covariance (ANCOVA) with gender as the covariate was used for between-group comparisons.

Results

Relative to healthy control group, insomnia and DSWPD group showed significantly more insomnia symptoms as measured by Insomnia Severity Index (p<.001). As compared to healthy control group, DSWPD group showed significantly more delay in circadian phase based on sleep diary and actigraphy derived mid-point of sleep, as well as greater preference towards eveningness as measured by the Morningness-Eveningness Questionnaire. DSWPD group also showed significantly more cognitive and somatic hyperarousal (p<.001, d = 1.36–2.31), sleep reactivity (p<.001, d = 1.73), dysfunctional belief about sleep (p<.001, d = 1.59), as well as poorer sleep hygiene practices (p<.001, d = 2.62), compared to healthy control. There were no significant differences in the circadian parameters, PSAS, FIRST, DBAS-16, and SHPS between DSWPD and insomnia groups.

Conclusion

Several insomnia-related cognitive and behavioural factors, namely hyperarousal, sleep reactivity, maladaptive beliefs about sleep, and poor sleep hygiene, are also evident in youths with DSWPD. The findings had important implications for the conceptual understanding and clinical management of DSWPD.

Support (if any)

This work was supported by the Seed Fund for Basic Research (University Research Committee, The University of Hong Kong) awarded to Dr. Shirley Li.
595 The associations between excessive daytime sleepiness and emotional lability in typically developing adolescents
Authors: Giorgio Lisa-Marie , Somerville Gail , Boursier Johanne , Gruber Reut
Published: May 2021

Introduction

Excessive daytime sleepiness (EDS), defined as a tendency to fall asleep unintentionally during the day, and emotional lability, characterized by emotional outbursts and quick changes in mood, are prevalent amongst adolescents. They contribute to functional impairments and are inter-related, but are frequently investigated independently. In addition, sleep duration is related to both EDS and emotional/behavioral regulation, but previous studies did not take this into account. The aim of this study was to characterize the associations between emotional lability, impulsivity and EDS in adolescents while controlling for objectively measured sleep duration. It was hypothesized that higher levels of EDS in adolescents would be associated with higher levels of emotional lability and impulsivity in adolescents above and beyond the impact of sleep duration.

Methods

Participants included 52 typically developing adolescents (38 females) aged 11 to 16 years old (Mean age = 13.10 years, SD = 1.59). EDS was measured using the Sleep Disorders Inventory for Students. Emotional lability and impulsivity were measured using the Conners Global Index Scale. Sleep was measured using actigraphy and sleep logs.

Results

Parallel multiple regression analyses were conducted with EDS as the independent variable, and emotional lability or impulsivity as the dependent variables, while controlling for age, gender, bedtime, waketimes, and sleep duration. These analyses revealed significant positive association between EDS and emotional lability such that adolescents with high levels of EDS also presented with high levels of emotional lability (F(6, 51) = 4.631, p = < .001, β =.62, p = <.001). There were no significant associations found between EDS and impulsivity.

Conclusion

This study found that EDS was associated with emotional, but not behavioral, dysregulation in adolescents. Interventions aimed at reducing EDS and at improving adolescents’ emotional regulation should be considered as a means to optimize adolescents’ daytime functioning. Limitations of the current study include the use of a cross-sectional design that does not permit determination of causality. Future research should be conducted to better understand the mechanisms underlying the interplay between EDS and daytime functioning of adolescents.

Support (if any):
597 Sleep Bruxism in Preschool Children: Associations with Emotional-Behavioral Problems
Authors: Laganière Christine , Kenny Samantha , Gaudreau Hélène , Pokhvisneva Irina , Bouvette-Turcot Andrée-Anne , Meaney Michael , Pennestri Marie-Helene
Published: May 2021

Introduction

Several psychosocial factors contribute to the etiology of sleep bruxism in childhood, including emotional-behavioral problems, as well as environmental and familial factors. It is known that sleep bruxism is prevalent in preschoolers, but most etiology studies were conducted with school-aged children or adolescents. Studies focusing on younger, preschool-aged populations that consider family-related factors are lacking. This study aimed to assess the relationship between emotional-behavioral problems and the presence of sleep bruxism in preschoolers, while taking maternal depressive symptoms into consideration.

Methods

Three hundred eighty-three mother-child dyads from the Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) cohort were included in the present study. Mothers completed the Child’s Sleep Habits Questionnaires (CSHQ; includes the frequency of bruxism), a questionnaire about their child’s emotional-behavioral problems (CBCL; anxiety and depressive problems), and reported their own depressive symptoms (CES-D). Measures were completed at two timepoints: when children were 4 and 5 years old. Generalized Estimating Equation (GEE) models were used to evaluate the relationship between sleep bruxism frequency and children’s emotional-behavioral problems, while controlling for maternal depressive symptoms, child’s biological sex, family socioeconomic status, and age.

Results

Maternal reports indicated that 12% of children experienced sleep bruxism at least sometimes at age four, and 20% did at age five. Children’s anxiety and depressive symptoms were associated with increased sleep bruxism frequency (p < 0.05). Associations between children’s emotional-behavioral problems and bruxism remained statistically significant when controlling for maternal depressive symptoms, child’s biological sex, family socioeconomic status, and time (p < 0.05).

Conclusion

In this normative cohort of children, sleep bruxism was associated with anxiety and depressive symptoms in children as young as age four. Furthermore, this relationship can still be observed when the severity of maternal depressive symptoms is considered. Whether anxiety and depressive symptoms contribute to sleep bruxism, or vice versa, remain to be further investigated. Nevertheless, results suggest that screening of emotional-behavioral problems should be considered in children experiencing sleep bruxism.

Support (if any)

Fonds de recherche du Québec - Santé
598 Sleep Variability and Infant Anthropometry during the First 6 Months
Authors: Tsai Shao-Yu , Tung Yi-Ching , Tsai Shao-Yu
Published: May 2021

Introduction

Sleep plays a crucial role in children’s health and development, and emerging evidence suggests that sleep disturbances during infancy negatively impact both the neurocognitive and socioemotional outcomes later in life. However, no study has taken the variability of sleep into account when examining physical growth in infancy, which is a critical period for both healthy sleep and weight development. The purpose of the study was to examine the association between sleep variability and physical growth in infants aged 6 months.

Methods

316 healthy infants recruited during their 6-month well-child checkups had their weight and length measured, and wore an actigraph on the ankle for a week. Average weekday, weekend, and all week sleep duration were computed, with infants categorized into three groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with sleep variability as the primary predictor variable of interest and infant anthropometry as the dependent variable.

Results

Average weekday daily sleep duration was 10.76 (1.06) hours which was similar to the average weekend daily sleep duration of 10.68 (1.06) hours. In both unadjusted and adjusted models controlling for potential confounding variables, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, and weight-for-age z scores when compared with infants in the regular sleep group (35.1%, all p < 0.05).

Conclusion

Weekday-weekend sleep pattern differences exist even as early as in the first 6 months of life, and either weekend catch-up sleep or weekend sleep loss is associated with higher infant anthropometric markers. Our findings suggest that sleep assessments in infants in well-child checkups should include not only global assessments of average sleep duration but also address sleep pattern regularity.

Support (if any)

This study was funded by the National Health Research Institutes, Taiwan, NHRI-EX102-10229PC.
599 Exploring Ways to Optimize Parental Involvement in Adolescent Sleep Interventions
Authors: Zoltanski Ava , Levenson Jessica , Reyes Zoe , Bahary Sigalle , Ford Hannah , Patel Garima , Miller Elizabeth , Mukundan Aishwarya
Published: May 2021

Introduction

Sleep is critical to the health and functioning of adolescents, but most teens do not obtain the recommended amount of sleep each night. Some sleep interventions have been efficacious in promoting sleep among adolescents, though others have had a more limited impact. One potential strategy for improving the efficacy of adolescent sleep promotion programs is to optimize the role of parents in supporting their child’s sleep. Recent findings on parental involvement in adolescent sleep suggest that monitoring can improve sleep duration but may be challenged by disagreements about sleep between parents and adolescents. Thus, it is crucial to understand how to involve parents in adolescent sleep promotion while supporting adolescent autonomy. Here, we report qualitative data on strategies for involving parents in adolescent sleep promotion in a way that is acceptable and effective. This data was collected specifically to inform the development of a sleep promotion program for adolescents.

Methods

We conducted 9 focus groups (3 each for youth, parents of adolescents, and healthcare providers treating adolescents). Transcripts of focus group proceedings were coded and thematically analyzed using inductive and deductive approaches, focusing on parents’ current role in their child’s sleep and the proposed role of parents in an adolescent sleep program.

Results

Some parents report being involved in their child’s sleep habits by setting bedtimes and supervising a consistent sleep routine. Adolescents prefer parental support that encourages child autonomy for their own sleep routine. To maintain healthy sleep habits, parents report that physicians or other trusted adults may play a key role in facilitating the negotiation of sleep habits that addresses the priorities of both parents and adolescents.

Conclusion

Our findings support adolescent preference for autonomy in their health behaviors consistent with their developing independence during this development period. Future work should focus on improved understanding of how adolescents and parents can negotiate adolescent autonomy and should examine the efficacy of a sleep promotion program based on varying levels of parental involvement.

Support (if any):
620 Description of 14&6 variant on polysomnography
Authors: Powell Weston , Nash Jessica , Ruth Chris , Chan Jeremy , Lockhart Carey
Published: May 2021

Introduction

Benign variants or incidental findings are often identified on routine polysomnography. One such variant is 14-and-6 hertz positive spikes, first described on EEG in 1951; however, the significance of 14-and-6 positive spikes found on polysomnography has not been previously described.

Methods

We conducted a retrospective review of patients with 14-and-6 Hz spikes on polysomnography and compared clinical findings on polysomnography with age and sex-matched controls.

Results

Mean age was 8.6 years (range 2–16). Sleep indices did not differ between cases and controls. Patients with 14-and-6 Hz spikes had lower obstructive apnea-hypopnea index and were less likely to be diagnosed with obstructive sleep apnea. Patients with 14-and-6 Hz spikes did not differ from controls in frequency of formal neurology evaluation, whether a full EEG was obtained, or neurologic diagnoses. Patients with 14-and-6 Hz spikes were less likely to be diagnosed with behavioral or developmental disorders.

Conclusion

14-and-6 Hz spikes can be seen in children of all ages and does not seem to be associated with any sleep, neurologic, or developmental disorders.

Support (if any):
628 Longitudinal Association between NREM Sleep Depth and Arousability with ADHD and Internalizing Disorders in Adolescence
Authors: Ricci Anna , Fernandez-Mendoza Julio , He Fan , Calhoun Susan , Younes Magdy , Fang Jidong , Lukenbill Nicole , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: May 2021

Introduction

Sleep depth decreases in the transition from childhood to adolescence, even in typically developing (TD) youth. However, it remains unknown whether this developmental trajectory in NREM sleep depth differs across adolescents with psychiatric/behavioral disorders.

Methods

We analyzed the sleep EEG of 392 subjects aged 5–12 at baseline and 12–22 at follow-up (45.2% female, 23.2% racial/ethnic minority), of whom 246 were TD adolescents (controls), 62 were diagnosed with a psychiatric/behavioral disorder and were taking stimulant, anti-depressant, anxiolytic, sedative and/or anti-psychotic medications, and 84 were un-medicated. NREM sleep depth was measured at both time points using the odds ratio product (ORP), which provides a standardized continuous EEG measure of NREM sleep depth/arousability (higher ORP reflects lighter NREM sleep). General linear models examined mean differences between groups on the percent change in ORP between baseline and follow-up (ΔORP) while adjusting for sex, race/ethnicity, age, BMI and AHI at follow-up, and PSG system, psychiatric/behavioral disorders, psychoactive medications and ORP at baseline as well as time-to-follow-up.

Results

Overall, medicated (80.4%, 95%CI=66.2–94.6) and un-medicated (66.1%, 95%CI=53.0–79.1) subjects showed a higher ΔORP compared to controls (52.2%, 95%CI=40.0–64.5, p<0.01 and p<0.05, respectively) but did not differ between each other (p=0.134). Specifically, un-medicated subjects with ADHD (n=56) showed a higher ΔORP (77.3%, 95%CI=62.4–92.1) compared to controls (p<0.01), while subjects with ADHD on stimulant medication (n=36) did not differ (66.1%, 95%CI=48.9–93.2) from controls (p=0.268) or from un-medicated ADHD subjects (p=0.303). Subjects with internalizing disorders on psychoactive medications (n=29) showed a higher ΔORP (104.9%, 95%CI=82.8–127.0) compared to controls (p<0.01) and to un-medicated subjects (n=27) with internalizing disorders (60.1%, 95%CI=36.8–83.3, p<0.01), who did not differ from controls (p=0.772).

Conclusion

The greater increase in ORP in the transition to adolescence in un-medicated youth with ADHD suggests that decreased NREM sleep depth may be a biomarker of the disorder. In contrast, the greater increase in ORP in medicated youth with internalizing disorders suggests that psychoactive medications impact NREM sleep depth in these children as they transition to adolescence. These data have important implications for sleep EEG studies that include medicated and un-medicated youth with comorbid psychiatric disorders.

Support (if any)

NIH Awards Number R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127
644 Sleep Quality in Intensive Care Unit Patients with Advanced Heart Failure
Authors: Edmiston Elizabeth , Dolansky Mary
Published: May 2021

Introduction

Around 75% of Americans with heart failure (HF) report poor sleep quality, a much higher percentage than the general population. This is especially concerning since poor sleep quality is associated with poor cardiac event-free survival. Persons with HF are hospitalized often and between 10–51% of those hospitalized are admitted to an intensive care unit ICU. Poor sleep quality is a common complaint in ICU with over 50% of patients rating sleep quality as poor to very poor. The purpose of the study was to evaluate changes in sleep quality in persons with advanced HF who were admitted to an ICU.

Methods

Persons with advanced HF admitted to ICU were recruited into this pilot study (age 29–89). Using the Pittsburgh Sleep Quality Index, self-reported sleep quality was assessed at three time points: pre-admission, during hospitalization, and post-discharge. Scores greater than five indicated poor sleep quality. A Repeated Measures Analysis of Variance (RMANOVA) test compared means from the same participant over time for sleep quality (N=22).

Results

At baseline, 93% of participants reported poor sleep, 90% during hospitalization, and 86% post-discharge. A significant difference among the three time points was found [F (2, 42) =5.341; p<.01]. The mean sleep quality score pre-admission was 11.77 and SD=3.69, during hospitalization M=12.27 and SD=3.65, and post-discharge M=9.32 and SD=4.56. The mean difference of sleep quality pre-admission and sleep quality during hospitalization was not significant. However, the mean difference of sleep quality pre-admission and sleep quality post-discharge was significant (Mean difference=2.46; p<.05). Also, a significant difference in sleep quality during hospitalization and post-discharge was found (Mean difference=2.96; p<.05).

Conclusion

The number of participants who reported poor sleep during hospitalization was much larger than previously reported in the literature. Also, participants reported significantly better sleep quality post-discharge than pre-admission and during hospitalization. Furthermore, this population may be vulnerable for poor sleep due to symptom severity prior to hospital admission, diuretic use, and poor sleep hygiene. Implementation of sleep hygiene strategies are needed during hospitalization to promote sleep and to teach sleep hygiene self-management.

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650 The Association between Sleep and Psychological Distress among New York Healthcare Workers During the COVID-19 Pandemic
Authors: Diaz Franchesca , Bramley Sean , Venner Hadiah , Shaw Kaitlin , McMurry Cara , Cornelius Talea , Schwartz Joseph , Shechter Ari , Abdalla Marwah
Published: May 2021

Introduction

Healthcare workers (HCWs) treating patients with COVID-19 report high rates of acute stress, depressive and anxiety symptoms. We examined whether sleep disturbances were associated with psychological distress in New York City (NYC) HCWs during the initial peak of COVID-19 in-patient admissions (April 9 - May 11, 2020).

Methods

HCWs (physicians, nurses, and advanced practice providers) completed a web-based survey which screened for acute stress (4-item Primary Care PTSD screen), depressive symptoms (Patient Health Questionnaire-2), and anxiety (2-item Generalized Anxiety Disorder scale). Past week insomnia symptoms were assessed with a modified item from the Insomnia Severity Index (5-point Likert Scale: none, mild, moderate, severe, very severe). Insomnia was defined as having “moderate, severe, or very severe” symptoms. Short sleep (SS) was defined as self-reported sleep duration <6 hours per day. Poisson regression analyses predicting psychological distress from SS and, separately insomnia. adjusting for age, gender, race/ethnicity, clinical setting (COVID-focused or not COVID-focused), physician vs. non-physician status, and redeployment status, were performed.

Results

Data included 813 HCWs (80.6% female, 59.0% White, 75.6% worked in a COVID-focused setting). Mean sleep duration was 5.79 ± 1.22 hours/night. The prevalence of SS and insomnia were 38.8% and 72.8%; the prevalence of acute stress, depressive symptoms, and anxiety were 57.9%, 33.8% and 48.2%, respectively. Having SS, vs. not was associated with acute stress (adjusted prevalence ratio [PR]: 1.21, 95% CI: 1.07, 1.31), depressive symptoms (PR: 1.65, 95% CI: 1.35, 2.02), and anxiety (PR: 1.51, 95% CI: 1.30, 1.74). Presence of insomnia symptoms vs. “none or mild” was associated with acute stress (PR: 1.92, 95% CI: 1.57, 2.34), depressive symptoms (PR: 3.13, 95% CI: 2.16, 4.52), and anxiety (PR: 2.40, 95% CI: 1.86, 3.11).

Conclusion

Among NYC HCWs, sleep disturbances, including SS and insomnia symptoms during COVID-19 are common. In our study, SS and insomnia were associated with acute stress, depressive symptoms, and anxiety in HCWs, however further research on whether a bidirectional relationship exists between sleep and psychological distress during the COVID19 pandemic are still needed.

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652 Association Between Poor Sleep and Lymphocyte Subsets In Chronic HIV Infection
Authors: Borker Priya , Macatangay Bernard , Punjabi Naresh , Rinaldo Charles , Wolinsky Steven , Hyong-Jin Cho Joshua , McKay Heather , Patel Sanjay
Published: May 2021

Introduction

Low CD4+ T lymphocyte counts and CD4+/CD8+ lymphocyte ratios predict mortality and cardiovascular risk among people living with HIV (PLWH). Whether polysomnographic (PSG) sleep measures impact T lymphocyte subset counts among PLWH is unknown. We sought to evaluate the association between lymphocyte subsets and PSG-derived sleep measures in a cohort with HIV seropositive men.

Methods

We analyzed data from HIV seropositive men who have sex with men participating in the Multicenter AIDS Cohort Study on antiretroviral therapy for >1 year with undetectable (<500 copies/mL) plasma HIV-1 RNA who underwent a sleep evaluation with home polysomnography. The following seven sleep parameters were examined: total sleep time (TST), sleep efficiency, sleep stage (N1, N2, N3, and REM) duration, and apnea-hypopnea index. Multivariable linear regression models adjusted for age and body mass index were used to assess whether sleep measures were associated with CD4+ T cell count, CD8+ T cell count, or CD4+/CD8+ ratio.

Results

Participants (n= 286) had a mean age of 55.2 ± 11.3 years, 52.8% had sleep apnea and mean CD4+ count was 728 ± 306 cells/mm3. None of the sleep measures were associated with CD4+ counts but longer TST and REM duration were associated with lower CD8+ counts and higher CD4+/CD8+ ratio. In adjusted analyses, every one hour increase in TST was associated with a 35 ± 18 cells/mm3 lower CD8+ count (p=0.049) and 6.3% elevation in CD4+/CD8+ ratio (p=0.006) while every hour increase in REM was associated with 123 ± 50 cells/mm3 lower CD8+ count (p=0.01) and 20% elevation in CD4+/CD8+ ratio (p=0.003).

Conclusion

In PLWH, longer total sleep time and REM sleep duration are associated with protective CD4+/CD8+ ratios due to lower CD8+ cell count. Further research is needed to assess if longer sleep duration is associated with decreased inflammatory markers.

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American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship
659 Optimizing Telehealth technology in Sleep Medicine at a VA Medical center during the COVID19 pandemic
Authors: Konikkara John , Kabir Arif , David Robert , Donovan Lucas , Palen Brian
Published: May 2021

Introduction

The COVID19 pandemic poses an unprecedented challenge for healthcare delivery. Optimization of resources and safety of patients and healthcare workers is crucial. The aim of this study is to analyze impact on resource utilization at VA Maryland Healthcare System (VAMHCS). At the pandemic onset, we deployed a mail-in store-and-forward technology (SFT) for carrying out home sleep apnea testing (HSAT), using WatchpatDirect® Peripheral Arterial Tonometry-based testing. This led to a substantial decrease in reliance on care in the community (CITC) or out-of-VA care, resulting in fiscal savings. Interpretation of studies is done by VA physicians using a cloud-based network, resulting in improved workforce optimization and continuity of care.

Methods

We compared CITC expenditures for sleep studies in financial year (FY) 2019 (October 2018 to September 2019) with that of FY2020 in the VA Support Service Center Capital Assets (VSSC) database.

Results

In FY2019, VAMHCS conducted 402 polysomnograms, 805 HSATs and referred 64 patients to CITC, including 5 HSATs, with CITC costs of $102,388. CITC referral initiated by primary care providers often resulted in clinic visit and polysomnography (PSG). In FY2020, VAMHCS conducted 436 PSGs, 986 HSATs and referred 10 patients to CITC, including 3 HSATs, costing $6,780; a decrease of $95,608 compared to FY2019. The ratio of VA to CITC studies was 18:1 in FY2019, compared to 142:1 in FY2020. VAMHCS conducted 166 HSATs between 3-15-2020 and 6-30-2020, while the sleep lab was closed due to COVID surge, at a cost of $160 per study. According to VSSC data, an average of $1,005 is spent per patient (including a third-party administrator fee of $200) when utilizing CITC. Approximately 80% of CITC referrals underwent PSG. If all studies were done using CITC, it would have cost an additional $ 140,270. The cost would have been $546, 855 if all studies done between 3-15-2020 and 9-30-2020 were done through CITC.

Conclusion

The use of SFT during the pandemic resulted in VAMHCS relying less on CITC, leading to a decrease in expenditure, administrative burden and turnaround time. SFT minimizes the risk of infection transmission because PAT probes are disposable and obviates patient visits to the hospital.

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666 Sleep Architecture in the Intensive Care Unit As Revealed via Breathing and Heart Rate Variability
Authors: Ganglberger Wolfgang , Velpula Krishnamurthy Parimala , Bucklin Abigail , Tesh Ryan , Da Silva Cardoso Madalena , Sun Haoqi , Adra Noor , Leone Michael , Qader Quadri Syed Abdul , Ye Elissa , Kuller David , Thompson Taylor , Akeju Oluwaseun , Thomas Robert , Westover Michael
Published: May 2021

Introduction

Sleep in the intensive care unit (ICU) is difficult to measure by conventional polysomnography. We investigated the feasibility of assessing sleep state from readily available ICU signals: heart rate variability (HRV) from electrocardiography and breathing from a wearable respiratory band. We compared findings with an age and sex matched sleep laboratory group.

Methods

As part of a clinical trial, 102 adult non-ventilated patients in three ICUs in the Massachusetts General Hospital wore a respiratory band. Both heart rate variability (RR-intervals) from ECG, and breathing (respiratory effort waveforms) data for up to seven days per patient were obtained. 220 age- and sex-matched subjects from a sleep lab cohort who wore the same respiratory effort band and ECG were selected for comparison. We staged sleep from the HRV and breathing data using previously published deep neural network models. We defined discordant sleep epochs as those where HRV- and breathing-based models disagreed. Agreement was computed for the following pairs: (R,R),(N1,N1),(N2,N2),(N3,N3),(N1,W),(N1,N2),(N2,N3).

Results

Demographics: Mean(STD) age: ICU 68(9), sleeplab 68(9); BMI: ICU 27(6), sleeplab 31(6); ICU 40% female, sleeplab 44% female; race: ICU%:Sleeplab% 90:69 White, 5:4 Black, 2:7 Asian. 34% of ICU-subjects were in a medical ICU, 66% in a surgical ICU. Mean total sleep duration in the ICU was 8.9 hours (4.5h concordant, 4.4h discordant sleep). We observed increased amounts of discordant sleep in the ICU compared with the sleeplab cohort (4.4h vs. 1h, p<0.01). We found different REM sleep distributions (p<0.01) with reduced median (10% vs. 20%) but elevated 90% quantile (45% vs. 26%), elevated N1(%) (41% vs. 26%, p<0.05), reduced N2(%) (19 vs. 44, p<0.01), and reduced N2+N3(%) (34 vs. 59, p<0.05). We further observed higher mean respiratory rate (17.4 vs. 15.9 breaths per minute, p<0.01), lower inter-breath-intervals (3.9 vs. 4.7 seconds per breath, p<0.01), and more breathing variability than in sleeplab AHI<5 group but less than in AHI>15 group.

Conclusion

HRV and respiratory-based measures can assess sleep in the ICU. The findings of increased discordant sleep in the ICU might stem from limitations of the models, fundamental changes in sleep biology during critical illness, pharmaceutical drugs, sleep fragmentation, and/or associated pathology in the ICU.

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