bluuebunny/crossref_metadata_2025 huggingface dataset:
1228 The Impact of Modified Uvulopalatopharyngoplasty as a Bridge to Hypoglossal Nerve Stimulation Eligibility
Authors: Norooz Sheeva , Levri John
Published: April 2024

Introduction

Severe Obstructive Sleep Apnea (OSA) presents a significant challenge, particularly in cases where patients exhibit intolerance to conventional treatments like Continuous Positive Airway Pressure (CPAP). When the Apnea-Hypopnea Index (AHI) remains markedly high, individuals often seek advanced interventions, such as Hypoglossal Nerve Stimulation (HGNS). However, some individuals face elevated AHI scores that surpass the threshold for qualification for HGNS. This narrative documents a patient's journey through a series of interventions, starting from failed CPAP therapy to undergoing Modified Uvulopalatopharyngoplasty (UPPP), which played a pivotal role in reducing their AHI. Subsequently, the placement of an HGNS implant led to the resolution of their OSA.

Report of case(s)

Our patient, a 65-year-old man battling severe OSA, experienced CPAP intolerance with an initial AHI of 88. Despite weight loss, his AHI remained above the acceptable range (15-65) for HGNS. Seeking alternatives, the patient underwent a transformative Modified UPPP, resulting in a significant reduction of his AHI. This improvement enabled his eligibility for HGNS. Post-implantation, marked improvements ensued: cessation of snoring, enhanced sleep quality, and substantial overall well-being. Despite transient swallowing difficulties post-surgery, the patient’s overall course was without complications and largely successful. His journey highlights UPPP’s pivotal role in lowering AHI to qualify patients for advanced therapies, suggesting a promising strategy for managing severe OSA in individuals with refractory AHI levels.

Conclusion

In conclusion, our patient's journey showcases the transformative impact of Modified UPPP, not only in reducing AHI and enabling eligibility for HGNS but also in revealing a pathway for tailored interventions in severe OSA cases. This emphasizes the importance of personalized treatment strategies, and prompts consideration for the integration of multi-tiered interventions in managing complex cases of OSA.

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1229 Dual Neurostimulator Therapy for CSA and OSA in an Elderly Gentleman with Native Pacemaker
Authors: Wasim Alina , Singh Supriya
Published: April 2024

Introduction

We describe a case of severe central sleep apnea with concomitant obstructive apnea treated with a stepwise approach with Transvenous phrenic nerve stimulation and Hypoglossal nerve stimulator.

Report of case(s)

70 yo male with medical history of diabetes, chronic kidney disease stage 3, coronary artery disease with coronary artery bypass in 1997, aflutter with failed ablation (2015, persistent atrial fibrillation, bradycardia with pacemaker implantation (2016), lymphocytic leukemia, treated with methotrexate, underwent a home sleep study in 2018 which showed severe sleep apnea (AHI 55% and O2 nadir 72%). This was followed by a titration study which showed predominant CSA not amenable to CPAP, BPAP or BPAP ST. Echo was performed which showed LVEF 40%. Baseline in lab PSG was performed which showed AHI of 89.5/hour (225 central,36 mixed and 15 obstructive events). REM AHI: 65, REM RDI 65, Supine AHI 90/hour and supine RDI 90.1. Cheyne stokes breathing was observed throughout the study along with significant sleep hypoxia. Medical management failed and patient was not a candidate for ASV given low EF. Remede device was implanted in 2018 for management of CSA. For obstructive apnea, APAP was prescribed however patient tolerance remained poor with suboptimal control of OSA. Repeat PSG showed resolution of CSA and CCB with persistent severe obstructive events AHI 72. With control of CSA, patient underwent DISE which showed Anteroposterior collapse of the vellum qualifying the patient for Inspire.

Conclusion

Traditional treatment for CSA involves optimization of any underlying medical conditions and positive-pressure ventilation with certain limitations. In a subset of patients, CSA remains refractory to medical management and failure rates of PAP therapy remain high. Transvenous PNS significantly improves CSA severity, sleep quality, ventricular function, and QOL regardless of HF status and should be considered in patients with high CSA burden. Once CSA management is optimized, patients with high OSA burden and PAP intolerance can then be considered for HNS. Most of these patients with underlying heart failure may have native ICD or pacemaker, requiring careful assessment of device-device interaction.

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1230 Management of Severe OSA with HGNS: Importance of In-Lab Sleep Studies for Accurate Assessment-bA Case Report
Authors: Cassimere Crystal , Khan Safia
Published: April 2024

Introduction

Continuous positive airway pressure (CPAP) therapy is gold standard treatment for obstructive sleep apnea. Compliance issues and CPAP/BPAP intolerance have paved the way for alternative interventions such as the Hypoglossal Nerve Stimulation (HGNS) device. HGNS works by directly stimulating the hypoglossal nerve in synchrony with respirations to open the airway via tongue stiffening and protrusion, ultimately preventing airway collapse during sleep.1

Report of case(s)

This case report is about a 70-year-old male who has history of severe OSA with significant hypoxemia, being managed with a HGNS implant due to CPAP intolerance. Sleep study after HGNS device activation, showed adequate treatment of OSA, AHI improved to normal range, however, persistent hypoxemia (SpO2 less than 88% for 90 min) was noted. An overnight pulse oximetry study again revealed significant hypoxemia with SpO2 less than 88% for 121 minutes. A home sleep study showed ongoing moderate OSA and hypoxemia with an AHI 26.2 per hour based on 3% desaturation hypopneas and AHI 16.0 per hour based on 4% desaturation hypopneas, in association with significant hypoxemia (SpO2 less than 88% for 54 min) despite using the HGNS implant. He was tested with an in-lab sleep study for the purpose of initiation of supplemental oxygen for management of significant hypoxemia. This study showed significant improvement of AHI to normal range of < 5/hour at setting of 2.7 V, and no significant hypoxemia was noted.

Conclusion

The case highlights a potential discrepancy in evaluating sleep apnea severity using home sleep apnea tests in patients with HGNS device. Most insurance companies approve home sleep apnea tests, but it is advised that patients with HGNS devices showing persistent significant OSA or hypoxemia on a home sleep study undergo a repeat in-lab sleep study for a more accurate estimation of sleep apnea severity and hypoxemia.

Support (if any)

References 1. Olson MD, Junna MR. Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea. Neurotherapeutics. 2021 Jan;18(1):91-99. doi: 10.1007/s13311-021-01012-x. Epub 2021 Feb 8. PMID: 33559036; PMCID: PMC8116425. 2. Punjabi NM, Aurora RN, Patil SP. Home sleep testing for obstructive sleep apnea: one night is enough! Chest. 2013 Feb 1;143(2):291-294. doi: 10.1378/chest.12-2699. PMID: 23381307; PMCID: PMC3566993.
1232 Shall We Hold or Shall We Sleep
Authors: Truong Khanh , Khan Safia
Published: April 2024

Introduction

Nocturia is a common symptom among individuals with untreated and undiagnosed obstructive sleep apnea and is described as waking up from sleep two or more times to void. Interestingly, nocturia is not included in the American Academy of Sleep Medicine clinical practice recommendation to evaluate OSA in adults. Women's OSA symptoms differ from men's, and they are sometimes ignored or attributed to depression or insomnia, leading to an underestimation of OSA diagnosis. Especially nocturia in women is more frequently disregarded as a cause for sleep disturbances. A recent systematic analysis found a lack of data on the prevalence of OSA in Asians, particularly Asian women.

Report of case(s)

A 65-year-old Asian female with a history of osteoporosis who presented to the clinic with a chief complaint of nocturia. Historically, patient went to bed at 11 P.M. and awoke at 6 A.M. She denied history of any other sleep disorders. She complained of frequent nocturia which occured 3-4 times per night, requiring her to wake up every 1 or 2 hours to use the bathroom affecting sleep maintenance. She tried oxybutynin and mirabegron without much improvement. She did not report snoring, having witnessed apneas, or daytime fatigue. Her BMI was 21 and her neck circumference was 13 inches. A home sleep study was done resulting AHI 21.6, showing evidence of moderate obstructive sleep apnea. Patient was recommended to start Auto-CPAP. At 6-month follow up, she reported improvement in her nocturia symptom.

Conclusion

OSA has received increased public attention in recent years, and it is recognized to have serious health consequences if left untreated. Current screening standards in primary care include BMI, sex, age, pharyngeal anatomy, snoring, excessive daytime sleepiness, and the presence of hypertension. However, nocturia isn't included despite the fact that it is frequently reported and related with OSA. Nocturia is improved by treating OSA with PAP treatment or a mandibular advancement device. As a result, more research needs to be done on screening for OSA when nocturia is present, particularly in Asian women, in order to increase the efficacy of the screening method.

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1234 Managing Idiopathic Hypersomnia in a Patient Following Sleeve Gastrectomy
Authors: Uy Roma Balbin , Hershner Shelley
Published: April 2024

Introduction

Sleeve gastrectomy (SG) is a weight loss surgery removing approximately 80% of the stomach1 resulting in a narrower, tubular stomach “sleeve”. It's considered a restrictive procedure wherein weight loss is achieved by limiting the volume of food intake by diminishing the stomach’s capacity. In Roux-en-Y(RYGB), parts of the small intestine is bypassed and the remaining portion is connected to a newly created smaller stomach. By surgically bypassing regions of the small intestine, RYGB limits nutrient absorption leading to weight loss. It’s considered both a restrictive and malabsortive procedure; thus RYGB is associated with more pharmacologic/metabolic concerns compared to SG. Although there is minimal literature comparing drug absorption between SG vs RYGB, some data proposes both SG and RYGB lead to nutrional deficiencies suggesting SG may also be a malabsorptive procedure altering drug pharmacokinetics by increasing transit time, altering gastric pH and reducing bioavailability for extended-release formulations.

Report of case(s)

A 41-year-old female with past medical history of sleeve gastrectomy is seen for management of idiopathic hypersomnia (IH). IH was confirmed after a polysomnogram ruled out obstructive sleep apnea (OSA). The MSLT revealed a mean sleep latency of 6.8 minutes without SOREMPs, and excluded central causes. She has tried multiple combination of medications: dextroamphetamine and amphetamine immediate (IR) and extended release (XR), modafinil, and armodafinil. Currently, she is taking dextroamphetamine and amphetamine IR 30 mg in the morning and 15 mg in the afternoon and modafinil 200mg in the morning. She reports significant sleepiness 2-3 hours after taking her medications.

Conclusion

While SG primarily impacts the stomach, it's crucial to note that the procedure can influence drug absorption with effects such as increased drug transit time, and changes in pH. In bariatric surgery patients, utilizing dosage forms that allows drug disintegration, resistant to acidic environments, and has increased bioavailability—such as liquids or even transdermal formulations—may mitigate altered drug absorption. For this patient, we have discussed smaller and more frequent doses of dextroamphetamine and amphetamine IR formulations e.g 20 mg IR every 3-4 hours (maximum 60 mg today daily dose). If this is not effective, calcium, magnesium, potassium & sodium oxybate can be considered.

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0136 Diurnal Patterns in Suicidal Thinking Among Young Adults
Authors: Tubbs Andrew , Hawkins Emma , Gorovoy Suzanne , Fernandez Fabian-Xosé , Grandner Michael , Perlis Michael
Published: April 2024

Introduction

Suicide is the second-leading cause of death among young adults. Disrupted sleep and circadian rhythms may contribute to the risk of suicide in this age group. Nocturnal wakefulness, for example, may create changes in brain function that contribute to increased incidence of suicide. However, there are limited data on whether suicidal cognitions vary across the day.

Methods

A sample of N=143 individuals aged 18-25 were recruited to participate in a week-long ecological momentary assessment study of sleep and suicidal thoughts. Sleep was sampled daily using a sleep diary, and suicide-related cognitions were sampled five times per day using automated text messages. Text surveys were scheduled across 24 hours (roughly at 2AM, 7AM, 12PM, 5PM and 10PM) and grouped into 6-hour bins (2300-0459, 0500-1059, 1100-1659, 1700-2259). Individuals with unusual or elevated levels of suicidal ideation were followed-up by study personnel for safety.

Results

A total of N=3442 text surveys were collected from N=134 participants. Participants provided an average of 26 surveys each (SD=8.3). A total of N=93 (2.8%) of surveys reported suicidal ideation. As a proportion of all surveys, suicidal ideation was most prevalent from 2300-0459 (N=18, 3.2%) and least from 0500-1059 (N=20, 2.2%). Among suicidal ideators, the desire to die was most elevated from 1100-1659 (1.8 out of 4, SD = 1.19), the intention to die was greatest from 1100-1659 (0.9 out of 3, SD=0.8), and the ability to resist the urge to die was lowest in the 0500-1059 (3.1 out of 4, SD=1.12). However, there were no statistical differences across time categories for the presence of suicidal ideation or severity/intensity of these thoughts.

Conclusion

Suicidal ideation was measured in nearly every hour of the 24-hour day, and severity of suicidal ideation appeared to fluctuate over time. Nevertheless, the presence of suicidal ideation and its severity did not differ statistically across the day, likely due to the small number of reported suicidal cognitions across the sample. Additional work will examine how sleep continuity and/or regularity may influence these findings.

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0140 The Relationship Between REM Sleep Prior to Analogue Trauma and Intrusive Memories
Authors: Drummond Sean P A , Alkalame Lawra , Ogden Jessica , Clark Jacob , Kate Porcheret , Risbrough Victoria
Published: April 2024

Introduction

Intrusive memories are a core feature of posttraumatic stress disorder (PTSD). They both predict the onset of the disorder and drive broader PTSD symptomology. Three meta-analyses concluded sleep (vs wake) after exposure to an analogue trauma decreases the likelihood of intrusive memories. However, the role of sleep prior to analogue trauma exposure has not yet been examined. This is important, insomnia, OSA, and shift work prior to trauma exposure increases the risk of PTSD 2.5-3.0 fold. Given the role of REM sleep in emotion regulation, REM sleep prior to trauma exposure may be particularly critical in the development of intrusive memories. Here, we examined the association between REM sleep prior to analogue trauma and intrusive memories.

Methods

To manipulate REM sleep, 27 healthy adults (MAge = 25.4, SD = 2.89, 56% Female) were randomised to either to a circadian misalignment (CM) condition or normal control (NC) condition for four nights. In CM, participants slept normally for two nights followed by a 4-hour phase advance on night three and an additional 4-hour phase advance on night four. In NC, participants had 8-hour sleep opportunities each night. On day 5, participants watched a trauma film and kept an intrusive memory diary for the next three days. Analyses focused on the relationship between REM sleep over 4 nights in the lab and subsequent intrusive memories.

Results

Greater REM sleep percentage (p = .004) and REM efficiency (p = .02) across 4 nights prior to analogue trauma, independent of group, were significantly associated with fewer intrusive memories in the 3 days after viewing the film.

Conclusion

Findings suggest REM sleep may serve to protect individuals against experiencing intrusive memories. This is consistent with evidence suggesting REM sleep influences emotional memory regulation. Occupations (e.g., emergency services/military personnel) who experience circadian disruptions likely to decrease REM sleep (e.g., from shift work) may be at heightened risk of experiencing intrusive memories after trauma exposure, and thus at increased risk of developing PTSD.

Support (if any)

US Department of Defence office of the Congressionally Directed Medical Research Programs (ID number: PR170893PI)
0145 Worsening ESS Thresholds Predict Five-year Mortality Risk: An NLP-informed Model
Authors: Bay Katherine , Maghsoudi Arash , Jones Melissa , Ramezani Amin , Sharafkhaneh Amir , Razjouyan Javad
Published: April 2024

Introduction

The Epworth Sleepiness Scale (ESS) is a validated tool for capturing self-reported excessive daytime sleepiness. We examined thresholds for association between ESS changes and risk of 5-year all-cause mortality.

Methods

ESS values were mined from progress note-derived free form texts using a natural language processing (NLP) pipeline with reported accuracy of 91%. Veterans in the VHA diagnosed with a sleep disorder or who had participated in a sleep study from January 13, 2000, to August 13, 2018, and with two exams at least 12 weeks apart were identified. Patients were categorized as having normal (0-10) or abnormal (11-24) ESS and characterized by changes in ESS over time: normal-normal, normal-abnormal, abnormal-abnormal, and abnormal-normal. Cox proportional hazards models and elbow plots were conducted to evaluate magnitude of and thresholds for risk of 5-year all-cause mortality adjustment for age and sex.

Results

At baseline, qualifying Veterans were mostly white (74.2%) and male (92.2%) with a mean age of 55.8 ± 13.3 (N = 21,605). One quarter experienced all-cause mortality within five years of their second exam (25.9%). Veterans with abnormal ESS at the second exam had a 6% greater risk of five-year all-cause mortality (aHR: 1.06; 95%CI:1.00,1.11) than those with normal ESS, after adjusting for age and sex. Mortality risk was 13% higher among those converting from normal-abnormal (aHR: 1.13; 95%CI: 1.08,1.32), compared to normal-normal, particularly among those 60 years (aHR: 1.20; 95%CI:1.08,1.32), after adjustment. Regardless of baseline ESS, participants whose score increased over 3-points had significantly higher risk of five-year mortality compared to lesser changes (aHR: 1.08; 95% CI: 1.01, 1.16), which was intensified among those 60 years of age and over (aHR: 1.14, 95% CI: 1.05, 1.23), after adjustment.

Conclusion

These results suggest that abnormal ESS may serve as a clinical marker for increased risk of 5-year all-cause mortality. Providers should pay particular attention to ESS increases over 3-points, particularly among those 60 and older.

Support (if any)

NHLBI K25 HL152006 [J.R.]; ZOLL Respicardia (31002) [A.S.], AHBPCE, FY2024-002 [J.R.]; and IQuESt F&A (CIN 13-413) at the Michael E. DeBakey VA Medical Center, and Baylor College of Medicine in Houston, TX.
0150 Promise of Early Completion Recovers Attention Control Performance After 24+ Hours of Extended Wakefulness
Authors: Dunn Timothy , Smith Max
Published: April 2024

Introduction

Extended wakefulness often covaries with effects of fatigue compounding performance decrements. Much work has sought to identify mitigation strategies. However, strategies that can be reasonably applied to operational tasks are lacking. In the current study, we leveraged recent motivational accounts of fatigue to determine the feasibility of the promise of early completion to recover attention control performance after extended wakefulness.

Methods

All participants completed 12 sessions of the antisaccade task and psychomotor vigilance task (PVT), starting at 0700 and completing at 1000 the next morning. The promise of early completion instruction was given prior to the 12th session; it was stated that the total time a participant would spend completing their last task was contingent on their performance: perform better than previous sessions and the time could be reduced, perform worse and the time could increase. In experiment 1a (N = 30), participants received the incentive instruction prior to completing their last PVT and did not receive it for the last antisaccade task (and vice versa in experiment 1b; N = 24). Four time points were considered: two at known high alertness times (session 1 – 0700 and session 3 – 1800), at 24 hours awake (session 11 – 0700), and the final incentivized session (session 12 – 1000).

Results

For experiment 1a, the incentivized final PVT showed a large decrease in the proportion of lapses relative to session 11 (p < .001, d = −1.32). Lapses in session 12 did not differ from sessions 1 or 3. For experiment 1b, the incentivized final antisaccade task showed a large increase in the proportion of correct trials (p < .001, d = 1.14) relative to session 11. Correct trials in session 12 did not differ from sessions 1 or 3.

Conclusion

The promise of early completion appears to be a strong incentive in recovering attention control performance back to baseline levels and was not task specific. Furthermore, these results dovetail with contemporary accounts of fatigue that hypothesize that decrements are due to shifts in motivation. Future work should aim to investigate a wide range of distractor types and apply the incentive to operational tasks.

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0151 Personalized Caffeine Recommendations to Achieve Optimal Alertness Levels
Authors: Vital-Lopez Francisco , Doty Tracy , Anlap Ian , Killgore William , Reifman Jaques
Published: April 2024

Introduction

Sleep loss impairs alertness, leading to increased injury risk and reduced productivity. Caffeine can safely and effectively mitigate the effects of sleep loss on alertness. However, to be effective, caffeine should be consumed at the right time and amount, depending on sleep history, work schedule and, importantly, sensitivity to sleep loss. Here, we present the 2B-Alert app, a unique smartphone application with capabilities to learn an individual’s trait-like response to sleep loss and to provide personalized caffeine recommendations to optimize alertness.

Methods

We conducted a prospective 62-h total sleep deprivation study to validate the capabilities of 2B-Alert. Throughout the challenge, 21 participants used the app to measure their alertness via the psychomotor vigilance test (PVT). The app used the PVT data collected during the first 36 h of wakefulness to learn each participant’s sleep-loss response and provided personalized caffeine recommendations (from 0 to 800 mg) at that time, so that each participant would sustain alertness at a pre-specified target level (PVT mean response time of 270 ms) during a 6-h period starting at 44 h into the challenge. To assess the effectiveness of the personalized recommendations, we counted the number of PVT data points during the 6-h period that fell within the target alertness level +/-2 times the within-subject variability of alertness impairment (i.e., +/-60 ms).

Results

Participants’ response to sleep loss varied widely from being highly resilient to being highly vulnerable. Accordingly, 2B-Alert recommended no caffeine to five participants, 100-400 mg to 11 participants, and 500-800 mg to five participants. Regardless of their sleep-loss response and the caffeine amount consumed, participants sustained the target alertness level ~80% of the time during the 6-h period.

Conclusion

2B-Alert automatically learns an individual’s trait-like response to sleep loss and provides personalized caffeine recommendations in real time so that individuals achieve a desired alertness level regardless of their susceptibility to sleep loss.

Support (if any)

This work was sponsored by the Military Operational Medicine Program Area Directorate of the U.S. Army Medical Research and Development Command (USAMRDC), Fort Detrick, MD. The Henry M. Jackson Foundation was supported by the USAMRDC under Contract No. W81XWH20C0031.
0152 Cabin Crew Alertness and Performance During Long-haul Flights
Authors: Arsintescu Lucia , Hilditch Cassie , Pradhan Sean , Gregory Kevin , Flynn-Evans Erin
Published: April 2024

Introduction

Sleep loss and circadian disruption pose a significant risk in aviation. Previous literature has shown that inflight rest facilities influence alertness and performance among pilots, but few studies have evaluated cabin crew. The aim of this research was to assess alertness and performance among cabin crewmembers sleeping in different rest locations during a long-haul out-and-back trip.

Methods

Twenty-nine (5 male) cabin crewmembers (Mage = 30.61, SD = 2.91) flew the same long-haul route (outbound and inbound) with an average flight duration of 10:41 (± 0:14) hours. Participants were randomly assigned to fly on an aircraft with a bunk in both directions or to fly an aircraft with a bunk in one direction and with a high comfort jump seat (HCJS) in the other direction. Throughout the study, they wore an Actiwatch and completed a sleep diary at bedtime and upon waking. They completed a Karolinska Sleepiness Scale (KSS) and a 5-minute Psychomotor Vigilance Task (PVT) at the beginning and at the end of each flight. Seventy-seven percent of flights had a bunk and 23% had a HCJS. A series of mixed-effects models were performed to assess the changes in KSS and PVT when crewmembers slept in the bunk during both directions of flight (bunk-only) compared to when sleep was obtained in the HCJS during one direction and bunk in the other (bunk + HCJS).

Results

Fifty-seven flights were included in the analyses. Cabin crewmembers who slept in bunk-only reported higher alertness at the end of the flight (b = 0.54, SE = 0.17, p = .002, Hedges’ g = -0.52) and had faster PVT response speed (b = 0.69, SE = 0.12, p < .001, Hedges’ g = 0.18) compared to bunk + HCJS. There were no significant differences in PVT lapses (p = 0.52).

Conclusion

Our results showed that cabin crewmembers reported greater alertness and performed better when they used the bunk-only. Further research is needed to understand how other factors such as duty start time and workload might influence the sleep of cabin crewmembers during long-haul flights.

Support (if any)

NASA Airspace Operations and Safety Program, System-Wide Safety Project.
0156 Subjective Sleepiness Across the Day in Patients with Sleep Disorders
Authors: Garcia-Martinez Alejandra , Jimenez-Genchi Alejandro , Rosenthal Leon
Published: April 2024

Introduction

According to the two-process model, sleep propensity rises during waking and it dissipates during sleep. However, the clinical assessment of subjective sleepiness usually overlooks changes of sleepiness across the day. A modified version of the Epworth sleepiness scale has been found to overcome this gap. With this instrument, an overall pattern of increasing sleepiness across the day has been reported. The aim of this study was to evaluate subjective sleepiness across the day in patients with sleep disorders.

Methods

Participants were recruited from the National Institute of Psychiatry. All patients who attended the sleep unit for the first time between December 2021 and November 2023 and filled the Time of Day Sleepiness Scale (ToDSS) were included. The ToDSS consists of 8 items of the Epworth sleepiness scale (ESS) but modified for gathering subjective perception of sleepiness in the morning, afternoon and evening. A general linear model with repeated measures was conducted to assess changes in sleepiness across the day.

Results

One hundred and ninety-five patients were included (female 68.4%, mean age 45.1 SD 15.3). All participants had at least one sleep disorder and 91.3% had a comorbid psychiatric disorder. Scores on ToDSS were: Morning 8.8 (SD=7.3) afternoon 10.6 (SD=6.9), evening 11.3 (SD=7.0); ESS=10.3 (SD=7.2). MANOVA showed a significant main effect for time (Pillai’s Trace 0.12; F=11.3, df 2,155, p<.001). There were no significant effects for interactions time x sleep disorder x and time x sleep disorder x psychiatric morbidity. In contrast, a significant effect was found for time x psychiatric morbidity (Pillai’s Trace 0.17; F=2.0, df 14, 312, p<.02). In participants with comorbid psychiatric disorders there was a significant increase in ToDSS from morning to afternoon (df 7, F=2.5, p=.01,) but not from afternoon to evening (df 7, F=2.0, p>.05)

Conclusion

Discussion These results are in line with previous research which has described a pattern of increasing subjective sleepiness across the day. But they also suggest this pattern might be different in patients with psychiatric morbidity. Additional research to characterize the clinical implications of these findings is needed.

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0157 Sleep, Participant-Reported Outcomes, and the Gut Microbiome in Colorectal Cancer Patients and Their Caregivers
Authors: Ahmed Ayaan , Lee Lena , Son Elisa , Ban Yuguang , Maki Katherine , Wallen Gwenyth , Kim Youngmee , Barb Jennifer
Published: April 2024

Introduction

Colorectal cancer is one of the most common cancers worldwide. Patients with this disease may experience gut dysbiosis and various psychoneurological symptoms (PNS) including, sleep disturbance, psychological distress, and pain. Family caregivers involved in managing their day-to-day needs may also experience similar PNS. This study aimed to explore associations between sleep characteristics and the gut microbiome in patient-caregiver dyads stratified by the presence or absence of PNS.

Methods

Patients with colorectal cancer and their sleep-partner caregivers (20 dyads, 55.49 years old, 60% female patients) self-reported PNS using the Patient Reported Outcomes Measurement Information System (PROMIS) once, from which participants were categorized, using K-means clustering, into normal and symptomatic PNS subgroups. Participants also completed the Sleep Consensus Diary daily for 14 consecutive days, from which sleep characteristics (sleep duration, time in bed, sleep onset latency, wake after sleep onset, and sleep efficiency) were derived. Participants provided stool samples, from which gut microbiome features were investigated using shotgun metagenomic sequencing. MetaPhAn3 for taxonomy classification and MicrobiomeAnalyst2.0 for alpha and beta diversity assessment were employed. PNS subgroup differences in differential taxa abundance, alpha and beta diversity, and gut microbiome feature associations with sleep characteristics were tested separately for patients and caregivers.

Results

55% of patients and 35% of caregivers were categorized into the symptomatic subgroup. Although no significant differences were observed in alpha and beta diversity between PNS subgroups, nine taxa were uniquely abundant in patients and five in caregivers (unadjusted p<.05) that differed between the PNS subgroups. Regarding sleep characteristics, among patients, greater sleep efficiency (p=.015), shorter time in bed (p=.043), and longer wake after sleep onset (p=.024) were associated with greater alpha diversity (assessed by the Simpson’s Diversity Index). However, no significant associations of sleep with alpha and beta diversity were found in caregivers.

Conclusion

Findings suggest sleep disturbance may be a psychoneurological contributor to gut dysbiosis in patients with colorectal cancer. Future investigations to elucidate bidirectional associations between sleep and gut health, one’s psychobehavioral impact on the partner’s gut microbiome, and other psychoneurological markers that are attributable to caregivers’ gut dysbiosis, with a larger sample and prospective longitudinal design, are warranted.

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0162 Preliminary Findings on the Moderating Effects of Exercise on Alcohol and Sleep
Authors: Nechyba Ashley , L’Houtellier Nina , Montalvo Jessica , Oliveira Bruno , Elvariste Stessie , Moise Rhoda , Blanc Judite , Seixas Azizi , Jean-Louis Girardin
Published: April 2024

Introduction

We sought to gauge how sleep was being affected by alcohol and how other factors that affect may contribute to sleep impairments may be moderated by exercise.

Methods

The overall sample comprised of 743 Black or African American participants from the New York City or the South Florida area from NIH funded studies called ESSENTIAL and MOSAIC. This data was collected from January 2020 to November 2023. A wearable device called Fitbit was used to capture steps. The baseline assessment comprised of questions about the frequency of substance use, Insomnia Severity Index, PROMIS Sleep Disturbance 8a, the Sleep Related Impairment 8a, Everyday Discrimination Scale, Assessment of Sleep Environment, and Holmes-Rahe Stress Inventory. To find the homogeneity of variances between groups, a Levene's test was performed between alcohol and a variety of factors that affect sleep.

Results

In the participant pool (n=743), 57% were female(n=424) and 43% were male(n=221). 27% of participants lived in the New York City area and 73% of participants lived in the South Florida area. 603 participants having at least one drink a month for all data captured in the baseline assessment. We carried out Levene's test statistic for stress (t=–8.408, df=741, m=.95, sd=1.076), everyday discrimination (t= –18.642, df=741, m=39.9, sd=12.846), sleep disturbance (t= –5.644, df=741, m=4.51, sd=9.441), insomnia (t= –11.899, df=741, m=10.24, sd=6.973), sleep environment (t= –42.931, df=741, m=39.43, sd=.572). The p-value was <.001 so there was a significant difference in variance between alcohol and each factor. For steps, 222 out of 234 participants reported at least one drink a month. We carried out Levene's test statistic for sleep disturbance (t= 7555.4862, sd= 4150.84545). The p-value was .040 so there was a significant difference in variance between alcohol and steps.

Conclusion

In South Florida and New York, alcohol consumption was associated with variance in sleep disturbance, sleep impairment, and insomnia symptoms. Alcohol consumption was associated with variance as sleep environment, stress, and discrimination.

Support (if any)

NIH R25HL-10-5444 R01HL142066, R01AG067523.
0164 The Effect of Delaying Class Times on Cognitive Performance in College
Authors: Jung Christopher
Published: April 2024

Introduction

High school start times have been studied in detail over the past two decades. Findings include better standardized test scores, absenteeism, GPA and fewer sick days with a delayed start time. Few studies to date have examined college course start times, however. The impacts of early college courses on GPA are mixed with one article reporting a better GPA while another reporting the opposite. Many other factors can influence overall GPA such as absenteeism, illness and drug and alcohol use. Because of this, I wanted to determine if there was an impact of early class times on exam scores. I hypothesized that exam scores would be lower on the 7:30 am exam when compared to the 7:30 pm exam.

Methods

Cumulative freshman level anatomy and physiology final exam scores were analyzed from two different sections during the fall 2017 semester at the University of Alaska Anchorage. Both exams had the same 100 questions, students were given 165 minutes to complete the exam and the same instructor taught both sections. The two exams were administered in different lecture halls. There were 67 students in the 7:30 pm section and 153 students in the 7:30 am section.

Results

Independent t-tests revealed that there was significantly (p < 0.05) better performance on the 7:30 pm exam (72.9 ± 15.3; mean ± STD) compared to the 7:30 am exam (64.1 ± 17; mean ± STD). Additionally, 19.4% received a failing grade in the 7:30 pm section compared to 46.4% in the 7:30 am section.

Conclusion

Sleep restriction, sleep inertia and an adverse circadian phase most likely contributed to worse performance on the morning exam, which should be further studied. These results suggest that college start times can have drastic and detrimental impacts on student success. College is expensive and time consuming. Administrators and faculty should be cognizant of class start times to optimize student success. These data suggest early morning classes may be detrimental to student performance and college class start times should be studied in further detail.

Support (if any)
0165 Association of Circadian Misalignment with Diet and Physical Activity in Adolescents
Authors: Ballester-Navarro Pura , Morales-Ghinaglia Natasha , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio
Published: April 2024

Introduction

Circadian rhythms, particularly the sleep-wake cycle, food intake (FI) and physical activity (PA) are reciprocally synchronized. Lipid and carbohydrate metabolism pace depend on circadian stability. Timing, quality and quantity of FI and PA align circadian clocks. Therefore, circadian misalignment, which is highly prevalent in adolescents, is potentially impacting this triad. We examined whether subjective and objective metrics of circadian misalignment are associated with FI and PA in adolescents.

Methods

We assessed 377 adolescents from the Penn State Child Cohort (median 16 years; 46% female; 22% racial/ethnic minority) who had a minimum of 3-nights of at-home actigraphy (ACT) and a 9-h in-lab polysomnography (PSG). ACT-measured sleep midpoint (SM) was calculated as the central point of the sleep period, while sleep regularity (SR) was calculated as the intra-individual standard deviation of the SM. Circadian preference (CP) was measured with the Morningness-Eveningness Questionnaire. Bouts of sedentary behavior (SB) and level of SB and of moderate-to-vigorous PA (MVPA) were also derived from ACT. FI was measured via the Youth/Adolescent Food Frequency Questionnaire. PA and FI were dependent variables. Stepwise linear regression models adjusted for demographics (sex, race/ethnicity, age, BMI percentile), sleep disorders (insomnia, PSG-apnea/hypopnea index) and insufficient sleep (ACT-mean sleep duration, ACT-sleep duration variability).

Results

A later SM was significantly associated with greater intake of carbohydrates (β=.125, p=.022), an association that was attenuated when adjusting for sleep variability (β=.094, p=.102). A later SM was also associated with greater bouts of SB, even when adjusting for all covariables (β=.167, p=.006). Neither SR nor CP were significantly associated with FI or PA in adolescents.

Conclusion

Adolescents with a delayed sleep phase are more likely to consume more carbohydrates and have greater number of periods of sedentary behavior. Circadian misalignment of the sleep-wake cycle, and its associated variability in sleep duration, should be an integral part of interventions targeting poor dietary choices and sedentarism in youth.

Support (if any)

NIH (R01HL136587, UL1TR000127)
0166 Population-Based Estimates of Drowsy Driving Among US Teens: A National Sleep Foundation Study
Authors: Dzierzewski Joseph , Nielson Spencer , Lopos John
Published: April 2024

Introduction

Drowsy driving represents a large public health concern, accounting for a significant proportion of motor vehicle crashes. Among US teenagers, motor vehicle crashes are the second leading cause of death. However, a dearth of research has documented the prevalence and frequency of drowsy driving in teens, as well as beliefs surrounding drowsy driving. The overarching goal of the present study was to document the prevalence, frequency, and perceptions of drowsy driving among teens.

Methods

We conducted a nationally-representative, probability-based survey of 1,124 US individuals aged 13 to 17 years to assess drowsy driving prevalence, frequency, and beliefs. Results have an estimated margin of error of ~4%. Survey respondents reported whether they have ever driven while so tired they had a hard time keeping their eyes open, how often they did so, what kept them from getting the sleep needed to drive alert, and perceived risks associated with drowsy driving. Measures of central tendency and dispersion were used to characterize responses.

Results

Approximately one in six teen drivers reported having driven drowsy. Projected to all US teen drivers, over 400,000 drive drowsy at least once per week. Teen drivers who work for pay were more than twice as likely to have reported drowsy driving than teens who didn’t work for pay. When asked about what prevented them from getting the sleep they needed to drive alert, the majority of teens pointed to work or school schedules. When asked about the risks associated with drowsy driving, 95% of teens said drowsy driving is extremely or very risky. However, when asked about the likelihood of drunk, drugged, distracted, and drowsy driving leading to death or serious injury, drowsy driving was seen as having the lowest risk of death or serious harm.

Conclusion

Due to a confluence of factors, including driving as a newly learned behavior and multiple competing time demands, teenagers find themselves at increased risks for drowsy driving and drowsy driving-related consequences. We found that approximately 1.7 million teenage drivers had driven while so tired they had a hard time keeping their eyes open. Increased attention to this preventable public health concern is needed.

Support (if any)
0170 Insomnia and Impulsivity: A Systematic Review and Meta-analysis
Authors: Yu Shijie , WANG Ran , Li Xiao , Li Shirley Xin , Wing Yun Kwok , Chan Ngan Yin , Chan Joey
Published: April 2024

Introduction

Growing evidence indicates that sleep disturbances are associated with impaired cognitive control, resulting in an increased risk for impulsive behaviors and risk-taking. However, the findings remained mixed and a synthesis of the evidence focusing on insomnia symptoms while including holistic measurements of impulsivity is lacking. This systematic review and meta-analysis aimed to examine whether insomnia symptoms are associated with impulsivity.

Methods

The review was performed following PRISMA guidelines. Four electronic databases, PubMed, Web of Science, Embase, and PsychINFO were systematically searched from inception to December 2022. Studies were included if they reported the correlation between quantitative measures of insomnia symptoms and impulsivity. Excluded studies were case reports, dissertations, reviews, or conference abstracts. Subgroup analyses were performed to determine whether different populations and measures of impulsivity affected the strength of the association. Data were pooled using the random-effects model and heterogeneity was quantified using I2.

Results

Across the 42 eligible studies, involving 17091 subjects (59% female; mean age 33 years), there was a significant positive association between insomnia symptoms and impulsivity (r= 0.16, 95% CI, 0.09- 0.24, p < 0.01). Subgroup analyses showed that impulsivity, as measured by self-report, was positively associated with insomnia symptoms (r = 0.22, 95% CI, 0.15- 0.29, p< 0.01), but this association was not found based on the behavioral measures of impulsivity (r = -0.11, 95% CI, -0.30- 0.09, p = 0.28). Meta-regression suggested that publication year was a significant moderator, with studies published more recently showing smaller effect sizes.

Conclusion

Our findings demonstrate that insomnia symptoms are associated with higher levels of self-reported impulsivity. This points to a crucial next step in clinical practices to target insomnia as a modifiable factor to reduce impulsivity and risk-taking behaviors. Future studies should evaluate this association using samples with a clinical diagnosis of insomnia, with behavioral measures of impulsivity. Furthermore, neuroimaging techniques could be incorporated to unveil the underlying neural mechanisms between impulsivity and insomnia.

Support (if any)

This work was funded by General Research Fund (Ref. 17619123), Research Grants Council, University Grants Committee, Hong Kong SAR, China.
0172 Predictive Relationships Between Baseline and Recovery Sleep and Neurobehavioral Measures During Sleep Deprivation
Authors: Goel Namni , Pasetes Lauren
Published: April 2024

Introduction

We investigated whether baseline sleep measures derived from actigraphy the night before total sleep deprivation (TSD) predicted cognitive performance and subjective sleepiness and fatigue during TSD. We also investigated whether these measures during TSD predicted that night’s recovery sleep.

Methods

Thirty-two adults (ages 27-53;14 females) participated in a five-day experiment under controlled conditions comprised of two baseline 8h time in bed (TIB) nights (B1, B2), approximately 39h of TSD, and two recovery nights of 8-10h TIB (R1=10h, R2=8h). Neurobehavioral measures including the Digit Symbol Substitution Test (DSST), Digit Span (DS), the 10-minute Psychomotor Vigilance Test (PVT), the Karolinska Sleepiness Scale, and the Profile of Mood States Fatigue scale were collected at 0400h, 1130h, and 1730h during TSD. During the second baseline night (B2) and the first recovery night (R1), wrist actigraphy (Actiwatch Spectrum) assessed sleep indices including sleep duration, sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), percent sleep, and the timing of sleep onset, offset, and midpoint. Pearson’s correlations determined relationships between B2 sleep and TSD neurobehavioral measures and between TSD neurobehavioral and R1 sleep measures (p< 0.05 was significant).

Results

Greater SE at baseline was significantly associated with less subjective sleepiness during TSD (r=−0.415;r2=0.172), and a later sleep onset (r=−0.409;r2=0.167) and a later midpoint (r=−0.376; r2=0.142) were significantly correlated with less subjective fatigue during TSD. Higher DSST scores during TSD were significantly associated with shorter duration, greater SOL, and a later sleep onset during recovery (r:−0.473-0.547; r2:0.172-0.299). Similarly, higher DS scores significantly correlated with later sleep onset (r=0.370; r2=0.137). Fewer PVT lapses during TSD were significantly associated with shorter duration, higher SE, lower WASO, higher percent sleep, and an earlier sleep offset during recovery (r:−0.417-0.489; r2:0.136-0.239).

Conclusion

Our novel findings demonstrated that measures of sleep continuity and timing the night before TSD predicted resilience to subjective sleepiness and fatigue, but not cognitive performance during TSD. By contrast, cognitive but not subjective performance resilience during TSD predicted that night’s recovery sleep duration, continuity, and timing. Thus, actigraphic measures uniquely predict subjective responses to TSD and reflect cognitive performance responses during sleep loss.

Support (if any)

NASA grants NNX14AN49G and 80NSSC20K0243 (NG)