bluuebunny/crossref_metadata_2025_split huggingface dataset:
1087 Early Session Effects of CBT-I on Insomnia and Depression
Authors: Bishop T M , Crean H F , Funderburk J S , Speed K J , Pigeon W R 
Published: May 2020

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) has been shown to reduce depressive symptomatology among patients with co-occurring insomnia and depression. Brief forms of CBT-I have been tested in various settings including primary care. As delivery formats of CBT-I broaden, it is important to enhance our understanding of what doses and what components of CBT-I, provide the optimal balance of treatment efficacy and brevity. In the present study, we examine session-by-session effects of CBT-I on insomnia and depression.

Methods
Fifty-four Veterans with insomnia and co-occurring depression or posttraumatic stress disorder were randomized to either four sessions of CBT-I or treatment as usual in a published parent study. We report here on the effects among those who received CBT-I (n =22). At each session participants provided a completed sleep diary and completed the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 for depression (PHQ-9).

Results
At baseline, participants endorsed a moderate level of both insomnia (ISI score = 18.5 [SD=4.2]) and depression (PHQ-9 score = 15.6 [SD=5.2]). A mean decrease of 4.0 points in ISI total score was observed between sessions 1 and 2 [t(21)=-3.88, p&lt;.001] and a 3.3 points between sessions 2 and 3 [t(19)=-2.63, p&lt;.05]. Mean PHQ-9 scores decreased by 2.9 points between sessions 1 and 2 [t(21)=-2.84, p&lt;.01] and a 2.8 points between sessions 2 and 3 [t(19)=-2.77, p&lt;.05]. In contrast, changes in ISI and PHQ-9 scores between baseline and session 1, and sessions 3 and 4 did not reach significance.

Conclusion
The majority of improvements in both insomnia and depression were observed following sessions 1 and 2 of CBT-I. Findings suggest that even a limited exposure to CBT-I may have a clinically significant impact on functioning across multiple domains. Whether such early improvements represent an optimal balance compared with the more modest additional improvements achieved by adding more sessions is discussed.

Support
This work was supported by the VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC.
1121 Nonmotor Symptoms Affect Sleep Quality in Early-Stage Parkinson’s Disease Patients With or Without Cognitive Dysfunction
Authors: Zhang L , Zhu J 
Published: May 2020

Abstract

Introduction
Parkinson’s disease (PD) patients frequently present with sleep disorders. This study was designed to assess the impact of nonmotor symptoms (NMSs) on subjective sleep quality in early-stage PD patients with and without cognitive dysfunction.

Methods
A sample of 389 early-stage PD patients (Hoehn and Yahr score ≤2.5, duration ≤5 years) was recruited for the present study. The Non-Motor Symptoms Questionnaire (NMS-Quest) was used to screen for global NMSs. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD). PD motor symptoms were measured with the Unified PD Rating Scale (UPDRS), part III. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive status, and the PD Sleep Scale (PDSS) was used to quantify sleep quality. Logistic regression models were built to identify factors associated with sleep disturbances.

Results
In our sample, approximately one-quarter of the PD patients suffered from sleep disturbances (23.7%). Our results also confirmed the high prevalence of cognitive dysfunction in patients with PD (39.8%). In total, the patients who suffered from NMSs, such as depressive symptoms, anxiety symptoms, urinary tract symptoms and hallucinations/delusions, had poorer sleep quality. Better cognition may protect against sleep disorders. In patients with cognitive dysfunction, the NMS-Hallucinations/delusions score was the most important risk factor for sleep disorders. In patients without cognitive dysfunction, NMSs such as anxiety and cognition and medication were related to sleep disorder.

Conclusion
NMSs in early-stage PD are highly associated with and are determinants of subjective sleep quality. Future studies should focus on elucidating the pathophysiology of these symptoms.

Support
Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant No. BE2018610)
1132 Pediatric Sensory Safe Sleep Study: How to Reduce Sensory Stimulation and Cultivate Compliance Among Children With Special Needs. A New Concept
Authors: Rice B , Albertario C , Veler H 
Published: May 2020

Abstract

Introduction
Children with neurodevelopmental disabilities (NDD) frequently suffer from sleep disturbances causing further worsening of behavior, developmental and day-to-day functioning. The important tool used to assess sleep and sleep disorders is polysomnography (PSG). While PSG provides children a less invasive option, children with NDD and/or sensory disorders are often more resistant to this overwhelming and dysregulating procedure. As a result, many children in need of PSG will avoid scheduling a study, or have inconclusive results due to noncompliance. Previous research had shown a program of desensitization improves the number of successfully completed PSGs in NDD children. Our goal is to develop best practice standards to accommodate the individualized need of patients in the sleep lab, in a way that will be available and practical to any center treating NDD children.

Methods
Children with NDD require more individualized care tactic therefore, we developed staff education and a process that would help troubleshoot the possibility of patient non-compliance by reducing triggering sensations and unaccommodating technician behaviors. Our process is made up of several key steps to address the behavioral needs of patients: (1) identify patients at risk upon referral; (2) referral to a child life specialist to identify individualized preparation strategies and complete a brief behavioral questionnaire for documentation; (3) mail a preparation kit to the family with a summary of preparation techniques and procedural steps; and (4) ensure sleep technicians have been provided with thorough information to best accommodate the unique patient needs. In addition, PSG conducted with a truncated montage to reduce the number of stimulating sensors applied to the patient and the lab is equipped with sensory toys to provide a relaxing environment.

Results
Results will be determined based on comparing the number of successfully completed overnight sleep studies for children with NDD in the years prior to intervention, to the total success rate following the implementation of the intervention process. As a secondary goal, we will gather parent satisfaction scores via morning questionnaires.

Conclusion
Research has proven across many modalities that adequate preparation and behavioral modifications produce successful encounters when working with the pediatric population.

Support
None
0115 The Effect of Zolpidem on Sleep Dependent Emotional Memory Consolidation
Authors: Simon K C , Whitehurst L , Zhang J , Mednick S 
Published: May 2020

Abstract

Introduction
Psychopharmacological treatment is widely promoted for insomnia treatment. Zolpidem (ZOL) is a GABA A agonist that depresses the central nervous that has demonstrated unexpected benefits, specifically increased sleep-dependent verbal memory via increased phase-amplitude coupling between slow oscillations and sleep spindles (Niknazar et al., 2015). Here we investigated if ZOL improved sleep-dependent emotional memory consolidation.

Methods
Using a within-subjects, cross-over design, we counterbalanced the administration of zolpidem (ZOL) or placebo (PBO) to 37 subjects in a double-blind study. Prior to drug or placebo administration, subjects rated their subjective physiological arousal of negative and neutral pictures. Subjects were tested on their recognition of the pictures twice, before (PM) and after (AM) a night of sleep. All subjects were monitored polysomnographically across the night.

Results
We analyzed emotional picture recognition using 2-by-2 ANOVA (emotion x drug condition). We found a main effect of emotional picture PM performance, such that negative pictures were remembered better than neutral pictures. There was a significant main effect of sleep on AM false alarm rate, with greater false alarms for negative than neutral pictures, a significant interaction between drug and emotion on AM dprime, and a significant interaction for the difference between AM and PM performance and drug condition. Specifically, we found memory maintenance for both emotional picture types in ZOL but negative picture memory decline in PBO. Across the night, ZOL showed greater memory performance than PBO if subjects had greater N2 SWA and N2 sigma activity (12-15Hz).

Conclusion
Zolpidem benefits sleep-dependent emotional memory consolidation by decreasing overnight forgetting. Further, it appears that spindle activity may play a key role in ZOL’s memory effect.

Support
NIH AG046646
1146 Interaction Of Mild Cognitive Impairment And Late-life Depression In Actigraphy And Self Report Of Sleep Problems
Authors: Aronis J , Daigle K , Almaghasilah A , Gilbert C , Fremouw T , Singer C , Abedi A , Hayes M 
Published: May 2020

Abstract

Introduction
Late-life depression has been proposed as a precursor to amnestic Mild Cognitive Impairment (aMCI), the prodrome of Alzheimer’s disease. Both conditions are associated with sleep and cognitive problems. We hypothesized that MCI and current depressive symptoms would co-occur more frequently, but express distinct sleep phenotypes.

Methods
Independently living older adults (N=80), age 62-90 (M=71.78, SD=5.98), were recruited from a geriatric psychiatry clinic and the community for a home sleep study. A clinical decision board and neurocognitive battery were used to determine MCI status. Participants completed the CES-D and depression history interview where endorsement of current depression was considered positive. Sleep was examined with wrist actigraphy for 7 days. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS) provided subjective sleep quality.

Results
Based on these criteria, 41.2% of the sample were determined to be MCI (n=33); the remainder were deemed normative for age (NC; n=47). Chi-square analyses showed a higher frequency of MCI were positive for current depression than expected (14.2%; p=0.017). Repeated-measures MANOVA, using current depression symptoms and MCI as factors, revealed MCI was associated with longer sleep latency (p=0.035) and wake bout time (p=0.039); whereas, current depression was associated with longer sleep latency, more fragmentation/WASO, and lower sleep efficiency (p’s&lt;0.05), self-report of poorer daytime dysfunction (p=0.005), and greater daytime sleepiness (p=0.001). MCI x current depression interactions were found for sleep latency (p=0.029); and PSQI sleep disturbances (p=0.005) and sleep medication (p=0.025).

Conclusion
Despite distinct sleep disordered phenotypes, the interaction of MCI and current depression is associated with delayed sleep onset, use sleep medication and report of sleep disturbances.

Support
This project was sponsored by: NASA, Maine Space Consortium; AG 056176, AG 053164 Vice President for Research, U. Maine; Maine Technology Institute; DoD Phase I SBIR and R44AG059536-01 SBIR Phase II Award.
1156 Polysomnographic Total Sleep Time: A Novel Biomarker For Dementia
Authors: Nowakowski S , Razjouyan J , Naik A D , Agrawal R , Velamuri K , Singh S , Sharafkhaneh A , Kunik M E 
Published: May 2020

Abstract

Introduction
Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined whether total sleep time (TST) derived from attended overnight polysomnography (PSG) studies is associated with an increased prevalence of dementia diagnosis and determined the optimal cut-point.

Methods
We identified 69,847 PSG sleep studies using CPT code 95810 from 2000-19 in the US Department of Veteran Affairs (VA) national database of patient care. We used natural language processing to verify PSG reports and extract TST values from the patient free-text notes. We examined a TST of 240-420 minutes in 10-minute increments using a run chart (time series) approach to determine the optimal cut-point for determining greater odds of dementia.

Results
Patients had a mean age of 55.4±13.8, 91.5% were male, and 64% were Caucasian. PSG studies revealed a mean TST of 310.6±79.5 minutes. The run chart time series analysis revealing &lt; 360 minutes being the optimal cut-point for increased odds of dementia (OR: 1.64, 95% CI: 1.36-1.99, p&lt;.05).

Conclusion
Lower TST predicted higher prevalence of dementia diagnosis. TST of 360 minutes may serve as the optimal cut-point to determine greater odds of dementia. This is an important study examining PSG sleep duration and the prevalence of dementia across 19 years in the largest integrated healthcare system in the US. TST may function as a potential biomarker for developing dementia.

Support
This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).
1159 Sleep Traits And Incident Delirium During A Decade Of Follow-up In 173,000 Participants
Authors: Gao L , Li P , Cui L , Johnson-Akeju O , Hu K 
Published: May 2020

Abstract

Introduction
Delirium is an acute decline in attention and cognition that is with associated long-term cognitive dysfunction in elderly patients. Accumulating evidence points to strong associations between sleep health and disorders of the brain. We tested whether baseline sleep duration, chronotype, daytime dozing, insomnia or sleep apnea predict incident delirium during hospitalization.

Methods
We studied participants from the UK Biobank who have been followed for up to 10 years until 2017. We included 173,221 participants (mean age 60±5; range 50-71 at baseline) who had at least one episode of hospitalization/surgery and were free from prior episodes of delirium. Delirium diagnosis, hospitalization and surgical events were derived using ICD-10 coding. Multivariate logistic regression models were performed to examine the associations of self-reported baseline sleep duration (&lt;6hrs/6-9h/&gt;9h), daytime dozing (often/rarely), insomnia (often/rarely) and presence of sleep apnea (ICD-10 and self-report) with incident delirium during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, and major confounders (number of hospitalizations/surgical procedures, BMI, diabetes, major cardiovascular diseases and risk factors, major neurological diseases, major respiratory diseases, cancer, alcohol, depression/anxiety, sedatives/sleep aides, antipsychotics, steroids and opioids).

Results
In total, 1,023 (5.7 per 1,000 subjects) developed delirium. A prior diagnosis of sleep apnea (n=1,294) saw almost a two-fold increased odds (OR 1.96, 95% CI: 1.30-2.30 p=0.001) while those who often had daytime dozing were also at increased risk (OR 1.35, 95% CI: 1.02-1.80, p=0.025). Both these effects were independent of each other. No independent effects on incident delirium were observed from sleep duration, insomnia, or chronotype.

Conclusion
Certain sleep disturbances, in particular sleep apnea and daytime dozing, are independently associated with an increased risk for developing delirium. Further work is warranted to examine underlying mechanisms and to test whether optimizing sleep health can reduce the risk of developing delirium.

Support
This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.
1184 Evaluation Of A Novel Sleep Medicine Educational Program For The Primary Care Provider
Authors: Lang R , Keenan B T , Kneeland-Szanto E , Rosen I M 
Published: May 2020

Abstract

Introduction
Inadequate exposure to and insufficient training in sleep medicine across the medical education continuum contributes to a lack of patient access to sleep care. We created a self-directed learning curriculum in sleep medicine aimed at practicing primary care providers.

Methods
In this pilot study, primary care providers, including physicians (PCP) and advanced practice nurses (APP-N), were invited to complete 3 application (app)-based core sleep educational modules in exchange for free continuing education and maintenance of certification credits. The modules were case-based and fully autonomous. Individuals had access to discussion boards moderated by a board-certified sleep physician and were given the option to complete two additional modules on advanced sleep topics. We assessed participants’ opinions on the course and any effect on behavior, measured as change in the number of sleep-related orders.

Results
Nineteen providers (12 PCP, 7 APP-N) completed the 3 required core modules. Five participants completed at least one additional module. A total of 94.4% reported they would recommend this curriculum to a colleague. Fifteen participants had prior experience with online courses; 93.3% noted that the sleep online modules provided a similar or better experience. Upon completion, 77.8% of learners anticipated this educational activity would contribute to either a great degree or completely to improvements in the health outcomes of their patients. All participants achieved the post-test score of 80% required to receive 1 CME/CNE credit per module completed. The number of sleep consultations or sleep study orders in the 4 months after course completion increased by 24.2% on average compared to the 4 months prior to the course (p=0.0157).

Conclusion
Based on Kirkpatrick’s model, this novel, app-based curriculum met levels 1-3 (positive reaction, knowledge transfer, and impact on behavior). Larger, longer-term studies are needed to assess the benefits of increasing knowledge in sleep medicine on patient care (Kirkpatrick Level 4).

Support
Funded by NIH NHLBI 5-R25-HL-120874-04
1185 Developing A Care Pathway For Insomnia In Older Adults And Adults With Dementia: Results Of A Consensus Meeting
Authors: Benca R , Ferziger R , Wickwire E M , Bertisch S , Biddle J , Boustani M , Culpepper L , Gooneratne N , Lett J , Manderscheid R , Mehra R , Reynolds C , Grandner M 
Published: May 2020

Abstract

Introduction
Insomnia among older adults and dementia patients carries a high public health burden. Yet, treatment is inconsistent or absent. Standardized, programmatic carepaths can be implemented in clinics/systems/communities to address this after tailoring to local environments. To determine what elements should be included, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building among diverse stakeholders.

Methods
Participants represented a wide range of stakeholders and specialties, including academic research, clinical care, industry, government, payors, sleep medicine, primary care, geriatrics, psychiatry, neurology, nursing, pharmacy, quality, and implementation science. 27 statements regarding key components of carepaths for insomnia in elderly and dementia populations were presented and discussed. These represented items addressing identification of patients, screening and assessment, deciding treatment modality and delivery, providing behavioral treatment, providing pharmacotherapy, addressing combined therapy, addressing comorbidities, and incorporating outcome evaluation. All N=20 participants voted individually whether they agreed or disagreed with each statement. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree.

Results
Despite diversity among attendees, median rate of agreement was 95% (IQR=85-95%). Mean score was 0.69 (SD=0.31). 95%CIs were computed for each proportion and compared to the mean. The following elements were significantly different from the mean (p&lt;0.05): medication decision trees (M=0.25), accounting for comorbidities (M=0.26), include outcome evaluation (M=0.30), utilization of EMR (M=0.40), incorporate caregiver (M=0.42), and differ across parts of the system (M=1.79).

Conclusion
Insomnia carepaths for older adults should address identification, screening and assessment, treatment decisions, treatment type and delivery, and evaluation. Organizations should consider these elements when designing carepaths for insomnia among older adults and dementia patients. Consensus-building should begin during the process of prioritizing care path components.

Support
Merck Research Labs provided support
1197 Utility of Fitbit Charge 2 for Sleep Monitoring in Patients With Obstructive Sleep Apnea
Authors: Kim D , Shin W , Byun J 
Published: May 2020

Abstract

Introduction
The wearable device may be useful in monitoring sleep. Many studies reported reliable data in detecting sleep-wake states and sleep stage proportion in healthy adults, However, only a few validation studies were performed evaluating sleep using the wearable devices in patients with obstructive sleep apnea(OSA), which showed insufficient accuracy. We aimed to evaluate the reliability of multi-sensory wristband (Fitbit Charge 2) in patients with OSA.

Methods
This was a preliminary analysis of a prospective single-center observational study. Consecutive patients underwent standard Polysomnography (PSG) for evaluation of OSA with Fitbit Charge 2. Sleep data from PSG and Fitbit charge 2 were compared using paired t-tests and Bland-Altman plots.

Results
A total of eighty-six patients were analyzed. Four of them had poor data quality, 18 of them did not show sleep stages. Compared with the PSG, Fitbit Charge 2 showed higher total sleep time (419.1±194.0 vs 269.8±22.6, p&lt;0.001) and sleep efficiency (95.8±2.5 vs 84.6±7.1, p&lt;0.001). Those with sleep stage data showed higher sleep efficacy (87.7±5.5 vs 82.37.5, p=0.024) and a lower proportion of N1 sleep (33.7±19.9 vs 65.3±38.8, p=0.01).

Conclusion
Fitbit Charge 2 showed limited utility in monitoring sleep in patients with obstructive sleep apnea.

Support
none