bluuebunny/crossref_metadata_2025_split huggingface dataset:
1211 Assessing the Accuracy of a Dry-EEG Headband for Measuring Brain Activity, Heart Rate, Breathing and Automatic Sleep Staging
Authors: Thorey V , Guillot A , El Kanbi K , Harris M , Arnal P J 
Published: May 2020

Abstract

Introduction
The development of new sleep study devices, adapted for daily use, is necessary for diagnosis of sleep disorders. However, this requires to be both suitable for daily use and capable of recording accurate electrophysiological data. This study assesses the signal acquisition of a comfortable sleep headband, using dry electrodes, and the performance of its automatic sleep staging algorithms compared to the gold-standard clinical PSG scored by 4 sleep experts.

Methods
42 participants slept at a sleep center wearing both the Dreem headband (DH) and a PSG simultaneously. We measured 1) the EEG signal similarity between both devices, 2) heart rate, breathing frequency and respiration rate variability (RRV) agreement, and 3) the performance of the headband automatic sleep scoring compared to PSG sleep experts manual scoring.

Results
Results demonstrate a strong correlation between the EEG signals acquired by the headband and those from the PSG, and the signals acquired by the headband enable monitoring of alpha (r= 0.75 ± 0.11), beta (r= 0.74 ± 0.14), delta (r = 0.78 ± 0.16), and theta (r = 0.63 ± 0.15) frequencies during sleep. The mean absolute error for heart rate, breathing frequency, and RRV was 2.2 ± 0.8 bpm, 0.3 ± 0.2 cpm and 3.1 ± 0.4 %, respectively. Automatic Sleep Staging reached an overall accuracy of 84.1 ± 7.5% (F1 score: 83.0 ± 8.4) for the headband to be compared with an average of 86.4 ± 5.5% (F1 score: 86.5 ± 5.5) for the 4 sleep experts.

Conclusion
These results demonstrate the capacity of the headband to both precisely monitor sleep-related physiological signals and process them accurately into sleep stages. This device paves the way for high-quality, large-scale, longitudinal sleep studies.

Support
This Study has been supported by Dreem sas.
1226 A Case of Hypoglossal Nerve Stimulation Induced Cheyne-Stoke Central Sleep Apnea
Authors: Rezayat Talayeh , Chang Melisa 
Published: May 2020

Abstract

Introduction
Treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP), mandibular advancement devices (MAD) and oral surgery have been reported to lead to emergent central sleep apnea (CSA). In this case report the emergence of CSA in a Cheyne-Stokes pattern following the use of hypoglossal nerve stimulator as a treatment modality for OSA is discussed.

Report of Case
A 70-year-old man with a history of hypothyroidism and severe OSA diagnosed via a home sleep apnea test with a respiratory event index (REI) of 38 events/ hr was intolerant of PAP therapy and an MAD did not effectively treat his OSA. He was deemed an appropriate candidate for hypoglossal nerve stimulation following a drug induced sleep endoscopy. Following implantation and activation, he developed a lip droop and was ruled out for a stroke. A polysomnogram was completed which showed significant improvement in his sleep apnea at a voltage range of 1.4-17V. At 1.8V he developed REM- supine central events. When the voltage was further increased to 1.9-2.0V non-REM supine central events arose. These events appeared to have Cheyne-Stoke morphology with a cycle duration of over 50s. He was set to an amplitude of 1.6 V with a positional belt for treatment of his OSA without any emergent CSA.

Conclusion
This patient developed central sleep apneas with Cheyne-Stoke morphology following treatment of obstructive sleep apnea using a hypoglossal nerve stimulator. The central events began at higher voltage settings (greater than 1.8V). He had no history of heart failure or arrhythmias. This higher voltage may lead to overshoot of the tongue out of the airway resulting in hyperpnea, hypocapnia and central apnea but the underlying pathophysiology for the Cheyne-Stoke pattern in the absence of heart failure remains unknown.
1233 Mitochondrial Myopathy Making It Hard To Sleep! OSA management in Mitochondrial Myopathy with a variant in SNAPC4 and PURA genes
Authors: Okorie Ugorji , Monceaux Brittany , Smalley Megan , Roberts Edmond , Liendo Cesar , Chernyshev Oleg 
Published: May 2020

Abstract

Introduction
No standard of care exists for management of sleep disorders/sleep disordered breathing (SDB) and Mitochondrial myopathies. Our case report describes our experience with this condition in a pediatric patient.

Report of Case
A ten-year-old middle eastern male with PMH of Mitochondrial myopathy was referred to Sleep Medicine by ENT with reported snoring, witnessed apneic spells and daytime fatigue. Flexible Video Laryngoscopy did not reveal tonsillar or adenoid hypertrophy so it was postulated that his OSA was a result of his craniofacial abnormalities and global hypotonia.
Genetic workup showed Mitochondrial complex II & III deficiency from a variant in SNAPC4 gene and PURA gene leading to failure to thrive, severe developmental delay, generalized muscle weakness, bradycardia requiring pacemaker, global hypotonia requiring nocturnal oxygen for chronic respiratory failure and G-tube placement due to difficulty with feedings.
Diagnostic PSG showed severe OSA with AHI of 11.3, RDI 11.8, REM AHI 56.0, REM RDI 56, and minimum oxygen saturation 85%. Subsequent PAP titration led to initiation of BIPAP therapy with settings of Auto-BiPAP EPAP min 5, IPAP max 20; PSmin 4; PSmax 6 cm H2O and continuation of nocturnal home oxygen. Sleep fragmentation improved to an arousal index of 3.1 with BIPAP. The patient and caregiver presented to the Sleep Medicine clinic 1 month after the PAP titration study with objective report showing &gt;4 hours use &gt;70% of the time and subjective satisfaction with BIPAP therapy with improvement in snoring and apnea.

Conclusion
Mitochondrial disorders lead to a deficiency of ATP affecting all organ systems and is most recognizable in the form of neuromuscular impairments. Neuromuscular impairments can translate into SDB issues such as OSA. Patients with genetic conditions such as mitochondrial myopathy should be routinely screened and evaluated for SDB and treated if warranted to significantly improve morbidity, mortality and quality of life.
0125 Sleep Deprivation Impairs the Ability to Overcome Pre-Existing Framing Bias
Authors: Honn K A , Whitney P , Hinson J M , Nusbaum A T , Van Dongen H 
Published: May 2020

Abstract

Introduction
When presented with a choice between sure gains or losses versus gambles, people tend to select sure gains over gambles, but gambles over sure losses. This pre-existing framing bias is embedded in the Framed Gambling Task (FGT), in which subjects choose between a sure option (gain or loss) and a gamble (card from one of two decks). For optimal performance, subjects need to recognize that one deck (‘good deck’) results in better average outcomes than the other deck (‘bad deck’) and select the gamble or sure option depending on the deck (good/bad) rather than the frame (sure loss/gain). A speeded version of the FGT, with 2s response deadlines to induce time pressure, was used in a laboratory total sleep deprivation (TSD) study to determine the impact of sleep loss on the ability to overcome pre-existing framing bias.

Methods
Eight-six subjects (ages 21–38; 47 females) were randomized (2:1 ratio) to a TSD condition (n=56) or control condition (n=30). They completed the speeded FGT at 11:00 on the baseline day (session 1), and again the following day (session 2) after 27h of wakefulness (TSD group) or 3h of wakefulness (control group). Performance accuracy was defined in terms of optimal task performance, i.e., gambling when the good deck was presented and not gambling when the bad deck was presented. Each test bout had 72 trials across three trial blocks.

Results
Accuracy improved across trial blocks (F1,84=20.44, p&lt;0.001). In session 2, the TSD group showed lower accuracy (condition by session interaction: F2,84=4.15, p=0.045) and less improvement across trial blocks (condition by session by trial block interaction: F2,168=3.97, p=0.021) than the control group. Even under TSD, the frequency of response timeouts (RT&gt;2s) was low (&lt;3.5% of trials).

Conclusion
Sleep deprivation degraded FGT performance under time pressure, indicating reduced ability to overcome pre-existing framing bias.

Support
PRMRP award W81XWH-16-1-0319
1241 A Case of Chronic Hypoventilation of Unknown Etiology with Improvement from a Wake Promoting Agent
Authors: Cole Melissa , Isaacs Thomas , Patel Amee 
Published: May 2020

Abstract

Introduction
We present a patient with chronic insomnia, excessive daytime sleepiness, and sleep-related hypoventilation that improved with a wake promoting agent in conjunction with BPAP.

Report of Case
A 15-year-old male with Cystic Fibrosis (single F508del mutation, positive sweat test, FEV1% of 98%) and Autism who presented with frequent headaches, chronic insomnia, and daytime sleepiness (PDSS of 22). Current medications included albuterol as needed. Sleep history was significant for restless leg symptoms. Labs revealed low serum ferritin. Sleep study two years prior showed an AHI of 3.4 and PMLD of 18.4. After completion of iron therapy and initiation of gabapentin, his chronic insomnia and serum ferritin improved. However, patient continued to have aggressive behavior, headaches, and snoring. Sleep study was repeated and revealed mild OSA with hypoventilation (AHI of 6.41, &gt;28% of total sleep time with TCO2 above 50 mm Hg). Initial serum bicarbonate was 29 mmol/L and progressively increased to 34 mmol/L. Due to evidence of persistent chronic hypoventilation, patient was trialed on BPAP. Subsequent sleep study with BPAP showed an AHI of 0, but with worsening sleep related hypoventilation (TCO2 of 56mmHg, &gt; 70% total sleep time with TCO2 above 50 mm Hg). Genetic, endocrine, and neurological work up for hypoventilation was negative. Due to persistent daytime sleepiness (PDSS of 24), MSLT was performed and showed evidence of hypersomnia. Modafinil was then initiated. With the combination of nocturnal BPAP use and Modafinil, daytime sleepiness improved (PDSS of 15) and he had normalization of CO2 and bicarbonate levels.

Conclusion
We present a patient with CF, with minimal lung disease, who demonstrated a negative work up for sleep related hypoventilation, in which dysregulation of control of breathing improved with the use of a wake promoting agent in conjunction with BPAP.
1263 Mandibular Advancement Device referrals and compliance at the VA
Authors: Hsieh Caleb , Ryden Armand , Zeidler Michelle 
Published: May 2020

Abstract

Introduction
For patients with obstructive sleep apnea (OSA) who are either intolerant or otherwise non-compliant with positive airway pressure (PAP) therapy, the use of a mandibular advancement device (MAD) is a viable and minimally invasive alternative for select individuals. Many device variations exist, but the common mechanism of action involves airway augmentation via traction on the lower jaw provided by a dental appliance. Prior studies have identified factors associated with treatment success, however, actual clinical experiences fluctuate widely. To identify patients within the VA that might benefit most from MAD, we conducted a preliminary review of MAD referrals within a one-year period at the West Los Angeles VA (WLA VA).

Report of Case
This retrospective database review was performed to identify areas for improvement in MAD referrals within the West Los Angeles VA network. The need for informed consent was waived as part of reviews preparatory to research as outlined in paragraph 23c of the VHA Directive 1200.05. Our database was queried for all MAD dental referrals between January 1, 2017 and Dec 31, 2017. All patients that completed at least one dental visit were included, those that did not complete referrals were excluded. Patient charts were reviewed for demographic data, comorbidities, dentition quality, pre- and post- MAD sleep studies, prior failed therapies, duration of MAD usage, reasons for discontinuation, and final OSA treatment modality. Between January 1, 2017 and December 31, 2017, 246 patients were referred for MAD dental evaluation. 184 initial evaluations were completed, 55 were discontinued for various reasons, and 7 were cancelled.
*** Preliminary data for first 84 patients***
Of 84 patients seen in dental clinic, 33 (39%) were deemed poor candidates either because of insufficient dentition or because of existing temporal-mandibular joint discomfort, 4 patients declined any intervention. Of 47 patients that received an MAD, 6 patients continued to use MAD alone, 20 switched to PAP or other modalities, and 21 were lost to follow up.

Conclusion
Pending more in depth analysis
0128 Mild Upper Airway Obstruction Leads to Increased Energy Intake and Growth Retardation that Persists After the Obstruction Removal
Authors: Rotenberg A , Assadi M , Agam N , Segev Y , Tarasiuk A 
Published: May 2020

Abstract

Introduction
Whereas pediatric obstructive sleep apnea may cause insufficient body weight gain and growth retardation, in some studies, metabolic syndrome and obesity were observed. Interestingly, treatment by adenotonsillectomy can lead to accelerated weight gain by an unclear mechanism. Here, we explored the effects of moderate upper airway obstruction (AO) and mild AO (mAO) and its removal (OR) on ventilation, resting energy expenditure (REE), food intake and growth during the diurnal cycle, from weaning to adulthood.

Methods
The trachea of 22-day-old rats was surgically narrowed to generate AO, mAO, and OR was performed after two weeks on mAO animals. Minute ventilation was recorded by whole body plethysmography and diurnal food intake, and REE was explored with metabolic cages 12 weeks post surgery.

Results
Following tracheal narrowing, inspiratory swings in esophageal pressure increased by 177% (p&lt;0.01) and 36% (p&lt;0.01) in AO and mAO rats, respectively, and was similar to the controls in the OR group. REE (Kcal/h/kg) was 3.7±0.1, 5.7±0.12 (p&lt;0.01), 4.1±0.08 (p&lt;0.01), and 3.6±0.15 in the control, AO, mAO, and OR groups, respectively. Increased EE in the AO and mAO groups was associated with up-regulation of ventilation by 133% and 56%, respectively (p&lt;0.01). In all groups, energy intake (EE) was higher during a 12 h active period compared to a sleep period (p&lt;0.01). EE during the lights on of AO and mAO animals increased by 136 % and 126%, respectively, and was similar to the control in the OR group. Active period EE increased by 19% in both obstructed groups (p&lt;0.01). Active period EE was 16.7 % higher in the OR group despite the normalization of ventilation and tracheal diameter to the control value. Increased REE was associated with hindrance of bone elongation (p&lt;0.01), and OR partially improved growth.

Conclusion
The need to maintain respiratory homeostasis during upper airway obstruction was associated with a persistent increase in energy intake. Surgical intervention may not be sufficient to correct the energy intake elevation, and endocrine regulation of feeding and growth may have greater impacts post intervention.

Support
This study was supported by the Israel Science Foundation grant no. 164/2018
0135 Self-Reported Sleep and Gut Microbiome Composition and Diversity: Associations in Well-Functioning Older Adults
Authors: Holingue C , Mueller N T , Tanaka T , Differding M K , Chia C W , Wu M N , Schrack J A , Simonsick E M , Spira A P 
Published: May 2020

Abstract

Introduction
The gut microbiome is believed to play an important role in health and disease, yet little is known about the link between sleep and the gut microbiome in humans. We investigated the association of self-reported sleep with gut microbiome composition and diversity in a cohort of well-functioning older adults.

Methods
We studied 791 participants (mean age = 71.5±12.0 years, 55% women) in the Baltimore Longitudinal Study of Aging with self-report sleep measures and whole-genome DNA sequencing of stool samples. Predictors (modeled as continuous variables) included insomnia symptoms from the Women’s Health Initiative Insomnia Rating Scale (WHIIRS), sleep duration (&lt;5, 5–6, 6–7, &gt;7 hours), and frequency of excessive daytime sleepiness (EDS). We tested their association with gut microbiome diversity (Shannon index) and relative abundance of individual taxa using Kendall Tau Correlation. Next, we assessed whether these sleep variables were associated with overall microbiome structure (Bray-Curtis), adjusting for age, sex, race, education, BMI, depressive symptoms, and number of comorbidities.

Results
Sleep duration was associated with overall microbiome composition (p&lt;0.01), with longer sleep duration associated with lower biodiversity of microbes in the gut (p&lt;0.05). In phylum-level analyses, higher WHIIRS total (i.e., more severe insomnia) was associated with lower relative abundance of Actinobacteria, while more frequent EDS was associated with lower relative abundance of Fusobacteria. More frequent trouble falling asleep, staying asleep, early waking, poorer sleep quality and higher WHIIRS total were associated with lower abundance of Synergistetes (all p&lt;0.05).

Conclusion
In well-functioning older adults, self-reported sleep duration, symptoms of insomnia, and EDS were associated with microbiome diversity and composition. The phylum Synergistetes, which has been associated with protective humoral immune response in prior literature, may be an important correlate of insomnia symptoms in older adults. Future investigations are needed to examine the gut microbiome as a driver or mediator of sleep-health associations.

Support
This study was supported in part by National Institute on Aging (NIA) grant R01AG050507, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.
0140 Dietary Macronutrients and Sleep Duration, Sleep Disturbance, and Daytime Fatigue
Authors: Barker M , St-Onge M , Seixas A , Killgore W D , Wills C C , Grandner M A 
Published: May 2020

Abstract

Introduction
We examined nationally-representative data on macronutrients associated with multiple dimensions of sleep health.

Methods
Data were obtained from the 2015–2016 National Health and Nutrition Examination Survey, (N=5,266 adults). Standard 24-h dietary recall procedures were analyzed to establish daily consumption of protein, carbohydrates, sugar, fiber, total fat, and saturated fat. Self-reported habitual sleep duration was categorized as very short (&lt;5h), short (5–6.5h), normal (7-8h), and long (&gt;8h). Sleep disturbance and daytime tiredness/fatigue were self-reported as either none, mild, moderate, or severe. Weighted multinomial logistic regressions with sleep variables as outcome/dependent variable and percent of each macronutrient as independent variable were adjusted for age, sex, race/ethnicity, education, and body mass index.

Results
Increased protein was associated with a decreased likelihood of very short sleep (RRR=0.01, p=0.019) and severe fatigue (RRR=0.06, p=0.020). Increased carbohydrates was associated with an increased likelihood of very short (RRR=61.17, p=0.001), short (RRR=3.96, p=0.017), and long (RRR=2.58, p=0.041) sleep, severe sleep disturbance (RRR=9.37, p=0.010) and fatigue (RRR=7.61, p=0.009). Increased sugar was associated with an increased likelihood of very short (RRR=24.17, p=0.001), short (RRR=3.29, p=0.017), and long (RRR=2.22, p=0.046) sleep, as well as mild (RRR=2.36, p=0.041) and severe (RRR=10.70, p=0.001) sleep disturbance, and severe fatigue (RRR=12.98, p&lt;0.0005). Increased fiber was associated with a decreased likelihood of long (RRR=0.01, p=0.032) sleep and severe sleep disturbance (RRR&lt;0.01, p&lt;0.0005), as well as moderate (RRR&lt;0.01, p=0.026) and severe (RRR&lt;0.01, p&lt;0.0005) fatigue. Increased fat was associated with a decreased likelihood of very short sleep (RRR=0.01, p=0.010). Increased saturated fat was associated with a decreased likelihood of very short sleep (RRR&lt;0.01, p=0.017).

Conclusion
Protein and fiber were associated with better sleep profiles overall and carbohydrate and sugar were associated with worse sleep, as well as increased prevalence of sleep disturbances and fatigue.

Support
Dr. Grandner is supported by R01MD011600
0150 Comparing Two Measures of Sleep Depth/ Intensity
Authors: Younes M , Schweitzer P K , Griffin K , Walsh J K , Balshaw R 
Published: May 2020

Abstract

Introduction
There is currently no well-validated method for evaluating objective sleep depth/intensity. Delta power is thought to reflect sleep depth based upon limited evidence. Odds-ratio-product (ORP) is a recently introduced continuous measure of sleep depth. We compared delta spectral power (delta) and ORP as measures of sleep depth/intensity during manipulations that altered sleep depth (sleep restriction with placebo or with a delta-promoting drug). We hypothesized that ORP will provide a more robust measure of sleep depth.

Methods
This is a secondary analysis of data from a study in which forty-one healthy subjects were sleep restricted and randomized to receive placebo or gaboxadol 15mg. Participants underwent consecutive in-laboratory sleep studies on two baseline, four sleep restriction (5 hours) and two recovery nights. The relation between delta or ORP during any given 30s epoch and sleep depth, operationally defined as the probability of arousal / awakening occurring during the next 30 seconds (arousability), was assessed.

Results
Mean ORP values differed significantly among the four sleep / wake stages, but delta power did not differentiate wake, N1 and N2. The relation between ORP and arousability was linear across the entire range of ORP whereas delta power detected differences in arousability only with delta values &lt 300 μV2. Correlations with arousability in individual subjects were stronger with ORP (p &lt 0.0001). Receiver operating characteristic analysis found the ability to predict imminent arousal to be significantly greater with ORP than with delta power for all experimental conditions (p &lt 0.0001). The increase in sleep depth with restriction alone was detected on the second day of restriction by ORP (p &lt 0.01) but not by delta.

Conclusion
As compared to delta power, ORP is more discriminating among sleep stages, more sensitive to sleep restriction, and more closely associated with arousability. These observations indicate ORP better reflects sleep depth/intensity.

Support
None