bluuebunny/crossref_metadata_2025 huggingface dataset:
0507 Prevalence and Components of Naptime vs. Bedtime Routines in Young Children
Authors: Mindell Jodi , Leichman Erin , Rotella Katie
Published: May 2022

Introduction

Bedtime routines are a well-established sleep-promoting practice for young children; however, little is known about the prevalence or components of naptime routines. Thus, the aim of this study was to explore the prevalence and activities (e.g., feeding, hygiene components) of home-based naptime routines for infants and toddlers.

Methods

Mothers of 465 infants and toddlers (4-36mos; M=18.5mos) completed an online questionnaire addressing questions about naptime routines and behaviors, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). The sample included infants (4-11.9m; n=147), younger 1-year-olds (12-17.9m; n=87), older 1-year-olds (18-23.9m; n=75), and 2-year-olds (24-36m; n=156).

Results

Overall, 95% (n=440) reported that their child naps at home, and 65% (n=301) indicated having a naptime routine lasting approximately half an hour (M=29.0 minutes; SD=31.0). As compared to 54% reporting a consistent naptime routine (³5 times per week), ranging from 50% in 2yos to 62% in younger-1yos, 81% had a consistent bedtime routine. Overall, mothers reported a mean 69.0% (SD=24.4) similarity between naptime and bedtime routine steps. A bath (18% at naptime vs. 90% at bedtime), washing-up (30% vs. 56%), lotion use (23% vs. 80%), breastfeeding/breastmilk (21% vs. 37%), and feeding to sleep (44.% vs. 47%) were less prevalent at naptime than bedtime.Prevalence ranges by age group were: bath 12% (2yos) to 23% (infants) at naptime and 84% (infants) to 93% (2yos) at bedtime; washing-up, 28% (infants) to 34% (older-1yos) at naptime and 54% (younger-1yos) to 58% (infants) at bedtime; lotion application, 19% (2yos) to 29% (younger-1yos) at naptime and 78% (2yos) to 83% (younger-1yos) at bedtime; breastfeeding, 8% (2yos) to 35% (infants) at naptime and 13% (2yos) to 65% (infants) at bedtime; and feeding to sleep, 31% (2yos) to 57% (infants) at naptime and 35% (2yos) to 58% (infants) at bedtime.

Conclusion

Overall, nearly all infants and toddlers napped, and just over half reported having a naptime routine. Naptime routines were much less prevalent than bedtime routines, but overall contained similar activities. Feeding behaviors across naptime and bedtime routines were more similar than hygiene components (e.g., bath), with slight variation by age. Psychoeducation about a naptime routine’s potential benefit may be warranted.

Support (If Any)

Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0512 Concurrent and longitudinal linkages between bedtime routines and social-emotional development in toddlers
Authors: Lam Joey , Heere Megan , Williamson Ariel , Mindell Jodi
Published: May 2022

Introduction

Sleep is important for optimal development in early childhood. Instituting a consistent bedtime routine is an empirically supported behavioral intervention to promote early childhood sleep health. However, prior work has focused on the benefits of a bedtime routine for sleep outcomes, with little research on its potential benefits to social-emotional development. Thus, the current study examined concurrent and longitudinal associations between a consistent bedtime routine (defined as 5 or more nights per week) and social-emotional development in toddlers (ages 12.0 to 19.9 months).

Methods

Caregivers of 32 infants (M = 12.5mos, 59.4% female) completed baseline questionnaires about the frequency of their child’s bedtime routine and other evening activities at their scheduled 12-month well-child visit. At their child’s 15-month well visit, caregivers completed questionnaires including items on bedtime routine frequency, the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

Results

Over half (59.4%) of caregivers reported a consistent child bedtime routine at 12 months and nearly three quarters (71.9%) reported a consistent bedtime routine at 15 months. Linear regression showed that having a consistent bedtime routine at 15 months was significantly associated with fewer concurrent social-emotional problems on the BITSEA, B = -2.40, p = .009, 95% CI [-3.86, -.94]. Toddlers who scored above the BITSEA cutoff for social-emotional concerns (31.3%) were engaged in a consistent bedtime routine less frequently (M = 4.50 nights/week) than those below the cutoff (M = 6.18 nights/week), p = .004, η2 = .24. However, bedtime routine frequency at 12 months did not predict 15-month BITSEA concerns, p>.05. No associations emerged between bedtime routine frequency at 12 or 15 months and the communication and personal-social ASQ scores.

Conclusion

A consistent bedtime routine is concurrently, but not longitudinally, associated with positive social-emotional development, including less frequent clinically significant concerns, in toddlers at 15 months of age. Bedtime routine frequency was not linked to communication or personal-social interactions. Implementing a consistent bedtime routine may be a feasible method to promote toddlers’ social-emotional development within the context of concerns.

Support (If Any)

This study was partially funded by the Simms/Mann Institute
0513 Sleep in Children in Need of a Bed and Living in Poverty
Authors: Carson Mikalya , Lamanna Erin , Dunnewald Majalisa , Fay Kate , Kyck Fiona , Mindell Jodi , Williamson Ariel
Published: May 2022

Introduction

Healthy sleep is important for child development, with youth living in poverty and especially those who do not have a bed at greater risk for sleep issues. This study assessed sleep in school-aged children identified by social services as needing a bed and living in poverty.

Methods

Fifty-two families (100% living ≤ 100% of the US poverty line) of children ages 8-12 years (M= 9.65; 55.8% girls; 61.5% non-Latinx Black) referred to a non-profit bed provision program completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of child sleep disturbances, sleep-related impairment, and sleep practices prior to bed provision. Comparisons were made to normative data for each measure based on converted T-scores/means.

Results

T-scores (M = 50; SD = 10) for caregiver and child reported child sleep disturbances (M= 46.81 and 47.22, respectively) and sleep-related impairment (M= 56.82 and 53.33, respectively) fell within the normal range. Although few caregiver-child dyads reported clinically significant (> 1 SD above the mean) child sleep disturbances (7.7% and 10.8%, respectively), 30.7% of caregivers and 27.4% of children reported clinically significant child sleep impairment scores compared to an expected rate of 15.9% from normative data. Regarding sleep practices, few caregiver (11.5%) and child (9.8%) reports of problematic sleep timing and caregiver-rated child bedtime routine inconsistency (13.5%) were > 1 SD above the normative mean. However, 25.5% of youth reported inconsistent bedtime routine scores > 1 SD above the normative mean, while 25.0% of caregivers and 31.4% of youth reported scores > 1 SD above the normative mean for child difficulty falling asleep without caregiver presence at bedtime. The prevalence of these elevated scores were greater than the expected prevalence of 15.9% in normative data.

Conclusion

Overall, children living in poverty and without an individual bed score similar to normative samples on sleep measures. However, a greater proportion of youth in this sample showed clinically significant sleep impairments and poor sleep practices compared to normative data. Future studies are needed to understand and promote healthy sleep among youth living in poverty.

Support (If Any)

American Academy of Sleep Medicine Foundation
0532 Defining Sleep Architecture in Pediatric Patients with Prader Willi Syndrome
Authors: Patel Neha , Lew Jenny , Nino Gustavo , Weiss Miriam , Aziz Julia
Published: May 2022

Introduction

Prader Willi Syndrome (PWS) is a rare genetic disorder characterized by infantile hypotonia, hyperphagia leading to early childhood obesity, and short stature. PWS patients are at risk for multiple sleep abnormalities including increased risk of obstructive sleep apnea, central sleep apnea, and excessive daytime sleepiness. The limited studies reviewing PSGs in pediatric PWS patients showed varying results. Our study aim is to characterize sleep characteristics in pediatric patients with PWS.

Methods

We conducted a retrospective chart review of pediatric patients with a genetically confirmed diagnosis of Prader Willi Syndrome from 2007 to 2015. In lab polysomnograms were scored using the AASM criteria for pediatric sleep studies. Data was collected on sleep architecture parameters and compared to normative data available for pediatric polysomnography. Given large variability in sleep architecture during infancy, subjects were divided into two age groups (< 1 years old, 1-19 years old).

Results

Fifty-one PSGs were reviewed of which 31 (60.7%) belong to males and 20 (39.3%) belong to females. Forty-one PSGs were initial studies and 11 were repeat studies. Age at the time of sleep study ranged from 11 days to 19 years old. 8 (15%) subjects were less than 1 years old and 44 (84%) were 1 year and older. For subjects less than one year old, mean sleep onset latency (min) was 21±33.4, REM onset latency (min) 35±27.2, SWS(%) 43.3±10.2, REM(%) 35.3±7.35, arousal index 9.7±11.9, wake after sleep onset (WASO) (min) 59.5±11.4 and sleep efficiency 82.4±9.4. For the 1-19 year age group, mean sleep onset latency (min) was 24.5±23.1, REM onset latency (min) 104± 59.9, SWS (%) 21.4±7.11, REM (%) 21.3±6.9, arousal index 7.3±5.4, WASO (min) 46.5±36.10 and sleep efficiency was 85.7±9.0.

Conclusion

In our population of PWS patients, REM onset latency was not decreased as shown in previous studies. Sleep efficiency was decreased. Other sleep parameters fell within normal range. Additional data on signs of excessive daytime sleepiness and sleep disordered breathing in this population is needed to understand if EDS persists with decreased sleep efficiency and otherwise normal sleep parameters and/or with OSA.

Support (If Any)
0541 Auto PAP adherence determinants of children during the pandemic: A single center experience
Authors: Rao Harish , Harrison Jessica , Slaven James , Bandyopadhyay Anuja , Jalou Hasnaa
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete upper airway obstruction, associated with gas exchange abnormalities, and sleep disruption resulting in OSA syndrome. OSA in majority of children improves after adenotonsillectomy, but with comorbidities or severe OSA, there is a high risk of residual OSA. Positive airway pressure (PAP) is a more definitive therapy for residual OSA when well tolerated. Reported CPAP adherence in children varies from 11-78%, but data on AutoPAP (APAP) acceptability and adherence has not been described.

Methods

Due to the limitations placed on PAP titration during the SARS-COV-2 pandemic, children (range 2-18 years) diagnosed with OSA at our institution were placed on APAP therapy (Auto CPAP or Auto BiPAP). We performed a retrospective analysis of APAP download data of children who met the criteria (adherence at 90 days>4 hours). Adherent (usage>70%) and non-adherent children were compared using Wilcoxon rank sum test. Logistic regression analyses were performed the effect of covariates including age, PSG AHI, Day 1-7 usage, Day 1-7 residual AHI, Day 1-14 usage, Day 1-14 residual AHI, Day 1-30 usage, Day 1-30 residual AHI or mean pressure at 90 day on compliance at 90 days.

Results

On day 90, 73 out of 90 children (40 boys) were using APAP >4 hours. Age, diagnostic PSG AHI, residual AHI (days 1-7; 1-14, 1-30), APAP median pressure, pressure (95% centile), and pressure (maximum) had no effect on adherence. Adherence at days (1-7; 1-14; 1-30) and day 1-90 residual AHI had a positive effect on adherence at day 90. There was no statistically significant difference in BMI z-score, age, PSG AHI, median pressure between the two groups. However, residual AHI was lower in the compliant group.

Conclusion

APAP was fairly well accepted in our study with the majority of children with usage > 4 hours at day 90. Adherence on (days 1-7 and 1-30) predicted APAP usage at day 90. This mirrors adherence data from adult OSA patients. APAP was effective in the compliant group with lower residual AHI. Further analysis of adherence characteristics such as; family history of PAP, PAP mode, mask, surgery and comorbidities is planned.

Support (If Any)
0562 Associations of Insomnia Symptoms and Unhealthy Alcohol Use with Post-Operative Healthcare Utilization in Veterans Undergoing Decompressive Laminectomy for Lumbar Spinal Stenosis
Authors: Tighe Caitlan , Bachrach Rachel , Perera Subashan , Weiner Debra
Published: May 2022

Introduction

Lumbar spinal stenosis (LSS) affects 11-39% of adults and contributes to significant pain and disability. Decompressive laminectomy (DL) is a common surgical intervention for LSS but many with medical and psychosocial comorbidities may not improve. Insomnia and unhealthy alcohol use, for example, are common among people living with chronic pain and may affect key laminectomy outcomes, such as healthcare utilization rates. We examined associations of self-reported rates of post-DL healthcare utilization in Veterans with insomnia symptoms and alcohol use.

Methods

We analyzed data from a multi-site prospective cohort study of Veterans with LSS undergoing DL. Participants (N=200) self-reported prior 12-month alcohol use behavior (Short Michigan Alcohol Screening Test; SMAST) and prior two-week insomnia symptoms (Insomnia Severity Index; ISI) prior to surgery; 12-months of post DL healthcare office visits, ER visits, hospitalizations, and mental health visits were reported over the telephone monthly. Negative binomial regression models via incident rate ratios (IRR) compared healthcare utilization rates between individuals reporting alcohol-related problems only (SMAST >2), insomnia symptoms only (ISI ≥ 8), and both to those reporting neither.

Results

Approximately 52% of participants reported insomnia symptoms, 75% unhealthy alcohol use, and 39% both. Rates of office, ER, and hospital visits were descriptively highest in those reporting insomnia only; mental health visits were highest in those with both insomnia and unhealthy alcohol use. Those with insomnia only had more ER (IRR=2.39, p=.04) and mental health visits (IRR=4.32, p=.03) than those with neither insomnia nor unhealthy alcohol use; individuals with both insomnia and unhealthy alcohol use also had more mental health visits (IRR=4.22, p=.01). Adjusting for covariates rendered IRRs attenuated and statistically nonsignificant, but magnitudes remained high.

Conclusion

Most Veterans with LSS reported insomnia symptoms and/or unhealthy alcohol use. Those with insomnia symptoms reported the highest rates of healthcare utilization, including higher rates of ER and mental health visits. Insomnia symptoms may contribute to post-operative healthcare utilization, lending support for assessment and intervention of sleep-related problems pre-laminectomy.

Support (If Any)

This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, grant # RX000798. Dr. Tighe is supported by Career Development/Capacity Building Award Number IK2 RX003393 from the United States (U.S.) Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. Dr. Bachrach is supported by a U.S. Department of Veterans Affairs Health Services Research and Development Service (HSR&D) Career Development Award (CDA 20-057).
0568 Multidimensional Sleep Health and Mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Chung Joon , Goodman Matthew , Lutsey Pamela , Huang Tianyi , Bertisch Suzanne , Redline Susan
Published: May 2022

Introduction

Prior research on the association of sleep with mortality has tended to focus on single sleep dimensions such as insufficiency. However, sleep health is conceptualized to consist of multiple inter-related dimensions: prior work suggests that simultaneous consideration of multiple sleep dimensions may better predict health outcomes than individual sleep measures considered in isolation. We tested the hypothesis that better multidimensional sleep health is associated with lower mortality in the Multi-Ethnic Study of Atherosclerosis, an ethnically-diverse prospective cohort study.

Methods

At baseline (2010-2013), sleep was measured objectively by at-home polysomnography and 7-day wrist actigraphy, additionally by validated questionnaires. A composite sleep score was constructed in a prior project by summary index whose interpretation is the sum/count of 13 sleep attributes, selected a priori, which met clinical criteria for favorability. We used proportional hazards models to estimate the association between sleep health scores and all-cause mortality, adjusting for socio-demographics, and lifestyle/behavioral factors such as smoking status, alcohol consumption, and Body Mass Index.

Results

1,757 participants were followed for a median of 5.9 years (Q1-Q3, 5.4–6.4 years) until death or last contact (128 deaths). After adjustment, each unit increase in composite sleep health scores (indicating healthier sleep) were associated with a 12% lower mortality risk (HRsummary_index: 0.88; 95% CI: 0.80, 0.96). This result was further supported by a similar association with mortality of a sleep score constructed by Principal Components Analysis. In post-hoc analyses, achievement of favorable actigraphic-estimated sleep regularity (midpoint sd <30 minutes; duration sd <90 minutes), sleep duration (6-8 hours), and Apnea-Hypopnea Index (≤15 events/hour) were significantly associated with lower mortality. Associations with mortality were in the expected direction for % N3, % R, and sleep fragmentation.

Conclusion

More favorable multidimensional sleep is associated with reduced mortality risk. Of specific sleep dimensions, sleep regularity, duration, and obstructive sleep apnea are suggested to be public health targets to potentially reduce risk of premature mortality.

Support (If Any)

This work was supported by the following National Institute of Health (NIH) grants: 5T32HL007901-19, 5K01HL138211-05, K01HL143034, R01HL098433. SR was partly funded by the NIH National Heart, Lung, and Blood Institute (NHLBI) R35HL135818.
0591 Use of FOSQ to characterize sleep disturbances in hospitalized patients with COPD exacerbation
Authors: Aiyer Ishan , Gill Yash , Taweesedt Pahnwat , Chohan Asad , Ratnani Iqbal , Surani Salim
Published: May 2022

Introduction

Sleep disturbances are common in COPD. Hospitalization due to COPD exacerbations likely have a negative impact on sleep in these patients and may contribute to their recovery. The aim of this study was to measure the prevalence of sleep disturbances in hospitalized patients with COPD and characterize their impact by use of the Functional outcomes of Sleep questionnaire (FOSQ).

Methods

The study was done at a community hospital. We included all patients who were admitted with a diagnosis of acute COPD exacerbation. Patients were administered the FOSQ on the day of discharge. Standard statistical methods were used to analyze the data

Results

A total of 54 patients - 28 males and 26 females filled out the questionnaire completely and were included in the analysis. The mean age was 66 +/- 14 years. The average FOSQ was 15 +/- 7. 60% of the patients had a FOSQ of <17.9 showing a high prevalence of sleep morbidity. Individual domains of the FOSQ -( mean +/- SD) showed the following values : General productivity of 3 +/- 2, vigilance 2.5 +/- 2.2, activity 7.2 +/- 2.2, and social outcomes 0.6 +/- 0.9 respectively. Vigilance scores and social outcomes domains were seen to be lower than those previously reported in patients with severe sleep apnea while activity domains were seen to be higher.

Conclusion

There is significant sleep-related morbidity in hospitalized patients with COPD exacerbation, with particularly high prevalence of overall sleep disturbances even after recovery and at the time of discharge. Domains related to social outcomes were the most affected, and vigilance domain scores were critically low. These data point to an urgent need for clinicians to include assessment of sleep quality while discharging patients with COPD exacerbations and providing them appropriate counseling. Future studies should focus on the best interventions to improve sleep in the patients and measure its impact on their lung function.

Support (If Any)

None
0661 Lightbox Therapy for Seasonal Affective Disorder in College Students
Authors: Zhang Meina , Guist Caitlin , Rossmann Patrick , Moon Chooza
Published: May 2022

Introduction

Seasonal affective disorder (SAD) is a mental health issue that can be defined as depressive mood disturbances that align with a seasonal pattern. Research shows that college students are at a higher risk of having SAD leading to poor academic performance and other severe mental disorders. Light therapy can help alleviate the symptoms of SAD. However, few detailed investigations have been conducted on the impacts of light therapy for SAD symptoms and adherence barrier for the therapy. The purpose of this project was to review a light therapy program for college students. Specifically, we aimed to assess the changes in depressive symptoms before and after using a light box and assessed feedback.

Methods

207 college students (mean age of 22.5 years (SD=5.3); female (80.7%)) participated in the light therapy program. Participants were given user instructions and asked to utilize the lightbox daily. Participants completed the patient health questionnaire (PHQ-9) at baseline and when they returned the lightbox along with their feedback of this therapy. Students also completed the open-ended questions. We used paired sample t-test to assess changes in the total PHQ-9 score.

Results

Participants spent 45 days, on average, using the device. Results showed that there was a significant decrease in PHQ-9 score from pre- to post-therapy [M(post-pre) = -2.78; p < .0001]. Most students said the therapy was effective (96.5%) and helped ease SAD symptoms and improve their mood. Some students planned to purchase a light box after the therapy. The major adherence barriers were finding enough time to use it and excessive brightness issue.

Conclusion

The findings suggest that light therapy has positive outcomes in easing college students’ SAD symptoms. Future randomized control trials are needed to assess the effectiveness of the intervention. However, to the time and brightness issues need to be assessed when designing the therapy instructions for college students.

Support (If Any)

This work was supported by the Alzheimer’s Association Research Grant (AARG-19-618403), University of Iowa Institute for Clinical and Translational Science (NIH/NCATS, UL1 TR002537), and the University of Iowa Center for Advancing Multimorbidity Science (NIH/ NINR P20 NR018081).
0701 STOP-BANG Score, Age, and Body Mass Index Predict Severity of Sleep Disordered Breathing in Women Veterans
Authors: Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Fung Constance , Josephson Karen , Song Yeonsu , Agrawal Alpna , Zhu Ruoyan , Mitchell Michael , Badr M Safwan , Washington Donna , Yano Elizabeth , Zeidler Michelle , Alessi Cathy , Martin Jennifer
Published: May 2022

Introduction

Despite increasing evidence that sleep disordered breathing (SDB) is common in women veterans, little is known of how to screen for SDB in this population. Some evidence suggests there are sex-related differences in SDB presentation, where women may be more likely to present with fatigue or depression, compared to men who may present with daytime sleepiness. The goal of this study was to evaluate whether commonly used measures predict SDB in women veterans.

Methods

Women veterans (N=179) without treated SDB, but with 1 or more SDB risk factors (identified from electronic medical records) completed baseline assessment as part of an ongoing controlled trial of treatment for SDB. Measures included: age, body mass index (BMI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FSS), Insomnia Severity Index (ISI), Patient-Health Questionnaire 9-item (PHQ-9), STOP-BANG score, and apnea-hypopnea index (AHI via WatchPAT home sleep apnea testing). Descriptive statistics and bivariate correlations testing the relationship between AHI and other measures were performed.

Results

Mean age was 49.8 [±13.8] years and BMI 29.6 [±6.0] kg/m2. Mean ESS was 8.1, FFS 13.9, ISI 14.0, PHQ-9 7.1, and STOP-BANG score 2.7. Mean AHI was 15.4 [±13.2], where higher AHI correlated with higher BMI (r=0.3, p<0.001), higher STOP-BANG score (r=0.4, p<0.001) and older age (r=0.4, p<0.001).

Conclusion

These findings support the use of the STOP-BANG score to predict SDB severity in women veterans with risk factors for SDB. Age and BMI may be particularly important predictors of SDB in this population. Sleepiness, depression, insomnia, and fatigue questionnaires were not related to SDB severity. Further work is needed to understand the role of patient-reported symptoms in those at-risk for SDB and to inform guidelines for the recognition of SDB in this important and understudied population.

Support (If Any)

VA HSR&D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&D COIN; VAGLAHS GRECC.
0707 Effects of obstructive sleep apnea on Anti-SARS-COV-2 igg levels in older adults vaccinated against covid-19
Authors: Pires Gabriel , Andersen Monica , Rosa Daniela , Tufik Sergio , Tufik Sergio
Published: May 2022

Introduction

Sleep disorders and sleep deprivation induces decreased antibody response following vaccination for different viral diseases (including H1N1, influenza and hepatitis A). The same has been speculated for COVID-19. This study aimed to assess whether obstructive sleep apnea (OSA) reduces antibody levels after COVID-19 vaccination among older adults.

Methods

This was a convenience-sample study composed of older adults (≥60 years old). Those who underwent polysomnography at the Sleep Institute (São Paulo, Brazil) and received complete COVID-19 vaccination schedule were considered eligible. Individuals with previous diagnosis of COVID-19, less than 15 days between vaccination and IgG testing, or CPAP use in the last 3 months were excluded. Anti-SARS-CoV-2 IgG levels were measured using a chemiluminescence assay. The participants were distributed in the following groups, according to their apnea-hypopnea index (AHI): no/mild OSA (AHI<15), moderate OSA (AHI≥15 and <30) and severe OSA (AHI≥30). The effects of OSA on IgG levels (ANOVA), the correlation between IgG levels and AHI (Spearman’s correlation test) and the association between serostatus (positive vs. negative) and OSA severity levels (X2 test) were analysed. Results were considered as statistically significant when p<0.05.

Results

The sample included 122 older adults (median age 72.0 - IQR: 5.7), of whom 35 (28.6%) had AHI no/mild OSA; 31 (25.4%) had moderate OSA, and 56 (45.9%) had severe OSA. Oxford/AstraZeneca was the most referred vaccine (n=111, 91.0%), followed by CoronaVac (n=9, 9.0%). Seropositive status (IgG count ≥50.0 AU/mL) was observed in 90.2% of the participants and the median IgG levels in the complete sample was 273.0 AU/ML (IQR: 744.0). No/mild, moderate and severe OSA groups presented IgG levels of 482.0 (IQR: 677.0), 285 (IQR: 884.0) and 181.0 (IQR: 598.0), respectively, with no statistical difference them (p=0.606). There was no statistically significant correlation between AHI index and IgG levels (Spearman’s rho=-0.169, p=0.063) and no significant association between serostatus and OSA severity groups (X2=0.912; p=0.634).

Conclusion

Anti-SARS-CoV-2 IgG levels after vaccination are not significantly affected by OSA among older adults. Thus, despite being at higher risk for severe cases, OSA does not decrease the antibody response following vaccination against COVID-19.

Support (If Any)

AFIP, CNPq, CAPES
0774 Positive Airway Pressure Utilization, Major Adverse Cardiovascular Events Incidence Risk and Mortality in Medicare Beneficiaries with Obstructive Sleep Apnea
Authors: Mazzotti Diego , Waitman Lemuel Russell , Gozal David , Song Xing
Published: May 2022

Introduction

Positive airway pressure (PAP) is the first line treatment for moderate-severe or symptomatic obstructive sleep apnea (OSA). Randomized controlled trials have established that PAP therapy has beneficial impact on cardiovascular and metabolic functions. However, evidence on the benefits of PAP for preventing major adverse cardiovascular events (MACE) is limited. We aimed to determine the association between PAP utilization and incidence of MACE and all-cause mortality in a large sample of Medicare beneficiaries.

Methods

Medicare beneficiaries (>65 years) with at least 5 years of consecutive enrollment to part A and B and ≥2 distinct OSA claims were collected from multi-state (Kansas, Missouri, Iowa, Wisconsin, Nebraska, Minnesota, Texas, Utah, North Dakota, South Dakota and Indiana), multi-year (2011-2017) Medicare fee-for-service claims data. We further required at least 1-year enrollment before the first OSA claim. Evidence of PAP utilization and index date was defined based on the first Healthcare Common Procedure Coding System PAP initiation codes (E0601, E0470, E0471) after first OSA diagnosis. MACE was defined as the first occurrence of myocardial infarction, coronary revascularization, stroke, or heart failure (identified by diagnostic and procedure code claims) after PAP initiation. Analyses were adjusted by age at initial OSA diagnosis, sex, race and presence of hypertension, type 2 diabetes, obesity, and evidence of MACE prior to the index date.

Results

Our sample included 212,445 eligible Medicare beneficiaries with evidence of OSA diagnosis (mean [SD] age 75 [5.7] years; 45.2% women; median [Q1, Q3] follow-up 4 [2.0, 4.9] years at censoring). Five-year MACE cumulative incidence rate was 59.3% and the mortality rate was 17.8%. In adjusted analyses, OSA patients with evidence of PAP utilization (50.8%) had significantly lower MACE incidence risk (HR=0.812; 95%CI=0.803-0.822; p<0.0001) when compared to those without evidence of using PAP. OSA patients with evidence of PAP utilization also had significantly lower mortality risk (HR=0.575; 95%CI=0.560-0.591; p<0.0001). Pre-existing hypertension, type II diabetes and obesity were also significantly associated with increased mortality and MACE risk.

Conclusion

PAP utilization based on device initiation derived from claims data is associated with lower MACE incidence and mortality in older adults that are Medicare beneficiaries.

Support (If Any)

American Heart Association (20CDA35310360), Patient-Centered Outcomes Research Institute (RI-CRN-2020-003-IC); NIH CTSA NCATS Frontiers: University of Kansas Clinical and Translational Science Institute (UL1TR002366); Tier 2 grant, University of Missouri.
0779 Describing the OSA Patient Journey from Testing to PAP Treatment
Authors: Cole Kathleen , Dexter R Benjamin , Woodford Caleb , Sterling Kimberly
Published: May 2022

Introduction

Patients diagnosed with obstructive sleep apnea (OSA) and prescribed positive airway pressure (PAP) therapy for treatment may have differences in experience based on insurance provider, sex, age, or comorbidity status. This retrospective, real-world analysis investigated the factors that impact the patient’s OSA journey from initial sleep test to starting PAP therapy.

Methods

De-identified US administrative claims data for patients with OSA who had a claim for a sleep test were used for this analysis. Age, sex, and insurance coverage were characterized at the time of the first sleep test. Comorbidity status was evaluated in the year prior to the sleep test by assessing ICD-9/10 codes associated with healthcare encounters. This protocol was submitted to an Institutional Review Board and was determined to be exempt from oversight.

Results

In a population of 1,912,381 patients, 46.6% were female with mean age of 51.0 years. Insurance coverage was 70.6% commercial, 19.9% Medicaid, and 9.5% Medicare Advantage. Four comorbid cohorts were evaluated including those with hypertension (52.2%), type 2 diabetes (21.7%), COPD (9.7%), and atrial fibrillation (5.9%). Time from sleep test to receiving a PAP device was 7 days longer for females than males (median 49 days vs 42 days). Regardless of type of sleep test (polysomnography (PSG), home sleep test (HST)), those with commercial insurance received a device faster (median 41 days, Medicaid 61 days, Medicare Advantage 50 days). In comparison to those without the respective comorbidity, COPD was the only group with a noticeable increase in time from sleep test to device (median 54 days for those with COPD vs. 43 days for those without). No noticeable differences were observed across age categories. For those that had a titration, it occurred a median of 23 days after PSG or 34 days after HST. Consequently, the two fastest pathways were PSG with split night titration and HST without titration.

Conclusion

This retrospective study identified the length of time it takes in a real-world setting for patients to get a PAP device after a sleep test. Depending on demographic factors this time can vary from 1-2 months, delaying the start of OSA treatment.

Support (If Any)

ResMed
0788 The effect of CPAP on quality of life in females with mild OSA: Post hoc analysis from the MERGE Randomised Trial
Authors: Wimms Alison , Kelly Julia , Turnbull Chris , McMillan Alison , Craig Sonia , O’Reilly John , Nickol Annabel , Hedley Emma , Decker Meredith , Willes Leslee , Calverley Peter , Benjafield Adam , Stradling John , Morrell Mary
Published: May 2022

Introduction

The MERGE trial was a multi-centre, randomised, parallel study that showed the beneficial effect of continuous positive airway pressure (CPAP) on quality-of-life in patients with mild obstructive sleep apnea (OSA) (Wimms et al. 2019); findings that have extended the new NICE guidance [Obstructive sleep apnoea/ hypopnoea syndrome and obesity hypoventilation syndrome in over 16s (NG202)].This post-hoc analysis aimed to determine whether differences between the sexes in symptoms and treatment response exist at the mild end of the OSA disease spectrum.

Methods

Patients were recruited (Nov 2016 - Feb 2019) to receive either CPAP plus standard care, or standard care alone. Mild OSA was defined as: apnea-hypopnea index (AHI) >5 to ≤15 events/hr. Symptoms and quality-of-life were measured by a range of generic and disease specific questionnaires at baseline and 3 months post CPAP commencement.

Results

233 participants (30% female) were included in this analysis. Females were on average older (mean ± SD) (51.9±10.4 vs 49.8±12.2 years) with higher BMI (32.2±5.0 vs 29.4±3.7 kg/m2) and had a lower AHI than males (median(IQR)) (9.60(6.50 -12.40) vs 10.30(7.10-13.20) events/hour).Females were sleepier (Epworth Sleepiness Score (ESS) (mean ± SD) (11.0±4.2 vs 9.5±4.4)), more fatigued (Fatigue Severity Score (FSS) (42±12.8 vs. 34.4±13.5)) and reported higher levels of anxiety, depression and insomnia. Reported quality-of-life was lower in the SF- 36 mental (41.8±13 vs. 47.3±10.9) and physical components (43.0±11.2 vs. 49.7±9.1), as well as in all individual domains. Females also reported worse scores in the Euroqol 5 Dimensions (EQ-5D) and Functional Outcomes of Sleep Questionnaire (FOSQ), compared to males.All symptoms improved with CPAP use for both sexes, however female patients had larger improvements in the ESS (mean difference(95%CI)) (-5.2 (-6.7, -3.6) vs (-2.0 (-3.0, -1.0)) p=0.0035, and SF-36 vitality (11.7 (7.9, 15.5) vs 5.6 (3.1, 8.1)) p=0.0092.

Conclusion

In mild OSA, female patients were more symptomatic and reported worse quality-of-life than males, despite having lower AHIs; all were improved with CPAP treatment.

Support (If Any)

Funded by ResMed
0793 Postoperative Monitoring in Children less than 2 years of Age undergoing Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Bhushan Bharat , Lavin Jennifer , Yasuda Mayuri , Billings Kathleen
Published: May 2022

Introduction

To analyze variables associated with postoperative monitoring in children <2 years of age undergoing adenotonsillectomy (T&A) for the management of obstructive sleep apnea (OSA).

Methods

Retrospective case series of children <2 years of age who underwent T&A for the management of OSA between 1/1/08-6/1/18. Postoperative respiratory complications and hospital course were analyzed to determine higher acuity of monitoring in Intensive Care Unit (ICU) versus observation unit was indicated.

Results

A total of 69 children were analyzed. Fifty-two (75.4%) patients were male, and their mean age was 18.8 months. Fifty-six (81.2%) children had severe OSA, 6 (8.7%) had moderate OSA, and 7 (10.1%) children had mild OSA. Thirty-seven (53.6%) children were monitored in the ICU; one (2.7%) child was admitted to the ICU directly from the sleep lab, and3 (8.1%) children were intubated. The average Apnea Hypopnea Index (AHI) for those who were intubated was 64.6 events/hour and low SpO2 average was 66.3%, when compared to an average of 36.2 events/hour and 75.5% respectively for the entire group. Three (8.1%) patients needed >2 liters/minute of O2, and 5 (13.5%) had minor O2 requirements. Only 7/32 (21.9%) patients monitored in the observation unit required supplemental O2.

Conclusion

A greater severity of AHI and low SpO2 nadir were associated with respiratory issues requiring monitoring of children in ICU after T&A for OSA. No specific PSG cut-off values for ICU versus observation unit were noted. Low incidences of respiratory issues were observed, and most children could have been monitored safely outside of the ICU setting.

Support (If Any)

None
0804 Enhanced Drug-Induced Sleep Endoscopy: Distinguishing Central from Obstructive Apneas
Authors: Cheong Crystal , Schwartz Alan , Seay Everett , Mora Jorge , Thaler Erica , Dedhia Raj
Published: May 2022

Introduction

Drug-induced sleep endoscopy (DISE) is a useful tool for assessing upper airway collapse in patients with obstructive sleep apnea (OSA) and frequently influences surgical plans. The standard DISE setup of an endoscopic tower with flexible bronchoscope is adequate for visualizing collapse configurations, but endoscopic findings do not always correlate with actual respiratory physiology. We describe our enhanced clinical DISE setup incorporating nasal flow and respiratory effort measurements, which facilitates differentiation between central and obstructive events. Central sleep apnea was detected in two patients who were originally diagnosed with OSA and underwent DISE during hypoglossal nerve stimulation candidacy workup.

Report of Cases: Case 1 is a 58-year-old male with cardiomyopathy, atrial fibrillation and congestive heart failure who was diagnosed with moderate OSA on a home sleep apnea test. He was PAP intolerant due to claustrophobia. DISE during baseline breathing revealed complete anteroposterior collapse at the palate, tongue base and epiglottis. However, central apneas with Cheyne-Stokes breathing were noticed when positive airway pressure (PAP) was applied. A subsequent polysomnogram revealed severe sleep apnea which was primarily central in nature with Cheyne-Stokes breathing and OSA. He declined retrying PAP and opted for phrenic nerve stimulation.

Case 2 is a 48-year-old male with a history of aortic valve repair, hypothyroidism, atrial

fibrillation provoked by excessive thyroxine, hypertension and moderate OSA diagnosed on several polysomnograms. He had been treated previously with nasal and palatal surgery, oral appliances and PAP. DISE revealed complete anteroposterior collapse of the palate and tongue base, but also central apneas during baseline breathing and at low PAP levels. Polysomnogram performed following his DISE confirmed central sleep apnea which was positional in nature. He chose to undergo positional therapy instead of PAP or phrenic nerve stimulation.

Conclusion

The nasal flow and respiratory effort measurements included in our enhanced DISE setup enable the sleep surgeon to recognize the absence of respiratory effort even in the face of soft tissue collapse observed on videoendoscopy. These cases demonstrate the ability of propofol to preserve pathophysiologic mechanisms of sleep apnea (i.e. central versus obstructive), and underscore the importance of DISE as a diagnostic tool prior to sleep surgery.

Support (If Any)

NIH 1R01HL144859-01
0818 Psychosis associated with sodium oxybate
Authors: Bhattacharyya Sarathi , Eng Kevin , Harris Brian , Zeidler Michelle
Published: May 2022

Introduction

Sodium oxybate is commonly used to treat narcolepsy with cataplexy. At the approved doses, the most common side effects are typically described as nausea, vomiting, dizziness, hypersomnia, urinary disturbances, and weight loss. Cases of medication-induced psychosis have been reported in the literature but remain exceedingly rare. We present a case of rapid-onset psychosis in a patient with systemic lupus erythematosus, which added complexity to the evaluation, treatment and clinical course.

Report of Cases: The patient is a 42 year old woman with a past history of fibromyalgia, lupus and a prior diagnosis of narcolepsy evaluated for daytime hypersomnia and poor night time sleep. Prior medications included sodium oxybate which was effective; and modafinil and amphetamines which created intolerable side effects. Prior sleep studies were not available and a repeat PSG/MSLT were performed. PSG did not show sleep disordered breathing or nocturnal movements and MSLT showed an average sleep latency of 5.4 minutes and 4 SOREMs. HLA DQB10602 was positive. The patient was reinitiated on sodium oxybate and titrated to 4.5g twice nightly. A few weeks later the patient developed visual hallucinations, persecutory delusions, and insomnia for 3 days. She was admitted for an evaluation to rule out lupus cerebritis, and auto-immune vs. infectious encephalitis. MRI/MRA, lumbar puncture, as well as inflammatory markers and rheumatologic and infectious work up were unrevealing. Sodium oxybate was discontinued on the day of admission and the patient’s mentation returned to baseline over the next few days. Discharge diagnosis was psychosis secondary to sodium oxybate.

Conclusion

Psychosis is an extremely rare side effect of sodium oxybate therapy among patients treated for cataplectic narcolepsy. It remains a diagnosis of exclusion, and any alternative diagnoses must be explored prior to making the diagnosis of psychosis secondary to sodium oxybate, particularly in the medically complex patient.

Support (If Any)

None
0849 Baclofen-induced severe central sleep apnea
Authors: Agrawal Ritwick , Teague Taylor
Published: May 2022

Introduction

Baclofen is a gamma-aminobutyric acid-B agonist that targets neurons in the spinal cord and brain. It has skeletal muscle-relaxant properties and is FDA approved to treat spasticity from spinal cord injury (SCI), multiple sclerosis, or traumatic brain injury. Off label use includes treatment of alcohol use disorder, hiccups, and muscle spasms. A rare respiratory side effect of baclofen is apnea, with reports of baclofen-induced central sleep apnea (CSA) in a pediatric patient and four adults with alcohol use disorder. We describe a case of severe CSA in a veteran with T7 paraplegia due to chronic baclofen use.

Report of Cases: A 42-year-old veteran with T7 paraplegia was referred to sleep medicine for unrefreshing sleep. He had a remote history of spinal cord injury complicated by spasticity that was being treated with oral baclofen (40 mg TID). Further evaluation of unrefreshing sleep was obtained with baseline polysomnography. A total of 146 apnea and hypopnea events were observed (5 obstructive apneas, 131 central apneas, 4 mixed apneas and 6 hypopneas) for an AHI of 43.2 events/hour. Minimum oxygen saturation was 85% with 0.3 minutes spent <89%. Respiratory pattern was suggestive of crescendo decrescendo breathing but did not meet diagnostic criteria for Cheyne-Stokes respiration (cycle length <40 seconds). Other causes of CSA were investigated but unrevealing. A diagnosis of baclofen-induced central sleep apnea was made.

Conclusion

Spasticity is a common consequence of SCI and is commonly managed with baclofen. Apnea is a rare respiratory side effect of baclofen but can significantly impact patients’ sleep quality and overall quality of life. Our case highlights how providers should have a high suspicion for sleep-disordered breathing in patients with chronic baclofen use.

Support (If Any)

1. Ghanavatian S, Derian A. Baclofen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 15, 2021.2. Locatelli F, Formica F, Galbiati S, et al. Polysomnographic Analysis of a Pediatric Case of Baclofen-Induced Central Sleep Apnea. J Clin Sleep Med. 2019;15(2):351-354. Published 2019 Feb 15. doi:10.5664/jcsm.76443. Olivier PY, Joyeux-Faure M, Gentina T, et al. Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series. Chest. 2016;149(5):e127-e131. doi:10.1016/j.chest.2015.10.001
0852 Narcolepsy Type 1 in a Pediatric Patient with Temporal Lobe Epilepsy
Authors: Najimi Neda , Shahid Asim , Prero Moshe
Published: May 2022

Introduction

Narcolepsy type-1 is clinically characterized by irrepressible daytime sleepiness and REM-sleep dissociation, including cataplexy. Cataplexy usually manifests as episodes of brief, symmetrical sudden loss of muscle tone with retained consciousness. It may be difficult to distinguish from seizure activity as they may share overlapping features. We discuss a pediatric patient with temporal lobe epilepsy with co-occuring Narcolepsy Type 1.

Report of Cases: A 17-year-old boy with obesity and a history of focal epilepsy secondary to intracranial hemorrhage in the neonatal period status-post right parieto-occipital resection at age 11, presented with worsening fall episodes and feeling of imbalance Following surgery, his seizures improved, but he was having excessive sleepiness. At age 13, he started experiencing episodes of slurred speech, feeling of imbalance, “body heaviness and tongue heaviness” with occasional falls. He denied loss of consciousness, body shaking, stiffening, or incontinence.

At age 17, he presented to medical attention due to increasing frequency of such episodes.

Physical exam was significant for BMI 42.7 kg/m , Mallampati 4, tonsils 3+ bilaterally, and homonymous hemianopia. Epworth Sleepiness Scale: 22/24. Video EEG was negative for epileptiform discharges despite occurrence of above-mentioned episodes increasing the clinical suspicion of Narcolepsy. Polysomnography revealed sleep latency of 0 minutes, REM latency of 2.6 minutes, and mild OSA. Toxicology screen was negative. MSLT showed mean sleep latency of 1.2 minutes with 3 SOREMPs. CSF orexin could not be obtained due to technical constraints.

He was diagnosed with Narcolepsy type-1 and started on Venlafaxine and Methylphenidate with resultant improvement in both daytime sleepiness, and the severity and frequency of cataplexy.

However, his feeling of imbalance persisted, prompting repeat video EEG which demonstrated left temporal lobe seizure activity. Anti-epileptic regimen was optimized with improvement in sensation of imbalance.

Conclusion

Temporal lobe epilepsy and Narcolepsy Type-1 can have overlapping features that make it difficult to distinguish between the two. While exceedingly rare, the two entities may co-occur. Diagnostic and therapeutic management require coordination between Sleep Medicine and Neurology. While PSG, MSLT, and CSF Orexin can clarify the diagnosis of narcolepsy, neurologic work up should be pursued if symptoms are not completely attributable to Narcolepsy.

Support (If Any)