bluuebunny/crossref_metadata_2025 huggingface dataset:
0848 The Utility of Pulse Wave Amplitude to Improve Interscorer Reliability
Authors: Al-Shawwa Baha , Fields Kerri , Ingram David
Published: April 2024

Introduction

While accurate scoring of arousals is crucial for identification of disrupted sleep architecture and hypopnea scoring, achieving acceptable interscorer reliability represents a major challenge. The drop in pulse wave amplitude (PWA) signal is a sensitive marker for arousals and is readily available in most conventional polysomnogram software. The aim of the current study was to examine interscorer agreement in scoring cortical arousals using EEG alone versus utilizing PWA drop signal as surrogate marker.

Methods

Arousals were scored using the same data on duplicate studies by the sleep laboratory medical director and education coordinator who is registered polysomnographic technologist (RPSGT). The first study was scored according to the American Academy of Sleep Medicine (AASM) arousal rule only. The second study used the drop in PWA as a marker for a possible cortical arousal in conjunction with the AASM arousal rule. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify possible arousals. Interscorer agreement and Cohen’s Kappa were calculated as measures of reliability.

Results

When scored using conventional EEG arousal criteria alone, there was an overall 90.3% agreement for all epochs with a corresponding Cohen’s Kappa of 0.642 (95% CI: 0.580-0.704), representing substantial agreement. When PWA assistance was utilized, agreement was significantly improved to 96.5% overall with a corresponding Cohen’s Kappa of 0.878 (95% CI: 0.840-0.917), representing almost perfect agreement.

Conclusion

Pulse wave amplitude may hold promise as a surrogate tool for identifying cortical arousals and improving interscorer reliability.

Support (if any)
0853 The Importance of Actigraphy in Assessment of Hypersomnia in Children
Authors: Snow Ayelet , Balog Matthew , Loghmanee Darius , Donskoy Innessa
Published: April 2024

Introduction

Daytime sleepiness is a significant pediatric health problem, with prevalence ranging from 4% in preadolescents to almost 20% in high school seniors (1,2,3). When hypersomnia is present both subjective and objective means of assessment is required. Subjective measures range from parent interview to self-report questionnaires and a daily diary filled over the course of days or months. Objective data is mostly acquired using actigraph devices. A systemic review by the American Academy of Sleep Medicine (AASM) found a single study examining nightly sleep duration using both actigraphy and sleep logs over the course of 2 weeks among adult sleep patients with excessive daytime sleepiness. It found self-reported daily total sleep time (TST) overestimated sleep by an average of 86 minutes (4). To the best of our knowledge there was no such comparison published in the pediatric population. We estimate that the same clinically significant difference exists in the pediatric population when comparing subjective report of daily total sleep time to an objective actigraphy measurement.

Methods

This retrospective cohort study used a convenience sample of 17 children aged between 6 to 20 years, presenting with hypersomnia to the sleep clinic between August 2022 and May 2023. Reported daily total sleep time was collected during their initial clinic visit and all children were given an actigraph for 2 weeks and were instructed to wear it continuously.

Results

Actigraph adherence was 91% with an average usage of 13 days. Self-reported daily TST was overestimated by 3.1 hours on average as compared to actigraph data. This was a statistically significant, t(16)=2.1199, p< 0.01.

Conclusion

Interviews, questionnaires, and diaries are subjective and tend to describe the perception of sleep. When evaluating hypersomnia an objective tool is essential. sleep insufficiency in hypersomnia patients may be overlooked when the daily total sleep time is assessed using the subjective patient’s report. The simultaneous use of actigraphy may be preferable in this assessment to avoid misdiagnosis and treatment errors.

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0858 A Predictive Model of Composite Sleep Health for Cardiovascular Disease Based on the RU-SATED Framework
Authors: Zhang Nan , Sun Mei , Tang Siyuan
Published: April 2024

Introduction

Sleep health is a multidimensional construct. Previous studies have focused on single dimensions of sleep health and their association with cardiovascular disease (CVD). This study aimed to generate a composite multidimensional sleep health (MSH) score by combining subjective and objective measurements of sleep based on the RU-SATED framework, which consisted of Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration, and examine the association between the composite MSH score and the prevalence of CVD.

Methods

This was a secondary analysis using data from the multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL). A total of 1,912 participants with complete baseline and actigraphy data were included in the analysis. The primary outcome was the prevalence of CVD, defined as self-reported coronary heart disease or stroke. Covariates included demographics (age, gender, education, and income) and major CVD risk factors (hypertension, dyslipidemia, diabetes, obesity, and smoking). Each domain in RU-SATED framework was measured using both self-reported questions and actigraphy, and converted to binary values with unfavorable conditions coded as 1. Receiver operating characteristic (ROC) curve was used to select the measurements with higher predictive accuracy for each domain. The composite MSH score was obtained by summing the scores from each single domain. Logistic regression analyses were performed to analyze the relationship between the composite MSH score and CVD prevalence.

Results

Subjectively measured sleep efficiency, timing, alertness, and satisfaction showed higher predictive values for CVD, and actigraphy-measured sleep duration and regularity were associated with better predictive performance. The odds ratio of the composite MSH associated with CVD was 1.261-fold (95% CI 1.060-1.500, p=0.009) after adjusting for covariates. Neither standalone subjective measures nor actigraphy measures of MSH were able to uncover this relationship (OR=1.161, 95% CI 0.978-1.378; OR=1.152, 95% CI 0.966-1.374).

Conclusion

In this study, actigraphy-measured or subjectively measured MSH did not predict the prevalence of CVD independently, whereas the composite MSH combined actigraphy-measured and subjective measurements could predict the prevalence of CVD. The results have inspired us to further explore standardized methods and reach a consensus in measuring MSH, using the RU-SATED framework as a guide.

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0862 Associations Between Daily Fluctuations in Sleep and Blood Pressure Among Those with and Without Insomnia
Authors: Egeler Mara , Phelps Claire , Vargas Ivan
Published: April 2024

Introduction

Hypertension is a major contributing factor for heart disease, with nearly half of US adults meeting criteria. While studies have begun to examine the relationship between insomnia and blood pressure (BP), little is still known regarding the relationship between daily fluctuations in sleep and BP. This study aimed to provide further clarification on the role insomnia plays in the development of hypertension, including the impact that daily fluctuations in sleep have on fluctuations in BP.

Methods

Participants included 61 adults from the greater Northwest Arkansas area (63.9% White, 67.2% Female, 30-79 y) who completed 10 consecutive days of sleep and blood pressure monitoring. Insomnia status was determined by an Insomnia Severity Index (ISI) score of 8 or higher. Sleep was assessed objectively through actigraphy and subjectively through sleep diaries. BP was measured during the morning and evening using an ambulatory BP monitor. Variables examined included actigraphy and diary based total sleep time (TST), total wake time (TWT), and sleep efficiency (SE), as well as morning, evening, and daily systolic and diastolic BP. A series of multiple regressions were used to examine differences in BP between those with and without insomnia. Mixed effects models were used to explore the relationship between deviations in sleep and BP.

Results

Insomnia status was not found to be associated with average systolic or diastolic BP in the morning (β = 0.09, p = 0.44, β = 0.07, p =0.51), evening (β = 0.15, p = 0.20, β = 0.13, p =0.25), or daily (β = 0.12, p =0.28, β = 0.10, p =0.35). Decreases in actigraphy derived TST were associated with increased next day morning systolic (β = -0.01, p < 0.01) and diastolic (β = -0.01, p = 0.02) BP when controlling for TWT.

Conclusion

The results of this study did not show support for insomnia serving as a predictor for hypertension. However, a nightly increase of total sleep time significantly decreased morning BP on the following day. Additional analyses will further dissect the association between daily fluctuations in sleep and BP.

Support (if any)

Graduate-Professional Student Congress Tiffany Marcantonio Research Grant
0863 Sleep Regularity and Cardiovascular Health Among U.S. Adults
Authors: Yang Li , Wallen Gwenyth , Barb Jennifer , Maki Katherine , Farmer Nicole
Published: April 2024

Introduction

Connections between sleep and cardiovascular risk and health are reported in adults. The sleep regularity index (SRI), a measure of day-to-day variability in sleep-wake times, has been shown to be associated with cardiovascular risk in older adults. The connection between SRI and cardiovascular health, the American Heart Association (AHA) derived concept of positive health promotion across the lifespan, has yet to be reported. The aim of this work is to investigate associations between SRI and cardiovascular risk and health.

Methods

Using National Health and Nutrition Examination Survey (NHANES) 2011-2014 data in US adults aged 40-75 years of age who are free of cardiovascular disease, the SRI was calculated from actigraphy across seven days using the ActiGraph model GT3X+, manufactured by ActiGraph of Pensacola, FL. Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) scores were calculated based on AHA. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the pooled cohort equations defined by the American College of Cardiology/AHA guidelines. The four-year interview weight was used for all complex sample analyses. SPSS complex sample general linear models were used to assess the association between SRI, ASCVD score, LE8, LS7, and demographic variables.

Results

Among the NHANES sample (n=5589; 52.8 % female; mean age = 54.5, SE = 0.17), the mean SRI score was 63.0 (SE = 0.52), the average ASCVD score was 0.12 (SE = .003), the mean LE8 and LS7 scores were 57.1 (SE = 0.46) and 6.6 (SE = 0.04). SRI was not significantly related to ASCVD score (β = -0.001, p = .062). Individuals with higher SRI scores reported higher LE8 (β = 0.265, p < .001) and LS7 (β = 0.035, p < .001) scores. After controlling for gender, race ethnicity, household food security, and SNAP participation status, SRI remained as a significant predictor to LE8 (β = 0.219, p < .001) and LS7 (β = 0.029, p <.001

Conclusion

Among U.S. adults aged 40 to 75 years of age, sleep regularity is positively associated with cardiovascular health.

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0864 Sleep Prior to Cardiac Arrest Is Associated with Physical Health-Related Quality of Life Early in Recovery
Authors: ten Brink Maia , Vargas William , Nieto Camila Dominguez-Imbert , Rojas Danielle , Cruz Gaspar , Shechter Ari , Agarwal Sachin , Birk Jeffrey
Published: April 2024

Introduction

Poor sleep increases risk of sudden cardiac arrest (CA). Survivors of hospital stays experience lasting sleep issues, and poor post-hospitalization sleep is associated with lower health-related quality of life (HRQoL) during recovery. It is unknown, however, whether better pre-CA sleep may serve as a premorbid asset that may prospectively predict HRQoL during early recovery beyond post-CA sleep.

Methods

In this interim analysis of an observational cohort study, 129 CA survivors were recruited from a large urban hospital. Upon discharge, patients reported on sleep in the month before their CA using the Pittsburgh Sleep Quality Index (PSQI). Post-CA physical function regarding activities of daily living was assessed via the Physical Self-Maintenance Scale. Demographic and CA severity variables were collected from medical records. A month later, patients reported on their HRQoL using the 36-item Short Form (SF-36) and post-CA sleep with the PSQI. We hypothesized that worse premorbid sleep quality (global PSQI score) would be associated with worse physical and mental HRQoL component scores (SF-36 PCS and MCS) at 1 month.

Results

Worse premorbid sleep (M = 8.67, SD = 4.03) was associated with worse PCS 1-month post- discharge (B = -0.68, p < .01), after adjusting for sex at birth, age, ethnicity, and time from CA to return of spontaneous circulation, an index of CA severity. Premorbid sleep was still a significant predictor (B = -0.58, p =.02) after adjusting for patients’ physical function at discharge and sleep one month later (M = 7.67, SD = 4.62). However, worse premorbid sleep was not significantly associated with worse MCS after adjusting for the same covariates (B = -0.50, p = .07). This remained non-significant controlling for physical function at discharge and sleep quality after a month (B = -0.22, p = .49).

Conclusion

These results suggest that people’s sleep before suffering a CA may predict their post-CA physical HRQoL, in ways that are at least partially independent from CA severity, physical function at discharge, and post-CA sleep. Future research should identify mechanisms (e.g., inflammation) by which a reserve of quality sleep improves post-CA physical recovery.

Support (if any)

This research was supported by NHLBI grants R01-HL151850 and R01-HL153311.
0865 Sleep Symptoms Associated with Glycohemoglobin in the General US Population: Data from NHANES
Authors: Anthony Gaby , Kennedy Kathryn , Killgore William , Grandner Michael
Published: April 2024

Introduction

Previous studies have linked insufficient sleep duration and sleep apnea to the development of Type-2 diabetes but few studies have explored associations between objective diabetes risk and other sleep symptoms in a general population sample.

Methods

Data were obtained from adults age 20 or older from the NHANES 2017-2020 prepandemic waves. Glycohemoglobin (assessed as HbA1c%) was measured using standard procedures on blood specimens obtained from a nationally-representative sample. Sleep symptoms assessed included general daytime sleepiness, sleep disturbance (frequency of difficulty falling asleep or staying asleep or sleeping too much), daytime tiredness, snoring, and choking/gasping during sleep. Linear regression analyses with HbA1c% as dependent variable were weighted using NHANES population weights. Secondary analyses explored whether these relationships depended on a previous diabetes diagnosis.

Results

In population-weighted analyses adjusted for age and sex, elevated A1c% was associated with frequent sleepiness (B=0.16, 95%CI [0.04,0.27]), sleep disturbance (B=0.18, 95%CI [0.09,0.27]), daytime tiredness (B=0.11, 95%CI [0.01,0.21]), snoring (B=0.25, 95%CI [0.17,0.33]), and choking/gasping (B=0.25, 95%CI [0.11,0.39]). After further adjustment for race/ethnicity, education, BMI, smoking, and sedentariness, relationships were still significant but attenuated for sleepiness (B=0.14), sleep disturbance (B=0.13), snoring (B=0.11), and choking/gasping (B=0.15). After final adjustment for sleep duration, relationships were still significant for sleepiness (B=0.13), sleep disturbance (B=0.12), snoring (B=0.11), and choking/gasping (B=0.15). No significant sleep-by-diabetes interactions were found.

Conclusion

General sleep symptoms experienced by many in the population are associated with objective risk for metabolic disease. Sleep health interventions aimed at these symptoms in general population samples may reduce this risk.

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0866 Prevalence of Obesity in Obstructive Sleep Apnea Within a Large Community-based Cohort of Middle-aged/Older Adults
Authors: Esmaeili Neda , Gell Laura , Taranto-Montemurro Luigi , Messineo Ludovico , Imler Théo , Sands Scott , Yee John , Cronin John , Wellman Andrew , White David P , Heinzer Raphael , Redline Susan , Azarbarzin Ali
Published: April 2024

Introduction

Obesity is a well-known risk factor for obstructive sleep apnea (OSA), gaining interest due to the global rise in obesity and novel obesity drugs. The rationale behind this lies in the role of obesity in the pathophysiology of OSA. However, many OSA patients are non-obese, and the association between obesity and OSA may vary by age and sex. Past population studies largely reported the prevalence of OSA according to different obesity categories. In this study, we sought to determine the prevalence of obesity across different levels of OSA severity, age, and sex.

Methods

The analytic sample included individuals with OSA from the Sleep Heart Health Study (SHHS). OSA severity was quantified using the apnea-hypopnea index (AHI4; apneas plus hypopneas with at least 4% oxygen desaturation per hour). Individuals were stratified by the severity of OSA (mild: 5≤AHI4< 15; moderate: 15≤AHI4< 30; severe: AHI4≥30 events/hour), body mass index (BMI), age, and sex.

Results

A total of 2950 of 5749 participants in SHHS had OSA (AHI4≥5 events/hour; 1729/788/433 mild/moderate/severe). Of these, 40.6% were female; mean±SD age was 65.3±10.7 years; and median [interquartile range] BMI was 28.8 [25.8; 32.3] kg/m2. For those with any OSA, 60.6% were non-obese (BMI< 30 kg/m2) and 39.4% were obese (BMI≥30 kg/m2). Across OSA severities, 34.1% of mild, 42.6% of moderate and 54.3% of severe OSA were obese. A greater proportion of younger adults (< 65 years) with OSA were obese (48.3%) than older adults (≥65 years) with OSA (30.9%). In older adults 26.7% of mild, 34.5% of moderate and 40.3%of severe OSA were obese. Finally, a greater proportion of females with OSA were obese (43.6%) than males with OSA (36.5%).

Conclusion

The majority of middle-aged/older adults with OSA are non-obese. The association between obesity and OSA varies by age and sex, with a higher prevalence of obesity in younger adults and in females with OSA. Additional analyses of data from the Multi-Ethnic Study of Atherosclerosis, the Osteoporotic Fractures in Men study, and the HypnoLaus study are being conducted to establish the association between OSA and obesity within other community-based samples.

Support (if any)

NHLBI R01HL153874, R35HL135818 and unrestricted grant support from Apnimed.
0872 Sleep-Disordered Breathing Is Associated with Endothelial Dysfunction in Adults
Authors: Savin Kimberly , Erickson Alexander , Pandya Nishtha , Mungarwadi Monica , Zollner Sophia , Liu Peter , Martin Jennifer , Badr M Safwan
Published: April 2024

Introduction

Short sleep duration and obstructive sleep apnea (OSA) are associated with increased rates of cardiovascular disease. Vascular inflammation and endothelial dysfunction are potential mechanisms for this association but can be burdensome or impractical to measure in clinical settings. Other characteristics of sleep health, such as sleep quality, insomnia symptoms, and daytime sleepiness, are infrequently studied in relation to endothelial function. The current study investigated the association between multiple dimensions of sleep health (apnea hypopnea index (AHI), insomnia symptoms, sleep quality, and daytime sleepiness) and endothelial dysfunction using peripheral arterial tonometry (PAT; EndoPAT, Itamar Medical).

Methods

Participants (N=43) with mild-to-moderate OSA, completed a baseline assessment including demographics, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). OSA severity was measured with AHI from one night of PSG (home or in-lab). Microvascular endothelial function was assessed using EndoPAT. The hyperemic response was measured following upper arm occlusion and the reactive hyperemia index (RHI) was calculated. Cross-sectional associations of sleep (ISI, PSQI, ESS, AHI), demographic characteristics (age, sex) and BMI with the natural log of RHI (used due to non-normality) were examined using linear regression models.

Results

In the study sample, mean (SD) age = 54.4 (12.6) years, 63% were female and 77% identified as Black race. Higher AHI (b = -.015. SE = .01, p =.03) and older age (b = -.01. SE = .003, p =.005) were significantly associated with lower RHI, indicating worse endothelial function. ISI, PSQI, ESS, sex, and BMI were not significantly associated with RHI (p’s>.05).

Conclusion

This study identified an association between OSA severity (higher AHI) and greater endothelial dysfunction, using the novel non-invasive EndoPAT, and null associations with other self-reported sleep characteristics. The study was underpowered to include covariate adjustment or interaction terms, but future studies with larger samples and studies examining potential benefits of OSA treatment on endothelial function are needed.

Support (if any)

R01HL146059, K24HL143055, K24HL13632. EndoPAT device provided by ZOLL Itimar.
0876 Obstructive Sleep Apnea Is Associated with Poor Cardiometabolic Markers in Type 1 Diabetes
Authors: Kessler Aleeza , Danyluk Alexandria , Tuna Kubra , Chagani Fatima , Hadigal Susheela , Leey Julio
Published: April 2024

Introduction

In patients with Type 2 diabetes (T2D), obstructive sleep apnea (OSA) is associated with worse cardiometabolic risk factors. Whether the same occur in Type 1 Diabetes (T1DM) has not been well established.

Methods

Retrospective cross-sectional study, we assessed T1D patients from our endocrinology clinic between 2015-2022, who had a sleep study done in the Sleep Center. We compared the groups for diabetes duration, glycemic control, complications, and metabolic profile. An unpaired t-test was performed for comparison of means, chi-square test for nominal data, and a p-value of P< 0.05 was considered statistically significant.

Results

We identified 55 patients with T1D and a sleep study, 33 had OSA based on sleep report and 22 did not. Both groups had similar diabetes duration, BMI, micro and macrovascular complications. Hypertension and dyslipidemia were more frequent in the OSA group (P< 0.05). A1C values were similar between OSA and non-OSA groups (7.5% vs 7.9%). Total daily insulin dose per kilogram was similar too (0.42 vs 0.30). Of the 14 patients with a follow up visit after initiation of PAP therapy, A1c levels remained unchanged before and 3-6 months after PAP initiation (7.7% vs. 7.0%, P=0.25), however, 57% of them improved their A1c level, and only 21% worsened. The OSA group had higher triglycerides (mean 142mg/dl vs 81.7mg/dl, P=0.003) and lower HDL (mean 44.5mg/dl vs 62.7mg/dl, P=0.06) despite similar A1c levels. In terms of liver fibrosis, an FIB-4 score < 1.3 was considered low risk based on ADA guidelines, and we found 14 out of 33 patients in the OSA group (42%) and 4 out of 22 patients in the non-OSA group (18%) had >1.3, (P=0.06).

Conclusion

In patients with T1DM, OSA is associated with metabolic features consistent with insulin resistance: trends towards higher BMI, insulin needs and worse lipid profile, despite similar A1c levels. The glycemic impact of OSA treatment in T1DM requires further investigation.

Support (if any)

Supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0881 Impact of Statin Withdrawal on Sleep Quality
Authors: Peyrel Paul , Bergron Jean , Sériès Frédéric , Laflamme Nathalie , Mauriège Pascale , Joanisse Denis
Published: April 2024

Introduction

Statins are benchmark lipid-lowering drugs, reducing blood cholesterol by controlling its synthesis. There are side effects linked to statins use, including statin-associated muscle symptoms (SAMS). These symptoms typically include myalgia, stiffness, weakness, fatigue and/or cramps. SAMS can lead to a reduction in muscle performance, as well as an altered health-related quality of life. Nevertheless, the potential effects of SAMS on sleep remains poorly documented. The objective of this exploratory work was to assess if measures of sleep disturbances and its consequences improve after drug withdrawal in SAMS self-reporters.

Methods

Patients (5 men [M] / 3 women [W], 44.8±6.3 yrs.) in a primary cardiovascular prevention cohort composed two groups: statin users with (SAMS, 2M/2W) or without symptoms (No SAMS, 3M/1W). All patients were required to have a low cardiovascular risk over ten years (i.e. Framingham Risk Score < 10%) and were using different types and doses of statins for more than two months. Sleep was measured objectively by actigraphy and subjectively using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Finally, a 10-point visual analog scale (VAS) was used to self-assess the intensity of SAMS, specifically at night. Measures were taken before and after two months of statins withdrawal.

Results

After withdrawal, we observed an improvement of objective sleep quality in the SAMS group (sleep efficiency: +3.79%, effect size [ES]: 0.33 [small effect]; wake after sleep onset: -15.6%, ES: -0.30 [small effect]; number of awakenings after sleep onset: -12.7%, ES: -0.45 [small effect]), concurrent with a decrease of subjective perception of SAMS intensity at night (VAS, from 4.5 to 1.0, ES: -0.79 [moderate effect]). A decrease of subjective daytime sleepiness (ESS, from 11.3 to 8.3, ES: -0.45 [small effect]) and an increase of subjective sleep quality (PSQI, from 7.66 to 6.33, ES: -0.31 [small effect]) were also seen in this group. On the other hand, the No SAMS group showed no change after drug withdrawal for any of the different objective and subjective sleep parameters (ES: -0.08 to 0.15 [trivial effects]).

Conclusion

Our preliminary data suggest that SAMS are associated with sleep disturbances and impaired sleep quality.

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0885 Exploring Sleep Health in the Context of COPD and Obesity: Insights from a Population-Based Cross-Sectional Study
Authors: Manuel Rachel , Khan Safia , Thakur Bhaskar
Published: April 2024

Introduction

Many individuals with obstructive lung disease such as COPD suffer from sleep disturbances. Poor sleep quality is related to disease severity. COPD has been associated with obesity in a bidirectional manner, though few studies have examined the interaction between COPD, obesity, and aspects of sleep health including quality and duration. This study aims to examine if decreased sleep duration and trouble sleeping are associated with increased risk of COPD and obesity.

Methods

Using data from three consecutive rounds of the National Health and Nutrition Examination Survey (2013-14, 2015-16, and 2017-18), a cross-sectional analysis was conducted. Sleep quality was assessed through the survey by inquiring if subjects experienced trouble sleeping. Sleep duration was categorized into normal (7-8 hours of sleep), short (< 7 hours of sleep), and long (>8 hours of sleep). Weight was categorized into normal weight, overweight, obese, and severely obese. Poisson regression and multinomial logistic regression analyses were used. Adjusted incidence rate ratio (aIRR) and adjusted relative Risk Ratios (aRRR) with their 95% CI were reported.

Results

The total sample size was 16,939, with females comprising the majority (52%), and ages ranging from 20 to 80 years. Those with COPD were more likely to report trouble sleeping (aIRR 1.48, p < 0.001). Obese and severely obese groups were also associated with trouble sleeping (aIRR 1.27 and 1.50 respectively, p < 0.001). An increased likelihood of trouble sleeping (p < 0.001) was observed among individuals with COPD and overweight (aIRR 1.54), obesity (aIRR 1.89), and severe obesity (aIRR 1.97). COPD was also found independently associated with long sleep duration (IRR 1.50, p < 0.004); however, in the same model, severely obese groups were significantly associated with shorter sleep duration (aRRR: 1.39, p: 0.002).

Conclusion

In the current study, COPD was associated with long sleep duration and trouble sleeping. Increasing obesity was associated with short sleep duration and trouble sleeping, consistent with previous findings that sleep deprivation likely contributes to obesity.

Support (if any)
0888 Characterization and Outcomes in Patients with Bronchiectasis and Obstructive Sleep Apnea with PAP Therapy
Authors: Baskaran Berty , Ahmed Nayla , Arias-Sanchez Pedro , Aksamit Timothy , Escalante Patricio
Published: April 2024

Introduction

Bronchiectasis (BE) is characterized by recurrent infections and dilated airways and has been associated with recurrent exacerbations and hospitalizations affecting quality of life. Approximately 40-60% of patients with BE have concomitant OSA, with an increased AHI (apnea-hypopnea index) in BE patients with Pseudomonas infections. We hypothesize that patients with BE are less tolerant of PAP therapies, contributing to worsening quality of life related to either condition. We aim to determine differences in PAP adherence and treatment response in patients with BE and OSA compared with a matched OSA-control group.

Methods

A retrospective cohort analysis was conducted on adult patients evaluated at Mayo Clinic Center for Sleep Medicine between January 2000 to December 2020. Inclusion criteria were patients greater than 18 years old diagnosed with BE and OSA per current guidelines and were prescribed PAP therapy. Control OSA patients were matched to BE/OSA patients by gender, BMI, and AHI severity. Exclusion criteria included cystic fibrosis, hospice enrollment, active lung transplant evaluation, and lack of sleep clinic follow-up. Follow-up visits determined PAP compliance and change in quality-of-life metrics over 3 years.

Results

We compared 50 patients with BE/OSA with 74 OSA matched controls. The etiology of BE in these cases included COPD (32%) or other etiologies (34%). Baseline characteristics were not statistically different in gender, BMI, and AHI severity across groups. Median treatment follow-up for the BE/OSA group was 3 years [IQR 2 to 4]. Importantly, there was no statistically significant difference in PAP adherence in patients with BE/OSA compared to OSA controls regardless of etiology of BE, but these patients more often required supplemental oxygen therapy. Interestingly, there was a statistically significant increase in MRC and decrease in FEV1 over time in BE patients compliant to therapy.

Conclusion

There was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence, except for need of oxygen supplementation in BE patients with OSA compared with matched non-BE OSA controls. FEV1 values decreased, and dyspnea score increased in BE patients compliant to PAP therapy; however, future larger studies should include longer-term follow-up to further assess the impact of PAP therapy on BE progression and outcomes.

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0897 The Relationship Between Marital Satisfaction and Sleep
Authors: David Michelle , Shurovi Sumayya , Cornelius Talea , Schwartz Joseph , Abdalla Marwah
Published: April 2024

Introduction

Relationship quality impacts health outcomes. Individuals with high marital satisfaction report having better health than those with low marital satisfaction (MS). How marital satisfaction may impact sleep health is unclear. We examined if MS is associated with subjective sleep quality and sleep duration among working adults.

Methods

The Worksite Blood Pressure Study is a multi-site study investigating psychological factors and ambulatory blood pressure. The study recruited 472 participants without major cardiovascular disease from 10 New York City worksites during 4 waves over 11 years. At Wave 4, participants completed the Dyadic Adjustment Scale (DAS), which assesses MS, and a sleep questionnaire derived from the Sleep Heart Health Study. Weekday sleep duration was reported using a one-time sleep diary. For this analysis, 20 items from the DAS were summed to create a sum score with higher scores indicating greater MS. Items assessing sleep quality were averaged (higher scores indicated worse sleep quality). The current analysis was restricted to 188 married participants at Wave 4 with complete data. Linear regression models were specified predicting (1) sleep quality and, separately (2) sleep duration from marital satisfaction. Covariates were age, sex, race/ethnicity, family income, and number of children in the home.

Results

Of the 188 participants, 91.0% were male, 7.5% were Black, and 4.8% were Hispanic/Latinx. Participants reported a median of 2 children living in the home and a median family income of $80,000-$89,999. Mean age was 53.0 years (SD = 8.0 years), mean marital satisfaction was 60.5 (SD = 13.2), mean sleep quality was 8.1 (SD = 4.2), and mean sleep duration was 6.5 hours/night (SD = 1.1 hours). Greater MS was significantly associated with better sleep quality (B = -0.09, 95% CI -0.13, -0.04, p < 0.001) but not with sleep duration (B = -0.00, 95% CI -0.02, 0.01, p = 0.47).

Conclusion

Greater MS was associated with better sleep quality; however, MS was not associated with sleep duration. Whether targeted interventions focusing on improving MS lead to improvements in sleep quality and/or sleep health is an area of active research.

Support (if any)

P01HL47540, NIH/NHLBI K23HL141682
0902 Increased Sleep Disruption in Patients with Advanced Cancer Undergoing Immunotherapy
Authors: Bhyravabhotla Kshama , Ebinama Ugochi , Faiz Saadia , Bashoura Lara , Sheshadri Ajay , Naing Aung , Balachandran Dave
Published: April 2024

Introduction

Sleep disruption is common in patients with advanced cancer. In addition to cancer-related factors, therapies such as chemotherapy, hormonal therapy and radiation may contribute to poor sleep. The role of immunotherapy in sleep disturbance is not well-studied; however, sparse evidence suggests that better sleep quality may improve clinical outcomes and reduce immunotherapy-related toxicity. We conducted a study to evaluate self-reported sleep in patients with advanced cancer receiving immunotherapy to better characterize their sleep quality.

Methods

We reviewed 250 patients sequentially undergoing immunotherapy in a single tertiary cancer center for advanced cancer from February 2020 to February 2022. The Pittsburgh Sleep Quality Index (PSQI) was used to quantify self-reported sleep quality. Individual components were assessed to gain a holistic picture of the patients’ perceptions of their sleep.

Results

The global PSQI score was greater than 5 in 75 of 250 patients (30%), signifying overall poor sleep. Mean global PSQI score was 6.97 with a standard deviation of 3.87 and a standard error of 0.24. Analysis of the other components of the PSQI revealed mild impairment of sleep efficiency, increased daytime sleepiness and decreased motivation. The mean score for sleep aid use was 0.94, indicating sleep aid use less than once a week. Notably, the mean score of self-reported sleep perception was 0.791 with a standard deviation of 0.716, indicating overall satisfaction with sleep quality.

Conclusion

To our knowledge, this is the largest series to characterize self-reported sleep disruption in patients with advanced cancer receiving immunotherapy. Our results show that there is significant sleep aid use and sleep disruption in up to 30% of patients receiving immunotherapy. There was notable discordance between self-reported perception of sleep and the global PSQI score. This may be due to lower expectations for quality sleep on the part of the patients, given cancer burden and other comorbidities. If so, routine sleep assessment and specialist evaluation is imperative to improve quality of life and assure these patients that a better quality of sleep is possible. Further studies are indicated to characterize sleep architecture in these patients and assess correlation with clinical outcomes such as tumor response and adverse event rates.

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0903 Physical Health Correlates of Subjective and Objective Sleep Markers in Patients with Cancer and Their Caregivers
Authors: Kim Youngmee , Tsai Thomas , Ting Amanda , Zeitzer Jamie , Ramos Alberto , Mendez Armando
Published: April 2024

Introduction

Sleep disturbance is frequently identified in patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraphy-derived sleep patterns correlate between patients and their sleep-partner caregivers, and how the two modes of sleep measurements are related to physical health. Also unknown is the degree to which different operationalizations of actigraphy-derived sleep markers associate with physical health.

Methods

Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads: on average 54 years old, 28% female patients, 60% Hispanic) completed sleep diaries daily and wore actigraphy continuously for 14 consecutive days, from which sleep duration and sleep onset latency (SOL) were calculated. Actigraphy-derived sleep markers were adjusted using sleep diary responses in two ways: One used the period participants intended to sleep (sleep intention method), and the other used the total period spent in bed (total bedtime method). Physical health was assessed via self-report and seven consecutive days of saliva collection, from which cortisol slope was quantified.

Results

Patients and their sleep-partner caregivers reported similar sleep patterns. Sleep duration, but not SOL had moderate level of agreement between self-report and actigraphy. Under the sleep intention method, caregivers’ longer SOL and longer self-reported than actigraphy-derived sleep duration and SOL were related to poorer self-reported physical health (|B|≥0.001, p<.043); none of the associations were significant among patients. On the other hand, under the total bedtime method, patients’ longer self-reported than actigraphy-derived SOL were related to poorer self-reported physical health (B=-0.119, p=.024); and none of the associations were significant among caregivers.

Conclusion

Findings suggest the employment of multimodal sleep and physical health assessments and operationalizations to precisely understand the characteristics and associations of sleep among patients with cancer and their sleep-partner caregivers. Psychobehavioral sleep interventions may consider paying attention to the differential impact of non-sleep activities in bed on patients’ health. Investigation with other sleep indices (wake after sleep onset and sleep-wake rhythms), self-reported and biological health outcomes, and of the dyadic associations of the study variables between patients and their caregivers is warranted.

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0905 Effects of Benign Prostatic Hyperplasia Surgery on Positive Airway Pressure Therapy Compliance in Sleep Apnea
Authors: Wong Stephanie , Quach Alan , Deibert Christopher , Harrington John
Published: April 2024

Introduction

Despite the high efficacy of continuous positive airway pressure (CPAP) to reverse the upper airway obstruction in obstructive sleep apnea (OSA), one of the greatest barriers to treatment is CPAP nonadherence. Benign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population that causes lower urinary tract symptoms (LUTS). Nocturia results in nighttime awakenings which may interfere with CPAP adherence. There are a variety of surgical interventions for the BPH. The aim of this study is to assess CPAP adherence rates before and after surgical intervention for treatment of BPH.

Methods

A within-subject retrospective analysis was performed at a single institution. Thus far, a sample size of 33 patients were analyzed and 16 met inclusion criteria. The target cohort included male patients who have a diagnosis of OSA and underwent surgical intervention for BPH between October 2013 and October 2023. The subjects included were also started on positive airway pressure (PAP) therapy before surgery. CPAP adherence measures were obtained one to six months prior to surgical intervention and compared to CPAP adherence measures six months post-surgical intervention. The change in PAP compliance from before surgical intervention to six months after surgery will be calculated and compared to a null value of zero (ie, no change) using a paired t-test.

Results

The average age of patients was 69.3. BPH procedures included were transurethral resection of the prostate (TURP) (37.5%), laser TURP (25%), holmium enucleation (6.25%), prostatic implantation (31.25%). When comparing pre-procedural (92.4%) CPAP usage days (%) versus post-procedural (89.8%), there were no significant differences (p=0.6425). Similarly, pre-procedural (374.6) CPAP average usage (minutes) versus post-procedural (409.4) did not show a statistically significant difference (p=0.1153).

Conclusion

Our early findings are consistent with previous research indicating that the presence of BPH had no significant effect on CPAP adherence. Our study reviewed post-procedural effects on CPAP adherence. Surgical intervention for benign prostatic hyperplasia did not affect adherence with CPAP in OSA.

Support (if any)

None
0909 Cortisol Reactivity to Experimental Pain and Psychological Stress in Facial Pain: Moderating Effects of Sleep
Authors: Altier Heather , Hamilton Katrina , Reid Matthew , Joo Eunyeong , Buenaver Luis
Published: April 2024

Introduction

Approximately 60% of individuals with temporomandibular joint disorders (TMD) report sleep disturbance. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system is common in TMD, but less is known about the effects of stressor type on HPA response. The present study measured salivary cortisol reactivity to quantitative sensory testing (QST) and to the Trier Social Stress Test (TSST) in a sample of TMD patients. It was hypothesized that poor sleep would amplify the effect of each type of stressor on cortisol reactivity.

Methods

TMD patients (N=33) completed QST and the TSST on two separate afternoons. Testing order was randomized. Salivary cortisol responses were measured at baseline, immediately post-testing, 15-, 20-, 25-, 30-, and 45-minutes post-testing. Psychosocial measures, including the Pittsburgh Sleep Quality Index (PSQI), were completed at baseline. Data was assessed for normality and heteroscedasticity, and cortisol levels were log-transformed. Two-level linear mixed effects models were analyzed in R with package lme4 to assess the effect of task on cortisol levels, controlling for time of day, baseline cortisol, age, sex, race, and education level. PSQI global score, subscales, and sleep duration were examined as moderators in separate models.

Results

TMD participants (Mage=33.5 + 10.1 years, 70% female, 64% white) endorsed poor sleep quality (PSQI global: µ=7.4, SD=3.6) and short sleep duration (M=6.4 + 1.4 hours). Salivary cortisol reactivity was greater following the TSST (t(350)=7.69, p<.001). PSQI sleep disturbance (t(348)=-2.36, p<.05) and sleep duration (t(348)=-2.04, p<.05) moderated the effect of task on cortisol reactivity; greater sleep disturbance was associated with greater cortisol reactivity to QST. Longer sleep duration was associated with lower cortisol reactivity for both tasks.

Conclusion

In our TMD sample, psychological stress produced greater stress reactivity than experimental pain. Greater sleep disturbance amplified stress reactivity to acute pain, but not to psychological stress. This finding is consistent with the literature on the deleterious effects of poor sleep on endogenous pain modulatory systems (i.e., hyperalgesia). Conversely, longer sleep duration attenuates the negative effects of both psychological and pain-related stress. Consequently, this study provides support for the importance of sleep as a protective factor in mitigating the harmful effects of stress in the context of chronic pain.

Support (if any)

CoEPEs; Blaustein Grant; T32NS070201
0915 Actual Condition Survey of Obstructive Respiratory Events in Convalescent Post-stroke Patients with Dysphagia
Authors: Miyachi Mai , Yamaguchi Kohei , Yanagida Ryosuke , Hino Takami , Yoshimi Kanako , Nakagawa Kazuharu , Tohara Haruka , Kisara Ayumi
Published: April 2024

Introduction

Sleep related breathing disorder is one of the risk factors for stroke. In addition, post-stroke patients often have dysphagia. Although sleep related breathing disorder and dysphagia occur in the oropharyngeal region, their relationship is not well defined and understudied, especially during the recovery phase. This study investigated the oral intake level and obstructive respiratory events in post-stroke patients with dysphagia.

Methods

Seventy post-stroke patients (36 men; mean age ± S.D., 72.1 ± 11.1) who were hospitalized in a rehabilitation hospital between August 2021 and October 2023 were recruited for this study. Age, sex, body height, body weight, and scores of the functional oral intake scale (FOIS) were collected from their medical record. The body mass index (BMI) was calculated from their height and weight. FOIS was used to evaluate swallowing function. The apnea hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), minimum oxygen saturation (min SpO2) was assessed to evaluate the severity of obstructive respiratory events using WatchPAT (Philips Japan, Ltd.), a portable device to test to diagnose sleep related breathing disorder. In the statistical analysis, we classified the FOIS into three groups: 7 points (no dysphagia), 6,5,4 points (ingestion of texture-modified diet), and 3,2,1 point (mainly feeding through tube). And Kruskal Wallis test was performed on AHI, 3%ODI, minSpO2.

Results

We obtained approval from our ethical committee before starting this study. According to the analysis, there was a significant difference between the groups in FOIS, AHI and min SpO2 (p < 0.05).

Conclusion

We showed that poorer oral intake was associated with worse obstructive respiratory events. Our results suggest that clinicians should pay attention to sleep related breathing disorder in post-stroke dysphagia patients in rehabilitation hospitals, also to prevent stroke recurrence.

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