bluuebunny/crossref_metadata_2025_split huggingface dataset:
1216 Markedly decreased ictal discharges with positive airway pressure (PAP) treatment in a patient with refractory epilepsy and severe obstructive sleep apnea
Authors: Massoud Mona , Schütz Sonja G 
Published: May 2020

Abstract

Introduction
Individuals with epilepsy are at increased risk for obstructive sleep apnea (OSA). Treatment of OSA with positive airway pressure (PAP) can result in decreased seizure frequency in patients with epilepsy, possibly due to decreased sleep disruption and normalization of oxygenation saturation levels when using PAP. The following case report demonstrates an example in which treatment of OSA with PAP resulted in a dramatic improvement of electroencephalographic seizures.

Report of Case
A 32 year-old man with refractory epilepsy presented to our office complaining of loud snoring, witnessed apneas, and excessive daytime sleepiness. Despite prior left frontal and left anterior temporal lobectomy, vagus nerve stimulator treatment, and excellent treatment adherence to four different antiepileptic medications, the patient continued to have 1-3 clinical seizures per day. Physical examination was notable for obesity (BMI=39.4 kg/m2), high arched palate and Mallampati class 4 airway. Long-term eletroencephalogram (EEG) monitoring was significant for frequent interictal discharges during wakefulness and sleep, as well as frequent subclinical seizures during sleep characterized by C3/P3 polyspike bursts followed by brief rhythmic fast activity. A diagnostic polysomnogram revealed severe OSA (AHI=69/hour). The patient subsequently underwent a PAP titration study with extended EEG montage, which was notable for a marked decrease in polyspike discharges on effective PAP pressures, from an average of 24 polyspike discharges per hour on PAP pressures &lt; 15 cm of water to an average of 3 polyspike discharges per hour on PAP pressures ≥ 15 cm of water. PAP treatment was initiated following the titration study.

Conclusion
This case demonstrates that effective treatment of OSA can lead to a reduction of abnormal EEG discharges in a patient with intractable epilepsy. Additional clinical follow up is needed to assess whether PAP treatment also resulted in decreased frequency of clinical seizures.
1269 Off-Label Use of Solriamfetol In Idiopathic Hypersomnia
Authors: Wong Tammy , Memon Talha 
Published: May 2020

Abstract

Introduction
Solriamfetol is a new daily dopamine and norepinephrine reuptake inhibitor indicated for improving daytime wakefulness in adults with obstructive sleep apnea (OSA) and narcolepsy. It was FDA-approved on 3/20/2019. In this report, we present a patient with refractory idiopathic hypersomnia (IHS) who benefitted from off-label use of solriamfetol at a private sleep center.

Report of Case
A 37-year-old non-obese female previously diagnosed with IHS vs narcolepsy, presented in 2015 with excessive daytime sleepiness since her mid-teens. She also had a history of periodic limb movement (PLM) and anxiety and trialed clonazepam, which caused daytime hangover effects. At her previous office, she began sodium oxybate but had psychiatric side effects, and was thus started on methylphenidate. Modafinil was added due to build-up of tolerance. Three separate polysomnographies (PSG) over 9 years revealed similar findings of mild snoring without OSA, PLM with variable arousals. Multiple sleep latency testing (MSLT) showed very rapid sleep onset &lt;4 min and no sleep-onset REM periods. The patient never had cataplexy but occasional hypnogogic hallucinations and sleep paralysis. All studies to-date suggested IHS, less likely narcolepsy without cataplexy, and at her initial visit, the patient trialed armodafinil instead of modafinil, and methylphenidate was weaned down. When seen again in 2017, the patient reported persistent daytime sleepiness on methylphenidate and modafinil (PSG-MSLT showed sleep latencies ~3.5 min on 5/5 nap opportunities), without cataplexy. When seen 9/2019, patient continued to have daytime sleepiness and fatigue. She was then weaned off methylphenidate and modafinil, and started on solriamfetol. Since then, she has been doing well solely on solriamfetol 75mg BID.

Conclusion
Off-label use of solriamfetol for IHS has been demonstrated to be effective in a treatment-resistant patient at a private sleep center. More data and further discussion in support of its off-label use are warranted for this patient population.
0158 Loss of Connexin 36 Elicits Abnormalities in Thalamocortical Network Activity Relevant to Neuropsychiatric Disorders
Authors: McNally J M , Thankachan S , Uygun D S , Basheer R 
Published: May 2020

Abstract

Introduction
Neuronal gap-junctions are extensively expressed in mammalian forebrain and suggested to contribute to state-regulation and thalamocortical network activity. However, the physiological role of gap-junctions on these processes remains poorly understood. Connexin-36 (Cxn36) is highly expressed in the brain, representing a mechanism for electrical coupling of inhibitory neurons. We examined the effects of global Cnx36 deletion on sleep/wake and spontaneous and evoked EEG activity.

Methods
We recorded in vivo EEG/EMG in Cxn36KO mice and littermate controls. Electrodes were stereotaxically implanted above frontal cortices. We analyzed sleep/wake states and algorithmically detected sleep spindles over 24 hours. Mice underwent auditory stimulation paradigms including the auditory steady state response (ASSR; 1 second train 20-50Hz clicks, 100 reps., 85dB) and mismatch negativity (MMN; 2.5kHz standard 90%, 10kHz deviant 10%, 300ms ISI, 90dB). Social behavior and investigation-evoked EEG activity were also assessed via the social habituation task (repeated 5 min exposures to novel mouse).

Results
Cnx36KO mice exhibited limited sleep/wake abnormalities (n=7/group). Power spectra of EEG revealed significant impairments in spontaneous gamma-band activity (30-80Hz; All States, Light & Dark Phases), and beta activity (15-25Hz; All States, Light Phase). Sigma activity (10-15Hz) was significantly decreased (NREM and REM, Light phase). This was particularly pronounced during NREM-REM transitions. Despite no changes in spindle density, both spindle amplitude and duration were significantly decreased in Cnx36KOs. Cxn36KOs exhibited a blunted gamma-band response to acute ketamine (15mg/kg; IP), impaired 30 & 40Hz ASSR, and an abnormal response in the MMN task (decrease ERP peak amplitude & gamma). Finally, Cxn36KO mice exhibit impaired social habituation and significantly decreased investigation evoked slow gamma-band activity (30 - 55Hz).

Conclusion
Our data suggest Cxn36 plays a critical role in regulating thalamocortical network activity. Further, impairments in Cnx36KO mice reflect abnormalities in neuropsychiatric disorders, including schizophrenia, implicating Cnx36 containing gap junctions as a novel therapeutic target.

Support
Research supported by VA CDA Award BX002130 (JMM), VA Merit Awards BX004500 (JMM), BX001404 (RB), and NIMH RO1 MH39683 (Ritchie E. Brown).
0159 Reduced REM Sleep Percent in Frequent Cannabis Versus Non-Cannabis Users
Authors: Carr M , Borcsok R , Taylor M , Segust S , Pigeon W , Bradshaw C 
Published: May 2020

Abstract

Introduction
THC (the main psychoactive component of cannabis) has been shown to suppress REM sleep and decrease sleep latency, although this is not consistently replicated. Increased dream vividness is reported to occur in abstinent cannabis users, although dream quality in active users is unstudied. The current study aimed to assess the effects of cannabis use compared to non-use on objective sleep measures, dream reports, and self-reported anxiety, memory, and sleep quality. To collect objective sleep data we piloted the use of a portable PSG headband that allows EEG and EOG recording at home.

Methods
12 regular cannabis users (&gt; 3 days per week) & 9 non-users (aged 19 - 27; 43% female) participated; participants used no other drugs or alcohol on study nights. The most common form of cannabis use was smoking in joints with tobacco (range = 1 - 15 per day). Participants wore the PSG headband (the Hypnodyne ZMax) over 2 nights at home (2nd night used for analysis), and were instructed to awaken 4 times across the night to fill out brief dream reports. Objective sleep measures included TST, Sleep latency, REM latency, and REM percent. Self-report measures included the Pittsburgh Sleep Quality Index, Everyday Memory Questionnaire, and State-Trait Anxiety Index. Dream measures included recall frequency, word length, and three attributes rated on a 1–7 Likert scale - sensory vividness, emotional intensity, and bizarreness.

Results
There were no group differences on self-report measures. Cannabis users showed longer REM latency (t=2.23, p=.04) and lower REM% (U=22, p=.02); there were no other objective group differences. Cannabis users reported higher bizarreness in their dreams (t=2.07, p=.05); there were no other dream differences.

Conclusion
The study presents a novel approach to assess sleep at home and cannabis use. Significant differences emerged between users and non-users on REM latency, REM%, and dream bizarreness.

Support
N/A
0164 Evidence Suggesting Early Airway Collapse as Cause of Spontaneous Arousals
Authors: Rechul D , Rechul K 
Published: May 2020

Abstract

Introduction
Spontaneous arousals can occur in response to a number of stimuli like noise, movement, hypoxia, or airway obstruction. Some arousals occur “spontaneously” and in individuals donning a hyper-arousable phenotype, spontaneous arousals can dominate the sleep architecture. While arousal mechanisms for some stimuli have been well described, there is a profound lack of knowledge to explain spontaneous arousals. During clinical testing of a device that was designed by SleepMethods, Inc. to anticipate obstructive sleep apnea events by the ability to sense minute airway caliber changes, it was noted, incidentally that the device would signal impeding airway collapse but a spontaneous arousal followed the signal before an obstructive airway event ever developed. This phenomenon was observed many times within and between subjects, suggesting the possibility that very early airway changes are causing “spontaneous arousals”

Methods
Ten adults (7M;3F) aged 18-80y/o (avg. 54.7y/o) with a known AHI ≥ 15/hr (avg. AHI = 42.6/hr) underwent 1 overnight PSG recording while wearing the device. Patients were required to forego their usual CPAP therapy on the night of study in efforts to expose the device to an adequate number of total obstructive events (defined as apneas and hypopneas; RERAs and snores were excluded). Standard PSG analysis was performed. Scoring rules were applied to determine whether signals were true/false positives and/or true/false negatives based on pre-clinical data showing anticipation accuracy for up to 45 seconds prior to an obstructive airway event. Signals designed to herald obstructive events were noted, incidentally, appearing prior to spontaneous arousals.

Results
Preliminary results suggest that early phases of airway collapse, as the airway progresses from patency to clinically significant obstruction, are causing EEG arousals which, by current standards, are considered “spontaneous”. Because these findings were incidental to another primary purpose of the clinical study, data analysis is in early stages but currently suggesting at least an associative relationship.

Conclusion
If final data analysis shows statistically significant correlation between early airway collapse and “spontaneous arousals”, it may have tremendous implications for patients with hyper-arousability, insomnia, and/or pathologically elevated spontaneous arousal indices by proposing therapies aimed at airway patency maintenance.

Support
N/A
0173 Spring Forward, Fall Back: Increased Patient Safety-Related Adverse Events Following the Spring Time Change
Authors: Kolla B , Coombes B J , Morgenthaler T I , Mansukhani M P 
Published: May 2020

Abstract

Introduction
“Spring forward,” the start of daylight savings time (DST) reduces sleep opportunity by an hour. The resulting sleep deprivation in healthcare workers can increase the potential for medical errors. We examined the change in patient safety-related adverse events (AEs) following the time change in both spring and fall.

Methods
Self-reported AEs that occurred 7 days prior to and following the spring and fall time changes for years 2010–2017 in a large healthcare organization were ascertained. AEs likely resulting from human errors were identified. The change in the number of AEs (all AEs or restricted to those resulting from human error) following the spring and fall time change were modeled using negative binomial mixed models using a random effect to correct for non-independent observations in consecutive.

Results
Over the 8 year period, there were more AEs (all and human) in the 7 days following the change in time both in spring (All: 2812 V. 2699; Human: 1902 V. 1625) and fall (All: 3207 V. 3007; Human: 2189 V. 2087). However, the only statistically significant increase was for the estimated 18% increase in human errors following time change in spring (95% CI: 6% to 34%; p = 0.004). The 18% AE increase in spring was also significantly greater than the 5% increase in AE in fall (p = 0.018).

Conclusion
There is a significant increase in human error related AEs following the “spring forward” clock change which can jeopardize patient safety. Based on safety considerations, DST might best be eliminated; alternatively, policy makers and healthcare organizations should evaluate measures to mitigate the increased risk during this period.

Support
NA
0177 Measuring Sleep Health Across Survey, Actigraphy, and Diary Methods in Young Adults
Authors: Jakubowski K P , Wright A G , Matthews K A 
Published: May 2020

Abstract

Introduction
Sleep health is a relatively new construct including multiple dimensions of nighttime and daytime sleep across the 24-hour day. To date, few studies have investigated sleep health across various types of sleep measures. We collected sleep health data using survey, actigraphy, and daily diary, affording the unique ability to compare the latent factor structure of the sleep health construct across methods in a single sample of healthy young adults.

Methods
Undergraduates (N=540; 50% female; 71% white; mean age=18) self-reported sleep health via the 6-item RUSATED survey (Buysse, 2014), which queries “typical” sleep patterns including: daytime alertness and nocturnal sleep regularity, satisfaction, timing, efficiency, and duration (0=rarely/never to 2=usually/always); total score=0–12 (higher=better sleep health). A subsample (N=114) provided 7-day actigraphy and daily diaries, which were used to derive weeklong averages of the aforementioned sleep dimensions. Confirmatory factor analysis was conducted to assess model fit of three factors (survey, actigraphy, diary), each including within-method indicators of the six sleep dimensions; note the actigraphy model included diary satisfaction. Acceptable model fit was assessed using established criteria (e.g., Bentler, 1990): RMSEA &lt; .08, CFI &gt; .90, and TLI &gt; .90. Maximum likelihood estimation was used.

Results
Average RUSATED total score was 7.1 (SD=2.5). Average actigraphy [diary] sleep dimensions were: Alertness (i.e., proportion of days napped)=21% [25%]; Duration=6.2hr [7.1hr]; Timing (i.e., midpoint)=5:00am [3:30am]; Regularity (i.e., SD of midpoint)=56 min [40 min]; Efficiency= 82% [95%]; Satisfaction=“average” to “good”. The survey model demonstrated acceptable fit (RMSEA [90%CI] = .06 [.03, .09], CFI=.96, TLI=.92) after correlating regularity and timing, as suggested by modification indices; factor loadings [λ(SE)] ranged from .27(.05) for efficiency to .71(.04) for satisfaction. Fit was poor for the diary model, whereas the actigraphy model failed to converge.

Conclusion
Sleep health models demonstrated adequate fit using survey but not actigraphy or diary data. The lack of acceptable fit for the latter may reflect differences in the measurement timeframe (e.g., “typical” sleep vs. 7-day averages) or the smaller sample size for the actigraphy/diary measures. Determining how to best measure sleep health and ultimately apply it to health-relevant outcomes is a valuable research agenda.

Support
T32HL07560; T32MH018269
0184 Predicting Strategic Napping in Surgical Residents by Individual and Rotation Characteristics
Authors: Devine J K , Schwartz L P , Hursh S R , Mosher E , Schumacher S , Boyle L , Davis J E , Smith M , Fitzgibbons S 
Published: May 2020

Abstract

Introduction
Strategic napping, or napping on-shift, is recommended to reduce fatigue in medical residents. The actual prevalence of strategic napping in relation to residents’ workload, schedule, or demographics is largely unquantified. This study objectively measured sleep patterns and work schedules in surgical residents working a variety of service lines over a two-month period in order to identify which resident and service line attributes predict on-shift napping.

Methods
Surgical residents from an academic surgery program in the Washington, DC area provided schedule information, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu Watch) continuously for 8 weeks. Multiple linear regression was performed to predict percent days with on-shift napping from resident demographics (age, gender, post graduate year (PGY), sleep characteristics (ESS, total sleep time (TST), sleep efficiency (SE)), schedule characteristics (shift start time, shift length, rotation length, percent days on-shift, percent night shifts), and service line characteristics (service line category, number of service lines worked).

Results
Twenty-two (n=22) residents completed the study, rotating through at least 1 of 5 different service line categories (Acute Non-Elective Surgery, Elective Surgery, Night Float, Surgical Intensive Care Unit, and Other). Residents slept an average of 6 hours within a 24-hour period (370±129 minutes) with normal SE (87.13%±7.55%). ESS scores indicated excessive daytime sleepiness (11.64±4.03). Ninety-five percent (n=21) of residents napped at least once while on shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 2300-0500 hours. Earlier shift start times predicted less on-shift napping (B=-0.08,SE=0.04,β=-2.40,t=-2.09,p=0.05) while working more night shifts (B=1.55,SE=0.44,β=4.12,t=3.52,p=0.003) and shifts over 24 hours.

Conclusion
Residents take advantage of opportunities to nap on-shift, particularly when working at night. Despite naps, however, residents exhibit insufficient sleep with excessive daytime sleepiness, representing a safety risk to themselves and their patients.

Support
NA
0221 Late Meals, Sleep Duration, and Sleep Fragmentation: Findings From the American Time Use Survey
Authors: Iao S , Shedden K , Jansen E C , O’Brien L M , Chervin R D , Knutson K L , Dunietz G L 
Published: May 2020

Abstract

Introduction
Sleep hygiene recommendations discourage eating close to bedtime, though published data on the impact are not consistent. Associations between eating or drinking, within 1-hour prior to bedtime, sleep duration and sleep fragmentation were examined in a nationally-representative sample.

Methods
Data from the American Time Use Survey (ATUS), administered to a nationally representative sample of n=201,151 US residents aged ≥15 years were utilized. In an annual phone interview, ATUS participants were asked to record their activities during a 24-hour period (04:00am to 04:00am on the interview day) and were randomly selected to report weekdays or weekend activities. The present analysis included data from 2003–2018 and restricted to weekday respondents (n=124,242). Reporting of eating/drinking activities within 1-hour prior to bedtime was considered as a dichotomous variable (yes/no). Sleep fragmentation was defined as any awakening during the primary sleep episode (yes/no). Linear and logistic regression models, adjusted for age, sex, cohabitation, education and employment, were used to examine associations between eating/drinking and sleep duration or sleep fragmentation.

Results
In this ATUS sample, 56% of respondents were female and the mean age was 45 years. Mean sleep duration was 8.02 (0.007) hours, and 6% of survey participants ate/drank within 1-hour prior to bedtime. Overall, eating/drinking within 1-hour prior to bedtime was associated with longer sleep duration (p&lt;0.01). Women and men who ate/drank within 1-hour prior to bedtime, in comparison to those who did not, had 35 minutes and 26 minutes longer sleep duration (p- value&lt;0.0001) Eating/drinking activities within 1-hour prior to bedtime were associated with 1.8 higher odds of fragmented sleep (p&lt;0.001).

Conclusion
In this large population-based survey, weekday eating or drinking within 1-hour prior to bedtime was associated with sleep fragmentation and longer sleep duration. Causal pathways would be difficult to discern, though sleep fragmentation could lead to compensatory increases in sleep duration.

Support
None
0228 The Impact of Westward Travel Across 9 Time Zones on Sleep Behaviors of Female Collegiate Athletes
Authors: Frisco D J , Goodrich J A , Byrnes W C , Holliday M , Wright K P 
Published: May 2020

Abstract

Introduction
Jet lag can significantly impact an athlete’s health and performance. However, the effect of ultra long-haul travel (&gt; 12h flying time) westward across nine time zones on the sleep of female collegiate athletes is limited. We therefore studied the sleep behavior of NCAA Division I female volleyball players on an exhibition tour to China.

Methods
For this observational study, eleven females were recruited from a NCAA Division I Volleyball team. During the Tour, sleep behavior was monitored using wrist actigraphy (Actiwatch Spectrum, Phillips) before (5 days) outbound travel (PRE-FLIGHT), during air travel to (1) & from (2) China (FLIGHT-DAY 1 & 2) and during the athletes’ tour while in China (TOUR-DAY 1–8). Athletes were instructed to wear the actigraphs at all times, except during competition. Standard parameters were collected from the actigraph including sleep durations and sleep efficiency and expressed as mean ± sd.

Results
Sleep duration and sleep efficiency were similar for PRE-FLIGHT days (~8.3 hrs ± 1.5, 90.6 ± 3.2%). Sleep duration and efficiency were significantly lower on FLIGHT-DAY 1 & 2 compared to TOUR-DAY and PRE-FLIGHT, but were not significantly different from each other (~5.2 ± 2.4h, 80.5 ± 8.8%). Sleep duration during TOUR-DAY 1–7 followed a quadratic relationship, peaking on TOUR-DAY 1 and reaching a nadir on TOUR-DAY 5, before increasing again through TOUR-DAY 7 (p&lt;0.05). Sleep duration on TOUR-DAY 8 (~5.9 ± 0.9 h) was significantly lower than PRE-FLIGHT and TOUR-DAY 1,2,6 & 7.

Conclusion
During travel female collegiate volleyball players showed sleep disturbance. Implementation of sleep interventions for jet lag are warranted for athletes traveling across multiple time zones.

Support
PAC-12 Student-Athlete Health and Wellbeing Initiative, Grant #1554240