bluuebunny/crossref_metadata_2025_split huggingface dataset:
0524 Web-Delivered CBT for Insomnia Intervention Improves Sleep Among Adults with Insomnia and Depressive Symptoms
Authors: Batterham P J , Christensen H , Thorndike F P , Ritterband L M , Gerwien R , Enman N , Botbyl J , Maricich Y 
Published: May 2020

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) is the first line recommended treatment for adults with chronic insomnia. In a prior randomized controlled trial (RCT), data showed web-delivered CBT-I (SHUTi) reduced insomnia severity as well as symptoms of depression, among adults with insomnia and elevated depressive symptoms. The present study aimed to further evaluate the effectiveness of web CBT-I to improve sleep outcomes as measured by prospectively entered sleep diaries in this same sample.

Methods
A large-scale RCT (N=1149) of Australian adults with insomnia and depressive symptoms compared a 9-week, web CBT-I therapeutic with an attention-matched web program at baseline, posttest and 6-, 12-, and 18-month follow-ups. Although depression outcomes have been presented previously, the online sleep-diary derived variables have not yet been presented, including sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). Sleep diaries were entered online for 10 days at each assessment period.

Results
Data showed web CBT-I participants demonstrated greater reductions from baseline to posttest compared with control for the following sleep variables: SOL (LS mean difference [95% CI]=-22.3 min [-29.2, -15.3]; p&lt;.0001), WASO (-17.8 min [-23.4, -12.3]; p&lt;.0001), and number of awakenings (-0.38 [-0.68, -0.09]; p=.0113). Web CBT-I also showed greater improvements in SE (9.18% [7.25%, 11.10%]; p&lt;.0001) and sleep quality (0.41 [0.30, 0.53]; p&lt;.0001) from baseline to posttest compared with control. TST was not significantly different between groups at posttest or 6-month follow-up, although it improved over baseline at 12 (18.73 min [7.39, 30.07]; p=.0013) and 18 months (23.76 min [9.15, 38.36]; p=.0015) relative to control. All other significant sleep treatment effects were maintained in the treatment arm at 6, 12, and 18-month follow-up.

Conclusion
Data showed web CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and elevated depressive symptoms.

Support
Clinical trial ACTRN12611000121965 was funded by the Australian National Health and Medical Research Council. The statistical analysis described here was funded by Pear Therapeutics, Inc and conducted by Provonix.
0542 Exploratory Use of Artificial Intelligence Driven Acoustic Neuromodulation Improved Sleep, Depression, Anxiety, and Stress in Adults with Persisting Post-Concussion Symptoms
Authors: Tegeler C L , Howard L J , Brown K L , Kellar D C , Shaltout H A , Gerdes L , Tegeler C H 
Published: May 2020

Abstract

Introduction
In prior studies, High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) reduced persisting post-concussion symptoms (PPCS) of insomnia and depression and improved heart rate variability (HRV), but is operator dependent, with difficulty scaling. Cereset Research™ (CR), a noninvasive, closed-loop, artificial intelligence (AI) driven, acoustic neuromodulation technology uses the same core technology, echoing tones linked to brainwaves, but includes updated components, standardized AI driven protocols, software management of designs, and shorter sessions to improve scalability. This open label trial explores use of CR for PPCS.

Methods
5 adults (1 female, median age = 48, 31-64) with PPCS received a median of 8 CR sessions (range 7-9, 60 minutes each) over 11 (5-18) days as part of an open label IRB-approved exploratory study of CR for diverse health conditions. Data is collected at baseline (V1), 0-21 days (V2), 4-7 weeks later (V3), and 4-7 weeks thereafter (V4). Pre- and post-CR symptom inventories included concussion (RPQ), insomnia (ISI), depression (CES-D), anxiety (GAD-7), PTSD (PCL-C), and stress (PSS). Primary outcome is change in autonomics at V3 via HRV (SDNN and rMSSD) based on 10-minute BP and HR recordings using a BIOPAC device. Formal analysis of HRV outcome is pending, but we report preliminary changes in symptom outcomes.

Results
6 subjects have enrolled for sleep trouble related to PCCS, with 1 lost to follow-up after receiving intervention. For V1-V2 (n=5), median change in RPQ score is -23, ISI -10, CES-D -16, GAD-7 -7, PCL-C -16, and PSS -7. For V1-V3 (n=4), median change in RPQ -19, ISI -10.5, CES-D -6, GAD-7 -4.5, PCL-C -14.5, and PSS -3. No serious adverse events reported.

Conclusion
Preliminary results suggest similar, clinically meaningful reductions in ISI score, and concussion symptoms, as seen with HIRREM, suggesting promise as a scalable, non-drug intervention for insomnia with PPCS. Updated results will be presented.

Support: Support
Research grant received from, The Susanne Marcus Collins Foundation, Inc.
0549 Misperception of Neutral Faces in Insomnia
Authors: Akram U 
Published: May 2020

Abstract

Introduction
Emotional faces have been widely used amongst populations with mental health conditions to examine alterations in attention and perception relative to controls. Insomnia is associated with reduced emotion intensity ratings for facial expressions of fear, sadness and happiness. However, research is yet to examine whether neutral faces are accurately perceived amongst individuals with insomnia. This study compared normal-sleepers and individuals experiencing insomnia symptoms in their expression intensity rating of neutral faces.

Methods
Fifty-six normal-sleepers (NS: 19.69±4.07yrs, 73% female) scoring &lt;5 on the Insomnia Severity Index (ISI; 2.70±1.69) and 58 individuals experiencing clinically significant insomnia symptoms (INS:20.32±4.08yrs, 85% female) scoring ≥15 on the ISI (19.24±3.53), observed 12 neutral facial photographs. Between 0-100, participants were required to rate the extent to which each face appeared as: attractive; sad; happy; trustworthy; approachable; healthy; and sociable. 0 indicated not at all, 100 indicated very much so. The facial stimuli were taken from Karolinska Directed Emotional Faces database, and were presented in random order.

Results
The results revelated a main effect of group (F(1,117)=4.04,p=.047) and expression (F(7, 819)=39.08,p=.001) on intensity ratings. Whilst no significant group x expression interaction was confirmed (F(7,819)=1.03,p=.41), simple effects analysis determined that those experiencing insomnia symptoms rated neutral faces as significantly more attractive (34.30±14.82; t(117)=-2.73, p=.007; Cohens’ d=.50) and happy (34.83±13.87; t(117)=-2.23, p=.028; Cohens’ d=.41) when compared to normal-sleepers (Attractive: 26.89±14.76; Happy: 28.90±12.48). No significant differences were observed for all other ratings.

Conclusion
The present outcomes tentatively suggest that individuals experiencing clinically significant insomnia symptoms differentially perceive neutral faces when comparted with normal-sleepers. Specifically, neutral faces of other people were rated in a more positively valanced manner (i.e. more attractive and happier). Considering an individual’s capacity to correctly gauge facial expressions remains fundamental for effective social interaction, and in influencing social judgments, these outcomes present negative psychosocial implications for those with insomnia.

Support
n/a
0556 Sex-Specific Relationship Between Anxiety and Autonomic Nervous System Dysfunction in Obstructive Sleep Apnea
Authors: Pal A , Akey M A , Chatterjee R , Aguila A P , Martinez F , Aysola R , Macey P M 
Published: May 2020

Abstract

Introduction
Cardiovascular co-morbidities in obstructive sleep apnea (OSA) are hard to treat, perhaps due to autonomic nervous system (ANS) dysfunction. In OSA, intermittent hypoxia and poor tissue oxygen perfusion damage endothelial and nervous tissue, potentially underlying the dysfunction. Moreover, OSA is strongly associated with anxiety, which is independently associated with ANS dysfunction. We assessed sex-specific relationships between anxiety and cardiovascular markers of ANS dysfunction in OSA.

Methods
We studied people diagnosed with OSA and healthy controls. We collected 5 minutes of wakeful resting ECG, continuous non-invasive blood pressure, and respiration data. We calculated heart rate (HR), heart rate variability (HRV; sympathetic-vagal balance related to brainstem ANS output), mean arterial blood pressure (MAP), beat-to-beat MAP variability (BPV; related to peripheral autonomic function) and breathing rate (BR). We analyzed these measures with a multivariate regression model of anxiety symptoms (generalized anxiety disorder; GAD-7 scores), sex, and group (OSA vs. control), age/BMI/AHI covariates, and Bonferroni-corrected post-hoc comparisons (p≤0.05).

Results
We analyzed 64 subjects (32 OSA: AHI [mean±SEM] 24±4events/hour, 12 female, age 52±21years, BMI 33±2kg/m2; 32 control: 19 female, age 46±2; BMI 26±1). We observed significant main effects of anxiety, BMI, AHI, sex on HRV, but only group on BPV; post-hoc comparisons revealed high BPV only in OSA females. Secondary analyses included classifying by anxiety symptoms (GAD-7≥5), showing only OSA females with anxiety had higher BPV. Males showed higher HRV. AHI and anxiety were positively correlated with HRV in OSA males. AHI was negatively correlated with BR in OSA females.

Conclusion
We observed higher anxiety associated with higher BPV in OSA, especially in females. Unexpectedly, BR was lower in OSA females; longer breaths may have led to the greater BPV. Higher HRV in males complicated by OSA severity and anxiety could be related to higher sympathetic tone. The slightly older control group may have influenced the findings. Overall, our findings suggest anxiety in OSA is associated with peripheral and centrally-mediated autonomic dysfunction, but in a sex-specific manner.

Support
National Institutes of Health R56-NR-017435 and RO1-HL-135562.
0558 Sleep Disordered Breathing and Right Ventricular Electrocardiographic and Functional Characteristics in Group 1 Pulmonary Arterial Hypertension
Authors: Bhat A S , Wang L , Kaur S , Nawabit R , Highland K , Park M , Jellis C , Kwon D , Hill N , Mehra R , Pvdomics P 
Published: May 2020

Abstract

Introduction
Right ventricular (RV) electrophysiologic and functional alterations related to sleep disordered breathing (SDB) in pulmonary arterial hypertension (PAH) are not well understood. We hypothesize an association between SDB and RV electrophysiological/functional measures in World Symposium of Pulmonary Hypertension (WSPH) Group 1 PAH.

Methods
The NHLBI multicenter PVDOMICS study (NCT02980887) enrolls patients with PAH undergoing a battery of assessments including home sleep apnea testing(NOX-T3, Carefusion®) or with historical sleep study data. Logistic(OR,95%CI) and linear(beta coefficients,95%CI) regression models adjusted for age, sex, race, body mass index (BMI, kg/m2), PAH medications, supplemental oxygen(O2), positive airway pressure(PAP) were used to assess associations of SDB(apnea hypopnea index,(AHI), ≥3% desaturations(hypopnea), percentage recording time with SaO2&lt;90% (TRT&lt;90%) with electrocardiographic measures: RV hypertrophy(RVH), right bundle branch block(RBBB), and right axis deviation(RAD), echocardiographically-derived RV systolic pressure(RVSP) and RV ejection fraction(RVEF) from cardiac MRI. Analyses were performed based on an overall significance level of 0.05, using SAS software (version 9.4, Cary, NC).

Results
The analysis consisted of 182 PAH participants with age: 52.5±13.9 years, 71.4% female, 88.9% Caucasian, BMI:30.3±7.8 kg/m2, RVEF: 37.3±11.6, and RVSP: 67.0±23.4. None of the electrocardiographic measures were associated with AHI and only RVH was significantly associated with TRT&lt;90% (1.25:1.09,1.43),p=0.001. Although AHI was not associated with RVSP, a 10% increase in TRT&lt;90% was associated with a 2.60mmHg increase in RVSP (2.60:1.44,3.76),p&lt;0.001. Each 10-unit increase in AHI was associated with a 2.72% reduction of RVEF (-2.72:-4.89,-0.56),p=0.014, and each 10-unit increase in TRT&lt;90% was associated with a 0.72% reduction of RVEF (-0.72:-1.38,-0.06),p=0.033.

Conclusion
We identify nocturnal hypoxia as a predictor of RV electrophysiological and functional alterations even after consideration of confounding factors. SDB as determined by AHI was also more so associated with reduced RVEF than hypoxia. Future mechanistic studies should focus on further elucidation of SDB and nocturnal hypoxia on pathogenesis of RV dysfunction in PAH.

Support
U01HL125218/U01HL125205/U01HL125212/U01HL125208/U01HL125175/U01HL125215, U01HL125177/Pulmonary Hypertension Association
0570 Apnea-Hypopnea Index is Positively Correlated with Mood Disturbance
Authors: Stubbers K M , Thosar S S , Butler M P , Bowles N P , McHill A W , Berman A M , Herzig M X , Roberts S A , Clemons N A , Morimoto M , Shea S A , Emens J S 
Published: May 2020

Abstract

Introduction
The prevalence of mood disorders such as depression is higher in individuals with obstructive sleep apnea (OSA). Previous studies have found no significant correlation between the apnea-hypopnea index (AHI) and measures of mood and have only included participants who met diagnostic criteria for OSA. The current analysis sought to determine whether mood correlated with AHI in individuals with any AHI values including those that did not meet diagnostic criteria for OSA.

Methods
31 volunteers were studied (BMI=29.2±1.0 kg/m2, mean±SE), free from medication and without psychiatric illness or chronic medical conditions with the exception of untreated OSA, uncomplicated hypertension (BP&lt;160/100), or obesity. Following 1-3 weeks of an 8h habitual at home sleep schedule, participants completed the POMS-Brief questionnaire (POMS-B) to assess mood after undergoing overnight polysomnography to determine AHI. Total mood disturbance (TMD) scores were calculated by adding the scores on the POMS-B for each mood state subscale and subtracting the score for vigor-activity.

Results
The average AHI was 15.3±3.1 (range of 1.1-74.1) events per hour. The average POMS-B TMD score was 21±1.5 (range of 4-46). There was a significant correlation between the POMS-B TMD score and AHI (p=0.037, r2=0.14). This result was also seen in only those individuals with AHI scores &gt;5 (p=0.002, r2=0.4).

Conclusion
In this sample, individuals with higher AHI values displayed higher TMD scores. These results differ from previous data that showed no significant correlation between AHI and TMD. This is the first analysis to demonstrate a correlation between TMD and AHI while including individuals who didn’t meet diagnostic criteria for OSA. However, the relationship between AHI and TMD was also significant in those with AHI&gt;5. More data on these measures with larger sample sizes and a more equal representation of AHI values should be gathered to provide additional evidence for this relationship.

Support: Support
NIH R01-HL125893; CTSA UL1TR000128, R21HL140377
0576 Variation in Night to Night Home Sleep Testing
Authors: Rosenberg C 
Published: May 2020

Abstract

Introduction
Home sleep testing (HST) is becoming common in the evaluation of Obstructive Sleep Apnea (OSA). Studies confirmed good HST AHI correlations from different nights in a single patient. The following reviewed AHI and additional measures from HST’s. (Alice Night One))

Methods
We collected data from 20 patients from two consecutive nights of HST’s. 5 F 15 M, means AGE 49 (sd 14) and BMI 36 (sd 8). Both studies had over 4 hours of good sleep and acceptable data. Measures include abs(Night 1- Night 2) of AHI (Diff.AHI), of mean EKG (Diff.EKG) mean time SaO2 less than 90% (Diff.SaO2).

Results
These results reproduced the strong correlation of AHI, Time SaO2 less than 90 %: and mean EKG between two nights, .96, .72, .87 respectively. There was a strong correlation between Diff.AHI and Diff.SaO2, .63 (p .003). There were weaker correlations between AHI and Time SaO2 less than 90% on Night 1, .67 and Night 2, .75. Linear regression: Diff.AHI on Age (p=.2), BMI (p = .9), and Diff.EKG (p=.4).

Conclusion
These results again validate the small degree of AHI variation in night to night HST. They confirm a small degree of variation in the mean EKG and Time SaO2 less than 90%. There is a high correlation between AHI and time SaO2 less than 90% as these variables are dependent and the fall in SaO2 is used to define an event, especially on the HST. The BMI did not explain variation in AHI, there is a low correlation between AHI and BMI. Age could be a factor in AHI variation; yet, this is highly speculative with an N = 20. The correlations between AHI and Time SaO2 less than 90% are likely to be due to the relative health of the subjects and small number of subjects. One night of good, greater than 4 hours HST may be sufficient. This study did not evaluate success in meeting these parameters with a single night of testing.

Support
Louis B Stokes VHA, Cleveland, OH
0577 Cluster Analysis for the Association Between Obstructive Sleep Apnea Phenotypes: A Population-Based Longitudinal Study
Authors: Tempaku P F , Silva L O , Guimaraes T M , Vidigal T A , D’Almeida V , Andersen M L , Bittencourt L , Tufik S 
Published: May 2020

Abstract

Introduction
The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.

Methods
We used data derived from the Sao Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to an AHI equal or greater than 15 events per hour. Cluster analysis was performed using latent class analysis (LCA).

Results
Of the 1,042 individuals in the EPISONO baseline cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.4% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 clusters for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).

Conclusion
The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.

Support
This work was supported by grants from AFIP, FAPESP and CAPES.
0583 Obesity-Associated Sleep Hypoventilation Syndrome and Adverse Post-Operative Bariatric Surgery Outcomes
Authors: Chindamporn P , Bena J , Wang L , Zajichek A , Milinovich A , Kaw R , Kashyap S , Cetin D , Aminian A , Kempke N , Foldvary-Schaefer N , Aboussouan L S , Mehra R 
Published: May 2020

Abstract

Introduction
Although obesity hypoventilation syndrome (OHS) is associated with right ventricular dysfunction and increased mortality, its contribution to post-bariatric surgery risk remains unclear due to non-systematic OHS assessments. We hypothesize that patients with obesity-associated sleep hypoventilation (OASH) have increased adverse post-bariatric surgery outcomes than those without.

Methods
Patients undergoing polysomnography (PSG) prior to bariatric surgery at the Cleveland Clinic from 2011-2018 were retrospectively examined. OASH was defined by body mass index (BMI) ≥30kg/m2 and either PSG-based end-tidal CO2 ≥45mmHg or serum bicarbonate ≥27mEq/L. The following were considered individually and as a composite outcome: ICU stay, re-intubation, tracheostomy, discharge disposition or 30-day readmission. All-cause mortality was also examined. Outcomes were compared using two-sample t-test or Wilcoxon rank sum test and Chi-square or Fisher exact test. A multivariable logistic regression model included age, sex, BMI, apnea hypopnea index(AHI) and diabetes to examine OAHS and the composite outcome. All-cause mortality was compared using Kaplan-Meier estimation and hazard ratios from Cox proportional hazards models. SAS software (version 9.4) was used with overall significance level of 0.05.

Results
The sample comprised 1665 patients: age 45.2±12 years, 20.4% male, BMI=48.7±9 kg/m2, and 63.6% Caucasian. OASH prevalence was 68.5%. OAHS patients were older and more likely to be male with higher BMI, AHI and HbA1c. Although some individual outcomes were higher in OASH vs. non-OASH, findings were not statistically significant: re-intubation (1.5%vs.1.3%, p=0.81) and 30-day readmission (13.8% vs.11.3%, p=0.16). The composite outcome remained significantly associated with OAHS in the multivariable model: OR=1.36, 95%CI:1.005,1.845. Mortality was 2% in OASH and not significantly higher than non-OAHS (HR=1.39, 95%CI:0.56,3.42).

Conclusion
In this largest sample to date of systematically phenotyped OASH in patients undergoing bariatric surgery, we identify increased post-operative morbidity in those with OASH. Further study is needed to identify whether peri-operative treatment of OASH improves surgical outcomes.

Support
0587 Convenience vs Accuracy: Negative Predictability of the Home Sleep Test in Clinical Practice
Authors: Morse C D , Meissner S , Kodali L 
Published: May 2020

Abstract

Introduction
Sleep apnea is a serious disorder associated with numerous health conditions. In clinical practice, providers order screening home sleep testing (HST) for obstructive sleep apnea (OSA); however, there is limited research about the negative predictive value (NPV) and false negative rate of this test. Providers may not understand HST limitations; therefore, what is the NPV and false negative rate in clinical practice?

Methods
A retrospective study of non-diagnostic HST is conducted in a Northeastern US rural community sleep clinic. The study population includes adult patients ≥ 18 years old who underwent HST from 2016-2019. The non-diagnostic HST result is compared to the gold standard, the patient’s nocturnal polysomnogram (NPSG). The results provide the NPV (true negative/total) and false negative (true positive/total) for the non-diagnostic HST.

Results
We identified 211 potential patients with a mean age of 43 years, of which 67% were female. Of those, 85% (n=179) underwent NPSG, with the others declining/delaying testing or lost to follow up. The non-diagnostic HST showed 15.6% NPV for no apnea using AHI&lt;5 and 8.4% NPV using respiratory disturbance index (tRDI)&lt;5. The false negative rate for AHI/tRDI was 84.4% and 91.6%, respectively. The AHI for positive tests ranged from 5-89 per hour (mean AHI 14.9/tRDI 16/hour), of which OSA was identified with an elevated AHI (≥5) ranging from 54.2% mild, 21.8% moderate, and 8.4% severe.

Conclusion
The high false negative rate of the HST is alarming. Some providers and patients may forgo NPSG after non-diagnostic HST due to a lack of understanding for the HST’s limitations. Knowing that the non-diagnostic HST is a very poor predictor of no sleep apnea will help providers advise patients appropriately for the necessity of the NPSG. The subsequent NPSG provides an accurate diagnosis and, therefore, an informed decision about pursuing or eschewing sleep apnea treatment.

Support
none