bluuebunny/crossref_metadata_2025 huggingface dataset:
0862 Effect of meditation and relaxation on physiological markers of stress and sleep
Authors: Pal Amrita , Agrawal Anurag , Ghahremani Dara , Macey Paul
Published: May 2023

Introduction

Both breathing based meditation (interoceptive) and relaxation by improving blood circulation using heat and massage (exteroceptive) are known to reduce physiological stress. In this study, we determined the effect of stress-reduction on sleep. Our main population of interest was peri- and post- menopausal women who may develop sleep disorders correlated with early-life physical abuse.

Methods

20 adults (15 peri- and post-menopausal females), 13 with high risk of sleep apnea (determined by Berlin questionnaire, age mean±SEM, 54±3 years, waist-by-neck 2.6±0.07, BMI 26±1 kg/m2, Insomnia Severity Index (ISI) Scale 5.71±1.23, Generalized Anxiety (GAD-7) Score 5.33±1.22, Early Trauma Inventory Self-Report Short Form (ETISR-SF)physical 3±0.17. Dreem3 headband was used to get breathing rate (BR), sleep efficiency, sleep staging. Plethysmography was used to obtain mean and nadir oxygen saturation %, heart rate (HR), oxygen desaturation (4%) event index (ODI). BMI, age, waist/neck were recorded. Baseline sleep measures were compared against sleep after administration of 10 minutes rest, 10 minutes relaxation and 10 minutes of Ujjayi pranayama with repeats of 4 in-, 4 hold-, 6 out- breaths. ETISR-physical was correlated with all measures. Paired t-tests were conducted on sleep measures at baseline and after meditation/relaxation. One-sample t-tests were conducted on average % changes during meditation/relaxation compared to rest.

Results

Early-life physical trauma correlated positively with BR during REM sleep (Pearson R= 0.68). Deep sleep significantly (p=0.04) increased by 5% on the sleep after meditation/relaxation. Both meditation and relaxation techniques significantly (p< 0.01) lowered HR by 1.5% and 4.5%, and BR by 20% and 15% respectively during Ujjayi pranayama and relaxation. We observed significant increase (p< 0.05) in oxygen saturation with the Ujjayi pranayama by 0.3%.

Conclusion

Early-life physical abuse was correlated with faster breathing during REM sleep validating existing literature. Both HR and BR were reduced during meditation and relaxation techniques, thus validating their stress-reduction effects. % of deep sleep improved on the night when meditation/relaxation session was administered. Mind-body practices could improve deep sleep if practiced regularly even in peri- and post-menopausal women having early-life physical abuse trauma.

Support (if any)

Sleep Research Society (SRS) Small Research Grant 2022.
0863 Evaluation of sleep apnea among consecutive patients with all patterns of atrial fibrillation
Authors: Mills Eric , Cassidy Michael , Sofer Tamar , Tadros Thomas , Zei Paul , Sauer William , Romero Jorge , Martin David , Antman Elliott , Javaheri Sogol
Published: May 2023

Introduction

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and financial burden. Obstructive sleep apnea is more common in individuals with AF and may impair AF treatment efficacy including with catheter ablation. However, the prevalence of undiagnosed OSA in all-comers with AF is unknown.

Methods

This pragmatic, phase IV prospective cohort study will test 250-300 consecutive ambulatory AF patients with all patterns of atrial fibrillation (paroxysmal, persistent, and long-term persistent) and no prior sleep testing for OSA using the WatchPAT system, a home sleep test.

Results

We report the design, methodology, and results from the initial pilot enrollment of approximately 25% (N=52) of the planned sample size. The primary outcome is the prevalence of undiagnosed OSA in all-comers with AF. Additional outcomes of interest include the sensitivity and specificity of clinical screening instruments for OSA in the AF population and AF-related quality of life measurements among those with and without OSA. Results of the pilot dataset demonstrate a 77.5% prevalence of at least mild (AHI≥5) OSA or greater in all-comers with AF.

Conclusion

Based on our preliminary dataset representing one quarter of the planned total enrollment size of 250-300, there is a high prevalence of OSA in all-comers with AF.

Support (if any)

Zoll Medical
0868 Low-Fidelity Usability Testing of a Smartphone App to Treat Insomnia in Cancer Survivors
Authors: Cotter Riley , Kutana Samlau , Garland Sheila
Published: May 2023

Introduction

Cancer patients and survivors experience insomnia at a higher rate than the general population. Mobile health (mHealth) applications have considerable promise for the treatment of insomnia, but have been criticized for not following evidence-based treatment guidelines. To make insomnia treatment more accessible for survivors, iCANSleep has been developed using user-centered design principles to administer Cognitive-Behavioral Therapy for Insomnia via a smartphone app. The current research presents insights from the low-fidelity usability testing phase of development

Methods

Usability testing is an iterative process of testing an intervention’s user-interface and then applying the results to redesign the prototype to meet users’ needs. Eight cancer survivors from across Canada viewed a video demonstration of the app and completed semi-structured interviews about the app’s design and content. All interviews took place through video conferencing software and were recorded. Researchers transcribed interview responses and analyzed them for common themes.

Results

Participants (71% Female; Mage: 53) were generally very impressed with the design and layout of the app. Most (75%) participants were very interested in trying the app and reported that they would complete the app’s treatment program. Participants appreciated the integration of cancer-specific stories and material, the app’s simple, user-friendly design, the use of incentives and reinforcements, and the depth and breadth of its content. Those interviewed commented on the comprehensive sleep diary within the app and its apparent simplicity. Suggestions were made to streamline the onboarding and replace animations with real people.

Conclusion

User-centered development of the app is promising. The app’s patient-centeredness, accessibility, simplicity, and thoroughness were highlighted as strengths. The development team will integrate these results into the continued app development while working to make onboarding material more engaging. It is important to continue to engage patients throughout to ensure user engagement and effective care.

Support (if any)

Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).
0869 Non-Alcoholic Fatty Liver Disease is Associated with Worse Outcomes in Atrial Fibrillation patients with Obstructive Sleep Apnea
Authors: Aboelnasr Amr , Khokhlov Leonid , Vargas Guillermo Asmar , Thapa Usha , Eshaghabadi Mohammad Amin , Abdelhaleem Ahmed , El Labban Mohamad
Published: May 2023

Introduction

Managing atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA) is challenging and often associated with worse outcomes. Non-alcoholic fatty liver disease (NAFLD) is shown to be associated with increased cardiovascular morbidity and mortality. The effect of NAFLD on AF in patients with OSA is not well studied. This study aims to investigate this association in hospitalized patients.

Methods

We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. Outcomes were adjusted for age, gender, race, heart failure, diabetes, CKD, chronic respiratory failure, stroke and history of MI. P-value < 0.05 was statistically significant.

Results

We identified 1,843,865 hospitalizations for AF with history of OSA: NAFLD in 61,235 (3.4%). AF with OSA and NAFLD vs. no NAFLD had mean age 68.4 vs. 70.6, males 65.2% vs. 64.1%, white 78.2% vs. 80.2%, black 9.3% vs. 10.2%, obesity 45.7% vs. 46.5%, heart failure 69.2% vs. 59.6%, diabetes 59.2% vs. 51.1%, anemia 23.5% vs. 17.2%, CKD 52.4% vs. 40% and COPD 38.2% vs. 39.1%. In-hospital mortality was 11.4% in the NAFLD group vs. 2.5% in the non-NAFLD group (aOR 5.2, P< 0.001). NAFLD vs. non-NAFLD groups had GIB 9.4% vs. 4.5% (aOR 2.1, P< 0.001), cardiac arrest 3.4% vs. 0.9% (aOR 3.4, P< 0.001), cardiogenic shock 7% vs. 1.2% (aOR 4.9, P< 0.001), IMV 10.9% vs. 3.4% (aOR 3.3, P< 0.001) and LOS 7.7 vs. 5.6 (aIRR 1.27, P< 0.001).

Conclusion

Our study shows that NAFLD has worsened the outcomes of patients admitted with AF and has history of OSA. The fivefold increase in in-hospital mortality is likely related to the increase in in-hospital hemorrhagic events and cardiac arrest. Clinicians should be aware of this association. Further research is needed to mitigate the detrimental effect of liver disease on OSA and AF patients.

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0870 Non-pharmacological Sleep Interventions for Patients after Cardiac Surgery: A Systematic Review and Meta-analysis
Authors: Lee Sueyeon , Chen Pei , Zhu Bingqian , Park Chang , Balserak Bilgay
Published: May 2023

Introduction

Patients who have undergone cardiac surgery experience decreased sleep quality, which is associated with patients’ quality of life and mortality. Various interventions were conducted to improve sleep after cardiac surgery; however, findings have been inconsistent. This systematic review was conducted to examine the effects of non-pharmacological sleep interventions in patients after cardiac surgery.

Methods

The review was performed following PRISMA guidelines. CINAHL, PubMed, PsycINFO, Embase, Scopus, and Web of Science were searched. Studies were included if they were a randomized controlled trial that applied non-pharmacological sleep intervention in patients who underwent cardiac surgery and reported sleep as an outcome. Excluded studies conducted on non-open-heart surgery (e.g., percutaneous coronary intervention) or were theses, dissertations, reviews, or study protocols. Quality appraisal of included studies was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted, and mean effect size was separately calculated for studies with reverse-scored scales, which means higher scores indicate poorer sleep quality.

Results

Twenty studies (n=1,460 participants) were included. The most common cardiac surgery was coronary artery bypass graft, and sleep was mostly measured using subjective questionnaires in the studies; only 1 study applied both subjective and objective measures (Actigraphy). Sleep interventions were conducted in a hospital intensive care unit, ward, or outpatient clinic between 1 month before and 2 months after the surgery. The interventions were categorized into educational strategies, complementary medicine relaxation methods, complementary medicine sensory therapies, and the use of a device (e.g., earplugs or eye masks). The meta-analysis results showed that non-pharmacological interventions resulted in better sleep quality as compared to control group. The mean effect size was 0.66 for studies with regular scoring scales (95% confidence interval [CI], 0.38 to 0.94) and -0.83 with reverse scoring scales (95% CI, -1.23 to -0.42), which indicated that the sleep interventions were overall effective for improving sleep quality with medium-to-large effect sizes.

Conclusion

Non-pharmacological sleep interventions improved sleep quality in patients after cardiac surgery. More studies should be conducted to identify the most effective type of sleep intervention and examine the long-term effects of these interventions using objective measures of sleep.

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0871 Outcomes in Overlap Syndrome of COPD and OSA: A Secondary Data Analysis of STAGES
Authors: Clark Lindsey , Keenan Brendan , Hart Joanna , Pack Allan , Sawyer Amy
Published: May 2023

Introduction

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are highly prevalent, and termed Overlap Syndrome (OVS) when coexistent. Patient-reported outcomes (PROs) are impaired in both COPD and OSA alone, but their combined impact is unclear. We examined differences in the impact of COPD on PROs in adults with and without OSA.

Methods

Analyses included adults aged≥8 years with polysomnographic (PSG) data from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. We created sets of individuals with and without COPD, matched up to 1:5 on age±5 years, BMI±2.5 kg/m2, AHI±5 events/hour, and sex. Among all matched sets, we estimated the impact of COPD on fatigue (Fatigue Severity Scale), sleepiness (Epworth Sleepiness Scale), anxiety (Generalized Anxiety Disorder Questionnaire), depression (Personal Health Questionnaire-9), insomnia (Insomnia Severity Index), and function (Functional Outcomes of Sleep Questionnaire) using linear mixed effects models. We also examined whether the effect of COPD differed between those with (AHI≥10 events/hour) and without (AHI< 10 events/hour) OSA.

Results

Overall, 56 patients with COPD were matched to a total of 199 non-COPD controls (51.0% males). The sample was middle aged (55.8±11.8 years), overweight/obese (BMI 29.8±6.9 kg/m2), and had mild/moderate OSA (AHI 11.0±11.5 events/hour) on average; 26 (46.4%) of COPD cases had an AHI≥10. Among all patients, COPD was associated with worse PROs on average (p< 0.05 for all but ESS [p=0.070]). Among those with AHI< 10, there were no differences for any PRO between groups with and without COPD. However, COPD was associated with worse values of all PROs among those with OSA, including fatigue (mean [95% CI] difference = 9.8 [2.9, 16.7], p=0.006), sleepiness (2.8 [0.01, 5.7], p=0.050), anxiety (3.6 [1.1, 6.0], p=0.005), depression (4.4 [1.8, 7.0], p=0.001), insomnia (4.8 [2.0, 7.6], p=0.001) and function (-3.3 [-5.2, -1.5], p=0.001).

Conclusion

The effect of COPD on PROs is modified by OSA, with worse outcomes among those with OVS compared to OSA alone, but no impact of COPD among those without OSA. Identification of adults with OVS through early screening is crucial to prompt treatment of disease and reduce symptom burden.

Support (if any)

T32HL07713 P01 HL094307
0873 Physical Activity, Sleep, and Depressive Symptoms Among Cognitively Impaired Older Adults
Authors: Chung Debbie , Franco J , Cobb R , Pointek J , Seixas Azizi
Published: May 2023

Introduction

Cases of depressive symptoms are highly prevalent among older adults. Moreover, depression among older adults is strongly associated with cognitive impairment, with a prevalence of approximately 8% to 16% of aging adults (Blazer, 2003). Therefore, this study sought to investigate and examine the interplay between physical activity, insomnia, and depressive symptoms among cognitively impaired older adults without dementia using data from the Health and Retirement Study.

Methods

Depressive symptoms and insomnia levels are based on self-reports. We used a negative binomial to assess these relationships and present the incident rate ratios (IRRs) and 95% confidence intervals from our analysis of depressive symptoms associated with insomnia and moderate physical activity.

Results

We observed that insomnia (IRR: 1.18, 95% CI: 1.13-1.24) and moderate physical activity (IRR: 1.13, 95% CI: 1.07 – 1.19) are positively associated with an increase in depressive symptom levels among older adults. Model Two included an interaction term for insomnia and physical activity; results indicate that the interaction term is negative (IRR: .97 95% CI: .94 - .99). Model three tested gender to moderate the relationship between physical activity and depressive symptoms.

Conclusion

The results from the non-significant interaction term suggest that this relationship is non-significant. Similarly, the interaction term (gender x physical activity) results show that the link between physical activity and depressive symptoms did not vary by gender.

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0874 REM Sleep deterioration may modulate tinnitus
Authors: Guillard Robin , Léger Damien , Congedo Marco , Londero Alain
Published: May 2023

Introduction

Sleep quality deterioration often acts as aggravating comorbidity in a variety of chronic conditions. Tinnitus is an auditory symptom that often negatively combines with poor sleep quality, and it has been associated with sleep fragmentation and sleep apnea. Tinnitus is known to be heterogeneous and yet the relationship between tinnitus psychoacoustic characteristics and how precisely sleep is impacted has initiated limited explorative studies, notably for a particular subgroup of patients, which describes that their tinnitus perceived loudness is highly modulated by sleep.

Methods

For this observational prospective study, a sample of 29 tinnitus subjects were recruited. The study group was composed of 15 “on-off tinnitus” subjects who were reporting significant modulations of tinnitus loudness related to night sleep and naps, and a control group composed of 14 subjects that described a constant and permanent tinnitus that was not impacted by sleep. The control group was matched in age, gender and tinnitus impact on quality of life with the study group. All patients underwent a polysomnography (PSG) assessment for one complete night and were asked to fill a screening questionnaire and report tinnitus intensity before and after the PSG.

Results

The “On-off tinnitus” group subjects had less Stage 3 sleep (p< 0.01), less Rapid-Eye Movement (REM) Sleep (p< 0.05) and more Stage 2 sleep (p< 0.05) in proportion and duration compared to the control group subjects. In addition, in the “On-off tinnitus” sample, a correlation was found between REM sleep duration and tinnitus overnight modulation (p< 0.05) as well as tinnitus impact on quality of life (p< 0.05). These correlations were not present in the control group.

Conclusion

This study demonstrates that among the tinnitus population, patients presenting a tinnitus whose intensity is highly modulated by sleep have a deteriorated sleep quality, in which REM sleep may play a role in the overnight tinnitus modulation. Potential physiological explanations accounting for this observation are hypothesized and discussed.

Support (if any)

This study was supported by Felicia and Jean-Jacques Lopez-Loreta Foundation, Robin Guillard EIRL and APHP Hôtel Dieu sleep department.
0876 Sleep and Body Mass Index: The Enduring Effects of Sleep Duration and Wake After Sleep Onset in College Students
Authors: Lico Matthew , Kozak Andrea , Goldstick Jason , Pickett Scott
Published: May 2023

Introduction

College students are an at-risk population for poor sleep health and higher body mass index (BMI), which are both linked to negative health outcomes later in life. Most studies examining the relationship between sleep and BMI are cross-sectional or have collected self-reported sleep data. Therefore, the current study aimed to examine the longitudinal relationship between an objective measure of sleep assessed with a Phillips Respironics Actiwatch 2 device and BMI in college students. It was hypothesized that poorer sleep health would be related to higher BMI.

Methods

At three time points across the first two years of college (i.e., 8 months apart), participants (N=116) wore an Actiwatch 2 device for one week and had their height and weight measured. The sample demographics were 71% female, 72% White or Caucasian, and an average BMI of 24.07. Sleep health was defined by sleep duration, wake after sleep onset (WASO), sleep fragmentation, and midpoint of sleep. Each variable was scored as weekday (Sunday to Thursday) or weekend (Friday and Saturday).

Results

A linear mixed effects model using R was conducted after a person-mean variable (between person) and a person-mean centered variable (within person) were created for each participant. Weekday person-mean sleep duration was negatively related to BMI (t = -2.81), indicating shorter sleep duration was related to higher BMI across time. After controlling for between person effects, there were enduring relationships between both person-mean centered sleep duration (t = -3.12) and WASO (t = 2.06) and BMI, indicating that shorter sleep duration and greater WASO was related to higher BMI within participants across time. No significant relationships were found between weekend sleep variables and BMI.

Conclusion

The current findings add to a growing literature indicating that poor sleep health is related to increased BMI. In particular, the findings indicate that shorter sleep duration and greater WASO may increase risk for weight gain across time but are specific to weekday sleep behaviors. Although alterations in biological and behavioral processes likely serve as the mechanisms by which these variables influence BMI, additional research is needed to understand how this occurs and why weekday sleep behaviors are particularly important.

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0879 The Association Between Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review
Authors: Chehade Nabile El Hage , Fu Yuhan , Lor Dorothy , Shah Sagar , Ghoneim Sara , Issak Abdulfatah , Baroud Serge , Krishnan Sharan , Fass Ronnie
Published: May 2023

Introduction

The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) remains an area of controversy with varying hypotheses. Both disorders negatively impact health-related quality of life and lead to detrimental clinical outcomes. The aim of our study was to determine the association between OSA and GERD.

Methods

We performed a review of the literature across major databases including PubMed/MEDLINE, Embase, and Google Scholar in November 2021. Studies including patients with GERD and OSA were eligible for inclusion. The endpoints were to assess the association between OSA and GERD, the prevalence of OSA in patients with GERD or without GERD, and the prevalence of GERD in patients with or without OSA. Subgroup analyses were performed to determine whether body mass index (BMI), sex, smoking, or alcohol intake affect the degree of association. The total sleep time, sleep efficiency, and apnea hypopnea index (AHI) were compared between OSA patients with or without GERD. Results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I2 statistics

Results

6 studies involving 2950 patients with either GERD or OSA were included in the pooled analysis. Our findings suggest that there was a statistically significant association between GERD and OSA (OR=1.67, 95% CI [1.18, 2.37], P=0.004). The prevalence of GERD was higher in patients with OSA compared to those without OSA (OR=1.63, P=0.001). Conversely, there was no difference in the prevalence of OSA in patients with or without GERD (OR=1.94, P=0.11). Subgroup analysis shows that BMI, sex, smoking, and alcohol intake did not alter the association between GERD and OSA. In patients with OSA, there were no statistically significant differences in the total sleep time, sleep efficiency, and AHI between those with or without GERD. The mean differences were -5.89 minutes (P=0.19), -0.81% (P=0.67), and 0.80 (P=0.83), respectively.

Conclusion

Our results showed an increased prevalence of GERD is observed in patients with OSA but not vice-versa. However, the presence of GERD does not alter the total sleep time, sleep efficiency, and AHI in patients with OSA. BMI, sex, smoking, and alcohol intake do not seem to affect the strength of this association.

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0880 The Burden of Non-Alcoholic Fatty Liver Disease on Acute Heart Failure Admissions in Patients with Obstructive Sleep Apnea
Authors: Aboelnasr Amr , Khokhlov Leonid , Vargas Guillermo Asmar , Thapa Usha , Abdelhaleem Ahmed , Mejia Carlos , El Labban Mohamad
Published: May 2023

Introduction

Obstructive Sleep Apnea (OSA) is prevalent in heart failure and is associated with cardiovascular and all-cause mortality. The evidence is growing that Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with increased cardiovascular morbidity and mortality. There is limited scientific evidence of clinical outcomes in patients with Acute Heart Failure (AHF), OSA and NAFLD. Therefore, we sought to investigate this population.

Methods

We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AHF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was statistically significant.

Results

We identified 1,029,785 hospitalizations for AHF with history of OSA: NAFLD in 138,415 (3.7%). AHF with OSA and NAFLD vs. no NAFLD had mean age 65.8 vs. 67.9, males 62.2% vs. 59.2%, Caucasian race 71.6% vs. 68.7%, obesity 50.8%, 55.6%, atrial fibrillation 53.6% vs. 50.5%, diabetes 61.3% vs. 60.4%, anemia 24.8% vs. 20.3%, CKD 56.9% vs. 51.7 and COPD 42.7% vs. 48%. In-hospital mortality was 11.9% in the NAFLD group vs. 2.6% in the non-NAFLD group (aOR 5.2, P< 0.001). AHF and OSA with NAFLD vs. non-NAFLD groups had GIB 6.4% vs. 2.8% (aOR 2.4, P< 0.001), cardiac arrest 4% vs. 1.1% (aOR 3.7, P< 0.001), cardiogenic shock 13.1% vs. 2.6% (aOR 5.2, P< 0.001), IMV 13.2% vs. 5% (aOR 2.9, P< 0.001) and LOS 9.1 vs. 6.6 days (aIRR 1.3, P< 0.001).

Conclusion

In patients with OSA admitted for AHF, NAFLD is independently associated with five times higher odds of in-hospital mortality. It's also associated with a significantly higher incidence of cardiac arrest, cardiogenic shock, IMV and increased hospital LOS. The NAFLD group patients were younger, less obese, with more anemia and CKD. The chronic inflammatory process and humoral dysregulation associated with OSA and NAFLD would induce worsening outcomes of AHF hospitalization. Further research is needed on the impact of OSA optimization in patients with heart failure and NAFLD.

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0881 The Clinical and Policy Impact of Increasing Awareness about Sleep and CVD Health through Public health Programs for Women
Authors: Taylor Kayla , Campos Catherine , Estevez Daniella , Goodman Mackenzie , Kimble Rachel , Sur Nicole , Jean-Louis Girardin , Seixas Azizi
Published: May 2023

Introduction

Sleep is important for cardiometabolic health (CVH) and cardiovascular disease (CVD) prevention, especially for women. Relative to men, women have less awareness of CVD risk factors. Particularly, minority women have disproportionately higher prevalence of short sleep and CVD risk awareness. The primary objective of this review is to investigate the clinical, public health, and policy implications of three major public health programs: the Go Red for Women campaign, the Heart Centers for Women initiative, and the HEART for Women Act, on increasing CVD and sleep health awareness among women in the United States. The secondary objective is to create public health action plan to increase awareness of sleep health and CVD risk. The third objective is to describe barriers and facilitators of implementing the public health action plan for minority women.

Methods

To assess the impact of these interventions, a systematic review was conducted. Studies that directly examined the impact of the 3 CVD awareness programs on the prevalence of CVD in the U.S. Next, studies that evaluated the level of awareness of CVD risk factors and sleep were identified. The current literature was synthesized and described qualitatively to elucidate individual, provider, community and policy knowledge gaps in CVD and sleep health programs for women.

Results

Prevalence of CVD deaths among women decreased from 459,000/ year in 2004 to 339,500/year in 2015. Majority of these interventions include diet, exercise, and smoking cessation and exclude sleep and. Of the three programs, the Go Red for Women campaign proved to have the greatest public health and policy impact. From the results of systematic review, we created a public health action plan to increase awareness of sleep health and CVD risk. Third, we found patient, provider, and policy barriers and facilitators of implementing the public health action plan for minority women.

Conclusion

Public health action plans that focus on sleep health should be culturally sensitive to all women and accessible to those that live in both rural and urban areas addressing the importance of sufficient sleep and its benefits to CVH.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
0882 The Longitudinal Relationship between Objective Sleep and Cardiovascular Parameters During Pregnancy
Authors: Guo Yuqing , Xu Qi , Kehoe Priscilla , Qu Annie
Published: May 2023

Introduction

Growing evidence shows the important role of sleep on cardiovascular health in pregnant women with nearly 50% self-reporting poor sleep quality and 30% insufficient sleep. These sleep disturbances have been associated with adverse perinatal outcomes (e.g., hypertension, preterm births). Many studies have only used self-reported questionnaires during pregnancy. However, a few studies have utilized sleep labs and found that subjective and objective assessments of sleep varied from poor to low associations. The aim of this study was to examine the longitudinal relationship between objective sleep and cardiovascular parameters in pregnant women.

Methods

Seventeen healthy pregnant women with 88% self-identifying as Hispanic were consented to participate in the longitudinal observation study. Their average age was 27.8 years (SD=4.48). A validated Oura ring was used to daily monitor objective sleep and cardiovascular parameters across the pregnancy, including resting heart rate (HR), heart rate variability (HRV) indicated by RMSSD (root mean square of successive differences) of interbeat intervals, deep, light, and Rapid EYE Movement (REM) sleep, awake time and sleep onset latency. Mixed effects models were conducted to analyze daily changing patterns of these parameters using R-4.2.0 for Mac.

Results

Over the pregnancy, when deep and light sleep increased by 1 hour, heart rate decreased by 5.55 bpm (p< 0.001) and 1.32 bpm (p = 0.01), respectively; when REM sleep increased by 1 hour, heart rate increased by 2.15 bpm (p =0.049). Conversely, when deep and light sleep increased by 1 hour, RMSSD increased by 10.32 ms (p< 0.001) and 2.93 ms (p< 0.02), respectively; when REM sleep increased by 1 hour, RMSSD decreased by 7.27 ms (p=0.001). There were no significant associations between HR/RMSSD and awake time/sleep onset latency.

Conclusion

This study appears to be the first to investigate the longitudinal relationship between sleep and cardiovascular parameters among primarily Hispanic pregnant women in the U.S. in a non-lab setting. Our study provides preliminary evidence that longer deep/light sleep and shorter REM sleep may improve cardiovascular health among pregnant women.

Support (if any)

National Science Foundation grants including the Smart and Connected Communities (CNS: 1831918) and Collaborative Research: Integrative Heterogeneous Learning for Intensive Complex Longitudinal Data (DMS: 2210640).
0889 Isolated Rapid Eye Movement Sleep Behavior Disorder: Differences Between Sexes at Presentation
Authors: Alexandres Christina , McCarter Stuart , Tabatabai Grace , LeClair-Visonneau Laurene , Feemster John , Gossard Thomas , Jagielski Jack , Strainis Emma , St. Louis Erik
Published: May 2023

Introduction

Most older adults with isolated REM sleep behavior disorder (iRBD) are men, yet in younger adults there is greater parity between the sexes. Whether the clinical characteristics between women and men with iRBD may differ remains unclear. We aimed to analyze presenting clinical and demographic characteristics of iRBD in men and women.

Methods

We identified 130 women and 130 men with PSG confirmed iRBD who were matched for time of polysomnographic diagnosis, abstracted their clinical histories, and comparatively analyzed clinical characteristics between the sexes.

Results

RBD symptom onset average age (50.4 ± 20.0 vs. 55.4 ±16.9 years, p=0.03) and age at diagnosis (56.4 ±16.7 vs. 62.5 ± 13.3 years, p< 0.01) were younger in women than in men. Injury frequency was similar between groups. Antidepressant use prior to diagnosis (80.8% vs 53.0%, p< 0.01), psychiatric comorbidity (79.8% vs. 50.8%, p< 0.01) and chronic pain syndrome (39.2% vs. 17.4%, p< 0.01) diagnoses were more frequent in women than men. Insomnia (31.5% vs. 18.2%, p= 0.01), hypersomnoence (50.8% vs 37.9%, p=0.04) and overlap parasomnia disorder (13.8% vs 9.8%, p=0.06) were more frequent in women than men, while sleep apnea (43.1% vs. 70.5%, p < 0.01.) and vascular co-morbidity (62.3% vs 83.3%, p< 0.01) occurred more frequently in men than women. Autoimmunity was similar between sexes.

Conclusion

Women were younger when diagnosed, and had more frequent psychiatric diagnoses and antidepressant use, with different comorbid sleep disturbances and comorbidities than men with iRBD. Key sex differences in iRBD could imply different etiologies and aid accurate and timely diagnosis.

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0890 Multiple Sleep Measures and Cognition by Race/Ethnicity and Age
Authors: Alhasan Dana , Gaston Symielle , Whitehurst Lauren , Spira Adam , Sandler Dale , Jackson Chandra
Published: May 2023

Introduction

Disturbed sleep may affect cognition directly (e.g., through sleep fragmentation) and indirectly through effects on related health outcomes (e.g., cardiovascular health). However, investigations of sleep and cognition among diverse racial/ethnic samples and women are sparse.

Methods

We analyzed longitudinal associations among 50,000 Sister Study participants (enrollment: 2003-2009) who reported on short (< 7 hours) and long sleep duration (>9 hours), sleep debt (≥2-hour difference between longest and shortest sleep duration during the week), frequent napping (≥3 times/week), and insomnia symptoms. Participants completed an eight-item Dementia Screening Interview during two follow-up periods (2012-2014; 2017-2019). Poor cognition was quantified as a change in cognitive function indicative of impairment in ≥2 items. Adjusting for sociodemographic and health behavior characteristics, we used log-binomial regression to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between sleep dimensions and cognition, by race/ethnicity and age.

Results

Mean age was 55±8.9 years, 83% self-identified as Non-Hispanic [NH]-White, 9% NH-Black, and 5% Hispanic/Latina. Compared to NH-White women, NH-Black and Hispanic/Latina women reported higher prevalence of all poor sleep dimensions but lower prevalence of poor cognition. Participants with short and long sleep duration, sleep dept, napping, and insomnia symptoms had a higher prevalence of poor cognition (RR=1.09 [95% CI: 1.03-1.16]; RR=1.19 [1.06-1.35]; RR=1.18 [1.11-1.25]; RR=1.27 [1.18-1.39]; RR=1.33 [1.26-1.41], respectively). Estimates for short sleep with poor cognition were higher among minoritized racial/ethnic groups (RRNH-Black=1.15 [0.91-1.45]; RRHispanic/Latina=1.48 [1.09-2.03]; RRNH-White=1.08 [1.01-1.15]), although interactions terms were not statistically significant (p-value= 0.37 and 0.07, respectively). Patterns were similar for insomnia. Sleep debt and insomnia symptoms estimates with poor cognition were higher among younger than older groups (sleep debt: RRAge 26-55 years=1.20 [1.11-1.31]; RRAge 56-76 years =1.14 [1.05-1.25]; insomnia: RRAge 26-55 years=1.39 [1.27-1.51]; RRAge 56-76 years =1.27 [1.18-1.38]). Interaction terms were non-significant (p-value= 0.96 and 0.26, respectively).

Conclusion

Poor sleep health was associated with poorer cognition, and associations may be stronger among minoritized and younger women. Future studies using a life course perspective among large, more diverse populations can elucidate how early-life and later-life factors (e.g., psychosocial experiences; environmental conditions) accumulate to impact sleep health and contribute to differential cognitive risk in adulthood.

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0891 Sex-Specific Differences in Polysomnographic Biomarkers of Sleep Disruption and Sleep Disordered Breathing in Migraine
Authors: Carter Isabelle , Wang Lu , Saab Carl , Gruenthal Eric , Mehra Reena
Published: May 2023

Introduction

The importance of sex as a biological variable on the relationship of migraine and sleep disturbance has not been well-characterized. Given evidence of 1)bidirectional relationships of poor sleep and migraine severity and 2)greater activation of brain regions involved in emotional processing in women compared to men with migraine, we hypothesized that sleep architectural disruption may contribute to sex-specific differences in quality of life measures, particularly those attributed to emotional processing.

Methods

This was a retrospective cohort study of migraine patients aged >18 years seen in the Cleveland Clinic headache program with polysomnogram data. Migraine burden was measured by the 20-item migraine-specific quality of life(MSQOL) encompassing three domains: emotional function(EF), role function-preventative, and role function-restrictive. Linear regression models were used to assess the association of each MSQOL domain with sleep architectural measures and the statistical interaction with sex was examined. Coefficients and 95% confidence intervals were estimated and compared with adjustment of age, race, body mass index(BMI) and comorbidities.

Results

Of 245 patients with migraine,37(15.1%) were male. Males had higher AHI (10.0 [5.3, 18.5] vs. 5.7[1.8, 11.4], p=0.006). The difference in MSQOL-EF scores was not statistically significant (males:73.3[53.3,86.7] vs. females:60.0 [33.3,80.0], p= 0.066). There was no statistical difference in percent N2 or REM between sexes, though males had greater %N1, and lower %N3 (10.9[5.9,19.2] vs. 6.6[4.1,11.9],p=0.039). The association of MSQOL-EF with percent of N2 and REM sleep differed by sex. For each 5% increase in N2, there was a 5% reduction of MSQOL-EF 2.08 (-2.08, 95%CI [-6.86,2.70],p=0.39) in females compared to a 6.84 reduction in males (-6.84, 95%CI [-15.9,2.22],p=0.14), p-value for interaction=0.044. For each 5% increase in REM, MSQOL-EF increased 1.26 (1.26, 95%CI [-3.68,6.21],p=0.61) in females, and increased by 6.27 in males (6.27, 95%CI [-3.11,15.6], p=0.19),p-value for interaction=0.044.

Conclusion

Although males had greater sleep disruption compared to females, there was no significant difference in MSQOL-EF scores. However, sex-specific differences of extent of sleep stage composition and MSQOL-EF were observed suggesting influence of sleep architectural alterations on greater responsivity of migraine emotional processing in men versus women. Future investigation should better characterize longitudinal relationships and underlying neurobiological mechanisms underlying these findings.

Support (if any)

Association of Migraine Disorders
0892 Insomnia and poor sleep efficiency predict cognitive decline among non-demented elderly: findings from the Cretan Aging Cohort
Authors: Basta Maria , Skourti Eleni , Alexopoulou Christina , Ganiaris Andronikos , Aligizaki Marina , Zampetakis Alexandros , Zaganas Ioannis , Simos Panagiotis , Vgontzas Alexandros
Published: May 2023

Introduction

Previous cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the longitudinal associations between sleep quality/quantity with cognitive progression in non-demented community-dwelling elderly.

Methods

A sub-sample of 105 participants (77.5% females) from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years; baseline) were followed up 8 years later (follow-up). All participants underwent neuropsychiatric/neuropsychological evaluation on both phases. At baseline, subjective sleep complaints and objective sleep variables based on 3-day 24 hour actigraphy were assessed. The impact of baseline objective sleep characteristics and/or insomnia (as defined by at least two subjective sleep complaints) on cognitive progression was assessed with univariate and multivariate models controlling for confounders.

Results

At baseline 50 participants were diagnosed as CNI and 55 as MCI; at follow-up 60 participants (57.1%) displayed clinically significant cognitive deterioration while the remaining showed relatively stable cognitive status. The frequency of persons reporting insomnia symptoms at baseline was higher among those who displayed cognitive deterioration (31.7%) than those in the cognitively stable group (13.3%, p=0.037). Logistic regression analysis showed that participants with insomnia symptoms at baseline, were significantly more likely to deteriorate cognitively at follow-up (p=0.05, OR=2.90). Also, among objective sleep variables added to the model, it was poor sleep efficiency that was associated with cognitive deterioration (p=0.035, OR=3.48).

Conclusion

More than half of the participants displayed significant cognitive deterioration over 8 years and this decline was predicted by insomnia symptoms and objective poor sleep efficiency at baseline. Improving both quality and quantity of sleep may significantly delay the deterioration of cognitive function in non-demented community-dwelling elderly.

Support (if any)

National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397
0894 Impulsivity across early stages of synucleinopathy: from high-risk relatives, REM sleep behavior disorder to Parkinson’s disease
Authors: Zhou Li , Liu Yaping , Chau Steven Wai Ho , Huang Bei , Wang Jing , Chan Joey , Zhang Jihui , Yu Mandy W M , Tsang Jessie C C , Li Shirley Xin , Mok Vincent C T , Wing Yun Kwok
Published: May 2023

Introduction

Increased impulsivity is a common neuropsychiatric feature in patients with Parkinson’s disease (PD), especially attributed to the use of dopaminergic medications. Interestingly, emerging evidence suggested that impulsivity had changed in drug-naïve PD patients. However, it remains unclear whether impulsivity has been altered in prodromal stage of PD, namely isolated rapid eye movement sleep behavior disorder (iRBD) and their high-risk relatives.

Methods

This was a cross-sectional study with four groups of subjects, including early drug-naive PD patients, patients with iRBD and their first-degree relatives (iRBD-FDRs, a high-risk group with potential prodromal RBD features), and controls. A panel of neuropsychological computerized tasks, including go/no-go task, four-choice serial reaction time task (4CSRTT), beads task, balloon analogue risk task (BART) and delay/effort discounting task, would measure various dimensions of motor and decisional impulsivity.

Results

A total of 331 subjects were recruited, including 27 early drug-naïve PD patients (mean age ± SD: 70.1 ± 5.8 years, 77.8% man), 152 iRBD patients (67.2 ± 6.6 years, 77.6% man), 68 iRBD-FDRs (63.2 ± 6.4 years, 51.5% man), and 84 controls (67.4 ± 8.1years, 61.9% man). Early drug-naïve PD and iRBD patients had fewer numbers of extracted beads in beads task 1 (P< 0.001) and task 2 (P< 0.001) in making decisions and fewer numbers of pumps of unexploded blue balloons in BART (P< 0.001) than controls and iRBD-FDRs, suggesting a higher level of reflection impulsivity and a lower level of risk taking, respectively. In addition, early drug-naïve PD and iRBD patients had more no-go errors in go/no-go task (P=0.023), suggesting a marginally lower level of response inhibition in PD and iRBD groups. Early drug-naïve PD and iRBD patients had more premature responses in 4CSRTT than iRBD-FDRs (P=0.008). The delay and effort discounting indexes were comparable among four groups.

Conclusion

While risk taking and response inhibition decreased, reflection impulsivity actually increased in iRBD and drug-naïve PD patients. These novel findings indicated that a complex construct of altered impulsivity has already occurred at the earlier stage (at iRBD) of α-synucleinopathy, which will have implications for pathophysiology and clinical management.

Support (if any)

This study has been supported by the General Research Fund (14116119).
0895 Pharmacokinetics of pitolisant in breast milk and serum of healthy lactating women
Authors: Schmith Virginia , Bhise Neha , Dayno Jeffrey , Bauer Eric , Roy Michele , Budur Kumar , Brimhall Darin
Published: May 2023

Introduction

Pitolisant is a potent and highly selective histamine-3-receptor antagonist/inverse agonist approved for the treatment of excessive daytime sleepiness or cataplexy in adult patients with narcolepsy. A phase 4, open-label study was conducted to evaluate the pharmacokinetics (PK) of pitolisant and its major metabolite, BP1.3484, in breast milk and serum following a single dose of pitolisant administered to healthy lactating women.

Methods

In this study, eight healthy lactating women (aged 22-42 years) who met eligibility criteria were enrolled and received a single oral dose of pitolisant (35.6 mg). Serial breast milk samples were collected at pre-dose on Day 1 and at various intervals through 24 hours post-dose. Serial blood samples for PK analyses were collected at pre-dose and through 120 hours post-dose. Since the total infant dosage calculated from single dose data may be under-estimated, steady-state serum concentrations were predicted using noncompartmental methods and then multiplied by the 24-hour breast milk:serum ratio (AUCBM/S) to estimate a more appropriate total infant dose.

Results

Pitolisant was excreted in breast milk, with mean CmaxBM/S and AUCBM/S ratios of 85.2% and 123%, respectively. Concentrations of pitolisant in breast milk were only slightly lower than concentrations in serum. However, since the volume of breast milk was low, the percentage of the maternal dose expressed in breast milk was very low. Steady state calculations for a 6-month-old infant resulted in a mean total infant dosage of 0.005 mg/kg/day (SD 0.002), which is 1.15% of the maternal dose. For BP1.3484, maternal exposure and the calculated mean daily infant exposure were much lower than pitolisant. All subjects completed the study as planned. Five subjects (62.5%) reported a total of 8 treatment-emergent adverse events, which were mild in severity and resolved by end of the study.

Conclusion

Pitolisant is present in human milk, but the mean daily infant dosage in a 6-month-old infant after steady-state dosing of pitolisant in healthy lactating women was estimated to be very low. Overall, a single oral dose of pitolisant 35.6 mg was well-tolerated in healthy lactating women.

Support (if any)

The study was sponsored by Harmony Biosciences LLC.