bluuebunny/crossref_metadata_2025_split huggingface dataset:
0768 Time Course Of Improvement In Excessive Daytime Sleepiness And Cataplexy During Treatment With Pitolisant In Patients With Narcolepsy
Authors: Roy A , Davis C W , Vaughn B , Dayno J M , Dauvilliers Y , Schwartz J 
Published: May 2020

Abstract

Introduction
This analysis evaluated the efficacy of pitolisant over time in three 7- to 8-week, randomized, placebo-controlled studies of adults with narcolepsy.

Methods
Patients in all 3 studies (HARMONY-1, HARMONY-1bis, HARMONY-CTP) experienced excessive daytime sleepiness (EDS) at study baseline; patients in HARMONY-CTP also experienced ≥3 cataplexy attacks/week. Pitolisant was titrated to a maximum dose of 35.6 mg/day (HARMONY-1, HARMONY-CTP) or 17.8 mg/day (HARMONY-1bis). Change from baseline in mean Epworth Sleepiness Scale (ESS) score (3 studies) and mean weekly rate of cataplexy (WRC; 1 study) was compared for pitolisant versus placebo.

Results
In the higher-dose HARMONY-1 (pitolisant, n=31; placebo, n=30) and HARMONY-CTP (pitolisant, n=54; placebo, n=51) studies, ESS score improvement was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -2.8; P=0.015) and Week 3 (LS mean difference, -2.0; P=0.005), respectively. In the lower-dose HARMONY-1bis study (pitolisant, n=66; placebo, n=32), significant separation from placebo was first observed at Week 7 (LS mean difference, -2.3; P=0.044). At end-of-treatment, LS mean difference in ESS score change from baseline was -3.1 (P=0.022) in HARMONY-1, -3.4 (P&lt;0.001) in HARMONY-CTP, and -2.2 (P=0.030) in HARMONY-1bis. In HARMONY-CTP, LS mean WRC with pitolisant was 11.7 at baseline, 4.6 at end-of-treatment, and 5.1 after a 1-week, placebo-washout period. Improvement in WRC was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -5.3; P=0.004) and continued through end-of-treatment (LS mean difference, -6.2; P&lt;0.001); there was no evidence of rebound cataplexy after placebo-washout (LS mean difference, -4.9; P=0.027).

Conclusion
During pitolisant treatment, improvement in EDS occurred sooner (within first few weeks) and was more robust in studies that permitted titration to the maximum recommended dose (35.6 mg/day). The rate of cataplexy attacks decreased early during treatment, with no evidence of rebound when pitolisant was withdrawn.

Support
Bioprojet Pharma and Harmony Biosciences, LLC.
0770 &lt;Olfactory Disorders In Individuals With Diagnosis Of Narcolepsy&gt;
Authors: Truzzi G M , Naufel M F , Coelho F M 
Published: May 2020

Abstract

Introduction
Narcolepsy is a sleep disorder characterized mainly by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic-hypnopompic hallucinations and sleep fragmentation. Besides those most known manifestations, other findings may be present in patients with narcolepsy, such as weight gain, reduction in eating satiety and psychological alterations. It is also observed that part of the hypocretin-producing cells projections are present in the olfactory bulb, and the conditions appears to be related to changes in olfaction.

Methods
a cross sectional study was performed in patients diagnosed with narcolepsy followed up by the excessive daytime sleepiness outpatient clinic of the discipline o Sleep Biology and Medicine of the Department of Psychobiology of the Federal University of São Paulo, Brazil. Olfaction was assessed by the University of Pennsylvania Smell Identification Test (UPSIT) following an interview and nasal cavity examination. Patients with conditions and disorders that may cause hyposmia were excluded.

Results
77 patients were assessed, of which 56 had type-1 narcolepsy and 21 with type-2 narcolepsy. The results were compared with the test’s reference data. Most patients with type-1 and type-2 narcolepsy presented scores compatible with some degree of olfactory impairment. No significant difference was observed between the scores of patients with type-1 and type-2 narcolepsy.

Conclusion
The present study shows most patients with narcolepsy have some degree of olfactory impairment. This impairment doesn’t appear to be explained by alterations in the hypocretineric cells as pointed out in previous studies. The changes in olfaction in people with narcolepsy may cause the satiety alterations often observed in them. Other mechanisms involved with the genesis of hyposmia in those patients should be studied further.

Support
AFIP - Associação Fundo de Incentivo à Pesquisa
0777 Variations in Vigilance and Sleep Among Underground Mine Workers During 14 Consecutive Night Shifts
Authors: Laberge L , Lavigne A A , Auclair J , Hébert M 
Published: May 2020

Abstract

Introduction
Adverse effects of night shift work are well known but there is scarce data on how vigilance and sleep vary across a large number of consecutive night shifts.

Methods
In summer, 38 underground miners (mean age (SD): 36.8 (13.9) years) wore an actigraph, filled out the Morningness-Eveningness questionnaire, and completed a Visual Analog Scale capturing subjective vigilance (very sleepy to very alert) 4 times per shift (19:00, 22:00, 02:00, and 05:30) for 14 consecutive night shifts. Mixed effects linear regression models were used to account for repeated measures.

Results
Mean vigilance level is lower at 22:00, 02:00 and 05:30 than at the beginning of the shift at 19:00 (p&lt;0.001). Also, a more pronounced decrease in vigilance during the night was observed among older workers compared to younger workers (p&lt;0.05). Moreover, workers with greater eveningness have higher vigilance at the beginning of the first night shift at 19:00 (p&lt;0.001), but their decline in vigilance level during the night is faster than that observed in workers with greater morningness (p&lt;0.01). Interestingly, the mean vigilance decline observed at 02:00 and 05:30 (compared to 19:00) is slowed down for each additional night shift (p&lt;0.001). Furthermore, mean sleep efficiency is negatively associated with morningness and gradually decreases across consecutive night shifts (p&lt;0.05). In addition, mean sleep duration is shorter in older workers and is positively associated with morningness (p&lt;0.05).

Conclusion
Results show a progressive improvement in vigilance of mine workers assigned to a large number of consecutive 12-hour night shifts from 2 am onwards. This may probably be ascribed to an adjustment in homeostatic sleep propensity consecutive to the partial sleep deprivation associated with time spent traveling to the remote site before the first shift. However, circadian adjustment is unlikely considering the strong morning light exposure experienced daily after the night shift.

Support
College and Community Innovation Program of the Natural Sciences and Engineering Research Council of Canada (NSERC) (CUI2I 472201-14)
0778 Workplace Yoga Program Features and Associations With Shift Work and Sleep Among Nursing Staff
Authors: Zhang Y , Thind H , Kim S , Soup A , Punnett L , Duffy J 
Published: May 2020

Abstract

Introduction
Nursing staff are at risk for impaired sleep due to irregular schedules, long work hours, and other occupational stress. Yoga has demonstrated beneficial effects on sleep in healthy adults and patients with chronic diseases. However, yoga interventions are generally offered as 60-75-minute sessions; this long duration might not be suitable as a workplace program for nursing staff. The objective of this study is to examine workplace yoga program features and associations with shift work and sleep among nursing staff.

Methods
Online Qualtrics surveys were distributed among nurses and nursing assistants at a community hospital in the northeast U.S. Hypothetical workplace yoga program features were assessed including general interest, duration, frequency, timing with respect to work shift, and interest in home practice. Sleep duration and disturbances were assessed.

Results
Among the 541 participants (94% female; age 43±13y), over a third reported sleep ≤6hrs/day (38%) and sleep disturbances (38%), and 79% reported interest in workplace yoga. Among those reporting interest, after work (61%), 30min/session (73%), 3 sessions/week (56%), and interests in home practice (64%) were yoga features endorsed by nursing staff. Night or ≥12hr shift was associated with less interest in workplace yoga. Evening or ≥12hr shift was associated with less interest in yoga after work, while day or night shift was associated with less interest in yoga before work. Mild sleep disturbances were associated with more interest while severe disturbances were associated with less interest in yoga after work. Nursing staff with sleep≤6hrs/day reported less interest in yoga before work, but more interest in home yoga practice.

Conclusion
Nursing staff reported a high prevalence of short and disturbed sleep and interest in workplace yoga. Workplace yoga programs need to be designed according to nursing staff’s interest while considering the effect of shift work and sleep problems reported by nursing staff.

Support
Drs. Yuan Zhang and Jeanne F. Duffy were supported by NIH grant R01 AG044416.
0783 Relationship Between Chronotype And Sleep Duration Among Medical Students
Authors: Geoca A , Dowling M , Jain V 
Published: May 2020

Abstract

Introduction
Previous literature has supported the claim that longer sleepers have later chronotypes. It is also thought that later chronotypes may obtain less sleep during workdays. We aimed to study the association between sleep duration and chronotypes in The George Washington University (GWU) medical students.

Methods
Eighty-six medical students at GWU (62 F [71%], 24 M [29%]; ages 21-33 y [mean 24.4 y]) filled out the Munich Chronotype Questionnaire (MCTQ). Midpoint of the bedtime and wake times during workdays was used to determine chronotype. Subjects were split into two groupsbased on the median of the distribution (Md=7.5) of the self-reported sleep duration variable; those who sleep less than 7.5 hours (short sleepers), and those who sleep 7.5 hours or longer (long sleepers). Independent samples t-test was used to compare the chronotype measurementsof the long sleepers (n=39) versus short sleepers (n=41).

Results
Short sleepers had a mean of 6.48 (SD=0.72) hours of sleep while long sleepers had a mean of 8.11 (SD=0.53) hours of sleep. The range of chronotype measures was wider in the long sleepers (1.25 to 7.25; range=6) compared to that in the short sleepers group (1.42 to 5.280; range=3.86). We found no significant mean differences in chronotype between those who slept less than 7.5 hours (mean=3.188, SD=0.858) and those who sleep 7.5 hours or longer (mean=3.201, SD=1.20) [t(77)=0.056; p = .956].

Conclusion
Sleep duration among medical students was not associated with their chronotype. This is in opposition to other research findings of decreased sleep duration among later chronotypes. Our findings need to be replicated in a larger sample.

Support
NA
0785 Associations Between Circadian Preference And Sleep-related Thoughts: Data From The 2015 Sleep In America Poll
Authors: Jeon B , Luyster F S , Chasens E R 
Published: May 2020

Abstract

Introduction
Evening types of sleep tend to have poorer sleep quality and sleep habits than morning types. Maladaptive beliefs or thoughts about sleep can affect one’s sleep and may differ between evening and morning types. We examined the association between the circadian preference and sleep-related thoughts in U.S adults.

Methods
A secondary analysis used survey data from the 2015 National Sleep Foundation’s Sleep in America Poll. Questions included normal bedtime and wake-up time for week/work days and weekend/non-work days. Circadian preference was determined by midpoint of sleep calculated as midpoint of sleep on weekends corrected for average nightly sleep duration. Participants were excluded if their sleep midpoint was from noon to midnight. Midpoint of sleep was divided into two groups using median split (“earlier” vs. “later”). Sleep-related thoughts were “worry about getting a good sleep”, “overwhelming thoughts about getting enough sleep”, “motivation to get sleep”, and “concern about serious physical consequences due to poor sleep”; responded often/always or extremely to somewhat for these items were coded as maladaptive. Logistic regression analysis controlling for socio-demographics, sleep duration, and sleep disturbance (PROMIS Scale; higher scores = greater sleep disturbance) was conducted to examine the relationships between midpoint of sleep and sleep-related thoughts.

Results
The sample (N = 1011) was primarily White (73.6%), male (50.9%), college educated (62.2%), married/partnered (67.6%) with a mean age of 51.65 ± 17.05 years. Mean midpoint of sleep in “earlier” type was 2:33AM and 5:29AM in “later” type. “Later” type had shorter sleep duration on weekdays and longer sleep duration on weekends than “earlier” type (p &lt; .01), but average sleep duration was similar between two types. “Later” type had more “worry” and “overwhelming thoughts” (p &lt; .05) about sleep. In logistic models, midpoint of sleep was significant only for “concern” (p = .02).

Conclusion
In this study, late chronotype was associated with increased sleep disturbances and greater variability in sleep duration. The relationship between the timing of sleep and thoughts about the impact of impaired sleep remains unclear and an area for further study with objective measures.

Support
0788 Increased Rapid Eye Movement Density in Chinese Patients with Parkinson’s Disease and RBD
Authors: Zhang L , Zhu J 
Published: May 2020

Abstract

Introduction
Impaired rapid eye movement sleep is common among patients with Parkinson’s disease (PD). However, information on rapid eye movement density (REM density) among PD patients is currently lacking. The current study sought to characterize REM density in PD patients and to examine the associations between REM density sleep parameters and clinical manifestations.

Methods
We retrospectively recruited 172 PD patients. All participants were assessed with a two-night polysomnography, and REM density was calculated. Clinical assessments were completed in PD patients before polysomnography.

Results
Rapid eye movement sleep behavior disorder (RBD) were observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, and PDQ-39 scores in the Parkinson’s disease patients with rapid eye movement sleep behavior disorder (RBD) were significantly higher than in the patients without RBD (P&lt;0.05). The REM density was also significantly higher in the RBD patients than in the patients without RBD (P&lt;0.05). NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were higher in patients without RBD. The forward binary logistic regression model showed that REM density, UPDRS-III score and N3 sleep time were associated with RBD in the PD patients.

Conclusion
Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD.

Support
Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant No. BE2018610)
0795 The Relationship Between Restless Legs Syndrome and Hypothyroidism
Authors: Ahmed N , Kandil M , Elfil M , Jamal A , Koo B 
Published: May 2020

Abstract

Introduction
The diurnal nature of RLS and its response to dopamine hint that hormones may be central in RLS pathophysiology. Hypothyroidism has been linked to RLS, but studies are few and limited in scope. We sought to determine whether restless legs syndrome (RLS) is more prevalent in persons with hypothyroidism and whether hypothyroidism is more prevalent in persons with RLS.

Methods
Persons with hypothyroidism and controls without hypothyroidism were recruited through Research Match, an on-line registry of potential clinical research participants, and assessed for RLS using the Cambridge Hopkins questionnaire. Persons with RLS and controls without RLS were recruited through the RLS Foundation and Research Match and assessed for hypothyroidism by self-report of physician diagnosis. RLS severity was assessed using the International RLS Study Group Severity Scale and cause of hypothyroidism was assessed by self-report.

Results
266 hypothyroid subjects and 321 controls were comparable in age (52.3±13.4 vs. 53.9±11.7; p=0.14) and gender (91.7% vs. 91.3% women; p=0.85). 354 RLS and 313 control subjects were comparable in age (59.1±13.2 vs. 58.2±13.6; p=0.41) and gender (80.8% vs. 78.3%; p=0.42). Hypothyroid participants compared to controls had significantly higher RLS prevalence (14.3% vs. 8.1%; p=0.02). RLS participants compared to non-RLS controls had significantly higher hypothyroidism prevalence (22.3% vs. 13.8%; p=0.005). RLS severity was similar in persons with and those without hypothyroidism. Among 73 persons with RLS and comorbid hypothyroidism, 14 previously were hyperthyroid compared to 0 out of 37 persons with hypothyroidism without RLS (p=0.004).

Conclusion
RLS prevalence is increased in individuals with hypothyroidism and hypothyroidism prevalence is increased in individuals with RLS. Persons with comorbid hypothyroidism and RLS are significantly more likely than those with hypothyroidism alone to have had hyperthyroidism prior to hypothyroidism. The association between RLS and thyroid disease is likely to shed light on the complex biological mechanisms underlying RLS pathophysiology.

Support
None
0809 A Randomized Double-blind, Placebo Controlled Trial With Cross-over, To Assess The Efficacy Of Correcting Vitamin D Deficiency In Improving The Symptoms Of Restless Legs Syndrome (RLS)
Authors: Wong J , Gupta D , Nadhim A , Bhat S , Polos P 
Published: May 2020

Abstract

Introduction
Recent studies have shown an association of low Vitamin D levels and severity of RLS symptoms. However, effect of treatment of Vit D deficiency on RLS symptoms was not reported, nor were other exacerbating factors for RLS such as iron deficiency or OSA addressed in prior studies, but have been addressed in our study.

Methods
This is an ongoing study at the JFKMC Sleep Clinic. Eligible Patients with RLS include those with vitamin D 25,hydroxy deficiency (&lt;20 ng/ml), or insufficiency (&lt;30 ng/ml). Such patients will be enrolled in the study after comorbid conditions like iron deficiency and OSA have been adequately corrected. Randomization of the patients will be done by the JFK pharmacy so the patient and provider are blinded to the substance. Substance A or B could be either Vitamin D3 Capsule 50,000 IU, or placebo. Each patient takes A for 6 weeks and then crosses over to B for 6 weeks. Weekly iRLS questionnaires will be collected. Actiwatch Device, to assess activity count per minute, will be worn on the ankle at night for one week time periods: at baseline, at end of 6 weeks of taking A and then at the end of 6 weeks of taking B. Vitamin D levels will also be assessed after each course of supplementation and correlated with subjective and objective findings.

Results
Between July 7, 2019 to current, 50 consecutive patients seen in sleep clinic with RLS were assessed for vitamin D levels. Ages ranged from 23-86 years. 27 patients were female (54%). Two patients met inclusion criteria and have started their 13-week study.

Conclusion
This study will help to establish the role of Vitamin D deficiency as a risk factor for RLS, independent of ferritin levels, and comorbid OSA, in affected individuals. This may help to discover a potentially treatable form of RLS.

Support
No financial support.
0810 Sleep Disturbances In Returning Veterans That Are Homeless And Combat-exposed
Authors: Speed K J , Crean H J , Bishop T J , Hoff R , Pigeon W J 
Published: May 2020

Abstract

Introduction
Challenges with sleep (i.e., nightmares and insomnia) impact military service members both during and following deployment, but may occur more frequently in combat-exposed individuals. In addition, among the challenges faced following the transition from active duty to Veteran status are periods of homelessness, which may further contribute to sleep disturbances.

Methods
The present analyses utilized data from the Survey of Experiences of Returning Veterans, a national survey of recently returning combat Veterans focused on the examination of sex differences following exposure to traumatic events. The sample (n = 793) consisted of 58% males; females were oversampled and all branches were represented. Ordinal and multiple linear regressions were used to investigate the role of combat exposure and homelessness in predicting nightmare distress and insomnia severity.

Results
An ordinal regression found that combat exposure (b = -.02, p &lt;0.001), homelessness (b = -.31, p = 0.010), and insomnia severity (b = -.10, p &lt;0.001) each significantly predicted nightmare distress. These variables increased risk (SAS parameterizes these models so that negative coefficients are associated with increased risk). Demographic variables were not significantly related to nightmare distress. Similarly, combat exposure (β = .100, p = .002) was associated with insomnia severity, as was nightmare distress (β = .522, p &lt; .001). The moderational role of gender and homeless in the above models are also tested.

Conclusion
For those who have been combat exposed, have a history of homelessness, and report insomnia symptoms there is an increased odds of reporting nightmare distress, sleep disturbance is even more likely to occur. Although combat exposure and nightmare distress were predictive of insomnia severity, history of homelessness was not. These findings suggest that nightmare distress and insomnia symptoms are a significant concern in our returning combat-exposed Veterans, with nightmares being even more problematic for those at risk of homelessness.

Support
This study was funded by VHA CSR&D grant ZDA-01. Dr. Speed is supported, in part, by the VA Advanced Fellowship Program in Mental Health Illness Research and Treatment, the VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC.