bluuebunny/crossref_metadata_2025 huggingface dataset:
1134 Light Exposure At Daytime On Sleep Quality In Stroke Patient During Rehabilitation
Authors: Liao W , Lin S , Meng N , Tin H , Tsai S , Huang Y
Published: May 2020

Introduction

Lights maintain the day and night rhythm to set patients’ “wake-up cycle” and to stabilize their physiological functions, which may be expected to improve sleep. This study was aimed to investigate the relations between sleep quality and daytime light exposure in stroke patient during rehabilitation.

Methods

A cross-sectional study design was adopted and 120 stroke patients were recruited from rehabilitation wards of two medical centers and 116 patients completed this study. Research instruments including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Sleep Log, and Somnowatch (Germany) for actigaphy sleep and light were used to collect data and urinary melatonin concentration were measured.

Results

47.4% of the patients had poor sleep quality (PSQI>5), 74.1% had actigraphic sleep efficiency less than 85%, and 90.5% waked more than 30 minutes after sleep onset. The average exposure time at lower level light (≤149 lux) were 288.8 minutes, accounting for 48% of the day (8:00-18:00). Compared to lower light exposure group (less than 319.5 min at >150 lux), those who exposed to higher level light (more than 319.5 min at >150 lux) had increased 52.1 minutes in actigraphic total sleep time (TST, t=-2.134, p=0.035), increased 8% in actigraphic sleep efficiency (SE, t=-2.053, p=0.042), and decreased 41.1 minutes in actigraphic wake-after-sleep-onset (WASO, t=2.209, p=0.029). Urinary melatonin concentration increased 52.7 pg/ml, but not statistically significant (t=-1.277, p=0.205). Result of multiple regression analysis showed that after controlling for age, gender, post-stroke complications, and environmental interference, time of bright light exposure significantly affected subjective sleep satisfaction (p=0.014), TST (p=0.04), SE (p=0.041), and WASO (p=0.026).

Conclusion

Increasing time of bright illumination (≥150 lux) during daytime may improve sleep quality. Results of this study provide empirical references for non-drug intervention to improve sleep quality in patients with stroke.

Support

This study was supported by the Ministry of Science and Technology, MOST 105-2628-B-040 -005 -MY2.
1151 Is Timing Of Light Exposure Different In Women With Chronic Migraine?
Authors: Dawson S C , Kim M , Reid K , Burgess H J , Wyatt J K , Hedeker D , Park M , Rains J C , Espie C A , Taylor H L , Ong J C
Published: May 2020

Introduction

Light avoidance is a common coping behavior of individuals with migraine headaches. It is not known whether timing of light exposure is different in individuals with chronic migraine (CM) compared to those without migraine and how this may relate to headache frequency and severity. We tested this by examining timing of the brightest and darkest light and headaches in women with chronic migraines and healthy controls.

Methods

Sixteen women with CM (mean age = 33.07) and 18 female healthy controls (HC; mean age = 32.22) completed daily ratings of headache severity (0-10, severity > 2 classified as headache) concurrent with light exposure measured by wrist actigraphy for approximately one month (M=28.00 days, range=21-36). Start time of each day’s 10-hour periods of maximum light (M10) and 5-hour periods of lowest light (L5) were calculated and averaged for each participant. T-tests and Cohen’s d effect sizes were used to compare groups. Pearson correlation coefficients were calculated to examine associations between M10/L5 timing and headache frequency and severity.

Results

M10 was earlier in the CM group compared to the HC group (07:42±00:47 vs. 08:50±00:58, t(32)=3.69, p=0.0008, d=1.08). The CM group exhibited non-significant trend towards earlier L5 compared to the HC group (12:26±00:48 vs. 01:07±01:03, t(32)=1.89, p=0.0723, d=0.62). Among individuals with CM, later M10 timing was associated with more severe average daily headache (r=0.60, p=0.0136) and more frequent headaches (r=0.55, p=0.0257). Later L5 timing was significantly associated with more severe average daily headache (r=0.66, p=0.0052) and showed a non-significant trend toward association with more frequent headaches (r=0.47, p=0.0686).

Conclusion

Timing of the greatest light exposure period was earlier in CM compared to HC. Within the CM group, those who had earlier light and dark periods reported lower headache severity and fewer days with headaches. These findings suggest the possibility of a role for the circadian system in chronic migraine.

Support

This study was supported by grant R21NS081088 from the National Institutes of Health.
1155 The Association Between STOPBANG Risk and Sleep Quality in an mTBI Sample
Authors: Garcia A , Reljic T , Kenney K , Amma A , Troyanskaya M , Elisabeth W , William W , Richardson R
Published: May 2020

Introduction

Although Obstructive Sleep Apnea (OSA) is prevalent in the military population, traditional scoring/clinical cut-offs of available screening tools may not be appropriate for this younger, slimmer population. We additionally have limited information regarding utility of OSA screening in those with history of mild traumatic brain injury (mTBI). The current study compared multiple STOPBANG scoring methods to determine how well they were associated with self-reported sleep measures in an mTBI sample.

Methods

Secondary analyses were conducted from a large database of evaluations from a multi-center, longitudinal study of mTBI. Participants were included if they had completed the STOPBANG and additional sleep measures. The subsequent sample (N=486) included participants with history of mTBI (n=408) and controls (n=78). The sample was predominantly male (n=421) with a mean age of 39 (IQR = 31/37/47).

Results

Sleep efficiency was not significantly associated with any STOPBANG scoring, in the total sample or when controlling for mTBI. In the total sample, sleep quality was most strongly associated with traditional STOPBANG scoring (STOPBANG ≥ 3, β=0.51). Sleep duration was most strongly associated with Snoring/Tired/Hypertension (STP = 3, β=0.79). When controlling for mTBI, duration was most strongly associated with traditional scoring (β=0.48), while sleep quality was most strongly associated with Snoring/Tired/Hypertension (β=0.78). Follow-up analyses demonstrate a significant difference in correlation between groups for STP/Sleep Quality, with a stronger correlation for those without mTBI.

Conclusion

The STOPBANG measure was significantly associated with self-reported sleep quality/duration measures, but not sleep efficiency. Although traditional clinical cut-offs for OSA predicted sleep measures in this sample, the relationship between risk scores and outcomes became more nuanced when history of mTBI was included. Future studies are needed to understand the relationship between OSA risk and subsequent diagnosis in the mTBI population.

Support

Defense and Veterans Brain Injury Center (GDHS,W91YTZ-13-C-0015), DOD(W81XWH-12-2-0095), VA(I01 CX001135)
1162 Financial Savings and Improved Outcomes from an Innovative, Integrated Sleep Apnea Management Program for a Safety Net Population: 5-Year Results
Authors: Lim M S
Published: May 2020

Introduction

Sleep disorders are extremely common in the general population and are associated with an increased risk for fatal accidents, heart disease, stroke, neurocognitive decline, and diabetes. Sleep problems disproportionately affect socioeconomically disadvantaged and under resourced communities. We present here a 5-year analysis of a private-public partnership between a private sleep medicine practice (Redwood Pulmonary Medical Associates, RPMA) and county medical system (the Health Plan of San Mateo) to provide a coordinated, value-based sleep apnea program to adult residents of San Mateo County, CA.

Methods

Referring providers send referrals to a single location (RPMA), and sleep consultations, testing, follow-up care, and CPAP management occur out of the same location by a dedicated staff. Limited channel cardiopulmonary (CP) sleep testing initiated in the office and completed at home was done for most patients. Patients with AHI>5 plus daytime sleepiness were offered nasal CPAP, unlimited mask fittings, and compliance checks.

Results

2101 CP tests were successfully completed (93.5%). There were 49.6% females and 50.4% males, with an average age of 51.6 years. 31% had severe obstructive sleep apnea (OSA) and 59% were moderate or severe. 1471 (65%) of patients were given prescriptions for CPAP and 471 (32%) were still using CPAP at 5 years, 68.7% of whom were initiated within 3 years of the analysis. Of the patients returning satisfaction surveys, 97% would recommend the program to a relative or friend, and all respondents (99 to date) who were using CPAP felt it had benefitted their health overall. Comparing actual costs of the program to projected fee-for-service costs for the same services, the program saved the Health Plan of San Mateo $1,132,510, or 51.4%.

Conclusion

This program demonstrates the potential clinical and financial benefit of private-public partnerships in administering clinical programs to high risk populations, as private businesses can quickly adapt to new technologies, financial metrics, and standards of care.

Support

No outside financial support was provided
0118 Improved Working Memory is Related to Non-REM Delta Activity in Control but Not PTSD Participants
Authors: LaGoy A D , Kaskie R , Connaboy C , Laxinarayan S , Reifman J , Germain A , Ferrarelli F
Published: May 2020

Introduction

Individuals with post-traumatic stress disorder (PTSD) experience altered sleep and daytime function, including deficits in working memory (WM), the ability to store and manipulate information over short timeframes. As sleep contributes to WM, understanding how sleep parameters influence changes in WM may provide insight into potential intervention targets to improve or restore daytime function. Here, we investigated the relationship between sleep and WM improvement in Veterans with and without PTSD.

Methods

Forty-eight post-911 Veterans without PTSD (Control) and 37 with PTSD (PTSD) completed a 48-hour lab stay during which WM was assessed using a n-back task. Nighttime polysomnography, using high-density (64-channels) electroencephalography, quantified time spent in non-REM and REM sleep and log-transformed spectral activity for non-REM sleep in delta (.5-4Hz), theta (4-8Hz), alpha (8-12Hz), sigma (12-16Hz), and beta (16-32Hz) bands. Pearson’s correlations were used to assess associations between baseline sleep and baseline WM on 1-back trials. Within control and PTSD groups, independent samples t-tests were used to compare changes in sleep across nights between improvers and non-improvers categorized by 1-back accuracy changes across days.

Results

Proportions of improvers and non-improvers were similar between groups (χ 2 = .023, p = .880). Within either group, baseline sleep did not relate to baseline WM and changes in time spent in each sleep stage did not differ between improvers and non-improvers. Within the control group, improvers (n = 15; 3.67 ± 3.56) had a greater increase (t = -2.826, p = .007) in delta activity than non-improvers (n = 33; .77 ± 3.20), but this relationship was not observed in the PTSD group (11 improvers, 26 non-improvers).

Conclusion

Increased delta activity related to improved WM in the Control but not PTSD group. This suggests individuals with PTSD do not improve WM through non-REM sleep but that it may be a useful intervention target.

Support

USAMRMC MOMRP PT-130572 (PI: Reifman)
1167 Nursing Perceptions of Sleep Assessment in the Intensive Care Unit
Authors: Heavner M S , Jobe S L , Hurley J , Le B , Kantner C , Heavner J J , Shanholtz C , Verceles A , Wickwire E M
Published: May 2020

Introduction

Sleep disruption in intensive care unit (ICU) patients is highly prevalent and may contribute to adverse clinical outcomes. Although clinical practice guidelines recommend routine assessment of sleep, surveys of ICU clinicians indicate that sleep assessment programs (SAP) are rarely implemented. The purpose of the current project was to characterize sleep-related perceptions, practices, and knowledge among ICU nurses, to identify barriers and facilitators of implementation of a systematic SAP.

Methods

A 29-item, paper-based survey was administered to all nurses (N=220) in a medical ICU at a 750-bed academic medical center and a mixed ICU in a 300-bed community hospital. Voluntary survey completion was conducted over four weeks. Descriptive statistics were employed.

Results

A total of 163 surveys were completed (74.1%). Participants were primarily female (n=135; 82.8%), day-shift nurses (n=83; 50.9%), with 2-5 years of ICU experience (n=70; 42.9%). Respondents said they sometimes (n=52; 31.9%), and often (n=52; 31.9%), assess sleep, and 76.1% (n=124) reported not assessing sleep formally in the last three shifts. Approximately half of the respondents (n=85; 52.1%) were not aware of clinical practice guideline recommendations for sleep in the ICU. Most nurses reported that their unit could benefit from a SAP (n=101; 62.0%) and that they should have a primary responsibility in ensuring that sleep is discussed daily (n=144; 88.3%).

Conclusion

Despite published guidelines recommending routine sleep assessment, ICU nurses report infrequent assessment and a lack of awareness of these guidelines. However, ICU nurses believe implementation of routine sleep assessments would be beneficial to patient care. This suggests that SAP implementation would be positively received by ICU nurses. Future studies evaluating knowledge and site-specific perceptions and practices, as well as nursing staff characteristics, can further guide implementation of SAPs in the ICU.

Support
1172 Sleep Education Improves Screening for Sleep Disorders Among Physicians and Residents in Primary Care and Neurology Specialties
Authors: Jain S V , Kondapalli K , Moskowitz A , Combs D , Parathasarathy s
Published: May 2020

Introduction

Sleep disorders are under-diagnosed. The purpose of the study was to evaluate if providing sleep education improves screening and thereby, diagnosis of sleep disorders among physicians.

Methods

The study was approved by the institutional review board. Pediatric (P), neurology (N) and internal medicine (IM) physicians/residents participated in the study. After collecting demographics, including baseline screening rates (BSR), the participants were randomized to educational intervention- either manuscript or oral presentation reviewing insomnia, obstructive sleep apnea and sleep disorders in epilepsy. Questionnaires-baseline knowledge (BQ), post-intervention (PQ) and 9 months after the intervention, screening (SQ) evaluating screening rates (PSR) and usefulness of the study, were collected. The change in knowledge (PQ-BQ) and screening rates (PSR-BSR) were compared between the groups by t-test and ANCOVA after adjusting for BSR. t-tests were used to compare the knowledge and screening rates before and after the intervention in the entire cohort. Correlations identified the factors associated with improved screening rates.

Results

Thirty and 23 subjects completed the study and SQ, respectively. The average age was 30.4 (standards deviation [SD]= 3.1) with 53% female and practice experience of 2.5 years (SD=1.7) with 60% P, 23.3% N and 16.7% IM participants. There were no significant differences in the characteristics, and knowledge and screening rate change after the intervention between the two groups. However, for individual questions, the oral presentation group had improved knowledge about sleep disorders in epilepsy. The study improved knowledge by 82% for understanding, 77% for managing and 79% for screening for sleep disorders. Knowledge (Mean Difference [MD]= 0.22, p=0.0001) and screening rates (MD=0.29, p=0.001) improved significantly after the intervention in the entire cohort. The improvement in screening rates was associated with presence of screening by the physicians prior to the intervention (r=0.5, p=0.008).

Conclusion

The study showed that sleep education improved knowledge and screening for sleep disorders among physicians.

Support

The study was funded by the American Academy of Sleep Medicine Foundation Focused Project Award.
1192 The Accuracy of a Novel Sleep Ring Device for Estimating Sleep Onset with Good and Poor Sleepers
Authors: Scott H , Whitelaw A , Canty A , Lovato N , Lack L
Published: May 2020

Introduction

THIM is a new ring-like sleep device that, if found to accurately measure sleep onset, could be used for a variety of clinical purposes. These include administering a brief but effective treatment for insomnia called Intensive Sleep Retraining, facilitating the optimal 10-minute power nap, and administering Multiple Sleep Latency Tests (MSLTs) outside of the sleep laboratory. This study assessed the accuracy of THIM for measuring sleep onset latency compared to polysomnography (PSG).

Methods

Twenty healthy individuals aged 23.6 years (SD = 4.89) underwent overnight PSG recording whilst using THIM on two nights in the sleep laboratory, one week apart. On each night, participants completed sleep onset trials for four hours whilst monitored via PSG. In these trials, participants attempted to fall asleep whilst responding to vibrations emitted from THIM. Once they failed to respond to two consecutive stimuli, THIM woke them with an intense vibration. Participants had a short break before attempting the next trial.

Results

On average, THIM overestimated sleep onset on the first night by 0.24 minutes (SD = 0.90). On the second night, THIM overestimated sleep onset by 0.82 minutes (SD = 1.31) and this discrepancy was not significantly different to that obtained on the first night, p = .08. The accuracy of THIM did not differ between good sleepers (Insomnia Severity Index (ISI) score < 7) or poor sleepers (ISI score 8-15), p = .98.

Conclusion

The findings suggest that THIM is accurate at estimating sleep onset latency for both good and poor sleepers. The next step is to test THIM outside of the laboratory environment. The goal is to develop an accurate yet practical device that can translate laboratory-based procedures to the home environment, to the benefit of patients and clinicians wanting to improve sleep.

Support

The project was funded in-part by the manufacturers of THIM, Re-Time Pty. Ltd., with additional funding provided by Flinders University.
1195 Closed-Loop Electroencephalogram-Based Modulated Pink Noise to Facilitate Falling Asleep
Authors: Garcia-Molina G , Kalyan B , Aquino A
Published: May 2020

Introduction

During the wake to sleep transition, the EEG exhibits a reduction in the power in the beta (15-30 Hz) band and an increase in the power of the theta (4-8 Hz) band. In previous publications we reported that the log-ratio “ρ=10×log(β/θ)” quasi-monotonically decreases by an order of magnitude as sleep initiates.

Methods

We developed a closed-loop, real-time system that processes a single EEG signal (FPz-M2) to modulate the volume of (pink-noise) sound according to “ρ=10×log(β/θ)”. The volume was calibrated such that it progressively decreases as sleep initiates. The EEG was acquired using the Philips AliceTM PSG station connected to a laptop where the algorithm was implemented. The sound was played through a wearable headband connected to the laptop’s audio-output. The algorithm processes 6-second EEG windows to estimate: 1) a signal quality index, 2) the average “ρ”, and 3) the sleep stage using a deep-learning stager. The volume changes with “ρ” according to a sigmoidal model. From the time where N2 or N3 sleep has been continuously detected for 3 minutes, the volume decays to zero in an exponential fashion. Seven subjects without any sleep disorder diagnosis (3F/4M; 33.6 ± 8.7 years old) participated in a home-based trial and recorded 5 sleep sessions. The first familiarization session was followed by randomized 2-session blocks: Block 1: closed-loop volume modulation (active), and Block 2 open-loop (sham) constant volume decrease.

Results

A 2.2-minute decrease (p=0.1) in average sleep latency was found in the active condition (11.6 ± 5.0m) w.r.t. the sham condition (13.8 ± 6.1m).

A 5.2-minute decrease (p=0.08) in average N3 latency was found in the active condition (29.3 ± 10.4m) w.r.t. the sham condition (34.5 ± 13.6m).

The log-ratio decreased significantly faster (p<0.05) and more monotonously in the active condition suggesting a faster sleep-deepening due to the sound modulation.

Conclusion

Closed-loop modulation of the volume of pink-noise based on the EEG’s β/θ ratio may promote a faster sleep onset and a faster transition into deeper NREM sleep. The statistically trending results reported in this research grant further experimental validation with a larger number of subjects.

Support

Philips Sleep and Respiratory Care
1199 The Accuracy Of A New Sleep Ring Device For Tracking Sleep And Wakefulness Overnight Using Actigraphy
Authors: Scott H , Lovato N , Lack L
Published: May 2020

Introduction

THIM is a new consumer ring-like device that can passively monitor sleep overnight using actigraphy. This project aimed to develop the THIM sleep tracking algorithm (Study 1), and test its accuracy against polysomnography (PSG) with another independent sample of good and poor sleepers (Study 2).

Methods

Study 1: 25 healthy individuals (15 females) aged 25.38 years (SD = 6.39) slept overnight in the sleep laboratory with THIM, the Philips Spectrum, the Fitbit Flex, and PSG recording simultaneously. The THIM sleep tracking algorithm was developed by optimising sensitivity and specificity with PSG. Study 2: An additional 20 individuals (14 females) aged 23.22 years (SD = 5.02) slept overnight in the sleep laboratory with the same devices as in Study 1.

Results

Study 1: THIM showed high agreement with PSG for estimating sleep (sensitivity = .91) and reasonably high agreement for wakefulness (specificity = .59). There were no significant differences between PSG and THIM for total sleep time, t(24) = 0.76, p = .46, or sleep efficiency, t(24) = 0.56, p = .58. Study 2: THIM showed high agreement with PSG for estimating sleep (sensitivity = .89) and wakefulness (specificity = .59). Compared to PSG, THIM significantly underestimated total sleep time, t(19) = 2.10, p = .049, and sleep efficiency, t(19) = 2.20, p = .04, by an average of 21.35 minutes (SD = 45.52) and 4.44% (SD = 9.04), respectively.

Conclusion

Together, these studies suggest that THIM is reasonably accurate for monitoring sleep overnight in healthy individuals. Slight modifications to the algorithm and additional sensors could be added to THIM to improve its accuracy. Future research will examine the accuracy of THIM with larger sample sizes and particularly for people with insomnia, with the goal being to incorporate sleep tracking into a mobile-based treatment program for insomnia.

Support

The project was funded in-part by the manufacturers of THIM, Re-Time Pty. Ltd. Additional funding was provided by Flinders University.
1214 Higher Bedroom Temperature Associated With Poorer Sleep: Data From Over 3.75 Million Nights
Authors: Raj A , Ruder M , Rus H M , Gahan L , O’Mullane B , Danoff-Burg S , Raymann R
Published: May 2020

Introduction

Bedroom temperature can influence nocturnal thermoregulation and sleep. To date, limited, small experimental studies have shown that bedroom temperatures outside the recommended range of 65 and 70°F can negatively impact sleep. However, this association has not been studied in a large-scale data set. Using over 3.75 million nights of objectively measured data, we analyzed the associations between habitual bedroom temperatures and sleep.

Methods

Over 3.75 million nights of sleep and bedroom temperature data were collected using S+ by ResMed technology from 34,096 Individuals (57% male, 20-90 years, mean age 48.7 +/-14.5 years, all US residents). Multilevel regression analyses were used to analyze associations between bedroom temperature and sleep. A stricter alpha level of 0.001 was used to account for the large number of observations in the dataset.

Results

Bedroom temperature was above 70°F for 69% of nights, with the average temperature ranging between 68.8 and 76.2°F. For each 1°F increase in bedroom temperature between 60-85°F, sleep efficiency decreased by 0.06%. Likewise, higher bedroom temperatures were linked to shorter Total Sleep Time duration (-0.45 mins/°F), longer Sleep Onset Latency (+0.04 mins/°F), and longer Wake After Sleep Onset (+0.11 mins/°F), all ps<0.001.

Conclusion

Analyzing data from over 3.75 million nights, we found that many people sleep in a bedroom warmer than the optimal temperature. Further, higher bedroom temperatures - even within the recommended range for optimal sleep - are associated with poorer sleep and higher wakefulness. Bedroom thermostats and cooling options should be considered to achieve optimal sleeping temperature conditions.

Support

N/A
1223 Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil sequence
Authors: Martirosyan Zara , Malhotra Sonal
Published: May 2020

Introduction

Klippel- Feil Sequence (KFS) is a rare congenital condition that classically presents with a triad of congenital cervical spine fusion, reduced cervical spine flexion and low posterior hairline. KFS has been associated with several comorbidities including congenital heart defects, hearing loss, renal dysfunction, Chiari malformation and sleep disordered breathing (SDB). The co-occurrence of SDB and chiari malformation type 1 (CM1) has been reported in multiple individuals. However, the pathological basis of the connection between CM1 and SDB in the setting of KFS is not clearly understood.

Report of Case

Here we present a pediatric case report of a patient with KFS, SDB, drooling and dysphagia. The drooling and dysphagia prompted an MRI that revealed CM1. Baseline polysomnogram (PSG) showed mild central sleep apnea with apnea-hypopnea index (AHI) 6.06 comprised of central apnea index 4.81 and obstructive apnea index 1.28. Posterior fossa decompression of this patient, following neurology recommendations, resolved majority of the symptoms, namely the drooling, nocturnal cough, dysphagia and sleep disturbances. However unexpectedly repeat polysomnogram eight weeks after posterior fossa decompression revealed worsening central sleep apnea despite the patient being clinically asymptomatic.

Conclusion

Taken together this case highlights the point that while it is critical to recognize the association of SDB in the setting of KFS, decompression alone may not be sufficient to completely alleviate SDB and/or certain neurological symptoms such as nocturnal coughing. Our observations are consistent with the hypothesis that SDB in a setting of KFS is multifactorial and pathophysiology is not clearly understood.
1237 Positional central sleep apnea in a child: not always obstructive
Authors: Powell Weston , Chen Maida
Published: May 2020

Introduction

Spinal cord compression at the craniocervical junction can cause central sleep apnea (CSA) in children, due to mechanical disruption of respiratory control centers. Polysomnography (PSG) pre/post surgical decompression is indicated to evaluate treatment response.

Report of Case

A 5-year-old with Wolf-Hirschhorn syndrome, developmental delay, partial agenesis of the corpus callosum, hypotonia, incomplete segmentation of C1 with subluxation leading to stenosis, cleft palate, and obstructive sleep apnea (OSA) presented for post-surgical PSG. Prior PSGs revealed oAHI 55/hr and 7/hr, cAHI 3/hr and 2/hr at 1 and 10 months of age, respectively. At 46 months, patient underwent suboccipital decompression at C1 for severe craniocervical stenosis. Post-operative PSG revealed emergence of CSA with cAHI 8/hr and stability of OSA with an oAHI 8/hr. Positional analysis revealed worsening in lateral position (lateral cAHI 10.6/hr, supine cAHI 4.6/hr). Central events were up to 33 seconds long with nadir desaturation of 76% in lateral position compared to 20 seconds and nadir 88% in supine position. Head CT and MRI showed incomplete ossification of the C1 vertebra with subluxation of the left lateral mass leading to absence of CSF flow at the craniocervical junction. Repeat decompression and fixation is planned by neurosurgery; in the interim supine sleep was recommended and family declined BiPAP.

Conclusion

In our case, CSA worsened with left lateral positioning and improved with supine positioning. Lateral positioning likely increased subluxation of the left lateral mass seen on CT/MRI, and eased subluxation in supine sleep causing position-dependent dynamic impingement of the respiratory control centers at the level of subluxation. The absence of findings prior to decompression may reflect increased instability after decompression or increased stenosis with growth. Our case highlights the importance of positional analysis for central as well as the more conventional obstructive sleep apnea to understand pathogenesis and guide therapy.
1249 Reverse platypnoea-orthodeoxia syndrome: A rare cause of hypoxemia during in lab polysomnography
Authors: Sessums Mary T , Guzman Maria P , Dredla Brynn K
Published: May 2020

Introduction

Sleep related hypoxemia carries a broad differential diagnosis. Right-to-left shunting is a known cause of hypoxemia that is not correctable with supplemental oxygen. A patent foramen ovale (PFO) is an intra-cardiac shunt that results in hypoxemia and in rare instances can lead to platypnea-orthodeoxia syndrome (POS). POS is characterized by dyspnea and hypoxemia in the upright position, which improves when supine. We present a case of nocturnal hypoxemia and PFO with a unique clinical presentation consistent with reverse POS discovered on PSG.

Report of Case

57-year-old male with Class I obesity and a remote diagnosis of mild sleep-disordered breathing not treated with CPAP was referred to Sleep Medicine for excessive daytime sleepiness, snoring, and witnessed apneas. Polysomnography revealed basal oxygen saturation of ~88% during sleep. There was no evidence of apnea or hypopnea. Hypoxemia was not correctable with supplemental oxygen, suggestive of shunt physiology. Oxygen saturation was normal during upright exercise. Pulmonary hypertension was ruled out. Transesophageal echocardiogram revealed PFO with right-to-left shunt. Overall presentation was consistent with reverse POS secondary to PFO, which will be treated with percutaneous trans-catheter closure.

Conclusion

This is a rare case of reverse POS secondary to PFO, with shunt physiology initially suspected during Sleep Medicine evaluation based on PSG. Reverse POS is characterized by dyspnea and hypoxemia while supine, as opposed to upright as in classic POS. The precise pathophysiology of reverse POS is unclear. This case emphasizes the need to consider reverse POS in patients with supine hypoxemia refractory to oxygen therapy. Such findings on PSG should prompt further workup for causes of right-to-left shunt. This diagnosis should not be overlooked, as the underlying abnormality is often correctable. In this patient, we expect hypoxemia to resolve with percutaneous trans-catheter closure of PFO.
1259 Periodic Neck Myoclonus During Sleep (PNMS) is Associated with Upper Airway Resistant Syndrome, but Resolves with CPAP
Authors: Alfi Majed A , Avidan Alon Y
Published: May 2020

Introduction

Periodic neck myoclonus during Sleep (PNMS) is a movement disorder of sleep characterized by sudden myoclonic flexion or version of the head that manifest during REM and NREM sleep. While its finding has been attributed to a normal physiologic phenomenon, to the best of our knowledge, our case represents the first report of with PNMS attributed to sleep disordered breathing with resolution using CPAP

Report of Case

A 22 y/o male with no significant clinical history was referred for evaluation of snoring and excessive sleepiness. Nocturnal polysomnogram coupled with expanded EMG montage demonstrates evidence of upper airway resistance syndrome (UARS), characterized by frequents respiratory effort-related arousals (RERAS), primarily during REM sleep associated with arousals. The majority of these events resulted in sudden myoclonic movements of the neck and head that were associated with arousals and sleep fragmentation. PNMS manifested in the PSG as a flexion myoclonic motor artifact lasting 200-800 ms during REM sleep with an associated EEG arousal. The overall Respiratory Disturbance Index (RDI) was12/hr. The subsequent application of CPAP at a setting of 5-6 cm resolved these movements supporting this origin as a phenomenon of sleep-state instability.

Conclusion

While previous investigators have explained PNMS as an incidental finding or one common in patients with RBD, our case highlights a potential new mechanism for their appearance. This case helps shed more light on the origin of PNMS as a secondary phenomenon related to sleep state instability due to sleep disordered breathing given the temporal association with RERAS and dramatic resolution with CPAP therapy.
1262 Case Series on the Use of Volume Assured Pressure Support (VAPS) in Patients with Interstitial Lung Disease and Progressive Hypercapnia
Authors: LeMaster William , Jun Dale , De Cruz Sharon , Zeidler Michelle , Saggar Rajan
Published: May 2020

Introduction

Many patients with interstitial lung disease (ILD) experience progressive respiratory failure. While various therapies are implemented for acute hypercapnic respiratory failure during inpatient ILD flares, there is little data regarding the management of chronic hypercapnia in ILD with nocturnal Volume Assured Pressure Support (VAPS). We present three patients who were prescribed nocturnal VAPS for their progressive hypercapnia as a bridge to lung transplantation.

Report of Case

Patient 1 is a 45-year-old woman with rheumatoid arthritis related ILD and progressive hypercapnia. Despite optimal therapy, her ILD resulted in an admission for hypercapnic and hypoxemic respiratory failure requiring treatment with BPAP, then transition to nocturnal VAPS on discharge. Dyspnea and pCO2 improved as an outpatient (Fig. 1). Patient 2 is a 70-year-old female with history of scleroderma associated ILD with severe PH and hypercapnia. Initiation of VAPS improved her pCO2 levels although she was readmitted after a few months of treatment for an ILD flare. Patient 3 is a 60-year-old patient with connective tissue disease related ILD who was admitted for respiratory failure due to pneumonia and was transitioned to BPAP for hypercapnic respiratory failure. Due to insurance issues she has been unable to obtain a home VAPS and her pCO2 remains elevated. A plot of each patient’s pCO2 over time is in Figure 1.

Conclusion

In patients with severe lung disease, the normal decrease in tidal volumes that occurs with sleep can result in CO2 retention. Non-invasive ventilation (NIV) is well-studied in both stable obstructive lung disease and exacerbations but there is little data examining the utility of NIV to treat the chronic hypercapnia of ILD. In this case series, nocturnal VAPS stabilized or reduced PCO2 in patients with ILD and hypercapnia. Additional studies are needed to assess long term effects of VAPS in these patients.
1266 Primary Central apnea and loss of muscle atonia during REM
Authors: Hernandez M Elizabeth C , Velamuri Kanta
Published: May 2020

Introduction

Central sleep apnea (CSA) syndrome is defined when five or more central apneas and/or hypopneas are present per hour of sleep, more than 50% of all respiratory events. CSA usually occur during NREM stage and rarely during REM. CSA is important to recognize because of complications ranging from frequent nighttime awakenings,sleepiness to adverse cardiovascular outcomes. We present a 40 year old female patient with rare CSA during REM sleep and dream enactment.

Report of Case

40yo African American female with history of loud snoring, witnessed sleep apnea, and daytime fatigue. She reported nightmares, sleep talking, and acting out her dreams without injury. Epworth sleepiness score was 5 /24. Her past medical history is significant for depression and anxiety. She has no history of head trauma, no neurologic or cardiovascular disorders. Her medications include fluoxetine and,quetiapine. She denied substance use, narcotic use, or alcohol use.

Her level 1 sleep study showed predominantly REM-associated central sleep apneas which is rare. She also was observed to have loss of REM sleep muscle atonia suggestive of REM Behavior disorder.

Her sleep architecture was atypical with decreased N3 sleep stage. REM sleep duration was adequate. She was noted to have loss of REM muscle atonia based on AASM guidelins elevated chin EMG, excessive transient muscle activity, and witnessed movement during REM stage via video monitoring.

During the study, she had an apnea/hypopnea index (AHI) of 13.1 per hour of sleep, Central apneas were predominantly noted during REM stage, 10 per hour, comprised of 50% of her respiratory events. The minimum SpO2 value with CSA was 94%. She had normal sinus rhythm.

Her sleep was fragmented. A total arousals were 28.4/hour,and 7.9/hour were respiratory arousals, and the rest were spontaneous arousals.

An echocardiogram showed normal left ventricular ejection fraction of 55 to 60 %. Her room air arterial blood gas was normal with PaC02 of 37 mmHg. MRI of the brain/brainstem was ordered given her atypical REM sleep. She had no acute intracranial abnormalities. There is a non specific finding of a low lying cerebellar tonsils without evidence of Chiari I malformation.

Conclusion

Our patient has rare idiopathic central apnea in REM stage and is third case reported. She also has loss of muscle atonia during REM with dream enactment which is also rare in her age group. Injury precaution advised.
0132 Sex Differences in Evening Food Intake and Associated Weight Gain During Insufficient Sleep
Authors: Withrow D , Depner C M , Boland E M , Birks B R , Melanson E L , Higgins J , Eckel R H , Perreault L , Bergman B C , Wright K P
Published: May 2020

Introduction

Timing of food intake has emerged as a novel risk factor for weight gain and obesity. Higher evening food intake, especially during insufficient sleep, is associated with weight gain. We aimed to explore initial changes in evening food intake and the respiratory quotient (RQ) during insufficient sleep and subsequent weight gain. We also explored sex differences.

Methods

28 healthy adults (14F) aged 26.3±4.5y completed a 14–16 daylong laboratory protocol. In their home environment participants maintained one week of ~9h/night sleep schedules and consumed energy balanced diets for 3 days prior to completing the laboratory protocol. The laboratory protocol consisted of 3 baseline days of 9h/night scheduled sleep with energy balanced diets followed by 10 days of 5h/night scheduled sleep with ad-libitum food intake, with (n=14) and without (n=14) weekend recovery sleep. RQ was assessed on days 3 and 5 in a whole room calorimeter. Evening (dinner and after-dinner snacks) energy intake and body weight were assessed daily.

Results

A significant sex by condition effect was observed for evening food intake such that men and women were similar at baseline, but men ate more than women during insufficient sleep, when controlling for body mass (p<0.05). A significant sex by condition effect was also observed for RQ with women showing similar RQ during baseline and insufficient sleep and men showing a higher RQ during insufficient sleep versus baseline (p<0.05). Linear regression with food intake and RQ as predictors of weight gain showed that increased evening food intake, but not RQ, on the second day of sleep restriction was associated with weight gain in men, but not women, at the end of the study eight days later (p<0.05).

Conclusion

Findings suggest that rapid changes in evening food intake during insufficient sleep contributes to subsequent weight gain during sustained insufficient sleep, especially in men.

Support

NIH HL109706, DK111161, TR001082, DK048520, Sleep Research Society Foundation grant 011-JP-16 and Office of Naval Research MURI (N00014-15-1-2809).
0133 NLRP3 Inflammasomes Modulate Brain Vasohemodynamic Responses to Sleep Loss
Authors: Zielinski M R , Atochin D N , Desrosiers G
Published: May 2020

Introduction

Increased cerebral blood flow (CBF) is positively associated with non-rapid eye movement (NREM) sleep electroencephalogram (EEG) delta power, also known as slow-wave activity (SWA). The pro-inflammatory somnogenic cytokine interleukin-1 beta (IL-1β) can induce vasodilation and increase CBF. Nucleotide leucine-rich protein complex-3 (NLRP3) inflammasomes, which activate IL-1β, are increased in the cortex after sleep deprivation and increase SWA. We aimed to determine the relationship of NLRP3 inflammasomes on sleep loss-induced alterations in vasohemodynamics and SWA.

Methods

NLRP3 knock-out (KO) and wild-type (WT) mice underwent ad libitum sleep, 6 hours of sleep deprivation, or were given 10 ng of IL-1β or the vehicle intracerebroventricularly. SWA and CBF, blood velocity, and blood volume were determined concurrently during sleep/wake states using polysomnography and laser doppler flowmetry. Regional brain changes in CBF were determined using transponders, spectrophotometry, and fluorescent microspheres.

Results

SWA and CBF were significantly increased during the first 6 hours after sleep deprivation in WT but not NLRP3 KO mice. SWA and CBF significantly increased in the first 6 hours after IL-1β in both NLRP3 KO and WT mice. Additionally, alterations in cerebral blood velocity and volume demonstrated state specific changes that varied significantly during the transitions between states. SWA and CBF were significantly positively correlated during both ad libitum sleep and sleep after sleep deprivation in WT mice, although this relationship was not observed in NLRP3 KO mice. We also found significant phase-amplitude frequency coupling between SWA and CBF. Cortical changes CBF were significantly enhanced after sleep deprivation and IL-1β administration in WT mice, although were attenuated in the hypothalamus. NLRP3 KO mice showed these same regional effects in CBF after IL-1β but not sleep deprivation.

Conclusion

Our findings indicate that NLRP3 inflammasomes are involved in neurovascular coupling involving SWA.

Support

Department of Veterans Affairs IBX002823A (MRZ)
0147 Dynamic Alterations in Functional Connectivity Between Sleep- and Wake-Promoting Regions of the Human Brain at the Sleep Onset Period
Authors: Ishii T , Koike T , Nakagawa E , Sumiya M , Sadato N
Published: May 2020

Introduction

The sleep onset period, involving so-called stage N1 sleep largely, is characterized by a reduction in the amount of alpha activity compared to wakefulness. Various kinds of physiological and psychological changes are also apparent, such as slow eye movements, changes in muscle tonus, and the hypnagogic dream-like mentation. These phenomena are thought to be the reflection of dynamic alterations in the brain during the transition period, however, details of these changes have still been uncovered.

Methods

We aimed to investigate a dynamic shift in the brain connectivity at sleep onset using the method of EEG-fMRI simultaneous recording. Twenty-three healthy subjects participated. EEG/fMRI were recorded simultaneously during an hour’s nap in a 3T-MRI scanner and real-time monitoring of EEG was performed. To record the transition period between multiple times, an experimenter inside a scanner room touched a subject’s foot for inducing arousal when a shift to NREM sleep stage 1 was observed. EEG data were scored according to the AASM criteria. Based on sleep stages defined by polysomnographic findings, we investigated alterations in functional connectivity of sleep- and wake- promoting regions within the hypothalamus and other areas including the thalamus.

Results

Posterior alpha power showed significant positive correlation with BOLD signals in the anterior and medial dorsal thalamus. Connectivity between the thalamus and cortical regions reduced sharply in the descent to sleep stage. Meanwhile, BOLD signals of the sleep- and wake- promoting regions within the hypothalamus fluctuated with certain temporal lags from fluctuations of alpha rhythm at sleep onset.

Conclusion

Present findings provide preliminary evidence of dynamics of wake- and sleep- promoting regions in the human brain in vivo. Our data also support the hypothesis that reduced thalamocortical connectivity which limits the capacity to integrate information is associated with the transition of consciousness at sleep onset.

Support

None
0149 Nightly Sleep Characteristics are Associated with Next-Day Mindfulness
Authors: Lee S , Mu C , Gonzalez B D , Vinci C E , Small B J
Published: May 2020

Introduction

Previous research shows that insufficient and poor sleep is associated with perceiving more stressors the following day. Sleep may also be associated with daily mindfulness, a state in which one is highly aware and focused on the present moment without evaluating or judging that moment. The association between high mindfulness and better sleep is well-established; yet, less is known about the temporal directionality between sleep and mindfulness. This study examined whether nightly sleep predicts next-day mindfulness, and vice versa.

Methods

Participants were 60 middle-aged adults working as a full-time nurse at a cancer hospital (Mage=35.35±11.83). Using ecological momentary assessments for 14 days, we asked participants about their previous night’s sleep upon waking and participants completed the 5-item state Mindful Attention Awareness Scale an average of 3 times/day. Multilevel modeling examined variance at the between- and within-person levels and tested two temporal directions simultaneously: better sleep predicting mindfulness and mindfulness predicting better sleep.

Results

Daily mindfulness, sleep duration, sleep sufficiency, and sleep quality displayed 34%, 85%, 82%, and 85% within-person variation, respectively. At the within-person level, daily mindfulness was greater on days following longer than usual sleep duration (B=0.39hrs or 23min, p<.01) and greater than usual sleep sufficiency (B=0.26, p<.001). The within-person link between sleep sufficiency and mindfulness remained even after controlling for the strong association of workdays with less sleep sufficiency. Conversely, mindfulness was not predictive of sleep outcomes. At the between-person level, participants who had greater sleep sufficiency and higher sleep quality overall reported greater mindfulness. These associations remained after adjusting for sociodemographics, dayshift vs. nightshift, and workdays vs. non-work days.

Conclusion

Sufficient sleep duration and perceived sleep sufficiency may be antecedents of how mindful individuals are the following day. Future analyses will test whether the daily link between sleep and mindfulness contributes to health outcomes.

Support

This work was supported, in part, by the University of South Florida College of Behavioral & Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).