bluuebunny/crossref_metadata_2025 huggingface dataset:
0682 Evaluation Of An Incentive-based Intervention To Improve 90-day Adherence In Pap-naive Patients
Authors: Merchant G , Valentine K , Hevener W , Willes L , Ta D , Hernandez R , Gagnon R , Chen K , Blase A
Published: May 2020

Introduction

Although PAP therapy is the gold standard treatment for obstructive sleep apnea, adherence to treatment is suboptimal. Without sustained therapy adherence, patients are at risk of serious negative health outcomes. The objective of this study was to test whether a digitally delivered monetary and social reward program helped patients new to PAP therapy. Financial incentive schemes are effective in helping patients adhere to difficult medication or therapy plans. Additionally, there is an abundance of evidence that social support is a critical component to long-term health behavior change.

Methods

This prospective, randomized, single site pilot is evaluating the effectiveness of an app-based intervention in helping patients adhere to PAP therapy. The financial incentive design leverages loss aversion, and the social incentive design leverages the strength of close ties and variable reinforcement. The primary endpoint is mean PAP usage at 3 months. Secondary endpoints include Medicare compliance, change in functional status, and baseline scores of perceived disease severity, claustrophobia, coping skills, and health literacy as moderators of the intervention’s effectiveness. Study recruitment is ongoing, with an expected sample size of 150 subjects.

Results

Of the 132 subjects enrolled, 56% are male, 61% are Caucasian, and 65% are married. The mean age is 49.6 ± 12.0 years and mean BMI is 32.4 ± 8.4 kg/m2. Additional demographics such as income level, education level, and number of children along with the primary and secondary endpoints will be presented. A subgroup analysis of the primary endpoint will be generated for subjects identified as strugglers within the first 3 days of usage.

Conclusion

The results of this study will provide insight into methods such as financial and social incentives delivered via a smartphone on initial compliance with PAP therapy, as well as provide more information on the behavioral change associated with beginning PAP therapy.

Support

ResMed
0686 Diabetes Sleep Treatment Trial: The Effect Of Treatment Of OSA With CPAP On Glycemic Control In Type 2 Diabetes
Authors: Chasens E R , Sereika S M , Kortykowski M , Stansbury R , Burke L , Strollo P J , Bizhanova Z , Atwood C W
Published: May 2020

Introduction

Evidence remains unclear whether treatment of OSA with CPAP results in improved glycemic control. This study evaluated if CPAP improved glucose control compared to sham-CPAP and the effect of adherence to active CPAP on glucose control after 6 and 12 weeks of treatment.

Methods

This was a multi-center, double-blind clinical trial. Participants were adults with type 2 diabetes (T2D), A1C≥6.5%, apnea + hypopnea index (AHI)≥10, and naïve to CPAP. All participants received diabetes education. Glucose control was evaluated with frucostamine and A1C levels; CPAP adherence with a wireless modem system. Statistical analysis followed an “intent-to-treat” approach with linear mixed modeling. The dose of active CPAP was calculated as the percentage of days with active CPAP use≥4 hours and the average adherence of active CPAP with sham coded as “0”dose”.

Results

Randomized participants (N=98, CPAP=50; sham-CPAP=48) were primarily middle-aged (age=58.7±9.8 years), White (75%), males (57%) obese (BMI=36.2±6.6), suboptimal glucose control (A1C=7.9%±0.9) and OSA (AHI=23.9±14.4). There were no significant baseline differences except in A1C (Active CPAP=7.7%±0.8; sham-CPAP=8.1%±1.0). There was no significant difference in use of their devices at 6 or 12 weeks. Based on linear mixed modeling, participants on active CPAP had improved A1C (b (SE): -.76 (.24), P<.01) and frucostamine (-21.8 (10.5), P=.04) at 6 weeks with A1C trending to significance at 12 weeks (p=0.10). Both the % of cumulative days of active CPAP usage (≥4 hours/day) (.002 (.003), P=.09) and cumulative hours of active CPAP use (.03 (.03), P=.08) showed a trend being associated with greater change in A1C but not in frucostamine (P=.61, P=.51). The rate of change in A1C varied by time, increasing the % of cumulative days of CPAP use (≥4 hours/day) at week 6 predicted greater change in A1C (.006 (.002), P=.01) than week 12 (.002 (.003), P=.38). Higher average hours of CPAP usage were associated with greater change in A1C (.08 (.03), P=.01) at week 6 compared to week 12 (.03 (.03), P=.47).

Conclusion

In our study, individuals with T2D and OSA, adherence to active CPAP use improved glycemic control over 6 weeks.

Support

NIDDK grant R01DK096028; CTRI grant UL1TR001857 and UL1TR000005.
0705 High Incidence Of Inadequate Health Literacy In Adults With Obstructive Sleep Apnea Is Not Associated With Positive Airway Pressure Use
Authors: Watach A J , Saconi B , Sawyer A M
Published: May 2020

Introduction

Inadequate health literacy (HL) is associated with 1.5 - 3 times increased risk for poor health outcomes, nonadherence and lack of skills needed to manage one’s own health. Inadequate HL prevalence in adults with obstructive sleep apnea (OSA) may be as high as 30%. The relationship between HL and positive airway pressure (PAP) adherence has been rarely examined.

Methods

A secondary analysis of prospective observational data was conducted to: 1) examine the prevalence of inadequate HL in adults with newly-diagnosed OSA and 2) determine if inadequate HL is associated with 1-wk and 1-mo PAP use. HL was measured using a 3-item Health Literacy Screening Questionnaire. Descriptive statistics, multiple linear regression, and logistic regression were used.

Results

Participants (n=67) were white (85%), males (52%) and females (48%), middle-aged (50±12 yrs), 64.2% had a middle to high school education and severe OSA (mean AHI 38.2±21 events/hr). Mean PAP use was 4.62±2.43 hrs/night at 1-wk and 4.33±2.27hrs/night at 1-mo. Using a threshold of ≥4 hrs/night, 64% were adherent at 1-wk and 60% at 1-mo. Sixty two percent (n=42) screened positive for inadequate HL. A positive screen for inadequate HL (by individual screening items or by cumulative number of items screened positive) was not associated with PAP use (mean hr/night) at 1-wk or 1-mo (not retained in the final model). HL was also not associated with PAP non-adherence (<4hrs/night) or PAP failure (<2hrs/night) by logistic regression.

Conclusion

Inadequate HL may be prevalent in adults with OSA. OSA and PAP patient education content and design should align with HL abilities and skills. Disease and treatment education are influential on PAP adherence. Future research should consider adequacy of three generalized items to assess HL and disease-specific HL as more robust measures are available. Larger, heterogeneous sample sizes are needed to precisely estimate the relationship between HL and PAP adherence.

Support

Lead author receives support from NIH/NHLBI Award T32 HL07953.
0718 Hypoxemia and Pulmonary Hypertension in Patients with Concomitant Restrictive Ventilatory Defect and Sleep Apnea: The Overlap Syndrome
Authors: Xie J , Fan Z , Wang J , Li F
Published: May 2020

Introduction

Patients with severe restrictive ventilatory defect (RVD) have hypoxemia and a high risk of pulmonary hypertension (PHTN). Sleep apnea (SA) aggravates the severity of nocturnal desaturation significantly. The aim of this study was to investigate the severity of hypoxemia and prevalence of PHTN in patient with the overlap syndrome (OS) of RVD and SA.

Methods

Patients referred for both sleep test and spirometry for suspected SA and RVD or obstructive ventilatory defect (OVD) were recruited prospectively from January-December, 2018. SA was determined by an apnea-hypopnea index ≥5/h; mean nocturnal oxygen saturation (meanSaO2), minimum oxygen saturation (minSaO2), saturation lower than 90% (T90) were calculated automatically. RVD was diagnosed in the presence of forced expiratory volume in the first second/forced vital capacity (FVC) >0.7 and FVC<80% predicted value. PHTN was defined by systolic pulmonary arterial pressure (SPAP) ≥ 50mmHg, documented by noninvasive transthoracic echocardiography. Patients with PHTN secondary to extrapulmonary factors were excluded.

Results

Of 65 patients who completed the investigation, 16 (24.6%) subjects were diagnosed with isolated SA (without RVD or OVD), and 28 (43.1%) subjects were verified to have RVD, in which 22 (78.6%) were diagnosed with OS and 6 (21.4%) presented as isolated RVD. Patients with OS vs. those with isolated RVD had lower minSaO2 (78.3% vs. 88.7%, p=0.003) and meanSaO2 (91.5% vs. 95.8%, p=0.007) but higher T90 (37.2% vs. 0.3%, p=0.009). Patients with OS vs. those with isolated RVD or with isolated SA had higher SPAP (62.6 mmHg vs. 45.3 mmHg or 35.9 mmHg, p=0.334 or p=0.016 respectively). Higher proportion of patients with OS were diagnosed with PHTN than those with isolated RVD or isolated SA (8 [36.4%] vs. 1 [16%] or 1 [6.25%], p=0.360 or p=0.031, respectively). T90 was the only polysomnographic data associated with the prevalence of PHTN after adjusting for age and sex (OR 4.90, 95% CI 1.23-25.56, p=0.023).

Conclusion

Patients with the OS of RVD and SA had high odds of PHTN, which is probably associated with severe hypoxemia. Further investigation is needed to discern whether therapeutic strategies toward OS might eliminate PHTN in this cohort.

Support
0720 Study of Serum Adiponectin and Resistin in Patients with Obstructive Sleep Apnea
Authors: Gharraf H S , Zidan M H , Ayad M W
Published: May 2020

Introduction

The syndrome of OSA is a very common disorder with several important complications and is still under diagnosed. Obesity is considered to be a chronic disease rather than a life style b. Adipose tissue secretory function is disturbed by chronic intermitted hypoxia occurring in OSA. The aim of this study was to study the level of serum adiponectin and resistin in patients with OSA and we tried to assess their association to different parameters of SDB as well as concomitant co morbidities in each patient

Methods

This study contained two groups. Patients (group1) included 30 newly diagnosed OSA patients; controls (group 2) included 15 healthy volunteers. All patients were subjected to overnight polysomnography, routine laboratory investigations, Spirometry and fasting serum adiponectin and resistin

Results

Patients had statically significant lower serum adiponectin level than controls while serum resistin levels were statistically significant higher in patients than controls also serum adiponectin levels were significantly decreased with increase severity of OSA while serum resistin levels were increased significantly with increase severity of OSA, moreover there was a statistical significant decrease in serum adiponectin levels in patients group with increasing number of comorbidities existing in every patient a. There was a statistical significant increase in serum resistin levels in patients group with increasing number of comorbidities existing in every patient

Conclusion

this highlights the possible relationship of these hormones to the metabolic complications seen in OSA patients

Support

no conflict of interest
0735 Hyperglycemia Is Associated With An Altered Sleep Structure In Patients With Obstructive Sleep Apnea
Authors: Xue P , Gao Y , Zhou J , Tang X
Published: May 2020

Introduction

Although obstructive sleep apnea (OSA) is associated with abnormal glycometabolism, current evidence on the association between hyperglycemia and abnormal sleep structure is still limited among patients with OSA. We sought to evaluate whether hyperglycemia was associated with abnormal sleep architecture.

Methods

A total of 452 patients with OSA, who were free of previously diagnosed diabetes mellitus, were consecutively recruited. All participants underwent overnight polysomnography and 75-g oral glucose tolerance test. Patients were divided into normal glucose tolerance (NGT) and hyperglycemia (i.e. prediabetes and type 2 diabetes) according to the ADA criteria. The association between hyperglycemia and sleep architecture was examined using logistic regression model.

Results

Of 452 patients, 283 (63%) had hyperglycemia (age 43.9 ± 11.1) and 169 (37%) had NGT (age 40.1 ± 11.1). Compared to the NGT group, the hyperglycemia group had older age (P < 0.05), higher body mass index (27.5 ± 4.1 vs. 26.33 ± 4.4; P < 0.05) and higher AHI (apnea-hypopnea index) (57.41 ± 28.6 vs. 48.3 ± 28.2; P < 0.05). There were no differences in total sleep time, the percentage of time spent in rapid eye movement (REM) or non-rapid eye movement (NREM) sleep between groups. However, patients with hyperglycemia had more microarousal events, especially during the NREM sleep (214 (range 19-662) events/h vs. 148 (range 37-600) events/h; P < 0.05). In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤80%, were significantly greater during the REM sleep in patients with hyperglycemia (1.4 (total range 0-91.1) % vs. 1.1(0-78.6) %; P < 0.05). After adjusting potential confounders, logistic regression analyses showed that the presence of hyperglycemia was independently associated with the number of microarousals in NREM sleep (OR = 1.01, 95% CI = 1.00-1.02, P = 0.02).

Conclusion

Hyperglycemia is independently associated with abnormal sleep architecture among patients with OSA. Patients with hyperglycemia have significantly increased sleep fragmentation in NREM sleep and significantly increased hypoxia in REM sleep.

Support

This work was supported by the National Natural Science Foundation of China (81700087).
0763 Effects Of Solriamfetol On Driving Performance In Participants With Narcolepsy
Authors: Vinckenbosch F , Lammers G , Overeem S , Chen D , Wang G , Carter L , Zhou K , Ramaekers J , Vermeeren A
Published: May 2020

Introduction

Patients with narcolepsy have an increased risk of automobile accidents. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the US (Sunosi®) for adults with excessive daytime sleepiness (EDS) associated with narcolepsy (75-150 mg/day). This study evaluated the effects of solriamfetol on on-road driving performance in participants with narcolepsy.

Methods

In each period of this randomized, double-blind, placebo-controlled, crossover study (NCT 02806908; EudraCT 2015-003931-36), driving performance during an on-road driving test (a 1-hour drive on a public highway) was assessed at

2 hours and 6 hours postdose following 7 days of treatment with solriamfetol (150 mg/day × 3, then 300 mg/day × 4) or placebo. For assessment of driving performance, the primary endpoint was standard deviation of lateral position (SDLP), a measure of “weaving,” at 2 hours postdose. Comparisons (solriamfetol vs placebo) used a Wilcoxon signed-rank test.

Results

The study included 24 participants (54% male; mean age, 40 years); 22 were included in the analyses of SDLP data. At 2 hours postdose, SDLP for solriamfetol (median, 19.08 cm) was statistically significantly lower than that for placebo (median, 20.46 cm; P=0.0022; incomplete driving tests: solriamfetol, n=4; placebo, n=7), indicating a better performance with solriamfetol. At 6 hours postdose, SDLP for solriamfetol (median, 19.59 cm) was not statistically significantly different from that for placebo (median, 19.78 cm; P=0.1245; incomplete driving tests: solriamfetol, n=3; placebo, n=10). Common adverse events (≥5%) were headache, decreased appetite, somnolence, sleep disorder, agitation, nausea, and palpitations.

Conclusion

Solriamfetol (300 mg/day) improved SDLP, an important measure of driving performance, at 2 hours after administration in participants with narcolepsy.

Support

Jazz Pharmaceuticals
0789 Decreased Sigma Band Power During NREM Sleep in REM Sleep Behavior Disorder
Authors: Lee Y , Lee B
Published: May 2020

Introduction

REM sleep Behavior Disorder (RBD) is characterized by dream enacting behaviors and a loss of atonia during REM sleep. Early detection of RBD is important because it is considered premonitory symptoms neurodegenerative disorders. In this study, we investigated the slow and fast sigma band power of patients with RBD using frequency analysis.

Methods

Twenty patients who were diagnosed as RBD according to the ICSD-3 criteria and 20 age-matched controls who underwent polysomnography (PSG) for other sleep disorders (insomnia, snoring) and showed normal to mild obstructive sleep apnea (OSA). NREM sleep EEG data was extracted and N1 sleep data was excluded to minimize arousal artifact. Fast Fourier transform-based spectral power analysis was used to compute the power spectral densities of the EEG in the MATLAB environment. The sigma bands were divided into 2 discrete bands: slow sigma (11 to 13 Hz) and- fast sigma (13 to 15 Hz). Mann-Whitney U test by SPSS was used.

Results

RBD patients (61.9 ± 7.1 years old; 12 men) had a significantly lower sigma band power than the control group (61.5 ± 1.1 years old; 11 men) in central region (p = 0.028). Particularly, the slow sigma band power showed a bigger difference in all regions except O1 (F3 = 0.017, F4 = 0.027, C3 = 0.004, C4 = 0.009, O2 = 0.017).

Conclusion

Sigma power was lower in the RBD patients than in the control. It suggests that RBD has impaired cortical activity. Thus, decreased spindle activity during NREM sleep may be a potential biomarker of RBD.

Support
0792 Mandibular Movement Monitoring with Artificial Intelligence Analysis for the Diagnosis of Sleep Bruxism
Authors: Martinot J , Le-Dong N , Cuthbert V , Denison S , Gozal D , Pepin J
Published: May 2020

Introduction

Sleep bruxism (BXM) is the result of rhythmic muscular masticatory activity (RMMA) and can be captured by masseters surface electromyography (sEMG). Despite the multiple adverse negative consequences of BXM, a simple reliable home diagnostic device is currently unavailable, with in laboratory audio-video polysomnography (type I PSG) remaining the gold standard diagnostic tool. Mandibular movements (MM) recordings during sleep can readily identify RMMA, are simple to set up and can be easily repeated from night to night. Here, we aimed to identify stereotypical MM in patients with BXM, and to develop RMMA automatic detection and BXM diagnosis using an artificial intelligence-based approach.

Methods

MM were recorded by a dedicated sensor (Sunrise, Namur, Belgium) in 12 patients with BXM during type I PSG. The Sunrise system consists of a coin-sized hardware that is comfortably placed on the subject’s chin. Its embedded inertial measurement unit communicates via Bluetooth with a smartphone and automatically transfers MM signals to a cloud-based infrastructure at the end of the night. Data processing and analysis are then performed in Python programming language.

A time series cluster analysis was applied to sequences of masseters sEMG and MM signals during BXM episodes (n=300) and during spontaneous micro-arousals (n=300). Then, a convolutional neuronal network (CNN) was developed to identify BXM and distinguish it from spontaneous micro-arousals while exclusively relying on MM signal.

Results

Based on the cluster analysis, BXM periods were characterized by a specific pattern of MM signals (higher frequency and amplitude), which was closely associated with the sEMG signals but clearly differed from the MM signal patterns during micro-arousals.

CNN-based classifier distinguished the BXM events from other RMMAs during micro-arousals and respiratory efforts with an overall accuracy of 91%.

Conclusion

Sleep bruxism can be automatically identified, quantified, and characterized with mandibular movements analysis supported by artificial intelligence technology.

Support

This work was supported by the French National Research Agency (ANR-12-TECS-0010), in the framework of the “Investissements d’avenir” program (ANR-15-IDEX-02). https://life.univ-grenoble-alpes.fr.
0797 Restless Legs Syndrome and Perceived Olfactory and Taste Dysfunction: A Community-Based Study
Authors: Zhuang S , Yuan X , Ma C , Yang N , Liu C , Na M , Winkelman J W , Wu S , Gao X
Published: May 2020

Introduction

Restless legs syndrome (RLS), an under-recognized sensorimotor condition worldwide, is thought to be a prodromal symptom of Parkinson’s disease as suggested by previous evidences. However, its association with prodromal chemosensory impairments, including olfactory or taste dysfunction, has remained largely unknown. Few studies of small sample sizes were conducted in predominantly Caucasian populations and results were inconsistent.

Methods

We performed a cross-sectional analysis including 90,337 Chinese adults free of neurodegenerative diseases in the Kailuan study in 2016. Presence of RLS was defined using revised RLS diagnostic criteria and further verified by Cambridge-Hopkins questionnaire for RLS. Perceived olfactory and taste dysfunction was collected via a questionnaire. The association between RLS and perceived olfactory and taste dysfunction was assessed using logistic regression model, adjusting for potential cofounders such as age, sex, smoking, alcohol consumption sleep conditions and medical history.

Results

RLS was associated with high odds of having perceived olfactory and/or taste dysfunction (adjusted odds ratio =5.92; 95% confidence interval, 3.11, 11.3). The significant association persisted when using Cambridge-Hopkins questionnaire for RLS (adjusted odds ratio =5.55; 95% confidence interval, 2.37-13.0) or when excluding participants with major chronic diseases.

Conclusion

RLS was associated with increased odds of perceived olfactory and taste dysfunction.

Support

This research was supported by start-up grant from the College of Health and Human Development and the Department of Nutritional Sciences, Pennsylvania State University, the Institute for CyberScience Seed Grant Program, Pennsylvania State University, and Natural Science Foundation of Hebei Province (H2018209318).
0802 To Examine the Effect of Gabapentin Enacarbil in Primary Restless Legs Syndrome Patients Who are on Dopaminergic Agents and Exhibiting Augmentation
Authors: Bollu P , Goyal M , Sivaraman M , Taylor N , Yin L , Thakkar M , Sahota P
Published: May 2020

Introduction

Augmentation is defined as worsening of the symptoms of Restless Legs Syndrome after a brief period of initial improvement with dopaminergic agents resulting in either an earlier onset, increase in severity, quicker onset, spread to other body parts. The exact prevalence of this phenomenon is not known and in patients experiencing augmentation, it can pose a difficult diagnostic and therapeutic challenge to the clinician. In our study, we found extended-release gabapentin to be an effective intervention in patients experiencing dopaminergic augmentation

Methods

This is an open-label single-arm study done in patients exhibiting augmentation while on dopaminergic agents. Patients who were enrolled in the study were initiated on oral extended-release gabapentin(Horizont) 600 mg at 5 pm at the beginning of the study. At day 90, attempts were made to reduce or discontinue dopaminergic agents. International Restless Legs Syndrome-Rating Scale (IRLS) and Augmentation Severity Rating Scale(ASRS) were recorded at each visit.

Results

A total of 10 patients were enrolled in the study while only 8 patients completed it. Compared to the baseline (visit 2), there is a significant improvement in both the augmentation severity(p= 0.0131) and the IRLS (p=0.0497). Wilcoxon matched-pairs signed rank test was used for statistical analysis.

Conclusion

Extended-release Gabapentin is an effective treatment option in primary RLS patients experiencing augmentation secondary to dopaminergic medication usage.

Support

The study is funded and medication is provided by Arbor Pharmaceuticals.
0822 Frail Older Men With Nocturia are Disproportionately Affected by Excess Nocturnal Urine Production
Authors: Monaghan T F , Wagg A S , Agudelo C W , Rahman S N , Michelson K P , Epstein M R , Everaert K , Lazar J M , Weiss J P , Bliwise D L
Published: May 2020

Introduction

Nocturia is a risk factor for falls and hip fractures in older adults. We determined whether the Frailty Index (FI), incorporating comorbidities, functional performance, and physical signs, was associated with nocturia frequency and/or overnight urine production.

Methods

We examined nightly (24-hour) voiding diaries (men ≥65 years) in an outpatient urologic clinic demonstrating ≥2 nocturnal voids (n=158). FI calculations followed Rockwood (CMAJ 2005;173:489-95). A total of 39 conditions were assessed. Three FI groups were established: Low (≤0.077) (n=59), Intermediate (>0.077 and <0.179) (n=58), and High (≥0.179) (n=41). We compared number of nocturnal voids (NV), nocturnal urine volume (NUV) (in mL), and 24-hr total urine volume (24-hr TUV) (in mL) across groups.

Results

NV did not differ by group (p=0.333) (median for all groups=3). However, NUV (916 [671-1419] vs. 690 [505-942] vs. 630 [500-1050] mL) differentiated the High, Medium and Low FI groups (p<0.001 via Kruskal-Wallis with Bonferroni pairwise adjustments), respectively. Similarly, 24-hr TUV differentiated the 3 groups (2200 [1800-2550] vs. 1620 [1259-2119] vs. 1650 [1390-2517] mL, p=0.005). Differences in NUV remained significant (p=0.006) after eliminating Diabetes Mellitus cases (n=44). However, differences did not persist for 24-hr TUV (p=0.180).

Conclusion

Higher NUV, but not 24-hr TUV, was a robust correlate of frailty in these older men. Accounting for diabetes did not diminish the effect. Although undiagnosed sleep apnea remains a possible cause, recent chronobiologic data (Monaghan et al, Age Aging, 2020, in press) suggest that nocturia in the aged is characterized by excess free water clearance early in the sleep period. This argues against solute-driven urine production (as might be expected in sleep apnea) in accounting for the effect. Nocturia may represent a conspicuous and important change in circadian rhythm of urine production occurring in old age.

Support

N/A
0837 Well-Being Predicts Sleep Disturbance in a Prospective Cohort of Older Adults
Authors: Hershner S D , Swanson L M , Meng A , Jansen E C , Burke J F , Braley T J , Dunietz G L
Published: May 2020

Introduction

Lower well-being negatively impacts health among older adults. Optimal sleep - a determinant of health - has been associated with higher well-being. Several domains of well-being, e.g., mindfulness and purpose in life have been shown to improve sleep. But, whether well-being impacts sleep remains unclear. This study examined associations between well-being and sleep duration, sleep quality, and incident insomnia symptoms among a nationally representative sample of older US adults.

Methods

This study analyzed data from the 2011-2013 National Health and Aging Trends Study (NHATS), a longitudinal, annual survey of community-dwelling Medicare beneficiaries. The exposure, a validated scale of well-being used questions on purpose, emotion, and self-satisfaction and divided responses into quartiles. Sleep outcomes included sleep duration, sleep quality, and insomnia symptoms. Unadjusted and adjusted linear and logistic regression models examined relationships between the health characteristics and well-being score in 2012 and sleep outcomes in 2013. Covariates included demographics and health characteristics.

Results

Half of study participants (n=2,000) were women. The mean sleep duration was 7.2 and 7.3 (standard error(SE) ±0.1) for men and women. Poor sleep quality was reported by 30% of subjects and more frequently among Hispanic subjects, older adults, and those with less education. The mean well-being score was 17.2 (SE ±0.07). Higher well-being scores correlated with male gender, younger age, higher education, marriage, and increased physical activity. Well-being scores in the 2nd - 4th quartile had lower odds of poor sleep quality (4th quartile adjusted odd ratio 0.24 (95% CI 0.15, 0.38). The highest well-being quartile had a 4-fold lower incidence of insomnia symptoms. Well-being scores were not associated with sleep duration

Conclusion

Higher well-being may protect older adults against the development of insomnia and poor sleep quality. Strategies to improve well-being could offer an innovative way to improve the health of older Americans though better sleep.

Support

none
0839 Napping Stigma Among Frail Older Adults: Reflections from a Qualitative Study
Authors: Berkley A S , Carter P A
Published: May 2020

Introduction

Napping and other daytime sleep is often overlooked in insomnia research and poorly defined in many studies. Research has shown some correlations between older adults’ napping habits and increased medical co-morbidities and risks of dementia, but it has also shown that napping enhances memory consolidation and broader aspects of cognition in younger adults. Where along the aging spectrum this line between beneficial napping and potentially risky napping falls is not clear.

Methods

This study employed a qualitative descriptive approach in which semi-structured interviews (N=18) were supplemented by the widely used self-report instruments and anxiety scales.

Results

Insomnia in these older adults directly resulted in reduced energy and stamina, poor mood, and reduced functional capacity. Indirect effects included reduced social interaction and increased isolation. Several participants reported napping in qualitative interviews but denied daytime sleep on standard sleep assessments, and associated napping with anxiety and dread of functional and cognitive decline. Planned or intentional napping was viewed with guilt and denial, while dozing off accidentally was considered an acceptable coping strategy.

Conclusion

While research about the relationships between disordered sleep and cognitive impairment is still at an early stage, it seems ironic that the participants in this study stigmatized planned napping, which could potentially benefit their cognitive functioning, but seemed accepting of accidental napping, which may well indicate some more serious cognitive issues. More education about sleep needs for older adults is needed.

Support

I am grateful to the Longhorn Village chapter of Texas Exes for their Gerontology Nursing Scholarship, which helped to fund this project.
0844 Links of Napping With Subsequent All-Cause Hospitalizations and Emergency Department Visits in Older Adults
Authors: Tzuang M , Owusu J T , Huang J , Sheehan O C , Rebok G W , Kasper J , Spira A P
Published: May 2020

Introduction

Few studies have examined whether napping is associated with objective measures of health services use. We investigated links of napping characteristics with all-cause hospitalizations and emergency department (ED) visits in Medicare claims from a nationally representative sample of older adults.

Methods

Participants were 869 community-dwelling Medicare beneficiaries aged ≥65 years from Round 3 (2013) and Round 4 (2014) of the National Health and Aging Trends Study (NHATS) who had continuous fee-for-service coverage 1 year before and after the NHATS interview. Participants reported past-month napping frequency (re-categorized as non-nappers, infrequent nappers, frequent nappers), napping type (intentional, unintentional), and nap duration. Outcomes were from linked Medicare claims measured after napping assessment: all-cause ED visits and hospitalizations (yes vs. no), and number of hospitalizations and ED visits.

Results

Overall, 45.4% of participants were nappers, and 55.2% of the nappers reported taking unintentional naps. After adjustment for demographics, depressive/anxiety symptoms, medical comorbidities and BMI, compared with non-nappers, infrequent and frequent nappers had a higher odds of hospitalization (odds ratio (OR)=1.65 and 1.73, respectively, both p<0.05), as did unintentional nappers (OR=1.85, p<0.05). We found no significant adjusted associations of napping frequency with ED visits. However, compared with non-nappers, unintentional nappers had a higher odds of visiting the ED (OR=1.94, p<0.01). Additionally, compared to nappers taking short naps (≤30 minutes), those with naps >60 minutes had a greater number of ED visits (Incidence Rate Ratio=1.99, p<0.05).

Conclusion

Among older adults, napping—and particularly unintentional napping—may be a modifiable risk factor for health services use. More studies that consider multiple napping characteristics (e.g., duration, frequency), and using objective measures (e.g., actigraphy), are needed to advance understanding of how napping might influence health services use.

Support

National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”
0868 How Do Sleep Morbidities Differ Amongst Pregnant Women, Women Who Are Intending To Conceive, And Women Who Are Not Intending To Conceive?
Authors: Hartman A R , Geller P A , Morales K , Lee K , Kloss J , Perlis M L
Published: May 2020

Introduction

Maternal sleep disturbance is common during pregnancy and is associated with adverse maternal and child outcomes, such as postpartum depression and preterm birth. The extent to which sleep disorder symptoms are normative among women of reproductive age, however, is largely unknown. The present study’s primary aim was to explore cumulative sleep morbidity and the incidence of disorder-specific symptoms among reproductive-aged women of different childbearing statuses.

Methods

Sleep morbidity variables were examined cross-sectionally among three groups of reproductive-aged nulliparous women: those 1) currently pregnant (n=148), 2) currently intending to conceive (n=233), and 3) not currently intending to conceive (n=379). All subjects self-reported sleep disorder symptoms at baseline using the Sleep Disorders Symptom Checklist-25 (SDS-CL-25). This instrument measures symptoms related to 13 sleep disorders scaled 0 (never) to 4 (> 5 days per week). Average scores were calculated for each item, each of 13 sleep disorders, and for the whole instrument (0-100).

Results

Initial results indicated that pregnant women (M=22.80, SD=11.49) had a higher rate of cumulative sleep morbidity than women who were intending to conceive (M=20.33, SD=11.14) and women who were not intending to conceive (M=20.15, SD=12.03) (p=.05). Pregnant women also had increased rates of insomnia (M pregnant=8.38, SD=3.77; M intending=6.86, SD=3.60; M not intending=6.53, SD=3.47; p<.001) and restless legs syndrome/periodic limb movement disorder (M pregnant=2.77, SD=3.05; M intending=2.02, SD=2.28; M not intending=1.99, SD=2.43; p= .004) as compared to non-pregnant women.

Conclusion

These data suggest, as is widely held, that pregnant women have greater levels of sleep disturbance than women of a common reproductive age who are currently intending to conceive or who are not currently intending to conceive. The observed sleep disturbance appears to be limited to sleep initiation and maintenance and RLS/PLMs symptomatology. Additional analyses are ongoing.

Support

Perlis & Kloss: R21HD083628; Perlis K24AG055602
0901 Role of Nasopharynx Radiography in Diagnosis of Sleep Disordered Breathing in Children
Authors: Rao H S
Published: May 2020

Introduction

Sleep disordered breathing (SDB) in children comprises a wide spectrum of presentation ranging from primary snoring (prevalence 6-12%) to obstructive sleep apnea (OSA; prevalence 1-3%). In younger children, SDB is often secondary to adenotonsillar hypertrophy. Polysomnography is the gold standard test for evaluation of sleep disordered breathing. Yet, many providers order ancillary tests such as Radiography of Nasopharynx (NPX-ray) to assess for adenoidal hypertrophy. Previous studies evaluating efficacy of NPX-rays to diagnose airway obstruction have shown mixed results.

Methods

Retrospective chart review of 65 consecutive normally developed children who have had diagnostic polysomnography and NPX-rays over the past 3 years was performed. Data on age, sex, Obstructive Apnea Hypopnea Index (OAHI) and NPX-ray findings were collected. Our cohort mostly had the following diagnosis such as GERD, Asthma, Allergic rhinitis, ADHD and Obesity. Our cohort did not have neurological disorders or medications that could affect tone of upper airway. Standard pediatric AHI criteria was applied to categorize mild, moderate and severe OSA.

Results

Our cohort’s age ranged from 3-18 years (median age 10 years); 43 were males. Of the 24 children with normal sized adenoids with no obstruction; 6 had severe OSA and 4 had moderate OSA. 3 had hypertrophied adenoids on X-ray with occlusion of nasopharynx but only had mild OSA. Of the 15 children with prominent adenoids with some narrowing but no occlusion; 9 had severe OSA. Of the 9 children that had hypertrophied adenoids with no occlusion; 3 had moderate OSA and 3 had severe OSA. Of the 12 with mild enlargement, 4 had severe OSA. None of the 19 children with severe OSA showed airway occlusion by adenoids.

Conclusion

In our study, the size of the adenoids on X-ray of the Nasopharynx did not correlate with severity of SDB in children. Airway obstruction in OSA is dynamic and can occur at multiple sites affected by anatomical factors and upper airway collapsibility. As use of Nasopharyngeal radiography involves exposure to radiation, it should be used judiciously in diagnosis of SDB in children. Polysomnography is the gold standard test for evaluation of SBD in children.

Support

None.
0923 Doxepin in Children and Adolescents With Symptoms of Insomnia: A Single Center Experience
Authors: Shah Y , Kothare S
Published: May 2020

Introduction

Pediatric insomnia is a widespread problem and especially difficult to manage in children with neurodevelopmental disorders. There are currently no FDA- approved medications for pediatric patients to use once first line therapy fails. Doxepin is FDA-approved at low doses for use in transient or chronic sleep maintenance insomnia in adults. The objective of this study is to determine the tolerability and efficacy of doxepin in the pediatric population.

Methods

This is a retrospective single center chart review of children and adolescents (2-17 years of age) whose sleep failed to improve with behavioral intervention and melatonin who were then trialed on doxepin. Treatment was initiated at a median starting dose of 2mg and slowly escalated to a median maintenance dose of 10mg. Improvement in sleep was recorded using a 4-point Likert scale reported by parents on follow up visits.

Results

Total of 29 patients were included in analysis. Mean follow-up duration was 6.5 months (±3.5). Out of 29 patients, 4 (13.8%) patients discontinued doxepin due to lack of efficacy or side effects. 8 (27.6%) patients showed significant improvement of their insomnia, 8 (27.6%) showed moderate, 10 (34.5%) showed mild and 3 (10.3%) showed minimal to no improvement on treatment with doxepin (P<0.05) Only two patients (6.8%) experienced adverse effects in the form of behavioral side effects (aggression) and enuresis.

Conclusion

Our data suggests that doxepin is effective, safe and well-tolerated in the treatment of sleep initiation and maintenance insomnia as well as psychophysiological insomnia in child and adolescents with Ausitsm specutrm disorder, other neuro-developmental disorders and attention deficit hyperactivity disorder. It is also an effective, safe, and well-tolerated alternative in children suffering from chronic persistent insomnia. The results of this study suggests a promising emerging therapy for the treatment of insomnia in the pediatric population.

Support

None
0932 Media Use and Short Sleep Duration Among Children Aged 3-17 Years—National Survey of Children’s Health, 2016-2017
Authors: Wheaton A G , Greenlund K J
Published: May 2020

Introduction

Media use, such as television viewing and computer use, has been associated with insufficient sleep among children.

Methods

Analyses used data collected from parents of children aged 3-17 years via the National Survey of Children’s Health in 2016 and 2017 (N=60,547). The prevalence of age-specific short sleep duration (<10 hours for ages 3-5 years, <9 hours for ages 6-12 years, and <8 hours for ages 13-17 years) was calculated by time spent (none, <1 hour, 1 hour, 2 hours, 3 hours, ≥4 hours) in front of a television (television time) and with computers or other electronic devices not for homework (computer time) on an average weekday. The prevalence of short sleep duration was also calculated adjusting for child sex and race/ethnicity, household income, parental education, special health care needs, general health, and bedtime regularity.

Results

The prevalence of short sleep duration was 35% for ages 3-5 years, 37% for ages 6-12 years, and 32% for ages 13-17 years. There was a significant linear relationship between both television and computer time and short sleep duration prevalence for all age groups, with the exception of television time for 13-17 year olds. For ages 3-5 years, prevalence of short sleep duration ranged from 18% (none) to 48% (≥4 hours) for television time (linear trend p<0.0001) and 23% (none) to 49% (≥4 hours) for computer time (linear trend p<0.0001). For ages 6-12 years, prevalence ranged from 23% (none) to 57% (≥4 hours) for television time (linear trend p<0.0001) and 26% (none) to 58% (≥4 hours) for computer time (linear trend p<0.0001). For ages 13-17 years, prevalence ranged from 15% (none) to 41% (≥4 hours) for computer time (linear trend p<0.0001). The associations remained significant after adjustment for covariates.

Conclusion

Reducing media use may increase sleep duration for children. The association between media use and sleep duration is similar for television and computer time for younger children; however, focusing on recreational computer use may be beneficial among teens.

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0938 Sleep, Perfectionism and Cognitive Anxiety in Sports: An Exploratory Study
Authors: Ramos Socarras L , Bourgon V , Mercier K , Forest G
Published: May 2020

Introduction

Perfectionism has been related to cognitive anxiety in sports. The bidirectional association between sleep and anxiety has also been well studied. However, the relationship between sleep habits, anxiety and perfectionism in physically active young individuals hasn’t been documented yet. This was the objective of the present study.

Methods

150 young, physically active participants (10 to 18 years old; 47% boys, 51% girls) completed an online survey comprised of questions extracted from the Sport Multidimensional Perfectionism Scale-2, the Competitive State Anxiety Inventory-2R and the Adolescent Sleep Habits Survey. First, independent t-tests were conducted to compare sleep habits, personal standards (PS), perceived parental pressure (PPP) and perceived coach pressure (PCP) of more anxious (ANX) to less anxious (NOANX) participants. Then, stepwise multiple linear regression analyses were computed to examine the significant sleep habits and perfectionism variables associations with competitive cognitive anxiety.

Results

Results show that ANX participants have higher PS (t(148)=3.19, p=0.002), less total sleep time on weekend (TST; t(148)=-2.94, p=0.004), longer sleep onset latency (SOL) on weeknights (t(128.09)=2.28, p=0.03) and report more daytime sleepiness (t(148)=3.06, p=0.003) compared to NOANX participants. The significant sleep variables and PS collectively explained 17.7% of competitive cognitive anxiety variance (p=0.00). PS was the largest predictor (β=0.27, p=0.00), followed by daytime sleepiness (β=0.21, p=0.007), weekend TST (β=-0.17, p=0.023) and weeknight SOL (β=0.16, p=.038).

Conclusion

These results suggest that, even though PS is associated with cognitive anxiety, sleep seem to be an important factor to consider. Specifically, increased daytime sleepiness accompanied by difficulties falling asleep during school nights and no recovery sleep during weekends significantly contribute to competitive cognitive anxiety. These results could have important implications when addressing competitive anxiety issues in young athletes.

Support

N/A
0948 Sleep Quality, Depressive Symptoms, and Stress in Maternal Caregivers of Young Children with Bronchopulmonary Dysplasia
Authors: Feeley C , Chasens E
Published: May 2020

Introduction

Maternal caregivers of young children with a chronic illness, like bronchopulmonary dysplasia (BPD), often report increased levels of stress and depressive symptoms, as well as poor quality of sleep. Caregiving duties are time-intensive and extend into the nighttime hours. The purpose of this study is to examine sleep, depressive symptoms, and stress in maternal caregivers of young children with BPD, as well as determine if depressive symptoms is a mediating variable between sleep quality and stress.

Methods

61 maternal caregivers (mean age 29 yrs) of young children with BPD (mean age 14 mos) were recruited. Mothers had no reported history of a sleep disorder, and had a child diagnosed with BPD. The child had to have been home from the hospital for at least two months, and not require a ventilator or tracheotomy. Maternal caregivers were asked to complete a demographic questionnaire, as well as the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression Scale (CES-D). Upon completion, 56.9% of the sample was single, 67.2% were African American, and child had been home from hospital a mean of 8 mos.

Results

Over two thirds (67.2%) of the sample reported sleeping 6 or fewer hours a night, with a mean PSQI score of 7.6. Significant correlations were found between PSQI and CESD (; r=.546; p=.000), as well as PSQI and stress (r=.284; p=.031). Depressive symptoms were not found to mediate the relationship between sleep quality and stress, however, sleep quality was a significant predictor of stress (t=2.171; p=.034) and depressive symptoms (t=4.876; p=.000).

Conclusion

The majority of maternal caregivers of children with BPD reported insufficient and poor quality of sleep, which may affect their stress and depressive symptoms. Healthcare providers need to discuss the importance of sleep with caregivers, and ensure the child’s care schedule allows for sleep during the nighttime hours.

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0962 Sleep and Daytime Functioning in Gifted and Twice Exceptional Children
Authors: Théoret R , Bastien L , Godbout R
Published: May 2020

Introduction

Gifted (G) children display an asynchrony between intellectual development and social and emotional development. Twice exceptional (2e) children are G children with a neuropsychological disability. We compared the sleep and daytime behavior of G, 2e and typically developing (TD) children and we sought for group-specific relationships between sleep and daytime behavior.

Methods

23 children were recruited: seven G (8.7 years old, SD = 1.7), six 2e (9.8 years old, SD = 1.8) and 10 TD children (10.0 years old, SD = 2.2). Giftedness was diagnosed with neuropsychological tools. The Children’s Sleep Habits Questionnaire (CSHQ) assessed sleep quality, the Child Behavior Checklist (CBCL) assessed daytime functioning. Sleep quality and its impact on daytime functioning was measured with a MANCOVA, with the CBCL’s three main factors as dependent variables (internalizing problems, IP; externalizing problems, EP and total problems, TP), children group as the independent variable and the CSHQ total score as the covariate.

Results

G, 2e and TD groups scored 39.86, 39.17 and 39.70 on the CSHQ, respectively (n.s.). The three groups were not different on the CBCL, with respective mean T scores of 57.86, 50.33 and 48.60 for IP, 56.43, 55.67 and 47.80 for EP and 55.29, 53.83 and 46.40 for TP. Pillai’s trace statistics disclosed a significant relationship between CSHQ and CBCL scores regardless of groups (p = 0.04) but the influence of sleep quality did not differ among the groups for any of the three factors. The CSHQ total score was positively and significantly related to IP (p = 0.03, r = 0.47); relationships were not significant for EP (p = 0.96, r = -0.01) and TP (p = 0.17, r = 0.31).

Conclusion

Sleep quality influences internalizing problems in children, without group-specific relationships, but this association does not seem to differ between gifted, twice exceptional and TD children.

Support

N/A