bluuebunny/crossref_metadata_2025_split huggingface dataset:
0856 Relationship Between A Composite Measure Of Sleep Health And Bone Mineral Density In A Sample Of Older Women From The Study Of Osteoporotic Fractures
Authors: Kubala A G , Sullivan K J , Kline C E , Cauley J A 
Published: May 2020

Abstract

Introduction
Observational studies suggest poor sleep is related to lower bone mineral density (BMD) and increased osteoporosis risk. Yet, many studies focus on sleep duration and lack inclusion of other sleep characteristics. The sleep health construct simultaneously recognizes multiple dimensions of sleep and is operationalized as a composite score. Thus, we examined whether a composite measure of sleep health was related to BMD in a sample of older women.

Methods
The sample included 1968 older women (mean age: 83.6 ± 3.1 years) from the Study of Osteoporotic Fractures. Six sleep health domains (regularity, duration, satisfaction, timing, efficiency, sleepiness/alertness) were dichotomized into either “good” or “poor” categories. The number of “good” characteristics were summed into a score ranging from 0 (poor) to 6 (good). BMD (g/cm2) was measured at the femoral neck, total hip, and trochanter sites with dual energy x-ray absorptiometry. Multiple linear regression was used to explore the association between sleep health (composite score and the individual domains) with BMD (cross-sectional) and annualized percent change in BMD (longitudinal). All models were adjusted for age, body mass index, alcohol consumption, smoking, physical activity, education, diabetes, hyperthyroidism, fracture history, and cardiovascular disease.

Results
Average sleep health score was 3.8±1.2. Cross-sectionally, better sleep health was associated with higher BMD at the femoral neck (β=.04, p=.04) and trochanter (β=.05, p=.02). Sleep health was not cross-sectionally associated with BMD at the total hip (β=.03, p=.09) or with change in BMD at any region (Each p &gt;.13). The individual domain of sleep regularity was cross-sectionally related to BMD at the total hip and trochanter, respectively (β=.04, P=.04; β=.05, P=.02).

Conclusion
A multi-dimensional measure of sleep health was related to greater BMD cross-sectionally at the femoral neck and trochanter regions in a sample of older women. Future studies should focus on associations between sleep health and osteoporotic-related fractures.

Support
The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576
0860 Sleep Disorders In Female Military Personnel
Authors: Villarreal B , Foster S , Hansen S , Brock M , Sanchez H , Gerwell K , Carrizales F , Peterson A , Pruiksma K , Mysliwiec V 
Published: May 2020

Abstract

Introduction
Sleep is an essential biological function and the disruption of sleep has deleterious consequences. Military personnel experience unique stressors related to their service, elevating the risk of developing sleep disorders. The etiologies and impact of sleep disorders on military women’s health is poorly understood. This study is the first to prospectively assess whether military women with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA) have different gender roles, military service-associated factors, and biological characteristics than military men with the same disorders.

Methods
This is a prospective observational study of military personnel with sleep disturbances. The study will evaluate women and men matched for sleep disorder. Participants will complete an evaluation to include polysomnography (PSG), sleep questionnaires and validated clinical assessments of associated disorders of interest. The baseline demographics, questionnaire, and PSG results will be analyzed to assess for commonalities or differences between genders.

Results
We have enrolled 45 patients (24% female). Males had a higher BMI (29.1) than females (26). Males were also older (38) than females (35). The leading diagnosis in males was OSA (44%) and insomnia in females (64%). In males, the apnea-hypopnea index (AHI) was 11.3/hr, arousal index (ARI) was 20/hr, and sleep efficiency (SE) was 86.5%. Total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL) were 364.6, 40.9, and 12.6 minutes, respectively. In females, the average AHI was 6.6/hr, ARI was 15/hr, and SE was 87.2%. Their TST, WASO, and SOL were 359, 44, and 12.6 minutes, respectively.

Conclusion
Military personnel are at increased risk of sleep disorders. Literature comparing male and female characteristics and sleep disorders is scarce. In this study, baseline demographics were similar in both groups but insomnia was the leading diagnosis for women. This emphasizes the importance of adequate recognition and treatment of insomnia in this group.

Support
This study is supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health.
0861 Age, Race, And Continuous Positive Airway Pressure (CPAP) Confidence Score At 1-week Predict 3-month CPAP Adherence In Older Adults With Amnestic Mild Cognitive Impairment And Moderate To Severe Obstructive Sleep Apnea
Authors: Richards K C , Vallabhaneni V , Moelter S , Davis E M , Morrison J , Lozano A , Hanlon A , Wang Y , Wolk D , Gooneratne N 
Published: May 2020

Abstract

Introduction
Adherence to continuous positive airway pressure (CPAP) may delay cognitive decline in older adults with obstructive sleep apnea (OSA) and amnestic mild cognitive impairment (MCI), defined as deficits in memory that do not significantly impact daily functioning. The aim of this analysis was to identify predictors of CPAP adherence in this population.

Methods
Data are from Memories 2, an ongoing multisite clinical trial on the effect of treatment of moderate to severe OSA on cognitive decline in older adults 65-85 years of age who have amnestic MCI. Unadjusted and adjusted linear models were used to examine predictors of mean hours of CPAP use at 3 months. Predictors were age, sex (male/female), race (White/Non-White), education (more than high school, less than high school), Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and CPAP Comfort and Confidence scores at 7 days. Collinearity in the adjusted model for CPAP use at 3 months was examined using the variance inflation factor.

Results
Of 57 participants, most were male (54%), White (72%), with a mean age of 66.3 years (SD: 6.1). Mean AHI in this sample was 35.1 (SD: 19.9), with mean daily hours of CPAP use at 3 months 5.3 hours (SD: 2.3). Adjusted linear model results demonstrated that younger age (β=-0.13, SE=0.04, p=0.0032), White race (β=2.56, SE=0.58, p&lt;0.0001), and higher 7-day CPAP Confidence score (β=0.48, SE=0.17, p=0.0086) were significantly associated with CPAP use at 3 months. Sex, education, AHI, ESS, and CPAP comfort were not statistically significant predictors of adherence.

Conclusion
Tailored interventions to increase self-efficacy during the first 7 days of CPAP treatment, especially in Non-Whites and those older than 74 years, may improve long-term CPAP adherence in older adults with amnestic MCI.

Support
R01AG054435
0871 Air Pollution Exposure And Adverse Sleep Health Across The Life Course: A Systematic Review
Authors: Liu J , Wu T , Chen J 
Published: May 2020

Abstract

Introduction
An increasing number of epidemiologic studies have examined air pollution as a possible contributor to adverse sleep health, but the results were mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan.

Methods
PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining the direct epidemiological associations between air pollution exposures, both ambient and indoor, and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness.

Results
Twenty-two articles from 2010-2019 spanning a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other) were selected for inclusion. Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. Increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes in children and adolescents. In adults, air pollution exposure was most notably related to sleep disordered breathing severity.

Conclusion
Existing literature generally show negative relationships between exposure to air pollution and sleep health across different ages, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methodologies and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures an individual encounters may help ameliorate variability in the results reported by current published literature.

Support
yes
0880 A Pilot Study Evaluating the Effect of Head Elevation During Sleep on Obstructive Sleep Apnea in Pre-Pubertal Children with Down Syndrome
Authors: Kaplan K , Spielberg D , Petitto L , Musso M , Glaze D 
Published: May 2020

Abstract

Introduction
Children with down syndrome are at high risk for developing obstructive sleep apnea when compared to typically developing children. Treatment of obstructive sleep apnea is complicated as these children often struggle with traditional therapies such as positive airway pressure. In adult populations it has been shown that head elevation is successful in reducing the severity of OSA (AHI). The hypothesis of this study is that head elevation (30°) would improve OSA in a cohort of pre-pubertal children with down syndrome.

Methods
Children with down syndrome, aged 4-13, presenting to the sleep clinic at Texas Children’s Hospital were screened for enrollment into the study (n=21; 11 male). Subjects were randomized to begin a diagnostic polysomnogram with either the head of the bed flat (0°) or elevated (30°). Head position was alternated every 2 hours during the study. Studies were performed in an AASM pediatric sleep center by a registered PSG technologist. Studies were scored using AASM pediatric scoring rules. Data was analyzed using paired student t-tests. Each subject served as their own control.

Results
There was no significant difference in AHI (p=0.71), RDI (p=0.7), O2 nadir (p=0.17), total sleep time (p=0.34), sleep efficiency (p=0.28), time in REM sleep (p=0.94) or arousal index (p=0.14) when the head of the bed was flat (0°) versus elevated (30°). The study shows that head elevation is not successful in significantly reducing obstructive sleep apnea in a pre-pubertal pediatric population of children with down syndrome.

Conclusion
In children with down syndrome, aged 4-13, referred for a diagnostic sleep study, there is no improvement in OSA due to head elevation (30°) when compared to sleeping flat (0°). These findings were independent of if the subject started with the head of the bed flat or elevated. Other cofounders were eliminated as each subject served as their own control.

Support
No external funding was utilized for this study.
0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome
Authors: Yu Y A , Vaughn B V 
Published: May 2020

Abstract

Introduction
Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing.

Methods
This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed.

Results
Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen.

Conclusion
Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS.

Support
None.
0908 The Impact Of Adenotonsillectomy On Obstructive Sleep Apnea In Children With Trisomy 21: A Retrospective Cohort Study
Authors: Platt J , Adeleye A , Nettel-Aguirre A , Chugh A , Yunker W 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) has a prevalence of 1 - 5.7% in the general pediatric population. In children with Trisomy 21 (T21), OSA is estimated to be much higher, at 30-60%. The medical consequences of untreated OSA may be significant, therefore it is worthwhile to explore treatment options. Adenotonsillectomy (AT) is often the first line treatment in children, including those with T21. However, success rates of AT in patients with T21 is more variable, and postoperative complications can be higher. The aim of this study was to determine the impact of AT on the apnea hypopnea index (AHI) in patients with Trisomy 21.

Methods
A retrospective cohort study was conducted by reviewing children with T21 and the following criteria: 1) 0 to 18 years of age, 2) AT completed between January 2010 to December 2015, 3) pre- and post-operative polysomnogram (PSG). Data extraction included demographics, details of PSG both prior to and after surgery including severity of sleep apnea and oxygen levels, type of surgery, and surgical complications.

Results
Our sample consisted of 64 subjects. Mean pre-operative AHI was 32.2, while mean post-operative AHI was 8.0, for a difference of 21.7 (p = 0.0001). Mean pre-operative oxygen saturation was 92.5, while mean post-operative oxygen saturation was 93.7, for a difference of 1.2 (p = 0.01). There were 10 post-operative emergency room visits (15.3%), 2 admissions to hospital (3.1%) and 2 repeat surgeries for post-operative bleeding (3.1%).

Conclusion
Preliminary findings of this study show a statistically significant improvement in OSA severity as determined by change in AHI and mean oxygen saturations post AT in children with T21. Complication rates were low. Further data collection and analysis is underway.

Support
None.
0913 Ambulatory Blood Pressure Monitoring In Children With Obstructive Sleep Apnea Syndrome
Authors: Geng X , Wu Y , Ge W , Feng G , Zheng L , Xu Z , Ni X 
Published: May 2020

Abstract

Introduction
This study was performed to investigate the differences in blood pressure among different groups of snoring children and among different sleep stages.In recent years, the incidence of OSAS in children has increased year by year. Blood pressure research of OSAS children can better understand the occurrence of OSAS related complications. Early detection and intervention of blood pressure changes in children with OSAS can effectively reduce the incidence of cardiovascular disease in adulthood and lower the disease burden.

Methods
Habitually snoring children (snoring frequency of ≥3 nights per week) aged 3to 11 years were recruited from Beijing Children’s Hospital, Capital Medical University from 1 January 2017 to 30 June 2018. All children underwent polysomnography, and their blood pressure was monitored and calculated by the pulse transit time. The children were divided into those with primary snoring (PS), mild obstructive sleep apnea syndrome (OSAS), and moderate to severe OSAS according to their obstructive apnea-hypopnea index (OAHI).

Results
In total, 140 children were recruited. Ninety-seven had PS, 24 had mild OSAS, and 19 had moderate to severe OSAS. There were no differences in age, sex, or body mass index z-score among the groups. Statistically significant differences were found in the OAHI, oxygen desaturation index 3%, respiratory arousal index, and lowest oxygen saturation among the three groups. Children with moderate to severe OSAS had higher systolic and diastolic blood pressure than those with mild OSAS and PS (P &lt; 0.001). In all children, systolic and diastolic blood pressure was higher in the rapid eye movement (REM) sleep stage than in the non-REM sleep stage (P &lt; 0.05).

Conclusion
Children with moderate to severe OSAS had higher blood pressure than those with PS and mild OSAS. Blood pressure in the REM sleep stage was higher than that in other sleep stages in all groups of children.

Support
The Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority (XTYB201807);Capital Health Research and Development of Special Funding (2018-1-2091);National Key Research and Development Plan (2017YFC0112502)
0915 Sleep Patterns and the Effect of Late Bedtime on School-Age Children and Adolescents: Preliminary Results
Authors: Matsangas P , Gratsia S , Cocos A , Vastardis H , Shattuck N L 
Published: May 2020

Abstract

Introduction
School-age children (6-13yrs) and teenagers (14-17yrs) should receive 9-11hrs and 8-10hrs of sleep/day, respectively. Several studies have shown, however, that these age groups are chronically sleep deprived. Our study assessed the sleep patterns of a sample of children and teenagers in Athens, Greece. The study is part of a larger project investigating the association between orthodontic treatment and sleep disturbances.

Methods
Participants (N=27; 69% females; 21 school-age children 9-13yrs, 6 teenagers 14-17yrs) were under treatment in the Orthodontic Clinic of the National and Kapodistrian University. Sleep was assessed with actigraphy/logs for 59±19 days.

Results
Participants slept on average 7.36±0.42hrs/day. Nighttime sleep was on average 7.23±0.43hrs (percentage sleep: 87.3%±3.38%). Four (14.8%) participants napped at least once/week. Compared to the lowest sleep duration recommended for their age group, participants showed a chronic sleep deficit of 1.42±0.52hrs/day (range: 0.32-2.15hrs). The younger age group had an average sleep deficit of ~1.6hrs compared to ~0.8hrs for the teenagers (p=0.006). During the school year, daily sleep duration increased by ~0.73hrs on weekends (7.78±0.67hrs) compared to school nights (7.05±0.48hrs; p&lt;0.001). On average, school-age participants slept from 23:13 (±31min) until 7:19 (±22min) on school nights and from 23:23 (±2:72hrs) until 8:49 (±39min) on weekends. Teenagers slept from 00:34 (±36min) until 7:40 (±14min) on school nights and from 01:34 (±41min) until 10:34 (±48min) on weekends.

Conclusion
Our findings verify earlier survey results showing that restricted sleep is a problem for children and adolescents in Greece. To our surprise, both age groups go to bed quite late. The impact of late bedtime on sleep duration, however, is larger in the younger group due to their larger sleep needs. In contrast to earlier research in rural areas, napping was not common in our urban sample, probably due to extracurricular activities and studying at home.

Support
N/A
0916 The Use of Immersive Virtual Reality and Slow Breathing to Enhance Relaxation and Sleep in Adolescents
Authors: Yüksel D , Goldstone A , Prouty D , Forouzanfar M , Claudatos S , Lee Q , Wang R , Dulai T , Arra N , Volpe L , Durley I , Baker F , de Zambotti M 
Published: May 2020

Abstract

Introduction
Sleep disturbances frequently emerge during adolescence amongst profound, normative, sleep maturation and biopsychosocial changes. Factors like stress, worry or rumination may make falling asleep and maintaining sleep more difficult. Here, we evaluate the efficacy of a novel intervention based on virtual reality (VR) and slow breathing to promote bedtime relaxation and facilitate sleep in high-school adolescents.

Methods
Twenty-nine 16-18 year-old adolescents with (N=9, 6 girls) and without (N=20, 11 girls) sleep difficulties underwent two counterbalanced in-lab relaxation and baseline polysomnography (PSG) nights. For the relaxation condition, immediately preceding bedtime, participants were engaged in slow diaphragmatic breathing (to promote physiological downregulation) whilst passively experiencing a relaxation immersive VR environment, designed to promote cognitive relaxation/distraction (20min). On the baseline night, participants engaged in quiet activities (e.g., reading a book) before bedtime (20min).

Results
The VR intervention resulted in a significant immediate increase in perceived relaxation and reduced worry (p&lt;0.05). Also, heart rate dropped (~5bpm) in the pre-to-post intervention (p&lt;0.05), while no significant change in heart rate was evident before and after the time spent in quiet activities on the baseline night. PSG-defined sleep onset latency was shorter (~6min reduction) and sleep efficiency was greater (~3% increase) on the VR relaxation night compared to the baseline night (p&lt;0.05). In addition, baseline sleep onset latency was related to the magnitude of the baseline-to-relaxation reduction in sleep onset latency in participants (R2=0.70; p&lt;0.01). There was no apparent difference in responses to the VR intervention between adolescents with or without insomnia.

Conclusion
Our data highlight the potential for combining cognitive relaxation/distraction strategies, using immersive VR technology and physiological downregulation, to promote bedtime relaxation and improve overall sleep quality in adolescents. Further research is needed to evaluate the feasibility and effectiveness of such interventions over time.

Support
National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)