bluuebunny/crossref_metadata_2025 huggingface dataset:
0744 Cardiac Safety Profile of Pitolisant in Patients with Narcolepsy
Authors: Winter W , Wanaski S P , Patroneva A , Dayno J M
Published: May 2020

Introduction

Cardiovascular diseases are comorbid in patients with narcolepsy. Cardiovascular adverse effects are of concern with narcolepsy medications because of this comorbidity and most patients require lifelong pharmacotherapy. Pitolisant, a selective histamine 3 (H3)-receptor antagonist/inverse agonist, increases histamine transmission in the brain. In a QT study of healthy volunteers, pitolisant (35.6 mg/day) led to a mean increase of 4.2 msec in QTc interval. This analysis further characterized the cardiac safety of pitolisant (maximum dose, 35.6 mg/day) in adults with narcolepsy.

Methods

Data were obtained from a pooled analysis of 2 randomized, placebo-controlled, 7- or 8-week studies and from a 12-month, open-label study.

Results

Pooled analysis included 166 patients (pitolisant, n=85; placebo, n=81). Mean change in heart rate from baseline to end-of-treatment was -0.5 beats/min with pitolisant and -0.2 beats/min with placebo (LS mean difference, -0.4; P=0.744). Mean change was also similar for pitolisant versus placebo in systolic (LS mean difference, 0.0; P=0.983) and diastolic (LS mean difference, -0.6; P=0.552) blood pressure, as was mean change in QTc interval (LS mean difference, 0.4; P=0.911). Cardiac adverse events with pitolisant included heart rate increase (n=4), right bundle branch block (n=1), sinus tachycardia (n=1), and palpitations (n=1), and with placebo included blood pressure increase (n=1). In the long-term study, mean change from baseline in QTc interval was 3.1 msec at Month 6 (n=70) and 6.1 msec at Month 12 (n=67); 3 patients had a postbaseline increase >60 msec but none had QTc >500 msec.

Conclusion

In this analysis, no cardiac safety signals were observed during treatment with pitolisant administered up to the maximum recommended dose. Because concomitant use of pitolisant with other drugs known to increase the QT interval may add to the QT effects of pitolisant, avoid use of pitolisant in combination with these medications.

Support

Bioprojet Pharma and Harmony Biosciences, LLC.
0757 Increasing Number of Cases Who Had Both Hypersomnolence Disorders and Developmental Disorders With Orexin Measurements
Authors: Imanishi A , Yoshizawa K , Tsutsui K , Omori Y , Ono T , Ito Uemura S , Mishima K , Kondo H , Kanbayashi T
Published: May 2020

Introduction

Recently, attention has been paid to the relationship between developmental disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), and sleep disorders. We meet many developmental disorder patients who complaint hypersomnolence. Among these patients, cases with coexistence of central hypersomnia and developmental disorders, or developmental disorder alone were increased. Therefore, we first investigated patients with the complaint of hypersomnolence, who were also suspected developmental disorders. Furthermore, we have been measuring CSF orexin in 17 cases suspected of both disorders to investigate orexin levels of these patients.

Methods

86patients who complained of EDS with suspicion of developmental disorders had been examined. In order to diagnose hypersomnolence disorders, PSG and MSLT were performed. Psychological examinations were performed for diagnosing developmental disorders.We have been measuring for CSF orexin in 17 cases suspected both hypersomnolence and developmental disorders. We examined the onset of hypersomnolence and the clinical history of these ADHD or ASD cases for more details.

Results

In 86 examined cases, developmental disorders coexisted in 30 cases. Among 30 cases, ADHD were 18, ASD were 6 and both diagnosed were 6 cases. Among them, 20 cases diagnosed as having coexistence of hypersomnia (8: narcolepsy, 12: IHS) and developmental disorders (ADHD:12, ASD:4, ADHD/ASD:4). In 17 cases with orexin measurements, 10 cases coexisted ADHD and 4 cases coexisted ASD. Two cases diagnosed as both ADHD and ASD. In 10 ADHD cases, 3 cases had low orexin levels, and 7 cases had normal orexin levels. Other 7 ASD cases had normal orexin levels.

Conclusion

ADHD has a higher rate of central hypersomnia (12/18) compared with ASD and the rate of narcolepsy was also high (5/12). While patients in ASD was diagnosed as IHS (3/6), narcolepsy cases were not observed. It became clear that the majority of patients had developmental disorder or had a tendency for developmental disorder before the onset of hypersomnolence.Although it is possible that ADHD/ASD symptoms may be exacerbated by orexin dysfunctions, ADHD/ASD may not newly occur. There were cases with low orexin levels, but it seems that narcolepsy happened to coexist with developmental disorders.

Support

a
0767 Analysis Of The Effect On Blood Pressure And Heart Rate When Adding Solriamfetol (Sunosi) To Stimulant Therapy
Authors: Meskill G J , Meskill S D
Published: May 2020

Introduction

Solriamfetol is a non-stimulant wakefulness-promoting agent (WPA) indicated for the treatment of excessive daytime sleepiness in adult patients with obstructive sleep apnea or narcolepsy. It acts by inhibiting reuptake of dopamine and norepinephrine. Since many patients with excessive daytime sleepiness take stimulants, clinicians commonly ponder the safety of adding solriamfetol in this population due to concern of increased blood pressure and/or heart rate (HR).

Methods

We conducted a retrospective chart review and identified 18 patients who had solriamfetol added to their stimulant therapy. Of those, 7 to date have had a follow-up appointment after the addition of solriamfetol (6 on 150mg, 1 on 75mg). We collected the blood pressure and HR readings at the appointment immediately prior to and following the addition of solriamfetol and conducted a paired t-test.

Results

The systolic blood pressure (SBP) had a mean difference of -0.57 (95% CI -9.6 to 8.5, p=0.88), diastolic blood pressure (DBP) 1.7 (95% CI -4.4 to 7.9, p=0.52), mean arterial pressure (MAP) 0.95 (95% CI -5.6 to 7.5, p=0.73), and HR 6.6 (95% CI -0.07 to 13.2, p=0.052).

Conclusion

The addition of solriamfetol to stimulant therapy did not lead to a significant increase in SBP, DBP, MAP, or HR.

Support

none
0771 Explaining Self-reported Hypersomnolence In Seasonal Depression
Authors: Wescott D L , Hasler B P , Franzen P L , Roecklein K A
Published: May 2020

Introduction

Hypersomnolence is commonly reported in Major Depressive Disorder with Seasonal Pattern (Seasonal Affective Disorder; SAD). However, self-reported hypersomnolence may conflate long sleep duration, daytime sleepiness, fatigue, increased time in bed, or maladaptive sleep cognitions, undermining treatment efforts.

Methods

Eighty-eight participants ages 18-65 years old were recruited during the winter (SAD = 43, Control = 45). Depression severity was assessed by a clinician rated interview, and self-reported hypersomnolence was determined by assessing self-reported sleep duration. Participants wore an Actiwatch for 4-14 days and completed self-report measures of daytime sleepiness and fatigue. We performed a hierarchical linear regression to determine which factors best explain self-reported winter hypersomnolence: actigraphic total sleep time (TST), time in bed (TIB), depression severity, sleepiness, or fatigue. Due to collinearity of TST and TIB, we separated those variables into two models predicting hypersomnolence.

Results

SAD participants endorsed greater hypersomnolence than controls during the winter (B = .714; p < .001). In model 1, TST (OR(1,14) = .024, p <.001) and daytime sleepiness (OR(1,14) = .208, p = .03) significantly predicted the presence of self-reported winter hypersomnolence above and beyond age, gender, depression, and fatigue. In model 2, only TIB (OR(1, 14) = .021, p = .001) was a significant predictor. Post-hoc analyses indicated that fatigue and depression severity significantly predicted self-reported hypersomnolence when entered separately into the model. Sleepiness accounted for the largest change in pseudo-R2 in bth models.

Conclusion

We found evidence for the multifaceted etiology of self-reported hypersomnolence. Daytime sleepiness, sleep duration, time in bed, and the shared variance between fatigue and depression severity all explained self-reported hypersomnolence. Treatment of hypersomnolence should include actigraphy, and should be individually tailored based on presentation.

Support

NIMH K.A.R. MH103303
0772 Effects Of Solriamfetol On 24-hour Blood Pressure Patterns In Participants With Excessive Daytime Sleepiness Associated With Narcolepsy
Authors: Strollo P J , Malhotra A , Strohl K , Pepin J , Schweitzer P , Lammers G , Hedner J , Baladi M , Carter L , Bujanover S , Menno D , Dauvilliers Y
Published: May 2020

Introduction

Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy (75-150 mg/d) or obstructive sleep apnea (37.5-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes, have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of narcolepsy patients with a non-dipping BP profile.

Methods

Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with narcolepsy (n=236).

Results

At week 8, increases in BP were apparent in the 150 and 300 mg dose groups from 8 AM until 4 PM and 6 PM, respectively. At baseline, 52% (placebo) and 48% (combined solriamfetol) of participants were non-dippers (defined as <10% decrease in mean arterial pressure [MAP] during sleep). There was no increase in the percentage of non-dippers at week 8 relative to baseline (placebo, 44%; combined solriamfetol, 39%). Results were similar when dipping was defined by changes in systolic BP and diastolic BP.

Conclusion

The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with narcolepsy at any dose studied.

Support

Jazz Pharmaceuticals
0791 Effects of Low Frequency Electrical Stimulators as Nonpharmacological Treatment in Restless Legs Syndrome
Authors: Cho Y , Lee Y , Ku J , Kim K
Published: May 2020

Introduction

Non-pharmacological treatments for restless legs syndrome (RLS) is a treatment option for patients who have not yet started medical treatment, who do not respond to their prescribed medication, or who suffer from adverse effects of medication. This study aims to investigate the clinical effectiveness of low frequency electronic stimulators (LFES) as a non-pharmacological treatment.

Methods

This is a randomized, single-blind study. After screening 64 patients according to the inclusion/exclusion criteria, a total of 46 patients participated in the study. The participants were separated into an active group and a sham group with 22 and 24 members, respectively. The stimulation was administered using the tapping mode (3Hz) present on the machines used, and symptom changes were measured in both groups. The effects of the stimuli were analyzed with repeated measures ANOVA.

Results

Symptom severity was significantly reduced in the active group, and showed significant interaction effects in the time multiple group. Although both the active and sham groups reported improved symptoms upon receiving longer periods of treatment, the effect of the LFES was greater in the active group.

Conclusion

Analyzing the effects of LFES by dividing the active and sham groups revealed that LFES treatment resulted in symptom improvement when using effective stimulation intensity. LFES can be a non-pharmacological treatment option for RLS.

Support

None
0793 Nearly 25% of Restless Legs Syndrome (RLS) Patients Nationally Treated with Dopamine Agonists are Taking Higher Doses than the Maximum Recommended by FDA and Expert Guidelines
Authors: Winkelman J W
Published: May 2020

Introduction

Dopamine agonists (DAs) have been first-line therapy for restless legs syndrome (RLS) for 30 years. Long-term DA use is associated with augmentation, a dose-related iatrogenic worsening of RLS, which results in a vicious cycle of escalating DA dosing to manage worsening symptoms. The objective of this study was to investigate rates of high-dose DA prescribing in patients with RLS nationally.

Methods

Patients with a diagnosis of RLS (ICD-10 G255.81), and no diagnosis of Parkinson’s disease, treated with rotigotine, pramipexole, and ropinirole, alone or in combination for >180 days, were identified from National Prescription Audit database from October 2017-September 2018. Daily total dosage was grouped into low (FDA-approved) and high (above FDA-approved) dose ranges, respectively (rotigotine: >0-≤3mg/>3mg; pramipexole: >0-≤0.75mg/>0.75mg; ropinirole: >0-≤4mg/>4mg). When DAs were used in combination with each other, dose-equivalent algorithms were used (rotigotine/ropinirole/pramipexole, 1:1:4).

Results

Prescriptions for 244,423 patients meeting inclusion criteria were sampled, constituting 71,181,466 therapy days. For all patients on DA therapy for RLS, 23.5% (57,552/244,423) were prescribed higher than FDA-recommended doses. For patients on DA monotherapy, high-dose prescriptions were provided to 42.7% (819/1919) on rotigotine, 40.7% (38,342/94,275) on pramipexole, and 11.5% (16,900/146,355) on ropinirole. Nearly one-quarter (23.2%) of all pramipexole monotherapy prescriptions were for very high dosages (>1.25 mg). For patients on DA combination therapy, high-dose prescriptions were provided to 79.6% (1,491/1,874).

Conclusion

Roughly 25% of RLS patients treated with DAs were prescribed doses above FDA and expert guideline-recommended maximum doses. Patients on DA combination therapy had substantially higher rates of cumulative high-dose prescriptions. High-dosage DA use is likely due to dose escalation in response to augmentation, risking further augmentation and adverse events such as impulse control disorders. Prescriber education on risks of high-dose DA prescribing for RLS is important.

Support

Arbor Pharmaceuticals, LLC
0799 A Population-based Study of Adult Patients With Recurrent, Clinician Diagnosed Sleepwalking and/or Sleep Related Eating Disorder
Authors: Krahn L E , Tashman Y S , Lyng P J , Lloyd R M , Silber M H
Published: May 2020

Introduction

The ICSD-3 describes NREM-related parasomnias as abnormal sleep related complex movements where motor behavior occurs in the setting of absent or very minimal higher cognitive function. A population-based twin study reported that 3.9% of men and 3.1 % of women sleepwalk (SW) with 30% reported experiencing injury (Hublin 1997). Sleep related eating disorder (SRED) may be a variant of SW with a reported prevalence of 0.5-5 % (Michalska 2016). This study examined SW and SRED in a population-based sample permitting review of associated features, risk factors and outcomes.

Methods

The records-linkage system of the Rochester Epidemiology Project that includes all adults residing in Olmsted County MN was searched for documentation of patients seeking care for at least two episodes of sleepwalking and/or sleep eating. Records from 2007-2016 were included.

Results

56 cases were identified with 50 (89 %) having SW and 16 (29%) SRED. The gender breakdown was 50% male and 50% female with the mean age at diagnosis of 40 (SD 13). Childhood parasomnia events were reported by 23/36 (62%) and a family history in 21/35 (64%). Data were unavailable for the others. The number of parasomnia incidents was ≥ 10 for 21 (37%). A variety of experiences were documented, including leaving the bedroom (39%), injury (25%), and exiting through a window/balcony (5%). Associated factors were sleep deprivation (52%), untreated obstructive sleep apnea (34%), antidepressant use (41%), zolpidem use (18%), circadian disruption (14%) and alcohol use (9%). Polysomnography was conducted for 41 (74%). Documented interventions were medication discontinuation (18%) and starting a benzodiazepine (16%). In 21%, no treatment was given.

Conclusion

This population-based study of adults with clinician diagnosed recurrent SW and SRED revealed equal rates in men and women. The majority of patients with SRED also had SW. 25% of cases were associated with injuries.

Support

Rochester Epidemiology Project supported by NIH R01 AG034676 and AG052425 and the Mayo Foundation.
0812 Nightmares: An Independent Risk Factor For Cardiovascular Disease
Authors: Ulmer C S
Published: May 2020

Introduction

Associations between PTSD, sleep and cardiovascular disease are well-established in prior research, but few studies have examined adverse health correlates of nightmares. Nightmares are often called the “hallmark” symptom of PTSD and represent the cardinal sleep-specific manifestation of PTSD. Yet, prior studies have not examined nightmares’ independent contribution to cardiovascular disease risks beyond risks conferred by PTSD. The purpose of this study was to examine associations between nightmares and cardiovascular disease in Veterans with and without PTSD.

Methods

Participants were Veterans (N=3876; 78% male) serving since September 11, 2001, 1 or 2 tours of duty (73.5%), aged 38 years (SD=10.4), 31% meeting criteria for current PTSD, with equivalent proportions of African-Americans (48%) and Caucasians (48%). Nightmare frequency was assessed using the Davidson Trauma Scale (DTS), with “frequent” defined as occurring at least 2-3 times per week. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study (NVVRS) Self-report Medical Questionnaire. PTSD diagnosis was established using the Structured Clinical Interview for DSM-V.

Results

Frequent nightmares over the past week were endorsed by 33% of participants. Cardiovascular conditions were endorsed at the following rates: heart problems (6%); diabetes (6.6%); arthrosclerosis (0.5%); hypertension (29.2%); stroke (0.7%); and heart attack (1.2%). After adjusting for age, sex and race, frequent nightmares were associated with heart problems (F=7.50, p=.006), high blood pressure (F=23.84, p<.0001), and heart attack (F=7.19, p=.007). When PTSD was added to the model, these associations remained significant.

Conclusion

We found that frequent nightmares among Veterans are associated with cardiovascular conditions, even after controlling for the effects of PTSD. Additional research is needed to explore mechanisms explaining these associations and determine if reducing nightmare frequency and severity results in improved cardiovascular health.

Support

This work was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
0815 Violent Parasomnias In Patients With REM Without Atonia. Parasomnia Overlap Disorder Vs Pure Rem Behavior Disorder
Authors: Simmons J H , Meskill G J , Lavender M G
Published: May 2020

Introduction

REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. On literature review, harm to others using a weapon is not well established. Some opinions state REM-parasomnias do not consist of elaborate actions, such firing a gun. This has significant ramifications in forensic medicine when RBD is a consideration. We reviewed our RBD patients to identify instances in which a gun was used during a parasomnic event to characterize clinical features associated with such behaviors.

Methods

We reviewed over 57 RBD cases from Texas, between 2014-2017 seeking parasomnias in which a gun was used.

Results

We found two patients in whom a gun was used during a parasomnia, representing < 3.5% of cases. Case-1: 59 y/o F with a 5 year hx of parasomnias of screaming, thrashing, roaming and one instance in which she pointed an unloaded gun at her husband saying she was going to kill him. She had no recollection of the event. NPSG demonstrated REM without atonia, mild OSA (1a AHI of 11/hr) and frequent PLMS. Case-2 presented to a sleep center in 1989 at 33 y/o with 3 year Hx of EDS, found to have mild OSA unresponsive to PAP Tx, then diagnosed with narcolepsy. He later developed cataplexy and progressed to developing parasomnias 15 years later. He demonstrated REM without atonia on a CPAP re-titration NPSG study done in part for his parasomnias, 20 years after original assessment. PLMS were also demonstrated. His parasomnias consisted of yelling, screaming, roaming and one time he woke up finding bullet holes in his closet door with no recollection of firing his gun, which he kept near his bed.

Conclusion

RBD is associated with a wide range of parasomnic events, almost never captured in the laboratory. These patients had clear RBD findings. It is possible they had Parasomnia Overlap Disorder in which Non-REM parasomnias occur in patients with RBD. PLMS and or OSA may contribute by fragmenting sleep. Nonetheless, it is clear that RBD patients can have elaborate parasomnias involving the use of weapons. More attention of this is noteworthy since reports are lacking in the literature.

Support

N/A
0829 Sleep, Chronic Pain, and Global Health in Adults Ages 65 or Older
Authors: Tran L , Jeon B , Chasens E
Published: May 2020

Introduction

Understanding the association of sleep and pain in older adults can help improve their global health. The purpose of the study was to describe the associations between sleep, chronic pain, and global health in adults ages 65 or older.

Methods

This study was a secondary analysis of data from adults over 65 years in the 2015 Sleep in America Poll - Sleep and Pain by the National Sleep Foundation (NSF). The survey included demographics (age, race, marital status, education), sleep (duration, quality, insomnia symptoms), and pain (type [none, chronic, fleeting], intensity, location). Global health derived from general health, physical health, mental health, and quality of life with a potential range of 4-20; higher score=better health. The survey also queried fatigue and stress.

Results

The sample (N=248) was 65-91 years (mean age=72.8±5.9), male (53.6%), White (82.7%), married (65.7%), and with post-highschool education (54.4%). Average sleep duration was 425±74 minutes. “No pain” was reported by 38.7% of the sample (n=96), “fleeting pain” by 32.7% (n= 81), and “chronic pain” by 28.6% (n=71). The most common locations for chronic pain were shoulder or neck (63.2%) and back (69.4%). Average global health score was 9.8±2.9. There was no significant difference in time in bed, sleep duration, bedtime, or wake-up time between groups. Persons with chronic pain had higher average pain intensity, worst pain intensity, and current pain; they reported significantly lower sleep quality with significantly more restlessness, trouble staying asleep, and worry about getting a good night sleep (all p-values<.02), there was no significant difference in difficulty falling asleep compared to persons with no pain. Persons with chronic pain had significantly worse general health, physical health, mental health, global health, fatigue, and stress (all p-values<.02); but no significant difference in quality of life compared to persons with no pain.

Conclusion

We conclude that chronic pain has a significant negative impact on sleep and global health in the sample of adults ages 65 or older from the 2015 Sleep in America Poll - Sleep and Pain by the NSF.

Support

Undergraduate Research Mentoring Program, University of Pittsburgh School of Nursing.
0847 Association Between Cannabis Use Frequency and Sleep Duration Among a Representative Sample of US Adults
Authors: Bowles N P , Shea S A
Published: May 2020

Introduction

Cannabis use is on the rise in the US, and while the cannabis plant and related compounds are considered to have low toxicity, the impact on physiology including sleep remains unclear. Further, the bulk of cannabis research has focused on adolescents and young adults despite growing use among the elderly. Thus, this analysis sought to determine the impact of the frequency of cannabis use on sleep duration and determine if this relationship varies by age.

Methods

This cross-sectional study used data from the 2016-2018 Behavioral Risk Factor Surveillance System surveys. Multinomial logistic regression was used to evaluate the association between the frequency of cannabis use, 0-30 times over the prior 30 days; and average sleep duration, short (<7 hours); recommended (7-9 hours); and long (>9 hours) sleep.

Results

The study sample included 235,667 participants (48% male, 43% 18-44 years old and 35% 44-64 years old) of which 14,122 consumed cannabis. The weighted proportion who reported using cannabis 1-4x, 5-15x, or more than 16x/month were 3.1% (95% CI, 3.0%-3.3%), 2.1% (2.0%-2.2%), and 4.4% (4.2%-4.6%) respectively. In an age stratified model adjusted for sociodemographic and clinical characteristics, there were no associations between sleep and cannabis use up to 15x/month. Among those adults who consumed cannabis more than 16x/month: (1) 18-44 year olds were more likely to report either short sleep (risk ratio (RR), 1.21; 95% CI, 1.05-1.39) or long sleep (RR, 1.57; 95% CI, 1.11-2.22) as opposed to the recommended amount of sleep; whereas (2) 44-64 year olds demonstrated an increased risk for long sleep (RR, 1.77; 95% CI, 1.09-2.89); and (3) participants 65 years and older demonstrated an increased risk for short sleep (RR, 1.61; 95% CI, 1.04-2.49).

Conclusion

We demonstrate that modest cannabis use was not associated with sleep, whereas daily cannabis use is associated with age-dependent sleep duration above and below the recommended amount.

Support

KL2TR002370, 2R25HL105444-09.
0850 Self-report And Polysomnography Sleep And Mortality In Adults: A Machine Learning Replication Analysis
Authors: Wallace M L , Peppard P , Coleman T L , Mentch L , Buysse D J , Hall M H , Redline S , Hagen E H
Published: May 2020

Introduction

Individual sleep health characteristics (e.g. efficiency, timing, duration, architecture) and signs and symptoms of sleep disorders (e.g., difficulty falling and staying asleep, apnea hypopnea index, measures of oxygen desaturation) predict mortality in adults using traditional regression methods. However, it is important to examine and compare their predictive abilities in context of other established non-sleep predictors using high-dimensional methods that better reflect the complexity of the data. Therefore, we applied a novel random forest machine learning (RFML) hypothesis-testing framework to data from the Sleep Heart Health Study (SHHS) and the Wisconsin Sleep Cohort (WSC) to determine which risk factor domains (sleep, physical health, sociodemographic factors, medications, health behaviors, mental health) and sleep subdomains (self-report and polysomnography sleep health characteristics and signs and symptoms of sleep disorders) predict time to mortality in adults.

Methods

We harmonized 82 predictors across SHHS and WSC (32 sleep, 24 physical health, 8 sociodemographic, 9 medications, 4 mental health, 5 health behaviors) and fit sociodemographic-adjusted and fully-adjusted RFML models in each cohort to test the overall predictive importance of each domain and sleep subdomain. Permutation-based p-values and unbiased variable importance metrics (change in Harrell’s C *100, ΔC) were computed and summarized with medians across 20 independent subsampled testing sets in each cohort.

Results

In the fully-adjusted SHHS and WSC models, the most predictive domains were physical health (SHHS p<0.001, ΔC=1.48; WSC p=0.002, ΔC=2.68) and sleep (SHHS p=0.008, ΔC=0.71; WSC p=0.044, ΔC=1.65). Sleep subdomains were not significant in the fully adjusted model. However, the sociodemographic-adjusted models indicated that the predictive importance of sleep may be driven by polysomnography sleep health characteristics in SHHS (p=0.026, ΔC =0.77) and polysomnography signs of sleep apnea in WSC (p<0.001, ΔC=3.20).

Conclusion

Sleep is a strong predictor of mortality in adults that should be considered among other more routinely used predictors. Future research should examine differences and similarities between SHHS and WSC that may explain the finding that different aspects of sleep were important in each cohort.

Support

NIA grant AG056331, NHLBI grant HL114473, NHLBI grant R01HL62252, NIA grant R01AG036838, NIA grant R01AG058680.
0855 Primary Sleep Disorders And The Combined Outcome Of Poor Sleep Quality With Objective Short Sleep Duration In Older Persons
Authors: Miner B , Vaz Fragoso C A , Han L , Stone K L , Redeker N S , Yaggi H K
Published: May 2020

Introduction

Poor sleep quality with short sleep duration (SSD) is a high-risk phenotype that is likely to be associated with primary sleep disorders (obstructive sleep apnea [OSA], periodic limb movements of sleep [PLMS], and restless legs syndrome [RLS]) in older persons. We evaluated the associations among primary sleep disorders and this high-risk phenotype in older persons.

Methods

Using data on 3,058 men from the Osteoporotic Fractures in Men Sleep Study and 3,127 women from the Study of Osteoporotic Fractures, mean ages 76 and 84 years, respectively, we evaluated cross-sectional associations between primary sleep disorders and the combined outcome of poor sleep quality with actigraphic SSD. In women, OSA and RLS were evaluated by self-report. In men, OSA and PLMS were evaluated by polysomnography and RLS by self-report. Poor sleep quality was defined by Pittsburgh Sleep Quality Index score >5 and SSD by average total sleep time ≤6 hours from wrist actigraphy (averaged over ~5 days). Men and women were evaluated separately. Multivariate logistic regression models also included demographics, self-reported chronic conditions, anxiety, depression, and medication use.

Results

Poor sleep quality with actigraphic SSD was more prevalent in men (475 [15.6%]) than women (400 [13.1%]). In unadjusted models in men, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA, PLMS, and RLS (ORs [95% Cis] = 1.99 [1.57, 2.52], 2.11 [1.41, 3.18], and 5.58 [2.51, 12.43], respectively). In multivariable models in men, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA (1.59 [1.18, 2.14]) but not with PLMS or RLS. In unadjusted models in women, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA (3.57 [0.40, 31.88]) and RLS (5.60 [3.04, 10.32]), but results were not significant in multivariable models in women.

Conclusion

Older persons with primary sleep disorders have higher odds of poor sleep quality with actigraphic SSD. However, the predominant mechanisms underlying this high-risk phenotype may be driven more by medical and psychiatric comorbidity than by primary sleep disorders.

Support

The American Academy of Sleep Medicine Foundation and the Yale Claude D. Pepper Older Americans Independence Center
0859 Types Of Childhood Maltreatment And Sleep Regulation During Pregnancy
Authors: Touchette E , Servot S , Lemieux R , Berthelot N
Published: May 2020

Introduction

Pregnant women with history of childhood maltreatment would have around 2-fold increased odds of poor subjective sleep in comparison to pregnant women without history of trauma (Gelaye et al., 2015). Our aim was to evaluate whether different types of childhood maltreatment were associated with poorer subjective and objective sleep regulation during the second trimester of pregnancy.

Methods

Sleep regulation between 18-20 weeks of gestation was assessed in a sample of 55 expectant mothers, including 31 women exposed to childhood maltreatment. Three measures of sleep were administered: 7-day actigraph measures (Mini-Mitter/Respironics), 7-day sleep diary and the completion of Pittsburgh Sleep Quality Index. Childhood maltreatment was assessed using the Chilhood Trauma Questionnaire. Generalized linear regression models were used to examine the associations between sleep measures and types of childhood maltreatment after adjusting for confounding variables (e.g., maternal age, maternal wellbeing, education attainment and family income).

Results

Among the 31 participants with history of childhood maltreatment, 71% (n=22) reported emotional abuse, 26% (n=8) physical abuse, 39% (n=12) sexual abuse, 42% (n=13) emotional neglect and 65% (n=20) physical neglect. Pregnant women with childhood emotional abuse had around 2.8 higher score on PSQI in comparison to pregnant women without childhood emotional abuse (P<0.003). For objective sleep measures, pregnant women with childhood sexual abuse had around 1 hour less of nocturnal sleep (P<0.004), 30 minutes more nocturnal awakenings (P<0.03) and 6% less of sleep efficiency (P<0.01) compared with pregnant women without childhood sexual abuse.

Conclusion

Emotional abuse during childhood was associated with poorer perceived sleep quality during the 2nd trimester of pregnancy while childhood sexual abuse was particularly associated with objective measures of sleep regulation. Future larger studies are needed to confirm the impact of the different types of childhood maltreatment on maternal sleep quality during pregnancy.

Support

Social Sciences and Humanities Research Council (SSHRC, 2018-2020, Canada)
0894 A Two Item Questionnaire Reflecting Parental Concern As An Indicator Of The Severity Of Obstructive Sleep Apnea In Children
Authors: Tauman R , Lavi M , Greenfeld M , Fishman G , Wasserzug O , DeRowe A
Published: May 2020

Introduction

The currently available questionnaires based on parental reporting of OSA symptoms include large number of items and are not sufficient to the diagnosis and assessment of OSA severity. We aimed to evaluate a simple 2-item questionnaire regarding parental concern as a predictor of the severity of OSA in children as measured by polysomnography.

Methods

Prospective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child’s breathing.

Results

Ninety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Significant correlations were found between the need for surgery score and the apnea-hypopnea index (r=0.22, P = .029), as well as the mean SpO2 levels (r=-0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score and the child’s age were the only predictors for moderate-severe OSA (P = .01 and P = .043, respectively).

Conclusion

Querying parents on their perception of their child’s need for surgery is a sensitive, practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG.

Support
0899 Long-term Effects Of Adenotonsillectomy In Children Diagnosed With Obstructive Sleep Apnea On Risk Factors For Cardiovascular Morbidity
Authors: Even Tsur J , Auhasira R , Shiloh A , Novack V , Goldbart A
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity in adults. In children, cardiovascular morbidity associated with OSA is usually thought to resolve after tonsillectomy and adenoidectomy (T&A). There is no information regarding the long term effects of T&A on future cardiovascular morbidity in children diagnosed with OSA. In this study, we performed data mining to assess long-term effects of adenotonsillectomy on risk factors for cardiovascular disease, in young adults.

Methods

This study retrospectively investigated the population defined by a previous study in our institution [Tarasiuk etal Pediatrics 2004] and compared a group of children diagnosed with OSA and underwent T&A(n=130) to a group of children diagnosed with OSA that did not undergo T&A(n=90) to a control group without OSA (n=505). Demographic data, vital signs, anthropometric measurements, medical diagnoses (9th revision (ICD-9) codes) and medication purchases were captured from the HMO computerized database, between the years 1998-2018. When appropriate, univariate comparisons were made using χ 2-test or Fisher’s exact test for categorical variables, and one-way ANOVA or Kruskal-Wallis tests for quantitative variables. We performed multivariate logistic regression to model the factors associated with the diagnosis of obesity. IBM SPSS software, version 25.0, was used for statistical analysis.

Results

We have found that 20 years after their OSA diagnosis, patients (25.1 years, 52.2% males, 26.2 BMI) who were diagnosed with OSA at age 5 and did not undergo T&A consumed more medications associated with cardiovascular morbidity (anti-hypertensive, statins, aspirin) than those who underwent T&A(P<0.001). Surprisingly, multivariate logistic regression revealed that only females diagnosed with OSA (with or without T&A) were diagnosed as obese in comparison to those that did not have OSA (P<0.001).

Conclusion

Children who were diagnosed with OSA and were not operated will consume more medications (anti-hypertensive, anti-hyperlipidemia, aspirin) as young adults, a surrogate marker for early cardiovascular disease. OSA in girls seems to serve as a risk factor for obesity in their third decade of life. It is important to diagnose and treat OSA in children, and to monitor and prevent obesity, mainly in females.

Support

Israel Science Foundation (ISF) 1344/15
0909 Sleep Duraion And Related Factors Amongchinese Children: Across-sectional Studyabstract
Authors: Jun T
Published: May 2020

Introduction

It is known short sleep duration adversely affects children’s behavior and physical development. Sleep duration and sleep habit vary substantially in children with different ages, areas and races. However, our understanding on the sleep duration in Chinese children remains limited. The present study investigated the status of sleep durations in Chinese children and explored factors related to sleep loss.

Methods

A randomized, stratified, multi-stage cluster sampling method encompassed 11420 children in 25 schools from 7 districts in Beijing. Children aged 3 to 14 years were included, and their parents were invited to fill sleep habit related questionnaires about the performance of the last 3 months.

Results

The final cohort included 4736 boys and 4462 girls with a mean age of 8.8±3.8 years. The mean sleep duration of children ≥12 years of age was 9.4h, which was significantly lower than those < 12 years old (9.7h); this was in agreement with the trend of sleep durations of weekdays. On weekends and holidays, the sleep duration was approximately 10h for most children and similar in all age groups. Gender (male), age (≥12-year group), overweight, and suburban residence were significantly correlated with sleep loss in children (p< 0.001). A significantly high proportion of children with sleep loss displayed sleepiness during sitting and reading (19.1%), in the car (31.4%), in the afternoon (20.7%), and after lunch (17.5%).

Conclusion

The sleep duration reduced significantly in children ≥12 years of age as compared to younger children in Beijing. Factors such as gender (male), age (≥12-year group), overweight, and suburban residence are related to sleep loss. Children ≥12 years of age older with sleep loss were likely to experience daytime sleepiness.

Support

This work was supported by Beijing Municipal Science and Technology Project grant (Z161100000116050 and Z161100003216212) and Beijing Municipal Administration of Hospitals Clinical Technology Innovation Project grant (XMLX201701). .
0925 Associations Between Co-sleeping And Sleep Quality Of Urban Preschool Children
Authors: Stein M , DiSanti N , Weaver-Rogers S , Garcia W , Bonilla-Santiago G , Daniel L C
Published: May 2020

Introduction

Perspectives on co-sleeping vary by family cultural background and socio-demographic characteristics; furthermore, families may choose to co-sleep based on family values or out of necessity. To better understand the role of co-sleeping in young children from ethnic minority backgrounds, the current study sought to test the relationship between co-sleeping and sleep outcomes in an urban early childhood setting.

Methods

141 Parent-child dyads with children aged 1-5 years old (N=141,50.4% female, M=4.01 [SD=1.05]; 41% African American; 41% Latinx; median income $20-30,000) were recruited through an urban preschool. Parents completed demographic information and the Brief Child Sleep Questionnaire, which yielded insomnia and sleep hygiene indices. Step-wise regressions were used to examine the relationship between sleeping location and sleep outcomes (insomnia, sleep health, and child sleep quality), controlling for child age.

Results

Approximately half of the sample (n=71) reported that their child sleeps in a space shared by caregivers or siblings. Co-sleeping did not differ by race/ethnicity [χ 2(3)=1.45, p=.694], child age [F(1, 140)=2.15, p=.145], or income [χ 2(5)=7.05, p=.217]. Controlling for age, insomnia was higher in co-sleeping children [F(2,140)=4.10, p=.019], although sleep location was not a significant independent predictor. Sleep hygiene [F(2,140)=2.39, p=.095] and sleep quality [F(2,139)=0.94, p=.394] did not differ by sleeping location, when controlling for age.

Conclusion

Co-sleeping was common but was not related to sociodemographic factors as described in prior research. Controlling for age, co-sleeping predicted higher insomnia scores suggesting that co-sleeping may be related to symptoms of behavioral insomnia. Sleep hygiene practices and sleep quality did not differ by sleeping location, suggesting that in children without behavioral insomnia symptoms, co-sleeping may not affect sleep. Future studies that seek to better understand caregiver preference and intentions regarding co-sleeping may be important to intervention development seeking to improve behavioral insomnia in ethnic/minority samples.

Support
0929 Caregiver-Reported Versus Clinician-Documented Child Sleep Problems and Sleep-Related Health Behaviors in Primary Care
Authors: Williamson A A , Bhandari E , Cicalese O , Heaps E , Ostan A , Collins M , Lupini F , Mindell J A
Published: May 2020

Introduction

Sleep problems are highly prevalent in early childhood but often under-identified in pediatric primary care. This study identified the prevalence of caregiver-reported versus primary care provider (PCP)-documented sleep problems and sleep-related health behaviors in young children presenting to well child visits (WCVs).

Methods

Caregivers (85.4% mothers) of 198 young children (2-5 years, M = 3.3, 53.7% female, 62.9% Black) presenting to urban (74.1%) and suburban (25.9%) primary care sites for well child visits (WCVs) completed research surveys on child behavioral sleep problems, snoring, and sleep-related health behaviors (e.g., caffeine consumption) on the day of their child’s WCV. Electronic medical record review was used to identify the rate of PCP-documented sleep problems and related recommendations in the WCV progress note.

Results

Fifteen percent of caregivers reported a child sleep problem according to questionnaire data, which did not significantly differ from the 12.0% of children with a PCP-documented sleep problem in the WCV progress note (p = .31). However, significantly more caregivers (28.3%) reported bedtime difficulties (resistance; tantrums) on questionnaires (p <.001), which were not captured in the 12.0% of WCVs noting sleep problems. A total of 8% of WCVs included child sleep recommendations. Child snoring was reported by 17.0% of caregivers, but was less frequently documented in WCVs (4.5%, p <.001). Although many caregivers reported poor child sleep-related health behaviors, including daily child caffeine consumption (21.1%) and bedroom electronics (62.9%), significantly fewer PCPs documented these issues (caffeine: 2.0%; electronics: 6.6%) or related recommendations (decrease caffeine: 1.0%; eliminate electronics: 3.5%) in the progress note (all p-values <.001).

Conclusion

Although caregiver-endorsed child sleep problems on surveys did not differ from PCP-documented concerns, there are gaps in documenting other problematic sleep-related health behaviors, such as caffeine consumption and electronics use. More resources to address sleep-related health behaviors, as well as sleep problems, in pediatric primary care are needed.

Support

Sleep Research Society Foundation and K23HD094905 (AAW)
0942 Alternating Leg Muscle Activation and Hypnagogic Foot Tremor in Children: Comparative Study of Polysomnographic and Clinico-Demographic Variables
Authors: de Menezes G M , Almeida L A , Sander H H , Fernandes R M , Éckeli Á L
Published: May 2020

Introduction

The clinical and polysomnographic meaning of the Alternating Leg Muscle Activation (ALMA) and Hypnagogic Foot Tremor (HFT) patterns in children is not known.

Methods

A descriptive study was carried out to identify the prevalence and polysomnographic characteristics of ALMA and HFT sequences in a sample of 122 children sequentially admitted in the sleep laboratory, with the analysis of clinical and demographic characteristics of the ALMA/HFT group in relation to a comparison group without this condition, paired by age and gender.

Results

Sample prevalence was 14.8% for any HFT/ALMA event, 13.1% for ALMA and 10.7% for HFT. In the HFT/ALMA group, the mean age was 8 years old (2-12 years old), 66.7% of males. Obstructive Sleep Apnea was observed in 75% of children, but HFT / ALMA sequences only occasionally occurred in association with respiratory events. The use of medications with monoaminergic activity was associated with the occurrence of HFT/ALMA, p=0,019. There was higher N1 sleep content in the HFT / ALMA group, p=0,0301. There was no significant difference between both groups regarding the other clinical-demographic or polysomnographic parameters analyzed. Autonomic activation represented by heart rate fluctuations often occurred in association with the HFT / ALMA sequences, irrespective of the occurrence of arousals, awakenings, other motor or respiratory events.

Conclusion

HFT / ALMA is a frequent condition in children that are referred to the sleep lab.The stereotypy of the HFT / ALMA series suggests that their origin might be motor central pattern generators, which are potentially influenced by substances with monoaminergic effect. The finding of higher superficial sleep content in children with HFT / ALMA may indicate greater susceptibility to alteration of pediatric sleep architecture by such subtle motor events. The possibility of clinical consequences and cardiovascular diseases should be considered in relation to the association of HFT / ALMA with observed autonomic activation.

Support

None.