bluuebunny/crossref_metadata_2025 huggingface dataset:
1152 Genetic Risk Of Alzheimer’S Disease Is Linked To Short Sleep Duration
Authors: Leng Y , Yaffe K , Ackley S , Glymour M , Brenowitz W
Published: May 2020

Introduction

Sleep disturbances including short sleep duration are common in older adults, especially in those with Alzheimer’s disease (AD). However, it is unclear to what extent sleep duration is a manifestation of AD disease process. We examined whether genetic variants related to AD influence sleep duration in middle-aged and older adults and estimated the causal effects of AD on sleep duration using a mendelian randomization (MR) analysis.

Methods

We examined 406,687 UK Biobank participants with Caucasian genetic ancestry who self-reported sleep duration at baseline (2006-2010). Sleep duration was assessed by asking: “About how many hours sleep do you get in every 24 hours? (please include naps).” A genetic risk score for AD (AD-GRS) was calculated as a weighted sum of 23 previously identified AD-related single nucleotide polymorphisms in individuals of European ancestry. We evaluated whether AD-GRS predicted sleep duration using linear regression, adjusting for age, sex and principle components for genetic ancestry. We also stratified the analysis by age at baseline (≤55y or >55y) and conducted a MR analysis to estimate the effect of AD (ICD-9/10 codes for AD/dementia diagnosis) on sleep duration.

Results

The participants (aged 56.91±8.00y) had an average sleep duration of 7.2 (Standard deviation [SD]=1.1) hours and AD-GRS of 0.11 (SD=0.40) (range: -1.15~1.85). Higher AD-GRS score predicted shorter sleep duration (b= -0.013, 95%CI:-0.022,-0.005), mainly among those aged over 55y (b= -0.023, 95%CI:-0.034,-0.012) and not in those 55y or younger (b= 0.006, 95%CI:-0.012,0.013); p for interaction by age=0.02. MR analysis using AD-GRS as an instrumental variable suggested that AD was associated with 1.76 hrs (b=-1.76, -2.62~ -0.90) shorter sleep duration in those aged >55y.

Conclusion

Using a novel analytical approach, we found that higher genetic risk for AD predicted shorter sleep duration among older adults. This suggests shared genetic pathways; the biologic processes that lead to AD may also affect sleep duration.

Support

Dr. Leng received support from the National Institute on Aging (NIA) 1K99AG056598, and from GBHI, Alzheimer’s Association, and Alzheimer’s Society (GBHI ALZ UK-19-591141).
1153 Association Of Nocturnal Sleep Disturbance And Prospective Cognitive Decline In Cognitive Normal Elderly: Findings From The National Alzheimer’s Coordinating Center Uniform Dataset
Authors: Bubu O M , Mbah A K , Williams N J , Turner A D , Parekh A , Mullins A E , Kam K , Umasabor-Bubu O Q , Varga A W , Rapoport D M , Ayappa I , Jean-Louis G , Osorio R S
Published: May 2020

Introduction

We determined whether nocturnal sleep disturbance (NSD) is associated with prospective cognitive decline in clinically normal older adults

Methods

Prospective longitudinal study utilizing data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data set (UDS). NSD data, as characterized by the Neuropsychiatric Inventory Questionnaire (NPI-Q), were derived from 10,600 participants at baseline, with at least one UDS follow-up visit, from 32 National Institute of Aging Alzheimer’s Disease Research Centers (ADRC). Prospective cognitive decline was characterized as incident mild cognitive impairment (MCI) diagnosis during UDS follow-up. Logistic mixed-effects model with random intercept and slope examined associations between the NSD and longitudinal cognitive decline. All models included age at baseline, sex, years of education, APOE ε4 status and their interactions with time. Time was operationalized as years from baseline for each participant.

Results

Of the 10,600 cognitively normal participants at baseline, 1,017 (8.6%) had NSD. The proportion of males versus females with sleep problems was 10.1% vs. 9.3% respectively. For participants with NSD and no NSD, the mean (SD) age was 71 (7.3) and 70 (5.7) years and average follow-up time was 5.2 (2.6) and 4.9 (2.7) years, respectively. Participants with NSD were significantly more likely to develop incident MCI during UDS follow-up (OR: 1.42, p =.003). The interaction of NSD with time was significant (p< .001) suggesting an increase in the likelihood of conversion to MCI increased over time. Furthermore, there were significant differences in mean conversion rates to MCI in the NSD group when the previous time-point was compared to the next (p<01), with a time dependent dose response in the risk of conversion to MCI observed.

Conclusion

In elderly cognitive-normal individuals, nocturnal sleep disturbance is associated with a time-dependent progression risk to MCI. These findings are consistent with the role of disturbed sleep in the development of Alzheimer’s Disease.

Support

NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01HL118624, R21AG049348, R21AG055002, R01AG056031, R01AG022374, R21AG059179, R01AG056682, R01AG056531, K07AG05268503, K23HL125939)
1166 Investigating Social Workers’ Sleep Health Knowledge: Opportunities to Promote Sleep Health Among Underserved Populations
Authors: Spadola C E , Groton D , Lopez R , Burke S L , Hilditch C , Pandey A , Littlewood K , Zhou E S , Bertisch S M
Published: May 2020

Introduction

Social workers are often front-line psychosocial providers working with underserved populations, many of whom struggle with sleep. They are uniquely positioned to promote sleep health among individuals experiencing health inequities. However, U.S. accredited social work programs do not require sleep health training. We used both quantitative and qualitative methodologies to investigate social work students’: a) sleep health knowledge; b) self-reported sleep quality; c) prior sleep health education; and d) client discussions about sleep, in order to inform the development of a sleep health training for social work students.

Methods

Twenty-five social work students were recruited via a listserv email sent at a Florida university. Participants were asked to complete the Sleep Beliefs Scale (SBS) and the Pittsburgh Sleep Quality Index (PSQI) and then to participate in a one-hour long focus group (3 groups with 6-11 students/group) conducted by experienced qualitative researchers.

Results

Mean age was 27.0±11.5 yrs, 92.0% were female, and 48.0% were non-Hispanic white, 28.0% African American, 16.0% Hispanic, 8.0% other. Only 28.0% indicated that they had ever discussed sleep with clients. Knowledge of healthy sleep behaviors (assessed via the SBS) was moderate on a 0-20 scale (13.88, S.D.= 2.7). Participants had an average PSQI score of 8.8 (SD.=4.0), reported sleeping an average of 6.0 hours (SD=1.6), and mean sleep efficiency of 87.0% (SD=12.0). Themes from focus group data highlight students’ lack of exposure to sleep health training and a dearth of sleep discussions in clinical practice.

Conclusion

Though social work students acknowledged the importance of sleep health promotion, they reported feeling ill-equipped to promote healthy sleep practices due to lack of sleep education. Sleep health training could allow social workers to confidently promote healthy sleep practices among their clients, recognize when appropriate to refer clients for evaluation for sleep disorders, and improve social workers’ own sleep health. An online educational program was subsequently created by study investigators to meet these aims.

Support

American Academy of Sleep Medicine Foundation
1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider
Authors: Levri J M , Jobe S , Albrecht J , Scharf S , Johnson A , Wickwire E
Published: May 2020

Introduction

Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers.

Methods

Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI).

Results

A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses.

Conclusion

Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients.

Support

This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).
1180 The Use Of Natural Language Processing To Extract Data From Psg Sleep Study Reports Using National Vha Electronic Medical Record Data
Authors: Nowakowski S , Razjouyan J , Naik A D , Agrawal R , Velamuri K , Singh S , Sharafkhaneh A
Published: May 2020

Introduction

In 2007, Congress asked the Department of Veteran Affairs to pay closer attention to the incidence of sleep disorders among veterans. We aimed to use natural language processing (NLP), a method that applies algorithms to understand the meaning and structure of sentences within Electronic Health Record (EHR) patient free-text notes, to identify the number of attended polysomnography (PSG) studies conducted in the Veterans Health Administration (VHA) and to evaluate the performance of NLP in extracting sleep data from the notes.

Methods

We identified 481,115 sleep studies using CPT code 95810 from 2000-19 in the national VHA. We used rule-based regular expression method (phrases: “sleep stage” and “arousal index”) to identify attended PSG reports in the patient free-text notes in the EHR, of which 69,847 records met the rule-based criteria. We randomly selected 178 notes to compare the accuracy of the algorithm in mining sleep parameters: total sleep time (TST), sleep efficiency (SE) and sleep onset latency (SOL) compared to human manual chart review.

Results

The number of documented PSG studies increased each year from 963 in 2000 to 14,209 in 2018. System performance of NLP compared to manually annotated reference standard in detecting sleep parameters was 83% for TST, 87% for SE, and 81% for SOL (accuracy benchmark ≥ 80%).

Conclusion

This study showed that NLP is a useful technique to mine EHR and extract data from patients’ free-text notes. Reasons that NLP is not 100% accurate included, the note authors used different phrasing (e.g., “recording duration”) which the NLP algorithm did not detect/extract or authors omitting sleep continuity variables from the notes. Nevertheless, this automated strategy to identify and extract sleep data can serve as an effective tool in large health care systems to be used for research and evaluation to improve sleep medicine patient care and outcomes.

Support

This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).
1187 What Types Of Organizations Provide Sleep-focused Workplace Health Promotion Programs For Their Employees? An Analysis Of The 2017 CDC Workplace Health In America Survey
Authors: Robbins R , Rosenberg E , Barger L K , Weaver M , Quan S F , Zeepvat J , Czeisler C A , Grandner M A
Published: May 2020

Introduction

There has been a rise in workplace health promotion programs (WHPP)’s in the U.S., designed to improve a variety of employee health behaviors such as exercise and nutrition. Yet, relatively few focus on the third pillar of health: Sleep.

Methods

The CDC collected data from a nationally-representative cohort of companies in 2017. Participants in this Workplace Health in America study completed online surveys reporting the type of WHPP offerings at their worksite and characteristics of their worksite, including occupational field (e.g., agriculture, management, wholesale/retail), workforce size (i.e., small: <100; moderate: 100-499; and large: 500+) and company type (e.g., non-profit, profit-private, profit-public, government). We identified factors associated with an increased likelihood of sleep-focused WHPP using logistic regression adjusted for company size and type. Analyses were weighted for nationally-representative estimates.

Results

Of the N=2,843 companies that provided information, N=261 (11.74%) reported having a sleep program. Worksites with large workforces (OR=4.8, p<0.0005), for-profit public companies (OR=9.0, p<0.0005), in wholesale/retail (OR=3.8, p<0.0005), and those with employer-subsidized full health insurance (OR=12.7, p<0.0005) were more likely to have a sleep-focused WHPP. Other predictors included more long-standing WHPP programs (6 years, OR=4.4, p<0.0005), the presence of employee health in the company’s mission (OR=4.5, p<0.0005), leadership buy-in (OR=3.5, p=0.007), and an annual health promotion budget >$50,000 (OR=11.3, p<0.0005).

Conclusion

In general, workplaces with higher budgets, more well-established health promotion programs, and a mission to promote workplace health are more likely to include a sleep program. Also, publicly-traded companies and government were more likely than private companies to have a sleep program. Future research may consider defining barriers among small business and non-profit organizations for implementing sleep-focused workplace health programs.

Support

T32HL007901
1209 Effect Of Wearables On Sleep In Healthy Individuals: A Randomized Cross-over Trial And Validation Study
Authors: Berryhill S , Morton C J , Dean A , Berryhill A , Provencio-Dean N , Patel S I , Estep L , Combs D , Mashaqi S , Gerald L B , Krishnan J , Parthasarathy S
Published: May 2020

Introduction

To determine whether a wearable sleep-tracker improves perceived sleep quality in healthy subjects. To test whether wearables reliably measure sleep quantity and quality compared to polysomnography.

Methods

A single-center randomized cross-over trial of community-based participants without medical conditions or sleep disorders. Wearable device (WHOOP, Inc.) that provided feedback regarding sleep information to the participant for 1-week and maintaining sleep logs versus 1-week of maintaining sleep logs alone. Self-reported daily sleep behaviors were documented in sleep logs. Polysomnography was performed on one night when wearing the wearable. PROMIS Sleep disturbance sleep scale was measured at baseline, 7, and 14 days of study participation.

Results

In 32 participants (21 women; 23.8 + 5 years), wearables improved nighttime sleep quality (PROMIS sleep disturbance; B= -1.69; 95% Confidence Interval -3.11, -0.27; P=0.021) after adjusting for age, sex, baseline, and order effect. There was a small increase in self-reported daytime naps when wearing the device (B = 3.2; SE 1.4; P=0.023) but total daily sleep remained unchanged (P=0.43). The wearable had low bias (2.5 minutes) and low precision (5.6 minutes) errors for measuring sleep duration and measured dream sleep and slow wave sleep accurately (Intra-class coefficient 0.74 + 0.28 and 0.85 + 0.15, respectively). Bias and precision error for heart rate (bias -0.17%; precision 1.5%) and respiratory rate (bias 1.8%’ precision 6.7%) were very low when compared to that measured by electrocardiogram and inductance plethysmography during polysomnography.

Conclusion

In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables.

Support

WHOOP Inc.
1218 Obstructive Sleep Apnea Due To Oromandibular Dystonia And Treated With Botulinum Toxin
Authors: Hsieh Caleb , Hsu Nancy , Thomas Aaron , Chang Melisa , Ryden Armand , Zeidler Michelle
Published: May 2020

Introduction

Abnormalities of the upper airway are an underrecognized cause of obstructive sleep apnea (OSA). Oromandibular dystonia (OMD) is characterized by involuntary contractions of the masticatory, facial, pharyngeal or laryngeal muscles usually resulting in pain, dysarthria, dysphagia, or impaired mastication. We present a patient with OMD manifest as episodic OSA and sleep maintenance insomnia treated effectively with botulinum toxin injections of the temporalis and masseter muscles.

Report of Case

A 51-year-old man was referred for fatigue and insomnia. History was notable for prior facial trauma requiring jaw surgeries with titanium prostheses and chronic OMD requiring periodic botulinum toxin injections of the temporalis and masseter muscles.

An initial home sleep test (HST) 43 days after the last botulinum toxin injection showed a respiratory event index of 6.5 events/hour. Given severity of symptoms, positive airway pressure (PAP) was initiated; however, due to poor tolerance and persistent symptoms, he was referred for attended polysomnography (PSG). The PSG was done 13 days after an injection and showed apnea-hypopnea index (AHI) of 0 events/hour. Because the patient continued to endorse episodically severe symptoms that he felt paralleled the severity of OMD and waning of botulinum toxin effect, a repeat PSG was performed at a subjective botulinum toxin effect nadir. This PSG done at 83 days post-injection demonstrated AHI of 84 events/hour. PAP therapy was thus resumed, and the patient’s symptoms improved with increased frequency of botulinum toxin treatments.

Conclusion

To our knowledge, this is the first report of OSA due to chronic dystonia of the facial muscles. Botulinum toxin has demonstrated benefit in the treatment of OMD with efficacy generally lasting three to six months. While PAP remains the first-line treatment for OSA, in patients with structural or functional abnormalities of the upper airway, it is important to also consider treatment of the underlying anatomical defect.
1219 A CASE OF A NIGHT TIME AFFAIR
Authors: Ali Hamed , Stevens Suzanne
Published: May 2020

Introduction

Sleep associated seizures especially Nocturnal Frontal Lobe Epilepsy (NFLE) represents a spectrum of challenging clinical manifestations presenting as complex nocturnal movements/behaviors, making the diagnosis often difficult.

Report of Case

A 64 y/o male, with history of ongoing complex movements occurring during his sleep, with no history of strokes or neurological deficits. Had extensive neurologic workup (all negative) including routine electroencephalogram (EEG), prolonged inpatient EEG (12 hours), and MRI of the brain. Home sleep study showing moderate obstructive sleep apnea (OSA) AHI 24/hour successfully treated with CPAP therapy (residual AHI 1.7/hour) with improved nighttime symptoms initially. Wife recalls events as happening only at night while sleep, as patient often confused upon waking up in the morning, at times appear to sit up and smack his lips. No nighttime hallucinations, sleep paralysis, or acting out dreams were reported. Had two episodes associated with tongue biting and loss of bladder control. Another episode happened after a daytime nap, patient went outside and was mowing his lawn, went “completely blank “, appeared confused. No daytime or nighttime seizures were ever noticed. Patient do not recall any of the above events. Repeat EEG was normal. MRI/MRA of the head /neck showed small tiny focus in left frontoparietal lobe, suggesting remote cortical ischemic injury. Polysomnography (PSG) with seizure montage showed Interictal epileptic discharges (IEDs) foci recorded in the frontal/frontopolar leads without accompanying body movements. Interictal spike and wave activity seen during stage N2.

Initially treated with carbamazepine (had skin reaction) switched to levetiracetam with complete resolution of his symptoms.

Conclusion

This case illustrates the importance of reviewing the clinical history, behavior semiology, and diagnostic ancillary testing such as polysomnography with EEG monitoring in distinguishing nocturnal epileptic seizures from other nocturnal complex behavior disorders and parasomnias.
1256 Narcolepsy Type 2 in a Pediatric Patient with Auto-Immune Disease
Authors: Madhavarapu Sumith , Patel Amee
Published: May 2020

Introduction

We present a case of Narcolepsy Type 2 in the setting of concomitant auto-immune disease.

Report of Case

At 9 years of age, an African-American female was referred to a sleep center for fatigue, excessive daytime sleepiness (EDS), and snoring. Polysomnogram (PSG) at an outside facility recorded a total sleep time (TST) of 408 minutes, 92% sleep efficiency (SE), sleep onset latency (SOL) 22 minutes, REM latency 70 minutes, and apnea-hypopnea index (AHI) of 0.3. Multiple Sleep Latency Test (MSLT) was not done at that time. Due to her daytime sleepiness, methylphenidate was initiated empirically twice daily with improvement in daytime sleepiness and sleep maintenance. Over time, methylphenidate was steadily increased due to increasing daytime sleepiness. Between 14 to 15 years of age, she developed increased fatigue, skin changes, arthralgias, myalgias, and presented to our hospital in respiratory distress secondary to severe pulmonary hypertension. Clinical exam and workup indicated scleroderma. Methylphenidate was discontinued due to pulmonary hypertension. At 17 years of age (after receiving treatment for scleroderma and pulmonary hypertension), she had an overnight PSG followed by MSLT. PSG recorded TST 309 minutes, 67% SE, SOL 1.5 minutes, REM latency 48 minutes, AHI 0.2. The MSLT recorded a mean SOL of 2.4 minutes with 2 out of 4 sleep onset REM periods - diagnostic of narcolepsy. She does not endorse cataplexy, hallucinations or sleep paralysis.

Conclusion

While the link between Narcolepsy Type 1 and an auto-mediated process is more supported given consistent human leukocyte antigen findings, the link between Narcolepsy Type 2 and auto-immune mediated process is less clear. Patients with autoimmune disease may have symptoms of narcolepsy; therefore, they may benefit from screening for EDS.
1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation
Authors: Nuzhny V , Kleerup E C , Zeidler M R
Published: May 2020

Introduction

Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia.

Report of Case

This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask.

Conclusion

This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.
1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia
Authors: Manetta I , Almeida A , Schwartz D , Meira e Cruz M
Published: May 2020

Introduction

Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care.

Report of Case

We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3)

Conclusion

This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.
0129 Association of Sleep Quality with Serum Lipids in Obese Adults
Authors: Mehta B , Ankita A , Raghav P , Chambial S , Dutt N
Published: May 2020

Introduction

Sleep disturbances have been associated with metabolic dysregulation and have known to contribute to weight gain, obesity, type II diabetes, and cardiovascular disease risk. Obesity due to sleep fragmentation is mediated by multiple pathways like upregulation of orexin neurons and changes in appetite-regulating hormones like Leptin, Ghrelin, which affect food intake and hedonic feeding. Conversely, body mass index (BMI) is associated with alterations in sleep and with high circulating lipids and incidence of coronary heart disease. We hypothesized that poor sleep quality is associated with an adverse serum lipid profile.

Methods

In this cross-sectional study, till date, 27 obese adult participants were recruited after informed consent. The obesity criterion was taken as BMI ≥ 25 kg/m2. Anthropometric parameters, waist circumference, neck circumference, hip circumference, and BP were measured. Sleep quality was assessed by the “Pittsburgh Sleep Quality Index” (PSQI) questionnaire. A score of 5 or more was considered to be adverse sleep. The fasting blood sugar and lipid profile of each participant was determined.

Results

The average age, BMI and waist circumference of the subjects were 48.96 ±13.9 years, 32.41± 6.18 kg/m2 and 107.4 ±12.18 cm respectively. The Spearman correlation test revealed a significant correlation between the PSQI scores and triglyceride levels of the participants (p=0.033, r = 0.420). The correlation with BMI (p=0.33, r=0.192), fasting blood sugar (p=0.26, r=0.241), HDL (p=0.27, r = -0.221) and waist circumference (p=0.69, r = -0.082) were not found to be statistically significant.

Conclusion

We conclude that high triglyceride levels are associated with poor quality of sleep in adults. Although other biochemical parameters did not show a significant correlation, a greater sample size may give us a clear insight into it.

Support

The study is an intramural project supported by AIIMS, Jodhpur.
0157 The Relationship Between Reaction Time, Insomnia Severity, Sleepiness, and Dysfunctional Beliefs About Sleep
Authors: Gencarelli A M , Zurlinden T , Nicoletta A , Winters A , Sorrell A , Corbett Q , Everhart E
Published: May 2020

Introduction

Poor sleep quality has adverse effects ranging from decreased focus to increased work-related injuries. The Perceptual Vigilance Task (PVT), a measure of reaction time (RT) used to assess alertness is commonly used in sleep research. This study focuses on the relationship between dysfunctional sleep-related cognitions (Dysfunctional Beliefs and Attitudes About Sleep Scale [DBAS]), insomnia severity (Insomnia Severity Index [ISI]), and sleepiness (Epworth Sleepiness Scale [ESS]) and their association to PVT RT.

Methods

162 participants were recruited from East Carolina University. Inclusion criteria: right-handed adults; exclusion criteria: history of brain injury, seizure disorder, or vision impairment. Age range 18–39 (M = 20.15; SD = 3.01); 81 (49.1%) females.

Results

ISI was correlated with PVT RT for inter-stimulus interval delay times of 1000ms r(162) = .155, p =.05, 2000ms r(162) = .204, p = .009, 5000ms r(162) =.164, p = .04, and 6000ms r(162) = .181, p = .02. DBAS was correlated with PVT RT for delay times of 2000ms r(162) = .204, p =.021, 3000ms r(162) = .160, p = .04, 4000ms r(162) = .170, p = .03, 6000ms r(162) = .171, p = .030, 7000ms r(162) = .219, p =.005, and 8000ms r(162) = .158 p = .045. ESS was not correlated with PVT. A regression was calculated to predict reaction time at 7000ms delay based on the DBAS (F(1,151) = 2.51, p = .01), with an R2 of .12.

Conclusion

There is a diminishing association found between insomnia severity and RT during inter-stimulus delay times (>6000ms). Dysfunctional beliefs about sleep correlate with RT through 8000ms delay, eventually predicting RT. Regardless of severity of sleep disturbance, sleep-related bias may affect subjective feelings of wakefulness and objective levels of alertness (e.g., one who believes they are not obtaining sufficient sleep may act accordingly).

Support

N/A
0181 Stressor Reactivity to Insufficient Sleep in Oncology Nurses: Does Work Shift Matter?
Authors: Vigoureux T F , Lee S
Published: May 2020

Introduction

Individuals generally perceive more stressors on days following nights with shorter-than-usual sleep duration. Recent research shows that this daily sleep—stress relationship (i.e., stressor reactivity to insufficient sleep) is stronger for some than for others. Workers in certain occupations, such as oncology nurses, may be more prone to insufficient sleep and/or more stressors. Given the impact of work schedule on sleep, this study examined whether stressor reactivity to insufficient sleep differed between day and night shift nurses working at a cancer hospital.

Methods

Participants were 39 day-shift and 19 night-shift nurses at a cancer hospital (Mage=35.36±12.00). Using ecological momentary assessments for 14 days, we asked participants about their previous night’s sleep characteristics and their daily stressor frequency and severity before lunch, during afternoon, and before bedtime. Using multi-level modeling, we tested whether previous night’s sleep duration, quality, or sufficiency predicted next day’s total stressor frequency or severity. For analyses with significant within-person effects, we extracted a reactivity slope for each participant. We used t-tests to examine whether day and night shift nurses differed in reactivity.

Results

There were significant within-person associations of sleep duration with (a) stressor frequency (b=-.07, p<.001) and (b) stressor severity (b=-.76, p<.001), but no associations of sleep quality or sufficiency with stressor frequency or severity. Day and night shift nurses did not differ in either of these operationalizations of stressor reactivity to insufficient sleep, or on any stressor or sleep variables except for average sleep duration (Mnight=6.87±2.57 vs. Mday=8.02±1.84, p<.001).

Conclusion

These findings suggest that the phenomenon of perceiving more stressors in response to insufficient sleep exists regardless of work shifts. Given the previously found association between stressor reactivity to insufficient sleep and body mass index in middle-aged workers, further analyses will test how this reactivity is associated with health outcomes in oncology nurses.

Support

This work was supported, in part, by the University of South Florida College of Behavioral & Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).
0203 To and From the Night Shift: Risky On-the-Road Driving in Night Shift Workers
Authors: Murugan N , Sagong C , Cuamatzi Castelan A S , Moss K , Roth T , Drake C L , Cheng P
Published: May 2020

Introduction

Drowsy driving is a common occupational hazard for night shift workers (NSWs). While sleep loss is commonly identified as the primary culprit of drowsy driving, another critical factor to consider is circadian phase. However, the role of circadian phase in driving safety has not been well characterized in NSWs. This study examined if dim light melatonin offset (DLMOff, i.e. the cessation of melatonin secretion) is also a relevant phase marker of susceptibility to four different subtypes of risky on-the-road driving behaviors.

Methods

On-the-road driving was monitored over 8 weeks via a mobile application that tracked risky driving behaviors using accelerometer and GPS data from cell phones (N=15; 3052 total driving events recorded). Risky driving behaviors included: 1) frequency of hard-braking events, 2) frequency of aggressive-acceleration events, 3) duration of excessive-speeding, and 4) duration of phone-usage. At week 2, participants spent 24 hours in-lab where hourly saliva samples were collected and assayed for melatonin, and DLMOff was calculated. Phase angle of driving events relative to DLMOff was used as the predictor in nested mixed-effects regressions, with risky driving behaviors as the outcome variables.

Results

The most common occurrences of risky driving were phone-usage and hard-braking. On average, NSWs had 46.7% and 42.0% of driving events with at least one occurrence of phone-usage and hard-braking, respectively. Rates of aggressive-acceleration and speeding were 24.4% and 20.4%. Positive phase angles (i.e. driving after DLMOff) were associated with reduced rates of hard-braking and aggressive-acceleration, but not of phone-usage and excessive-speeding. Specifically, rates of hard-braking and aggressive-acceleration decreased by 4.5% (p<.01) and 3.4% (p=.05) every two hours following DLMOff, respectively.

Conclusion

The study suggests DLMOff appears to be an important variable for predicting accident risk in NSWs. If replicated, circadian phase should be considered in recommendations to increase occupational health and safety of NSWs.

Support

Support for this study was provided to PC by NHLBI (K23HL138166).
0219 Subjective Sleep Quality Measured Before, Predicts Psychological Safety After Simulated Combat Training. Testing the Bidirectional Link Between Sleep and Social Processes in the Military Operational Context
Authors: Sowden W , St. Pierre M , Mickelson C , Mantua J
Published: May 2020

Introduction

The research on sleep in the social-psychological domain is sparse. Gordon and colleagues (Gordon, Mendes, & Prather, 2017) proposed a bidirectional relationship between sleep and social processes. The current research tests this model in the military by examining the relationship between subjective sleep quality and an important social cognitive process in the contexts of military teams - psychological safety (i.e., an individual’s perceptions of interpersonal threat in their work environment; Edmondson, 1999).

Methods

One hundred and twenty-eight U.S. Army tank crewmen were surveyed prior to (T1), and immediately after (T2), participating in a two-week simulated combat training exercise. Each survey included the seven-item Insomnia Severity Index (ISI; Bastien et al., 2001), which served as a measure of subjective sleep quality (SSQ), and Edmonson’s seven-item Psychological Safety Questionnaire which measured team psychological safety (TPS). A cross-lagged panel model tested the effects of SSQ and TPS over the course of the training.

Results

Both SSQ and TPS were stable over the two time points, SSQT1: M=2.83, SD=.85, α=.83; SSQT2: M=2.63, SD=.83, α=.83; B=.387, SE=.08, β=.397, p<.001, and TPST1: M=3.7, SD=.72, α=.79; TPST2: M=3.67, SD=.75, α=.77; B=.619, SE=.07, β=.600, p<.001, respectively. Although SSQ and TPS were weakly related to one another at both time points, rT1=.122, p=.086 and rT2=.171, p = .028, only the cross-lagged path between SSQT1 predicting TPST2 was significant, B=.129, SE=.06, β=.147, p=.038. The cross-lagged path between TPST1 predicting SSQT2 was not significant, B=-.098, SE=.094, β=-.086, p=.296. Approximately 40% of the variance in CPS, R2=.4 as opposed to 17% in SSQ, R2=.17, was accounted for by the predictors in the model.

Conclusion

These results provide support for a directional (vs bidirectional) link between SSQ and TPS, insomuch that, in the context of military training, SSQ influences TPS, as opposed to the other way around. Elucidating the directionality of this relationship is not only important for advancing theory, but more importantly, it helps practitioners develop programs and policies that precisely address the right mechanism at the right time to maximize team effectiveness and wellbeing.

Support

This work was supported by the Military Operational Medicine Research Program (MOMRP).
0231 Sleep Behaviors of Female Collegiate Athletes
Authors: Frisco D J , Goodrich J A , Holliday M , Kroeker K A , Whiting C , Byrnes W C , Wright K P
Published: May 2020

Introduction

Sleep is critical to cognitive and physiologic function. It is likely being a female collegiate student athlete places unique demands upon sleep behavior. Therefore, we aimed to study the sleep behavior of female collegiate athletes versus a female collegiate control group.

Methods

Full time female students from the University of Colorado Boulder (Altitude = 1,624 m) were recruited from NCAA Division I athletic teams: Cross Country (XC, n=10), Lacrosse (LAX, n =17), Soccer (SOC, n=15), Golf (GOLF, n=6), Tennis (TENN, n=9). 31 female full-time students were recruited as Controls (CONT). Sleep was monitored with wrist actigraphy (Spectrum Actiwatch, Phillips) for a minimum of one week. Subjects were instructed to wear actigraphs at all times except during competition. Outcome variables included nightly sleep duration, total 24h sleep duration, sleep efficiency, sleep midpoint, social jet lag (SJL) and nap duration/frequency.

Results

On weekdays, XC, LAX and SOC had greater nightly sleep durations ~8.5h compared to TENN, GOLF and CONT (p<0.05). Relative to other groups, XC had the earliest sleep midpoint (3:34 AM ± 1:20 vs. 3:53 AM ± 1:15) while SOC and LAX had the lowest sleep efficiency (~87.3 ± 3.2% vs. ~89.6 ± 3.4%) (all p<0.05). There was significant SJL among CONT, LAX and SOC (difference of sleep midpoints on weekdays and weekends; p<0.05). While nightly sleep duration varied significantly between different groups, there were no significant differences in total daily sleep duration when naps are included. A greater percentage of CONT (87 %) napped compared to athletes (64.2 %) (p<0.05); napping duration/frequency of naps per week were not different between groups.

Conclusion

Variations in sleep behavior exists between collegiate student athletes based upon varsity sport with some sports being similar to controls and others being significantly different. Additional research is needed to determine the significance of these findings to academic and athletic performance.

Support

PAC-12 Student-Athlete Health and Wellbeing Initiative, Grant #1554240
0237 Effect of Chronic Intermittent Hypoxia on Spatial Performance in Rats
Authors: Xu J , Geng E , Brake L , Wiemken A , Keenan B , Kubin L , Schwab R
Published: May 2020

Introduction

Cognitive and spatial dysfunction is common among patients with obstructive sleep apnea (OSA). The cause of these abnormalities may be related to the effects of hypoxic damage in the brain during sleep. Here we report a rodent model for chronic intermittent hypoxia (CIH) that examines spatial performance tasks via a Barnes Maze paradigm. We hypothesized that increased severity of CIH yields decreased cognitive and spatial performance.

Methods

Three groups of rats were subject to varying levels of hypoxia conditions: sham (21% oxygen; n = 19), moderate (11% oxygen; n = 14), and severe (6% oxygen; n = 21). To deliver hypoxia, rats were exposed to three-minute cycles of oxygen between 21% and condition-specific nadir oxygen for 12 hours daily (during sleep) in specialized chambers. Barnes maze testing was performed at 0, 1, 2, and 3 months. Rats were placed on a circular platform with 19 shallow holes and one deeper target hole to escape the noxious sound. Each month, rats had 3 minutes to find the target hole in four daily trials over four consecutive days. Average maze completion time on day 4 was recorded.

Results

Rats from the three hypoxia groups did not differ significantly in mean maze completion time at baseline (0 months). Throughout the three months of exposure to hypoxic conditions, maze completion time on day 4 did not differ significantly from baseline for sham rats. However, by month 3, rats exposed to severe hypoxic conditions had a significantly larger percent increase from baseline compared to sham rats (p = 0.0358).

Conclusion

Our findings indicate that rats undergoing intermittent hypoxia perform worse than normoxic rats in spatial performance tasks. These data suggest there is a relationship between CIH and cognitive/spatial impairment.

Support

Funded by NIH P01 HL094307
0249 Effects of Alcohol Consumption on Sleep-Wake Pattern of a Rat Model of Anxiety
Authors: Fierro A , Cortés C , Eguibar J
Published: May 2020

Introduction

Anxiety is an important factor for self-administered alcohol as a tool to reduce its symptoms. However, alcohol is capable to disrupt sleep-wake patterns in subjects with medium- to high-alcohol consumption. We have selectively bred two sublines from Sprague-Dawley rats that differ on its yawning frequency. High-yawning (HY) rats have a mean of 20 yawns/h, whereas the Low-yawning (LY) rats have only 2 yawns/hour. LY rats also showed anxious responses when evaluated on standardized tests. The aim of this study was to assess the changes on sleep-wake patterns after chronic alcohol consumption.

Methods

We used 8 males from HY and LY sublines at 3 months of age, they lived in acrylic cages with water and food pellets available ad libitum under a 12:12 light-dark cycle (lights on at 0700) and temperature of 21±1 °C. All subjects were implanted to record EEG, EMG and EOG to characterize sleep-wake phases. A baseline sleep-wake recording was obtained for 24 h. A solution of 9.6% alcohol was administered as a single source of hydration for seven days and then a second sleep-wake recording was obtained. After that period, an additional bottle containing purified water was available. Position of the bottles was randomly changed daily. Water and alcohol consumption were measured daily for a period of 3 weeks and then a third sleep-wake recording was obtained.

Results

LY rats consumed more alcohol than HY rats (P<0.05), and they had an increase of bouts and duration of slow wave sleep and REM sleep on their active phase after alcohol administration (P<0.05).

Conclusion

LY rats display an anxious behavior and therefore consumed more alcohol compared to HY rats, and only LY rats were susceptible to alcohol effects on sleep on their active phase.

Support

Partially supported by CONACYT grants 243333 and 243247 to CC and JRE, respectively. Grants from VIEP-BUAP 2018 and CA in Neuroendocrinología BUAP-CA-288.
0252 Influence of Sleep on Negative Social Judgment
Authors: Corona F E , Mednick S C
Published: May 2020

Introduction

Sleep plays an important role in emotional regulation. Emotional regulation can be disrupted by psychosocial stress, including social judgment. It is not known whether sleep can regulate emotions arising from social judgment. The aim of this study is to determine if sleep can reduce emotional reactivity associated with negative social judgment.

Methods

On day one, subjects participated in a social judgment task (SJT) in the morning, followed by a nap or wake condition. Subjects’ physiological responses to social judgment task (skin conductance and heart rate) and mood were measured before and after the SJT, after the nap/wake condition, and once on day three.

Results

Mood ratings decreased after social judgment for all subjects, but increased following the nap intervention. Mood ratings improved after the 2 day delay. There were no changes in social status. Skin conductance during judgment decreased for subjects in nap condition, but not wake. After a 2 day delay, skin conductance decreased across subjects, with those in nap condition experiencing greater decrease. Heart rate response during social judgment exposure decreased only for those in nap group, with a 2 day delay showing decreased heart rate response across all subjects.

Conclusion

A nap directly following social judgment buffers negative response to the experience by decreasing emotional reactivity as measured by mood, skin conductance, and heart rate response. No differences were found between nappers and non-nappers on day three, suggesting that sleep benefits emotional reactivity associated with the stress of social judgment and that these benefits can happen with a nap or a night of sleep, more than a period of wake.

Support

University of California, Irvine.