bluuebunny/crossref_metadata_2025 huggingface dataset:
0292 Differential Utility of Psychomotor Vigilance Test vs. Sleep Latency Tests in Healthy Humans
Authors: Chaisilprungraung Thitaporn , Thomas Connie , Allotey-Addo Sidney , Stekl Emily , Denby Avery , Garriques Victoria , Chanatry Claire , Balkin Thomas , Hughes John , Doty Tracy
Published: May 2022

Introduction

The Psychomotor Vigilance Test (PVT), the Multiple Sleep Latency Test (MSLT), and the Maintenance of Wakefulness Test (MWT) are widely used in both sleep research and clinical settings. The PVT measures reaction time to a visual stimulus, whereas time to sleep onset is measured in both the MSLT and MWT, which differ primarily with respect to the instructions (i.e., whether to try to fall asleep vs. stay awake). Compared to sleep latency tests, the PVT is relatively inexpensive and easy to administer, so it is advisable to delimit the conditions under which its administration is most appropriate.

Methods

A comprehensive search of sleep studies on healthy adults revealed 30 studies in which both PVTs and sleep latency tests were administered – usually to assess the effects of various interventions on sleepiness and vigilance. Two reviewers compiled findings from each study and graded the levels of outcome agreement based on whether a test intervention produced similar effects on vigilance across tests.

Results

Of the 13 studies that included both PVT and MWT of studies, a high level of agreement (based on the presence and direction significant effect on vigilance) between test outcomes was evident in 8 (61.5%) of the studies. In contrast, a considerably lower percentage of studies in which both the PVT and MSLT were performed (6 of 17 studies; 35.3%) had high agreement between test outcomes. It was also found that the MSLT was more sensitive to interventions (e.g., caffeine, sleep loss, and cognitive workload) than the PVT in the majority of studies in which there was low agreement (5 of 6 studies; 83.3%).

Conclusion

There is generally more agreement between PVT and MWT measures than between PVT and MSLT measures in studies involving sleep loss. This is most likely because the PVT and MWT both require application of effort to resist sleepiness, whereas the MSLT involves the withdrawal of resistance to sleepiness. This suggests that the PVT is potentially more useful in operational environments (where ability to sustain performance is the primary concern) than in clinical settings (where the focus is on determining the severity of sleepiness).

Support (If Any)

Department of Defense Military Operational Medicine Research Program (MOMRP)
0296 Vigilant Attention Performance Advantage Conferred by TNFα G308A Polymorphism is Associated with Diminished Delta and Theta Power in the Non-REM Sleep EEG
Authors: Skeiky Lillian , Finlay Myles , Satterfield Brieann , Schmidt Michelle , Wisor Jonathan , Van Dongen Hans
Published: May 2022

Introduction

Carriers of the A allele of a single nucleotide polymorphism of the TNFα gene (G308A, rs1800629) are relatively resilient to vigilant attention performance impairment from total sleep deprivation (TSD), as compared to G/G homozygotes, and even exhibit a small performance advantage at baseline. The mechanism underlying this effect remains unclear. As TNFα is a sleep regulatory substance, we investigated whether TNFα G308A genotype is associated with systematic differences in markers of sleep homeostasis.

Methods

N=168 healthy young adults (ages 27.4±5.4y; 86 women) participated in one of seven in-laboratory TSD studies. During TSD, performance was assessed every 2–3h using a psychomotor vigilance test (PVT). The TSD period was preceded and followed by nocturnal sleep opportunities (baseline and recovery, respectively), which were recorded polysomnographically and scored according to AASM criteria. The EEG (C3-M2 derivation) of stages N2 and N3 non-REM sleep was investigated using spectral analysis.

Results

The genotype distribution of the sample was 0.6% A/A, 26.8% A/G, 72.6% G/G, in Hardy-Weinberg equilibrium (P=0.14). As documented previously, A allele carriers, compared to G/G homozygotes, had fewer PVT lapses (RTs>500ms) at baseline and during TSD, indicating greater resilience to sleep deprivation. During both baseline and recovery sleep, A allele carriers, compared to G/G homozygotes, displayed reduced power in the delta (0.8–4.0Hz; P=0.017) and theta (4.2–8.0Hz; P=0.004) bands of the non-REM sleep EEG.

Conclusion

The performance advantage of the A allele carriers brings to mind the “banking sleep” phenomenon previously observed in sleep deprivation studies with prior sleep extension, suggesting that the A allele carriers gained this advantage by essentially being able to bank sleep. If this interpretation is correct, then the diminished power in the delta and theta bands of the non-REM sleep EEG in the A allele carriers, which suggests reduced homeostatic sleep pressure during both baseline and recovery sleep, may imply that the A allele carriers operate at a lower homeostatic setpoint due to an underlying advantage in the recuperative efficiency of sleep.

Support (If Any)

NIH R01HL070154, R21CA167691, R01HL105768; ONR N00014-13-C-0063, N00014-13-1-0302, FAA DTFAAC-11-A-00003, CDMRP W81XWH-16-1-0319, USAMRDC W81XWH-05-1-0099, and an SRS Elliot D. Weitzman, M.D. Research Grant.
0301 Does Orexin Influence Sleep Fragmented Brain Inflammation? A Pilot Study
Authors: Nick Henry , Fenik Polina , Zhu Yan , Veasey Sigrid
Published: May 2022

Introduction

Fragmented sleep occurs when there are repetitive, short interruptions of sleep, resulting in less than six hours of sleep per day. Overall, however, in the United States, sleep fragmentation is reported by 30% of employed adults. Sleep fragmentation may be a risk factor for Alzheimer's disease, and orexin reduction appears effective in reducing amyloid plaque formation in mice with transgenic Alzheimer's disease. Orexin is a neuropeptide that regulates arousal, wakefulness, and appetite. Thus we hypothesized that loss of orexin might also be protective against sleep disruption injury in non-Alzheimer's mice. This study aims to combine sleep fragmentation with orexin loss to see if brain health is severely reduced.

Methods

The 24 mice in this study were split into four groups: B6 rested, B6 sleep fragmented, orexin knockout rested, orexin knockout sleep fragmented. The sleep fragmented mice were placed on a shaker table for 10½ weeks to initiate chronic sleep loss. The mice were all perfused within five to eight months of birth, and then the brains were cryopreserved and sliced. These sections were immunolabeled with different protein antibodies using immunohistochemistry techniques. The stained brains were either analyzed through microscope stereology counts or computer image analysis.

Results

Two-way ANOVA analysis for tyrosine hydroxylase, ionized calcium binding adaptor, and vesicular acetylcholine transporter had p<0.05 for the sleep fragmentation variable, showing differences in these antibodies for rested and sleep loss mice. ANOVA for cluster of differentiation 68, cofilin, postsynaptic density protein, and RanBP had p<0.05 for the genotype variable, showing differences in these antibodies for knockout and normal orexin mice. ANOVA for glial fibrillary acidic protein and amyloid-beta had p<0.05 for both variables, showing differences for sleep and orexin levels. There was no ANOVA significance for synapsin.

Conclusion

Our results show that knocking out orexinergic neurons causes hippocampal tissue damage, dampens the functioning of synapses, and diminishes the ability of the brain to adapt through plasticity and memory. Sleep fragmentation, however, increases phagocytic activity, and harms the acetylcholine and norepinepherine neurotransmitter pathways. When combined, cell communication worsens and the blood brain barrier loses function, resemblant of neurodegenerative diseases.

Support (If Any)

NIH AG054104; AG064231
0327 Age-Related Associations Between Chronotype and Sleep-Wake Cycles: A Big Data Analysis
Authors: Gottlieb Elie , Gahan Luke , Danoff-Burg Sharon , Rus Holly , Watson Nathaniel , Raymann Roy
Published: May 2022

Introduction

Circadian rhythms progressively delay throughout adolescence until older adulthood when they advance to become early as children. Chronotype represents a subjective assessment of when one feels their performance is optimal. Evidence suggests evening chronotype is associated with adverse health effects. Presently, it is unclear whether sleep-wake cycles and chronotype diverge across ages. Here, we examined whether self-reported chronotype was associated with the daily start of the sleep-wake cycle (indicated through objectively measured bedtime) across the lifespan using a large, ecologically-valid dataset.

Methods

Data from 11,026 users (mean age: 45.3, 54.3% female) across 1,167,489 nights were included in the analysis from the PSG-validated SleepScore Mobile Application, which uses a non-contact, sonar-based method to objectively capture sleep-related metrics, and questionnaires to assess self-reported lifestyle factors. Chronotype was subjectively assessed with a 5-item question ranging from definitely morning-type to definitely evening-type. Bedtime, a proxy for the daily start of the sleep-wake cycle, was captured as the time at which users started a sleep recording in the Application. Linear regressions were used for the analysis.

Results

Overall, chronotypes showed a near-normal distribution with a skew toward definite evening types (n=2147) compared to definite morning (n=1560) types (21.70% versus 15.70%). As expected, average bedtime was earliest for definite morning types (mean=23:02 ± 86.4 mins) and latest for definite evening types (mean=01:10 ± 102 mins). Across all chronotypes, linear regressions revealed a significant negative association between overall age and bedtime (p<0.0001). Among definitive evening types, younger ages had later bedtimes and older ages had earlier bedtimes (ß=-0.014, SE=0.002, p<0.00001). Further, the degree of change in bedtimes across age was largest for definite morning types, whereby average bedtime decreased from 23:38 (SD=86.3 mins) at age 20 to 22:29 (SD=88.2mins) at age 80 (ß=-0.019, SE = 0.002, p<0.00001).

Conclusion

The present analysis showed that, across chronotypes, younger ages had later bedtimes and older ages had earlier bedtimes, presumably driven by age-related changes in circadian rhythmicity. This association was also exemplified by morning-types showing the greatest change in bedtimes across the lifespan. Future prospective studies are warranted to examine the relationship between longitudinal changes to chronotype and endogenous circadian rhythmicity across the lifespan.

Support (If Any)
0341 Digital Health Technology to Support Autonomous Sleep Monitoring and Management in Multi-Domain Operational (MDO) Environments
Authors: Wolfson Megan , Pulantara Wayan , Mesias George , Nugent Katie , Clarke-Walper Kristina , Wilk Joshua , Germain Anne
Published: May 2022

Introduction

Sleep and fatigue management strategies can substantially impact the Armed Forces’ readiness and fitness. These strategies can be implemented with behavioral health personnel and Wi-Fi connectivity to support real-time assessment, monitoring, and intervention. However, these resources are not readily available in multi-domain operational (MDO) environments. An autonomous Wi-Fi-independent digital sleep and fatigue management tool (DSFMT) could offer a critical advantage in detecting, monitoring, and providing just-in-time sleep and fatigue recommendations for Soldiers and support unit performance. We describe how we adapted a validated sleep-focused clinical decision support platform into a DSFMT for use in MDO environments.

Methods

Semi-structured interviews were conducted with 6 Army Key Opinion Leaders (KOLs) to assess perceived utility of a DSFMT and identify key requirements. We also conducted a literature review to identify evidence-based sleep optimization and fatigue mitigation strategies in real or simulated military environments, or occupations with high sleep disruption. Directives for sleep and fatigue management from all branches of the U.S. Armed Forces were reviewed.

Results

KOLs were enthusiastic about the proposed DSFMT and emphasized three requirements: (1) brief and actionable content; (2) tap into Soldiers’ competitive nature; (3) provide unit level metrics to the medic. Five sleep education topics (e.g., consequences of insufficient sleep) and eight evidence-based sleep self-optimization strategies (e.g., sleep banking) were identified and included in the digital content. The resulting DSFMT consists of a smartphone-based Soldier App that captures self-reported sleep and fatigue data and offers individualized feedback and self-management strategies, and a Medic App that displays aggregate unit-level sleep and fatigue status. The apps operate when connected to Wi-Fi and have capabilities for offline data collection and transfer via Bluetooth.

Conclusion

We created an initial prototype of an autonomous Wi-Fi-independent DSFMT that can be used in MDO environments and meets KOL requirements. 246 Soldiers have field tested this prototype. Findings from ongoing acceptability and feasibility analyses will inform the next iteration.

Support (If Any)

This project is partially funded by MTEC-19-02-TeleSleep-001-2019-406. The opinions and assertions contained herein are those of the authors and do not necessarily reflect the views of the U.S. Army or the U.S. Department of Defense.
0343 In-person Expert Pillow Fitting Process Improves Sleep Quality and Duration
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Rodriguez Rodolfo , Gavrilova Larisa , Burke Colin , Carmon Kiara , Ledesma Duvia Lara , Gottlieb Elie
Published: May 2022

Introduction

The myriad of anecdotal claims about the benefits of different pillow types may complicate consumers’ ability to find a pillow that can support better sleep. Services that provide consumers with personalized recommendations may address this problem. This study examined the sleep of research participants using pillows selected during an in-store pillow fitting process compared to using their original pillows.

Methods

Healthy adults (71% female, ages 21-59) who reported interest in a new pillow participated in a 9-week field study using a pre-post intervention design. The intervention consisted of being guided through the Mattress Firm in-store pillow fitting process to be paired with a pillow that provided the best fit and support based on body type and sleeping position preferences. During the 4-week baseline period, participants used their regular pillow. Once they were fit for their new pillow, participants slept with that pillow for 5 weeks, including a 1-week adjustment period. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests and were used to test for statistical significance.

Results

There were 722 nights of tracked sleep across participants (n=17). Objective sleep measurements showed nightly improvement in SleepScore, a measure of objective sleep quality (p=.003), longer time in bed (+13 minutes, p=.034),longer sleep duration (+16 minutes, p=.010), a lower proportion of the night awake after falling asleep (p=.009), and better sleep maintenance (p=.009). In addition, participants got more deep sleep (+5.6 minutes, p=.017) and showed improved BodyScore, a measure of deep sleep (p=.031). Self-reported measures showed improvements in pillow comfort and overall comfort in bed; perceived ability to sleep through the night; perceived reduction in number of awakenings and amount of time awake at night; better overall sleep quality; and feeling more well-rested in the morning when using the fitted pillows compared to baseline (all ps <.05).

Conclusion

Objective and self-reported sleep improved among healthy adults using a pillow selected by an expert, in-person pillow fitting process. The results suggest that a pillow fitting process can improve sleep by helping individuals find a pillow that provides a personalized fit and optimal comfort.

Support (If Any)

Mattress Firm INC
0344 Use of an Adjustable Bed Base Improves Sleep Quality and Duration
Authors: Danoff-Burg Sharon , Rus Holly , Burke Colin , Weaver Morgan , Rodriguez Rodolfo , Carmon Kiara , Ledesma Duvia Lara , Gottlieb Elie
Published: May 2022

Introduction

The positional adjustment of a bed can potentially contribute to better sleep and alleviation of discomfort associated with a variety of medical conditions. As most studies in this area have focused on inclined sleeping for therapeutic purposes, understanding the impact of postural change on improving sleep among healthy individuals requires further research. This study compared sleep in an inclined position on an adjustable bed base to participants’ prior sleep on their original bed bases.

Methods

Healthy adults (61% female, ages 23-60) willing to sleep at an incline participated in an 8-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular bed base at home. During the 4-week intervention period, they used the Mattress Firm 600 Adjustable Base at home with head and/or feet raised (not flat). Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were over 1,100 nights of tracked sleep across 26 participants. Objective sleep measurements showed many nightly improvements during the intervention compared to baseline: increased time in bed (+21 minutes, p=.003), total sleep time (+21 minutes, p=.001), and REM (+5 minutes, p=.009); less WASO, both in duration (-3 minutes, p=.046) and proportion of the night (p=.015); fewer awakenings (p=.034); and better sleep maintenance (p=.014). Improvements also were observed in 3 objective sleep quality measures: SleepScore, BodyScore, and MindScore (ps<.05).Self-report measures revealed greater comfort and enjoyment when using the adjustable base, as well as perceived improvement in a variety of outcomes, including time to fall asleep and falling asleep within a preferred amount of time, ability to sleep through the night, sleep duration, sleep quality and satisfaction, and feeling more rested in the morning (ps<.05).

Conclusion

Objectively-measured sleep and self-reported sleep improved in duration and quality when using the adjustable base compared to healthy adults’ original bed bases. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as a comfortable and enjoyable experience.

Support (If Any)

Mattress Firm INC
0368 Leveraging the Electronic Health Record to Facilitate Shared-Medical Decision Making in a Large Health System: Response to the PAP Recall
Authors: Lance Colleen , Wang Lu , Foldvary-Schaefer Nancy , Wyllie Robert , Baugh Kristin , Kazaglis Louis , Carroll Don , Colwell Dawn , Hall Greg , Mehra Reena
Published: May 2022

Introduction

The positive airway pressure (PAP) device manufacturer recall afflicting ~4 million users has posed a major challenge for the care of patients with sleep disordered breathing. We report on the Cleveland Clinic enterprise-wide response efforts and relevant predictors of medical decision-making surrounding this recall.

Methods

A taskforce developed a strategic response to the recall with the goal of distributing enterprise-wide communications; providing key guidance to providers and patients. For patients, a multi-pronged, tiered approach of MyChart messaging, phone and mailings instructing device registration and continuing use of PAP until discussed with the provider was implemented. For providers, an Epic smartphrase, embedded with a tracker, was developed as a resource including details of a decision-making algorithm while awaiting remediation. A team of mid-level providers was trained in the use of the algorithm; and the smartphrase was utilized for targeted virtual visits and communications. Presented is a retrospective cohort analysis of demographics and comorbid predictors between the group of patients advised to continue therapy, versus those advised to discontinue. Wilcoxon rank sum test or t-test was used for comparisons.

Results

15,759 patients were contacted; message confirmed read/heard for 99.3%. Analysis of smartphrase use yielded 1135 instances (median,IQR): age:61.0 [51,70];48.5% female, 13.6% African American, body mass index(BMI) 33.5[29,38.9] kg/m2, apnea hypopnea index(AHI)=22.8[11.7,46.1] of whom n=770(67.8%) were advised to continued therapy. Predictors of provider guidance to continue versus temporarily hold PAP therapy respectively include: age:63[53,71] vs. 58[47,67] p<0.001, female:44% vs. 57%,p<0.001, BMI:33.9[29.5, 39.7] vs. 32.0[28.0,37.5],p<0.001, AHI:31.9[15.5, 58.0] vs.15.7[9.1,21.2],p<0.001 and the following comorbidities: hypertension:61.0% vs. 46.3%,p<0.001, coronary artery disease,11.3% vs. 3.6%,p<0.001,heart failure:2.6% vs. 0.6%,p<0.001, atrial fibrillation:9.5% vs. 2.5%,p<0.001 and chronic obstructive pulmonary disease:5.8% vs. 1.6%,p<0.001,but not diabetes.

Conclusion

We conclude that EHR tools can be used to coordinate device recall response efforts and guide both providers and patients. The use of a system smartphrase facilitated provider-patient shared medical decision-making to continue versus temporarily discontinue use of PAP therapy efficiently. Those advised to continue PAP therapy had higher burden of sleep apnea and cardiopulmonary comorbidity.

Support (If Any)
0375 Effectiveness of an intelligent sleep management system in the US military: Preliminary results
Authors: Mounts Charles
Published: May 2022

Introduction

There are well-recognized barriers limiting access to evidence-based sleep interventions in the military. Given the large number of patients seeking treatment and the shortage of trained specialist providers, demand greatly exceeds available supply. As part of a larger implementation effort, the purpose of this study was to evaluate health provider ratings of the effectiveness and usability of a novel sleep telehealth assessment at a busy military treatment facility.

Methods

Health providers were recruited from the Internal Medicine and Sleep Medicine clinics at Walter Reed National Military Medical Center. Effectiveness was defined a priori based on the established Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework. Providers from participating clinics completed a questionnaire that measured specific aspects of effectiveness: perceived satisfaction, usability, improvement, credibility, risks, benefits, acceptability and overall satisfaction with a sleep assessment report.

Results

Providers (n=16) were surveyed regarding perceived satisfaction, usability, improvement, credibility, risks, benefits, and acceptability of the sleep assessment report were rated favorably, with each domain being rated with a positive or very positive response by more than 75% of providers. All providers viewed the usability of the report favorably and all but one provider had a positive view on the report improving their documentation of sleep problems.

Conclusion

Health care providers at our hospital rated a novel sleep telehealth assessment as highly effective across established key domains of implementation science. Providers were highly satisfied with the content, usability, and credibility of the report, and felt this intervention would improve their documentation. Research is ongoing to further evaluate the implementation of the system.

Support (If Any)

This research was supported by an investigator-initiated research award from the Department of Defense (via the Medical Technology Enterprise Consortium) to the University of Maryland, Baltimore (PI: EMW).
0377 Success Rates of Self-Applied Type 2 Studies in 191 Participants
Authors: Tomson Heather , Lambing Kari , Bender Amy , Decock Darren
Published: May 2022

Introduction

Wait times for the gold standard Type 1 polysomnograms are lengthy, and the pandemic has only increased the backlog. The need for having home sleep testing has grown yet Type 3 home sleep apnea tests (HSAT) can be inaccurate despite their popularity. In this study, we assessed the reliability of a self-applied in-home Type 2 sleep test using the Cerebra Sleep System.

Methods

213 sleep files were collected from 191 participants that had their Type 2 device shipped to their home with no prior training. Participants watched videos and read written instructions to self-apply the full Type 2 system. The lab-quality in-home PSG included a recording of EEG (Fp1,Fp2), EOG (E1, E2), EMG (chin), EMG (legs), respiratory channels (one effort or two RIP belts), nasal flow, and pulse oximetry. The study was considered successful if the head unit (EEG/EOG/EMG), leg EMG, nasal flow, and oximetry were present for recordings of 3 and 4 hours in duration.

Results

Based on a 4-hour success criterion, 82.6% of studies were considered successful. This percentage increased with 3 hours (85.4%). When studies did fail at the 4-hour criterion, 10.8% had failures of all signals, 5.4% had failures of 4/5 signals, 10.8% had failures of 3/5 signals, 16.2% had failures of 2/5 signals, and 56.8% had failures of 1/5 signals. The head unit failed on 15 records (7%), the right leg on 9 records (4.2%), the left leg on 6 records (2.8%), the cannula on 12 records (5.6%), and the oximeter on 7 records (3.3%). For 13 participants who had a failed study, the issues were resolved in 6 cases (46%) with a second night of recording.

Conclusion

We found that the Cerebra Sleep System Type 2 in-home test showed reliable performance with a high success rate. When studies did fail, in most cases, a single signal was the source of the problem. For patients suspected of having sleep disordered breathing or other sleep disorders, Type 2 testing is a reliable, convenient, and safe alternative to in-lab polysomnography and performs similar success rates to Type 3 HSATs.

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0378 Daytime PAP Accommodation: A Breath of Fresh Air
Authors: Newitt Jennifer , Holmes William , Strollo Patrick
Published: May 2022

Introduction

Rising healthcare costs and resource utilization represents a growing problem in the United States, especially for individuals with progressive neuromuscular disorders. Diagnosis and treatment of obstructive sleep apnea has been demonstrated to decrease healthcare resources in the general population; however, there is no well-defined approach to diagnosis and management of sleep-disordered breathing (SDB) in patients with neuromuscular disease (NMD). Many providers believe it best to diagnose and introduce positive airway pressure (PAP) support during a single overnight in-laboratory sleep study. Patients with NMD require a team with understanding of sleep physiology, complex pulmonary pathophysiology, disease process and progression, and advanced PAP therapy modes and indications. Optimal treatment requires patient and caregiver education, frequent monitoring of PAP data, ongoing evaluation of oxygenation and ventilation parameters, as well as assistance with device issues. We hypothesized a focused, personalized approach to managing patients with NMD will improve patient adherence to PAP therapy, nocturnal oxygenation, and ventilation, as well as limit hospital admissions.

Methods

10 patients diagnosed with NMD (including muscular dystrophy, diaphragm paralysis, and scoliosis) presented to UPMC Montefiore sleep lab for daytime accommodation study with a pulmonary-sleep physician and dual-trained respiratory therapist-sleep technician. The visit included mask fitting, patient education, and initiation of PAP therapy with titration of bilevel pressure settings. Data collected included: pre- and 3-month-post nocturnal oxygen saturation and serum bicarbonate level; data download at 3 months including device usage, leak, average PAP pressures; and number of hospital admissions.

Results

All 10 patients demonstrated initiation of PAP therapy with usage on 100% of days for minimum of 6 hours per night. There was improvement in average nocturnal oxygen saturation and serum bicarbonate level after visit compared to prior. 3 patients were hospitalized in 6-12 months following, none for respiratory related reasons.

Conclusion

In this pilot study, an innovative daytime PAP accommodation study for patients with sleep-disordered breathing due to NMD results in excellent initiation and adherence to PAP therapy, as well as improvement in oxygenation and ventilation and minimal hospitalizations. Future studies are necessary including a larger randomized trial to demonstrate the safety and efficacy of home based NIV initiation.

Support (If Any)

NIH T32 HL082610-15, American Thoracic Society ASPIRE fellowship
0399 Patient Preference and Nocturnal Experience With Sodium Oxybate Treatment for Narcolepsy: Interim Data From RESTORE
Authors: Roy Asim , Harsh John , Ajayi Akinyemi , Stern Thomas , Seiden David , Dubow Jordan
Published: May 2022

Introduction

Available, immediate-release oxybate products for narcolepsy require patients to awaken for a second dose 2.5-4 h after the first to cover a full night of sleep. The investigational, extended-release once-nightly sodium oxybate (ON-SXB; FT218) eliminates this middle-of-the-night dosing. This interim analysis from the ongoing RESTORE study (NCT04451668) assessed patient preferences for ON-SXB versus twice-nightly sodium oxybate (SXB) and experiences with the second nightly SXB dose in patients who switched from twice-nightly SXB to ON-SXB.

Methods

Participants enrolled in the open-label extension/switch study (RESTORE) were aged ≥16 y with a confirmed diagnosis of narcolepsy type 1 or 2 from the phase 3 REST-ON trial or receiving stable doses of twice-nightly SXB for ≥1 month. Initial ON-SXB doses for switch patients were equivalent/closest to their previous total nightly SXB dose. Patient preference questionnaires were completed by switch patients 3 months after switching and nocturnal adverse event (AE) questionnaires at baseline.

Results

At an interim data cutoff date of November 22, 2021, 46 participants completed patient preference questionnaires; 93.5% (43/46) preferred ON-SXB to twice-nightly SXB. Nocturnal AE questionnaires were completed by 76 switch participants. In the 3 months before switching to ON-SXB, 62% (47/76) had unintentionally missed their second twice-nightly SXB dose, with 86% experiencing worse narcolepsy symptoms the next day. Forty percent (30/76) reported taking their second twice-nightly SXB dose >4 h after the first dose, with 47% reporting being somewhat, quite a bit, or extremely groggy/unsteady the next morning. For 76% (58/76), taking a second nighttime dose was somewhat, quite a bit, or extremely inconvenient. Additionally, 91% (69/76) reported that they had arisen from bed after the second dose; of these, 5 reported associated falls, and 3 had injuries. Anxiety (25%) and the need for someone else to wake them (21%) were also reported. One participant reported that the medication was missing when they awoke for the second dose.

Conclusion

These interim data indicate that individuals with narcolepsy and prior experience taking SXB prefer ON-SXB to twice-nightly SXB. Treatment burden from the second nightly SXB dose may be alleviated with ON-SXB.

Support (If Any)

Avadel Pharmaceuticals
0413 Are High Intellectual Abilities a Protective Factor for Psycho-social Repercussions in Children with Narcolepsy?
Authors: Thieux Marine , Zhang Min , Marcastel Agathe , Poitrinal Alice , Vassias Fanny , Guyon Aurore , Herbillon Vania , Guignard-Perret Anne , Franco Patricia
Published: May 2022

Introduction

Narcolepsy can have deleterious impact on cognitive and psychosocial functioning. Adequate intellectual abilities are generally a protective factor for bio-psycho-social adjustments in chronic disorders. The main objective of this study was to describe sleep, cognitive abilities and psychosocial repercussions between children with narcolepsy and controls according to the intellectual abilities’ classification.

Methods

Children with narcolepsy and controls underwent one-night polysomnography, completed an intellectual abilities assessment (WISC) and filled in the Epworth Sleepiness Scale for children, the Insomnia Severity Index, the Children Depression Inventory and the Conners. Comparisons between children with narcolepsy and controls were made in two subgroups with High intellectual Potentialities (HP; with an IQ or a verbal or reasoning index higher or equal to 130 evaluated by the WISC) or without HP.

Results

The group with HP consisted of 25 children with narcolepsy (40% boys, median 11,5 years) and 25 controls (68% boys, median 11,7 years). Compared to the controls, the children with narcolepsy did not present the same intellectual profile at the WISC (lower perceptual reasoning index and less discrepancy between verbal and perceptual indexes). They had fewer conduct disorders and a tendency to have fewer school difficulties, learning disabilities, and impulsivity than controls. The group without HP consisted of 22 children with narcolepsy (55% boys, median 12,1 years) and 21 controls (68% boys, median 10 years). The children with narcolepsy presented the same intellectual profile at the WISC as their peers without narcolepsy, but they reported more school difficulties and higher insomnia scores. Compared to controls, both groups of children with narcolepsy had higher sleepiness scores and showed a classic pattern of narcolepsy characteristics on the PSG. There was no difference for the socio-economic level of parents between groups.

Conclusion

In children with narcolepsy, high intellectual abilities act as protective factor against the impact of the disease on cognitive and adaptive functioning, whereas normal-to-low intellectual abilities predict a greater impact of the pathology on daily-life functioning, highlighting the need for multifactorial management.

Support (If Any)

This work was supported by a French Grant from the SFRMS to Marine Thieux.
0415 Does HLA DQB1*0602 testing at our center improve the management of the patient with suspect narcolepsy? A quality improvement project
Authors: Miller Evan , Masood Muaaz , Healy William , Gunsolus Brandy , Bravo-Egana Valia
Published: May 2022

Introduction

The gene DRB1*06:02, a subtype of the DQ6 antigen, has been identified as the DQ6 subtype with the strongest association with narcolepsy type 1 (NT1). As many as 98% of patients diagnosed with narcolepsy-cataplexy are positive for DQB1*06:02. However, DQB1*06:02 has a prevalence of 12-38% in the general population and is commonly found in individuals without NT1. Testing for DQB1*06:02 may still be helpful in the diagnosis of patients with symptoms characteristic of narcolepsy owing to its high negative predictive value of 99%. When ordered appropriately, HLA-testing may reduce unnecessary sleep studies on patients.

Methods

All patients who underwent genetic testing for HLA DQB1*06:02 at our institution between 2015 and 2021 were included (n=8). A retrospective chart review was conducted to gather data on age, gender, total sleep time, apnea-hypopnea index, sleep efficiency, sleep latency, rapid eye movement (REM) latency, mean sleep latency, sleep-onset REM episodes, HLA DQB1*06:02 result, ordering specialty, whether genetic testing was performed before or after multiple sleep latency test (MSLT) and the final diagnosis. These parameters were evaluated in all patients to determine the utility of genetic testing in narcolepsy.

Results

The patients’ age ranged from 15 to 83 years old and 6 of 8 patients (75%) were male. 38% of tested patients were positive for HLADQB1*06:02. One patient with narcolepsy type 1 by MSLT was negative for HLA DQB1*06:02. 1 of 3 patients (33%) with a positive HLA DQB1*06:02 proceeded to have an MSLT performed at our institution. The ordering specialty was neurology in 7of 8 (87.5%) patients.

Conclusion

HLA DQB1*06:02 testing should not be ordered on patients with an MSLT consistent with narcolepsy. If a high index of suspicion for narcolepsy is present and HLA DQB1*06:02 testing is ordered, a positive result should be followed by an MSLT as it was uncertain an MSLT was ever obtained anywhere in these patients. Genetic testing with HLA DQB1*06:02 did not change management in any of the patients where it was performed. Consultation with a sleep specialist prior to performing HLA DQb1*06:02 testing to determine its medical necessity may be a cost-effective strategy.

Support (If Any)

none
0427 Having Insomnia vs. Identifying as an “Insomniac”: What is the role of insomnia severity?
Authors: Boyle Julia , Muench Alexandria , Thompson Michelle , Seewald Mark , Vargas Ivan , Perlis Michael
Published: May 2022

Introduction

The present study sought to evaluate whether insomnia severity (i.e., sleep continuity disturbance) is worse in those who endorse insomnia identity (i.e., identify as an “insomniac”) vs. those who endorse “having insomnia.”

Methods

This study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area. This dataset (n=3,483) was comprised of adults between 18 and 90 years of age (X̅age=53.6±11.0; female [76.4%]; White [91.4%]). All subjects in this analysis endorsed sleep problems. Subjects answered questions regarding demographics, sleep continuity (in minutes), and insomnia identity (“Do you think of yourself as someone that has insomnia” and “do you think of yourself as an ‘insomniac’"?). For both questions, individuals were categorized by their answers: strongly agree, agree, undecided, disagree, strongly disagree. MANOVAs and two-way ANOVAs were conducted to assess group differences (α=.01).

Results

Most individuals endorsed “having insomnia” (n=2,301 [66.1%; strongly agree and agree]) but did NOT endorse being an ‘insomniac’ (n=1,981 [56.9%; undecided, disagree, and strongly disagree]). For all measures, except TST, the two groups did not differ with respect to insomnia severity (i.e., SL[55.4±48.5;60.5±52.1], WASO[45.1±51.7;47.6±55.3], EMA[71.8±51.6;72.9±52.4], and TST [328±75.5;319.6±76.4, p=.009]). The magnitude of the differences between these groups ranged from 1-10 minutes.

Conclusion

It was found that individuals are more likely to endorse ‘having insomnia’ than they are to endorse being an ‘insomniac.’ Despite the implicit differences in “having” something vs. “being” something, the groups did not differ appreciably with respect to sleep continuity. Thus, the tendency to have insomnia identity may not be related to insomnia severity considerations. It is possible, if not likely, that such differences may be related to frequency or chronicity of insomnia. Barring, or in addition to these things, insomnia identity may be related to the mismatch between sleep ability and need and/or related to other non-specific factors. Future directions include refining the group definitions to include forms of insomnia identity that occur with relatively normal sleep continuity (i.e., normal severity and/or frequency and/or chronicity). It will also be important to evaluate whether the various forms of insomnia identity vary with age, sex, or disease comorbidity.

Support (If Any)

K24AG055602
0432 Insomnia is Associated with Endothelial Dysfunction in Young Adulthood: the Penn State Child Cohort
Authors: Fernandez-Mendoza Julio , Gao Zhaohui , Calhoun Susan , Brandt Kristen , He Fan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: May 2022

Introduction

Clinical and population-based studies in middle-aged and older adults have shown that insomnia is associated with prevalent and incident cardiovascular diseases. However, there is a lack of studies demonstrating an association between insomnia and subclinical cardiovascular measures such as endothelial function in young adults from the general population.

Methods

We studied 200 subjects from the Penn State Child Cohort (20-30 years old, 47% male, 22% racial/ethnic minority), who underwent a thorough clinical history and physical examination to ascertain the presence of sleep disorders and body mass index (BMI), in-lab polysomnography to ascertain the apnea/hypopnea index (AHI), and Doppler ultrasound to assess flow-mediated dilation (FMD). We identified the presence of moderate-to-severe difficulties initiating and/or maintaining sleep (i.e., poor sleep) and of insomnia, the latter including a physician diagnosis of the disorder. The study outcome was FMD as a continuous measure and the square root of FMD (sqrt-FMD) to test the robustness of the analysis. General linear models adjusted for sex, age, race/ethnicity, BMI, AHI, alcohol intake, and sleep medication use.

Results

Compared to normal sleepers (0.111±0.003), subjects with poor sleep (0.104±0.006) and insomnia (0.092±0.008) showed a significant association with lower FMD levels (p-linear<0.05), with subjects with insomnia having significantly lower FMD levels (p=0.029). Results remained significant and in the same direction based on sqrt-FMD (p-linear=0.015).

Conclusion

These data indicate that insomnia is associated with increased risk for cardiovascular disease as early as young adulthood, and independent of major contributors such as obesity, sleep apnea or alcohol use. These data further reinforce the need to include insomnia as a target in the preventative efforts for cardiovascular disease.

Support (If Any)

National Institutes of Health (R01HL136587, UL1TR000127)
0433 Does Social Media Use Before Bed Lead to Sleep Continuity Disturbance?
Authors: Snyder Hope , Walker Jamie , Bell Jessica , Egeler Mara , Hire Veronica , Vargas Ivan
Published: May 2022

Introduction

Research shows that the use of electronics before bed can negatively impact the circadian rhythm and sleep. Less is known, however, about social media use in relation to sleep continuity disturbance (i.e., insomnia). In the early months of the COVID-19 pandemic, social media use increased and updates about the pandemic were easily accessible online. It is possible that social media use before bed could introduce additional psychological stressors due to availability of negative content online and known correlations to depression and anxiety. Thus, the aim of this research was to examine how social media use before bed influenced different subtypes of insomnia during the initial months of the pandemic.

Methods

4,138 adults (mean age = 45.8 years; 79% women) completed a national online survey during April – June 2020. Social media use before bed was measured using the first item on the Social Media Engagement questionnaire (i.e., “How often do you use social media in the 15 minutes before you go to sleep?”). Participants responded to this item based on how many days per week (range = 1-7). Sleep disturbance was assessed using a retrospective sleep diary and the Insomnia Severity Index (ISI). The sleep diary asked about sleep continuity (e.g., sleep latency, wake after sleep onset, total sleep time) during the past month.

Results

Results from separate regression analyses supported that social media use before bed was positively related to greater ISI scores, b = 0.25, t = 8.0, p < 0.001. For example, those who use social media before bed every day reported greater mean ISI scores and sleep latency times (mean ISI = 9.5; SL = 37.5 minutes) compared to those who reported never using social media before bed (mean ISI = 7.7; SL = 27.9 minutes). In contrast, social media use before bed was not related to other sleep continuity variables.

Conclusion

The present data supports that social media use before bed is related to insomnia symptoms, specifically difficulty with sleep initiation. These findings are significant as they may help us understand which aspects of insomnia are most vulnerable to the negative impact of online social interactions, especially during a highly stressful period, such as the COVID-19 pandemic.

Support (If Any)

K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)
0445 Non-pharmacological Insomnia Therapy is Robust to Co-occurring Pain in Older Adults
Authors: Krause Adam , Ahmadi Maryam , O'Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Saletin Jared , Goldstein-Piekarski Andrea
Published: May 2022

Introduction

Pain worsens insomnia symptoms and increases hyperarousal during sleep. The effectiveness of treatments for improving insomnia symptoms may therefore be affected by co-occurring pain, though this currently remains unknown.

Methods

We tested the hypotheses that (1) higher levels of pain will lead to smaller improvements in subjective and objective markers of insomnia following a non-pharmacological insomnia treatment and (2) insomnia treatment will moderate the relationship between pain and markers of insomnia. 114 adults >60 years (age=69.7, SD=6.3, 66% female) with insomnia (Insomnia Severity Index [ISI] score >10, Mean=16.1, SD=4.5) underwent polysomnographic (PSG) recordings before and after completing a 6-session non-pharmacological insomnia treatment regimen. Pain severity (Brief Pain Inventory), insomnia symptoms (ISI), and hyperarousal derived from the PSG (relative α-band power [7.5-12.0Hz] across all sleep stages) were acquired at each time-point. Two-tailed paired t-tests were used to determine the main effects of treatment on insomnia and alpha power. Ranked-correlation tests were used to assess the impact of baseline pain on treatment outcomes, and mixed-effects models were employed to assess whether the relationship between pain and markers of insomnia differed pre- and post-treatment.

Results

Non-pharmacological insomnia treatment reduced insomnia symptom severity (t=19.4, p<0.001) but not α-power (t=0.97, p=0.33). Baseline pain severity was not associated with insomnia symptom improvement (ρ=-0.09, p=0.49) nor with changes in α-power (ρ=-0.19, p=0.23). There was no significant pain-by-time interaction in determining insomnia symptom improvement (β=-0.05, t=-0.18, p=0.86), and a trending pain-by-time interaction in determining changes in α-power (β=-0.007, t=-1.8, p = 0.07).

Conclusion

These findings suggest that pain is not likely to alter the effectiveness of non-pharmacological treatment for subjective insomnia symptoms, but pain may reduce change in the markers of hyperarousal in older adults with co-occurring pain and insomnia.

Support (If Any)

National Institute of Mental Health grant 1R01MH101468-01