bluuebunny/crossref_metadata_2025_split huggingface dataset:
1008 Brain Age Based on Sleep Encephalography is Elevated in HIV+ Adults on ART
Authors: Leone M J , Sun H , Boutros C , Sullivan L , Thomas R J , Robbins G , Mukerji S , Westover M 
Published: May 2020

Abstract

Introduction
Sleep EEG is a promising tool to measure brain aging in vulnerable populations such as people with HIV, who are high risk of brain aging due to co-morbidities, increased inflammation, and antiretroviral neurotoxicity. Our lab previously developed a machine learning model that estimates age from sleep EEG (brain age, BA), which reliably predicts chronological age (CA) in healthy adults. The difference between BA and CA, the brain age index (BAI), independently predicts mortality, and is increased by cardiovascular co-morbidities. Here, we assessed BAI in HIV+ compared to matched HIV- adults.

Methods
Sleep EEGs from 43 treated HIV+ adults were gathered and matched to controls (HIV-, n=284) by age, gender, race, alcoholism, smoking and substance use history. We compared BAI between groups and used additional causal interference methods to ensure robustness. Individual EEG features that underlie BA prediction were also compared. We performed a sub-analysis of BAI between HIV+ with or without a history of AIDS.

Results
After matching, mean CA of HIV+ vs HIV- adults were 49 and 48 years, respectively (n.s.). The mean HIV+ BAI was 3.04 years higher than HIV- (4.4 vs 1.4 yr; p=0.048). We found consistent and significant results with alternative causal inference methods. Several EEG features predictive of BA were different in the HIV+ and HIV- cohorts. Most notably, non-REM stage 2 sleep (N2) delta power (1-4Hz) was decreased in HIV+ vs. HIV- adults, while theta (4-8Hz) and alpha (8-12Hz) power were increased. Those with AIDS (n=19, BAI=4.40) did not have significantly different BAI than HIV+ without AIDS (n=23, BAI=5.22). HIV+ subjects had higher rates of insomnia (56% vs 29%, p&lt;0.001), obstructive apnea (47% vs 30%, p=0.03), depression (49% vs 23%, p&lt;0.001), and bipolar disorder (19% vs 4%, p&lt;0.001).

Conclusion
HIV+ individuals on ART have excess sleep-EEG based brain age compared to matched controls. This excess brain age is partially due to reduction in delta power during N2, suggesting decreased sleep depth. These results suggest sleep EEG could be a valuable brain aging biomarker for the HIV population.

Support
This research is supported by the Harvard Center for AIDS Research HU CFAR NIH/NIAID 5P30AI060354-16.
1016 Multiple Sleep Disturbances and Hypertension Risk Among White, Black, and Hispanic/Latina Women
Authors: Lunyera J , Park Y M , Ward J B , Gaston S A , Bhavsar N A , Muntner P , Sandler D P , Jackson C L 
Published: May 2020

Abstract

Introduction
Poor sleep has been associated with a higher risk of hypertension, but few prospective studies have included multiple sleep dimensions and few have investigated age differences or racial/ethnic disparities in this relationship among pre- and post-menopausal women.

Methods
To investigate the association between sleep disturbances and hypertension risk, we used data from women in the United States enrolled in the Sister Study who were aged 35 to 74 years at baseline (2003 to 2009) and did not have hypertension at enrollment. Participants were followed through September 2017. Sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping, and insomnia symptoms were reported at baseline. During follow-up, participants reported whether they were diagnosed by a healthcare provider with hypertension. Adjusting for sociodemographic characteristics, health behaviors, and health conditions including diabetes and depression, we used Cox Proportional Hazards regression to estimate hypertension risk among women with vs. without unfavorable sleep characteristics. We also investigated potential modification by race/ethnicity, age,and menopausal status.

Results
Of 33,175 women without hypertension at baseline (mean age ± standard deviation: 53.9 ±8.8 years; 88.8% White, 6.4% Black, and 4.9% Hispanic/Latina), 19.9% developed hypertension over a median follow-up of 9.2 years (interquartile range: 7.6 to 10.9). After adjustment, insomnia symptoms (hazard ratio[HR]=1.08 (95% Confidence Interval [CI]: 1.03-1.15)) and insomnia symptoms combined with short sleep (HR=1.14 (95% CI: 1.06-1.23)) were associated with incident hypertension. While similar across race/ethnicity, these associations were stronger in younger (age &lt;54 vs. ≥54 years) and premenopausal vs. postmenopausal women (p-values for interaction &lt;0.05).

Conclusion
Sleep disturbances related to insomnia were associated with an increased risk of hypertension, especially among younger and premenopausal women.

Support
This work was funded by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01 [CLJ] and Z01 ES044005 [DPS]).
1022 Association Between Homocysteine and Sleep in Postmenopausal Women
Authors: Banzoli C V , Bezerra A G , D’Almeida V , Andersen M L , Tufik S V , Hachul H V 
Published: May 2020

Abstract

Introduction
Homocysteine (Hcy) is a sulfur amino acid, considered an independent risk factor for cardiovascular disease. Excessive Hcy directly harms the endothelium and can lead to premature atherosclerosis, with progression to stroke and acute myocardial infarction. One of the causes of hyperhomocysteinemia (Hhcy) is known to be hypoestrogenism. Hypoestrogenism increases the cardiovascular risk as well as the occurrence of sleep disorders. Hhcy prevalence varies by population and its value in postmenopausal women in Brazil is unknown. Objective: To evaluate the prevalence of hyperhomocysteinemia in postmenopausal women in the city of São Paulo. Check if there is an association between the variables: Hcy and lipid profile; Hcy and hot flushes; Hcy and subjective sleep parameters

Methods
A population-based cross-sectional study was conducted that included a total of 1,042 volunteers living in the city of São Paulo in 2007. This research is part of the São Paulo Sleep Epidemiological Study (EPISONO). Study approved by the Ethics Committee (CEP # 0593/06) and registered with ClinicalTrials.gov (NCT00596713). Hcy, total cholesterol, HDL, LDL, triglycerides were measured. Sleep questionnaires PSQI, IGI, Epworth Sleepiness Scale were used. The GLzM (Generalized Linear Model) was used to verify the association between the different variables. Dependent variables were used in binominal and gama distribution when needed

Results
The sample consisted of 193 postmenopausal women, with a mean age of 58 years (SD ± 9). The prevalence of Hhcy in this sample was 4.7%, while 14.7% had dyslipidemia 22.8% with hypertriglyceridemia and 29% with low HDL levels. There was an association between Hcy and HDL. There was no association between Hcy and hot flushes, Hcy and LDL, nor with Hcy and sleep parameters.

Conclusion
The studied population presented low prevalence of Hhcy and there was no association between Hcy and sleep parameters.

Support
This research was support by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001.
1025 Sleep Patterns In Head Neck Cancer Patients During Radiotherapy
Authors: Gu F , Jungquist C , Sonia A , Liu L , Repasky E , Schlecht N , Reid M , Ambrosone C , Andrew R , Singh A 
Published: May 2020

Abstract

Introduction
Sleep disturbances are reported to be highly prevalent in head and neck cancer (HNC) patients, but no carefully assessed sleep data exists in patients with HNC undergoing concurrent chemoradiotherapy (CRT).

Methods
To objectively assess sleep patterns in this study population, we conducted a pilot study in 15 patients and 13 non-cancer healthy volunteers. Patients wore the wrist Actiwatch Spectrum (Philips Respironics) at week 1, 3, and 6/7 during the 7-week treatment period. Volunteers wore the Actiwatch for one week. We used the Actiware software to calculate sleep parameters. A sleep log was used as a complement to define participants’ bedtime and rise-up time. Any sleep episode scored by the software during daytime was considered as a nap.

Results
Compared to healthy volunteers, patients had lower overnight sleep efficiency, longer sleep onset latency and more waking time after sleep onset (WASO), indicating more difficulty falling asleep and maintaining sleep. During CRT, patients’ sleep efficiency decreased whereas latency and WASO increased, indicating possible the decrease of sleep quality. Sleep efficiency of &lt;85% has been used previously as a cut-off for poor sleep; based on this criteria, 45% of HNC patients had poor sleep at treatment baseline, compared to 31% in non-cancer volunteers, and this proportion increased to 51% by the end of treatment. Patients had longer napping time: compared to healthy volunteers, the napping time was on average 2 hours longer at baseline, and 3 hours longer at the end of treatment, indicating unhealthy sleep habits of these patients.

Conclusion
Our data suggested HNC patients had severe sleep disturbances and unhealthy sleep habits, which were aggravated during CRT treatment.

Support
This study was supported by UL1TR001412-04, a Clinical and Translational Research Award under SUNY-Buffalo.
1030 An Exploration of the Impact of Cognitive Behavioural Therapy of Insomnia (CBT-I) on Perceived Cognitive Impairment in Breast Cancer Survivors
Authors: Walsh N , Garland S , Lester R , McCarthy J , Laing K 
Published: May 2020

Abstract

Introduction
Insomnia and cognitive impairment are prevalent and persistent symptoms in cancer survivors. Cognitive Behavior Therapy is effective for improving insomnia and comorbid symptoms in cancer survivors but there are very few empirically supported treatments that can improve cognitive impairment. This feasibility study explored the impact of CBT-I on perceived cognitive impairment in breast cancer survivors.

Methods
We enrolled 10 early stage breast cancer survivors with insomnia disorder and perceived cognitive impairment. Participants received 7 individual sessions of CBT-I over the course of 8 weeks and completed the Insomnia Severity Index (ISI), the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog) questionnaires and The Hospital Anxiety and Depression Scale (HADS) at baseline and post-treatment. Paired samples t-tests were used to assess change over time.

Results
The sample was predominantly diagnosed with stage II breast cancer (60%). Women were an average age of 50.8 (SD 6.84) and 18.2 (SD 3.62) years of education. CBT-I significantly reduced insomnia severity [19.4 to 7.1; t(9)= 6.56, p &lt; .001] and improved perceived cognitive impairment [t(9)= -3.55, p &lt; .01], perceived cognitive ability [t(9)= -2.87, p &lt; .05], quality of life [t(9)= -3.14, p &lt; .05], and overall subjective cognitive function [t(9)= -3.67, p &lt; .01]. Although participants began treatment with low levels of mood disturbance, CBT-I further decreased symptoms of anxiety (baseline: M= 10.10, SD= 4.34; post-treatment M= 8.20, SD= 3.91) and depression (baseline: M= 7.90, SD= 3.45; post-treatment M= 5.30, SD= 2.83), although not statistically significant.

Conclusion
This study suggests CBT-I may improve perceived cognitive impairment in cancer survivors, in addition to insomnia and mood. Future randomized controlled trials with larger samples and objective measurements of cognition are needed.

Support
Nyissa Walsh is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute (BHCRI). Dr. Sheila Garland is supported by a Scotiabank New Investigator Award from BHCRI.
1056 Perceived Financial Difficulty Predicts Sleep Quality In Participants With Type 2 Diabetes And Obstructive Sleep Apnea
Authors: Morris J L , Baniak L , Belcher S M , Imes C , Luyster F , Scott P W , Sereika S , Chasens E R 
Published: May 2020

Abstract

Introduction
People with multiple chronic conditions such as type 2 diabetes (T2D) and obstructive sleep apnea (OSA) are at increased risk for poor sleep quality. It is unclear if social determinants of health (SDoH) such as race, perceived financial difficulty, education, gender, and marital status are associated with sleep quality in this population. The purpose of this cross-sectional secondary analysis of data from the Diabetes Sleep Treatment Trial was to explore SDoH and disease severity as predictors of sleep quality in persons with both OSA and T2D.

Methods
Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and A1C for glycemic control. SDoH included perceived financial difficulty (none/moderate-severe), race (White/African American), sex (f/m), marital status (no/yes), education (≤ or &gt; 2 years post high school), and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Correlations and linear regression modeling investigated associations between SDoH and disease severity on sleep quality. Post-hoc correlations were explored for significant relations among SDoH.

Results
The sample (N = 229) was middle-aged (57.6 ± 10.0; 66 % White and 34% African American; and 54 % men vs. 46% women. Participants carried a high burden of disease (mean AHI = 20.7±18.1, mean A1C = 7.9 %±1.7%). Disease severity was not significantly associated with sleep quality (all p &gt;.05). The perception of worse financial difficulty was the only SDoH that predicted worse sleep quality (b=-1.54, p=.015). Characteristics significantly associated with worse financial difficulty were being African American, female, ≤ 2 years post high school, and younger (all p&lt;.01).

Conclusion
Financial difficulty may be a more important predictor of subjective measures of sleep quality than disease severity in patients with OSA and T2D. Researchers and clinicians should be aware of these characteristics as potential markers of vulnerability to poor sleep quality in this population.

Support
The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK096028) and through the Clinical +Translational Research Institute grants UL1TR001857 and UL1TR000005.
1060 Screening For Obstructive Sleep Apnea In Severe Gastroesophageal Reflux Disease Patients: A Forgotten Association?
Authors: De A , Gharib H , Frenia D , Velpari S 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is an emerging epidemic in the USA and remains underdiagnosed. Investigations of Gastroesophageal reflux disease (GERD) poses a substantial burden on patient-welfare and costs to the health system. Current literature has highlighted the association between severe GERD and OSA, and other sleep disorders. We conducted a retrospective analysis of patient records undergoing Bravo pH monitoring for refractory GERD to measure the prevalence of OSA and screening.

Methods
Records of patients who underwent outpatient Bravo pH monitoring at a teaching hospital were reviewed from August 2018 to May 2019. 72 records were reviewed in our analysis. Analysis variables included age, gender, body mass index, history of hypertension and OSA. Outpatient records were reviewed for documentation for OSA or screening and demographics were obtained for calculation of a partial STOP-BANG score (a validated OSA screening tool).

Results
8 out of 72 (11%) were excluded due to incomplete documentation regarding their history. Of the remaining 64, 2 had a known diagnosis of OSA (3%) and 1 was due a sleep study for maintenance insomnia. Of the remaining 61 patients, none had documentation of a history pertaining to sleep complaints or full screening for OSA. 4 of the 8 components to the STOP-BANG criteria were documented and used to measure risk of OSA in these patients. 23 (39%) patients had a score of 3 or above characterizing them as intermediate risk. The other 4 components were not used due to a lack of clinical information. 13 of these patients had a positive Bravo test, 2 had an inconclusive result and 8 had a negative result. Of the 61 patients in total, 31 had a positive Bravo result and 9 had an inconclusive result.

Conclusion
In our study, we found that 39% of patients based on demographic data were of intermediate risk of OSA. Over half of these patients had a positive result for GERD. Despite the increased awareness of sleep disorders it is still neglected despite prevalent associated comorbid conditions. This study highlights the failure to screen for this modifiable risk factor within a teaching environment.

Support
None
1063 Depression Moderates the Association Between Posttraumatic Stress Disorder and Nightmare Severity in Nurses
Authors: Shapiro T , Messman B , Slavish D C , Alkire C , Wardle-Pinkston S , Dietch J , Kelly K , Ruggero C , Taylor D 
Published: May 2020

Abstract

Introduction
Nurses report a higher prevalence of posttraumatic stress disorder (PTSD) than the general population, and approximately 18% of nurses report having depression. Nightmares are a common symptom of PTSD, and both nightmares and PTSD are correlated with depression. Nightmares may represent a possible clinical target for improving outcomes in both disorders. This study assessed associations between PTSD and depressive symptoms with nightmare severity, and whether depressive symptoms moderated associations between PTSD and nightmare severity.

Methods
Participants were 461 nurses (91% female; 77% white, mean age = 38.39 years) recruited from two hospitals for a parent study. Participants completed the Patient Health Questionnaire (PHQ-9), Post-traumatic Stress Disorder Checklist (PCL-5), and 14 days of sleep diaries to assess daily nightmare frequency and severity (on a scale of 0 = not at all severe to 3 = very severe).

Results
22.1% of participants reported at least one nightmare across the 14 days, with a mean daily nightmare frequency of 1.17 (SD = 2.15) and a mean severity of 0.11 (SD = 0.18). PCL-5 and PHQ-9 scores were significantly correlated with nightmare severity (r = 0.27; r = 0.24, respectively) and each other (r = 0.69). PHQ-9 scores moderated the association between PCL-5 scores and nightmare severity (β = -.01, SE = &lt;0.01, p = 0.015). For individuals 1 SD below the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity. For individuals 1 SD above the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity, but to a lesser degree.

Conclusion
Both depressive and PTSD symptoms were associated with more severe nightmares. Surprisingly, the association between PTSD symptoms and nightmare severity was stronger for those with lower depressive symptoms. Results suggest depression, PTSD, and nightmares may represent a partially overlapping symptom cluster. Research should investigate how nightmare treatment may reduce PTSD and depressive symptoms.

Support
NIAID R01AI128359-01
1064 Sleep Patterns Among Urban Haitian Earthquake Survivors Who Experienced the Trauma of Nonpartner Sexual Violence: A Latent Class Analysis Approach
Authors: Rahill G J , Joshi M J , Blanc J , Rice C 
Published: May 2020

Abstract

Introduction
Sleep health is crucial to recovery from trauma. Haiti’s Cité Soleil residents (approximately 350,000) live in extreme poverty and regularly experience or witness life-threatening events, including gang and non-partner sexual violence (NPSV). Differences in levels of sleep disturbance among men and women in resource-limited settings who survive disasters as well as NPSV are understudied. In a larger study in which we investigated trauma symptoms among 2010 Haiti earthquake survivors via the Trauma-symptom checklist -40 (N=526; 290 males, 236 females), we also assessed self-reported frequency of sleep disturbance symptoms using the measure’s sleep disturbance subscale, comparing the latter by NPSV victim status and by gender.

Methods
SAS enabled 3-Class Latent Class Analysis (LCA): Class 1 (“No symptoms”), Class 2 (“Some symptoms”), Class 3 (“All Symptoms)”.

Results
Distribution of class membership differed by gender (χ2 = 23.9, df = 2, p &lt; .0001). Proportions of respondents assigned to the three classes differed between genders (Females: Class 1, 29.2%; Class 2, 35.5%; Class 3, 35.3%); Males: Class 1, 25.7%; Class 2, 54.4%; Class 3, 19.9%). NPSV status influenced levels of sleep disturbance symptoms, and membership distribution differed across classes by gender (χ2 = 23.9, df = 2, p &lt; .0001). Class 2 membership was greater for men (65.9%), but class 3 membership was greater for women (59.3%). Women who experienced NPSV were statistically more likely members of sleep disturbance symptom classes (Class 2 or Class 3) than Class 1 (χ2= 14.9, df = 2, p = 0.0006). No difference was found in Class membership for men reporting NPSV (χ2= 1.6, df = 2, p = 0.45).

Conclusion
Investigating the sleep health of Cité Soleil residents adds to the body of literature on sleep health, sleep equity and gendered vulnerability. Findings suggest women in post-disaster settings, especially in LMICs, are at even greater risk for a variety of adverse health outcomes and for suboptimal sleep, even when local men have similar traumatogenic experiences, such as NPSV. Girls and women in post-disaster LMIC settings need trauma-informed sleep health promotion and NPSV-prevention.

Support
N/A
1081 Associations Among REM Density And Parasympathetic Activity, Nightmares, And Hyperarousal In Trauma-exposed Individuals
Authors: Oliver K I , Hinton J A , Daffre C , Dominguez J , Seo J , Gannon K , Lasko N B , Pace-Schott E F 
Published: May 2020

Abstract

Introduction
Individuals with posttraumatic stress disorder (PTSD) exhibit autonomic hyperarousal and nightmares. We hypothesized that REM density (REMD) and REM heart rate variability would predict self-reported hyperarousal, nightmares, and PTSD diagnosis in trauma-exposed individuals.

Methods
Ninety-nine individuals (aged 18-40, 68 females) exposed to a DSM-5 PTSD criterion-A trauma within the past two years (48 meeting PTSD criteria) completed a night of ambulatory polysomnography (PSG) preceded by an acclimation night. REMD in scored sleep recordings were computed using the Matlab program written by Benjamin Yetton. Indices of parasympathetic tone during REM were computed using Kubios software and included Average Root Mean Square of the Successive Differences (RMSSD) and High Frequency power (HFpower). Participants completed two weeks of sleep diaries with nightmare questionnaire and completed the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). Hyperarousal-item scores were computed from the PCL-5 without the sleep item (PCLhyp) and from the CAPS-5 (CAPShyp), and these scores (with their sleep items) were combined into a Composite Hyperarousal Index (CHI). Nightmare rate was the proportion of sleep diaries reporting a nightmare. Simple regressions measured associations among REMD, REM parasympathetic indices, hyperarousal measures, and nightmare rate.

Results
REMD did not significantly predict PTSD diagnosis or hyperarousal scores but did predict decreased parasympathetic activity for both RMSSD (p= 0.002, R= -0.316) and HFpower (p= 0.016 R= -0.250). REMD predicted increased nightmare rate (p= 0.011 R= 0.262). Parasympathetic tone was negatively correlated with CAPShyp, PCLhyp, and CHI for both RMSSD (p= 0.04, 0.011, &lt;0.000, respectively) and HFpower (p= 0.051, 0.021, 0.010, respectively). Lower parasympathetic tone also predicted PTSD diagnosis with both RMSSD (p=0.012, t=2.559) and HFpower (p=0.010, t=2.627), but did not predict nightmare rate.

Conclusion
REMD predicted decreased parasympathetic tone and higher nightmare rate. Parasympathetic tone, but not REMD, predicted hyperarousal and PTSD diagnosis.

Support
R01MH109638