bluuebunny/crossref_metadata_2025_split huggingface dataset:
0812 Nightmares: An Independent Risk Factor For Cardiovascular Disease
Authors: Ulmer C S 
Published: May 2020

Abstract

Introduction
Associations between PTSD, sleep and cardiovascular disease are well-established in prior research, but few studies have examined adverse health correlates of nightmares. Nightmares are often called the “hallmark” symptom of PTSD and represent the cardinal sleep-specific manifestation of PTSD. Yet, prior studies have not examined nightmares’ independent contribution to cardiovascular disease risks beyond risks conferred by PTSD. The purpose of this study was to examine associations between nightmares and cardiovascular disease in Veterans with and without PTSD.

Methods
Participants were Veterans (N=3876; 78% male) serving since September 11, 2001, 1 or 2 tours of duty (73.5%), aged 38 years (SD=10.4), 31% meeting criteria for current PTSD, with equivalent proportions of African-Americans (48%) and Caucasians (48%). Nightmare frequency was assessed using the Davidson Trauma Scale (DTS), with “frequent” defined as occurring at least 2-3 times per week. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study (NVVRS) Self-report Medical Questionnaire. PTSD diagnosis was established using the Structured Clinical Interview for DSM-V.

Results
Frequent nightmares over the past week were endorsed by 33% of participants. Cardiovascular conditions were endorsed at the following rates: heart problems (6%); diabetes (6.6%); arthrosclerosis (0.5%); hypertension (29.2%); stroke (0.7%); and heart attack (1.2%). After adjusting for age, sex and race, frequent nightmares were associated with heart problems (F=7.50, p=.006), high blood pressure (F=23.84, p&lt;.0001), and heart attack (F=7.19, p=.007). When PTSD was added to the model, these associations remained significant.

Conclusion
We found that frequent nightmares among Veterans are associated with cardiovascular conditions, even after controlling for the effects of PTSD. Additional research is needed to explore mechanisms explaining these associations and determine if reducing nightmare frequency and severity results in improved cardiovascular health.

Support
This work was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
0815 Violent Parasomnias In Patients With REM Without Atonia. Parasomnia Overlap Disorder Vs Pure Rem Behavior Disorder
Authors: Simmons J H , Meskill G J , Lavender M G 
Published: May 2020

Abstract

Introduction
REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. On literature review, harm to others using a weapon is not well established. Some opinions state REM-parasomnias do not consist of elaborate actions, such firing a gun. This has significant ramifications in forensic medicine when RBD is a consideration. We reviewed our RBD patients to identify instances in which a gun was used during a parasomnic event to characterize clinical features associated with such behaviors.

Methods
We reviewed over 57 RBD cases from Texas, between 2014-2017 seeking parasomnias in which a gun was used.

Results
We found two patients in whom a gun was used during a parasomnia, representing &lt; 3.5% of cases. Case-1: 59 y/o F with a 5 year hx of parasomnias of screaming, thrashing, roaming and one instance in which she pointed an unloaded gun at her husband saying she was going to kill him. She had no recollection of the event. NPSG demonstrated REM without atonia, mild OSA (1a AHI of 11/hr) and frequent PLMS. Case-2 presented to a sleep center in 1989 at 33 y/o with 3 year Hx of EDS, found to have mild OSA unresponsive to PAP Tx, then diagnosed with narcolepsy. He later developed cataplexy and progressed to developing parasomnias 15 years later. He demonstrated REM without atonia on a CPAP re-titration NPSG study done in part for his parasomnias, 20 years after original assessment. PLMS were also demonstrated. His parasomnias consisted of yelling, screaming, roaming and one time he woke up finding bullet holes in his closet door with no recollection of firing his gun, which he kept near his bed.

Conclusion
RBD is associated with a wide range of parasomnic events, almost never captured in the laboratory. These patients had clear RBD findings. It is possible they had Parasomnia Overlap Disorder in which Non-REM parasomnias occur in patients with RBD. PLMS and or OSA may contribute by fragmenting sleep. Nonetheless, it is clear that RBD patients can have elaborate parasomnias involving the use of weapons. More attention of this is noteworthy since reports are lacking in the literature.

Support
N/A
0829 Sleep, Chronic Pain, and Global Health in Adults Ages 65 or Older
Authors: Tran L , Jeon B , Chasens E 
Published: May 2020

Abstract

Introduction
Understanding the association of sleep and pain in older adults can help improve their global health. The purpose of the study was to describe the associations between sleep, chronic pain, and global health in adults ages 65 or older.

Methods
This study was a secondary analysis of data from adults over 65 years in the 2015 Sleep in America Poll - Sleep and Pain by the National Sleep Foundation (NSF). The survey included demographics (age, race, marital status, education), sleep (duration, quality, insomnia symptoms), and pain (type [none, chronic, fleeting], intensity, location). Global health derived from general health, physical health, mental health, and quality of life with a potential range of 4-20; higher score=better health. The survey also queried fatigue and stress.

Results
The sample (N=248) was 65-91 years (mean age=72.8±5.9), male (53.6%), White (82.7%), married (65.7%), and with post-highschool education (54.4%). Average sleep duration was 425±74 minutes. “No pain” was reported by 38.7% of the sample (n=96), “fleeting pain” by 32.7% (n= 81), and “chronic pain” by 28.6% (n=71). The most common locations for chronic pain were shoulder or neck (63.2%) and back (69.4%). Average global health score was 9.8±2.9. There was no significant difference in time in bed, sleep duration, bedtime, or wake-up time between groups. Persons with chronic pain had higher average pain intensity, worst pain intensity, and current pain; they reported significantly lower sleep quality with significantly more restlessness, trouble staying asleep, and worry about getting a good night sleep (all p-values&lt;.02), there was no significant difference in difficulty falling asleep compared to persons with no pain. Persons with chronic pain had significantly worse general health, physical health, mental health, global health, fatigue, and stress (all p-values&lt;.02); but no significant difference in quality of life compared to persons with no pain.

Conclusion
We conclude that chronic pain has a significant negative impact on sleep and global health in the sample of adults ages 65 or older from the 2015 Sleep in America Poll - Sleep and Pain by the NSF.

Support
Undergraduate Research Mentoring Program, University of Pittsburgh School of Nursing.
0847 Association Between Cannabis Use Frequency and Sleep Duration Among a Representative Sample of US Adults
Authors: Bowles N P , Shea S A 
Published: May 2020

Abstract

Introduction
Cannabis use is on the rise in the US, and while the cannabis plant and related compounds are considered to have low toxicity, the impact on physiology including sleep remains unclear. Further, the bulk of cannabis research has focused on adolescents and young adults despite growing use among the elderly. Thus, this analysis sought to determine the impact of the frequency of cannabis use on sleep duration and determine if this relationship varies by age.

Methods
This cross-sectional study used data from the 2016-2018 Behavioral Risk Factor Surveillance System surveys. Multinomial logistic regression was used to evaluate the association between the frequency of cannabis use, 0-30 times over the prior 30 days; and average sleep duration, short (&lt;7 hours); recommended (7-9 hours); and long (&gt;9 hours) sleep.

Results
The study sample included 235,667 participants (48% male, 43% 18-44 years old and 35% 44-64 years old) of which 14,122 consumed cannabis. The weighted proportion who reported using cannabis 1-4x, 5-15x, or more than 16x/month were 3.1% (95% CI, 3.0%-3.3%), 2.1% (2.0%-2.2%), and 4.4% (4.2%-4.6%) respectively. In an age stratified model adjusted for sociodemographic and clinical characteristics, there were no associations between sleep and cannabis use up to 15x/month. Among those adults who consumed cannabis more than 16x/month: (1) 18-44 year olds were more likely to report either short sleep (risk ratio (RR), 1.21; 95% CI, 1.05-1.39) or long sleep (RR, 1.57; 95% CI, 1.11-2.22) as opposed to the recommended amount of sleep; whereas (2) 44-64 year olds demonstrated an increased risk for long sleep (RR, 1.77; 95% CI, 1.09-2.89); and (3) participants 65 years and older demonstrated an increased risk for short sleep (RR, 1.61; 95% CI, 1.04-2.49).

Conclusion
We demonstrate that modest cannabis use was not associated with sleep, whereas daily cannabis use is associated with age-dependent sleep duration above and below the recommended amount.

Support
KL2TR002370, 2R25HL105444-09.
0850 Self-report And Polysomnography Sleep And Mortality In Adults: A Machine Learning Replication Analysis
Authors: Wallace M L , Peppard P , Coleman T L , Mentch L , Buysse D J , Hall M H , Redline S , Hagen E H 
Published: May 2020

Abstract

Introduction
Individual sleep health characteristics (e.g. efficiency, timing, duration, architecture) and signs and symptoms of sleep disorders (e.g., difficulty falling and staying asleep, apnea hypopnea index, measures of oxygen desaturation) predict mortality in adults using traditional regression methods. However, it is important to examine and compare their predictive abilities in context of other established non-sleep predictors using high-dimensional methods that better reflect the complexity of the data. Therefore, we applied a novel random forest machine learning (RFML) hypothesis-testing framework to data from the Sleep Heart Health Study (SHHS) and the Wisconsin Sleep Cohort (WSC) to determine which risk factor domains (sleep, physical health, sociodemographic factors, medications, health behaviors, mental health) and sleep subdomains (self-report and polysomnography sleep health characteristics and signs and symptoms of sleep disorders) predict time to mortality in adults.

Methods
We harmonized 82 predictors across SHHS and WSC (32 sleep, 24 physical health, 8 sociodemographic, 9 medications, 4 mental health, 5 health behaviors) and fit sociodemographic-adjusted and fully-adjusted RFML models in each cohort to test the overall predictive importance of each domain and sleep subdomain. Permutation-based p-values and unbiased variable importance metrics (change in Harrell’s C *100, ΔC) were computed and summarized with medians across 20 independent subsampled testing sets in each cohort.

Results
In the fully-adjusted SHHS and WSC models, the most predictive domains were physical health (SHHS p&lt;0.001, ΔC=1.48; WSC p=0.002, ΔC=2.68) and sleep (SHHS p=0.008, ΔC=0.71; WSC p=0.044, ΔC=1.65). Sleep subdomains were not significant in the fully adjusted model. However, the sociodemographic-adjusted models indicated that the predictive importance of sleep may be driven by polysomnography sleep health characteristics in SHHS (p=0.026, ΔC =0.77) and polysomnography signs of sleep apnea in WSC (p&lt;0.001, ΔC=3.20).

Conclusion
Sleep is a strong predictor of mortality in adults that should be considered among other more routinely used predictors. Future research should examine differences and similarities between SHHS and WSC that may explain the finding that different aspects of sleep were important in each cohort.

Support
NIA grant AG056331, NHLBI grant HL114473, NHLBI grant R01HL62252, NIA grant R01AG036838, NIA grant R01AG058680.
0855 Primary Sleep Disorders And The Combined Outcome Of Poor Sleep Quality With Objective Short Sleep Duration In Older Persons
Authors: Miner B , Vaz Fragoso C A , Han L , Stone K L , Redeker N S , Yaggi H K 
Published: May 2020

Abstract

Introduction
Poor sleep quality with short sleep duration (SSD) is a high-risk phenotype that is likely to be associated with primary sleep disorders (obstructive sleep apnea [OSA], periodic limb movements of sleep [PLMS], and restless legs syndrome [RLS]) in older persons. We evaluated the associations among primary sleep disorders and this high-risk phenotype in older persons.

Methods
Using data on 3,058 men from the Osteoporotic Fractures in Men Sleep Study and 3,127 women from the Study of Osteoporotic Fractures, mean ages 76 and 84 years, respectively, we evaluated cross-sectional associations between primary sleep disorders and the combined outcome of poor sleep quality with actigraphic SSD. In women, OSA and RLS were evaluated by self-report. In men, OSA and PLMS were evaluated by polysomnography and RLS by self-report. Poor sleep quality was defined by Pittsburgh Sleep Quality Index score &gt;5 and SSD by average total sleep time ≤6 hours from wrist actigraphy (averaged over ~5 days). Men and women were evaluated separately. Multivariate logistic regression models also included demographics, self-reported chronic conditions, anxiety, depression, and medication use.

Results
Poor sleep quality with actigraphic SSD was more prevalent in men (475 [15.6%]) than women (400 [13.1%]). In unadjusted models in men, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA, PLMS, and RLS (ORs [95% Cis] = 1.99 [1.57, 2.52], 2.11 [1.41, 3.18], and 5.58 [2.51, 12.43], respectively). In multivariable models in men, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA (1.59 [1.18, 2.14]) but not with PLMS or RLS. In unadjusted models in women, odds of poor sleep quality with actigraphic SSD were significantly higher with OSA (3.57 [0.40, 31.88]) and RLS (5.60 [3.04, 10.32]), but results were not significant in multivariable models in women.

Conclusion
Older persons with primary sleep disorders have higher odds of poor sleep quality with actigraphic SSD. However, the predominant mechanisms underlying this high-risk phenotype may be driven more by medical and psychiatric comorbidity than by primary sleep disorders.

Support
The American Academy of Sleep Medicine Foundation and the Yale Claude D. Pepper Older Americans Independence Center
0859 Types Of Childhood Maltreatment And Sleep Regulation During Pregnancy
Authors: Touchette E , Servot S , Lemieux R , Berthelot N 
Published: May 2020

Abstract

Introduction
Pregnant women with history of childhood maltreatment would have around 2-fold increased odds of poor subjective sleep in comparison to pregnant women without history of trauma (Gelaye et al., 2015). Our aim was to evaluate whether different types of childhood maltreatment were associated with poorer subjective and objective sleep regulation during the second trimester of pregnancy.

Methods
Sleep regulation between 18-20 weeks of gestation was assessed in a sample of 55 expectant mothers, including 31 women exposed to childhood maltreatment. Three measures of sleep were administered: 7-day actigraph measures (Mini-Mitter/Respironics), 7-day sleep diary and the completion of Pittsburgh Sleep Quality Index. Childhood maltreatment was assessed using the Chilhood Trauma Questionnaire. Generalized linear regression models were used to examine the associations between sleep measures and types of childhood maltreatment after adjusting for confounding variables (e.g., maternal age, maternal wellbeing, education attainment and family income).

Results
Among the 31 participants with history of childhood maltreatment, 71% (n=22) reported emotional abuse, 26% (n=8) physical abuse, 39% (n=12) sexual abuse, 42% (n=13) emotional neglect and 65% (n=20) physical neglect. Pregnant women with childhood emotional abuse had around 2.8 higher score on PSQI in comparison to pregnant women without childhood emotional abuse (P&lt;0.003). For objective sleep measures, pregnant women with childhood sexual abuse had around 1 hour less of nocturnal sleep (P&lt;0.004), 30 minutes more nocturnal awakenings (P&lt;0.03) and 6% less of sleep efficiency (P&lt;0.01) compared with pregnant women without childhood sexual abuse.

Conclusion
Emotional abuse during childhood was associated with poorer perceived sleep quality during the 2nd trimester of pregnancy while childhood sexual abuse was particularly associated with objective measures of sleep regulation. Future larger studies are needed to confirm the impact of the different types of childhood maltreatment on maternal sleep quality during pregnancy.

Support
Social Sciences and Humanities Research Council (SSHRC, 2018-2020, Canada)
0894 A Two Item Questionnaire Reflecting Parental Concern As An Indicator Of The Severity Of Obstructive Sleep Apnea In Children
Authors: Tauman R , Lavi M , Greenfeld M , Fishman G , Wasserzug O , DeRowe A 
Published: May 2020

Abstract

Introduction
The currently available questionnaires based on parental reporting of OSA symptoms include large number of items and are not sufficient to the diagnosis and assessment of OSA severity. We aimed to evaluate a simple 2-item questionnaire regarding parental concern as a predictor of the severity of OSA in children as measured by polysomnography.

Methods
Prospective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child’s breathing.

Results
Ninety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Significant correlations were found between the need for surgery score and the apnea-hypopnea index (r=0.22, P = .029), as well as the mean SpO2 levels (r=-0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score and the child’s age were the only predictors for moderate-severe OSA (P = .01 and P = .043, respectively).

Conclusion
Querying parents on their perception of their child’s need for surgery is a sensitive, practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG.

Support
0899 Long-term Effects Of Adenotonsillectomy In Children Diagnosed With Obstructive Sleep Apnea On Risk Factors For Cardiovascular Morbidity
Authors: Even Tsur J , Auhasira R , Shiloh A , Novack V , Goldbart A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity in adults. In children, cardiovascular morbidity associated with OSA is usually thought to resolve after tonsillectomy and adenoidectomy (T&A). There is no information regarding the long term effects of T&A on future cardiovascular morbidity in children diagnosed with OSA. In this study, we performed data mining to assess long-term effects of adenotonsillectomy on risk factors for cardiovascular disease, in young adults.

Methods
This study retrospectively investigated the population defined by a previous study in our institution [Tarasiuk etal Pediatrics 2004] and compared a group of children diagnosed with OSA and underwent T&A(n=130) to a group of children diagnosed with OSA that did not undergo T&A(n=90) to a control group without OSA (n=505). Demographic data, vital signs, anthropometric measurements, medical diagnoses (9th revision (ICD-9) codes) and medication purchases were captured from the HMO computerized database, between the years 1998-2018. When appropriate, univariate comparisons were made using χ 2-test or Fisher’s exact test for categorical variables, and one-way ANOVA or Kruskal-Wallis tests for quantitative variables. We performed multivariate logistic regression to model the factors associated with the diagnosis of obesity. IBM SPSS software, version 25.0, was used for statistical analysis.

Results
We have found that 20 years after their OSA diagnosis, patients (25.1 years, 52.2% males, 26.2 BMI) who were diagnosed with OSA at age 5 and did not undergo T&A consumed more medications associated with cardiovascular morbidity (anti-hypertensive, statins, aspirin) than those who underwent T&A(P&lt;0.001). Surprisingly, multivariate logistic regression revealed that only females diagnosed with OSA (with or without T&A) were diagnosed as obese in comparison to those that did not have OSA (P&lt;0.001).

Conclusion
Children who were diagnosed with OSA and were not operated will consume more medications (anti-hypertensive, anti-hyperlipidemia, aspirin) as young adults, a surrogate marker for early cardiovascular disease. OSA in girls seems to serve as a risk factor for obesity in their third decade of life. It is important to diagnose and treat OSA in children, and to monitor and prevent obesity, mainly in females.

Support
Israel Science Foundation (ISF) 1344/15
0909 Sleep Duraion And Related Factors Amongchinese Children: Across-sectional Studyabstract
Authors: Jun T 
Published: May 2020

Abstract

Introduction
It is known short sleep duration adversely affects children’s behavior and physical development. Sleep duration and sleep habit vary substantially in children with different ages, areas and races. However, our understanding on the sleep duration in Chinese children remains limited. The present study investigated the status of sleep durations in Chinese children and explored factors related to sleep loss.

Methods
A randomized, stratified, multi-stage cluster sampling method encompassed 11420 children in 25 schools from 7 districts in Beijing. Children aged 3 to 14 years were included, and their parents were invited to fill sleep habit related questionnaires about the performance of the last 3 months.

Results
The final cohort included 4736 boys and 4462 girls with a mean age of 8.8±3.8 years. The mean sleep duration of children ≥12 years of age was 9.4h, which was significantly lower than those &lt; 12 years old (9.7h); this was in agreement with the trend of sleep durations of weekdays. On weekends and holidays, the sleep duration was approximately 10h for most children and similar in all age groups. Gender (male), age (≥12-year group), overweight, and suburban residence were significantly correlated with sleep loss in children (p&lt; 0.001). A significantly high proportion of children with sleep loss displayed sleepiness during sitting and reading (19.1%), in the car (31.4%), in the afternoon (20.7%), and after lunch (17.5%).

Conclusion
The sleep duration reduced significantly in children ≥12 years of age as compared to younger children in Beijing. Factors such as gender (male), age (≥12-year group), overweight, and suburban residence are related to sleep loss. Children ≥12 years of age older with sleep loss were likely to experience daytime sleepiness.

Support
This work was supported by Beijing Municipal Science and Technology Project grant (Z161100000116050 and Z161100003216212) and Beijing Municipal Administration of Hospitals Clinical Technology Innovation Project grant (XMLX201701). .