bluuebunny/crossref_metadata_2025 huggingface dataset:
0896 Predictors of Total Sleep Duration in Adults with Epilepsy
Authors: Smith Matthew , Araujo Matheus , Andrews Noah , Wang Lu , Foldvary-Schaefer Nancy
Published: May 2023

Introduction

Sleep deprivation is a common seizure trigger in adults with epilepsy (AWE). Yet, few prospective studies explore the relationship between seizure control and sleep duration. We studied factors associated with sleep duration in AWE participating in a prospective, cross sectional study investigating prevalence of sleep disorders. We hypothesized seizure frequency would be inversely associated with sleep duration.

Methods

Participants were AWE with quantifiable seizures who completed PSG, validated instruments and seizure/sleep diaries for at least 7 days in whom prior knowledge of sleep disorder symptoms was unknown. Linear regression models were fit for Total Sleep Duration (TSD; average sleep duration during the major sleep period) and 24-hour TSD (TSD24; average sleep duration during the major sleep period + daytime naps). Independent variables were monthly seizure frequency excluding auras(MSF), monthly generalized seizure frequency(GSF), epilepsy classification (focal vs. generalized), Beck Depression Inventory(BDI) and Insomnia Severity Index(ISI) scores, age, sex, body mass index(BMI), anti-seizure medication(ASM) number and standardized dose and apnea hypopnea index(AHI). Analyses were performed based on significance level 0.05, using SAS (version 9.4, Cary, NC).

Results

The sample included 126 participants (age 37.5(IQR:28,49), 67.5% female, BMI 28.0(IQR:24.0,32.3), 74.6% focal epilepsy). TSD was 7.5 + 1.9hr and TSD24 7.5 + 1.9hr. Median MSF was 0.5(IQR:0.0,4.0) with 75% having >1 seizure/mo. Median GSF was 0.75 + 9.1 with 19% having >1/mo. Median standardized ASM dose was 1.8(IQR:0.8,2.5) and 46.8% took monotherapy. After adjustment, female sex and ISI were inversely associated with TSD (female sex -1.01, 95%CI[-1.56,-0.17]; ISI -0.09, 95%CI[-0.15,-0.02]) and TSD24 (female sex -1.44, 95%CI[-2052,-0.37]; ISI -0.09, 95%CI[-0.17,-0.01]). GSF>1 was associated with longer TSD24 than those with GSF < 1(2.26, 95%CI[1.03,3.50] vs. 0.43, 95%CI[-0.49,1.35]). With every 1-unit increase in GSF, TSD24 increased 0.22hr(coefficient 0.22, 95%CI[0.07,0.36]). Other epilepsy-related variables were not associated with sleep duration.

Conclusion

In this first detailed analysis of TSD in AWE, female sex and higher insomnia severity were associated with shorter TSD and TSD24, and higher GSF was associated with longer TSD24. Neither TSD nor TSD24 were associated with MSF. These findings may inform future studies investigating sleep in AWE.

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0897 Sleep Architecture and Epileptiform Discharges in Rett Syndrome
Authors: Bricker Katelyn , Vaughn Bradley , Fan Zheng (Jane)
Published: May 2023

Introduction

Rett syndrome (RTT) is an X-linked dominant neurodevelopmental disorder affecting females and is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Sleep issues and frequent epileptiform discharges are common in RTT. Typical comorbidities in RTT include poor growth, feeding difficulties, hyperventilation and breath-holding, seizures, scoliosis, and disrupted sleep. Although polysomnographic studies indicate sleep disruption in patients with RTT, few evaluate if the epileptiform activity is associated with significantly greater changes in sleep. We analyzed if epileptiform discharges were associated with greater sleep changes than those seen without epileptiform discharges.

Methods

This retrospective case control of 10 RTT subjects (mean age, 11.19 years; ranged from 1 to 33 years) underwent standard in-lab polysomnography (PSG) recording. Subjects were compared to 10 age and gender matched controls with an AHI < 5 and no chronic medical problems. Rett children were divided into those with epileptiform discharges and those without. The two groups were compared using binomial cutoffs for each sleep parameter, and significance was determined by Fisher’s Exact Test. All studies were scored using the AASM criteria.

Results

Comparing our cohort of RTT patients to control subjects, the RTT patients have higher N3% of sleep, decreased N2%, and shorter sleep onset latency. 4 of the 10 PSGs are notable for frequent interictal epileptiform discharges. However, comparing those RTT patients with epileptiform discharges to those without, only REM latency trending shorter in those with epileptiform discharges (p= 0.057). No other significant differences were seen sleep staging, latency, total sleep time, efficiency, periodic limb movements nor respiratory parameters.

Conclusion

Our cohort did not find major differences in sleep features between those RTT patients with epileptiform discharges compared to those without. This may be related to a lack of influence of epileptiform discharges on these parameters or related to our small sample size. Although our cohort did not show major significant differences between those with epileptiform discharges, further study is required to delineate a more subtle relationship of these discharges to sleep.

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0899 Use of Artificial Intelligence for Early Characterization of Patients with RBD/RWA
Authors: Herdegen James , Cataline Joseph , Nygate Yoav , Gu Jiansan , Witek Natalie , Fernandez Chris , Watson Nathaniel
Published: May 2023

Introduction

The prevalence of polysomnography (PSG) confirmed REM sleep behavior disorder (RBD) has been estimated at 0.68% of the general population, and that of probable RBD at 5.65%. Isolated RBD is considered a pre-clinical marker of neurodegeneration with strong predictive value. Large longitudinal cohort studies demonstrate 81–91% of idiopathic RBD patients, followed for ≥14-years, will develop a definite neurodegenerative disease or mild cognitive impairment. Furthermore, high prevalence of sleep apnea (SA) exists in patients with RBD/REM without atonia (RWA), which can confound analysis of EMG tone and arousal activity. We demonstrate predictive AI models for RBD/RWA in subjects with and without SA.

Methods

Patients with known RBD/RWA who underwent PSG were divided into sub-groups with (n=86, RBDSA) and without SA (n=19, RBDNSA). Patient demographics, PSG characteristics, and co-morbid conditions were reviewed. Random forest (RF) models of PSG indices and Deep Learning (DL) methods identified predictive characteristics of RBD/RWA, sensitivity and specificity for RBD/RWA detection were estimated, and feature importance analysis was performed.

Results

Subjects with RBDSA compared to RBDNSA demonstrated greater BMI, AHI, Arousals (ArI), and Periodic Limb Movements (PLMs). In a Parkinson’s disease subgroup (n=12, RBDPD) compared to non-Parkinson’s sub-group, sleep was more fragmented, showing higher WASO, ArI, and PLMs. RF modeling demonstrated sensitivity/specificity of 67%/96% for RBDNSA subjects, and 79%/52% for RBDSA. Feature importance analysis resulted in several top-features for RBDNSA: N3 time, TST, AHI, REM duration, and sleep latency, while different top-features were observed for RBDSA: ratio of leg events in REM vs. non-REM, TST, ratio of arousals in REM vs. non-REM, REM duration, and REM time.

Conclusion

AI approaches including RF models produced high specificity and moderate sensitivity for RBDNSA subjects. Observed specificity was lower for RBDSA patients. We hypothesize the performance difference attributable to similarity and additional complexity in sleep disturbance characteristics between RBD and SA. Broad implementation of AI methods show potential to expand early detection and diagnosis of RBD and associated neurodegenerative conditions through expanded analysis, and follow-up, including RWA spectrum patients that don’t meet clinical thresholds for diagnosable RBD.

Support (if any)

None
0906 Feasibility of measures of sleep, circadian timing and lipid profiles for identifying mild cognitive impairment
Authors: Kim Seong Jae , Jang Jae-Won , Choi Min Seo , Suh In Bum , Lee Jung Hie
Published: May 2023

Introduction

Sleep disruption and circadian misalignment has been evident in patients with mild cognitive impairment (MCI). Together, sleep and circadian rhythm dysregulation can contribute to dyslipidemia, which has been proposed to play crucial roles in neurodegenerative process according to its known neurotoxicity. We aimed to compare parameters regarding lipid, nocturnal sleep and circadian timing between amnestic MCI (aMCI) and normal controls (NC), and to determine whether those parameters can be associated with the presence of aMCI in the elderly.

Methods

Participants above 50 years old were recruited from the Dementia Clinic at Kangwon National University Hospital, and two Public Care Centers for dementia patients. Neurocognitive tests were administered to each participant. The diagnosis of aMCI was made according to Petersen’s criteria. Eighteen aMCI patients (76.6 ±6.1 years) and 21 NC (70.4±6.7years) were finally selected. Actigraphy monitoring (Actiwatch 2; Respironics, USA) was conducted for 5 days. The dim light melatonin onset (DLMO) as an indicator of circadian timing was determined from five hourly saliva samples obtained before sleep onset. Fasting plasma total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were assayed. The sleep parameters, DLMO and lipid profiles were compared between the two groups. For these measures, receiver operating characteristic (ROC) analysis was performed to assess the usefulness of discriminating between the aMCI and NC.

Results

There were no significant differences in sleep parameters, DLMO and lipid profiles between the aMCI and NC groups. The bedtime and sleep onset were derived as indicators for discriminating aMCI (p=0.003 and p=0.054, respectively). The area under the ROC for bedtime was 0.861(cut-off scores ≥ 22:02, sensitivity= 0.76, specificity=0.75).

Conclusion

We did not reveal the usefulness of the DLMO and lipid profiles for identifying aMCI. However, we found that the bedtime had good discrimination power between aMCI and cognitively normal elderly, suggesting later sleep habits would be associated with the presence of aMCI in the elderly.

Support (if any)

Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science and ICT (2020R1F1A1050416); Research Funds from the Institute of Medical Science, Chosun University, Republic of Korea, 2022.
0907 Macro and microarchitectural sleep features in Alzheimer’s dementia and mild cognitive impairment in a large clinical cohort
Authors: Zheng Kevin , Little David , Laberinto Kim , Jaiyeola A J , Sadeghi Kolia , Tjiptarto Nurkurniati , Arslan Alex , Martin Ciara , Patino Angelica , Kleinschmidt Dave , Alday Phillip , Puryear Corey , Westover M Brandon , Donoghue Jacob , Pathmanathan Jay
Published: May 2023

Introduction

Recent work has characterized polysomnographic (PSG) changes in Alzheimer’s Dementia (AD) that correlate with disease severity and precede clinical diagnosis, although these findings are limited by relatively small sample sizes and a lack of studies examining sleep microarchitecture. In this study we examined sleep macro- and microarchitectural features in large cohorts of patients with AD and mild cognitive impairment (MCI).

Methods

Using a database of over 15,000 clinical PSGs with associated clinical metadata, 125 and 173 subjects were identified with mild AD and MCI, respectively. 260 age and sex matched subjects without neurological disease were identified as healthy controls (HC). Sleep staging results were based on AASM criteria, and micro-architectural features were assessed using an algorithm (Wake EEG Similarity Index, WESI) trained to predict state using spectral data from a unique healthy adult cohort.

Results

Sleep fragmentation was apparent in both the MCI and AD cohorts (relative to healthy controls), with AD subjects demonstrating substantially more severe PSG disturbances. Healthy controls demonstrated 400 minutes of total sleep time, in contrast to 374 minutes for MCI subjects and 362 minutes for AD subjects. Healthy subjects demonstrated 33 minutes of wake after sleep onset (WASO), compared to 60 and 67 minutes for MCI and AD subjects, respectively. As has been previously reported in smaller cohorts, wakeful bouts and N1 durations were substantially prolonged for AD and (to a lesser extent) MCI subjects, while N2, N3, and REM durations were reduced (with a pronounced reduction in AD N3 percentage). Sleep microarchitectural features assessed using WESI demonstrated that AD and MCI subjects had markedly higher relative wakefulness in all sleep stages except for N3, which showed the same sleep depth as HC.

Conclusion

We confirm increased sleep fragmentation and loss of deeper sleep stages that correlate to disease severity. Spectral features of all sleep stages except N3 appear more wakeful in AD and MCI subjects, suggesting microarousals or impaired sleep maintenance contribute to sleep pathology. While N3 duration was markedly reduced, depth of sleep as measured by the WESI algorithm was comparable between populations. PSG findings offer promise as early diagnostic and therapeutic targets.

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0911 Sleep Duration Is Associated with Subclinical Carotid Plaque Burden
Authors: Agudelo Christian , Ramos Alberto , Gardener Hannah , Cheung Ken , Elkind Mitchell , Sacco Ralph , Rundek Tatjana
Published: May 2023

Introduction

Sleep duration is associated with stroke risk and is one of eight essential components of cardiovascular health according to the American Heart Association. As stroke disproportionately burdens Black and Hispanic populations in the United States, we hypothesized that long and short sleep duration would be associated with greater subclinical carotid atherosclerosis, a precursor of stroke, in the racially and ethnically diverse Northern Manhattan Study (NOMAS).

Methods

NOMAS is a study of community-dwelling adults that recorded self-reported nightly sleep duration and daytime sleepiness. Carotid plaque presence, total plaque area, and intima media thickness were measured by ultrasound. Linear and logistic regression models examined the cross-sectional associations of sleep duration groups (primary exposure) or daytime sleepiness (secondary exposure) with measures of carotid atherosclerosis. Models adjusted for age, sex, race/ethnicity, education, health insurance, smoking, alcohol use, physical activity, body mass index, hypertension, diabetes, hypercholesterolemia, and cardiac disease.

Results

The sample (n=1,553) had a mean age of 64.7±8.5 years and was 61.9% female, 64.8% Hispanic and 18.2% non-Hispanic Black. Of the sample, 55.6% had carotid plaque, 22.3% reported nightly short sleep (< 6 hours), 66.6% intermediate sleep (≥6 and < 9 hours), and 11.1% long sleep (≥9 hours). Compared to intermediate sleep, long sleep was associated with greater odds of carotid plaque presence (OR 1.5, 95% CI 1.1-2.2) and greater odds of plaque within the tertile of largest plaque area (OR 1.7, 95% CI 1.0-2.7), each relative to plaque absence after full covariate adjustment. Short sleep was associated with lower odds of plaque within the tertile of largest carotid plaque area but was not associated with plaque presence. Daytime sleepiness was not associated with carotid measures.

Conclusion

Subclinical carotid atherosclerosis may mediate previously observed relationships between long sleep and increased stroke risk.

Support (if any)

This work was supported by the National Institutes of Health through grants from the National Institute of Neurological Disorders and Stroke (R37 NS029993, PI: Sacco/Elkind) and the National Institute on Aging (R01 AG067568, PI: Ramos), and by The Evelyn F. McKnight Brain Institute.
0912 Striatal atrophy and clinical correlates in REM sleep behavior disorder
Authors: Tang Shi , Huang Bei , Wang Jing , Zhou Li , Chau Steven Wai Ho , Chan Joey , Liu Yaping , Wing Yun Kwok
Published: May 2023

Introduction

Idiopathic/isolated REM sleep behavior disorder (iRBD) is regarded as the most specific prodromal stage of ⍺-synucleinopathies including Parkinson’s disease (PD). Striatal dopamine dysfunction is a pathological hallmark in PD, which has been similarly reported in iRBD as a sensitive marker for detecting early ⍺-synucleinopathies. In contrary, although there is a broad consensus that patients with PD have striatal volumes reduction, studies in iRBD are relatively scarce and inconsistent. In this study, we aim to investigate the difference of striatal nuclei volumes between iRBD and controls and their correlation with clinical presentations.

Methods

Altogether 105 patients (mean age=68.19, male 76.2%) with polysomnography-confirmed iRBD and 85 age and sex comparable controls (mean age=66.74, male 64.7%) underwent 3-tesla MRI and clinical assessments. FreeSurfer automatic segmentation pipelines measured the size of bilateral striatal nuclei including caudate, putamen, pallidum and accumbens area. The comparisons of the volume of individual striatal nucleus were made between iRBD and controls with age, sex, handness, and total intracranial volume as covariates. Correlations were performed to investigate the association between striatal nuclei volume and clinical domains in motor (Unified Parkinson’s Disease Rating Scale, Part III), cognitive (Montreal Cognitive Assessment, MoCA), visual (pareidolia), autonomic function (Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction, SCOPA-AUT) and mood symptoms (Hospital Anxiety and Depression Scale).

Results

There were smaller volumes in the bilateral putamen (t=-2.13/-2.32, p=0.03/0.02, left/right side respectively) and accumbens area (t=-2.58/-2.07, p=0.01/0.04, left/right side respectively) in iRBD comparing to controls. In addition, MoCA score was significantly positively correlated with the volumes of bilateral putamen (r=0.212/0.213, p=0.032/0.033), while pareidolia score was significantly negatively correlated with volumes of bilateral putamen (r=-0.205/-0.233, p=0.039/0.018,) and accumbens area (r=-0.249/-0.279, p=0.012/0.004, left/right respectively). The SCOPA-AUT score was significantly negatively correlated with volumes of the left putamen (r=-0.286, p=0.014) and the left accumbens area (r=-0.245, p=0.037). No other correlations with mood and motor features were found.

Conclusion

In this large case-control study, PD-like striatal atrophy was already present in patients with iRBD, which were significantly associated with worse cognitive performance, visual and autonomic dysfunction.

Support (if any)

This study was supported by Hong Kong Health and Medical Research Fund, 08191416.
0913 Evaluation of a Single-Session Sleep Intervention for Air Force Trainees
Authors: Ellis Jordan , Burns Rosemary Estevez , Mallawaarachchi Indika , Qun Xin Wang , Cassidy Daniel , Aycock Chase , Krunnfusz Andrea , Jones John , Klesges Robert , Talcott Wayne
Published: May 2023

Introduction

Sleep insufficiency is highly prevalent in military personnel and has detrimental impacts on operational readiness and health. Sleep health across this population does not appear to have improved despite targeted health promotion programs and efforts to bolster evidence-based tertiary care for sleep disorders. There is some evidence that problematic sleep may emerge in early military training environments and persist throughout a service member’s career. Approximately 37,000 personnel complete Air Force (USAF) technical training each year to learn job-specific skills. The purpose of the present study was to assess the effectiveness of a single-session, group-based sleep intervention in USAF Technical Training.

Methods

A brief (40-min) intervention incorporating behavioral sleep medicine interventions and motivational interviewing was developed and tailored for the target population. Three military units were assigned to receive either the brief sleep intervention (n = 203) or an active control group receiving a brief tobacco intervention (n = 118). Students were queried at two weeks post-intervention to assess their sleep time and quality using the Self-Assessment of Sleep Survey-Split (SASS-Y). Participants included 321 USAF technical school students (Mean age = 21), and the majority identified as male (82%), White (67%), and non-Hispanic (75%). Propensity-score-weighted multivariable logistic regression was utilized to compare the sleep outcomes between intervention and control groups at follow-up.

Results

At follow-up, students in the sleep intervention were significantly more likely to report sleeping > 6 hours per night on weekdays (OR = 1.49, p < .001) and more likely to endorse “Good” or “Very Good” sleep quality (OR = 1.50, p = .032) as compared to the control group. Follow-up results also showed that 69.2% of students in the sleep intervention group reported having engaged in the self-selected positive sleep ‘Action Step’ they chose and wrote down during the intervention.

Conclusion

This is, to our knowledge, the first study to design and test a brief motivational interviewing and behavioral sleep intervention in USAF technical training. Results suggest that a single-session, group-level intervention can promote behavioral changes and improve sleep health. Future efforts should consider low-touch additions (e.g., text messaging) to support the durability of intervention effects.

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0915 Comparison of In-person Versus Telehealth Positive Airway Pressure Set Up for Rural Veterans
Authors: Murray Benjamin , Seo Jiyeon , Bhattacharyya Sarathi , Mempin Roberto , Harris Brian , Smith Connor , Mitchell Michael , Lee Diane , Moghtaderi Isabel , Martin Jennifer , Gomez Alexander , Ryden Armand , Sarmiento Kathleen , Zeidler Michelle
Published: May 2023

Introduction

Traditionally, positive airway pressure (PAP) therapy is initiated in a face-to-face visit. This can be a barrier to accessing care for rural Veterans. The COVID-19 pandemic led to the implementation of telehealth PAP set-ups at two large VA sleep centers providing an opportunity to assess the effectiveness of telehealth versus face-to-face PAP initiation in rural Veterans.

Methods

We performed a retrospective cohort study of rural Veterans (defined by the Rural-Urban Commuting Areas system) to compare outcomes for those who initiated PAP with in-person visits prior to the COVID-19 pandemic to those who initiated PAP with telehealth during the COVID-19 pandemic. We assessed the days of PAP use, hours of PAP use and residual Apnea Hypopnea Index (AHI) at 30-day and 90-day intervals in these two groups. We excluded individuals who received a replacement device, and those who received PAP on or after June 14, 2021, due to a safety recall of PAP devices that may have affected use.

Results

PAP initiation data was available for 93 individuals, approximately half of whom were initiated on PAP in-person (n=46) and half by telehealth (n=47). There were no significant differences between the in-person and telehealth groups in terms of age, BMI, and AHI, which were 57.23±16 vs 60.67±14 (mean±SD), 31.81±5 vs 31.99±13, and 27.52±23/hr vs 28.85±22/hr respectively. The average number of days per month with PAP use at 30-day and 90-day intervals for in-person vs telehealth set-up was 17.59±11 vs 15.38±12 (p=0.36) and 15.54±13 vs 14.11±14 (p=0.60) respectively. The average number of hours of PAP use at 30-days and 90-days for in-person vs telehealth set-up was 3.25±3 vs 3.11±3 (p=0.82) and 3.15±3 vs 3.07±3 (p=0.90) respectively. The residual AHI at 30-days and 90-days for in-person vs telehealth set-up was 6.61±8/hr vs 5.25±6/hr (p=0.37) and 6.35±8/hr vs 7.68±11/hr (p=0.60)

Conclusion

In this cohort of rural Veterans, there were no significant differences in outcomes for those who initiated PAP therapy via telehealth when compared to in-person. This supports the feasibility of more widespread implementation of telehealth services for treatment of OSA in order to improve access without compromising patient outcomes.

Support (if any)

VA OCC FY21 RFA, VAGLAHS GRECC, K24HL143055
0916 Q4 no More: Optimizing Clincial Decision Support to Decrease Inpatient Sleep Disruptions
Authors: Kadura Sullafa , Eisner Lauren , Poulakis Alexander , Wielgus Oskar , Lin Jennifer
Published: May 2023

Introduction

Orders such as vital signs (VS) and neurological checks (NC) contain frequency options to help clinicians align workflows with patient needs. However, these clinical decision support (CDS) systems often default to around-the-clock, and clinicians may over-accept around-the-clock, leading to unnecessary sleep disruptions.

Methods

We added two radio buttons to VS/NC orders: q4 hour while awake (q4WA) and TID while awake (TIDWA). We gave presentations on CDS to inpatient neurology unit (INU) residents and staff pre-intervention. We sent reminders to INU residents to review and modify (when appropriate) around-the-clock orders via secure chat. We defined the pre-intervention period as six months before and the post-intervention period as six months following. Order frequencies and NC/VS performed from 11 pm–7 am were obtained via EHR. Pre- and post-intervention data were analyzed using interrupted time-series analysis (ITSA).

Results

Post-intervention, there was a significant decrease in q4 order frequencies (VS 15% and NC 17%,p< 0.001) across the institution. Subgroup analysis of the INU revealed more significant reductions in q4 frequencies (VS 54% and NC 48%, p< 0.001). Sleep-friendly orders significantly increased for VS and NC (0% to 6.7%, 0% to 7.8%). Sub-group analysis of the INU was again more profound, with sleep-friendly orders increasing from 0% to 16% for both VS and NC. Additionally, overnight VS and NC performed decreased by 11% and 17% post-intervention (p< 0.001) at the institution, with a further reduction in the INU (45% and 35% decrease for VS and NC, p< 0.001). The case-mix index was appropriately lower in the population with while awake orders (1.2749) versus around-the-clock orders (2.2684)

Conclusion

CDS modifications significantly increased sleep-friendly orders while reducing around-the-clock order frequencies and NC/VS completed overnight. These results were more profound on the INU, indicating that a combination of CDS changes, education, and chat reminders demonstrated a higher impact than CDS changes alone.

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0920 Enrichment and Patterns of Comorbidities in the Electronic Health Record of Patients with diagnosed Obstructive Sleep Apnea
Authors: Te Tue , Keenan Brendan , Veatch Olivia , Hubbard Rebecca , Pack Allan
Published: May 2023

Introduction

Obstructive Sleep Apnea (OSA) is the most common respiratory disorder of sleep and an independent risk factor for multiple other medical conditions related to poor quality of life and increased mortality and morbidity. The current study utilized the electronic health record (EHR) to examine relationships between OSA and common comorbidities within a large-scale dataset.

Methods

Cases with OSA and non-cases (controls) were defined using a validated EHR case identification algorithm, and matched based on age, sex, and observation period. We collapsed International Classification of Disease codes into PheCodes representing common etiologies and identified the top 20 most common comorbidities in the EHR among cases. We then compared overall and annual prevalence between matched cases and controls using conditional logistic regression. Latent class analysis (LCA) was used to identify subtypes of cases defined by specific combinations of comorbidities.

Results

Overall, 60,586 EHR-defined cases and 60,586 matched controls (from a total of 1,226,755 EHR-defined controls) were identified. Matched pairs had a median (IQR) age of 54 (45-63) years and 57.4% were males. BMI was higher in cases (median [IQR] = 35.9 [29.6, 41.0] kg/m2) than matched controls (28.0 [24.0, 32.0] kg/m2). Patients with OSA were at significantly greater risk of having each of the top PheCodes when compared to matched controls, with odds ratios ranging from 3.1 to 30.8 in the full matched set and 1.3 to 10.2 after controlling for BMI in the subset with available data. LCA identified 5 distinct subgroups based on comorbidities, labeled as High Comorbidity Burden, Cardiovascular Comorbidities, Depressive and Inflammatory Conditions, Low Comorbidity Burden, and Obesity and Cardiometabolic Dysregulation.

Conclusion

Our study demonstrates the power of leveraging the EHR to understand the relative health burden of OSA. In addition to showing enrichment for a number of comorbidities, we identified 5 subtypes defined by specific combinations of comorbidities in the EHR. These results could be informative for understanding likely disease outcomes and improved prevention and clinical care.

Support (if any)

National Research Service Awards (NRSA) T32 HL07713 National Institutes of Health (NIH) P01 HL094307
0922 Interference of racial and socioeconomic factors in the sleep of a large Brazilian city: lessons for comparisons between countries
Authors: Dokkedal-Silva Vinicius , Fernandes Guilherme , Tufik Sergio , Andersen Monica
Published: May 2023

Introduction

Investigation on the effects of racial and socioeconomic parameters on sleep has markedly increased along the years. The vast majority of these studies take place on countries in North America or Europe, thus making it necessary that new initiatives are conducted in developing nations. The objective of this study was to evaluate how race and socioeconomic factors influence sleep in the city of São Paulo, Brazil.

Methods

Health and sleep parameters of participants of the EPISONO (2007) study were assessed with validated questionnaires and a night of polysomnographic examination. Data regarding their self-identified race was collected during this protocol. Among the applied questionnaires, scores in the Critério de Classificação Econômica Brasil (CCEB) questionnaire were adopted in this analysis. General Linear Models were used to investigate the relationship between objective sleep parameters and the racial and socioeconomic classification according to the CCEB questionnaire.

Results

1,008 participants of the EPISONO were included (mean age=42.3 years; 574 women). Class C Blacks had greater total sleep time (TST) than Class A Whites, while Class C Asians presented less TST. Indigenous participants had reduced wake after sleep onset (WASO) time when sided to Whites and, similarly, Class D Blacks presented lower WASO compared to Class A Whites. Arousal index was lower in Class B and C individuals when comparing to Class A individuals and higher in Class C Blacks when compared to Class A Whites.

Conclusion

The variety of results when comparing socioeconomic and racial factors highlights the richness of the interplay between these parameters. While some findings are similar to those of North American and European studies, there are differences underlining the necessity of evaluating the socioeconomic and racial background of each population cautiously. Future research on sleep patterns of the Brazilian population concerning the effect of race and socioeconomic status is essential and a promising frontier of investigation to be explored.

Support (if any)

Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.
0924 Poor sleep regularity is widespread among first-year medical students
Authors: Marquardt Matthew , Fisher Fielding , Grandner Michael , Khan Meena
Published: May 2023

Introduction

Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Sleep regularity is increasingly recognized as a key driver for sleep quality and health. This study sought to determine the prevalence of and the factors that contribute to irregular sleep among first-year medical students.

Methods

A one-time, 130-item survey was distributed to the first year medical school class three months into the first semester. Quantitative and open-text questions asked about various sleep health related topics, including sleep regularity across weekdays (WDs) and weekends (WEs) for the past two weeks. Likert scale responses were treated as continuous data and reported as mean ± standard deviation. Means for WD and WE times were compared using paired t-tests. Statistical significance was considered a p-value ≤0.05.

Results

Out of 209 medical students in the first-year class, 58% (n=121) completed the sleep irregularity items on the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. The differences between WD and WE times for getting into bed (1.03 hours ± 0.90 hours), falling asleep (0.92 ± 0.80 hours), waking up (1.62 ± 0.84 hours), and getting out of bed (1.89 ± 0.93 hours) were significant (p< 0.001). Furthermore, 49.3% of participants reported significant bedtime or wake time variability (>3 hours difference from one day to another) at least once per week during the past 3 months. This occurred despite respondents expressing a strong belief in the importance of sleep consistency (7.1 ± 2.25 on a 10-point Likert scale; 0=Strongly Disagree, 5=Neutral, 10=Strongly Agree).

Conclusion

Poor sleep regularity is widespread during the first year of medical school. While students are aware of the importance of consistent bedtimes and wake times, they rarely follow this knowledge suggesting that external factors encountered during medical school such as poorly balanced academic workloads or stress might be to blame. Future studies should seek to better understand the factors contributing to poor sleep regularity in medical school and develop interventions to help students address any barriers.

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0925 Population Health and Data Analytics as an Opportunity for Improving Care Quality in Sleep Medicine
Authors: Stothard Ellen , Hickey Mark , Wertz Adam
Published: May 2023

Introduction

The volume and diversity of sleep-related and quality of life complaints in sleep medicine has increased through improved availability of data from wearables and public education on sleep health. Future shifts away from quantity and towards quality-based compensation by insurance payors will require practices to understand and actively monitor population health and outcomes data and implement data-driven practices to improve diagnostic efficiency. Currently, prevalence and population health data benchmarks are incomplete or absent in many aspects of sleep disorders treatment. The integrated care model of sleep medicine, with board-certified primary sleep physicians, an in-house Positive Airway Pressure (PAP) Therapy clinic and certified sleep medicine Dentist, is uniquely positioned to improve care by characterizing the impact of clinical decision-making on care cost and quality.

Methods

Population health data was gathered in the course of patient care in the integrated care model. Baseline/Diagnostic Home Sleep Apnea Test (HSAT) results from 2018-2021 were included. Diagnostic severity was categorized based on AASM treatment guidelines. Matched therapy visits were included from PAP Therapy Initiation or Compliance visit and treatment outcomes, as well as non-PAP treatments for sleep-disordered breathing, Oral Appliance (OA) and Inspire Therapy.

Results

20% of 8531 Diagnostic HSAT results were non-diagnostic for sleep apnea, 35% were Mild, 21% Moderate and 24% Severe. Of non-diagnostic tests, 81% had no sleep apnea treatment associated. Of Mild diagnostic tests, 49% had associated PAP initiation or compliance, 9% had associated OA, and 42% had no treatment associated. The relationship between diagnostic severity and associated treatment was significant (Χ2 < 0.0001). Further, Moderate and Severe resulting diagnostic tests had no associated treatment in 24% and 28% of cases, respectively.

Conclusion

Sleep medicine patients are commonly symptomatic and often have major quality of life complaints. Yet as these data demonstrate, there is a substantial proportion of patients who do not have an associated treatment after a positive diagnostic home sleep apnea test. Future studies should include additional demographic and follow up data to better understand care pathways both for patients who receive a positive diagnostic test but pursue alternative treatment methods, as well as more complicated non-diagnostic sleep disorders patients.

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0927 The Evolution of Costs for Telehealth versus In-person PAP Initiation for Patients with Sleep Apnea over the COVID Pandemic
Authors: Jambulingam Nikita , Sarmiento Kathleen , Gomez Alexander , Huynh Angela , Sanders Elizabeth , Smith Connor , Mitchell Michael , Lee Diane , Ryden Armand , Martin Jennifer , Zeidler Michelle
Published: May 2023

Introduction

During the COVID pandemic, at the San Francisco VA Healthcare System (VASFHS), positive airway pressure (PAP) set-up visits transitioned from in person to a mix of in person and telehealth for patients newly diagnosed sleep apnea. As part of a larger study examining the clinical outcomes resulting from telehealth versus in-person PAP initiation, we performed a cost analysis of these two treatment pathways within VASFHS.

Methods

The telehealth pathway included mailing of PAP machines to patients (initially from VASFHS and later through a centralized national distributor), with follow-up video/phone education by respiratory therapists (RTs) and registered sleep technicians (RSTs). We used a bottom-up analysis to examine the total variable direct cost of telehealth versus in-person PAP initiation at various points through the COVID pandemic for patients newly diagnosed with sleep apnea at VASFHS.

Results

The total variable direct cost of telehealth PAP initiation was $49.66 per patient mid-pandemic (Feb-Dec 2020) compared to $31.02 per patient post-pandemic (Oct-Dec 2022). The total variable direct cost of in-person PAP initiation was $16.76 per patient pre-pandemic (Jan-Dec 2019) compared to $22.71 per patient post-pandemic. The reduction in costs (37.5%) for telehealth PAP initiation mid- to post-pandemic was due to 25% less RT/RST time required and elimination of PAP shipping costs as PAP distribution became nationally centralized. The increase in costs (35.5%) for in-person PAP initiation pre- to post-pandemic was largely due to elimination of group PAP initiation sessions (33.3% more RT/RST time required for individual PAP initiation). Post-pandemic, telehealth PAP initiation cost was 36.6% more than in-person due to 25% more RT/RST time required and five times as much troubleshooting help required for the telehealth pathway.

Conclusion

With integration of telehealth for PAP initiation, as RT/RSTs gained more expertise with this interface through the pandemic and as distribution of PAP machines/supplies became centralized, costs were significantly reduced, making telehealth a financially sustainable workflow. Future cost analysis can evaluate if group rather than individual telehealth PAP initiation would yield additional cost savings, placing it on par with the cost of in-person PAP initiation.

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VA OCC FY21 RFA, VAGLAHS GRECC, K24HL143055
0928 The Self-Reported Practice of Light Exposure Recommendations in the Morning, Daytime, Evening, and Nighttime
Authors: Gottlieb Elie , Gahan Luke , Wilson Samantha , Watson Nathaniel F , Raymann Roy
Published: May 2023

Introduction

While it is well known that ocular light strongly entrains the central circadian clock, there has been a lack of evidence-based recommendations for daytime, evening, and nighttime light exposure for healthy adults. Recently, an expert consensus report with recommendations for light exposure has been published. Although the general population is likely not yet acquainted with these recommendations, we examined the self-reported practice of daily and nightly light exposure based on these published guidelines.

Methods

Online survey data were collected from 168 participants through convenience sampling (age range: 25-80, mean age: 58.9 + 12.6 years, 55% female). The practice of expert, consensus-based light recommendations was assessed with 4 items on an 8-point frequency scale ranging from “Never” to “Every day of the week”. The scale covered 1) indoor daytime light recommendations, 2) indoor evening light recommendations, 3) nighttime light recommendations for the sleep environment, and 4) an additional morning-specific question.

Results

Within the first hour after waking up, the majority of respondents (53%) reported never receiving exposure to at least 15 minutes of sunlight or simulated bright light, with only 16% reporting exposure every day of the week. Throughout the daytime, 54% of respondents reported receiving consistent natural indoor light or sunlight every day of the week, and 8% reported never receiving any. During the evening, 47% of respondents reported never dimming lights and avoiding bright light starting at least 3 hours before bedtime. However, 24% reported avoiding bright light sources before bedtime every day of the week. While sleeping, nearly 80% of respondents reported keeping their bedroom as dark as possible, no brighter than natural moonlight, every day of the week, with only 10% reporting never doing so.

Conclusion

Self-reported practice of recently published light recommendations was poor for both morning and evening light exposure. These findings suggest that sleep and circadian health campaigns should focus on the importance of bright light in the morning upon awakening, and of dimmed light in the late evening before bedtime.

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SleepScore Labs
0932 Sleep Difficulties: Prevalence, relationship with psychological outcomes, and interindividual differences in student-athletes
Authors: Charest Jonathan , Cook Jesse , Werthner Penny , Samuels Charles
Published: May 2023

Introduction

Mental health issues are a leading cause of decreased academic and athletic performances when left untreated. Recently, the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) have highlighted the fundamental importance of mental health among young athletes. Sleep represents a core feature of mental health, and student-athletes represent a vulnerable population for sleep restriction and disruption due to the demands of their courseload and training schedule. This investigation was performed to identify differences in sleep and mental health across gender, race/ethnicity, and sport type.

Methods

Data were obtained throughout the academic semester from Canadian institutions, with student-athletes completing the Athlete Sleep Screening Questionnaire (ASSQ), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire (PHQ-9). ASSQ captured sleep and circadian health, while GAD-7 and PHQ-9 assessed anxiety and depressive symptoms, respectively. Linear regression determined gender, race/ethnicity, and sport type differences across ASSQ sleep problems score, ASSQ sleep items, GAD-7 score, PHQ-9 score, and PHQ-9 item #9 (suicidal ideation).

Results

Final sample (N=559) was 53.0% female, 79.1% white, comprised of young individual (Mean Age = 18.9 ± 3.21), and included student-athletes from basketball, field-hockey, football, ice-hockey, soccer, volleyball, track & field and swimming. Females reported more overall sleep difficulties (p=0.01), medication use (p=0.04) and WASO (p=0.001) compared to males. Females also reported higher anxiety (p < 0.0001), depression (p< 0.0001), and suicidal ideation (p=0.03). Significant variance in total sleep time (TST) (p=0.001) and sleep satisfaction (p=0.04) was observed across race/ethnicity, with student-athletes identifying as Black or African American reporting the lowest TST, while Asian or Pacific Islander student-athletes reported the lowest sleep satisfaction. Significant variance in sleep difficulties score (p< 0.0001), TST (p < 0.0001), and satisfaction (p< 0.0001), as well as anxiety (p < 0.0001) and depression (p< 0.0001) was observed across sport type. Football student-athletes reported the highest sleep difficulties score, and lowest TST satisfaction. Field-hockey student-athletes reported the highest anxiety and depression.

Conclusion

Results suggest that sleep and mental health challenges present differently across gender, race/ethnicity, and sport type. Clarifying these unique and specific challenges to student-athlete sleep and mental health is necessary to enhance and personalize interventions.

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Mitacs #IT23469
0934 An Analysis of 5,212 Sleep Medicine Providers’ Online Patient Reviews
Authors: Shaffer Nicholas , Meraj Adeel
Published: May 2023

Introduction

Online provider rating websites are an increasingly popular medium for patients to provide reviews & feedback and obtain information about varying healthcare providers. There have yet to be studies on what factors significantly impact sleep medicine provider ratings. Healthgrades is a popular healthcare provider rating database with over 11 million patient reviews. This study analyzes various dimensions to determine what factors correlate with average sleep medicine provider ratings to improve patient satisfaction.

Methods

Data were collected on 5,212 sleep medicine providers’ online profiles using web data extraction software. Factors such as medical degree, gender, age, and ethnicity were compared to online ratings using Pearson correlation and ANOVA analysis via statistics software.

Results

Variables with positive correlation in provider rating include the presence of a headshot (pc=0.106, p< 0.01), designation of trustworthiness (pc=0.152, p< 0.01), and presence of care philosophy statement (pc=0.105, p< 0.01). The only variable with a negative correlation in provider rating was increasing age (p=-0.109, p< 0.01). A one-way ANOVA revealed that there was a statistically significant difference in mean rating between different healthcare degrees (F(122.271, 5062.570)=[17.955], p=<.001). Tukey’s HSD Test for multiple comparisons found that the mean value of ratings was significantly different between allopathic physicians and sleep medicine dentists (p=0.000, 95% C.I.=[-0.943,0.070]), physician assistants (p=0.000, 95% C.I.=[-1.268,-0.239]), and nurse practitioners (p=0.000, 95% C.I.=[-0.941,-0.188]). There was no statistically significant difference in mean online rating between allopathic physicians and osteopathic physicians (p=0.505), sleep psychologists (p=0.344), or foreign medical graduates (p=0.998), respectively.

Conclusion

This study suggests patients perceive sleep medicine providers’ online profiles with headshots, care philosophy statements, and designation of trustworthiness as contributing factors when rating. Additionally, degree type and age matter when rating online. Patients do not value factors such as ethnicity or gender strongly when rating their sleep medicine provider. Further study is needed to determine factors influencing non-physician providers’ higher ratings when compared to U.S. medical graduates. This study demonstrates the importance of building an online presence for sleep medicine practices and identifying characteristics patients value. The expectation is that this information can be used to improve the quality of care delivered in the field of sleep medicine.

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