bluuebunny/crossref_metadata_2025_split huggingface dataset:
0666 Implementing a Sleep Technician Supervised Mask/Interface Fitting Session Can Improve Adherence With Home Automatic Positive Airway Pressure Therapy
Authors: Syed Z , Mehta I , Khorfan F 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common disorder associated with increased risk of motor vehicle accidents in addition to cardiovascular and neurocognitive comorbidities. Home Automatic Positive Airway Pressure (APAP) therapy is becoming a mainstay treatment of OSA in the outpatient setting. It is typically prescribed without any prior supervised titration. Discomfort related to the APAP interface is thought to contribute to poor adherence with home APAP use. We examined whether implementing a dedicated and personalized interface fitting session improves APAP adherence.

Methods
After obtaining IRB approval, 132 adult patients newly diagnosed with OSA were prospectively randomized into two groups (Groups A and B). Group A received a personalized interface/mask fitting session supervised by a sleep technician prior to starting home APAP therapy. During this 30-minute session, patients were educated on APAP use and sampled different masks to address any issues with comfort, leaks, etc. Group B received the usual care where they obtained an interface through Durable Medical Equipment. APAP adherence and interface air leaks during the initial 30 days of home APAP use were compared between the two groups.

Results
Mean APAP adherence during the initial 30 days of APAP therapy was 12.9% higher in Group A compared to Group B; p=0.05. Fewer APAP interface air leaks were present in Group A (14.8 l/min) compared to Group B (21.2 l/min); p=0.04.

Conclusion
Discomfort related to the APAP interface can quickly lead to non-adherence with APAP therapy. Initial experience of APAP treatment is important in determining subsequent use. Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician can improve APAP adherence. Potential benefits of increased APAP adherence include improvement in quality of sleep and in turn improvement in quality of life.

Support
Prior studies have shown that the initial experience of APAP treatment was highly important in determining subsequent use. Patients establish a pattern of APAP adherence during the early days of treatment and maintain this pattern long-term. Early intervention with solutions may help improve APAP adherence.
0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures
Authors: Weingarten J A , Dubrovsky B , Cunningham J , Chin W , Howladar A , Gikashvili L 
Published: May 2020

Abstract

Introduction
Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA.

Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p&lt;0.1 criterion. AHI and SpO2nadir were forced into the models.

Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2&lt;1%), lower total arousal index (TAI, p=0.006, R2&lt;1%), higher total sleep time (TST, p=0.003, R2&lt;1%), higher PSQI (p&lt;0.001, R2=5%), and higher CESD (p=0.001, R2&lt;1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2&lt;1%), lower TAI (p&lt;0.001, R2=1%), higher PSQI (p&lt;0.001, R2=3%, and higher CESD (p&lt;0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men.

Conclusion
On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables.

Support
none
0738 Advance Taper of Antidepressants Prior to Multiple Sleep Latency Testing Increases the Number of Sleep-Onset Rapid Eye Movement Periods and Reduces Mean Sleep Latency
Authors: Kolla B , Jahani Kondori M , Silber M , Samman H , Dhankikar S , Mansukhani M P 
Published: May 2020

Abstract

Introduction
Patients presenting with excessive sleepiness are frequently on antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited.

Methods
Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014-2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement suppressing antidepressants (REMS-AD) at assessment and during testing, actigraphy and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMS), proportion with ≥2 SOREMS and mean sleep latency (MSL) in patients who were on REMS-AD and discontinued prior to testing versus those who remained on REMS-AD were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT wherever feasible; fluoxetine is stopped 4 weeks prior. Regression analyses accounting for demographic, clinical and other medication-related confounders were performed.

Results
A total of 502 patients (age=38.18±15.90 years; 67% female) underwent MSLT; 178 (35%) were on REMS-AD at the time of assessment. REMS-AD were discontinued prior to testing in 121/178 (70%) patients. Patients tapered off REMS-AD were more likely to have ≥2 SOREMS (OR-12.20; 95%CI=1.60-92.94) compared to patients who remained on REMS-AD at the time of the MSLT. They also had shorter MSL (8.77±0.46 vs 10.21±0.28; p&gt;0.009) and higher odds of having ≥2 SOREMS (OR=2.22; 95%CI=1.23-3.98) compared to patients not on REMS-AD at initial assessment. These differences persisted after regression analyses accounting for confounders.

Conclusion
Patients who taper off REMS-AD prior to MSLT are more likely to demonstrate ≥2SOREMs and have a shorter MSL. Pending further prospective investigations, clinicians should preferably withdraw REMs-AD before an MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.

Support
None
0759 Phase 2 Proof Of Concept Study Of SUVN-G3031, A Histamine H3 Receptor Inverse Agonist For The Potential Treatment Of Narcolepsy
Authors: Nirogi R , Goyal V , Jayarajan P , Bhyrapuneni G , Ravula J , Jetta S , Shinde A 
Published: May 2020

Abstract

Introduction
SUVN-G3031 is a potent inverse agonist at histamine H3 receptor (H3R) with selectivity over 70 other targets. SUVN-G3031 has excellent pharmacokinetics in rats and dogs. SUVN-G3031 demonstrated dose dependent receptor occupancy in rats with marked wake-promoting and anticataplectic effects in orexin knockout mice supporting its potential therapeutic utility in the treatment of narcolepsy. Long-term safety studies in animals and Phase 1 evaluation for safety, tolerability and pharmacokinetics demonstrated no concern for further development of SUVN-G3031.

Methods
SUVN-G3031 is currently being evaluated in a Phase 2 proof of concept study in USA for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380). This is a double-blind, placebo-controlled, parallel-group, multicenter study to evaluate the safety, tolerability, pharmacokinetics and efficacy of SUVN-G3031 in comparison to placebo in patients with narcolepsy with and without cataplexy. Participants with an ESS score of ≥ 12; and mean MWT time of &lt; 12 min are being randomized at a ratio of 1:1:1 to 2 mg SUVN-G3031, 4 mg SUVN-G3031 or placebo. Patients are to be stratified based on the type of narcolepsy. Each patient will receive study drug once daily for 14 days. The primary objective of the study is to evaluate the effectiveness of SUVN-G3031 compared to placebo as measured by an improvement in the maintenance of wakefulness test (MWT) score. Various secondary, exploratory, safety endpoints and steady state plasma concentrations will be evaluated.

Results
This study has been initiated in Q3 2019 and subject recruitment is expected to be completed by Q2 2020.

Conclusion
This study is a phase 2 clinical trial evaluating the efficacy and safety of SUVN-G3031 as a monotherapy in patients with narcolepsy with and without cataplexy. Safety and efficacy results from the study are expected in Q3 2020.

Support
None
0818 Cyclic Alternating Pattern as Indicator for Subjective Sleep Quality in Community-Dwelling Older Men
Authors: Hartmann S , Baumert M 
Published: May 2020

Abstract

Introduction
The micro-architecture of NREM sleep displays a cyclic alternating pattern (CAP) comprising activation phases of slow high-amplitude waves (A1), fast low-amplitude brain activity rhythms (A3) or a mixture of both (A2). In this study, we investigated the relationship between CAP and subjective sleep quality parameters reported by community-dwelling older men from the Osteoporotic Fractures in Men Sleep Study.

Methods
CAP was scored in 2,811 overnight EEG recordings using a high performance automated CAP detection system. We quantified the ratio between CAP time and NREM sleep time (CAP rate), the number of A1-phases per hour of NREM sleep (A1 index), and the number of A2+A3-phases per hour of NREM sleep (A2+A3 index). Also, participants were asked to score the quality of their sleep on a Likert scale with five items from light to deep, from short to long, and from restless to restful. The relationship between CAP parameters and the subjective sleep quality measures was determined using ANCOVA with traditional sleep disturbance indices such as obstructive apnea-hypopnea index and arousal index as covariate.

Results
CAP rate decreased significantly with increasing quality of sleep for all three subjective measures (light vs. deep: 58.8±22.3% vs. 54.6±20.5%, p &lt; 0.001; short vs. long: 58.4±21.4% vs. 55.1±20.5%, p &lt; 0.001, restless vs. restful: 59.4±20.8% vs. 55.6±21.0%, p = 0.002). The A1 index did not show any significant variations across all three sleep quality parameters. The A2+A3 index behaved similarly to the CAP rate with decreasing values for each subjective measure (all: p &lt; 0.001).

Conclusion
CAP rate, especially A2+A3-phases, are reduced in older men who report good sleep quality, while A1 index did not show any significant relationship with subjective sleep quality measures. Hence, CAP is an indicator of sleep quality.

Support
The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839.
0825 Sleep During Pregnancy Through One Year Postpartum: Correspondence Between Actigraphy and Self-Report Measures
Authors: Beverly Hery C M , Christian L M 
Published: May 2020

Abstract

Introduction
Disrupted sleep and shorter sleep duration is common in pregnancy, due to hormonal changes and physical discomfort, and in postpartum due to new infants. Objective data in this population studied over more than one year are lacking. The current analysis focuses on actigraphy-based and self-reported sleep. We examined the level of correspondence between these two complementary measurement modalities.

Methods
Pregnant women were enrolled in the Stress and Health in Pregnancy and Postpartum (SHIPP) study. Study visits were conducted from 2016-2019 during the 3rd trimester, 4-6 weeks postpartum, and 4 months, 8 months, and 12 months postpartum. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and provided wrist-actigraphy data (Actiwatch, Philips Respironics) for one week prior to each study visit. Actigraphy-based time in bed (TIB), total sleep time (TST), sleep efficiency (SE), WASO and sleep latency (SL) were calculated. Correlations were conducted between actigraphy-based and self-reported PSQI sleep measures.

Results
79 women (28.9±4.6 years) provided complete actigraphy data (≥3 valid days; 6.4±1.0 days) for at least one time point. Objective TST from the 3rd trimester to 12-months postpartum was 7.19, 6.87, 6.86, 6.89, and 6.78 hours, respectively. Actigraphy-based TIB was positively correlated with self-reported TIB at all five visits (r’s: 0.37-0.62, p’s&lt;0.01). Actigraphy-based TST was positively correlated with self-reported TST (r’s: 0.27-0.48, p’s&lt;0.05) at all visits. Actigraphy-based SE was negatively correlated with the PSQI Global Score at 4, 8, and 12 months postpartum (r’s: -0.29 to -0.39, p’s&lt;0.05). Of note, actigraphy-based WASO and SL were not consistently correlated with any self-reported PSQI sleep measures.

Conclusion
Ensuring collection of accurate sleep data during pregnancy and postpartum is important, as poor sleep is associated with negative health outcomes for both mother and child. Self-reported data is common in large, epidemiologic studies yet actigraphy-based measures may capture different aspects of sleep than self-report.

Support
This study was supported by the National Institutes of Health (R01 NR01366).
0840 Sleep Quality in Clinically Indicated In-Laboratory Polysomnography
Authors: Roth R H , Harrison E , Kang H , Lobo J , Logan J , Sohn M , Kwon Y 
Published: May 2020

Abstract

Introduction
Few studies have explored how patients sleep or what characteristics might be predictive of poor sleep during clinically-indicated polysomnography (PSG) in an in-laboratory setting.

Methods
We reviewed clinically indicated diagnostic PSG studies completed over a 10-year period in a single academic sleep center. Total sleep time (TST) and sleep efficiency (SE) were used as proxies for sleep quality. Patients were categorized as normal or poor sleepers based on TST &lt;4 hours or SE &lt;50%. Multivariate linear and logistic regression analyses were performed to determine factors associated with sleep quality while controlling for demographics, medications, comorbidities and measures of sleep.

Results
We included 4957 patients, who were mostly female (58.9%), middle-aged (52.9 y), Caucasian (69.3%), and overweight or obese (91.3%). 3682 patients (74.2%) were diagnosed with sleep apnea (Apnea Hypopnea Index(AHI)&gt;5/hr).
Average TST was 5.75±1.43 hours (Interquartile range [IQR] = 4.94 - 6.73) and average SE was 75.1%±16.1% (IQR=66.9 - 87.2). TST and SE were lower for males compared to females (5.48 vs 5.93 hr, p&lt;0.001; 73% vs 77%, p&lt;0.001). In multivariable analysis, older age (TST: OR = 1.04, 95% CI:[1.03,1.05]; SE: OR = 1.04, 95% CI:[1.04,1.05]), male sex (TST: 1.38,[1.14,1.68]; SE: 1.34,[1.07,1.68]), normal body habitus (TST: 1.47,[1.02,2.08]; SE: 1.51,[1.01,2.27]) and a higher AHI (TST: 1.02,[1.02,1.03]; SE: 1.02,[1.003,1.03]) were significantly associated with being a poor sleeper for both TST and SE. Antidepressant use was associated with poor sleep for TST (0.77, [0.59,1]), but not for SE (0.98, [0.73,1.3]).

Conclusion
Sleep quality during the in-laboratory PSG differed by sex, age and presence of sleep apnea. Sleep quality during in-lab PSG is thought to be compromised by obtrusive monitoring and an unfamiliar environment, but average sleep quality may be higher than expected for patients in the laboratory. Future studies should consider examining in-lab sleep quality in different patient populations.

Support
N/A
0862 Adequate Sleep Duration Enhances Cardiovascular Benefits Of A Physical Activity Intervention In Older African Americans
Authors: Hoddy K K , Singh P , Beyl R A , Kirwan J P , Carmichael O T , Newton R L 
Published: May 2020

Abstract

Introduction
African Americans are at a greater risk for cardiovascular disease and inadequate sleep than are corresponding whites. Age-associated declines in sleep duration, cardiovascular health, and physical activity highlight the need to understand the relationship among these variables in this population. While physical activity is thought to be beneficial for promoting sleep quality, it remains unknown how habitual short sleep during a physical activity intervention influences the intervention response in this population.

Methods
Sedentary older African Americans (n=27; 65-85 years old; 74% female) participating in the intervention arm of a 12-week randomized controlled physical activity trial (NCT03474302) were categorized as short (n= 15) or adequate (n=12) sleepers, defined as sleeping &lt;6 hours/night or &gt;6 hours/night on average during the intervention. Participants wore validated activity monitors at baseline and 12 weeks, and commercially available sleep monitors were worn daily. Differences in cardiovascular outcomes at baseline and 12 weeks were assessed between sleep categories using sex-adjusted linear mixed models.

Results
The intervention increased accelerometer derived steps (p=0.04) with no between group differences (p=0.78). Moderate to vigorous activity (MVA) duration increased (p&lt;0.001), but change was greater in adequate sleepers (9 minutes; p&lt;0.05). Body weight did not significantly change (-0.71 kg; p=0.11) and changes were similar between groups (p=0.55). Total (p=0.046) and LDL cholesterol (p=0.04) decreased over time. Adequate sleepers experienced improvements in systolic blood pressure (-10 ± 4.5 mmHg; p=0.03), total cholesterol (-30 ± 11 mg/dL; p=0.01), and LDL cholesterol (-23 ± 9 mg/dL; p=0.01) from baseline while short sleepers did not (all p&gt;0.05). Significant differences or trends between adequate and poor sleepers were observed (-10.5 mmHg; p=0.096; -30 mg/dL p=0.044; -21 mg/dL; p=0.095, respectively).

Conclusion
Adequate sleep during a physical activity intervention may be important to elicit cardiovascular benefits. Thus, research evaluating sleep extension complementary to increased physical activity is warranted in short sleepers.

Support
BrightFocus (A20175472); National Institute of General Medical Sciences of the National Institutes of Health (U54-GM104940)
0863 Age-categorized Trends In Self-reported Sleep Duration For The Non-institutionalized U.s. Civilian Population From 2004-2013: Considerations Of Racial/ethnic Variations
Authors: Christina M , Bubu O M , Donley T , Blanc J , Oji E , Turner A D , Mbah A K , Williams N J , Youngstedt S , Shochat T , Azizi S A , Osorio R S , Jean-Louis G 
Published: May 2020

Abstract

Introduction
We examined age-categorized trends in self-reported sleep duration using data from the National Health Interview Survey (NHIS) 2004-2013 and explored how these trends may vary based on individuals’ race/ethnicity.

Methods
Study participants were aged 18-85 (N=258,158). Sleep duration within a 24-hour period on average was categorized as ≤ 6hrs (short-sleep), 7-8 hours (adequate-sleep), and ≥ 9hrs (long-sleep). Age was categorized as 18 - &lt;26, 26 - &lt;65 and 65 - 85. Racial categories included non-Hispanic Whites (NHW), Blacks/African Americans (AAs) and Hispanics. Adjusted multinomial logistic regression models examined trends in self-reported sleep duration across age-categories and assessed race/ethnic differences in these trends.

Results
Mean sleep duration (hrs.) across all years was 7.4, 7.0, and 7.5, for ages 18 - &lt;26, 26 - &lt;65 and 65 - 85, respectively and was relatively stable from 2004-2013. However, compared to individuals ages 18 - &lt;26, those categorized as ages 26 - &lt;65 were 55% more likely to be short sleepers while those ages 65 - 85 were 20% less likely to be short sleepers (P &lt; .001 for all). Mean sleep duration was 7.2hrs, for NHW and 7.1hrs for AAs and Hispanics, and showed increasing trend toward short sleep beginning in 2007 through 2013 (P &lt;.01 for trend). In the age 18 - &lt;26 category, compared to whites, blacks and Hispanics were 35% and 29% more likely to be short sleepers, respectively. In the age 26 - &lt;65 category, compared to whites, blacks and Hispanics were 35% and 21% more likely to be short sleepers, respectively. In the age 65 - 85 category, compared to whites, blacks were 19% more likely to be short sleepers (P &lt; .001 for all).

Conclusion
Continued surveillance of population-level sleep trends among minority populations is essential as growing race/ethnic (age specific) disparities in self-reported sleep duration may have consequences for racial/ethnic health disparities.

Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01AG056531, R25HL105444, R25NS094093, K07AG05268503, R01HL142066, K23HL125939)
0869 Slow Wave Sleep Is Associated With Decreased Risk Of Gestational Diabetes Mellitus
Authors: Izci Balserak B , Bronas U , Prasad B , Shah K , Steffen A , Carley D 
Published: May 2020

Abstract

Introduction
Pregnancy is associated with disrupted slow-wave sleep (SWS) and a high prevalence of sleep disordered breathing (SDB), which may further exacerbate the decrease of deep sleep. Reduced slow wave sleep may impair glucose homeostasis, contributing to Gestational Diabetes Mellitus (GDM). Studies investigating EEG markers of deep and light sleep, and their associations with SDB and GDM are lacking. In this study, we measured associations of EEG Delta-power with objective SDB measures assessed in late-pregnancy to determine if changes in these bands are associated with GDM risk.

Methods
74 women (24-36 weeks pregnancy) underwent overnight polysomnography. Spectral profiles for Delta relative power were created for NREM and REM sleep after removing epochs with movements or muscle artifacts. The association of Delta power with SDB, assessed by the Apnea Hypopnea-Index (AHI) and AHI-based SDB severity (none, mild, moderate, severe) was tested by multivariate linear regression including demographic variables with bivariate correlations (p&lt;0.2) versus Delta-power. Conditional-regression was used to explore relationships between Delta-power and GDM, controlling for covariates.

Results
Obstructive Sleep Apnea (OSA, AHI&gt;5) was present in 14% of subjects (8 GDM-cases and 3 controls). In bivariate analyses, AHI, AHI-severity categories and OSA were associated with Delta-power in NREM (all p&lt;0.2) and AHI was associated with Delta relative-power in REM (p=0.18). However, these associations did not remain significant after adjusting for covariates. Delta relative-power in NREM was significantly associated with decreased risk of GDM (OR:0.50, 95%CI-0.25,0.91), but, in REM sleep, was not associated with GDM risk (OR:1.25, 95%CI-0.79,1.97).

Conclusion
These analyses failed to demonstrate an association between OSA or OSA severity and EEG Delta power. However, lower levels of SWS, characterized by low Delta power were associated with increased GDM risk.

Support
NIH-R00-NR013187