bluuebunny/crossref_metadata_2025 huggingface dataset:
428 Baroreflex sensitivity during handgrip in obstructive sleep apnea with and without CPAP
Authors: Pal Amrita , Martinez Fernando , Aysola Ravi , Harper Ronald , Henderson Luke , Macey Paul
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) disrupts multiple aspect of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS.

Methods

We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR and their variabilities: BPV and HRV (sympathetic-vagal).

Results

Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p < 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p < 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups.

Conclusion

BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage.

Support (if any)

NR-017435, HL135562
437 Efficacy of a novel oral appliance and the influence of OSA pathophysiological traits on treatment response
Authors: Tong Benjamin , Bull Christopher , Chiang Alan , Donegan Michelle , Brown Elizabeth , Kwan Benjamin , Eckert Danny
Published: May 2021

Introduction

Oral appliance therapy is a recommended alternative to CPAP for OSA. Approximately 50% of patients have a major reduction in OSA severity but successful treatment outcome remains challenging to predict. Previous prediction methods have focused on clinical variables which have poor predictive value. OSA is recognised as a heterogenous disorder caused by 4 pathophysiological traits. The influence of OSA pathophysiological traits on oral appliance treatment outcome has been explored in recent physiological studies using simplified phenotyping methods. In this preliminary report, we prospectively compared differences in the 4 OSA phenotypes between responders and incomplete responders to a novel oral appliance with built in oral airway using gold standard phenotyping methodology.

Methods

Data from 22 people with OSA (AHI>10events/h) have been analysed to date. A diagnostic in-laboratory PSG was initially conducted to confirm OSA. A detailed physiology PSG was carried out prior to commencement of oral appliance therapy. For this study night participants were instrumented with standard PSG equipment, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular electrodes inserted perorally into the genioglossus to quantify baseline OSA phenotypic traits. Pcrit was quantified via CPAP dial downs and the non-anatomical traits were quantified from naturally occurring apneas and hypopneas. Participants were then fitted with a next generation novel oral appliance with a built-in oral airway (Oventus O2Vent Optima™) and titrated to at least 75% of maximum mandibular advancement. After acclimatization to therapy, participants were invited to undergo a treatment efficacy PSG.

Results

Oral appliance therapy reduced the AHI by 52% (21[15,31] vs. 11[7,16] events/h, p<0.001). 46% of participants responded to oral appliance therapy based on the definition of AHI < 10events/h. Preliminary analyses indicated that estimates of baseline upper airway collapsibility tended to be different in responders versus non-responders (responders have less collapsible airways).

Conclusion

The novel oral appliance reduced OSA severity by 50% with resolution of OSA in half of participants. Baseline pharyngeal collapsibility may be an important physiological predictor of treatment outcome.

Support (if any):
453 Cost-Effectiveness of Requalifying for Positive Airway Pressure Treatment After Initial Nonadherence
Authors: May Anna , Wang Lu , Singer Mendel
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is effectively treated with continuous positive airway pressure (CPAP). However, many people are not able to become adherent in the initial 90-day trial window for this therapy. Medicare requires a polysomnography and repeat trial documenting adherence before continuing payment for these services. Oral appliance therapy (OAT) is also an OSA first-line therapy but is less effective than CPAP.

Methods

We created a decision tree to model 4 strategies over a 5-year time horizon: (1) current policy, (2) direct referral for CPAP equipment, (3) OAT followed by CPAP under current policy, and (4) OAT followed by direct CPAP referral in a the Medicare population with mild-moderate OSA and nonadherence to a first attempt at CPAP therapy. Medicare fee schedules in 2020 defined costs. Incremental cost-effectiveness (ICER) was used to identify the supreme strategy

Results

The current policy was the most expensive. Both the current policy and direct DME referral were dominated by starting with OAT. OAT followed by titration was the most cost-effective strategy with an ICER of $42,586.47. The ICER was sensitive to adherence in the direct CPAP strategy and probability of getting CPAP equipment (vs. lost to follow-up).

Conclusion

Starting with OAT therapy in those that were CPAP nonadherent on first attempt is cost-effective. Despite decreased effectiveness, the increase adherence to OAT make it an attractive option for retrial of OSA therapy. If OAT therapy fails, the current policy is more cost-effective than direct CPAP referral.

Support (if any)

This study was supported Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.
454 Obesity does not modify the effect of 4 months of CPAP on leptin or adiponectin
Authors: Pak Victoria , Maislin David , Keenan Brendan , Townsend Raymond , Benediktsdottir Bryndis , Guo Xiaofeng , Pack Allan , Gislason Thorarinn , Kuna Samuel
Published: May 2021

Introduction

Leptin and adiponectin are cytokines produced by adipocytes. Leptin is involved in the pathogenesis of obesity and adiponectin is cardioprotective. Previous studies in adults with obstructive sleep apnea (OSA) assessing the effect of continuous positive airway pressure (CPAP) on these cytokines are conflicting, and whether obesity modifies the effect remains unknown. We examined the baseline and follow up levels of changes in plasma leptin and adiponectin following 4 months of CPAP treatment among obese (BMI>30) and non-obese (BMI≤30) participants.

Methods

We evaluated 221 adults (84.6% males) in the Penn Icelandic Sleep Apnea (PISA) Study, with mean (±SD) body mass index (BMI) 31.7±4.9 kg/m2 and apnea-hypopnea index (AHI) 35.7±15.6 events/hour. Associations between changes in natural log of the biomarkers in obese and non-obese participants were evaluated, controlling for a priori baseline covariates of age, baseline BMI, race, sex, site, and current smoking status.

Results

The mean proportional change (from baseline to follow-up) in log-transformed adiponectin and leptin in CPAP adherent participants was not significantly different between BMI groups. The baseline to follow up change in leptin post-CPAP was 1.01 (95% CI 0.95–1.08) in obese participants and 1.05 (95% CI 0.96–1.14) in non-obese participants. For adiponectin, the change post-CPAP was 1.04 (95% CI 0.95–1.15) in obese participants and 1.08 (95% CI 0.96–1.22) in non-obese participants.

Conclusion

CPAP treatment did not have an impact on leptin or adiponectin levels. We also find no evidence for obesity modifying the effect of four months of CPAP on leptin or adiponectin.

Support (if any)

1P01-1HL094307
462 Redefining Positive Airway Pressure Adherence Phenotypes Utilizing Deep Neural Networks and Unsupervised Clustering
Authors: Nygate Yoav , Rusk Sam , Fernandez Chris , Glattard Nick , Watson Nathaniel , Hevener William , Beine Bretton , Munafo Dominic
Published: May 2021

Introduction

Improving positive airway pressure (PAP) adherence is crucial to obstructive sleep apnea (OSA) treatment success. We have previously shown the potential of utilizing Deep Neural Network (DNN) models to accurately predict future PAP usage, based on predefined compliance phenotypes, to enable early patient outreach and interventions. These phenotypes were limited, based solely on usage patterns. We propose an unsupervised learning methodology for redefining these adherence phenotypes in order to assist with the creation of more precise and personalized patient categorization.

Methods

We trained a DNN model to predict PAP compliance based on daily usage patterns, where compliance was defined as the requirement for 4 hours of PAP usage a night on over 70% of the recorded nights. The DNN model was trained on N=14,000 patients with 455 days of daily PAP usage data. The latent dimension of the trained DNN model was used as a feature vector containing rich usage pattern information content associated with overall PAP compliance. Along with the 455 days of daily PAP usage data, our dataset included additional patient demographics such as age, sex, apnea-hypopnea index, and BMI. These parameters, along with the extracted usage patterns, were applied together as inputs to an unsupervised clustering algorithm. The clusters that emerged from the algorithm were then used as indicators for new PAP compliance phenotypes.

Results

Two main clusters emerged: highly compliant and highly non-compliant. Furthermore, in the transition between the two main clusters, a sparse cluster of struggling patients emerged. This method allows for the continuous monitoring of patients as they transition from one cluster to the other.

Conclusion

In this research, we have shown that by utilizing historical PAP usage patterns along with additional patient information we can identify PAP specific adherence phenotypes. Clinically, this allows focus of PAP adherence program resources to be targeted early on to patients susceptible to treatment non-adherence. Furthermore, the transition between the two main phenotypes can also indicate when personalized intervention is necessary to maximize treatment success and outcomes. Lastly, providers can transition patients in the highly non-compliant group more quickly to alternative therapies.

Support (if any):
468 Optimizing treatment of the intra-oral negative air pressure for obstructive sleep apnea
Authors: Chen Chia-Chi , Lin Chia-Mo
Published: May 2021

Introduction

The intra-oral negative air pressure device (iNAP) is designed to develop a negative pressure gradient in the oral cavity of the user. The pressure gradient provides a force to move the tongue and soft palate forward. Previous works show the treatment response rate of intra-oral pressure therapy varying between 25–79%. However, for those OSA patients with very high BMI or AHI, they may need higher pressure to achieve optimizing treatment outcome.

Methods

To provide an optimizing treatment of intra-oral pressure, 30 patients treated with iNAP successfully completed one baseline PSG and one treatment PSG with in-laboratory pressure adjustment. When conducting the iNAP titration PSG, the initial treatment pressure is 40mmHg. iNAP pressure should be increased by at least 10mmHg an interval no shorter than 15 min. In order to eliminate obstructive respiratory events, iNAP pressure should be increased when observe obstructive apnea or hypopnea or unambiguous snoring.

Results

A total of 30 patients presented their consent to participate in this study. The mean age of the patients was 51.2 ± 13.97 years, and their mean body mass index (BMI) was 25.87 ± 3.41 kg/m2. The mean baseline AHI was 39.59 ± 20.05 events/h, which decreased significantly to 8.17 ± 8.11 events/h. No significant change in sleep efficacy, and percentage of N1 stage was found in the treatment PSG. However, significant improvements in the percentage of N3 stage, Min SpO2, and arousal index were observed in the treatment PSG.

Conclusion

In this study, the clinical response rate, as defined by the Sher criteria, was 86% (26/30 patients), when the Tx PSG response was compared with the baseline values. Besides, the mean AHI under final titration pressure is 2.58. The results show that increasing intraoral pressure would help to further improve the sleep apnea.

Support (if any)

This study was sponsored by Somnics, Inc.
475 Automatic detection of self-similarity and prediction of CPAP failure
Authors: Oppersma Eline , Ganglberger Wolfgang , Sun Haoqi , Thomas Robert , Westover Michael
Published: May 2021

Introduction

Sleep disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. Tolerance and efficacy of continuous positive airway pressure (CPAP), the primary form of therapy for sleep apnea, is often poor. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. The current study aimed to develop a computational approach to detect HLG based on self-similarity in respiratory oscillations during sleep solely using breathing patterns, measured via Respiratory Inductance Plethysmography (RIP). To quantify the potential utility of the developed similarity metric, the presented algorithm was used to predict acute CPAP failure.

Methods

We developed an algorithm for detecting apneas as periods with reduced breathing effort, manifested in the RIP signal as low signal amplitude. Our algorithm calculates self-similarity in breathing patterns between consecutive periods of apnea or hypopnea. Working under the assumption that high loop gain induces self-similar respiratory oscillations and increases the risk of failure during CPAP, the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict failure of CPAP, which we defined as titration central apnea index (CAI)>10. Central apnea labels are obtained both from manual scoring by sleep technologists, and from an automated algorithm developed for this study. The Massachusetts General Hospital (MGH) sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings.

Results

Diagnostic CAI based on technologist labels predicted failure of CPAP with an AUC of 0.82 ±0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ±0.02. A subanalysis was performed on a population with technologist labeled diagnostic CAI>5. Full night similarity predicted failure with an AUC of 0.57 ±0.07 for manual and 0.65 ±0.06 for automated labels.

Conclusion

This study showed that central apnea labels can be derived in an automated way. The proposed self-similarity feature, as a surrogate estimate of expressed respiratory high loop gain and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow-limitation, and can aid prediction of CPAP failure or success.

Support (if any):
478 The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality
Authors: Patel Salma , Zareba Wojciech , LaFleur Bonnie , Couderc Jean-Philippe , Xia Xiaojuan , Woosley Raymond , Combs Daniel , Patel Imran , Mashaqi Saif , Perez Karolina , Parthasarathy Sairam
Published: May 2021

Introduction

Sleep disordered breathing (SDB) is associated with increased mortality. Obstructive apneas/hypopneas have been associated with an increase in both QTc duration and QT variability. These markers of ventricular repolarization are associated with arrhythmias and death. It is unknown whether SDB-related QTc changes are responsible for the relationship between QTc/QT variability and cardiovascular death (CVD).

Methods

From the Sleep Heart Health Study, we randomly selected 200 subjects in each of four groups based on overall apnea/hypopnea index: those with no SDB and those in either, mild, moderate or severe SDB at baseline, matched for gender, age and BMI. Respiratory-related channels and electrocardiograms (ECG) from each polysomnography were analyzed. QTc was calculated using Bazett’s heart rate correction. The following measures of QT variability were obtained: i) standard deviation of QT intervals (SDQT) at 1- and 5-minute intervals and ii) short-term interval QT variability (STVQT) at 5-minute intervals. Cox proportional hazards regression models were used to evaluate potential predictors of CVD.

Results

Twenty-nine subjects were excluded either due to missing data or low quality ECG. The 771 subjects included were 68±10 years of age, half were female. During follow-up, 220 subjects (28.5%) died of CVD among whom, 67 (30.5%) had comorbid severe SDB, 45 (20.5%) had no SDB, and the remaining CVD deaths had mild (47, 21.4%) and moderate 61 (27.7%) SDB. The CVD patients were more likely to be older(p<0.001), hypertensive (p<0.001), diabetic(p<0.001), and had increased SDQT(p<0.001), STVQT(p<0.001) and QTc (0.017). After adjusting for covariates, the presence of mild (p=0.562), moderate(p=0.439) and severe SDB (p=0.912) did not moderate the association between QTc prolongation and CVD. Additionally, mild (p=0.486), moderate(p=0.478) and severe SDB (p=0.849) did not moderate the association between SDQT and CVD. Similarly, mild (p=0.144), moderate(p=0.594) and severe SDB (p=0.508) did not moderate the association between STVQT and CVD. However, QTc, SDQT, STVQT, mild and severe SDB were individually associated with CVD (p=0.004, 0.000, 0.000, 0.014, 0.022, respectively).

Conclusion

SDB was not a factor in the relationship between QTc prolongation/QT variability and CVD.

Support (if any)

American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career and Development Award (5299903)
499 Utilization of Diagnostic Sleep Testing Prior to Idiopathic Hypersomnia Diagnosis Among US Adults: A Real-World Claims Analysis
Authors: Saad Ragy , Ben-Joseph Rami , Prince Patricia , Stack Catharine , Bujanover Shay , Taylor Ben
Published: May 2021

Introduction

A retrospective analysis was conducted to characterize diagnostic sleep testing during the 12 months before diagnosis of idiopathic hypersomnia (IH), a hypersomnolence disorder with no approved treatments.

Methods

IBM® MarketScan® claims data were analyzed (1/1/14–9/30/19) to identify adults with newly diagnosed IH, defined as ≥2 claims with an IH diagnosis code ≥1 day and ≤180 days apart, and without an IH diagnosis ≤12 months before cohort entry. Demographics, diagnosing physician specialty, and diagnostic sleep disorder testing (identified via claims with procedure codes for multiple sleep latency test/maintenance of wakefulness test [MSLT/MWT], home sleep test, and polysomnography) were summarized. Analyses were performed on patients with IH diagnosis codes recorded in any position on the claims (“overall IH”) and in the primary position (“primary IH”) to understand the effects of applying a more specific definition of IH.

Results

Of 32,948,986 eligible people, 4,980 (0.015%) newly diagnosed IH patients were identified. Mean age was 43 years and 67% were female; those with primary IH (n=2,205; 44% of overall IH) were younger (mean age, 39 years) and more likely to be female (73%). Long sleep time was documented for 69% of the overall IH group and 67% of the primary IH group. The top 3 diagnosing physicians’ specialties were similar for overall IH/primary IH: pulmonology (23%/26%), neurology (14%/16%), and internal medicine (11%/10%). Few patients (9% overall IH; 7% with primary IH) were diagnosed in family practice. Any sleep testing was performed in 44% of overall IH and 53% of primary IH patients. Polysomnography and MSLT/MWT, the most frequently used sleep tests, were less common in overall IH (39% and 22%) than in primary IH (48% and 32%).

Conclusion

IH patients were typically diagnosed by specialists, outside of general medical practice. The most common diagnosing physicians were pulmonologists and neurologists for both the overall and primary IH groups. Objective sleep testing was more frequently documented in diagnosis of primary IH but utilization was low regardless of the definition of IH diagnosis. Further research is needed to investigate the utilization of sleep testing by clinicians for diagnosing IH.

Support (if any)

Jazz Pharmaceuticals
508 Narcolepsy Associated With a History of Head Injury: A Retrospective Review
Authors: Stultz Debbie , Osburn Savanna , Burns Tyler , Gills Thomas , Welch Darrell , Shaffer Christina , Walton Robin , Cope Amy , Pawlowska-Wajswol Sylvia
Published: May 2021

Introduction

Head injuries are becoming much more prevalent and may be secondary to sports injuries, motor vehicle accidents, falls, domestic violence, assault, and military blast explosions. Sleepiness may occur acutely and/or chronically after a head injury. Chronic hypersomnia may be overlooked or under-reported in those with a history of head injury, and the association may not be made. Hypersomnia can occur in those with mild, moderate, and severe head injuries, with or without loss of consciousness. The pathophysiology/neuropathology of sleep-wake disturbances after Traumatic Brain Injury was discussed by Lim and Baumann 2020 in their Up To Date review entitled “Sleep-wake disorders in patients with traumatic brain injury”. They reported possible abnormalities in orexin/hypocretin, decreased histaminergic neurons, melatonin abnormalities, decreased serotonergic neurons, decreased noradrenergic neurons, and structural brain changes that can play a role. It is also possible that a head injury occurs in someone predisposed to the development of narcolepsy or that the sleepiness of undiagnosed narcolepsy leads to increased injuries.

Methods

A retrospective review of charts from 2013 to 2020 revealed 176 patients diagnosed with narcolepsy in our psychiatric/sleep outpatient practice. Information on head injuries was obtained by questionnaires completed by the patient and/or interview with staff. Narcolepsy was diagnosed by PSG/MSLT and/or DSM-V criteria of narcolepsy.

Results

Of the 176 patients diagnosed with narcolepsy, 125 were female (71%) and 51 were male (29%). The age range was 11 to 75 years, with an average age of 39 years old. Cataplexy was present in 117 patients (66.8%). A history of a head injury was reported at intake by 50 patients (28.4%). Of the patients with a history of a head injury, 34 (68%) were female, 16 (32%) were male, and 36 (72 %) had a history of cataplexy.

Conclusion

This study revealed 28.4% of patients diagnosed with narcolepsy reported a history of a head injury of varying degrees of severity. While direct causation cannot be declared, the association of a head injury and continued hypersomnia suggests further evaluation of narcolepsy may be beneficial.

Support (if any)

**No support for this study was given.
534 Food Insecurity and Sleep Health by Race/Ethnicity and Age Group in the United States
Authors: Riley Nyree , Alhasan Dana , Jackson W Braxton , Jackson Chandra
Published: May 2021

Introduction

Food insecurity may influence sleep through poor mental health (e.g., depression) and immune system suppression. Although prior studies have found food insecurity to be associated with poor sleep, few studies have investigated the food security-sleep association among racially/ethnically diverse participants and with multiple sleep dimensions.

Methods

Using National Health Interview Survey data, we examined overall, age-, sex/gender-, and racial/ethnic-specific associations between food insecurity and sleep health. Food security was categorized as very low, low, marginal, and high. Sleep duration was categorized as very short (<6 hours), short (<7 hours), recommended (7–9 hours), and long (≥9 hours). Sleep disturbances included trouble falling and staying asleep, insomnia symptoms, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CI) for sleep dimensions by very low, low, and marginal vs. high food security.

Results

The 177,435 participants’ mean age was 47.2±0.1 years, 52.0% were women, 68.4% were Non-Hispanic (NH)-White. Among individuals reporting very low food security, 75.4% had an annual income of <$35,000 and 60.3% were ≥50 years old. After adjustment, very low vs. high food security was associated with a higher prevalence of very short (PR=2.61 [95%CI: 2.44–2.80]) and short (PR=1.66 [95% CI: 1.60–1.72]) sleep duration. Very low vs. high food security was associated with both trouble falling asleep (PR=2.21 [95% CI: 2.12–2.30]) and trouble staying asleep (PR=1.98 [95% CI: 1.91–2.06]). Very low vs. high food security was associated with higher prevalence of very short sleep duration among Asians (PR=3.64 [95% CI: 2.67–4.97]), Whites (PR=2.73 [95% CI: 2.50–2.99]), Blacks (PR=2.03 [95% CI: 1.80–2.31]), and Hispanic/Latinxs (PR=2.65 [95% CI: 2.30–3.07]).

Conclusion

Food insecurity was associated with poor sleep in a diverse sample of the US population.

Support (if any):
546 Association of personality traits with napping behaviors in older adults
Authors: Shen Yuqi , Rojo-Wissar Darlynn , Duggan Katherine , Hasler Brant , Spira Adam
Published: May 2021

Introduction

Greater neuroticism and lower conscientiousness are linked to poorer nighttime sleep among older adults, but little is known about the association between personality and daytime sleep. Napping increases in older adulthood, and napping has been linked to health outcomes, including cognitive impairment. Thus, it is important to extend personality and sleep research to investigate napping behavior. We examined the association between personality and napping in a nationally representative cohort of older adults.

Methods

We studied 742 adults aged ≥65 years from the National Health and Aging Trends Study (NHATS) who completed the sleep and personality modules in NHATS rounds 3 or 4 (2013–2014). Personality dimensions (neuroticism, extraversion, openness, agreeableness, conscientiousness) were assessed by the Midlife Development Inventory Personality Scales. Participants reported nap frequency over the past month (most days or everyday [nappers-frequent]; some days [nappers-infrequent]; rarely/never [non-nappers]); napping intention (intentional/unintentional); and average nap duration (coded as ≤40 minutes [short]; and >40 minutes [long], consistent with previous studies). Personality dimensions were included together in all models. Model 1 adjusted for age, sex, education, and BMI, and Model 2 further adjusted for anxiety and depression, comorbidities, sleep medications, and nighttime sleep duration. Only nappers were included in models with nap frequency, intention, or duration as outcomes (n=387).

Results

There were no personality differences between nappers and non-nappers. Among nappers, however, higher neuroticism was associated with lower odds of frequent naps (OR=0.73, 95% CI: 0.55,0.97), and higher agreeableness was associated with greater odds of unintentional napping (OR=1.95, 95% CI:1.12, 3.41) and lower odds of long nap duration (OR=0.54, 95% CI:0.33, 0.90) in Model 1. Associations remained in Model 2. Higher neuroticism was also associated with greater odds of long nap duration in Model 1 (OR=1.40, 95% CI:1.03, 1.91), but not after further adjustment in Model 2.

Conclusion

This is, to our knowledge, the first study examining the association between personality and daytime napping behaviors among a large sample of older adults, extending the literature on personality and nighttime sleep in this population. Because napping behaviors are associated with health outcomes, personality may be an important factor to consider in interventions addressing napping.

Support (if any)

NIH grant 5T32MH014592-39
559 Effect of Weekly Text Message Feedback on Continuous Positive Airway Pressure Adherence in Pediatric Obstructive Sleep Apnea
Authors: Finch Christina , Bercovitch Robert
Published: May 2021

Introduction

Continuous Positive Airway Pressure (CPAP) is an effective treatment for Obstructive Sleep Apnea (OSA) in children. However, adherence to CPAP therapy is often suboptimal. CPAP telemonitoring with automated feedback messaging has been shown to improved adherence in adults with OSA, but has not been widely studied as an intervention for children with OSA. This pilot study was conducted to investigate if feedback messaging could similarly improve CPAP adherence in children.

Methods

Pediatric OSA subjects (ages 11–17) with poor CPAP compliance or newly prescribed CPAP were selected from an outpatient Sleep Medicine clinic to receive weekly text messages with scripted feedback on CPAP adherence. Patients already meeting adherence goals were excluded from the study. Parental consent was obtained and participants were given the option to have text messages sent to parents or directly to the patient. Adherence was monitored over a four-month intervention period and compared to pre-intervention usage as a self-matched control. Total hours of use per month and numbers of days used per month were collected through daily remote CPAP monitoring. Average hours per use and average daily use per 30-day period were additional adherence measurements calculated. Data was analyzed using two-tailed paired T-tests with level of significance set at p<0.05.

Results

There was no significant change in CPAP adherence (p>.05) after initiation of weekly feedback messaging for the five patients included in the study. No participant, before or after intervention, met the Medicare definition of compliance (≥4hr nightly use for ≥ 70% of nights) and average adherence declined following intervention.

Conclusion

In a small pilot study, weekly feedback text messaging did not improve CPAP adherence in pediatric patients with OSA. This finding contrasts with larger studies in adult patients with OSA that have demonstrated improved CPAP adherence with automated feedback messaging. With the increasing use of telemedicine for CPAP follow-up, new strategies to successfully utilize this approach in the pediatric population may be needed.

Support (if any)

None.
564 Patient Charactarestics With Normal to Mild Apnea Hypopnea Index Undergoing Polysomnography to Diagnose Obstructive Sleep Apnea
Authors: AlTeneiji Majid , Schmalz Leah , Adeleye Adetayo
Published: May 2021

Introduction

Polysomnography (PSG) testing is expensive and not easily accessible. Waiting time for a routine PSG at the Alberta Children’s Hospital (ACH) can be up to a year. Majority of PSG studies performed are for diagnosis of obstructive sleep apnea (OSA). A previous quality improvement (QI) project conducted at the ACH showed that two-thirds of children who had undergone initial PSG testing had an apnea hypopnea index (AHI) in the normal or mild range. Given our limited resources, better characterization of patient referral characteristics and process factors as documented on the PSG requisition will inform our triage process, decrease wait time, improve resource allocation and information provided to referral sources.

Methods

Retrospective review of PSG’s performed for the initial diagnosis of OSA was completed between January 2018 and March 2020 at the ACH. Patient referral characteristics (age, sex, growth parameters, medical diagnosis, indication for PSG, previous airway surgery), process factors (source of referral, PSG referral and completion date, triage status) and AHI were recorded. Patients were divided into two groups (group A: normal and mild; group B: moderate and severe) based on AHI. Data obtained from the groupings were compared and analyzed descriptively. PSG triage to completion time was also calculated for each group.

Results

A total of 798 initial PSG studies were completed between January 2018 and March 2020. Of the PSG’s reviewed 64.8% were in group A and 35.2% were in group B. Common medical diagnoses in group A included ADHD, Asthma and Autism, whereas group B had T21 and Enuresis. History of previous airway surgery did not differ between groups.

Conclusion

Further clarification of the patient’s underlying medical diagnosis (referral characteristic) may help inform our triage process. The implication of previous airway surgery (process factor) on AHI severity is unclear at this point. More data is actively being collected to further interrogate these preliminary findings.

Support (if any):
581 Impact of Weight on Insomnia Severity, Sleep Quality, and Insomnia Improvement in a Clinically Referred Pediatric Sample
Authors: Duraccio Kara , Graef Danielle , Beebe Dean , Byars Kelly
Published: May 2021

Introduction

Children with overweight/obesity are more likely to have shortened sleep, though little is known about the role of weight status in insomnia severity, sleep quality, and sleep hygiene in clinically referred youth.

Methods

A total of 1133 children (43.7% female) presented to a Pediatric Behavioral Sleep Medicine Clinic for insomnia. At the initial evaluation, caregivers of children ages 2–10.9 years (N = 744) completed the Pediatric Insomnia Severity Scale (PISI) and the Children’s Sleep Habits Questionnaire (CSHQ); adolescents ages 11–18 years (N = 389) completed the PISI, the Adolescent Sleep Hygiene Scale (ASHS), and the Adolescent Sleep Wake Scale (ASWS). The PISI was completed during at least one Pediatric Behavioral Sleep Medicine visit subsequent to evaluation and initiation of treatment. Patient height and weight, objectively measured within 3 months of the initial evaluation, was used to determine sex-adjusted body mass index z-scores (BMIz). Hierarchal linear regression models were used to determine the impact of BMIz on baseline PISI insomnia severity scores, and CSHQ, ASHS, and ASWS total scores, after covarying for income. Repeated-measures general linear modeling was used to determine whether weight status moderated improvement in insomnia severity over time, covarying for income.

Results

For children (ages 2–10.9), weight was not associated with baseline insomnia severity (p=.62) or predictive of insomnia improvement following behavioral sleep medicine intervention (p=.71), though higher weight predicted poorer parent-reported sleep quality (p=.006). For adolescents (ages 11–18), higher weight was predictive of higher baseline insomnia severity (p=.026), though did not predict insomnia improvement over time (p = .86); higher weight was also predictive of poorer sleep hygiene (p<.001) and worse sleep quality (p=.03).

Conclusion

Initial insomnia severity and subjective sleep quality may be worse for youth of higher weight, particularly for adolescents; these findings increase our understanding of how and when overweight/obesity negatively impacts sleep. Fortunately, youth with higher weight respond equally well to pediatric behavioral sleep medicine interventions as their lower-weight peers, suggesting that these interventions need not be modified based on patient weight.

Support (if any)

Cincinnati Children’s Hospital Medical Center Division of Behavioral Medicine and Clinical Psychology’s Research Funds
608 Efficacy of a Treatment for Sleep-Related Problems in Children with Anxiety: A Mixed Methods Study
Authors: Chevalier Lydia , Pariseau Emily , Long Kristin , Langer David , Pincus Donna
Published: May 2021

Introduction

School-aged children with anxiety frequently experience sleep-related problems (SRPs) such as bedtime resistance. Results are mixed, but some children with anxiety also report longer sleep onset latency (SOL). Despite the link between SRPs and mental and physical health consequences, limited research has evaluated the efficacy of brief sleep treatments in this population.

Methods

A mixed methods approach employing a multiple-baseline single-case design and qualitative methods was used to evaluate the efficacy of a four-session parent training intervention in ten children with anxiety and chronic insomnia (M=9.6 years, range 8–12 years, 8 female). Questionnaires on SRPs and anxiety were completed by parents and children at baseline, one-week post-treatment, and one-month follow-up assessments. Subjective SOL (i.e., sleep diary) and objective SOL (i.e., actigraphy) were measured daily during assessment and treatment weeks. Parents and children completed qualitative interviews at the post-treatment assessment.

Results

The majority of participants no longer met criteria for chronic insomnia at post-treatment (n=9) or follow-up (n=6). SRPs (e.g., bedtime resistance) were significantly less frequent at post-treatment and follow-up than at baseline. The majority of participants demonstrated significant reductions in subjective (n=7) but not objective (n=3) SOL at post-treatment or follow-up compared to baseline. Qualitatively, parents and children described improvements in sleep during treatment. Some parents described discovering while completing sleep diaries that their child believed themselves to be taking longer to fall asleep at the beginning of treatment than they actually were (i.e., sleep misperception), and that this sleep misperception improved during treatment.

Conclusion

The findings of the current study support the preliminary efficacy of a brief parent training intervention to treat SRPs in school-aged children with anxiety. They also begin to help elucidate mixed findings in the literature on sleep of children with anxiety by providing a potential reason for discrepancies between subjective and objective SOL in this population. Specifically, qualitative findings suggest that this discrepancy may be related to sleep misperception, that children with anxiety may feel themselves to be taking a long time to fall asleep even when objective measures of SOL are within the normative range.

Support (if any)

Boston University Clara Mayo Memorial Research Fellowship
626 Association between Co-Sleep and Behavioral Problems among Preschoolers in Taiwan
Authors: Wu Yu-Ting , Huang Ya-Chuan , Chang Yung-Sen , Yang Chien-Ming
Published: May 2021

Introduction

‘Co-sleep’ is defined as the sleep arrangements in which parents and their child sharing a sleeping surface (bed-sharing or room-sharing). Similar to the other Asian countries, Taiwan has a high reported rates of bed-sharing. Previous researches had shown shorter sleep duration and poorer sleep quality in children with co-sleep. However, the association between co-sleep and the children’s emotional and behavioral problems has not been well studied. This study aims to explore the association between sleeping arrangements and children’s sleep, as well as their daytime emotional and behavioral problems.

Methods

9,582 caregivers of preschoolers (age= 4.70±0.806; Male: Female=52%:48%) completed a questionnaire regarding their children’s sleep schedule, the Children’s Sleep Habits Questionnaire (CSHQ) and Strength and Difficulties Questions (SDQ). The reported frequency on the items of the CHSQ question regarding co-sleep, asking whether the child falls asleep in parent’s or sibling’ s bed or sleep alone, were used to divide the children into three groups: usually co-sleep group, sometimes co-sleep group and sleep-alone group.

Results

Among 2,967 preschoolers, 6,272 children (65.5%) reported usually co-sleep, 816 children (8.5%) reported sometimes co-sleep, and 2,494 children (26%) reported sleeping alone. One-way ANOVAs showed significant differences among three groups in: 1) sleep patterns, including weekday nighttime sleep duration (F=24.43, p<.01), weekend nighttime sleep duration (F=3.13, p<.05), weekday nap duration (F=4.24, p<.05), and weekend nap time (F=4.39, p<.05); 2) sleep problems on the CHSQ, including bed time resistance (F=7027.25, p<.01), sleep onset delay (F=33.06, p<.01), sleep duration (F=65.51, p<.01), sleep anxiety (F=788.48, p<.01), night waking (F=37.90, p<.01), parasomnias (F=47.43, p<.01), sleep disorder breathing (F=7.58, p<.01), and sleepiness (F=13.44, p<.01); 3) behavioral problems and development on the SDQ, including hyperactivity (F=21.16, p<.01), emotional symptom (F=23.08, p<.01), conduct problem (F=8.65, p<.01), peer problems (F=20.59, p<.01), and prosocial (F=17.67, p<.01).

Conclusion

Our results indicate that children with more frequent co-sleep may have shorter sleep duration, more sleep problems as well as more external and internal behavioral problems, while sleep-alone children showed more prosocial behaviors, longer sleep duration, and less sleep problems. The potential developmental problems related to co-sleep may be underestimated in Asian culture and need more attentions.

Support (if any):
637 Cumulative risk associated with poor sleep health in children and adolescents
Authors: Covington Lauren , Ji Xiaopeng , Brownlow Janeese , Laurenceau Jean-Philippe
Published: May 2021

Introduction

Social risk factors are associated with poor sleep outcomes across the life course. It is unclear if this association varies based on biological factors, such as age and gender. Therefore, the purpose of this analysis was to identify if age or gender moderated the association between cumulative risk and sleep duration/regularity in a national sample of children and adolescents.

Methods

We completed a secondary data analysis using the National Survey of Children’s Health 2017–2018 publicly available dataset. In a sample of 36,997 children age 6–17 years, we explored the association between a social cumulative risk index score (CRI) and child sleep duration and regularity. We included eight dichotomous social risk variables in the CRI: parental education

Results

Age was a significant moderator of the association between CRI and short sleep duration, such that the magnitude of the CRI-sleep relationship was greater in school-age children (age 6–11; b = -0.13, p<0.001) compared to adolescents (age 12–17 years; b = -0.05, p<0.001). Age was not a significant moderator between CRI and sleep irregularity. However, CRI independently predicted increased odds of sleep irregularity (OR = 1.30, p<.001) and older age moderately increased the odds of sleep irregularity (OR = 1.21, p = 0.06). Sex was not a significant moderator of the association between CRI and sleep duration or sleep regularity. However, female sex was positively associated with sleep duration (b = 0.06, p = 0.11), but was not a significant independent predictor of sleep irregularity.

Conclusion

Younger children with cumulative risk factors are at risk for short sleep duration. Further research is needed to uncover biological mechanisms underlying multiple sleep parameters across developmental ages.

Support (if any):
655 The Role of Insomnia Symptoms in the Relation between Perceived Vulnerability to Disease and COVID-19 Anxiety
Authors: Campbell Rebecca , Walker Jamie , Makhanova Anastasia , Vargas Ivan
Published: May 2021

Introduction

Individuals who report greater perceived vulnerability to disease (e.g., experience emotional discomfort to situations where pathogen transmission is likely) also have the tendency to endorse more anxiety. Insomnia is also associated with greater anxiety. This study assessed (1) whether perceived vulnerability to disease was associated with increased anxiety related to COVID-19 and (2) whether this association was moderated or mediated by insomnia symptoms.

Methods

1199 primarily female (n = 845), white (n = 982) participants (mage = 30.52) completed an online survey including the Sleep Disorder Symptom Checklist- 25 (SDS-CL-25), Perceived Vulnerability to Disease (PVD) scale, and a rating of COVID-19 anxiety (scale = 0–100; m = 55.81, sd = 25.39). Insomnia symptoms were calculated using the sum of SDS-CL-25 items 3–6 (m = 7.55, sd = 3.58). The PVD subscales germ aversion (GA; m = 4.18, sd = 1.22) and perceived vulnerability to infection (PVI; m = 3.69, sd = 1.39) were also computed.

Results

Regressions were used to test if insomnia mediated the impact of GA and PVI on COVID-19 anxiety. The relations between COVID-19 anxiety and insomnia (b = 1.30, t(1197) = 6.47), GA (b =3.60, t(1197) = 6.09), and PVI (b =3.73, t(1197) = 7.20) were significant (p’s < .001). Mediation analyses using the mediation package in R (bootstrap estimation = 1000 samples) showed direct effects of GA (b = 3.26, 95% CI = 2.04 – 4.42, p < .001) and PVI (b = 3.16, 95% CI = 2.00 – 4.22, p < .001) and mediation effects of insomnia (b =.44, 95% CI = .19 - .73, p < .001; b =.58, 95% CI = .33 - .86, p < .001, respectively). According to the moderation analyses, the association between PVD and COVID-19 anxiety did not significantly vary at different levels of insomnia.

Conclusion

Results suggest insomnia symptoms partially mediate the relationship between perceived vulnerability to disease and COVID-19 anxiety. These associations are likely bidirectional, and therefore, more work in this area is needed, especially with regard to how improved sleep may attenuate risk factors for anxiety.

Support (if any)

K23HL141581 (PI: Vargas)