bluuebunny/crossref_metadata_2025 huggingface dataset:
537 Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?
Authors: Zaheed Afsara , Spira Adam , Chervin Ronald , Zahodne Laura
Published: May 2021

Introduction

Alzheimer’s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations.

Methods

Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., “baseline”) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values.

Results

Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed.

Conclusion

Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD.

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543 EEG-Based Deep Neural Network Model for Brain Age Prediction and Its Association with Patient Health Conditions
Authors: Nygate Yoav , Rusk Sam , Fernandez Chris , Glattard Nick , Arguelles Jessica , Shi Jiaxiao , Hwang Dennis , Watson Nathaniel
Published: May 2021

Introduction

Electroencephalogram (EEG) provides clinically relevant information for personalized patient health evaluation and comprehensive assessment of sleep. EEG-based indices have been associated with neurodegenerative conditions, psychiatric disorders, and metabolic and cardiovascular disease, and hold promise as a biomarker for brain health.

Methods

A deep neural network (DNN) model was trained to predict the age of patients using raw EEG signals recorded during clinical polysomnography (PSG). The DNN was trained on N=126,241 PSGs, validated on N=6,638, and tested on a holdout set of N=1,172. The holdout dataset included several categories of patient demographic and diagnostic parameters, allowing us to examine the association between brain age and a variety of medical conditions. Brain age was assessed by subtracting the individual’s chronological brain age from their EEG-predicted brain age (Brain Age Index; BAI), and then taking the absolute value of this variable (Absolute Brain Age Index; ABAI). We then constructed two regression models to test the relationship between BAI/ABAI and the following list of patient parameters: sex, BMI, depression, alcohol/drug problems, memory/concentration problems, epilepsy/seizures, diabetes, stroke, severe excessive daytime sleepiness (e.g., Epworth Sleepiness Scale ≥ 16; EDS), apnea-hypopnea index (AHI), arousal index (ArI), and sleep efficiency (SE).

Results

The DNN brain age model produced a mean absolute error of 4.604 and a Pearson’s r value of 0.933 which surpass the performance of prior research. In our regression analyses, we found a statistically significant relationship between the ABAI and: epilepsy and seizure disorders, stroke, elevated AHI, elevated ArI, and low SE (all p<0.05). This demonstrates these health conditions are associated with deviations of one’s predicted brain age from their chronological brain age. We also found patients with diabetes, depression, severe EDS, hypertension, and/or memory and concentration problems showed, on average, an elevated BAI compared to the healthy population sample (all p<0.05).

Conclusion

We show DNNs can accurately predict the brain age of healthy patients based on their raw, PSG derived, EEG recordings. Furthermore, we reveal indices, such as BAI and ABAI, display unique characteristics within different diseased populations, highlighting their potential value as novel diagnostic biomarker and potential “vital sign” of brain health.

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592 Objective vs. Subjective Sleep Data in Early Childhood: Implications for Health Disparities Research
Authors: Cicalese Olivia , Williamson Ariel , Mindell Jodi , Meltzer Lisa
Published: May 2021

Introduction

Given limited psychometric research with families of lower socioeconomic status (SES) and/or non-White backgrounds, this study explored the feasibility of and discrepancies between actigraphy and maternal-reported nightly child sleep in preschoolers of lower-SES and primarily Black backgrounds.

Methods

Twenty-seven children (Mage=3.3 years, SD = 1.2 years; 59.3% girls; 85.2% Black; 100% family income <125% of the US poverty level) were asked to wear an actigraph for 14 days while mothers completed telephone-based sleep diaries. Bedtime, wake time, nighttime sleep duration, nap duration, and 24-hour sleep duration were collected by both measures. Paired t-tests examined actigraphic versus mother-reported child sleep.

Results

Twenty-six percent of dyads (n=7) were excluded due to insufficient data (1-hour difference between measures on >50% of nights). There were no significant demographic differences between dyads with and without discrepant data. Diary-derived sleep onset was calculated by adding caregiver-reported bedtime and caregiver-reported sleep onset latency. There was no significant difference between actigraphy-derived sleep onset (M=10:20PM, SD=69min) and diary-derived sleep onset (M=9:59PM, SD=51min). Average actigraphy sleep offset (M=7:27 AM, SD=62 min) was 42 minutes earlier than diary-derived wake time (M=8:09 AM, SD=84 min), p<.05. Actigraphy-estimated nighttime (M=8.38 hours, SD=.80) and 24-hour sleep duration (M=9.31 hours, SD=1.13) were 0.92 and 0.85 hours shorter, respectively, than diary-derived nighttime (M=9.30 hours, SD=1.07) and total sleep duration (M=10.16 hours, SD=1.17), p<.005. There were no significant differences in average nap duration. The primary mother-reported barrier in completing diaries was limited awareness of child sleep due to work schedules.

Conclusion

Study results highlight some of the challenges of collecting and scoring actigraphy and diary data in preschoolers of lower-income backgrounds, in particular missing diary data and discrepancies between actigraphy and diaries. These findings suggest a need to incorporate both subjective parental report and objective measurement of child sleep in clinical and research contexts, as well determine ways to enhance feasibility and scoring procedures.

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K23HD094905 (AAW)
604 The Relationship between Birth Order and Sleep Patterns in 6-Month-Olds
Authors: Kenny Samantha , Lannes Émilie M , Dubois-Comtois Karine , Beliveau Marie-Julie , Pennestri Marie-Helene
Published: May 2021

Introduction

The influence of birth order has been investigated in many areas of child development, but few studies have examined its relationship with infant sleep; those that have yield contradictory findings. Moreover, nocturnal parental practices may differ depending on the number of children, but these characteristics are rarely studied. This study aimed to compare nocturnal parental practices and sleep patterns of first-born to non-first-born 6-month-olds.

Methods

The mothers of fifty-two 6-month-olds completed a 14-day sleep diary to record their infant’s sleep. The following variables were averaged: total nocturnal sleep duration (in minutes), longest consecutive sleep duration (without interruption; in minutes) and number of nocturnal awakenings. Independent t-tests were used to compare each sleep variable between first-borns (n = 21) and non-first-borns (2nd, 3rd or 4th born, n = 31). Chi-square tests were used to compare parental sleep practices (breastfeeding frequency and infant sleep location) between first-borns and non-first-borns.

Results

First-borns had a longer consecutive nocturnal sleep duration (417.83 ± 142.42 vs. 310.08 ± 118.23; p < .01) and fewer nocturnal awakenings (1.69 ± 1.07 vs. 2.57 ± 1.09; p < .01) than non-first-borns. However, first-born and non-first-born infants did not differ in terms of total nocturnal sleep duration (p > .05). Breastfeeding frequency and sleep location differed as a function of birth order: 57.9% of first-born infants were exclusively breastfed, compared to 89.7% of non-firstborn infants (χ2 (1, N = 52) = 6.56; p < .05). Furthermore, 20.0% of first-borns slept in the parents’ room, compared to 56.7% of non-first-borns (χ2 (1, N = 50) = 6.62; p < .05).

Conclusion

First-born infants had longer periods of consecutive sleep and fewer nocturnal awakenings than non-first-borns; however, birth order was not associated with maternal reports of total nocturnal sleep duration. These results suggest that non-first-borns have more fragmented sleep. Moreover, sleep-related practices also differed between mothers of first-born and non-first-born infants. A study conducted in a larger sample and using objective sleep measures could clarify whether these different sleep patterns reflect specific nocturnal parental sleep-related practices, or if the presence of other children in the home play a role in infant sleep consolidation.

Support (if any)

SSHRC, FRQS
618 Qualitative analysis of bedtime challenges and parental interventions in foster care children
Authors: Nogales Josefina Muñoz , Valentine Madeline , Rigos Priscilla , Kim Josephine , KIm Jinu , Alfano Candice , McGlinchey Eleanor , Ripple Carol , Wolfson Amy
Published: May 2021

Introduction

Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties.

Methods

Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedtime?

Results

483 foster care parents responded. Responses to bedtime difficulties were coded using 27 categories (e.g., parasomnias, bedtime resistance, trouble self-soothing); responses to what helps your child sleep well were coded based on 22 categories (e.g., comfort items, melatonin, TV as in intervention, communication to reassure safety). The most prevalent sleep/bedtime difficulties were fear/anxiety (23.2%), nightmares (19.6%), environment (18.4%). For example, one parent responded: “He fears never waking up. He fears that the sun is not going to come back up. He fears that the bad guys will come get him.” Difficulties varied by age-- 4–5: fear/anxiety, destabilization from call/visit biological parent, nightmares; 6–9: nightmares, fear/anxiety, environment; 10–11: fear/anxiety, nightmares, emotional/behavioral difficulties. Most frequent parenting approaches were bedtime routine (63.0%), reading before bedtime (36.5%), physical reassurance (26.6%). Interventions also varied according to age-- 4–5: routine, reading, physical reassurance; 6–9: routine, reading, noise control; 10–11: routine, technology regulation, reading.

Conclusion

Foster caregivers reported fear/anxiety as most common bedtime difficulty and physical reassurance as most frequent parenting strategy for healthy sleep. Findings suggest that anxiety and fear often interfere with sleep and, in turn, physical reassurance as a helpful bedtime strategy. Undoubtedly, there is a need for sleep research and preventive interventions for children in foster care.

Support (if any)

Summer Student Research Support, Loyola University Maryland, College of Arts and Sciences
624 The association of circadian rhythms with cognitive functioning in children with attention-deficit hyperactivity disorder
Authors: Li Xiao , Shea Ka Sin Caroline , Wong Ching Kwong Dino , Chiu Waiyan Vivian , Lau Lok Fan , Yu Wai Man Mandy , Li Albert Martin , Wing Y K , Lai Yee Ching Kelly , Li Shirley Xin
Published: May 2021

Introduction

Disrupted circadian rhythms is associated with impaired cognitive function. Although circadian rhythm disturbances are commonly seen in individuals with attention-deficit hyperactivity disorder (ADHD), whether their cognitive functioning is thus affected remains unclear. This study aimed to examine the associations of circadian-related parameters with different cognitive abilities in children with ADHD.

Methods

Fifty-seven children with ADHD were recruited into this study (age range: 6–12 years, 66.7% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. Cognitive functioning was assessed with Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span test and N-back task for working memory, Tower of London test for planning skills and Bergs Card Sorting Test for set-shifting ability. The relationship between circadian parameters and cognitive performance was analyzed using multiple regression while controlling for age, sex, ADHD medication, the day of cognitive assessment (school days vs non-school days), total sleep time, and CSHQ total score.

Results

Increased activity during the most active 10-h period of the day (St. β = 0.39, p = 0.012) was related to more omission errors on CPT, and later onset of the least active 5-h period of the day (St. β = 0.44, p = 0.004) was associated with longer correct reaction time on CPT. Lower relative amplitude was associated with poorer performance on Digit Span (St. β = 0.33, p = 0.042). No significant associations were found between the circadian-related parameters and the performance on other tasks measuring processing speed and executive functions.

Conclusion

Circadian rest-activity rhythms (blunted rest-activity rhythms, higher daytime activity, and later onset of nocturnal rest) were associated with cognitive functioning in ADHD children. Future longitudinal studies are needed to explore the long-term impact of circadian rhythm disturbances and the effects of circadian-focused intervention on cognitive functioning in ADHD children.

Support (if any)

This work was supported by the Health and Medical Research Fund (Project No.: 30160604).
681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim Analysis
Authors: Mansour Wissam , Knauert Melissa
Published: May 2021

Introduction

Millions worldwide have been infected with COVID-19. Risk factors for poor outcomes include older age, obesity, cardiovascular disease, diabetes, COPD, and minority ethnicity. The impact of sleep apnea (OSA) on COVID-19 illness remains a topic of ongoing research. The association seems plausible as OSA shares common risk factors with COVID-19 comorbidities. The aim of our study is to investigate if the severity of OSA correlates with COVID-19 hospitalization outcomes.

Methods

The study is an observational retrospective electronic medical chart review of patients admitted to the Yale Health system for COVID-19 illness, who have an ICD medical history diagnosis of sleep apnea. Subjects with an available sleep study were grouped based on AHI severity. Composite outcome was determined by mortality or critical illness (ICU admission, mechanical ventilation, High-Flow nasal cannula or noninvasive ventilation). Interim analysis was conducted with data from 256 patients. Logistic regression was performed to calculate OR associated with the primary outcome comparing mild versus moderate-severe OSA groups.

Results

The sample of 256 patients included 50% females, with a median age of 64 (IQR,55–73) and BMI of 36 (IQR,30–41). Race distribution composed of 45% Whites and 40% African-Americans with 18% identifying as Hispanic. Overall mortality rate was 16%. Median length of stay (LOS) was 9 days (IQR,5 -15). 155 patients had a recorded AHI with a median of 26/hour (IQR,11–51) grouped into mild (34%), moderate (20%) and severe (45%) disease. Severe sleep apnea had the highest mortality rate of 19% and median LOS of 10 days (IQR,5- 16) compared to moderate (6% mortality,9 days (IQR,6–14)) and mild (17% mortality,6 days (IQR,4–11)) disease; differences were not statistically significant. Univariate logistic regression analysis demonstrated no significant difference in the composite outcome for mild versus moderate-severe OSA groups (OR=1.2; 95% CI:0.58–2.32).

Conclusion

Severe OSA appeared to have a trend towards an association with higher mortality versus moderate but not mild disease. Comparing moderate-severe disease to a reference group of mild disease did not demonstrate a significant difference in our composite outcome of death or critical illness. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support (if any)

N/A
687 Changes in adolescent sleep habits during the COVID-19 pandemic
Authors: Ham Grace , Fobian Aaron , Stager Lindsay , Morriss Skylar
Published: May 2021

Introduction

During the COVID-19 pandemic, adolescents have experienced significant lifestyle changes. With an increase in technological dependency and changes in school formats, sleep behaviors may be altered. As individuals with overweight or obesity (OWOB) already report higher rates of sleep issues, they may be particularly at risk during this time. However, to date, there are no data on changes in sleep behavior in adolescents with OWOB during the COVID-19 pandemic.

Methods

Participants included 10 adolescents with BMI ≥85th percentile (Mage=16.30 years, SDage=1.06; 60% male; 70% African American). Prior to the COVID-19 pandemic, participants completed sleep diaries twice per day for one week, noting caffeine intake, bedtime, naps, perceived sleep quality, and media use in bed. Participants then completed sleep diaries again during the COVID-19 pandemic. Five separate paired-samples t-tests assessed differences in sleep behaviors and quality.

Results

A paired-samples t-test demonstrated significantly earlier average bedtime before (M=11:20 PM, SD=55.16 minutes) than during (M=12:29 AM, SD=71.27 minutes) COVID-19 (t(9)=-3.0, p=0.015). A second paired-samples t-test demonstrated lower average media use in bed before (M=11.67, SD=10.97 minutes) than during (M=32.13, SD=27.28 minutes) the COVID-19 pandemic (t(9)=-2.3, p=0.050). No other significant differences were found.

Conclusion

Adolescents engaged in later bedtimes and increased media use in bed during the COVID-19 pandemic. This suggests adolescents’ sleep schedules have shifted later during the COVID-19 school year, due to either later wake times associated with virtual schooling or disruption in typical daily schedule as a result of the pandemic. However, no differences were found regarding caffeine intake, number of naps, and sleep quality. The significant findings regarding later adolescent bedtimes may reflect delayed sleep phase or possibly improved circadian alignment due to delayed school start times and at-home classes. The null findings regarding naps and caffeine intake may be reflective of the stability of daytime sleepiness. While we would expect daytime sleepiness to improve with increased circadian alignment, the effects may be diminished by increased media use in bed and decreased energy expenditure during the day. Given the observed relationships, current sleep hygiene interventions may require a focus on stimulus control and reducing time with media in bed.

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718 Investigating Decreased Positive Airway Pressure Compliance in a Veteran Affairs Sleep Medicine Clinic During the 2020 Pandemic
Authors: Earl David , Cutrufello Nicholas , Kern Joseph , Begay Melissa , Grigg-Damberger Madeleine , Ianus Vlad
Published: May 2021

Introduction

Positive airway pressure (PAP) compliance for the treatment of sleep apnea at the Albuquerque Veterans Affairs (VA) Sleep Medicine clinic has been observed to be lower in new setup patients after the onset of the COVID-19 pandemic. The reasons for decreased PAP compliance during the COVID-19 pandemic are unclear. The primary outcome will be to identify if there is a common reason that patients at the Albuquerque VA were less compliant with PAP after the onset of the COVID-19 pandemic.

Methods

Compliance data for 4/1/2020 through 9/30/2020 was compared to compliance data for 4/1/2019 through 9/30/2019. Compliance after PAP machine setup was confirmed to be lower during the 2020 time period. Noncompliant patients will be selected by setup type, new versus machine replacement, and surveyed for reasons for noncompliance. The survey will be conducted at the Albuquerque VA Sleep Center and will include questions regarding beliefs, barriers, and challenges with the use of PAP therapy during the coronavirus pandemic. The definition for initial PAP compliance will be the use of PAP therapy for greater than or equal to four hours per night on at least 70% of nights.

Results

For the 6-month time period of 4/1/2019 through 9/30/2019, there were 758 PAP setups at the Albuquerque VA. The 30-day compliance for the 758 setups was found to be 61.4%. Comparatively, for the six-month period of 4/1/2020 through 9/30/2020, there were 462 setups with a 30-day compliance result of 49.7%. A survey consisting of questions designed to elicit barriers to use as well as beliefs regarding PAP and COVID-19 will be administered to 20% (n = 46) of the non-compliant patients who were set up with a PAP machine during the 2020 study period.

Conclusion

PAP compliance after machine setup was lower at the Albuquerque VA sleep center in 2020 versus 2019 (49.7% versus 61.4%). The reasons for the lower observed compliance are attributed to the effects of the coronavirus pandemic. A random sampling of the non-compliant patients during the 2020 time period will be performed and the results will be presented once available.

Support (if any)

None
749 Is daytime sleepiness a risk factor for depression and the prevalence of depression in patients with EDS referred for PSG
Authors: Pervaiz Hassan , Roth Heidi , Vaughn Bradley
Published: May 2021

Introduction

Excessive daytime sleepiness affects 18.9–27% of the general population. [1] Patients with excessive daytime sleepiness have a higher prevalence of major depressive episodes. [2] Depression is also associated with poor medical compliance which may further affect management of excessive day time sleepiness. [3] We therefore are interested in the prevalence of depression in patients undergoing in-lab testing for excessive sleepiness and the association of positive depression screening.

Methods

Retrospective review of diagnostic polysomnograms (PSG) in a tertiary care facility was conducted on patients over 18 years of age. The elements collected include: gender, age, BMI, Depression scale defined by PHQ-9, EDS defined by Epworth’s Sleepiness scale, AHI = Apnea Hypopnea Index, PLMS = Periodic Limb Movements in Sleep.

Results

There were a total of 32 subjects. Median age was 49 with 43% male and average BMI of 35. The mean PHQ-9 score was 5.8. The mean Epworth score was 8.5. The correlation of the two values was r= 0.078. 12 patients are classified as having EDS. 7 patients (58.3%) in the EDS group were positive for depression screen. 18 patients (90%) without EDS were positive for depression screen. There is no statistical difference 2 groups (58.3% vs 90%, p=1). The mean PHQ-9 score in EDS group is 5.5. The mean PHQ-9 score in non EDS group is 5.95. There is no statistical difference between 2 groups PHQ-9(5.5 vs 5.95, p=0.779).

Conclusion

Our study cohort did not find a correlation between subjective sleepiness and depression in individuals presenting for in lab polysomnography. This may be related to the sample size or be an indication that many other factors contribute to the sleepiness in this cohort.

Support (if any)

1. Hein M. et al (2019) Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography. J Affect Disord. 2. Chellappa SL. et al (2006) Excessive daytime sleepiness in patients with depressive disorder. Braz J Psychiatry. 3. Grenard JL et al (2011) Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med
770 Does Improving Sleep Lead to Better Mental Health? A Meta-Analysis of Randomised Controlled Trials
Authors: Scott Alexander
Published: May 2021

Introduction

Sleep and mental health go hand-in-hand; however, the extent to which sleep is causally related to the experience of mental health difficulties is unclear. One way to test whether there is a causal link is to evaluate the extent to which interventions that improve sleep also improve mental health over time.

Methods

We conducted a systematic review and meta-analysis of 54 randomised controlled trials (N = 6,876) that reported the effects of interventions that successfully improved sleep on overall composite mental health, as well as on six specific mental health difficulties including depression, anxiety, stress, psychosis spectrum experiences, suicidal ideation, and PTSD.

Results

Improving sleep had a medium-sized effect on composite mental health (g+ = -0.47), and depression (g+ = -0.54), small-to-medium sized effects on anxiety (g+ = -0.40), and stress (g+ = -0.42), and small effects on positive psychosis spectrum experiences (g+ = -0.26). We also found a significant dose response relationship, in that greater improvements in sleep were associated with greater improvements in composite mental health.

Conclusion

Taken together, the findings suggest that sleep is causally related to the experience of mental health difficulties. Improving sleep leads to better mental health, especially for experiences of depression, anxiety, and stress. Future research might profitably consider how interventions that improve sleep be better incorporated into routine mental health care, as well as the possible mechanisms of action that might explain how sleep exerts its effects on mental health.

Support (if any)

This research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG- 0817-20027). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
803 Sleep Disturbances in Patients with Frontotemporal Dementia
Authors: Walker Nathan , Vaughn Bradley
Published: May 2021

Introduction

Frontotemporal dementia (FTD) is a degenerative process and,as the name implies, involves the frontal and temporal lobes of the brain. Patients with FTD make up 10–15% of all cases of dementia and 20% diagnosed before age 65, however not much is reported about sleep disturbances in these patients. Given the area of neuronal loss one would expect that sleep may be influenced early and by issues in arousal mechanisms and in breathing pattern. This study examined the polysomnography (PSG) reports of patients with a diagnosis FTD.

Methods

A retrospective chart review was performed to identify patients with both a diagnosis of FTD and having undergone a PSG. 23 patients were identified as fulfilling both requirements. Data recorded included, diagnosis, age at time of PSG, Epworth sleepiness scale (ESS), total sleep time (TST), wake after sleep onset (WASO), sleep latency (SL), REM sleep latency, sleep efficiency (SE), percentage of stage N1, N2, N3, and REM sleep, apnea-hypopnea index (AHI), presence of Cheyne-Stoke breathing, periodic limb movement index, and presence of REM without atonia.

Results

Patient age ranged from 57–85 years. Average ESS was 8.8 with only 5 patients reported excessive daytime sleepiness(as assessed by ESS). The average TST was 290 minutes, average SL was 37.9 minutes, average WASO was 147.5 minutes, and average sleep efficiency was 60.3%. Patients spent the majority of time in N2 sleep with an average of 68.3% of the time spent in N2. The average time spent in N3 was 9.6% of sleep. 8.9% of sleep was spent in REM. 83% of patients were diagnosed with sleep apnea (as defined by an AHI > 5), with an average AHI of 20.2 events/hour. Cheyne-Stokes breathing was only noted in 4 of the 23 patients, or 17%. Periodic limb movements of sleep were noted in 48% of the patients (n=11). REM without atonia or RBD was not noted for any patients.

Conclusion

This study shows that patients with FTD suffer from typical sleep disturbances, however there is a high prevalence of sleep apnea as well as PLMS. In addition, patients with FTD have decreased sleep efficiency with increased WASO.

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819 A RARE CASE OF RESPIRATORY SENSE LEAD DYSFUNCTION IN A PATIENT WITH A HYPOGLOSSAL NERVE STIMULATOR
Authors: Toolsie Omesh , Zacharias Rajesh , Oster Joel , Ostrow Peter , Schumaker Greg , Wein Richard , Grover Aarti
Published: May 2021

Introduction

In patients with moderate to severe obstructive sleep apnea (OSA) who are intolerant to PAP therapy, hypoglossal nerve stimulation (HGNS) is being increasingly considered as alternative treatment. Implantation involves placing cuff electrodes on inclusion branches of the hypoglossal nerve and a respiratory effort-sensing lead which is placed between the right intercostal muscle layers. These are connected to the implantable pulse generator which usually sits in a right infraclavicular pocket.

Report of case(s)

A 49-year-old male with severe OSA (AHI 30.8/hour) was implanted with a HGNS two years ago with successful activation a month later. He successfully up titrated his amplitude to the maximum stimulation level within his set range (0.9v – 1.7v). He underwent HGNS titration with AHI reduction to 13.9/hour at 2.1 volts and given a new higher range of 1.5 to 2.5 volts. This was accompanied by reduction in snoring, witnessed apneas and associated arousals with more consolidated sleep and improvement in his Epworth sleepiness score to 3 from 12 as noted prior to HGNS. The patient continued to up titrate over the next six months within his new range to 2.4 volts, when he reported increased sensitivity and intolerance at every stimulation level with recurrence of snoring and daytime sleepiness. He underwent interrogation of his device with subsequent awake endoscopy and change to his electrode configuration with a new lower range of 1.0 to 2.0 volts. However, he continued to have the same complaints. A second interrogation revealed increased impedance within the circuit of the respiratory sensing lead which was reproducible. The patient underwent sensing lead replacement in the operating room. He has since been able to increase stimulation levels without complaints and improvement in his OSA symptoms and is scheduled to have a follow-up hone sleep test (HST).

Conclusion

This case illustrates the importance of a structured approach in the evaluation of a reduced tolerance to HGNS. This includes assessing adherence, interrogation of the device’s circuitry, evaluating electrode configurations, stimulation thresholds with consideration for awake endoscopy. Repeating this process may be necessary to detect rare or delayed mechanical problems that may occur over time with HGNS.

Support (if any):
Biological and molecular characterization of linalool-mediated field resistance against Xanthomonas citri subsp. citri in citrus trees
Authors: Shimada Takehiko , Endo Tomoko , Fujii Hiroshi , Rodríguez Ana , Yoshioka Terutaka , Peña Leandro , Omura Mitsuo
Published: April 2021

The biological and molecular traits of the Ponkan mandarin (Citrus reticulata Blanco) were characterized in an investigation of the mechanisms of field resistance against citrus canker disease caused by the bacterial pathogen, Xanthomonas citri subsp. citri (Xcc). Various conventional citrus varieties that show diverse responses to Xcc were investigated, and the temporal changes in Xcc titer in response to linalool concentrations among the varieties revealed differences in Xcc proliferation trends in the inoculated leaves of the immune, field-resistant and susceptible varieties. In addition, increased linalool accumulation was inversely related to Xcc titers in the field-resistant varieties, which is likely caused by host--pathogen interactions. Quantitative trait locus (QTL) analysis using the F1 population of the resistant Ponkan mandarin and susceptible ‘Harehime’ (‘E-647’ × ‘Miyagawa-wase’) cultivar revealed that linalool accumulation and Xcc susceptibility QTLs overlapped. These results provide novel insights into the molecular mechanisms of linalool-mediated field resistance to Xcc, and suggest that high linalool concentrations in leaves has an antibacterial effect and becomes a candidate-biomarker target for citrus breeding to produce seedlings with linalool-mediated field resistance against Xcc.
RNA in situ hybridization and expression of related genes regulating the accumulation of triterpenoids in Cyclocarya paliurus
Authors: Chen Xiaoling , Chen Biqin , Shang Xulan , Fang Shengzuo
Published: April 2021

Cyclocarya paliurus (Batal.) Iljinskaja, a woody medicinal species in the Juglandaceae, grows extensively in subtropical areas of China. Triterpenoids in the leaves have health-promoting effects, including hypoglycemic and hypolipidemic activities. To understand triterpenoid biosynthesis, transport and accumulation in C. paliurus during the growing season, gene cloning, gene expression and RNA in situ hybridization of related genes were used, and accumulation was examined in various organs. The complete coding sequences (CDSs) of three genes, CpHMGR, CpDXR and CpSQS, were obtained from GenBank and RACE. RNA in situ hybridization signals of the three genes mainly occurred in the epidermis, palisade tissue, phloem and xylem of leaf, shoot and root, with the signals generally consistent with the accumulation of metabolites in tissues, except in the xylem. Both gene expression and triterpenoid accumulations showed seasonal variations in all organs. However, total triterpenoid content in the leaves was significantly higher than that in the shoots, with the maximum in shoots in August and in leaves in October. According to Pearson correlation analysis, triterpenoid accumulation in the leaves was significantly positively related with the relative expression of CpSQS. However, the relation between gene expression and accumulation was dependent on the role of the gene in the pathway as well as on the plant organ. The results suggested that most of the intermediates catalyzed by CpHMGR and CpDXR in young shoots and roots were used in growth and flowering in the spring, whereas subsequent triterpenoid biosynthesis in the downstream catalyzed by CpSQS mainly occurred in the leaves by using transferred and in situ intermediates as substrates. Thus, this study provides a reference to improve triterpenoid accumulation in future C. paliurus plantations.
Protocol for Successful Transmission of ‘Candidatus Liberibacter asiaticus’ from Citrus to Citrus Using Diaphorina citri
Authors: Lopes Silvio A. , Cifuentes-Arenas Juan C.
Published: May 2021

A protocol to successfully transmit the huanglongbing (HLB) pathogen, ‘Candidatus Liberibacter asiaticus’, between citrus plants by using the Asian citrus psyllid (ACP) and an alternative way to help growers control ACP are proposed. Best results were obtained when pathogen acquisition by adults reared on fully symptomatic ‘Ca. Liberibacter asiaticus’-positive plants, latency, and inoculation occurred at ambient air temperatures ranging from 24 to 28°C and when a single infective adult ACP was confined for 7 days on soft, newly developing vegetative shoots (stages v2 to v4). No infection resulted from confinement of infective ACP adults on mature leaves (stage v6). Under the described conditions, single ACP adults could successfully transmit ‘Ca. Liberibacter asiaticus’ to an average of 56.5% (35 to 83%) of plantlets with v2 to v4 shoots growing in 0.3-liter tubes and to 80.5% (76 to 86%) of plants with v2 to v4 shoots growing in 4.7-liter pots. The use of single insects and plantlets reduces labor, space, and other resources necessary to undertake transmission tests. It also reduces time needed for transmission studies and should help accelerate research on HLB. The results were used to develop an index for favorability to infection (IFI) to determine orchard vulnerabilities to ‘Ca. Liberibacter asiaticus’. The IFI is based on the heterogeneous population of new shoots that occurs on tree canopies and may offer alternative or complementary alternatives to the laborious and costly insect surveys currently used in most instances to determine threshold levels for insecticide applications.
Developing a Social Determinants of Learning™ Framework: A Case Study
Authors: Sanderson Carla D. , Hollinger-Smith Linda M. , Cox Karen
Published: May 2021

AIM

The aim of the study was to propose a framework, social determinants of learning™ (SDOL™), an actionable model to address learning disparities and expand learning opportunities to support nursing student diversity, equity, and inclusion.

BACKGROUND

There is significant growth in the racial and ethnic diversity across students at all levels of higher education, mirroring the growing diversity of the US population. Yet, lower rates of persistence and higher attrition rates among these student groups continue.

METHOD

The authors established six socially imposed forces, causative domains, as foundational to the SDOL framework. Key attributes of each domain were identified through a literature search. A case study illustrates an initial study of interventions targeting specific domains of the framework aimed toward student success.

CONCLUSION

Equitable education for all has far-reaching implications across nursing education and higher education in general. Further development and testing of the SDOL framework will support the goal of equitable education for all.
Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes
Authors: Tartavoulle Todd , Landry Jessica
Published: May 2021

AIM

This study evaluated the effects of a program designed to help students provide culturally competent care for lesbian, gay, bisexual, transgender, questioning/queer, intersex, plus (LGBTQI+) patients.

BACKGROUND

The LGBTQI+ community faces disparities linked to stigma and discrimination. The Advocacy™ Program was developed to supplement the curriculum in schools of nursing.

METHOD

Nursing students from six schools of nursing (n = 1,398) received advocacy training. Students were administered the Genderism and Transphobia Scale, the Homonegativity Scale, and additional knowledge questions before and after training.

RESULTS

The findings were positive, indicating an increase in student attitude scores, vocabulary and disparity knowledge, and knowledge regarding care for an LGBTQI+ client (p < .05).

CONCLUSION

By building a culture of inclusion through recognition of diverse patients in the curriculum, nursing schools can develop a culture of connection that strengthens patient-provider relationships and improves mental and physical health.
Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates
Authors: Killion Emma
Published: May 2021

Background:

Red blood cell (RBC) transfusions have been implicated in the development of necrotizing enterocolitis (NEC) in premature infants. Some evidence exists to support that withholding feedings during transfusion reduces the risk of subsequent NEC development.

Purpose:

To review the most recent literature on this topic to determine best evidence-based practice regarding withholding or not withholding feedings during RBC transfusions.

Methods/Search Strategy:

Four databases were searched using keywords and MeSH terms including “necrotizing enterocolitis,” “NEC,” “NPO,” and “transfusion,” with specifications limiting the search to articles published in the last 10 years and limiting the population to neonates.

Findings:

Four studies did not demonstrate a reduction in transfusion-associated necrotizing enterocolitis (TANEC) with the implementation of feeding protocols during packed red blood cell (PRBC) transfusions. One study concluded that it could not confirm the benefit of withholding feeds during transfusion to reduce the risk of TANEC. A 2020 randomized controlled trial (RCT) found no difference in splanchnic oxygenation when enteral feeds are withheld, continued, or restricted during a PRBC transfusion. Holding feedings during PRBC transfusions did not result in adverse nutritional outcomes.

Implications for Practice:

To determine best evidence-based practice surrounding feeding protocols during RBC transfusions in very low-birth-weight and premature infants less than 37 weeks' gestation.

Implications for Research:

It is recommended that large, multicentered, adequately powered RCTs be conducted in this area. Individual institutions should standardize their practice to improve quality, safety, and patient outcomes.
Pedicled fibular graft in knee-sparing tumor resection surgery: a retrospective case series
Authors: Badawey Mohamed Youness , Ebeid Walid , Salah Eldeen Mostafa , Elshamly Ibrahim Khairy , Hayyawi Fahad Abdulazeez , Abosenna Wesam
Published: May 2021

Background:

Several viable options have been discussed in the literature for management of bone defects that result from resection of proximal tibial sarcomas. Pedicled vascularized fibular graft alone as a reconstructive technique can be considered as an alternative method that needs to be evaluated regarding adequacy, safety, and applicability for these situations.

Methods:

This is a retrospective case series study of 23 patients (14 male and nine female) aged from 7 yr to 40 yr with proximal tibial sarcomas that were managed from 1999 through 2017 by a knee-sparing limb salvage technique. Routine clinical and radiographic examinations were performed with histopathologic diagnosis that found 16 patients who had conventional osteosarcoma, three patients who had parosteal osteosarcoma, three patients who had Ewing sarcoma, and one patient who had fibrosarcoma. One patient had initial lung metastasis.

Results:

The average functional score from the revised Musculoskeletal Tumor Society rating scale (MSTS) was 26 (86.6%). Local recurrence occurred in two patients who were managed by amputation. Overall survival in our study was 91.4% with mortality of two patients.

Conclusions:

Pedicled vascularized fibular graft alone as a novel reconstructive technique after knee-sparing limb salvage surgery for juxtaarticular proximal tibial sarcoma is an effective technique with overall good oncologic and functional results.

Level of Evidence:

Level IV
Results of fixed-angle device fixation (dynamic hip screw) in femoral neck fractures in young adults: a prospective study of 20 cases
Authors: Beder Fady Kamal , El-Hamalawy Ahmed Goda , Abdel-Kader Khaled F.M. , Abdelmoneim Mohamed A.
Published: May 2021

Background:

Femoral neck fractures constitute nearly half of the fractures of the hip. In young patients, hip preservation is advocated. Multiple cannulated screws and dynamic hip screws (DHS) are the preferred modalities. DHS gives better antirotational stability and fixation in femoral neck fractures. The purpose of this study was to assess functional outcomes after fixation of femoral neck fractures using DHS.

Methods:

A prospective case series study of 20 patients with femoral neck fracture were treated with DHS fixation. Exclusion criteria were patients with pathologic fractures, same-side shaft femoral fractures, skeletally immature patients, and those who were using walking aids before injury. Outcome was assessed by Harris Hip Score (HHS) and by radiographs at 3 and 6 mo.

Results:

The mean age at presentation was (38.5) years. Union was achieved in 19 patients (95%). The mean follow-up period was 7.13 months with a minimum of 6 mo for all patients included. There was a significant difference in nonunion rates if the tip-apex distance was more than 25 mm. Mean HHS at 6-month follow-up was 87.50 with a standard deviation±11.318.

Conclusions:

DHS results in better functional outcome with lower complication rates in transcervical and vertical shear femoral neck fractures in young adults.

Level of Evidence:

Level IV
An unusual presentation of osteosarcoma in the proximal femur with peculiar diagnostic characteristics: a retrospective series
Authors: Jamshidi Khodamorad , Zandrahimi Farshad , Bagherifard Abolfazl , Mohammadi Fatemeh , Mirzaei Alireza
Published: May 2021

Background:

Diagnosis of osteosarcoma in the proximal femur is challenging because of its atypical features. Hence, further characterization of the tumors of this location is necessary. In this study, we evaluated the characteristic features and outcomes of osteosarcoma in the proximal femur.

Methods:

Fifteen patients with proximal femoral osteosarcoma proximal to the intertrochanteric region were evaluated. The demographic, clinical, and radiologic characteristics of the patients were investigated. A modified Lodwick-Madewell system was used for the classification of the osteolysis pattern.

Results:

From a total of the 446 patients who had osteosarcoma, 24(5.4%) were identified in the proximal femur. The main clinical symptom was pain without mass. The osteolysis pattern was ill-defined in 10, “moth-eaten” in three, change of margin in one, and well-defined without sclerotic rim in one patient. Bone matrix mineralization was present in nine patients, which was in osteoid form in seven patients and in calcified form in two patients. Cortical destruction was seen in six patients. Peripheral edema and joint effusion were identified in nine and seven, respectively, out of 12 patients who had an MRI. Soft-tissue component and periosteal reaction were not seen in any patient. At a mean follow-up of 7.3 yr, four patients were deceased.

Conclusions:

Osteosarcoma of the proximal femur generally presents without classical features. Most notably, the tumor almost never has an extraosseous tumor mass. Therefore, the absence of an extraosseous component does not preclude the diagnosis of osteosarcoma in the femoral neck.

Level of Evidence:

Level IV.