bluuebunny/crossref_metadata_2025 huggingface dataset:
1117 Associations Between Health Behaviors And Sleep Duration In Women With Depression
Authors: Peprah R , Jenkins D , Donley T , Sexias A , Jean-Louis G
Published: May 2020

Introduction

Sleep duration can have important effects on health. Long and short sleep has been associated with negative health outcomes in women. Depression may aggravate an already impaired sleep quality. This study explored associations between sleep duration and depression in pregnant women.

Methods

We analyzed data for adult women (n=9,372) from the 2017 and 2018 National Health Interview Survey (NHIS), which is a nationally representative study of the US civilian non-institutionalized population. Sleep was categorized by short (≤6 hrs), normal/healthy (7-8 hrs), and long (≥9 hrs) sleep. Using STATA 15.0 for Windows, we report weighted frequencies and Chi-and square tests. Alpha of 0.05 was used for all significance levels.

Results

Of the sample, 81.7% of the women were White, 10.6% were Black and 7.7% were other minorities. The mean age was 51.4±18.3. We found that the proportion of women who reported short sleep increased with age (p<0.000). Current drinkers (37%) had higher numbers of normal sleep than those who were former drinkers or abstainers (p<0.000). With respect to BMI, more obese women were short and sleepers (17% and 4% respectively), but women with normal BMI (19%) were normal sleepers (p<0.000). In short sleepers, more women had trouble falling asleep (13%) and staying asleep (17%), but reported not using medication and never feeling rested. Similar results were found for long sleepers. Higher proportions of normal sleepers reported not have trouble falling asleep (27%), staying asleep (26%), or using medication for sleep (40%) (p<0.000). However, of those who reported normal sleep, greater frequencies of working up feeling rested occurred only 3-6 times in the past week (p<0.000).

Conclusion

In this study, women with depression self-reported more normal sleep duration. This finding is inconsistent with previous research. Whether this association is causal and what pathways explain this association is unknown.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, K01HL135452, and K07AG052685.
1140 Sleep Disturbances, Lifestyle, And Self-Management In Adults With Subarachnoid Hemorrhage
Authors: Byun E , McCurry S , Kwon S , Kim B , Thompson H
Published: May 2020

Introduction

Subarachnoid hemorrhage (SAH) survivors often suffer sleep disturbances. Self-management strategies focusing on lifestyle changes and health-promoting behaviors may improve sleep in SAH survivors. Few studies have examined sleep in SAH survivors, and little is known about sleep management practices used to improve their sleep. The purposes of this study were to: 1) describe the prevalence of sleep disturbances using subjective and objective sleep measures, and 2) explore interest in and engagement with self-management practices to promote sleep health in SAH survivors.

Methods

We conducted a cross-sectional study with a convenience sample of 30 SAH survivors recruited from a university hospital. We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness using the Epworth Sleepiness Scale (ESS), and objective sleep using wrist actigraphy. We conducted content analysis of semi-structured interviews, with two authors each coding sleep disturbances and self-management practices addressing sleep.

Results

Seventy-three percent of SAH survivors reported poor sleep quality (PSQI > 5) and 27% had daytime sleepiness (ESS > 10). Actigraphy analysis indicated that 41% of SAH survivors slept less than 7 hours or more than 9 hours. Interview content analyses suggested 3 themes and 15 sub-categories: 1) Sleep disturbances (difficulties in falling asleep, wake after sleep onset, daytime sleepiness, too much or insufficient sleep, and poor sleep quality), 2) Sleep management practices (exercise, regular sleep schedule, relaxation, keeping busy and staying active, changing beverage intake, taking supplements, taking medication, recharging energy, and barriers to sleep management), and 3) Healthcare providers (discussing sleep problems with health care providers).

Conclusion

Sleep disturbances are highly prevalent and an urgent need exists to focus on improving sleep in SAH survivors. Developing tailored interventions that incorporate self-management and lifestyle change would be a critical next step to improve sleep and promote health in this at-risk population.

Support

This research was supported by grants from the National Institutes of Health/National Institute of Nursing Research (K23 NR017404), University of Washington Institute of Translational Health Science Translational Research Scholars Program (UL1 TR000423), and University of Washington School of Nursing Research and Intramural Funding Program.
1142 Comprehensive Phenotyping Of Ambulatory Sleep Patterns In Multiple Sclerosis
Authors: Braley T J , Kratz A L , Whibley D , Goldstein C
Published: May 2020

Introduction

The majority of sleep research in persons with multiple sclerosis (PwMS) has been siloed, restricted to evaluation of one or a few sleep measures in isolation. To fully characterize the impact of sleep disturbances in MS, multifaceted phenotyping of sleep is required. The objective of this study was to more comprehensively quantify sleep in PwMS, using a recently developed multi-domain framework of duration, continuity, regularity, sleepiness/alertness, and quality.

Methods

Data were derived from a parent study that examined associations between actigraphy and polysomnography-based measures of sleep and cognitive function in MS. Actigraphy was recorded in n=55 PwMS for 7-12 days (Actiwatch2®, Philips Respironics). Sleep metrics included: duration=mean total sleep time (TST, minutes); continuity=mean wake time after sleep onset (minutes), and regularity=stddev wake-up time (hours). ‘Extreme’ values for continuity/regularity were defined as the most extreme third of the distributions. ‘Extreme’ TST values were defined as the lowest or highest sixth of the distributions. Sleepiness (Epworth Sleepiness Scale score) and sleep quality [Pittsburgh Sleep Quality Index (PSQI) sleep quality item] were dichotomized by accepted cutoffs (>10 and >1, respectively).

Results

Sleep was recorded for a mean of 8.2 days (stddev=0.95). Median (1st, 3rd quartile) values were as follows: duration 459.79 (430.75, 490.60), continuity 37.00 (23.44, 52.57), regularity 1.02 (0.75, 1.32), sleepiness/alertness 8 (4, 12), and sleep quality 1.00 (1.00, 2.00). Extreme values based on data distributions were: short sleep <=426.25 minutes (18%), long sleep >515.5 minutes (16%), poor sleep continuity ≥45 minutes (33%), and poor sleep regularity ≥1.17 hours (33%). Sleepiness and poor sleep quality were present in 36% and 40% respectively. For comparison, in a historical cohort of non-MS patients, the extreme third of sleep regularity was a stddev of 0.75 hours, 13% had ESS of >10, and 16% had poor sleep quality.

Conclusion

In this study of ambulatory sleep patterns in PwMS, we found greater irregularity of sleep-wake timing, and higher prevalence of sleepiness and poor sleep quality than published normative data. Efforts should be made to include these measures in the assessment of sleep-related contributions to MS outcomes.

Support

The authors received no external support for this work.
1163 Nickel, Dime or Dollar: Breaking Down Broken Notions of Cost in Sleep Diagnostics
Authors: Jambulingam N , Stretch R , Butz D , Zeidler M
Published: May 2020

Introduction

Home sleep apnea tests (HSATs) are convenient alternatives to in-lab polysomnograms (PSGs) but high non-diagnostic rates limit their utility. A clinical decision support tool (CDST) to triage patients to HSAT versus PSG was developed at the Greater Los Angeles VA Healthcare System (GLA-VAHS). It uses a random forest ensemble to reduce non-diagnostic HSAT rates by 46%. While prior studies have found PSGs to be more profitable than HSATs on a per unit basis, these analyses do not factor in relative profitability over time. Additionally, no prior studies have quantified the financial impact of a CDST in diagnostic sleep testing.

Methods

We performed an analysis of the overall profitability of HSATs and PSGs in 2018-2019 within GLA-VAHS which has 6 PSG beds. Revenue was calculated using 2019 Medicare reimbursement rates. Contribution margin (CM) analysis was used to factor out the high fixed costs of healthcare infrastructure, instead focusing on variable direct costs (VDCs). CM analysis is especially useful when calculated on a per diem basis instead of per study, adjusting for number of tests performed in a given day. CM was calculated by subtracting VDCs from revenue under two simulated conditions: with and without the CDST.

Results

PSGs were 2.5 times more profitable than HSATs on a per unit basis (CM $200/study vs. $81/study). However, on a per day basis, PSGs were only 1.4 times more profitable than HSATs at average nightly occupancy rates of 75% (CM $902/day vs. $646/day). Using the CDST to guide testing, 2.2 times more diagnostic HSATs could be performed per day. As a result, HSATs were 1.3 times more profitable than PSGs on a per day basis with CDST use (CM $1,211/day vs. $902/day).

Conclusion

This analysis demonstrates that implementing a CDST and maximizing utilization of HSATs allow hospitals to better allocate limited sleep lab resources, increase diagnostic throughput and generate higher profits. Analyzing costs using contribution margin avoids erroneous assumptions about profitability and leads to better-informed administrative decisions regarding sleep lab expansion.

Support
1174 Assessing Sleep Disorders in Primary Care: A Provider Survey About the Importance of Sleep Health
Authors: Klingman K J , Morse A , Williams N , Grandner M A , Perlis M L
Published: May 2020

Introduction

Conditions commonly managed by primary care providers (PCPs) such as depression, diabetes, and heart disease, commonly co-occur with sleep disorders. If PCPs could readily identify comorbid sleep disorders in this context, it may provide a pathway to more effective management of both types of disorders. Currently, it is unknown what might encourage or discourage PCPs from routinely screening their patients for sleep disorders.

Methods

PCPs from UPENN and GHS completed surveys regarding sleep health. The 30-item instrument comprised demographic, 14 VAS (0%-100%=strongly disagree-strongly agree), 4 open-ended, 3 yes/no, and 2 multiple-choice questions.

Results

Ninety-nine PCPs responded and were predominately female (61% F, 37%M, 2% other), Caucasian (81%), on-average 45yrs old (25-70) and in primary care for 16yrs (1-43). Fifty-six percent were MDs, 21%DOs, 17%PAs, and 6%NPs. PCPs rated sleep disorders as highly important for cardiopulmonary, mental, and general health (85, 84, & 83%), with no difference (per linear regression, p>0.05) according to system or provider characteristics. PCPs reported high importance for knowing about and diagnosing sleep disorders (88% & 82%) within their practices. Lower comfort levels were reported for discussing (78%) sleep disorders, overseeing/following (62%), diagnosing (60%), or treating (48%) patients. Eighty percent of PCPs stated an efficient sleep disorders screener would be useful for their practice; this perception varied (per logistic regression) according to provider credentials (Wald=0.037) and Hispanic/Latino ethnicity (Wald=0.025). PCPs reported time constraints limit their responsiveness to sleep disorders

Conclusion

A large disparity exists between the importance PCPs place on sleep disorders and their low comfort levels with following, diagnosing, and treating sleep disorders. PCPs endorsed the need to have available an efficient sleep disorders screener to use in their practice.

Support

No funding was received for this study.
1177 Cost Effectiveness Of Diagnostic Approaches To Sleep Apnea Evaluation During Inpatient Rehabilitation For Moderate To Severe TBI
Authors: Nakase-Richardson R , Dismuke-Greer C , Jeanne H , Drashser-Phillips L , Schwartz D , Calero K , Bogner J , Whyte J , Almeida E , Ketchum J , Magalang U
Published: May 2020

Introduction

Recent work has highlighted prevalent obstructive sleep apnea (OSA) after traumatic brain injury (TBI) when patients are vulnerable to disruption of neural repair. The recently completed clinical trial comparing screening and diagnostic tools for OSA during inpatient rehabilitation provided the opportunity to conduct economic modeling of phased approaches using actual trial findings to address one perspective (the payor) on the value of phased testing.

Methods

A cost-effectiveness analysis of four phased approaches to OSA diagnosis including initial utilization of portable sleep monitoring [HSAT] regardless of pre-test probability, determination of pre-test probability using two prediction models [STOPBANG, MAPI], and initial assessment using Level 1 polysomnography was conducted. The analyses were modeled assuming all participants were considered high risk thus a negative screen or portable diagnostic test would result in a participant being referred for Level 1 polysomnography. The cost aversion used in analyses were derived from a recent white paper on the economic modeling of untreated OSA. Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5).

Results

At AHI ≥15 (33.6%), the prediction models (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and effectiveness relative to the HSAT approach (-$5,210) and initial use of Level 1 PSG (-$5,011). Sensitivity analyses at AHI ≥5 (70.1%) revealed the initial use of HSAT (-$6,322.85) relative to the prediction models (MAPI [-$6,249.71], STOPBANG [-$6,237) and initial assessment with Level 1 PSG (-$5,977) resulted in greater savings and cost effectiveness.

Conclusion

The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-effective approach varying by incidence of OSA.

Support

PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
1201 Performance Evaluation Of A Novel Contactless Breathing Monitor And Machine Learning Algorithm For Sleep Stage Classification In A Healthy Population
Authors: Lauteslager T , Kampakis S , Williams A J , Maslik M , Siddiqui F
Published: May 2020

Introduction

Although polysomnography (PSG) remains the gold standard for sleep assessment in a lab setting, non-EEG signals such as respiration and motion are directly affected by sleep stages and can be used for sleep stage prediction. Importantly, these signals can be obtained in a low-cost and unobtrusive manner, allowing for large scale and longitudinal data collection in a home environment. The Circadia C100 System (FDA 510(k) clearance expected Q1 2020) is a novel ‘nearable’ device that uses radar for contactless monitoring of respiration and motion. The current study aims to validate the performance of the associated sleep analysis algorithm.

Methods

A total of 41 nights of sleep data were recorded from 33 healthy participants using the device, alongside PSG. Data were recorded both in a sleep lab and home environment. PSG data were scored by RPSGT-certified technicians. Respiration and movement features were extracted, and machine learning algorithms were developed to perform sleep stage classification and predict sleep metrics. Algorithms were trained and validated on PSG data using cross-validation.

Results

An epoch-by-epoch true positive rate of 56.2%, 79.4%, 55.5% and 72.6% was found for ‘Wake’, ‘REM’, ‘Light’ and ‘Deep’ respectively. No statistical differences in performance were found between home-recorded and lab-recorded contactless data. Mean absolute error of total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE) was 13.2 minutes, 11.3 minutes and 3%, respectively. The contactless monitor was found to outperform both medical grade and clinical grade actigraphy based devices: The Philips Actiwatch Spectrum Plus and the Fitbit Alta HR.

Conclusion

Current results are encouraging and suggest that the contactless monitor could be used for long-term sleep assessment and continuous evaluation of sleep therapy outcomes. Further clinical validation work is ongoing in subjects diagnosed with sleep disorders such as obstructive sleep apnea.

Support

-
1204 Analyzing User Journey Data In Digital Health: Predicting Dropout From A Digital CBT-I Intervention
Authors: Bremer V , Chow P , Funk B , Thorndike F , Ritterband L
Published: May 2020

Introduction

Intervention dropout is an important factor for the evaluation and implementation of digital therapeutics, including in insomnia. Large amounts of individualized data (logins, questionnaires, EMA data) in these interventions can combine to create user journeys - the data generated by the path an individual takes to navigate the digital therapeutic. User journeys can provide insight about how likely users are to drop out of an intervention on an individual level and lead to increased prediction performance. Thus, the goal of this study is to provide a step-by-step guide for the analysis of user journeys and utilize this guide to predict intervention dropout, illustrated with an example from a data in a RCT of digital therapeutic for chronic insomnia, for which outcomes have previously been published.

Methods

Analysis of user journeys includes data transformation, feature engineering, and statistical model analysis, using machine learning techniques. A framework is established to leverage user journeys to predict various behaviors. For this study, the framework was applied to predict dropouts of 151 participants from a fully automated web-based program (SHUTi) that delivered cognitive behavioral therapy for insomnia. For this task, support vector machines, logistic regression with regularization, and boosted decision trees were applied at different points in 9-week intervention. These techniques were evaluated based on their predictive performance.

Results

After model evaluation, a decision tree ensemble achieved AUC values ranging between 0.6-0.9 based on application of machine earning techniques. Various handcrafted and theory-driven features (e.g., time to complete certain intervention steps, time to get out of bed after arising, and days since last system interaction contributed to prediction performance.

Conclusion

Results indicate that utilizing a user journey framework and analysis can predict intervention dropout. Further, handcrafted theory-driven features can increase prediction performance. This prediction of dropout could lead to an enhanced clinical decision-making in digital therapeutics.

Support

The original study evaluating the efficacy of this intervention has been reported elsewhere and was funded by grant R01 MH86758 from the National Institute of Mental Health.
1208 Sleep Stage Prediction And Sleep Disordered Breathing Detection Using Raw Actigraphy And Photoplethysmography From Wearable Consumer Device
Authors: Olsen M , Sorensen H , Jennum P , Mignot E
Published: May 2020

Introduction

Wearable, multisensory consumer devices that estimate sleep are prevalent and hold great potential. Most validated actigraphic prediction studies of sleep stages (SS) have only used low resolution (30 sec) data and the Cole-Kripke algorithm. Other algorithms are often proprietary and not accessible or validated. We present an automatic, data-driven deep learning algorithm that process raw actigraphy (ACC) and photoplethysmography (PPG) using a low-cost consumer device at high (25Hz) and low resolution to predict SS and to detect sleep disordered breathing (SDB) events.

Methods

Our automatic, data-driven algorithm is a deep neural network trained and evaluated to predict SS and SDB events on 236 recordings of ACC data from a wrist-worn accelerometer and PPG data from the overlapping PSG. The network was tested on raw ACC and PPG data, which was collected at 25 Hz using the HUAMI Arc2 wristband from 39 participants that underwent a nocturnal polysomnography (PSG).

Results

Overall accuracy (Acc), recall (Re), specificity (Sp), and kappa (κ) per subject on the test dataset the prediction of wake, NREM, REM was Acc=76.6%, Re=72.4%, Sp=78.0%, kappa=0.42. On average, we found a 7 % higher performance using the raw sensor data as input instead of processed, low resolution inputs. PPG was especially useful for REM detection. The network assigned 55.6% of patients to the correct SDB severity group when using an apnea-hypopnea index above 15.

Conclusion

Current results show that SS prediction is significantly improved when using the raw sensor data; it indicates that the system holds promise as a potential pervasive monitoring device for patients with chronic sleep disorders. In contrast the system did not show potential as a sleep apnea screening tool. Additional studies are ongoing to examine the effects of pathology such as sleep apnea and periodic leg movement on SS prediction.

Support

Technical University of Denmark; University of Copenhagen, Copenhagen Center for Health Technology, Klarman Family Foundation.
1211 Assessing the Accuracy of a Dry-EEG Headband for Measuring Brain Activity, Heart Rate, Breathing and Automatic Sleep Staging
Authors: Thorey V , Guillot A , El Kanbi K , Harris M , Arnal P J
Published: May 2020

Introduction

The development of new sleep study devices, adapted for daily use, is necessary for diagnosis of sleep disorders. However, this requires to be both suitable for daily use and capable of recording accurate electrophysiological data. This study assesses the signal acquisition of a comfortable sleep headband, using dry electrodes, and the performance of its automatic sleep staging algorithms compared to the gold-standard clinical PSG scored by 4 sleep experts.

Methods

42 participants slept at a sleep center wearing both the Dreem headband (DH) and a PSG simultaneously. We measured 1) the EEG signal similarity between both devices, 2) heart rate, breathing frequency and respiration rate variability (RRV) agreement, and 3) the performance of the headband automatic sleep scoring compared to PSG sleep experts manual scoring.

Results

Results demonstrate a strong correlation between the EEG signals acquired by the headband and those from the PSG, and the signals acquired by the headband enable monitoring of alpha (r= 0.75 ± 0.11), beta (r= 0.74 ± 0.14), delta (r = 0.78 ± 0.16), and theta (r = 0.63 ± 0.15) frequencies during sleep. The mean absolute error for heart rate, breathing frequency, and RRV was 2.2 ± 0.8 bpm, 0.3 ± 0.2 cpm and 3.1 ± 0.4 %, respectively. Automatic Sleep Staging reached an overall accuracy of 84.1 ± 7.5% (F1 score: 83.0 ± 8.4) for the headband to be compared with an average of 86.4 ± 5.5% (F1 score: 86.5 ± 5.5) for the 4 sleep experts.

Conclusion

These results demonstrate the capacity of the headband to both precisely monitor sleep-related physiological signals and process them accurately into sleep stages. This device paves the way for high-quality, large-scale, longitudinal sleep studies.

Support

This Study has been supported by Dreem sas.
1226 A Case of Hypoglossal Nerve Stimulation Induced Cheyne-Stoke Central Sleep Apnea
Authors: Rezayat Talayeh , Chang Melisa
Published: May 2020

Introduction

Treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP), mandibular advancement devices (MAD) and oral surgery have been reported to lead to emergent central sleep apnea (CSA). In this case report the emergence of CSA in a Cheyne-Stokes pattern following the use of hypoglossal nerve stimulator as a treatment modality for OSA is discussed.

Report of Case

A 70-year-old man with a history of hypothyroidism and severe OSA diagnosed via a home sleep apnea test with a respiratory event index (REI) of 38 events/ hr was intolerant of PAP therapy and an MAD did not effectively treat his OSA. He was deemed an appropriate candidate for hypoglossal nerve stimulation following a drug induced sleep endoscopy. Following implantation and activation, he developed a lip droop and was ruled out for a stroke. A polysomnogram was completed which showed significant improvement in his sleep apnea at a voltage range of 1.4-17V. At 1.8V he developed REM- supine central events. When the voltage was further increased to 1.9-2.0V non-REM supine central events arose. These events appeared to have Cheyne-Stoke morphology with a cycle duration of over 50s. He was set to an amplitude of 1.6 V with a positional belt for treatment of his OSA without any emergent CSA.

Conclusion

This patient developed central sleep apneas with Cheyne-Stoke morphology following treatment of obstructive sleep apnea using a hypoglossal nerve stimulator. The central events began at higher voltage settings (greater than 1.8V). He had no history of heart failure or arrhythmias. This higher voltage may lead to overshoot of the tongue out of the airway resulting in hyperpnea, hypocapnia and central apnea but the underlying pathophysiology for the Cheyne-Stoke pattern in the absence of heart failure remains unknown.
1233 Mitochondrial Myopathy Making It Hard To Sleep! OSA management in Mitochondrial Myopathy with a variant in SNAPC4 and PURA genes
Authors: Okorie Ugorji , Monceaux Brittany , Smalley Megan , Roberts Edmond , Liendo Cesar , Chernyshev Oleg
Published: May 2020

Introduction

No standard of care exists for management of sleep disorders/sleep disordered breathing (SDB) and Mitochondrial myopathies. Our case report describes our experience with this condition in a pediatric patient.

Report of Case

A ten-year-old middle eastern male with PMH of Mitochondrial myopathy was referred to Sleep Medicine by ENT with reported snoring, witnessed apneic spells and daytime fatigue. Flexible Video Laryngoscopy did not reveal tonsillar or adenoid hypertrophy so it was postulated that his OSA was a result of his craniofacial abnormalities and global hypotonia.

Genetic workup showed Mitochondrial complex II & III deficiency from a variant in SNAPC4 gene and PURA gene leading to failure to thrive, severe developmental delay, generalized muscle weakness, bradycardia requiring pacemaker, global hypotonia requiring nocturnal oxygen for chronic respiratory failure and G-tube placement due to difficulty with feedings.

Diagnostic PSG showed severe OSA with AHI of 11.3, RDI 11.8, REM AHI 56.0, REM RDI 56, and minimum oxygen saturation 85%. Subsequent PAP titration led to initiation of BIPAP therapy with settings of Auto-BiPAP EPAP min 5, IPAP max 20; PSmin 4; PSmax 6 cm H2O and continuation of nocturnal home oxygen. Sleep fragmentation improved to an arousal index of 3.1 with BIPAP. The patient and caregiver presented to the Sleep Medicine clinic 1 month after the PAP titration study with objective report showing >4 hours use >70% of the time and subjective satisfaction with BIPAP therapy with improvement in snoring and apnea.

Conclusion

Mitochondrial disorders lead to a deficiency of ATP affecting all organ systems and is most recognizable in the form of neuromuscular impairments. Neuromuscular impairments can translate into SDB issues such as OSA. Patients with genetic conditions such as mitochondrial myopathy should be routinely screened and evaluated for SDB and treated if warranted to significantly improve morbidity, mortality and quality of life.
0125 Sleep Deprivation Impairs the Ability to Overcome Pre-Existing Framing Bias
Authors: Honn K A , Whitney P , Hinson J M , Nusbaum A T , Van Dongen H
Published: May 2020

Introduction

When presented with a choice between sure gains or losses versus gambles, people tend to select sure gains over gambles, but gambles over sure losses. This pre-existing framing bias is embedded in the Framed Gambling Task (FGT), in which subjects choose between a sure option (gain or loss) and a gamble (card from one of two decks). For optimal performance, subjects need to recognize that one deck (‘good deck’) results in better average outcomes than the other deck (‘bad deck’) and select the gamble or sure option depending on the deck (good/bad) rather than the frame (sure loss/gain). A speeded version of the FGT, with 2s response deadlines to induce time pressure, was used in a laboratory total sleep deprivation (TSD) study to determine the impact of sleep loss on the ability to overcome pre-existing framing bias.

Methods

Eight-six subjects (ages 21–38; 47 females) were randomized (2:1 ratio) to a TSD condition (n=56) or control condition (n=30). They completed the speeded FGT at 11:00 on the baseline day (session 1), and again the following day (session 2) after 27h of wakefulness (TSD group) or 3h of wakefulness (control group). Performance accuracy was defined in terms of optimal task performance, i.e., gambling when the good deck was presented and not gambling when the bad deck was presented. Each test bout had 72 trials across three trial blocks.

Results

Accuracy improved across trial blocks (F1,84=20.44, p<0.001). In session 2, the TSD group showed lower accuracy (condition by session interaction: F2,84=4.15, p=0.045) and less improvement across trial blocks (condition by session by trial block interaction: F2,168=3.97, p=0.021) than the control group. Even under TSD, the frequency of response timeouts (RT>2s) was low (<3.5% of trials).

Conclusion

Sleep deprivation degraded FGT performance under time pressure, indicating reduced ability to overcome pre-existing framing bias.

Support

PRMRP award W81XWH-16-1-0319
1241 A Case of Chronic Hypoventilation of Unknown Etiology with Improvement from a Wake Promoting Agent
Authors: Cole Melissa , Isaacs Thomas , Patel Amee
Published: May 2020

Introduction

We present a patient with chronic insomnia, excessive daytime sleepiness, and sleep-related hypoventilation that improved with a wake promoting agent in conjunction with BPAP.

Report of Case

A 15-year-old male with Cystic Fibrosis (single F508del mutation, positive sweat test, FEV1% of 98%) and Autism who presented with frequent headaches, chronic insomnia, and daytime sleepiness (PDSS of 22). Current medications included albuterol as needed. Sleep history was significant for restless leg symptoms. Labs revealed low serum ferritin. Sleep study two years prior showed an AHI of 3.4 and PMLD of 18.4. After completion of iron therapy and initiation of gabapentin, his chronic insomnia and serum ferritin improved. However, patient continued to have aggressive behavior, headaches, and snoring. Sleep study was repeated and revealed mild OSA with hypoventilation (AHI of 6.41, >28% of total sleep time with TCO2 above 50 mm Hg). Initial serum bicarbonate was 29 mmol/L and progressively increased to 34 mmol/L. Due to evidence of persistent chronic hypoventilation, patient was trialed on BPAP. Subsequent sleep study with BPAP showed an AHI of 0, but with worsening sleep related hypoventilation (TCO2 of 56mmHg, > 70% total sleep time with TCO2 above 50 mm Hg). Genetic, endocrine, and neurological work up for hypoventilation was negative. Due to persistent daytime sleepiness (PDSS of 24), MSLT was performed and showed evidence of hypersomnia. Modafinil was then initiated. With the combination of nocturnal BPAP use and Modafinil, daytime sleepiness improved (PDSS of 15) and he had normalization of CO2 and bicarbonate levels.

Conclusion

We present a patient with CF, with minimal lung disease, who demonstrated a negative work up for sleep related hypoventilation, in which dysregulation of control of breathing improved with the use of a wake promoting agent in conjunction with BPAP.
1263 Mandibular Advancement Device referrals and compliance at the VA
Authors: Hsieh Caleb , Ryden Armand , Zeidler Michelle
Published: May 2020

Introduction

For patients with obstructive sleep apnea (OSA) who are either intolerant or otherwise non-compliant with positive airway pressure (PAP) therapy, the use of a mandibular advancement device (MAD) is a viable and minimally invasive alternative for select individuals. Many device variations exist, but the common mechanism of action involves airway augmentation via traction on the lower jaw provided by a dental appliance. Prior studies have identified factors associated with treatment success, however, actual clinical experiences fluctuate widely. To identify patients within the VA that might benefit most from MAD, we conducted a preliminary review of MAD referrals within a one-year period at the West Los Angeles VA (WLA VA).

Report of Case

This retrospective database review was performed to identify areas for improvement in MAD referrals within the West Los Angeles VA network. The need for informed consent was waived as part of reviews preparatory to research as outlined in paragraph 23c of the VHA Directive 1200.05. Our database was queried for all MAD dental referrals between January 1, 2017 and Dec 31, 2017. All patients that completed at least one dental visit were included, those that did not complete referrals were excluded. Patient charts were reviewed for demographic data, comorbidities, dentition quality, pre- and post- MAD sleep studies, prior failed therapies, duration of MAD usage, reasons for discontinuation, and final OSA treatment modality. Between January 1, 2017 and December 31, 2017, 246 patients were referred for MAD dental evaluation. 184 initial evaluations were completed, 55 were discontinued for various reasons, and 7 were cancelled.

*** Preliminary data for first 84 patients***

Of 84 patients seen in dental clinic, 33 (39%) were deemed poor candidates either because of insufficient dentition or because of existing temporal-mandibular joint discomfort, 4 patients declined any intervention. Of 47 patients that received an MAD, 6 patients continued to use MAD alone, 20 switched to PAP or other modalities, and 21 were lost to follow up.

Conclusion

Pending more in depth analysis
0128 Mild Upper Airway Obstruction Leads to Increased Energy Intake and Growth Retardation that Persists After the Obstruction Removal
Authors: Rotenberg A , Assadi M , Agam N , Segev Y , Tarasiuk A
Published: May 2020

Introduction

Whereas pediatric obstructive sleep apnea may cause insufficient body weight gain and growth retardation, in some studies, metabolic syndrome and obesity were observed. Interestingly, treatment by adenotonsillectomy can lead to accelerated weight gain by an unclear mechanism. Here, we explored the effects of moderate upper airway obstruction (AO) and mild AO (mAO) and its removal (OR) on ventilation, resting energy expenditure (REE), food intake and growth during the diurnal cycle, from weaning to adulthood.

Methods

The trachea of 22-day-old rats was surgically narrowed to generate AO, mAO, and OR was performed after two weeks on mAO animals. Minute ventilation was recorded by whole body plethysmography and diurnal food intake, and REE was explored with metabolic cages 12 weeks post surgery.

Results

Following tracheal narrowing, inspiratory swings in esophageal pressure increased by 177% (p<0.01) and 36% (p<0.01) in AO and mAO rats, respectively, and was similar to the controls in the OR group. REE (Kcal/h/kg) was 3.7±0.1, 5.7±0.12 (p<0.01), 4.1±0.08 (p<0.01), and 3.6±0.15 in the control, AO, mAO, and OR groups, respectively. Increased EE in the AO and mAO groups was associated with up-regulation of ventilation by 133% and 56%, respectively (p<0.01). In all groups, energy intake (EE) was higher during a 12 h active period compared to a sleep period (p<0.01). EE during the lights on of AO and mAO animals increased by 136 % and 126%, respectively, and was similar to the control in the OR group. Active period EE increased by 19% in both obstructed groups (p<0.01). Active period EE was 16.7 % higher in the OR group despite the normalization of ventilation and tracheal diameter to the control value. Increased REE was associated with hindrance of bone elongation (p<0.01), and OR partially improved growth.

Conclusion

The need to maintain respiratory homeostasis during upper airway obstruction was associated with a persistent increase in energy intake. Surgical intervention may not be sufficient to correct the energy intake elevation, and endocrine regulation of feeding and growth may have greater impacts post intervention.

Support

This study was supported by the Israel Science Foundation grant no. 164/2018
0135 Self-Reported Sleep and Gut Microbiome Composition and Diversity: Associations in Well-Functioning Older Adults
Authors: Holingue C , Mueller N T , Tanaka T , Differding M K , Chia C W , Wu M N , Schrack J A , Simonsick E M , Spira A P
Published: May 2020

Introduction

The gut microbiome is believed to play an important role in health and disease, yet little is known about the link between sleep and the gut microbiome in humans. We investigated the association of self-reported sleep with gut microbiome composition and diversity in a cohort of well-functioning older adults.

Methods

We studied 791 participants (mean age = 71.5±12.0 years, 55% women) in the Baltimore Longitudinal Study of Aging with self-report sleep measures and whole-genome DNA sequencing of stool samples. Predictors (modeled as continuous variables) included insomnia symptoms from the Women’s Health Initiative Insomnia Rating Scale (WHIIRS), sleep duration (<5, 5–6, 6–7, >7 hours), and frequency of excessive daytime sleepiness (EDS). We tested their association with gut microbiome diversity (Shannon index) and relative abundance of individual taxa using Kendall Tau Correlation. Next, we assessed whether these sleep variables were associated with overall microbiome structure (Bray-Curtis), adjusting for age, sex, race, education, BMI, depressive symptoms, and number of comorbidities.

Results

Sleep duration was associated with overall microbiome composition (p<0.01), with longer sleep duration associated with lower biodiversity of microbes in the gut (p<0.05). In phylum-level analyses, higher WHIIRS total (i.e., more severe insomnia) was associated with lower relative abundance of Actinobacteria, while more frequent EDS was associated with lower relative abundance of Fusobacteria. More frequent trouble falling asleep, staying asleep, early waking, poorer sleep quality and higher WHIIRS total were associated with lower abundance of Synergistetes (all p<0.05).

Conclusion

In well-functioning older adults, self-reported sleep duration, symptoms of insomnia, and EDS were associated with microbiome diversity and composition. The phylum Synergistetes, which has been associated with protective humoral immune response in prior literature, may be an important correlate of insomnia symptoms in older adults. Future investigations are needed to examine the gut microbiome as a driver or mediator of sleep-health associations.

Support

This study was supported in part by National Institute on Aging (NIA) grant R01AG050507, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.
0140 Dietary Macronutrients and Sleep Duration, Sleep Disturbance, and Daytime Fatigue
Authors: Barker M , St-Onge M , Seixas A , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

We examined nationally-representative data on macronutrients associated with multiple dimensions of sleep health.

Methods

Data were obtained from the 2015–2016 National Health and Nutrition Examination Survey, (N=5,266 adults). Standard 24-h dietary recall procedures were analyzed to establish daily consumption of protein, carbohydrates, sugar, fiber, total fat, and saturated fat. Self-reported habitual sleep duration was categorized as very short (<5h), short (5–6.5h), normal (7-8h), and long (>8h). Sleep disturbance and daytime tiredness/fatigue were self-reported as either none, mild, moderate, or severe. Weighted multinomial logistic regressions with sleep variables as outcome/dependent variable and percent of each macronutrient as independent variable were adjusted for age, sex, race/ethnicity, education, and body mass index.

Results

Increased protein was associated with a decreased likelihood of very short sleep (RRR=0.01, p=0.019) and severe fatigue (RRR=0.06, p=0.020). Increased carbohydrates was associated with an increased likelihood of very short (RRR=61.17, p=0.001), short (RRR=3.96, p=0.017), and long (RRR=2.58, p=0.041) sleep, severe sleep disturbance (RRR=9.37, p=0.010) and fatigue (RRR=7.61, p=0.009). Increased sugar was associated with an increased likelihood of very short (RRR=24.17, p=0.001), short (RRR=3.29, p=0.017), and long (RRR=2.22, p=0.046) sleep, as well as mild (RRR=2.36, p=0.041) and severe (RRR=10.70, p=0.001) sleep disturbance, and severe fatigue (RRR=12.98, p<0.0005). Increased fiber was associated with a decreased likelihood of long (RRR=0.01, p=0.032) sleep and severe sleep disturbance (RRR<0.01, p<0.0005), as well as moderate (RRR<0.01, p=0.026) and severe (RRR<0.01, p<0.0005) fatigue. Increased fat was associated with a decreased likelihood of very short sleep (RRR=0.01, p=0.010). Increased saturated fat was associated with a decreased likelihood of very short sleep (RRR<0.01, p=0.017).

Conclusion

Protein and fiber were associated with better sleep profiles overall and carbohydrate and sugar were associated with worse sleep, as well as increased prevalence of sleep disturbances and fatigue.

Support

Dr. Grandner is supported by R01MD011600
0150 Comparing Two Measures of Sleep Depth/ Intensity
Authors: Younes M , Schweitzer P K , Griffin K , Walsh J K , Balshaw R
Published: May 2020

Introduction

There is currently no well-validated method for evaluating objective sleep depth/intensity. Delta power is thought to reflect sleep depth based upon limited evidence. Odds-ratio-product (ORP) is a recently introduced continuous measure of sleep depth. We compared delta spectral power (delta) and ORP as measures of sleep depth/intensity during manipulations that altered sleep depth (sleep restriction with placebo or with a delta-promoting drug). We hypothesized that ORP will provide a more robust measure of sleep depth.

Methods

This is a secondary analysis of data from a study in which forty-one healthy subjects were sleep restricted and randomized to receive placebo or gaboxadol 15mg. Participants underwent consecutive in-laboratory sleep studies on two baseline, four sleep restriction (5 hours) and two recovery nights. The relation between delta or ORP during any given 30s epoch and sleep depth, operationally defined as the probability of arousal / awakening occurring during the next 30 seconds (arousability), was assessed.

Results

Mean ORP values differed significantly among the four sleep / wake stages, but delta power did not differentiate wake, N1 and N2. The relation between ORP and arousability was linear across the entire range of ORP whereas delta power detected differences in arousability only with delta values < 300 μV2. Correlations with arousability in individual subjects were stronger with ORP (p < 0.0001). Receiver operating characteristic analysis found the ability to predict imminent arousal to be significantly greater with ORP than with delta power for all experimental conditions (p < 0.0001). The increase in sleep depth with restriction alone was detected on the second day of restriction by ORP (p < 0.01) but not by delta.

Conclusion

As compared to delta power, ORP is more discriminating among sleep stages, more sensitive to sleep restriction, and more closely associated with arousability. These observations indicate ORP better reflects sleep depth/intensity.

Support

None
0154 Role of Noradrenergic Projection to the Preoptic Area in Regulation of Arousal
Authors: Antila H , Kwak I , Covarrubias I , Baik J , Hong J , Stucynski J , Weber F , Chung S
Published: May 2020

Introduction

Locus coeruleus (LC) is a noradrenergic nucleus in the brainstem involved in the regulation of attention, arousal, mood and sensory gating. LC projects to multiple brain regions and recent development of novel systems neuroscience tools allows the dissection of projection-specific LC function in more detail. One of the regions with noradrenergic projection is the preoptic area of the hypothalamus (POA). POA has been shown to contain neurons that are important for regulating sleep, and we have examined the function of the LC projection to the POA in sleep and arousal.

Methods

We used optogenetics, chemogenetics, fiber photometry and in vivo electrophysiology to study the function of LC noradrenergic projection to the POA.

Results

Norepinephrine release in the POA fluctuates with brain state changes indicating that the LC to POA projection may be involved in regulating sleep and arousal. Optogenetic stimulation of LC fibers in the POA promotes wakefulness. Furthermore, optogenetic stimulation of the LC fibers in the POA modulates the activity of sleep- and wake-active neurons.

Conclusion

We have identified the role of the LC noradrenergic projection to the POA in the regulation of brain states. Stimulation of the LC fibers in the POA promotes wakefulness and modulates the activity dynamics of sleep- and wake-active neurons in the POA. Our results provide more detailed information about the role of this specific projection, which has been known to exist for a long time, but with insufficient in vivo evidence of its precise function.

Support

Sigrid Juselius foundation, Alfred P. Sloan Research Fellowship in Neuroscience, The Whitehall foundation grant, McCabe Fund Award, NARSAD Young Investigator Award.
0182 The Sleep Regularity Questionnaire: Development and Preliminary Psychometric Properties
Authors: Donovan E K , Dzierzewski J M
Published: May 2020

Introduction

Sleep is a critically important behavior which influences diverse aspects of health, functioning, and longevity. An increasing literature suggests the importance of sleep regularity, also referred to as sleep inconsistency, sleep variability, or intraindividual variability in sleep. Given there is no brief, subjective measure of sleep regularity, the purpose of this study was to examine the psychometric properties of an in-development, ten-item Sleep Regularity Questionnaire (SRQ).

Methods

In an online study of sleep and health, participants (n = 3284; Mage (SD)= 42.74(16.72); 47.8% female; 77.1% white) completed the in-development SRQ, as well as other sleep-related measures including the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI).

Results

An exploratory factor analysis on a random half of the sample revealed a two factor structure, with four items representing “circadian regularity” and two items representing “sleep disturbance regularity.” A confirmatory factor analysis on the other random half of the sample fit the two factor model with good model fit indices (X2 = 50.9, df = 7, p < .001; RMSEA = .06; CFI= .99; NFI = .99; IFI = .99; TLI = .98). The SRQ was negatively associated with poor sleep quality measured via the PSQI (r = -.37, p < .001) and negatively associated with insomnia severity measured via the ISI (r = -.40, p < .001).

Conclusion

The SRQ appears to be a valid instrument for the assessment of sleep regularity in adults that is related to, but distinct from, other established sleep constructs. Future research will benefit from examining test-retest reliability of the measure as well as assessing the validity of the SRQ as a measure of objective sleep regularity by comparing it to conventional diary, actigraphy, and/or polysomnography methods of sleep assessment.

Support

This work was supported by the National Institute on Aging of the National Institutes of Health under Award Number K23AG049955 (PI: Dzierzewski). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.