bluuebunny/crossref_metadata_2025 huggingface dataset:
0829 Effects of Sex on Sleep EEG in Typical and Atypical Neurodevelopment
Authors: Kozhemiako Nataliia , Purcell Shaun M ·
Published: April 2024

Introduction

Sleep electroencephalography (EEG) patterns exhibit intricate variations influenced by multiple factors, including sex-specific disparities. While sex effects in sleep neurophysiology are relatively well-described in adults, information is more limited in pediatric samples, even less so in specific cohorts such as neurodevelopmental disorders (NDD). In this study we aimed to describe sex differences in a comprehensive set of EEG-derived sleep features in non-NDD individuals and compare those to the NDD cohorts including autism spectrum disorder(ASD), attention deficit hyperactivity disorder(ADHD), and intellectual disabilities(ID).

Methods

We used whole-night polysomnography data from a large National Sleep Research Resource sample, spanning from 2.5 to 17.5 years and Nationwide Children’s Hospital Sleep Databank, a pediatric sleep clinic cohort. Using ICD codes, we have defined the NDD subsets for ASD (N=196), ADHD (N=525), intellectual disabilities (N=167), and no-NDD sample (N=1523). The open-source package Luna was used to derive multiple sleep features including sleep spindles, slow oscillations (SOs) and spectral power across standard frequency bands. Linear regression models controlling for age were used to investigate sex effects with standardized b-coefficients (bstd) and p-values reported.

Results

Almost half of sleep EEG features expressed nominally significant sex differences in the no-NDD cohort (165 out of 351 tested EEG metrics), although their effect sizes were rather small. The strongest sex differences were observed in fast spindle density across all channels (largest effect at C4, bstd=-0.22,p=7x10-6 at C3, higher in girls), SO duration across all channels (largest effect at F3, bstd=0.24,p=1x10-5, longer in boys), occipital spectral power in alpha and sigma bands during REM sleep (bstd=-0.23,p=7x10-6 at O1, higher in girls). Generally, the NDD groups expressed similar pattern of sex differences evidenced by significant correlation between the standardized beta coefficients of each disorder and no-NDD group across all metrics (Pearson’s r=0.32 in ASD, 0.34 in ADHD and 0.27 in ID) although we also found evidence of disorder-specific sex differences.

Conclusion

Our findings indicate that multiple sleep EEG metrics express significant sex differences in childhood which are also observed in NDD populations. Such sex differences could potentially relate to disorder-relevant factors such as the differential prevalence of sleep issues in boys and girls or symptom manifestation.

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0844 Improving the Care of Pediatric Patients with Narcolepsy
Authors: Castner Lauren , Grekowicz Megan , Samphere Suzanne , Walden Krista , Flint Korina , Da Gambrell-Sanders 'Jhnae , Anderson Deb , Willis Rebecca , Malsch Thomasien , Bandla Hari
Published: April 2024

Introduction

Narcolepsy is a rare disorder characterized by disabling excessive daytime sleepiness and signs of REM-sleep dissociation. Pediatric narcolepsy has a different clinical presentation and may be difficult assess, but still can lead to severe impairments. Due to the importance of narcolepsy and the effects on quality of life we aimed to analyze and adjust our processes for caring for pediatric patients with narcolepsy to reach 90% compliance or greater with recommended quality measures.

Methods

Utilizing the AASM Quality Measures, medical records were reviewed from the Children’s Wisconsin Sleep Disorders Center with a diagnosis of narcolepsy from January 2018 until May 2023. Baseline compliance with recommended quality metrics were established. Those with a compliance rate of 80% or less were selected for the four step Plan-Do-Study-Act cycle. Data was continuously collected and analyzed quarterly to track compliance and address deficiencies in current processes.

Results

Pre-intervention data collection from 2017-2018 had compliance of 52% in documentation of the sleepiness assessment. Practice adjustments included educating clinical staff and distributing clinic questionnaires which improved compliance to 100%. With telehealth, compliance decreased to 90% and required an adjustment to clinical providers performing the assessment. Additional changes included developing an EMR Narcolepsy template to include safety counseling and education. Utilization of telehealth allowed annual follow up to remain >90%, even if patients delayed or cancelled an annual visit. For the small population of new patients compliance fluctuated between 0-100% for initiating treatment in part due to parent scheduling and clinic availability.

Conclusion

It is essential to ensure proper diagnosis, prompt treatment initiation, regular follow up of symptoms and response to treatment, and safety practices for those with Narcolepsy. With simple adjustments, compliance improved, but due the COVID-19 pandemic care delivery changed. The plan was to temporarily shift to a telehealth model, telehealth enabled us more flexibility to discuss results and manage treatments when necessary. Utilization of online questionnaires through patient portals can update the EMR. Work is ongoing to further explore how technology can be used to reach patients and maintain consistent follow up.

Support (if any)

Internal funding provided by the Children’s Wisconsin Department of Pediatrics
0849 Characterization of Patient Referrals to ED/Inpatient Admission from an Outpatient Pediatric Sleep Center
Authors: hiranrattana Anunya , Fitzgerald Rebecca , Kehoe Anna , Heckler Gillian , Gilbert Christianna , Katwa Umakanth , Maski Kiran
Published: April 2024

Introduction

The medical complexity of patients referred to our pediatric laboratory has been increasing. These children are at higher risk of severe sleep disordered breathing and/or risk of emergent medical issues during the study. As a result, patients may need to be referred directly to emergency room or inpatient admission from the ambulatory sleep lab. In this single site pediatric sleep lab quality improvement project, we identify the frequency of ED/inpatient referrals from attended, in-lab sleep studies, reasons for referrals, and contributing factors for referral.

Methods

This is a cohort study of patients who had in-lab ambulatory polysomnogram at Boston Children’s Hospital between March 2017 to May 2022 identified through chart review search terms (ED or inpatient diagnostic codes within 24 hours of polysomnogram billing code). We performed chart review for demographics, past medical history, sleep study variables, medications, and disposition. We used chi-square tests to compare age and medical complexity categories.

Results

Of 6724 PSG studies conducted, 95 (1.4%) patients were referred to ED or inpatient admission within 24 hours from the sleep study. Demographics: Patients ranged in age from 1 month to 20 years [mean age 5.5(6) years] and the cohort was 38% female, 53% Caucasian, 12% Black, 2% Asian, 13% Hispanic, 6% other, 14% race/ethnicity not reported. Of the 95 patients referred to ED/inpatient hospitalization, 64% needed continued medical assistance in the morning due to various problems including persistent hypoxia, hypercarbia, altered mental status, difficulty tolerating oral intake, or need for assistance ambulating. Features such as age and patient triage level assigned prior to sleep study did not predict whether patient returned to baseline upon wakening. The reason for referral for ED or admission included severe sleep disordered breathing (e.g. obstructive sleep apnea or central sleep apnea; 33.8%), persistent hypoxia/hypercarbia (23.1%), cardiac (e.g. arrhythmias, worsening heart disease; 10.8%), vomiting/diarrhea (10.8%), neurologic (e.g. seizures, paroxysmal events, altered mental status; 7.7%), infection (e.g. fever/infection concern; 3.1%), allergy/anaphylaxis (1.5%), behavioral/psychiatric (1.5%), and metabolic derangements (e.g. hypoglycemia; 1%).

Conclusion

This quality improvement project informs sleep lab policies and procedures regarding staffing, training and management of urgent medical issues that arise during pediatric sleep studies.

Support (if any)

None
0850 Implementation of the San Diego Sleep Survey (SDSS) in Children with Autism
Authors: Warner M , Wu F , Inkelis S , Mung K , Stauffer Jacy , Linke A , Bhattacharjee R
Published: April 2024

Introduction

Children with autism (CWA) experience a high frequency of sleep disorders, which impact their well-being and development. Polysomnography faces challenges due to sensory sensitivities and communication difficulties in CWA. Therefore, sleep questionnaires play a critical role in gathering comprehensive information about sleep patterns and disturbances, potentially aiding in the identification of sleep disorders. The diagnostic potential of questionnaires could facilitate earlier access to tailored interventions for CWA, promoting enhanced sleep quality and better overall health outcomes.

Methods

Caregivers of patients aged 1 to 21 years referred to Rady Children’s Hospital Sleep Center, San Diego, CA, completed the San Diego Sleep Survey (SDSS) via the Epic® EMR system. CWA were identified using diagnostic codes (ICD-9/10). Additionally, surveys were collected from children without sleep complaints (control) at San Ysidro Children’s Dental Center and Chula Vista Medical Plaza. The SDSS, a 51-item scale, employed a 4-item Likert-type scale (Never, Sometimes, Usually, Do Not Know) for graded insights into sleep problems. Five domain scores assessed pediatric sleep problems: insomnia, sleep-disordered breathing (SDB), sleep disorder (e.g., parasomnia), sleep hygiene, and daytime symptoms (DS). A subset also completed the Pediatric Sleep Questionnaire (PSQ) and Children’s Sleep Habits Questionnaire (CSHQ) for comparative purposes.

Results

2103 patients completed SDSS (age 8.6±4.8). Of these, 241 CWA were identified (age 8.2±4.7; 64 females [27%]). Compared to controls (n=135, age 9.4±2.4), CWA had significantly better hygiene scores (9.3±2.3 vs 9.9±2.3, p=0.03), higher insomnia scores (17.1±4.4 vs 12.9±3.3, p< 0.01), higher SDB scores (18.4±6.2 vs 13.8±6.1, p< 0.01) and higher DS scores (31.5±7.0 vs 19.5±5.9, p< 0.01). 89 CWA completed the PSQ which identified 71 children (81%) with a positive SDB score (PSQ Total Score ≥8) compared to 189 children (65%) with a positive SBD score on SDSS. Forty-eight CWA completed the CSHQ; and all patients had a positive score (CSHQ Total Score ≥41).

Conclusion

The SDSS is a viable method for evaluating sleep disturbance in CWA, recognizing abnormalities in various domains. Future analyses will compare SDSS to PSQ and CSHQ to assess convergent validity for screening for sleep disorders. Additionally, sensitivity/specificity analyses of SDSS compared to the gold-standard of polysomnography will be explored.

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0852 Self-help Strategies for Sleep in Children and Adolescents with Epilepsy
Authors: Wu Pei-Yu , Weng Wen-Chin , Tsai Shao-Yu
Published: April 2024

Introduction

Children and adolescents with epilepsy have more sleep problems compared to their healthy peers. These sleep problems not only negatively impact development and quality of life, but also pose challenges in managing epilepsy effectively. The purpose of this cross-sectional study was to explore the use of self-help strategies for sleep among children and adolescents with epilepsy and examine the association between these strategies and sleep.

Methods

Seventy-five children and adolescents with epilepsy aged 1 to 17 years (mean age: 10.29 years) were recruited from a university-affiliated hospital between July 2022 and November 2023 in Taipei, Taiwan. They wore an actigraph on their wrist for a week, while their parents concurrently completed a sleep diary to document the utilization of any self-help strategies for sleep during the same period. Parent-reported sleep in children and adolescents was obtained using the Children's Sleep Habits Questionnaire (CSHQ). Data were analyzed using independent samples t-test.

Results

Of all the participants, only 17 (22.7%) children and adolescents had a nighttime sleep efficiency greater than 85%. The average total score of the CSHQ was 52.31±7.46, indicating moderate to severe sleep disturbance. Thirty-one (41.3%) parents reported using self-help strategies to help their children and adolescents sleep. These strategies included listening to music or stories (n = 14, 18.7%), reading books (n = 13, 17.3%), accompany (n = 6, 8%), using relaxation techniques (n = 2, 2.7%), feeding (n = 2, 2.7%), and giving teething toys (n = 2, 2.7%). There were no statistically significant differences (p > 0.05) in sleep efficiency and CSHQ scores between children and adolescents who used self-help strategies for sleep and those who did not.

Conclusion

Many children and adolescents with epilepsy experience sleep disturbance and poor sleep quality, with a significant proportion attempting to use self-help strategies to improve their sleep. Our findings highlight the importance of managing sleep in this population and suggest the need for further exploration into the effectiveness of specific self-help strategies for sleep in children and adolescents with epilepsy.

Support (if any)

This work was supported by the National Science and Technology Council, Taiwan, NSTC 112-2628-B-002-003.
0868 Cardiac Remodeling: Apnea-Hypopnea Index as a Predictor for Changes in Left Atrial Volume
Authors: Chung Steve , Kokinda Sussan , Nguyen-Phan Andy , Chervin Ronald , Schuetz Sonja
Published: April 2024

Introduction

Left atrial (LA) size and volume are of interest in sleep-disordered breathing (SDB) as they are associated with cardiac arrhythmias. However, whether the apnea-hypopnea index (AHI) predicts LA longitudinal changes over time remains unknown.

Methods

This retrospective cohort study includes adults (≥18 years) without congestive heart failure (CHF) who were referred for a diagnostic in-laboratory polysomnogram (PSG) between January 2019 and March 2020; a baseline echocardiogram within one year of the PSG; and a follow-up echocardiogram more than one year after the initial studies. Clinical, PSG and echocardiographic variables, including LA volume and LA size, were abstracted from the medical record. SDB was classified as absent, mild, moderate, or severe (AHI ≤4.9/h, 5.0-14.9/h, 15.0-29.9/h, and ≥30/h, respectively). Regression models were used to assess the baseline cross-sectional relationships between AHI and LA measures, and the association of baseline AHI with LA changes over time.

Results

We identified 103 patients (58.8% male, median age 66 years (interquartile range, IQR 52-71)) with and without SDB (AHI median 19.9, IQR 7.3 – 35.6). The median time between baseline and follow-up echocardiograms was 3.2 years (IQR 2.3-4.1). AHI was associated with larger LA volume (β=0.64, p=0.0002) and LA size (β=0.08, p=0.04) at baseline. AHI also predicted changes in LA volume over time (β=0.57, p=0.02), but not changes in LA size. A dose-dependent relationship between SDB severity and changes in LA volume was noted: Individuals without OSA demonstrated a slight decrease in LA volume over time (median -7, IQR -36 - -5) whereas those with severe SDB demonstrated an increase in LV volume (median 13, IQR -9 – +18). Individuals with mild/moderate SDB fell between those groups.

Conclusion

Many patients with SDB are at risk for cardiac arrhythmias. Our results indicate that SDB severity at baseline predicts changes in LA volume over time. These findings may help identify patients at risk for LA enlargement and associated arrhythmias, and suggest a potential opportunity for early intervention to decrease cardiovascular risk.

Support (if any)

NIH R25NS088248
0874 Impact of Physical Activity on Subsequent Night's Sleep in Patients After Cardiac Surgery
Authors: Lee Sueyeon , Park Chang
Published: April 2024

Introduction

After cardiac surgery, patients often experience sleep disturbances, including poor sleep quality and increased awakenings. Sleep benefits postoperative physical function and overall recovery and has been related to physical activity. Physical activity and sleep have daily variations, but no study has examined their relationships on a daily basis after cardiac surgery. To address this gap, we investigated the effects of daily physical activity on daily sleep in postsurgical cardiac patients.

Methods

Employing a longitudinal pilot study design, 33 adults aged 18 to 80 who had undergone cardiac surgery were recruited from one hospital in Chicago and using an online recruitment site. Daily physical activity and sleep were measured in participants’ homes using a wrist-worn ActiGraph over 7 days and nights. Sociodemographic and psychosocial factors were assessed through self-reported online questionnaires. Mixed-effects model analyses were applied to examine the effects of daily physical activity on five sleep variables; covariates were selected from bivariate correlational and regression analyses as well as previous research evidence.

Results

Participants were mostly male (57.6%), non-Hispanic whites (63.6%) and had a mean age of 60.8 ± 10.1 years. Their mean body mass index (BMI) indicated overweight (28.4 ± 5.2 kg/m2), and 54.6% had undergone coronary artery bypass graft surgery 85.7 ± 91.2 months earlier. In mixed-effects model analyses, higher moderate-to-vigorous physical activity was significantly associated with lower next-day sleep latency (b=-1.32, p<.05). Among covariates, lower depression (b=2.72, p<.05), higher companionship (b=0.37, p<.05), and higher instrumental support (b=2.40, p<.05) were associated with lower daily wake after sleep onset, increased daily sleep efficiency, and longer total sleep time, respectively. In addition, older age, higher BMI, and a higher comorbidity index predicted more daily sleep disturbances.

Conclusion

In postsurgical cardiac patients, daily physical activity should be assessed and managed as a means to enhance daily sleep. Tailoring sleep interventions to individuals based on their comorbidities and psychosocial factors is also important. Future research should explore interactions between daily physical activity and sleep in a larger sample of postsurgical cardiac patients during varying time periods after surgery and should comprehensively assess sleep status, including sleep disorders, daytime napping, and daytime sleepiness.

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0877 Sleep Quality and Dyslipidemia Among Young and Midlife Women
Authors: Ajmani Mallika , Holzman Claudia , Tauman Riva , Lyu Xiru , Catov Janet , Dunietz Galit Levi
Published: April 2024

Introduction

Sleep quality is associated with poor cardiometabolic health in women and men. However, these associations have been infrequently reported among young and midlife women. Therefore, we examined the influence of poor sleep quality on dyslipidemia in a cohort of women from Michigan.

Methods

We utilized the POUCHmoms Study, a large and socioeconomically diverse community-based cohort of 648 young and midlife women from five Michigan communities. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), a widely used self-report questionnaire with 19 dimensions of sleep. A score >5 on the PSQI was considered indicative of poor sleep quality. Fasting lipids levels were assessed in plasma for all women. Based on clinical guidelines for dyslipidemia, we classified women by high and low lipid levels; High-density lipoprotein < 40 mg/dl, Low-density lipoprotein>160 mg/dl, Total Cholesterol >240mg/dl, Triglycerides>200mg/dl. Health, sociodemographic and lifestyle information was collected through questionnaires. Next, we grouped women by low and elevated (borderline/high) lipids levels and examined associations with poor sleep quality. Bivariate analysis was used for determining the association between the lipid levels with covariates of interest. Logistic regression models, adjusting for sociodemographic, health and lifestyle characteristics, were utilized to assess the association between poor sleep quality and dyslipidemia.

Results

Women in this cohort had a mean age of 38y and 68% were white. More than half (60%) reported poor sleep quality. The prevalence of low HDL and high total cholesterol was 41% and 30% respectively. Women with poor sleep quality were more likely to have low HDL (adjusted OR=3.17, 95% CI: 1.78, 6.96) than women with good sleep quality. Associations of poor sleep quality with high levels of triglycerides, LDL, and total cholesterol were not statistically significant. However, when we grouped women by elevated/high levels, we found that high triglycerides and low HDL levels were associated with poor sleep quality (adjusted OR=1.94, 95% CI: 1.06, 3.54) and (adjusted OR=2.65, 95% CI: 1.71, 4.12), respectively.

Conclusion

In this cohort of young and midlife women, we found significant associations between poor sleep quality, high triglycerides, and low HDL. These findings highlight the potential influence of sleep quality on cardiovascular function among women.

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0880 Relationships Between Multimorbidity and Disturbed Sleep Phenotypes in Chronic Spinal Cord Injury
Authors: Graves Letitia , May Anna , Xu Zixiang , Sun Jiayang , Carter Patricia , Bogie Kath
Published: April 2024

Introduction

Disturbed sleep is a modifiable risk factor for a variety of co-morbidities. Treatment of sleep disorders can provide a key target for improving cardiometabolic health and overall wellness. Despite evidence suggesting higher prevalence of disturbed sleep in Veterans with spinal cord injury (SCI) compared to the non-injured population, the intersectional effects of sleep-wake disruption remain undefined. The purpose of this study is to examine existing data from the spinal cord injury-pressure injury resource (SCI-PIR) database to assess prevalence and identify relationships among sleep disorders and cardiometabolic risk after spinal cord injury.

Methods

This retrospective longitudinal national database cohort study utilized the VA’s SCI-PIR database containing comprehensive clinical data for 29,000 individual Veterans with SCI with over 120,000 encounters. SCI-PIR data includes clinical characteristics of Veterans with SCI, demographics, and comorbidities identified as being relevant to sleep and cardiometabolic risk. We queried the database for ICD9 diagnosis codes related to cardiovascular, metabolic, psychologic, and sleep conditions to identify sleep disorder subgroups defined by clustering of cardiometabolic risk factors and sleep diagnoses within SCI individuals diagnosed with sleep disorders.

Results

In the sample of 18,894 Veterans, sleep disturbances were diagnosed in only 16.25% of the sample. Sleep apnea (6.7%) and insomnia (4.3%) were the most common sleep diagnosis. Correspondence analysis of sleep, cardiac disorders, and other co-morbidities demonstrated two clusters. The first cluster showed a robust link between sleep apnea, hypersomnia, heart failure and arrhythmias, and secondary associations with coronary artery disease, chronic kidney disease, obesity, diabetes, and hyperlipidemia. The second cluster showed a strong relationship between insomnia, anxiety, and post-traumatic stress disorder.

Conclusion

Sleep disturbances are common in Veterans with SCI, but underdiagnosed. Our findings support the link between medical complications and consequences of disturbed sleep and cardiometabolic risk. This will enable development of SCI validated sleep instruments and clinical decision tools that identify those at highest risk for sleep disorders lead to the development of targeted interventions and treatments to advance precision health for Veterans with SCI.

Support (if any)

NIH grant R25 HL105400 and VHA Office of Research, Supplement to Promote Diversity
0882 The Association Between Objective Daytime Sleepiness and Glucose Metabolism in OSA Patients: A Metabolomics Study
Authors: Li Yun , Le Chen  , Chen Baixin , Dai Yanyuan , Vgontzas Alexandros
Published: April 2024

Introduction

Objective, but not subjective excessive daytime sleepiness (EDS) has been proposed to link to cardiometabolic comorbidity in obstructive sleep apnea (OSA). We aimed to examine the joint effect of OSA and objective EDS on glucose metabolism and the underlying mechanisms.

Methods

The multiple sleep latency test (MSLT) and Epworth sleepiness scale (ESS) were used to assess objective and subjective EDS, respectively. Disordered glucose metabolism was defined as either a physician-diagnosis or having fasting blood glucose levels ≥ 5.6 mmol/L. Values of fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) higher or equal to the median values of our sample were defined as high fasting insulin and insulin resistance. Serum metabolomics was used to explore the underlying pathways.

Results

Among 114 consecutive OSA patients, lower MSLT values was marginally significantly associated with higher levels of fasting blood glucose (β = −0.181, p = 0.052, poor strength), and significantly associated with insulin (β = −0.308, p = 0.002, fair strength) and HOMA-IR (β = −0.321, p = 0.001, fair strength). Furthermore, objective EDS was significantly associated with increased odds of disordered glucose metabolism (OR = 5.781, 95%CI 1.232 - 27.135), elevated fasting insulin (OR = 4.317, 95%CI 1.357 - 13.731) and insulin resistance (OR = 5.621, 95%CI 1.581 - 19.984). Metabolomics analyses showed that dysregulation of valine-related metabolism linked the association between objective EDS and impaired glucose metabolism in patients with OSA. No association between subjective EDS and impaired glucose metabolism was observed.

Conclusion

OSA with objective, but not subjective EDS is associated with impaired glucose metabolism. Dysregulation of valine-related metabolism may contribute to the association between objective EDS and impaired glucose metabolism in OSA.

Support (if any)

This study was supported by the National Natural Science Foundation of China [No.81970087; No.82270105; No.82300117] and 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant [2020LKSFG05B].
0884 Slow Wave Sleep Is Associated with Glucose Metabolism in Obstructive Sleep Apnea: A Registry-based Study
Authors: Fu Cong , Yu Huan
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is a common condition being increasingly recognized and is a known risk factor for cardiovascular and metabolic disease. Impaired sleep architecture and (or) frequent nocturnal hypoxia are characteristic features in patients with OSA. However, little is known about the sleep parameters linking OSA with glucose metabolism. The objective of this study was to evaluate the association between glycated hemoglobin (HbA1c) and sleep traits from polysomnography and subjective sleep diary in a Chinese population with proven OSA (Huashan OSA Registry Study, Hs-OSARS).

Methods

535 participants were recruited in Huashan OSA Registry Study, from January 2018 to August 2021. Objective sleep characteristics were measured via one-night laboratory PSG and biochemical parameters was tested the next morning. Associations were conducted using Pearson’s correlation with adjustments for age, gender, and body mass index (BMI). Regression was used to investigate predictive power of sleep subscales for glucose levels.

Results

Among the participants, 133 subjects underwent HbA1c and lipid profile (triglyceride, total cholesterol, LDL- and HDL-cholesterol, etc). Age, BMI, ApoE, TC and non-HDL-C (rage=0.281, p=0.001; rBMI =0.249, p=0.004; rApoE=0.250, p=0.004; rTC=0.264, p=0.005; rnon-HDL-C=0.281, p=0.002) had positive associations with HbA1c. Among sleep traits, only stage 3 sleep had a negative association with HbA1c (r=-0.219, p=0.011). After controlling for gender, age and BMI, these associations remained and were statistically significant. Stepwise regression analysis found that non-HDL-C, stage 3 sleep and age were significant predictors retained in the model. Upon fixing the covariates (including gender, age and BMI), TC and stage 3 sleep were significant for predicting HbA1c outcomes.

Conclusion

Insufficient slow wave sleep is associated with higher blood glucose levels. Our study shows that other PSG indices, such as total sleep time, sleep efficiency, arousal index, apnea-hypopnea index and hypoxemic burden, are not associated with HbA1c. These findings highlight the importance for clinicians to evaluate and improve the slow wave sleep as part of preventing glucose metabolism impairment in OSA patients.

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0886 Impact of Multidimensional Sleep Health on Glycemic Control and Self-Reported Health Outcomes in Type 1 Diabetes
Authors: Irsheed Ghada Abu , Steffen Alana , Martyn-Nemeth Pamela , Park Minsun , Quinn Laurie , Duffecy Jennifer , Baron Kelly , Mihailescue Dan , Reutrakul Sirimon
Published: April 2024

Introduction

Sleep is important to health in patients with type 1 diabetes (T1D). This study comprehensively explored the impact of individual sleep dimensions, (e.g. satisfaction, alertness, timing, efficiency, duration, and regularity) as well as global multidimensional sleep health (MSH) on glycemic control and other self-reported health outcomes in T1D.

Methods

Data from 118 adults with T1D participating in an ongoing sleep intervention study (NCT04506151) were analyzed. Satisfaction was assessed by the Pittsburgh Sleep Quality Index and alertness by the Epworth Sleepiness Scale. Timing (sleep midpoint), efficiency, duration, and regularity (standard deviation of sleep midpoint) were derived from 7-day actigraphy. A composite MSH score was the sum of “Good” individual sleep health dimensions. Glycemic control was assessed through blinded 7-day continuous glucose monitoring (time-in-range (TIR, % of glucose levels between 70-180 mg/dL) and %CV), and hemoglobin A1C level (A1C). Self-reported outcomes (diabetes self-care and psychological factors) were collected through validated questionnaires. Multiple regression analyses were performed to determine whether individual sleep dimension and MSH scores independently predicted glycemic control or self-reported outcomes.

Results

Median (IQR) age was 33.87 (27.4, 43.61) years, 69.49% were female, and mean (SD) A1C was 6.74% (.93). After adjusting for covariates, only less sleep regularity was associated with poorer glycemic control [higher %CV (β=.262, p<.01), less TIR (β=-.280, p<.01) and higher A1C (β=-.175, p<.05)]. Sleep satisfaction was associated with higher diabetes quality of life (β=-.243, p<.01), lower diabetes distress (β=-.189, p<.05), lower fatigue (β=-.249, p<.01), and lower depression (β=-.211, p<.05). Daytime sleepiness was associated with higher fatigue (β=.228, p<.05), while later sleep timing was associated with higher depressive symptoms (β=.211, p<.05). Higher sleep efficiency was associated with lower anxiety and depression (β=-.305, p<.01, β=-.293, p<.01), respectively. Sleep duration was not associated with any outcomes. Higher MSH was significantly associated with higher TIR (β=.191, p<.05), lower A1C level (β=-.266, p<.01), and lower depression (β=-.211, p<.05), Diabetes self-care measures were not predicted by any individual sleep dimensions or MSH score.

Conclusion

Individual sleep dimensions and MSH composite score are linked to glycemic and self-reported psychological outcomes, highlighting the importance of comprehensive sleep health evaluation in T1D.

Support (if any)

NIH/NIDDK R01DK121726
0887 Effects of Melatonin on Glucose, Insulin, and C-Peptide Dynamics in Carriers of MTNR1B Type 2 Diabetes Risk Variant
Authors: Qian Jingyi , Anderson Phillip , Stefanovski Darko , Vujovic Nina , Kelly Lauren , Lepson Joshua , Nguyen Hoa , Byrne Sean , Mandrup-Poulsen Thomas , Adler Gail , Wang Wei , Garaulet Marta , Saxena Richa , Scheer Frank
Published: April 2024

Introduction

Genome-wide association studies identified the common variant rs10830963 in the MTNR1B gene (encoding melatonin receptor 1B) as a risk factor for type 2 diabetes. This sparked great interest in the role of the circadian hormone melatonin in glycemic control; however, the mechanisms underlying this association remain unclear. We investigated whether exogenous melatonin administration worsens glucose tolerance, insulin sensitivity, and beta-cell function, and whether such effect is stronger in MTNR1B G-allele risk carriers compared to non-carriers.

Methods

Twenty-one healthy participants of European ancestry were studied in a double-blind, randomized, cross-over trial, including ten MTNR1B risk carriers (mean age±SD, 29±10y; BMI, 24.4±2.6kg/m2; 5 women) and eleven non-carriers (32±10y; 22.5±3.0kg/m2; 3 women). Each participant underwent a highly-controlled 5-day laboratory protocol, during which they received 5mg oral melatonin or placebo in randomized order on two nonconsecutive days. Elevated circulating melatonin levels after melatonin administration were confirmed by hourly blood draw. Insulin sensitivity (SI), beta-cell function, and disposition index (DI, product of insulin secretion and sensitivity) were derived from insulin-modified frequently-sampled intravenous glucose tolerance test (FSIGT) using minimal models.

Results

The effect of melatonin versus placebo differed significantly between MTNR1B genotypes for glucose incremental area under the curve (iAUC180min, Pinteraction=0.005), insulin iAUC20min (Pinteraction=0.03), and C-peptide iAUC20min (Pinteraction=0.03) during FSIGT, with 11.7% increase in glucose iAUC180min (95%CI 3.1%─20.2%, P=0.03), 25.2% decrease in insulin iAUC20min (4.4%─41.2%, P=0.06), and 19.2% decrease in C-peptide iAUC20min (4.9%─31.2%, P=0.04) in carriers, without significant changes in non-carriers (n.s.). While we did not find significant effects of melatonin nor its interaction effects with MTNR1B genotype on DI and SI, first-phase insulin secretion was affected differently by melatonin in carriers and non-carriers (Pinteraction=0.001), with a 40.0% reduction in carriers (27.6%─50.3%, P< 0.0001), but no significant changes in non-carriers (n.s.).

Conclusion

Exogenous melatonin administration significantly impaired glucose tolerance and beta-cell function in MTNR1B risk carriers, but not in non-carriers. These data suggest that first-phase insulin secretion plays an important role in mediating the effect of melatonin on glucose control and its interaction with MTNR1B genotype.

Support (if any)

NIDDK Grant R01-DK102696 to FAJLS and RS, ADA fellowship 1-17-PDF-103 to JQ, and CTSA-UL1RR025758 to Harvard University and Brigham and Women’s Hospital.
0894 Effects of Chronic Rhinosinusitis (CRS) on Sleep Duration and Variability in World Trade Center (WTC) Responders
Authors: Ravi Sri Saranya , Castillo Horacio Romero , De Resende Adriana , Legard Alicia , Martillo Katarina , Varga Andrew , Osorio Ricardo , Parekh Ankit , Black Kathleen , Rapoport David , Mullins Anna , de la Hoz Rafael , Udasin Iris , Lu Shou-En , Sunderram Jag , Ayappa Indu
Published: April 2024

Introduction

43.5% of World Trade Center rescue and recovery workers demonstrate symptoms of chronic rhinosinusitis (CRS). Subjects with CRS report increased sleep complaints and shorter subjective sleep duration compared to those without CRS. Discomfort from nasal symptoms during sleep may result in shorter sleep duration and an increased night-to-night variability. We compare actigraphic assessment of sleep duration and variability in subjects with and without CRS.

Methods

WTC-responders in an on-going study assessing sleep apnea and Alzheimer's disease biomarkers underwent 2-week actigraphy with sleep diary before in-lab polysomnography. Demographics, CRS symptoms, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), sleep duration and complaint information were obtained. CRS+ was defined as ≥3 symptoms: facial pain, post-nasal drip, nasal congestion, blocked nose, loss of smell, sneezing, sore throat or hoarseness. Nightly actigraphy data were analyzed using Cole-Kripke algorithm and averaged over all nights to obtain mean total sleep time (TST) and coefficient of variability (CV) across nights. Group comparisons were performed using two-sample t-test with significance level at p< 0.05.

Results

42 subjects (74%M/26%F, age 64.7±5, BMI 28.6±6kg/m2) had 14 nights (range=11-17) of actigraphy data. Subjective sleep duration and TST by actigraphy were correlated (r=0.4, p=0.02). 19(45%) were CRS+ vs 23(55%) CRS-. Age, sex, BMI, and sleep apnea prevalence did not differ between CRS+ vs CRS- groups. Mean (SD) ISI in CRS+=8.4(5.4), CRS- =5.4(5.4), p=0.08. ESS in CRS+=4.2(2.5), CRS- =4.6(3.0), p=0.6. Although not statistically significant, mean subjective sleep duration in hours was shorter and more variable in CRS+=7.84(1.3) than CRS- =8.34(0.7), p=0.1. Actigraphic sleep duration (TST) in hours was shorter and more variable in CRS+ [6.59(1.2), CV=22.7(9.5)] than CRS- [6.80(0.8), CV=20.7(7.2)].

Conclusion

WTC-responders with CRS symptoms report shorter subjective sleep and greater insomnia similar to our previous findings. While we did not demonstrate a significant difference in actigraphic sleep duration or variability between CRS groups, we were limited by a small sample size. The high prevalence of CRS and sleep complaints in this population and the association of reduced sleep duration and increased morbidity and mortality highlights the importance of establishing if there is a shorter sleep duration in CRS+ patients through further investigation.

Support (if any)

NIOSH:U01OH011852, K24HL109156, NCATS:TL1TR004420
0896 Years of Life Lost Due to Insufficient Sleep and Associated Economic Burden in China from 2010 to 2018
Authors: Yan Xumeng , Han Fang , Wang Haowei , Li Zhihui , Kawachi Ichiro , Li Xiaoyu
Published: April 2024

Introduction

Research on the health and economic costs due to insufficient sleep remains scant in developing countries. This study aims to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China.

Methods

This study estimated both individual and aggregate YLLs due to short sleep (i.e., ≤ 6 h) among Chinese adults aged 20 years or older by sex and 5-year age groups from 2010 to 2018. Life expectancy estimates were derived from nationally representative prevalence data, relative mortality risks from meta-analyses, and life tables in China.

Results

Younger age groups and males had more YLLs due to short sleep compared to their counterparts. The individual YLLs were 0·98, 0·95, 0·94 for men, and 0·78, 0·74, 0·73 for women aged 20-24 in 2010, 2014, and 2018, respectively. Patterns of individual YLLs were largely stable across the years. In aggregate, China experienced a rise from 66·75 million YLLs in 2010 to 95·29 million YLLs in 2014, and to 115·05 million YLLs in 2018. Compared to 2010 ($191·83 billion USD), the associated economic cost in 2014 increased to $ 422·24 billion USD, and the cost in 2018 more than tripled ($628·15 billion USD). The percentage of cost to Chinese GDP in corresponding years was 3·23%, 4·09%, and 4·62%.

Conclusion

Insufficient sleep is associated with reduced life expectancy in China. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.

Support (if any)
0898 Social Vulnerability and Sleep Health in Young Adults with Type 1 Diabetes
Authors: Howard Quiana , Hickman Ronald , Griggs Stephanie
Published: April 2024

Introduction

Young adults aged 18 to 26 years with type 1 diabetes (T1D) are at high risk for social vulnerability and poor sleep health (sleep disturbance and shorter sleep duration) due to social, economic, and geographic shifts. However, the role of social vulnerability in the sleep health of young adults with T1D is not well understood. The purpose of this quantitative descriptive study was to examine the association between indicators of individual- and neighborhood- level social vulnerability and sleep health among young adults with T1D.

Methods

The Centers for Disease Control/Agency for Toxic Substances and Disease Registry Social Vulnerability Index was used to measure neighborhood-level social vulnerability (socioeconomic status, housing type/characteristics, racial and ethnic minority status, and transportation). Individual-level social vulnerability was measured with a 7-item composite based on the National Patient Social Determinants of Health Risk Assessment Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (race, ethnicity, education, language, income, employment, and stress). Sleep disturbance was measured with the 4-item Patient-Reported Outcomes Measurement Information System was used to measure sleep disturbance and research grade actigraphy over 14 days.

Results

Forty-four young adults with T1D (38.6% female, mean age 20.9 years, mean A1C 8.6%) completed the baseline measures of a 12-week interventional study. Higher individual level social vulnerability was associated with higher sleep disturbance in the unadjusted and adjusted models (B = .414, p < .001, R2 = .171; B = .446, p = .010, R2 = .218). Higher neighborhood level social vulnerability was associated with shorter actigraphy-derived sleep duration in the unadjusted models (B = -.326, p = .043, R2 = .106); however, the association was no longer significant in the adjusted models (p = .068). Models were adjusted for sex, T1D duration, and BMI. The associations between individual level social vulnerability and sleep duration or neighborhood level social vulnerability and sleep disturbances were not significant.

Conclusion

More research is warranted to better understand the intricate relationship and role of multiple individual and neighborhood-level social drivers in the sleep health of young adults with T1D.

Support (if any)

National Institute of Nursing Research R00NR018886 & Dean’s Legacy Fellowship Case Western Reserve University.
0899 Bidirectional Links of Daily Sleep Quality and Duration with Pain in Veterans with Alcohol Use Disorder
Authors: tracy Eunjin , So Christine , Kanaley Jill , Trull Timothy , Manrique-Acevedo Camila , McCrae Christina , Miller Mary Beth
Published: April 2024

Introduction

Military Veterans tend to experience chronic pain and sleep problems of higher intensity and prevalence than the general population, and may be more likely to self-medicate with substances such as alcohol. Research suggests that sleep and pain are interrelated. However, few studies have examined bidirectional links between daily sleep quality and duration with pain among Veterans, especially those with alcohol use disorders. Furthermore, it has not been studied whether daily alcohol consumption (whether they drank or not) moderates everyday associations between sleep and pain among Veterans with alcohol use disorders.

Methods

114 Veterans with alcohol use disorder (82.5% men: mean age = 38.86 [range 21–67]) completed 14 days of diaries assessing their sleep quality, sleep duration, pain, and drinking quantity. Multilevel modeling examined the effects of daily variability in sleep (within-person effects) and average levels of sleep (between-person effects) on pain the following day. To examine the effects of pain on sleep, multilevel modeling examined the effects of daily variability in pain and average levels of pain on sleep.

Results

Regarding bidirectional links of sleep quality and pain, greater daily (b=−.86, se=.41, p=.04) and average (b=−15.51, se=3.28, p<.001) sleep quality were associated with lower next-day pain. Higher average pain was associated with poorer sleep quality (b=−.01, se=.002, p< .001), but daily pain was not associated with daily sleep quality. Regarding bidirectional links of sleep duration and pain, there was no daily association between sleep duration and pain, but greater average sleep duration was associated with lower pain levels (b=−4.84, se=1.60, p=.003). Daily drinking did not moderate these associations.

Conclusion

Both sleep quality and sleep duration are closely associated with pain among Veterans with alcohol use disorder. Fluctuations of daily sleep quality affected Veterans’ pain experience in everyday life regardless of alcohol consumption; in contrast, fluctuation of daily pain did not affect daily sleep quality, implying that Veterans with alcohol use disorder are sensitive to poor sleep quality. The results support that sleep quality may buffer daily pain experiences among this patient population.

Support (if any)

5K23AA026895
0901 Effects of a Physical Activity Intervention on Sleep Among Cancer Survivors in the Cancer Prevention Study-3
Authors: Zhong Charlie , Grant Amber , Whalen Scott , Reddy Ananaya , Peoples Anita , Patel Alpa , Rees-Punia Erika
Published: April 2024

Introduction

Disruptions to sleep have been reported in many cancer survivors, with lasting impacts reported several years after treatment. Physical activity (PA) has been shown to improve sleep outcomes. We evaluated the effects on self-reported and device measured sleep outcomes within a PA intervention among cancer survivors.

Methods

The Health and Energy through Active Living Every Day (HEALED) intervention was a randomized controlled trial of 415 cancer survivors identified from the American Cancer Society (ACS) Cancer Prevention Study-3 (CPS-3) cohort enrolled in a year-long, web-based, PA intervention to increase social support, improve exercise self-efficacy, and facilitate self-monitoring of PA. Participants were randomized 2:1 to an interactive PA website (intervention) or a static balance and flexibility website (controls). Sleep was assessed through PROMIS 6-item Sleep Disturbance Scale and SATED sleep questionnaire. In addition, participants were provided a Fitbit Charge 5 to self-monitor PA and sleep. We conducted an intent-to-treat analysis and calculated t-tests to evaluate change in sleep outcomes between the two groups at the end of the 1-year study period.

Results

A total of 351 participants completed the year-long intervention. Most participants were White (93%), female (94%), had a history of breast cancer (73%), were on average 62 years old (sd=8) and 6 years (sd=2) post-diagnosis. At baseline, both control (5 (metabolic equivalent task) MET-hours/day) and intervention (4.9 MET-hours/day) self-reported similar levels of moderate to vigorous physical activity (MVPA). Both groups reported good sleep quality at baseline with a SATED score of 8.0 (sd=1.8) and PROMIS of 48 (sd=7.5) in controls and 7.8 (sd=1.8) and 49 (sd=7.6), respectively, in intervention. The intervention group reported higher MVPA after 1 year (6.7 MET-hours/day vs 5.4 MET-hours/day, p=0.01). There were no statistically significant changes in self-reported sleep quality.

Conclusion

Long-term cancer survivors, with relatively healthy sleep quality at baseline, randomized to a PA intervention did report increased MVPA after a year, but this had little impact on sleep. Results with device-based MVPA and sleep measures are forthcoming.

Support (if any)

The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 cohort. This analysis was also supported through an unrestricted research grant from Sleep Number Corporation.