bluuebunny/crossref_metadata_2025 huggingface dataset:
0666 Implementing a Sleep Technician Supervised Mask/Interface Fitting Session Can Improve Adherence With Home Automatic Positive Airway Pressure Therapy
Authors: Syed Z , Mehta I , Khorfan F
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a common disorder associated with increased risk of motor vehicle accidents in addition to cardiovascular and neurocognitive comorbidities. Home Automatic Positive Airway Pressure (APAP) therapy is becoming a mainstay treatment of OSA in the outpatient setting. It is typically prescribed without any prior supervised titration. Discomfort related to the APAP interface is thought to contribute to poor adherence with home APAP use. We examined whether implementing a dedicated and personalized interface fitting session improves APAP adherence.

Methods

After obtaining IRB approval, 132 adult patients newly diagnosed with OSA were prospectively randomized into two groups (Groups A and B). Group A received a personalized interface/mask fitting session supervised by a sleep technician prior to starting home APAP therapy. During this 30-minute session, patients were educated on APAP use and sampled different masks to address any issues with comfort, leaks, etc. Group B received the usual care where they obtained an interface through Durable Medical Equipment. APAP adherence and interface air leaks during the initial 30 days of home APAP use were compared between the two groups.

Results

Mean APAP adherence during the initial 30 days of APAP therapy was 12.9% higher in Group A compared to Group B; p=0.05. Fewer APAP interface air leaks were present in Group A (14.8 l/min) compared to Group B (21.2 l/min); p=0.04.

Conclusion

Discomfort related to the APAP interface can quickly lead to non-adherence with APAP therapy. Initial experience of APAP treatment is important in determining subsequent use. Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician can improve APAP adherence. Potential benefits of increased APAP adherence include improvement in quality of sleep and in turn improvement in quality of life.

Support

Prior studies have shown that the initial experience of APAP treatment was highly important in determining subsequent use. Patients establish a pattern of APAP adherence during the early days of treatment and maintain this pattern long-term. Early intervention with solutions may help improve APAP adherence.
0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures
Authors: Weingarten J A , Dubrovsky B , Cunningham J , Chin W , Howladar A , Gikashvili L
Published: May 2020

Introduction

Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA.

Methods

A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p<0.1 criterion. AHI and SpO2nadir were forced into the models.

Results

Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2<1%), lower total arousal index (TAI, p=0.006, R2<1%), higher total sleep time (TST, p=0.003, R2<1%), higher PSQI (p<0.001, R2=5%), and higher CESD (p=0.001, R2<1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2<1%), lower TAI (p<0.001, R2=1%), higher PSQI (p<0.001, R2=3%, and higher CESD (p<0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men.

Conclusion

On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables.

Support

none
0738 Advance Taper of Antidepressants Prior to Multiple Sleep Latency Testing Increases the Number of Sleep-Onset Rapid Eye Movement Periods and Reduces Mean Sleep Latency
Authors: Kolla B , Jahani Kondori M , Silber M , Samman H , Dhankikar S , Mansukhani M P
Published: May 2020

Introduction

Patients presenting with excessive sleepiness are frequently on antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited.

Methods

Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014-2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement suppressing antidepressants (REMS-AD) at assessment and during testing, actigraphy and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMS), proportion with ≥2 SOREMS and mean sleep latency (MSL) in patients who were on REMS-AD and discontinued prior to testing versus those who remained on REMS-AD were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT wherever feasible; fluoxetine is stopped 4 weeks prior. Regression analyses accounting for demographic, clinical and other medication-related confounders were performed.

Results

A total of 502 patients (age=38.18±15.90 years; 67% female) underwent MSLT; 178 (35%) were on REMS-AD at the time of assessment. REMS-AD were discontinued prior to testing in 121/178 (70%) patients. Patients tapered off REMS-AD were more likely to have ≥2 SOREMS (OR-12.20; 95%CI=1.60-92.94) compared to patients who remained on REMS-AD at the time of the MSLT. They also had shorter MSL (8.77±0.46 vs 10.21±0.28; p>0.009) and higher odds of having ≥2 SOREMS (OR=2.22; 95%CI=1.23-3.98) compared to patients not on REMS-AD at initial assessment. These differences persisted after regression analyses accounting for confounders.

Conclusion

Patients who taper off REMS-AD prior to MSLT are more likely to demonstrate ≥2SOREMs and have a shorter MSL. Pending further prospective investigations, clinicians should preferably withdraw REMs-AD before an MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.

Support

None
0759 Phase 2 Proof Of Concept Study Of SUVN-G3031, A Histamine H3 Receptor Inverse Agonist For The Potential Treatment Of Narcolepsy
Authors: Nirogi R , Goyal V , Jayarajan P , Bhyrapuneni G , Ravula J , Jetta S , Shinde A
Published: May 2020

Introduction

SUVN-G3031 is a potent inverse agonist at histamine H3 receptor (H3R) with selectivity over 70 other targets. SUVN-G3031 has excellent pharmacokinetics in rats and dogs. SUVN-G3031 demonstrated dose dependent receptor occupancy in rats with marked wake-promoting and anticataplectic effects in orexin knockout mice supporting its potential therapeutic utility in the treatment of narcolepsy. Long-term safety studies in animals and Phase 1 evaluation for safety, tolerability and pharmacokinetics demonstrated no concern for further development of SUVN-G3031.

Methods

SUVN-G3031 is currently being evaluated in a Phase 2 proof of concept study in USA for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380). This is a double-blind, placebo-controlled, parallel-group, multicenter study to evaluate the safety, tolerability, pharmacokinetics and efficacy of SUVN-G3031 in comparison to placebo in patients with narcolepsy with and without cataplexy. Participants with an ESS score of ≥ 12; and mean MWT time of < 12 min are being randomized at a ratio of 1:1:1 to 2 mg SUVN-G3031, 4 mg SUVN-G3031 or placebo. Patients are to be stratified based on the type of narcolepsy. Each patient will receive study drug once daily for 14 days. The primary objective of the study is to evaluate the effectiveness of SUVN-G3031 compared to placebo as measured by an improvement in the maintenance of wakefulness test (MWT) score. Various secondary, exploratory, safety endpoints and steady state plasma concentrations will be evaluated.

Results

This study has been initiated in Q3 2019 and subject recruitment is expected to be completed by Q2 2020.

Conclusion

This study is a phase 2 clinical trial evaluating the efficacy and safety of SUVN-G3031 as a monotherapy in patients with narcolepsy with and without cataplexy. Safety and efficacy results from the study are expected in Q3 2020.

Support

None
0818 Cyclic Alternating Pattern as Indicator for Subjective Sleep Quality in Community-Dwelling Older Men
Authors: Hartmann S , Baumert M
Published: May 2020

Introduction

The micro-architecture of NREM sleep displays a cyclic alternating pattern (CAP) comprising activation phases of slow high-amplitude waves (A1), fast low-amplitude brain activity rhythms (A3) or a mixture of both (A2). In this study, we investigated the relationship between CAP and subjective sleep quality parameters reported by community-dwelling older men from the Osteoporotic Fractures in Men Sleep Study.

Methods

CAP was scored in 2,811 overnight EEG recordings using a high performance automated CAP detection system. We quantified the ratio between CAP time and NREM sleep time (CAP rate), the number of A1-phases per hour of NREM sleep (A1 index), and the number of A2+A3-phases per hour of NREM sleep (A2+A3 index). Also, participants were asked to score the quality of their sleep on a Likert scale with five items from light to deep, from short to long, and from restless to restful. The relationship between CAP parameters and the subjective sleep quality measures was determined using ANCOVA with traditional sleep disturbance indices such as obstructive apnea-hypopnea index and arousal index as covariate.

Results

CAP rate decreased significantly with increasing quality of sleep for all three subjective measures (light vs. deep: 58.8±22.3% vs. 54.6±20.5%, p < 0.001; short vs. long: 58.4±21.4% vs. 55.1±20.5%, p < 0.001, restless vs. restful: 59.4±20.8% vs. 55.6±21.0%, p = 0.002). The A1 index did not show any significant variations across all three sleep quality parameters. The A2+A3 index behaved similarly to the CAP rate with decreasing values for each subjective measure (all: p < 0.001).

Conclusion

CAP rate, especially A2+A3-phases, are reduced in older men who report good sleep quality, while A1 index did not show any significant relationship with subjective sleep quality measures. Hence, CAP is an indicator of sleep quality.

Support

The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839.
0825 Sleep During Pregnancy Through One Year Postpartum: Correspondence Between Actigraphy and Self-Report Measures
Authors: Beverly Hery C M , Christian L M
Published: May 2020

Introduction

Disrupted sleep and shorter sleep duration is common in pregnancy, due to hormonal changes and physical discomfort, and in postpartum due to new infants. Objective data in this population studied over more than one year are lacking. The current analysis focuses on actigraphy-based and self-reported sleep. We examined the level of correspondence between these two complementary measurement modalities.

Methods

Pregnant women were enrolled in the Stress and Health in Pregnancy and Postpartum (SHIPP) study. Study visits were conducted from 2016-2019 during the 3rd trimester, 4-6 weeks postpartum, and 4 months, 8 months, and 12 months postpartum. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and provided wrist-actigraphy data (Actiwatch, Philips Respironics) for one week prior to each study visit. Actigraphy-based time in bed (TIB), total sleep time (TST), sleep efficiency (SE), WASO and sleep latency (SL) were calculated. Correlations were conducted between actigraphy-based and self-reported PSQI sleep measures.

Results

79 women (28.9±4.6 years) provided complete actigraphy data (≥3 valid days; 6.4±1.0 days) for at least one time point. Objective TST from the 3rd trimester to 12-months postpartum was 7.19, 6.87, 6.86, 6.89, and 6.78 hours, respectively. Actigraphy-based TIB was positively correlated with self-reported TIB at all five visits (r’s: 0.37-0.62, p’s<0.01). Actigraphy-based TST was positively correlated with self-reported TST (r’s: 0.27-0.48, p’s<0.05) at all visits. Actigraphy-based SE was negatively correlated with the PSQI Global Score at 4, 8, and 12 months postpartum (r’s: -0.29 to -0.39, p’s<0.05). Of note, actigraphy-based WASO and SL were not consistently correlated with any self-reported PSQI sleep measures.

Conclusion

Ensuring collection of accurate sleep data during pregnancy and postpartum is important, as poor sleep is associated with negative health outcomes for both mother and child. Self-reported data is common in large, epidemiologic studies yet actigraphy-based measures may capture different aspects of sleep than self-report.

Support

This study was supported by the National Institutes of Health (R01 NR01366).
0840 Sleep Quality in Clinically Indicated In-Laboratory Polysomnography
Authors: Roth R H , Harrison E , Kang H , Lobo J , Logan J , Sohn M , Kwon Y
Published: May 2020

Introduction

Few studies have explored how patients sleep or what characteristics might be predictive of poor sleep during clinically-indicated polysomnography (PSG) in an in-laboratory setting.

Methods

We reviewed clinically indicated diagnostic PSG studies completed over a 10-year period in a single academic sleep center. Total sleep time (TST) and sleep efficiency (SE) were used as proxies for sleep quality. Patients were categorized as normal or poor sleepers based on TST <4 hours or SE <50%. Multivariate linear and logistic regression analyses were performed to determine factors associated with sleep quality while controlling for demographics, medications, comorbidities and measures of sleep.

Results

We included 4957 patients, who were mostly female (58.9%), middle-aged (52.9 y), Caucasian (69.3%), and overweight or obese (91.3%). 3682 patients (74.2%) were diagnosed with sleep apnea (Apnea Hypopnea Index(AHI)>5/hr).

Average TST was 5.75±1.43 hours (Interquartile range [IQR] = 4.94 - 6.73) and average SE was 75.1%±16.1% (IQR=66.9 - 87.2). TST and SE were lower for males compared to females (5.48 vs 5.93 hr, p<0.001; 73% vs 77%, p<0.001). In multivariable analysis, older age (TST: OR = 1.04, 95% CI:[1.03,1.05]; SE: OR = 1.04, 95% CI:[1.04,1.05]), male sex (TST: 1.38,[1.14,1.68]; SE: 1.34,[1.07,1.68]), normal body habitus (TST: 1.47,[1.02,2.08]; SE: 1.51,[1.01,2.27]) and a higher AHI (TST: 1.02,[1.02,1.03]; SE: 1.02,[1.003,1.03]) were significantly associated with being a poor sleeper for both TST and SE. Antidepressant use was associated with poor sleep for TST (0.77, [0.59,1]), but not for SE (0.98, [0.73,1.3]).

Conclusion

Sleep quality during the in-laboratory PSG differed by sex, age and presence of sleep apnea. Sleep quality during in-lab PSG is thought to be compromised by obtrusive monitoring and an unfamiliar environment, but average sleep quality may be higher than expected for patients in the laboratory. Future studies should consider examining in-lab sleep quality in different patient populations.

Support

N/A
0862 Adequate Sleep Duration Enhances Cardiovascular Benefits Of A Physical Activity Intervention In Older African Americans
Authors: Hoddy K K , Singh P , Beyl R A , Kirwan J P , Carmichael O T , Newton R L
Published: May 2020

Introduction

African Americans are at a greater risk for cardiovascular disease and inadequate sleep than are corresponding whites. Age-associated declines in sleep duration, cardiovascular health, and physical activity highlight the need to understand the relationship among these variables in this population. While physical activity is thought to be beneficial for promoting sleep quality, it remains unknown how habitual short sleep during a physical activity intervention influences the intervention response in this population.

Methods

Sedentary older African Americans (n=27; 65-85 years old; 74% female) participating in the intervention arm of a 12-week randomized controlled physical activity trial (NCT03474302) were categorized as short (n= 15) or adequate (n=12) sleepers, defined as sleeping <6 hours/night or >6 hours/night on average during the intervention. Participants wore validated activity monitors at baseline and 12 weeks, and commercially available sleep monitors were worn daily. Differences in cardiovascular outcomes at baseline and 12 weeks were assessed between sleep categories using sex-adjusted linear mixed models.

Results

The intervention increased accelerometer derived steps (p=0.04) with no between group differences (p=0.78). Moderate to vigorous activity (MVA) duration increased (p<0.001), but change was greater in adequate sleepers (9 minutes; p<0.05). Body weight did not significantly change (-0.71 kg; p=0.11) and changes were similar between groups (p=0.55). Total (p=0.046) and LDL cholesterol (p=0.04) decreased over time. Adequate sleepers experienced improvements in systolic blood pressure (-10 ± 4.5 mmHg; p=0.03), total cholesterol (-30 ± 11 mg/dL; p=0.01), and LDL cholesterol (-23 ± 9 mg/dL; p=0.01) from baseline while short sleepers did not (all p>0.05). Significant differences or trends between adequate and poor sleepers were observed (-10.5 mmHg; p=0.096; -30 mg/dL p=0.044; -21 mg/dL; p=0.095, respectively).

Conclusion

Adequate sleep during a physical activity intervention may be important to elicit cardiovascular benefits. Thus, research evaluating sleep extension complementary to increased physical activity is warranted in short sleepers.

Support

BrightFocus (A20175472); National Institute of General Medical Sciences of the National Institutes of Health (U54-GM104940)
0863 Age-categorized Trends In Self-reported Sleep Duration For The Non-institutionalized U.s. Civilian Population From 2004-2013: Considerations Of Racial/ethnic Variations
Authors: Christina M , Bubu O M , Donley T , Blanc J , Oji E , Turner A D , Mbah A K , Williams N J , Youngstedt S , Shochat T , Azizi S A , Osorio R S , Jean-Louis G
Published: May 2020

Introduction

We examined age-categorized trends in self-reported sleep duration using data from the National Health Interview Survey (NHIS) 2004-2013 and explored how these trends may vary based on individuals’ race/ethnicity.

Methods

Study participants were aged 18-85 (N=258,158). Sleep duration within a 24-hour period on average was categorized as ≤ 6hrs (short-sleep), 7-8 hours (adequate-sleep), and ≥ 9hrs (long-sleep). Age was categorized as 18 - <26, 26 - <65 and 65 - 85. Racial categories included non-Hispanic Whites (NHW), Blacks/African Americans (AAs) and Hispanics. Adjusted multinomial logistic regression models examined trends in self-reported sleep duration across age-categories and assessed race/ethnic differences in these trends.

Results

Mean sleep duration (hrs.) across all years was 7.4, 7.0, and 7.5, for ages 18 - <26, 26 - <65 and 65 - 85, respectively and was relatively stable from 2004-2013. However, compared to individuals ages 18 - <26, those categorized as ages 26 - <65 were 55% more likely to be short sleepers while those ages 65 - 85 were 20% less likely to be short sleepers (P < .001 for all). Mean sleep duration was 7.2hrs, for NHW and 7.1hrs for AAs and Hispanics, and showed increasing trend toward short sleep beginning in 2007 through 2013 (P <.01 for trend). In the age 18 - <26 category, compared to whites, blacks and Hispanics were 35% and 29% more likely to be short sleepers, respectively. In the age 26 - <65 category, compared to whites, blacks and Hispanics were 35% and 21% more likely to be short sleepers, respectively. In the age 65 - 85 category, compared to whites, blacks were 19% more likely to be short sleepers (P < .001 for all).

Conclusion

Continued surveillance of population-level sleep trends among minority populations is essential as growing race/ethnic (age specific) disparities in self-reported sleep duration may have consequences for racial/ethnic health disparities.

Support

NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01AG056531, R25HL105444, R25NS094093, K07AG05268503, R01HL142066, K23HL125939)
0869 Slow Wave Sleep Is Associated With Decreased Risk Of Gestational Diabetes Mellitus
Authors: Izci Balserak B , Bronas U , Prasad B , Shah K , Steffen A , Carley D
Published: May 2020

Introduction

Pregnancy is associated with disrupted slow-wave sleep (SWS) and a high prevalence of sleep disordered breathing (SDB), which may further exacerbate the decrease of deep sleep. Reduced slow wave sleep may impair glucose homeostasis, contributing to Gestational Diabetes Mellitus (GDM). Studies investigating EEG markers of deep and light sleep, and their associations with SDB and GDM are lacking. In this study, we measured associations of EEG Delta-power with objective SDB measures assessed in late-pregnancy to determine if changes in these bands are associated with GDM risk.

Methods

74 women (24-36 weeks pregnancy) underwent overnight polysomnography. Spectral profiles for Delta relative power were created for NREM and REM sleep after removing epochs with movements or muscle artifacts. The association of Delta power with SDB, assessed by the Apnea Hypopnea-Index (AHI) and AHI-based SDB severity (none, mild, moderate, severe) was tested by multivariate linear regression including demographic variables with bivariate correlations (p<0.2) versus Delta-power. Conditional-regression was used to explore relationships between Delta-power and GDM, controlling for covariates.

Results

Obstructive Sleep Apnea (OSA, AHI>5) was present in 14% of subjects (8 GDM-cases and 3 controls). In bivariate analyses, AHI, AHI-severity categories and OSA were associated with Delta-power in NREM (all p<0.2) and AHI was associated with Delta relative-power in REM (p=0.18). However, these associations did not remain significant after adjusting for covariates. Delta relative-power in NREM was significantly associated with decreased risk of GDM (OR:0.50, 95%CI-0.25,0.91), but, in REM sleep, was not associated with GDM risk (OR:1.25, 95%CI-0.79,1.97).

Conclusion

These analyses failed to demonstrate an association between OSA or OSA severity and EEG Delta power. However, lower levels of SWS, characterized by low Delta power were associated with increased GDM risk.

Support

NIH-R00-NR013187
0910 Prevalence And Risk Factors Of Obstructive Sleep Apnea Syndrome In 3-14 Yearsold Children In Beijing: A Cross-sectional Surveyabstract
Authors: Wei W
Published: May 2020

Introduction

To explore the prevalence and risk factors of obstructive sleep apnea syndrome (OSAS) in 3-14 years old children in Beijing.

Methods

A cross-sectional study of random stratified cluster sampling was conducted on 3-14 years old children and adolescents in Beijing. The preliminary screening was completed through Pediatric Sleep Questionnaire (PSQ) investigation and the diagnosis of OSAS was conducted by polysomnography.

Results

After random sampling, a total of 11 kindergartens, 7 primary schools and 8 junior high schools from 7 districts of Beijing were involved in the survey. A total of 11420 questionnaires were sent out, and 10743 (94.07%) were recovered. The final effective data were 9198 (effective response rate 85.62%). The age of the investigated children was 8.8±3.8 years. PSQ positive rate was 8.86% (95CI 8.28-9.44%). With diagnostic criteria AHI≥5, the estimated prevalence of OSAS in Beijing children was 5.90% (95%CI 3.72-8.28%); with ICSD-3 diagnostic criteria (OAHI>1), the estimated prevalence was 8.08% (95% CI 5.74-10.62%). Overweight (OR=3.13), frequent allergic rhinitis (OR=6.80) and family snoring history (OR=6.14) were important risk factors for children’s OSAS.

Conclusion

PSQ was used in Beijing children’s OSAS epidemiological survey with good reliability and validity. The positive rate of the PSQ screening was 8.86% (95CI 8.28-9.44%);the estimated prevalence of OSAS in children aged 3-14 years in Beijing was 5.90% (95%CI 3.72-8.28%) with criteria AHI≥5 and 8.08% (95%CI 5.74-10.62%) with criteria OAHI>1, respectively. Gender, BMI, history of ENT and family history of snoring were important risk factors for children’s OSAS.

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).
0921 Insomnia in Adolescents: Patient-Centered Outcomes and Perspectives
Authors: Honaker S M , Simon S L , Byars K C , Graef D M , Williamson A A , Meltzer L
Published: May 2020

Introduction

An estimated 25-40% of adolescents endorse symptoms of insomnia. While research has demonstrated that insomnia is associated with impaired functioning, little is known regarding which insomnia symptoms or outcomes are most burdensome for adolescents. Patient-centered outcomes (PCO) are clinical and research questions and outcomes that are meaningful to patients. This study is the first to evaluate PCOs in adolescents with insomnia.

Methods

We conducted an online survey of adolescents in the USA, UK, Canada, Australia, and New Zealand who were 13 - 18 years old and reported experiencing one or more insomnia symptoms. Participants were recruited using targeted advertising on Facebook. Participants reported on insomnia symptom severity, frequency, and duration, help-seeking behavior, areas of insomnia-related impairment, and research priorities.

Results

Of the N=3034 respondents, 99.3% (n=3014) met inclusion criteria. Participants were predominantly female (77.0%) and white non-Hispanic (70.8%), with a mean age of 16.1 years (SD=1.3). Most (87.5%) met DSM-V diagnostic criteria for insomnia, yet only 29.3% reported seeking professional help. Over half (52.1%) reported a symptom duration of three or more years. Insomnia symptoms reported were sleep initiation difficulties (94.4%), sleep fragmentation (65.3%), premature awakening (54.5%), and difficulty sleeping independently (22.3%). The most burdensome areas of insomnia-related impairment were reported to be mood (72.2%), attentional focus (61.0%), pain (49.7%), worry (46.3%) and sleepiness (38.7%). Adolescents with insomnia most frequently endorsed the following research priorities: causes of insomnia (66.4%), early detection (66.1%), public education about sleep (49.1%) and non-pharmacological treatments (48.3%).

Conclusion

Adolescents with insomnia report significant insomnia-related distress and impairment, with symptoms often persisting for three or more years. However, adolescents with insomnia often do not seek professional help. Areas perceived as most problematic to adolescents living with insomnia (e.g., mood, focus, pain) should be considered as important outcomes for insomnia researchers.

Support

This publication was made possible with support from Grant Number UL1TR002529 (A Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award and the Indiana University School of Medicine.
0924 Adolescent Perceptions of Insomnia Treatment
Authors: Simon S L , Meltzer L J , Williamson A A , Graef D M , Byars K C , Honaker S M
Published: May 2020

Introduction

Approximately 10% of adolescents meet diagnostic criteria for insomnia, which is associated with increased health problems, academic difficulties, and psychological morbidity. Empirical evidence supports cognitive-behavioral treatments for insomnia, yet research suggests adolescent insomnia is undertreated. Thus, the goal of this study was to evaluate adolescent perceptions about insomnia treatment seeking and strategies.

Methods

Adolescents ages 13-18 years with self-reported insomnia symptoms completed an online survey assessing treatment-seeking behaviors and management strategies. English-speaking participants were recruited using targeted Facebook advertising. Descriptive statistics were used to summarize results.

Results

Of the 3,014 survey respondents, participants were predominantly female (77%) and white non-Hispanic (71%), with a mean age of 16±1.3 years. Most (87%) met DSM-V diagnostic criteria for insomnia, but only 29% reported seeking professional help for insomnia. Of these, participants reported waiting an average of 1-2 years after symptom onset to seek treatment. Participants most often sought help from a mental health professional (18%) or primary care provider (13%), while <2% saw a sleep specialist. Across adolescents, the most commonly endorsed strategies to manage insomnia symptoms were daytime caffeine consumption (48%), staying out of bed except when trying to sleep (38%), and daily exercise (28%). Nearly half of participants endorsed currently using medications to help with sleep, most commonly melatonin (18%) and antihistamine-based sleep aids (10%). Participants reported greatest preference to take medication (64%), meet individually with a sleep specialist (48%), or use a phone or tablet application (40%) to help with sleep. While 30% of participants felt that sleep researchers should prioritize increasing access to insomnia treatment, 20% encouraged developing new modes for treatment delivery (e.g., online).

Conclusion

Adolescents with insomnia reported using behavioral and pharmacological strategies to help with sleep, with very few receiving treatment from a sleep specialist. Further research is needed to increase accessibility and acceptability of interventions for adolescent insomnia.

Support

N/A
0952 Parent-Child Perceptions About Healthy Sleep Promotion in a Mobile Health Sleep Extension Intervention
Authors: Mitchell J A , Eck C , Hickey J , Huffnagle N , Fiks A G , Zemel B S , Dinges D F , Williamson A A
Published: May 2020

Introduction

Over half of school-aged children sleep insufficiently and sleep promoting interventions are urgently needed. To effectively promote pediatric sleep health, it is critical to obtain feedback from youth and their families about acceptable intervention strategies. This qualitative study examined perceptions about healthy sleep promotion in parent-child dyads participating in a mobile health sleep extension intervention.

Methods

A total of 26 parent-child dyads (child mean age 11 years, SD = 0.67; 46% non-Latinx White; 19% Black) participated in a mobile intervention to extend child sleep duration over 11 weeks (2-week baseline; 7-week intervention; 2-week follow-up). Participants wore a FitBit during the study, were provided with a sleep duration goal, and received general sleep health-promoting electronic messages using the University of Pennsylvania’s Way to Health platform. Following the intervention, parents and their children separately completed a semi-structured telephone interview to capture perceptions of the intervention strategies. Three coders developed a codebook using an inductive approach to identify emergent themes and conducted coding in NVivo.

Results

Emergent themes fell into domains of intervention acceptability/feasibility and barriers. Mobile messaging about the child’s sleep duration goal was well-received, although child participants in particular desired more personalized messaging, with sleep promotion targeted to their specific sleep habits. Parents and children both discussed ancillary benefits to intervention participation, including an enhanced focus on sleep. Barriers to sleep extension during the intervention and maintenance of any gains post-intervention were related to: competing child academic, social, and extracurricular demands; family factors (work schedules; family rules and norms); and the challenges of limiting ubiquitous electronic devices.

Conclusion

Despite high parent-child acceptability of a mobile child sleep extension intervention, individual and contextual barriers may limit long-term adherence. Tailoring healthy sleep messages to target these factors could improve sustained benefits to child sleep.

Support

Sleep Research Society Foundation and K23HD094905 (AAW); NIH/NCATS UL1TR001878 (JAM and DFD) and K01HL123612 (JAM).
0955 Does Primary Caregiver Influence Sleep in Preschoolers? Evidence from a Large-Scale Longitudinal Study in China
Authors: Li W , Wang G , Zhang Y , Zhao J , Jiang F
Published: May 2020

Introduction

The aim of the study is to characterize sleep disturbances and sleep patterns in preschoolers, and to examine the potential role of primary caregivers and particularly its transition on children’s sleep in a large-scale cohort study in China.

Methods

A representative sample of 20324 newly enrolled preschoolers(age 3-4 years) were recruited in Shanghai,China at 2016.11. Sleep disturbances were examined at 3 timepoints from age 3-4 years to 5-6 years by the Children’s Sleep Habits Questionnaire(CSHQ). Data on bedtime, onset time and offset time were included, along with primary caregivers derived from each follow-up. Prevalence and trend estimates of sleep disturbances and sleep patterns were presented. Multivariable logistic regression and propensity score-adjusted models for sleep disturbances at wave3 on different caregiving models were analysed adjusting for demographics, socioeconomic status, family characteristics, maternal mental health and CSHQ total score at baseline.

Results

Prevalence of global sleep disturbances (CSHQ total score>41) steadily fell from 84.2% to 73.8%. Specifically, behavioral sleep problem domains of “Bedtime besistance”and “Sleep anxiety” decreased from 66.4% to 47.3% and 53.4% to 37.8%, respectively. Meanwhile, Bedtime gradually delayed from 21:04(SD=0:37) to 21:20(SD=0:33) while offset time changed slightly from 7:13(SD=0:29) to 7:17(SD=0:27). Compared with counterparts in western countries, children slept for a shorter nocturnal sleep duration (NSD) with 9.51(SD=0.57) hours at wave1, 9.42(SD=0.57) hours at wave2 and 9.42(SD=0.52) hours at wave3. Different caregiving models were independently associated with sleep disturbances at wave3. Taking “Predominant parental care” as reference, “Predominant grandparental care” and “Transition from parental to grandparental care” were associated with higher odds of sleep disturbances (OR=1.32, 95% CI [1.17, 1.48], p<0.001 and OR=1.25, 95% CI [1.03, 1.52], p=0.020, respectively). While “Transition from grandparental to parental care” has no significant effect(OR=1.04, 95%CI [0.94, 1.15], p=0.436).

Conclusion

Grandparental care is associated with increased risk of sleep disturbances among preschoolers in China. Parenting and Grandparenting factors should be considered when assessing and treating sleep disturbances and optimizeing sleep health in preschoolers.

Support

Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81728017); Ministry of Science and Technology (2016YFC1305203); Shanghai Science and Technology Commission (17XD1402800, 18695840200, 2018SHZDZX05, 18JC1420305);
0965 The Association Between Liquid Consumption and Sleep Patterns in School Children
Authors: Raine P , Wang J , Pitt S
Published: May 2020

Introduction

Liquid consumption is essential for daily function and may also play a role in sleep regulation. The aim of this study was to assess 1) the association between the frequency of liquid consumption and sleep patterns; and 2) the different types of liquids on the association between liquid consumption and sleep.

Methods

Participants included 597 children ages 9-13 years old from the China Jintan Child Cohort Study. To assess child liquid intake, children self-reported the types of liquids consumed and the frequency these liquids were consumed. To assess sleep patterns, both parents and children reported sleep patterns using the parent-reported Child Sleep Habit Questionnaire (CSHQ) and a child self-reported questionnaire. Descriptive statistics and independent sample t-tests analyses were performed to examine the differential effects of liquid consumption frequency and sleeping habits.

Results

Overall, a slight dose-dependent relationship between liquid consumption and sleep quality was observed. Less sleep problems and improved sleep quality were observed for water (bedtime resistance, sleep anxiety, night awakenings, parasomnias, sleep-disordered breathing, daytime sleepiness; p<0.05) and milk (parasomnias, sleep-disordered breathing, p<0.05) consumption. Caffeinated soda tended to increase sleep problems (sleep-disordered breathing, p<0.05). Sleep onset delay had a different pattern from that of other subscales, in which water increased sleep problems and caffeinated soda decreased sleep problems. There was some discrepancy between parent- and self-reported parasomnias, but sleep disordered breathing showed consistent patterns.

Conclusion

Children who consumed more liquid, especially water and milk, were more likely to experience less sleep problems. However, caffeinated soda consumption may be linked to increased sleep problems. Findings suggest that school children may need consume more healthy liquids for better sleep patterns. Future randomized-controlled trial studies are needed to verify these findings.

Support

This study was funded by the National Institutes of Environmental Health Sciences and the National Institutes of Health (R01-ES-018858, K02-ES-019878, and K01-ES015877).
0966 Sleep-Wake Patterns in Mothers and Children in a Rural Community With Limited Access to Electricity: Results from the Ghana Randomized Air Pollution and Health Study
Authors: Kundel V , Darko P , Taweesedt P , Parekh A , Ayappa I , Lee A , Darby J , Kaali S , Asante K
Published: May 2020

Introduction

Studies measuring objective sleep duration in rural/indigenous populations are limited, showing sleep duration similar to that of industrialized countries. Little is known about sleep duration in women of reproductive age, and children within these populations. Our study is the first to objectively characterize sleep in mothers and children in an agrarian community with limited access to electricity, utilizing data from the Ghana Randomized Air Pollution and Heath Study (GRAPHS).

Methods

The GRAPHS cohort, a cluster-randomized trial, evaluated the efficacy of clean fuels on birthweight and infant pneumonia incidence in central Ghana. The study initially recruited pregnant women and newborns in 2013. This study is now utilizing wrist-actigraphy to analyze sleep-wake patterns among mothers and children of GRAPHS. We have thus far analyzed actigraphy in 39 mothers and 49 children (including 25 mother-child pairs), using the Motionlogger-MicroWatch with the Cole-Kripke algorithm to assess total sleep time (TST). We report baseline characteristics and sleep-wake patterns of our sample.

Results

Mean age of mothers was 33.5 years, (range 22-48), and mean age of children was 3.9 years (3-4). Average nights recorded were 4 (standard deviation [SD] 2.1). For mothers, average median time-in-bed was 7.9 (SD 1.2) hours, TST was 6.4 (SD .9) hours, and sleep efficiency was 82% (SD 7.9). Median bedtime was 9:33pm (SD 1.5 hours), and median wake-time was 5:56am (SD 1.4 hours). For children, average median time-in-bed was 9.9 (SD 1.0) hours, TST was 8.2 (SD 0.9) hours, and sleep efficiency was 83% (SD 6). Median bedtime was 8:03pm (SD 0.8 hours), and median wake-time was 6:06am (SD 0.6 hours). There was no correlation between sleep measures in mother-child pairs.

Conclusion

In an agrarian Ghanaian community with limited access to electricity, objective sleep measures in women were similar to prior studies conducted in indigenous/rural populations of developing African countries (Ndiaye et.al.2007, Samson et.al.2016), though data in children is lacking for comparison. When compared with post-industrialized countries, objective sleep measures for this age group of non-gravid women are sparse. In toddlers however, TST was lower in our cohort when compared with objective sleep amongst toddlers in industrialized nations.

Support

2K24HL109156-06A1
0999 Predictors Of Natural Resolution Of Behavioral Sleep Problems In Early Childhood
Authors: Garrison M M
Published: May 2020

Introduction

Primary care providers are often unsure which patients require treatment for behavioral sleep problems of early childhood vs. which are likely to improve without intervention. Given limited treatment resources as well as the time and cost burden that intervention can pose for families, it may be helpful to identify the predictors of children whose behavioral sleep problems are likely to resolve -- and stay resolved -- without active intervention.

Methods

Here, we use the control arm of a randomized trial of 2.5 to 5 year-old community-recruited children with behavioral sleep problems to examine the natural history of behavioral sleep problems and the predictors of resolution. Of 217 families in the control arm, 146 had inadequate mean sleep duration at baseline (< 10.5 hours/night per diary) and were eligible for inclusion in the analysis. Data were drawn from sleep diaries and parent report surveys conducted at baseline, 3 and 12 months. Improvement was defined as increased duration by either at least 60 min from baseline or by 30 min to at least 10.5 hours/night. We conducted an exploratory logistic regression to identify predictors of natural resolution.

Results

Of the 146 eligible families, 130 had follow-up data at both 3 and 12 months and were included in this analysis. Of those 130, only 22 (17%) had substantially improved sleep by 3 months follow-up, and 10 of these continued to have improved sleep duration at 12 months. The strongest predictors of natural improvement both at 3 and 12 months were female child sex, having either infant or school-aged siblings, CBQ low-intensity pleasure score (i.e., children who tend to respond positively to cuddling, reading, and other gentle activities), mean duration of sleep onset latency per diary, parent-reported parasomnias on the CSHQ, and age under 4 years.

Conclusion

These findings suggest that contrary to common beliefs of both primary care providers and parents, relatively few children will experience a clinically meaningful improvement in sleep duration without intervention.

Support

This work is supported by a grant from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD): 5R01HD071937.
Estimating daytime sleepiness with previous night electroencephalography, electrooculography, and electromyography spectrograms in patients with suspected sleep apnea using a convolutional neural network
Authors: Nikkonen Sami , Korkalainen Henri , Kainulainen Samu , Myllymaa Sami , Leino Akseli , Kalevo Laura , Oksenberg Arie , Leppänen Timo , Töyräs Juha
Published: May 2020

A common symptom of obstructive sleep apnea (OSA) is excessive daytime sleepiness (EDS). The gold standard test for EDS is the multiple sleep latency test (MSLT). However, due to its high cost, MSLT is not routinely conducted for OSA patients and EDS is instead evaluated using sleep questionnaires. This is problematic however, since sleep questionnaires are subjective and correlate poorly with the MSLT. Therefore, new objective tools are needed for reliable evaluation of EDS. The aim of this study was to test our hypothesis that EDS can be estimated with neural network analysis of previous night polysomnographic signals. We trained a convolutional neural network (CNN) classifier using electroencephalography, electrooculography, and chin electromyography signals from 2,014 patients with suspected OSA. The CNN was trained to classify the patients into four sleepiness categories based on their mean sleep latency (MSL); severe (MSL < 5min), moderate (5 ≤ MSL < 10), mild (10 ≤ MSL < 15), and normal (MSL ≥ 15). The CNN classified patients to the four sleepiness categories with an overall accuracy of 60.6% and Cohen’s kappa value of 0.464. In two-group classification scheme with sleepy (MSL < 10 min) and non-sleepy (MSL ≥ 10) patients, the CNN achieved an accuracy of 77.2%, with sensitivity of 76.5%, and specificity of 77.9%. Our results show that previous night’s polysomnographic signals can be used for objective estimation of EDS with at least moderate accuracy. Since the diagnosis of OSA is currently confirmed by polysomnography, the classifier could be used simultaneously to get an objective estimate of the daytime sleepiness with minimal extra workload.
Exploratory analyses of postanesthetic effects of desflurane using behavioral test battery of mice
Authors: Niikura Ryo , Miyazaki Tomoyuki , Yonezaki Kumiko , Uchimoto Kazuhiro , Takase Kenkichi , Goto Takahisa
Published: May 2020

Halogenated ethers, such as desflurane, sevoflurane, and isoflurane, are known to exert an array of effects besides sedation. However, the postanesthetic effects of desflurane remain undiscovered as no study has explored these effects systematically. Phenotypic screening using behavioral test batteries is a powerful method to identify such effects. In the present study, we behaviorally phenotyped desflurane-treated mice to investigate postanesthetic effects. We applied comprehensive behavioral test batteries measuring sensorimotor functions, anxiety, depression, sociability, attention, and learning abilities, starting 7 days after anesthesia performed with 8.0% desflurane for 6 h. Although our previous study revealed postanesthetic effects of isoflurane in adult mice, in the current study, desflurane-treated mice exhibited no such effects in any behavioral test. To further examine whether desflurane affect behavior in more early time point, we built up a new additional test battery, which carried out 1 day or 3 days after exposure to desflurane. Mice treated with desflurane 1 day before testing showed more slips than other two groups in the first trial, suggesting mild acute side effects of desflurane on motor coordination. These results suggest the safety of desflurane in clinical settings and imply that postanesthetic effects are unique to each halogenated ether.