bluuebunny/crossref_metadata_2025 huggingface dataset:
0532 Global prevalence of mild Obstructive Sleep Apnea in females
Authors: Wimms Alison , Benjafield Adam , Valentine Kate , Malhotra Atul
Published: May 2023

Introduction

CPAP has been shown to be beneficial in symptomatic mild OSA. While many healthcare systems have appropriate pathways for treatment of moderate-severe OSA, there remain questions on how to manage treatment optimally for the mild OSA population. Females with OSA tend to be milder than their male counterparts, with lower AHIs, less oxygen desaturations, and different symptoms such as fatigue and insomnia. Females with mild OSA are at risk of being underdiagnosed and under treated. We explored global prevalence data to understand better the scope of this issue.

Methods

A recent publication contained estimations of the global prevalence and burden of OSA. This prevalence was calculated using sex and aged matched data from published prevalence studies, along with estimates for countries without prevalence data, a process which was done by matching the country to a similar country with prevalence data based on BMI, race, and geographical proximity. Finally, a newly developed conversion algorithm was used to standardize different scoring methodologies and to provide equivalent AHI. Raw data from this global prevalence exploration have been divided by sex, and then categorized based on the World Bank 2022 country income rankings, in order to estimate the prevalence of mild OSA in women.

Results

Data from adults aged 30-70 from 164 countries were included in this analysis. Data from 29 low-income countries were excluded due to insufficient information. Based on AASM 2012 scoring, it is estimated that globally at least 202,157,057 of 1,513,628,587 (13.4%) females have mild OSA. The prevalence of mild OSA was 14.6, 15.3, and 10.6% in females; compared to 23.5, 18.3, and 16.3% in males; in high income, upper-middle income, and lower-middle income countries, respectively. The prevalence of moderate-severe OSA was 9.9, 8.5, and 9.4% in females; compared to 22.2, 18.8, and 13.6% in males; in high income, upper-middle income, and lower-middle income countries, respectively.

Conclusion

Globally, mild OSA affects at least 202 million females (13.4%). The highest global OSA prevalence of 15.3% was seen in upper-middle income countries. Continuing awareness, education and appropriate treatment pathways are crucial to ensure this important group are not overlooked.

Support (if any)

This analysis was funded by ResMed.
0557 Sleep apnea detection using photoplethysmography using wearable electronic devices : A systematic review and meta-analysis
Authors: Sharma Rohit , Nguyen-Luu Tristan , Singh Prashant Kumar , Sardar Sundus , Saraza Mohammad , Abbas Sayeda Z , Mirza Wasique
Published: May 2023

Introduction

Sleep apnea, a hyper common disorder is estimated to affect almost 1 billion people with the prevalence of more than 50% in some countries. It is almost impossible to do gold standard polysomnography for all the population for screening. Multiple studies have reported the use of cost effective wearable devices using photoplethysmography (PPG) for the screening. To our knowledge, we presented the first meta-analysis of all studies looking at PPG and screening of sleep apnea.

Methods

We conducted a systematic review and meta-analysis under the PRISMA guidelines. Study Eligibility criteria included patients aged > 18 without a prior diagnosis of sleep disorder. The intervention included screening using a wearable device using PPG with comparison using standard of care sleep study (e.g polysomnography). The databases used were Cochrane, PubMed, Embase and Google scholar. Search strategy with Boolean logic included Sleep apnea, wearable device, smart, photoplethysmography, PPG, smart and smartwatch. Outcomes were pooled diagnostic odds ratio, meta-analyzed area under the curve (AUC),, and forest plots of sensitivity & specificity. Statistical analysis was done using the programming language R with R package mada. Fixed and random effects models were used to derive diagnostic odds ratio (DOR) and paired forest plots for sensitivity & specificity. Summary Receiver operation curve was made using proportional hazard model and Reitsma et al model with a bivariate approach.

Results

The search strategy revealed following number of studies: PubMed (270), Cochrane (0), Embase (41), and Google Scholar(728). Total of 12 studies were included. We found high DOR with the fixed effect model which was 28.979. Mean DOR with the random effects model was 27.6. Bivariate diagnostic random-effects meta-analyzed AUC was 0.902. Studies used various electronic devices some of which are commercially available such as E4 Wristband, Galaxy watch 4, Smartwatch GT2, Belun ring etc. 4 studies used PPG solely while others used multimodal data. 7 studies used conventional machine learning algorithm for analysis.

Conclusion

Screening of sleep apnea could be done in a cost-effective manner from commercially available devices using photoplethysmography owing to possible high sensitivity, AUC and DOR. More studies for data replicability and further standardization is needed.

Support (if any)
0569 Upper Airway Stimulation for OSA: A case series of patients developing intolerance to a previously well tolerated setting
Authors: Brahmandam Sravya , Chan Lawrence , Khan Meena , Chase Margaret
Published: May 2023

Introduction

Hypoglossal nerve stimulation (HNS) is an effective treatment for moderate to severe OSA in patients unable to tolerate PAP therapy. Longitudinal stability of HNS stimulation threshold has been reported. We report a series of 3 patients who developed intolerance over time to previously tolerated and efficacious HNS settings necessitating adjustment to therapy.

Methods

Retrospective chart review.

Results

Patient 1 is a 49 y/o male with moderate OSA implanted with HNS in June 2019. Titration study February 2020 found 2.1V was optimal amplitude. He reported tolerance and benefit of this setting until July 2022. Tongue protrusion was assessed and found to be good at 1.3V. He subsequently tolerated 1.3V well, self-escalating to 1.6V at follow up in Oct 2022. HST is pending. Patient 2 is a 62 y/o female with severe OSA implanted with HNS in Nov 2019. At titration March 2020 3V was optimal amplitude. She reported tolerance and benefit of this setting until December 2021. Tongue protrusion was assessed and found to be good at 2.3V. At follow up April 2022 she reported good tolerance and benefit of 2.3V and HST in July 2022 showed an REI of 8.7. Patient 3 is a 61 y/o female with moderate OSA implanted with HNS in April 2021. At titration August 2021 1.5V was optimal amplitude. She reported tolerance and benefit of this setting until February 2022. Tongue protrusion was assessed and found to be good at 1.0V. HST April 2022 demonstrated an REI of 6.6 at 1V. The patient reported tolerance and benefit to therapy at this level.

Conclusion

Most patients demonstrate stability in HNS stimulation threshold over time, but we describe 3 patients who developed intolerance of a previously tolerated therapeutic setting. No patients reported changes in medical issues, medications, or weight loss as an explanation for developing intolerance. Possible etiologies include delayed nerve healing or change in nerve conduction over time. This may represent a source of potential non-adherence to therapy. Consideration for reduction in amplitude based on objective tongue protrusion may be an appropriate intervention for these patients. Adjustments to therapy should be followed by objective measures of efficacy.

Support (if any)
0640 Depression Symptom Outcomes After a Self-Guided Mobile Application CBT-I Intervention Among College Students
Authors: Hire Veronica , Egeler Mara , Walker Jamie , Dickens Harrison , Vargas Ivan
Published: May 2023

Introduction

Previous research has shown that approximately 78% of college students who suffer from insomnia also endorsed depressive symptoms. Students with depression were 9.5 times more likely to have insomnia than students who did not have depression. There has also been evidence that Cognitive Behavioral Therapy for Insomnia (CBT-I) can reduce depression symptoms. However, the effectiveness of a self-guided mobile version of CBT-I (iCBT-I) in reducing depression among college students has yet to be evaluated. This study aims to assess depression symptoms among students who engaged in a self-guided iCBT-I intervention.

Methods

The study uses a between- and within-subjects design to assess biweekly changes in depression symptom severity before and after completing a four-week mobile intervention for insomnia (i.e., CBT-I Coach). Participants included 39 University of Arkansas college students with a baseline insomnia severity index score ≥ 15. Participants were randomized into the intervention group or a wait-list control group. Participants in both groups are asked to use the CBT-I Coach app for 4 weeks (control group began intervention after a four-week delay). Every four weeks, the Center for Epidemiological Studies Depression Scale was administered to assess depressive symptomology.

Results

Preliminary analyses showed a reduction in CES-D mean scores between baseline (M = 28.3) and week four (M = 25.4) of the intervention group. The intervention group also experienced a depression score rebound at week eight (M = 28.9). The wait-list control group experienced little change in mean CES-D scores from pre-to-post intervention, baseline (M = 23.4), week four (M = 24.2), week eight (M = 23.7).

Conclusion

These results may lend evidence for the short-term effectiveness of iCBT-I in reducing depression symptoms. This could allow for wider dissemination of this treatment modality across a population who suffer from comorbid insomnia and depression.

Support (if any)

K23 HL141581
0641 Difficulty Maintaining Sleep and Sleep Quality mediate the Relationship between Sleep Disturbances and Depression
Authors: Kim Kelly , Huskey Alisa , Taylor Daniel
Published: May 2023

Introduction

Prior epidemiological research has established the relationship between sleep disturbances and depression. Sleep disturbances are also common prodromal features of and comorbid with depression. However, limitations exist across past studies, including the frequent focus on “sleep disturbances” over well-defined facets of sleep, inattention to mediators, and a lack of focus on special populations. As such, there is a need to delineate the relationship between sleep disturbances and depression across specific facets of sleep, particularly in special populations. The current study examined multiple sleep facets as mediators of the relationship between general sleep disturbances and depression severity in college student athletes.

Methods

Student athletes (N = 993) from the Pacific Athlete Conference-12 completed the Athlete Sleep Screening Questionnaire-Sleep Difficulty Subscale (ASSQ-SDS) and Patient Health Questionnaire-9 (PHQ-9). Parallel multiple mediator models were conducted to examine whether the relationship between sleep disturbances and depression severity was mediated by sleep duration, sleep quality, sleep onset latency, and difficulty maintaining sleep.

Results

Using bootstrapping with 5,000 resamples, the indirect effect of sleep disturbances on depression severity was significantly different from zero through sleep quality (indirect effect = .17, SE = .07, 95% CI [.04, .31]) and difficulty maintaining sleep (indirect effect = .12, SE = .03, 95% CI [.06, .19]). Sleep disturbances were associated with sleep quality (b = .29, SE = .01, p < .001) and difficulty maintaining sleep (b = .16, SE = .01, p < .001). Sleep quality (b = .59, SE = .16, p < .001) and difficulty maintaining sleep (b = .78, SE = .17, p < .001) were associated with depression severity. No other mediators reached statistical significance.

Conclusion

Results demonstrate that perceived sleep quality and difficulty maintaining sleep mediate the relationship between general sleep disturbances and depression severity in college student athletes. Findings suggest that sleep quality and difficulty maintaining sleep may be more impactful on depression than other facets of sleep and may be clinically useful targets of intervention for depression.

Support (if any)
0661 Natural History of Nightmares from Childhood to Young Adulthood: A Longitudinal, Population-based Study
Authors: Atha Raegan , Paquet Caitlin , Calhoun Susan , He Fan , Vgontzas Alexandros , Liao Jason , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: May 2023

Introduction

Nightmares are common in childhood and typically become less prevalent in adulthood. However, little is known about the natural course of nightmares as children grow into adulthood. The purpose of this study was to examine the longitudinal trajectory of nightmares from childhood to adulthood to determine population-based remission, incidence, and persistence rates.

Methods

The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline) who returned for follow-up visits during adolescence and young adulthood. For the current study, 258 young adults (25.1±2.7 years old, 53.9% female, 24.8% minority population) completed their follow-up visit (15.9±2.0 years later). Nightmares were defined by parent-report in childhood and self-report in adulthood, based on severity. Rates of persistence, remission, and incidence for nightmares were computed.

Results

The persistence rate was 28% for mild childhood nightmares and 23% for moderate-to-severe childhood nightmares. About 13% of children with mild nightmares experienced a worsening into moderate-to-severe adult nightmares. The full remission rates was 58% and 32% for mild and moderate-to-severe severe childhood nightmares, respectively. About 45% of children with moderate-to-severe severe nightmares experienced partial remission into mild adult nightmares. Among children without nightmares, 32% and 8% developed mild and moderate-to-severe nightmares, respectively, in adulthood.

Conclusion

Moderate-to-severe nightmares only fully remit in about a third of children in by young adulthood. In addition, about one out of ten children with mild nightmares will worsen in severity by young adulthood. Furthermore, a significant number of children will newly-develop significant nightmares in young adulthood. Given the association of nightmares with adverse mental health outcomes, nightmares should become a focus of independent research and prevention practices.

Support (if any)

National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0679 Do Individuals with ADHD and Sleep Disorders Symptoms Exhibit Worse Executive Function?
Authors: Seewald Mark , Rosenfield Brad , Ramsay J Russell , Alio Courtney , DiTomasso Robert , Muench Alexandria , Boyle Julia , Thompson Michelle , Perlis Michael
Published: May 2023

Introduction

Sleep disorders in individuals with Attention Deficit Hyperactivity Disorder (ADHD) are more prevalent than in people without ADHD. Given that sleep disorders (e.g., insomnia and OSA) impact daytime function (e.g., mood, memory, motivation, attention, executive function [EF], etc.), it is reasonable to wonder if these domains interact. Thus, the aim of the present analysis was to evaluate subjects diagnosed with ADHD who were also symptomatic for insomnia or OSA on a self-report measure of executive function. The hypothesis for the analysis being: subjects with insomnia would show more severe executive function deficits as compared to subjects without symptoms of insomnia and/or subjects with OSA.

Methods

This analysis includes data from 149 subjects diagnosed with ADHD (38% female, Mage 32.8±13.2yrs). Sleep disorder and EF data was provided by the Penn ADHD Treatment and Research Program. Database assessments were gathered from intakes, which included the SDS-CL-25 (a comprehensive screener for sleep disorders) and the BDEFS-LF (a self-report measure of EF deficit). In order to type individuals as “symptom positive” for insomnia or OSA, subjects were required to score >3 for any item within each category. These groups were then compared for their scores on the BDEFS-LF (total score and for three factor scores: self-restraint score [BDEFS-SR], self-regulation of emotions score [BDEFS-SRM], and self-motivation score [BDEFS-SM]).

Results

Subjects with-and-without insomnia symptoms were not found to significantly differ on the BDEFS-T, or any of the three sub-scales. In contrast, subjects with-and-without OSA symptoms significantly differed on the BDEFS-T (p=0.0328), and on two of the three sub-scales (BDEFS-SR [p=0.0183] & BDEFS-SRM [p=0.0032]).

Conclusion

Contrary to our hypothesis, it was the symptom positive OSA group that showed the most deficits on executive function (as measured by the BDEFS-T). This suggests that, in people with ADHD, sleep fragmentation and/or hypoxia may be more associated with EF deficits than problems with sleep initiation or maintenance. This said, it is also possible that other measures of insomnia that better represent sleep insufficiency and/or total nocturnal wakefulness may be more associated with executive functioning deficits, alone or in combination with the sleep sequela of OSA.

Support (if any)
0702 Suicidality in Patients Using Opioid Medications to Treat Severe, Refractory Restless Legs Syndrome: Prevalence and Associations
Authors: Zackon Jordana , Winkelman John
Published: May 2023

Introduction

Prior investigations demonstrate a high prevalence of suicidal ideation and behavior in Restless Legs Syndrome (RLS) patients, particularly those with depression and severe RLS symptoms. The present study examines the prevalence of, and associations with, active suicidal ideation (ASI) and passive suicidal ideation (PSI) in patients using prescribed opioids for severe refractory RLS.

Methods

The National RLS Opioid Registry is an observational longitudinal study consisting of individuals taking a prescribed opioid for diagnosed RLS, nearly all with previously augmented symptoms. Information on opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric symptoms, and opioid abuse risk factors were collected at baseline and every 6 months thereafter by REDCap surveys. Two years following enrollment, the C-SSRS was utilized to assess both PSI and ASI in the previous year, whereas the last question on the PHQ-9 assessed PSI in the past two weeks.

Results

At baseline, participants reported a reduction in previous suicidality following initiation of opioids: ASI from 22.0% to 7.0%, and PSI from 36.7% to 13.4%. At the 2-year PHQ-9 survey, 10.1% of registry participants reported PSI within the two previous weeks. At that same 2-year assessment, on the C-SSRS, 7.8% of participants reported both PSI and ASI in the past year. Overall, suicidality was associated with depression, anxiety, female sex, and perceived opioid stigma. PSI was less likely to be present in those taking methadone. Serial mediation analysis found that both RLS severity and depression severity moderated the relationship between methadone use and PSI. Specifically, methadone use was associated with decreased RLS severity, which was associated with decreased depression severity, and then further, less PSI.

Conclusion

Maximal treatment of RLS symptoms and approaches which mitigate the other clinical features associated with ASI and PSI in this population (anxiety, depression, stigma) are worthy of independent therapeutic attention. Similarly, this data may be useful for prescribers when assessing the appropriateness of opioid treatment for individual patients.

Support (if any)

The National RLS Opioid Registry has received support from the RLS Foundation, the Baszucki Brain Research Fund, Florence Petrlik Family Foundation, Diane and Richard Brainerd, and the Blakeley Foundation.
0747 Association of a novel EEG biomarker of sleep depth with cardiac autonomic modulation in adolescents
Authors: Isely Alexis , He Fan , Fang Jidong , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Ricci Anna , Fernandez-Mendoza Julio
Published: May 2023

Introduction

The odds ratio product (ORP), a continuous spectral EEG measure of sleep depth, increases in the transition to adolescence and with psychiatric/behavioral disorders; however, its association with cardiac physiology has been largely unexplored. Heart rate variability (HRV), a continuous spectral EKG measure of cardiac autonomic balance, includes HR oscillations at low frequencies (LF), the standard deviation between normal heart beats or R-R intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD), reflecting sympathetic vs. parasympathetic tone. We aimed to examine the longitudinal association of non-rapid eye movement (NREM) sleep ORP with 24-hour HRV in adolescents.

Methods

We studied 606 children (Md=9y), of whom 418 were followed-up as adolescents (Md=16y) from the Penn State Child Cohort. We extracted ORP in NREM sleep and in the 9s following cortical arousals (ORP-9) from 9-hour, in-lab polysomnography (PSG), and frequency and time-domain HRV indices from 24-h Holter EKG monitoring immediately following PSG. We stratified 24-h HRV data into daytime and nighttime periods. Linear regression analyses examined the associations between change in ORP and ORP-9 with adolescent 24-h HRV indices, adjusting for age, race, sex, BMI, metabolic syndrome score, AHI, insomnia symptoms, actigraphy-TST, and childhood nighttime HRV indices.

Results

While there were no significant associations between ORP and HRV indices in childhood, there were significant longitudinal and cross-sectional associations in adolescence. Longitudinally, a greater increase in ORP since childhood was associated with lower nighttime Log-LF and SDNN in adolescence (both P< 0.05). Similar longitudinal associations were found for ORP-9, with the addition of higher daytime HR and lower daytime SDNN and RMSSD (all P< 0.05). Cross-sectionally, higher ORP and ORP-9 were associated with higher 24-h HR, yet lower Log-LF, SDNN or RMSSD, for both daytime and nighttime periods in adolescence (all P< 0.05).

Conclusion

Greater developmental declines in sleep depth and increases in arousability during NREM sleep are associated with impaired cardiac autonomic balance in adolescence, independent of sleep apnea, insomnia or insufficient sleep. These data also suggest a coupling between fine-grain spectral measures of the sleeping brain and those of sympathetic/parasympathetic cardiac modulation, which may inform cardiovascular risk early in life.

Support (if any)

NIH (R01HL136587, R01MH118308, UL1TR000127)
0750 Earlier bedtimes mediate the effect of a brief behavioral intervention on children’s BMIz
Authors: Hart Chantelle , Coffman Donna , Carskadon Mary , Raynor Hollie , Jelalian Elissa , Owens Judith A , Hawley Nicola , Wing Rena
Published: May 2023

Introduction

We demonstrated that a brief behavioral intervention enhanced children’s sleep; those with clinically meaningful improvements in sleep (> 30 m/night), had improvements in body mass index (BMI) and BMI z-scores (BMIz). Given emerging evidence regarding the potential importance of not only sleep duration but sleep timing (i.e., bedtimes) for obesity risk reduction, we explored whether sleep duration and/or sleep timing mediated effects of intervention on BMI and BMIz. We hypothesized that the effect of the intervention on 8-week BMI/BMIz would be mediated by earlier bedtimes and longer sleep duration at 2 weeks post-randomization.

Methods

Participants were 71 children 8-11 years old (mean (SD) age = 9.72 (1.00); 69% female; mean (SD) BMIz = 0.91 (0.935)) who slept < 9.5 h/night and were randomized to a 4-session behavioral intervention to increase nocturnal sleep duration (primarily via advancing bedtimes) or to a control (4 sessions; continue with sleep as usual). Sleep was assessed via 7-day actigraphy; height and weight were measured to calculate BMI/BMIz at baseline, 2- and 8-weeks post randomization. We assessed mediation using the medflex R package. Models predicting 8-week BMIz and BMI controlled for baseline BMIz and BMI, respectively. Duration (mean actigraph sleep period) and bedtime (mean actigraph sleep onset) were entered as continuous variables in models.

Results

Relative to control, the behavioral intervention decreased children’s 8-week BMIz by -0.027 (SE = 0.013) via its effect on week 2 bedtimes (z = -2.066, p = 0.039). There was no direct effect of intervention on 8-week BMIz (z = 1.584, p = 0.113), and although of marginal significance, week 2 sleep duration did not mediate effects of intervention on 8-week BMIz (z = -1.937, p = 0.053). Findings focused on BMI, although consistent, did not reach statistical significance.

Conclusion

A behavioral intervention designed to enhance school-aged children’s nocturnal sleep had a positive impact on children’s weight status via its effect on bedtimes, and to a lesser degree, sleep duration. Findings add to emerging work supporting the potential importance of sleep timing in weight regulation.

Support (if any)

R01HL092910; P20GM139743
0762 Early life sleep characteristics and their associations with 1 to 5.5 years old respiratory and allergic multi-trajectories
Authors: Saade Danielle , Delvert Rosalie , Raherison-Semjen Chantal , Dumas Orianne , Sedki Mohammed , de Lauzon-Guillain Blandine , Leynaert Bénédicte , Nadif Rachel , Bédard Annabelle , Plancoulaine Sabine
Published: May 2023

Introduction

Sleep troubles have been associated with respiratory and allergic health problems in children, however the time line of their association is overlooked. The current study examined the associations between: (1) sleep patterns at age 1 year and respiratory and allergic multi-trajectories between 1 and 5.5 years; (2) respiratory and allergic multi-trajectories between 1 and 5.5 years and sleep patterns at age 5.5 years in a French birth cohort.

Methods

Clusters of sleep characteristics at age 1 year (nocturnal sleep duration (NSD), day sleep duration (DSD), sleep onset difficulties (SOD), night awakenings (NA)) and at age 5.5 years (NSD, SOD, NA) and respiratory and allergic symptoms multi-trajectory groups between 1 and 5.5 years (wheezing, asthma medication, eczema, allergic conjunctivitis) were identified using unsupervised methods. Associations between sleep clusters at each age and multi-trajectory groups were assessed using multinomial regressions adjusted for potential confounding factors among 9,577 children.

Results

Two sleep clusters were identified at both age 1 and 5.5 years: C1a (79.9%, age 1 year) and C1b (83.1%, age 5.5 years) characterized by adequate sleep duration and good sleep quality; C2a (20.1%, age 1 year) and C2b (16.9%, age 5.5 years) characterized by shorter sleep duration and poorer sleep quality. Four multi-trajectory groups were also identified: G1 (no/few symptoms, 44.4%), G2 (persistent non-respiratory allergic symptoms, 23.1%), G3 (transient early respiratory symptoms, 25.2%), G4 (persistent respiratory and allergic symptoms, 7.3%). Belonging to cluster C2a was associated with an increased odds of belonging to G3 (adjusted odds ratio [95% interval confidence]; 1.14 [0.99-1.31]) and G4 (1.29 [1.05-1.59]). After accounting for sleep clusters at age 1 year, belonging to G4 was associated with an increased odds of belonging to cluster C2b (1.21 [0.98-1.5]).

Conclusion

Sleep disturbances at 1 year were associated with poorer respiratory and allergic health between 1 and 5.5 years and respiratory and allergic problems between age 1 and 5.5 years were associated with sleep troubles at 5.5 years suggesting bidirectionality. Further research is needed to explore potential coevolution of sleep and allergic and respiratory troubles during early childhood.

Support (if any)

ANR-21-CE36-0001-01
0763 EFFECT OF RACIAL AND SOCIOECONOMIC DISPARITIES ON SLEEP DURATION IN CHILDREN
Authors: Rao Harish
Published: May 2023

Introduction

National Survey of Children’s Health is a population-based, nationally representative online and paper survey of primary caregivers of noninstitutionalized U.S. persons aged ≤17 years. Data from 2016-2018 survey (MMWR 2021) published by the Center for Disease Control (CDC) highlighted the racial and economic disparities in sleep duration among children. Children from Black and Hispanic ethnicities had significantly lower sleep duration compared to their white counterparts. Short sleep duration was also more prevalent among families with lower income or lower parental educational attainment. We analyzed the data from questionnaires administered to parents of children presenting for polysomnogram.

Methods

We analyzed a consecutive sample of caregiver completed questionnaires (n=252) of patients between 4- 18 years referred for polysomnogram to our Pediatric Sleep Program. Questions ranged from demographic information to sleep wake times, sleep duration, sleep environment and parental knowledge of age-appropriate sleep requirement. Regression analysis was performed to study the effect of parental education and ethnicity on sleep duration and parental knowledge of sleep requirement.

Results

Children born to mothers with college education or higher had significantly longer duration of sleep (p< 0.05). Mothers with college education or higher were also more aware of age-appropriate sleep requirements. (p< 0.05). Children of Asian, White, and Mixed ethnicity were more likely to have age-appropriate sleep duration compared to Black and Hispanic (p< 0.05). Parents of Asian and White ethnicity were more aware of age-appropriate sleep requirement (p< 0.05). Parental marital status or father’s education status did not show similar effects on sleep duration or knowledge about sleep requirement.

Conclusion

Maternal education and family ethnicity had a significant effect on sleep duration as well as awareness of age-appropriate sleep requirement. Children from families with lower parental educational attainment and Black and Hispanic ethnicities have shorter sleep duration. Findings from our small community-based study mirrored data from large population-based data collected by CDC. Sleep disparity associated with various social determinants of health can increase family stress resulting in environmental and psychological factors that negatively affect sleep duration. Targeted education regarding age-appropriate sleep duration should be provided for ethnic minorities and families with lower income and lower parental education attainment.

Support (if any)
0790 Sleep, Early Solid Introduction, and Allergic Disease in Infancy
Authors: Mindell Jodi , Carson Mikayla , Leichman Erin S , Gould Russell , Alunkal Linda , Mack Catherine , Walters Russel
Published: May 2023

Introduction

Early complementary (solid) food introduction (< 6 months) is at times recommended to reduce the risk of allergic disease, specifically food allergy. However, little is known about solid food introduction and allergic disease as they relate to sleep problems during infancy. Thus, the purpose of this study was to assess the association of sleep problems with early solid food introduction and allergic disease during the first year of life.

Methods

Mothers of 300 infants (0-11.9 mos, M=5.87) completed an online questionnaire about infant sleep, solid food introduction (non-milk, -juice, -formula), and allergic disease (including atopic dermatitis, itchy/dry skin, food allergies). Prevalence of sleep problems was compared in the context of presence or absence of early solid food introduction and allergic disease, using chi-square.

Results

Overall, 29.3% of infants were reported to have a sleep problem, 29.0% atopic dermatitis and/or itchy/dry/flaky (AD/IDF) skin, and 10.7% food allergies. Of infants who were 6 months or older at the time of the study, 24.4% were introduced to solids early (< 6 months). Those infants with early solid food introduction were less likely to have a reported sleep problem (19.5%) compared to those introduced to solids starting at 6 months or later (37.8%), p < .05. For all infants, sleep problems were more likely to be reported in association with AD/IDF than those without those skin conditions (39.1% vs 25.4%), p < .05. No statistically significant differences were found in sleep problem rates between those with a food allergy (40.1%) and those without a food allergy (28.0%), p > .05.

Conclusion

Overall, lower sleep problem rates were associated with early introduction (before 6 months) of solid foods. Presence of sleep problems was associated with reports of atopic dermatitis and itchy/dry/flaky skin. Sleep problems were unrelated to food allergies, although overall rates of food allergies were low in this study.

Support (if any)

Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0830 Novel OSA-driven metric predicts incident dementia in sleep apnea in two different community-based cohort studies
Authors: Trucios Gonzalo Labarca , Esmaeili Neda , Hu Wen-Hsin , Gell Laura , Messineo Ludovico , Vena Daniel , Stone Katie , Yaffe Kristine , Ensrud Kris , Michos Erin , Kwon Younghoon , Redline Susan , White David , Wellman Andrew , Azarbarzin Ali
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is associated with intermittent hypoxemia and sleep fragmentation. In OSA, sleep fragmentation is often measured by the number of electroencephalographic arousals per hour of sleep without considering their intensity. In this study, we sought to determine the association of “arousal intensity” with increased risk of dementia in two independent community-based cohorts: the Osteoporotic Fractures in Men Study (MrOS) and the Multiethnic Study of Atherosclerosis (MESA).

Methods

Arousal intensity was calculated from the baseline polysomnogram of the MrOS and MESA cohorts. We included participants with available data from baseline study to Visit 4 (median follow-up 10.7 [IQR: 10.3 – 11.1] years) in MrOS and from Mesa Sleep to 2018 in MESA (median follow-up 6.8 [IQR:6.2 – 7.3] years). Dementia at baseline or those who reported positive airway pressure therapy were excluded. The primary analysis assessed the association of arousal intensity with incident dementia (primary outcome). Dementia was defined as a significant change in the Teng Mini Mental Test plus self-report of medical diagnosis during the follow-up visit in MrOS and based on the ICD-9 codes from hospital discharge data in MESA. Multiple logistic regression analyses were used to obtain the adjusted odds ratio per 1 standard deviation increase in arousal intensity after adjusting for anthropometric/demographic variables, depression, alcohol, tobacco, and AHI.

Results

A total of 1,136 MrOS and 1,923 MESA participants with complete data were included, with a median age of 76 [IQR 72 – 80] years, (100% Male) and 67 [IQR: 61 - 75] years, (46.3% Male), respectively. In MrOS, 11.4% of men had events and every 1SD increase in arousal intensity was associated with a 23% [95%CI: 0 to 50; p< 0.05] increased risk of incident dementia. In MESA, 3.5% of men had events and every 1SD increase in arousal intensity was associated with a 29% [95%CI: 1 to 65; p< 0.05] increased risk of incident dementia.

Conclusion

In two independent cohorts, high arousal intensity was associated with an increased risk of incident dementia after adjusting for relevant confounders. Quantifying arousal intensity may provide added value for cognitive risk stratification in sleep apnea.

Support (if any)

AASM Foundation (grant number: 254-FP-21).
0842 Feasibility of daytime bright light exposure and urinary 6-sulfatoxymelatonin profiling in the medical ICU: A pilot study
Authors: Intihar Taylor , Doyle Margaret , Lukas Molly , Wright Kenneth , Redeker Nancy , Pisani Margaret , Yaggi H , Knauert Melissa
Published: May 2023

Introduction

Bright daytime light, dim evening light, and near darkness during sleep are optimal lighting conditions to support circadian physiology, wakefulness, and sleep. Such light patterns are absent in the medical intensive care unit (MICU) and are considered one factor contributing to the delayed circadian timing observed in MICU patients. We, therefore, conducted a pilot trial assessing the use of daytime bright light (DBL) in the MICU and tested the feasibility of using urinary 6-sulfatoxymelatonin (aMT6s) as a marker of circadian phase and amplitude.

Methods

We enrolled patients aged >50 years admitted to the MICU without pre-existing circadian disruption. Urine samples were collected every 4 hours starting on study day 1 (D1). Patients were randomized to receive bright light (>1200lux at the angle of gaze, 5000K) for 4 hours or 8 hours starting at 09:00 on D2. Circadian metrics of aMT6s amplitude and acrophase were calculated via gamma distribution cosinor analysis.

Results

Eight (6 males, 2 females) out of 14 pilot participants produced sufficient urine for sampling; one was subsequently excluded due to exogenous melatonin use. Of the seven patients in the analysis, one did not have significant cosinor fit. Mean (SD) age was 74 (9) years and APACHE II illness severity score was 24 (4). D1 median (IQR) aMT6s amplitude was 29,389ng (447-125,874ng) and acrophase was 12:42 (8:30-13:54). D2 (after DBL start), median amplitude was 847,381ng (372-1,694,391ng) and acrophase was 04:36 (03:06-06:06). Six patients received 4-hours and two patients received 8-hours of DBL. Sample size was inadequate for testing differences in circadian outcomes between light assignments and study days.

Conclusion

DBL may promote earlier circadian timing and greater circadian amplitude in critically ill patients. Findings support feasibility of aMT6s in assessing circadian phase and amplitude in MICU patients who produce urine; however, a significant proportion of MICU patients are anuric. Consequently, sample size limitations, potential for masking, and infrequent urine sampling warrant further investigation. These pilot findings have influenced the frequency of aMT6s sampling (e.g., change to hourly) in an ongoing RCT evaluating the impact of DBL versus usual light exposure on circadian rhythms in critical illness.

Support (if any)

K23HL138229, AASM Foundation
0866 Geographic Insufficient Sleep Duration and Cardiometabolic Risk Among Adolescents and Adults in the T1D Exchange Clinic Registry
Authors: Griggs Stephanie , Howard Quiana , Bolton Pamela , Motairek Issam , Al-Kindi Sadeer , Still Carolyn Harmon , Hickman Ronald
Published: May 2023

Introduction

Individuals with type 1 diabetes (T1D) are at a heightened risk for cardiometabolic disease and associated risk factors. Insufficient sleep duration (< 7 hours) may accentuate this risk, but little is known about its geographic distribution. Insufficient sleep is disproportionately distributed across the United States. We sought to determine whether the geographic distribution of insufficient sleep was associated with individual cardiometabolic risk among 18,620 adolescents and adults ages 13-90 years in the T1D Exchange Clinic Registry.

Methods

We linked residence zip codes with prevalence of insufficient sleep generated from the Population Level Analysis and Community Estimates (PLACES) dataset. We examined associations between geographic patterns of sleep duration (area-level) and individual cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index) using multivariable linear regression adjusting for age, sex at birth, T1D duration, and race/ethnicity.

Results

Geographic areas with shorter sleep duration experienced multiple individual cardiometabolic risk factors. Specifically, shorter geographic level sleep duration was associated with higher glycemia (□= .156, p < .001, R2 = .144), higher body mass index (□ = .037, p < .001, R2 = .125), higher low density lipoprotein cholesterol (□ = .022, p < .001, R2 = .031), and higher systolic blood pressure (□ = .021, p < .001, R2 = .142), even after adjusting for covariates (age, sex, type 1 diabetes duration, and race/ethnicity). There were significant differences in age, race/ethnicity, and sex. The association between shorter area-level sleep duration and diastolic blood pressure was no longer significant after adjusting for covariates.

Conclusion

Adolescents and adults with T1D living in areas with a higher prevalence of insufficient sleep had higher cardiometabolic risk even after considering covariates. Future studies are warranted to unravel underlying mechanisms contributing to cardiometabolic risk at the individual level (e.g., sympathetic dysregulation, discrimination, insulin insensitivity, and inflammation) as well as other geographic contributions (e.g., air, light noise pollution, redlining). Understanding the determinants of geographic variability would enhance the utility of these data for public health campaigns.

Support (if any)

This research is supported by the National Institute of Nursing Research (R00NR018886).
0898 Title: Test - Retest Reliability of the Multiple Sleep Latency Test in Non-cataplectic Central Hypersomnia Disorders
Authors: Mora-Munoz Laura , Araujo Matheus , Andrews Noah , Wang Lu , Foldvary-Schaefer Nancy
Published: May 2023

Introduction

Differentiation of narcolepsy type II (NT2) and idiopathic hypersomnia (IH) is challenging in clinical practice. Diagnostic criteria rely on the multiple sleep latency test (MSLT), previously shown to have poor reproducibility in these disorders. We leveraged a large polysomnographic database to study test-retest reliability in non-cataplectic central hypersomnia disorders.

Methods

Patients evaluated at Cleveland Clinic Sleep Disorders Center from 2008-2021 with suspected central hypersomnia disorders excluding narcolepsy type I with >1 PSG/MSLT were included. Studies not meeting validity criteria (< 7hr sleep time on PSG, < 5 MSLT trials, use of REM suppressants/alerting medications within 14 days) were excluded. Diagnostic groupings included NT2, IH and Normal/Indeterminate based on ICSD-3. Reliability and correlation between tests was performed using intra-class and Spearman’s correlations, respectively. Data is presented as mean+SD or median [25th,75th percentiles] for continuous variables and N(%) for categorical variables.

Results

A total of 58 patients (62.1% female, age 31.9 yr [18.5, 48.6]) were included. Interval between MSLTs was 3.6 + 3.18 yr (same diagnosis on both tests: 3.24 + 3.15; changed diagnosis: 3.98 + 3.22). Diagnosis based on MSLT 1 was NT2 8(13.8%), IH 20(34.5%) and Normal/Indeterminate 30(51.7%). Overall, 33(56.9%) patients remained in the same diagnostic category including 3(5.2%) NT2, 12(20.7%) IH and 18(31.0 %) Normal/Indeterminate. Of 25(43.1%) cases changing diagnosis, 3(5.2%) changed from NT2 to IH and 2(3.4%) to Normal/Indeterminate; 4(6.9%) changed from IH to NT2 and 4(6.9%) to Normal/Indeterminate; 5(8.6%) changed from Normal/Indeterminate to NT2 and 7(12.1%) to IH. Median MSL on tests 1 and 2 were 10.8 [4.6,12.9] and 9.0 [4.5,13.1], respectively. Correlation was moderate MSL [0.59 (0.39, 0.73), p< 0.001] and fair for SOREMPs [0.32 (0.07, 0.53), p=0.015]. Intra-class correlation showed moderate reliability in test-retest for MSL [0.56 (0.36, 0.72)] and SOREMPs [0.54 (0.33, 0.70)].

Conclusion

MSLT test-retest reproducibility in non-cataplectic central hypersomnias was moderate in a tertiary care clinic population. While more favorable than prior studies, these findings underscore diagnostic challenges that may contribute to misdiagnosis of patients with hypersomnia.

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0931 App-Supported Sleep Coaching: Implications for Sleep Duration and Sleep Quality
Authors: Grandner Michael , Gorovoy Suzanne
Published: May 2023

Introduction

Sleep coaching programs have emerged to address sleep health needs for subclinical populations. Yet, few such programs have been formally evaluated.

Methods

Data were obtained from N=51 consecutive users who completed the 12-week Sleep Reset program. Sleep Reset (Simple Habit, Inc.) includes ongoing text-based communication with trained coaches and a mobile app that includes a sleep diary, educational modules, mindfulness exercises, and progress-tracking. Potential users with a contraindicated medical/psychiatric problem or a likely sleep disorder (including Insomnia Disorder) are referred for additional care/support. The coaching included information about sleep and circadian principles (e.g., sleep hygiene, behavioral scheduling, light exposure, relaxation) and techniques based on CBTI (e.g., stimulus control). T-tests examined change scores for diary-derived sleep latency (SL), wake after sleep onset (WASO), total sleep time (TST), number of awakenings (NWAK), and sleep efficiency (SE). N=3 had uninterpretable baseline TST. Post-hoc analyses examined those who reported at least one sleep continuity disturbance (SL>=30, WASO>=30, SE< 0.85; N=44) vs none (N=7) and short sleepers (TST< 360 min; N=19) vs 6+ hours (N=32).

Results

Those who participated in the program saw a mean increase in SE of 6.4% (95%CI [2.7%,10.2%], t(50)=3.4, p=0.001) and TST of 57.8 mins (95%CI [33.8,81.8], t(47)=4.9, p< 0.0005), and a mean decrease in SL of 12.2 mins (95%CI [-20.0,-4.4], t(50)=-3.1, p=0.003), WASO of 32.4 mins (95%CI [-52.7,-12.0]. t(50)=-3.2, p=0.002), and NWAK of 0.3 awakenings (95%CI [-0.7,-0.01], t(50)=-2.1, p=0.046). Those who reported a problem were more likely to show an improvement in SE (+7.9% vs -0.3%, p=0.001), SL (-14.8 vs +4.0 mins, p=0.0008), and WASO (-40.5 vs +15.8 mins, p=0.0001), but groups did not differ in terms of change in NWAK and TST. Short sleepers saw a relative improvement in SE (+12.2% vs +3.0%, p=0.037) and TST (+109.8 vs +23.7 mins, p=0.0001), but no differences in change to SL, WASO, and NWAK.

Conclusion

The sleep coaching program improved sleep quality and duration for participants without sleep disorders. Those with baseline sleep continuity problems received the most benefit to SL and WASO, and short sleepers saw a nearly 2-hour average increase in TST. Future studies need to extend this work with control groups.

Support (if any)