bluuebunny/crossref_metadata_2025_split huggingface dataset:
1128 Sleep Apnea and Periodic Limb Movements are Highly Prevalent in Patients With Multiple Sclerosis
Authors: Palotai M , Weiner H L , Chitnis T , Duffy J F , Guttmann C R 
Published: May 2020

Abstract

Introduction
The pathogenesis of multiple sclerosis (MS)-related fatigue is multi-factorial, including neurogenic, inflammatory, endocrine, metabolic, mood, as well as sleep disorder-related mechanisms. The confounding effect of sleep disorders on the association between fatigue and neurodegenerative changes in the brain has not been investigated. Our objectives were to assess the prevalence of sleep apnea and periodic limb movements in the framework of a prospective study which investigates the neurogenic causation of treatment-resistant fatigue in MS.

Methods
MS patients enrolled in a National MS Society-funded prospective study (grant identifier RG-1501-03141) underwent a one-night at-home sleep test (HST) using a NOX T3 portable monitor. HST recordings were scored by a registered polysomnographic technologist. Respiratory Event (REI) and Periodic Limb Movement (PLMI) Indices were calculated for each patient.

Results
Out of 36 patients, 7 (20%) had mild (REI=5-14), 1 (3%) had moderate (REI=15-29), and 1 (3%) had severe sleep-disordered breathing (REI≥30). Fourteen (42%) of the patients had mild (PLMI=5-24), 4 (11%) had moderate (PLMI=25-49), and 7 (19%) had severe periodic limb movements (PLMI≥50). Overall, 81% of the patients had at least mild sleep-disordered breathing and/or periodic limb movements.

Conclusion
Sleep abnormalities (i.e., sleep apnea and periodic limb movements) are highly prevalent in patients with MS. We plan to compare the MRI exams of subgroups of MS patients with fatigue, to test the hypothesis that fronto-striatal circuitry is more affected by lesions in patients without sleep apnea compared to those with sleep apnea.

Support
This investigation was supported by a grant from the National Multiple Sclerosis Society (grant identifier RG-1501-03141). The home sleep test equipment was provided by a DURIP grant from the Office of Naval Research (grant N00014-15-1-2917).
1147 Sleep Correlates With Improved Functional Outcome In The Intensive Care Unit
Authors: Markun L C , Sampat A , Dutta R , Palchik G A , Chow M , Park K J , Yee A H 
Published: May 2020

Abstract

Introduction
Disruption of sleep may have significant implications in acute brain injury, functional recovery, and critical illness. Few data exist characterizing sleep architecture in patients admitted to an intensive care unit (ICU). We aim to describe sleep and clinical characteristics in patients with acute brain injury and critical illness.

Methods
Retrospective analysis was performed in ICU patients who underwent continuous electroencephalographic (EEG) monitoring from 2018-2019. Sleep was scored based on AASM-defined EEG criteria. Clinical variables, EEG characteristics, and modified Ranking Scale (mRS) were collected. Good outcome was defined as mRS&lt;3. Differences were assessed using chi-square analysis and t-test.

Results
205 patients were reviewed with a mean age of 57 years (range 18-91) and a majority (57%) were male. Patients carried a primary neurologic/neurosurgical (61%) or medical/surgical (39%) diagnosis. Status epilepticus, subdural hemorrhage, traumatic brain injury, encephalopathy and cardiac arrest accounted for the majority of diagnoses encountered. Only 58 patients (28%) achieved N1 sleep; of these 76.4% achieved N2, 2.8% N3, and none achieved REM. Of those achieving any sleep, 43% had good outcomes versus only 23% in those who did not (t=-7.45, p&lt;0.001). Neurological patients were more likely to attain sleep compared to those with other primary diagnoses (χ 2 (1)=7.08, p=0.008). Centrally acting anesthetics did not account for sleep differences between neurologic and non-neurologic patients (χ² (1)=2.01, p=0.16). However, those with primary brain injury reached sleep more often in the absence of anesthetic use (χ 2 (1)=4.82, p=0.03). The overall mortality was 32% in this cohort.

Conclusion
Most critically ill patients do not achieve electrophysiologic sleep. Of those who do, N1/N2 stages are seen most often. Neurological patients were more likely to sleep, and achieving any sleep was associated with improved functional outcome. Further studies are needed to determine whether sleep augmentation in the critically ill impacts functional outcome.

Support
N/A.
1152 Genetic Risk Of Alzheimer’S Disease Is Linked To Short Sleep Duration
Authors: Leng Y , Yaffe K , Ackley S , Glymour M , Brenowitz W 
Published: May 2020

Abstract

Introduction
Sleep disturbances including short sleep duration are common in older adults, especially in those with Alzheimer’s disease (AD). However, it is unclear to what extent sleep duration is a manifestation of AD disease process. We examined whether genetic variants related to AD influence sleep duration in middle-aged and older adults and estimated the causal effects of AD on sleep duration using a mendelian randomization (MR) analysis.

Methods
We examined 406,687 UK Biobank participants with Caucasian genetic ancestry who self-reported sleep duration at baseline (2006-2010). Sleep duration was assessed by asking: “About how many hours sleep do you get in every 24 hours? (please include naps).” A genetic risk score for AD (AD-GRS) was calculated as a weighted sum of 23 previously identified AD-related single nucleotide polymorphisms in individuals of European ancestry. We evaluated whether AD-GRS predicted sleep duration using linear regression, adjusting for age, sex and principle components for genetic ancestry. We also stratified the analysis by age at baseline (≤55y or &gt;55y) and conducted a MR analysis to estimate the effect of AD (ICD-9/10 codes for AD/dementia diagnosis) on sleep duration.

Results
The participants (aged 56.91±8.00y) had an average sleep duration of 7.2 (Standard deviation [SD]=1.1) hours and AD-GRS of 0.11 (SD=0.40) (range: -1.15~1.85). Higher AD-GRS score predicted shorter sleep duration (b= -0.013, 95%CI:-0.022,-0.005), mainly among those aged over 55y (b= -0.023, 95%CI:-0.034,-0.012) and not in those 55y or younger (b= 0.006, 95%CI:-0.012,0.013); p for interaction by age=0.02. MR analysis using AD-GRS as an instrumental variable suggested that AD was associated with 1.76 hrs (b=-1.76, -2.62~ -0.90) shorter sleep duration in those aged &gt;55y.

Conclusion
Using a novel analytical approach, we found that higher genetic risk for AD predicted shorter sleep duration among older adults. This suggests shared genetic pathways; the biologic processes that lead to AD may also affect sleep duration.

Support
Dr. Leng received support from the National Institute on Aging (NIA) 1K99AG056598, and from GBHI, Alzheimer’s Association, and Alzheimer’s Society (GBHI ALZ UK-19-591141).
1153 Association Of Nocturnal Sleep Disturbance And Prospective Cognitive Decline In Cognitive Normal Elderly: Findings From The National Alzheimer’s Coordinating Center Uniform Dataset
Authors: Bubu O M , Mbah A K , Williams N J , Turner A D , Parekh A , Mullins A E , Kam K , Umasabor-Bubu O Q , Varga A W , Rapoport D M , Ayappa I , Jean-Louis G , Osorio R S 
Published: May 2020

Abstract

Introduction
We determined whether nocturnal sleep disturbance (NSD) is associated with prospective cognitive decline in clinically normal older adults

Methods
Prospective longitudinal study utilizing data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data set (UDS). NSD data, as characterized by the Neuropsychiatric Inventory Questionnaire (NPI-Q), were derived from 10,600 participants at baseline, with at least one UDS follow-up visit, from 32 National Institute of Aging Alzheimer’s Disease Research Centers (ADRC). Prospective cognitive decline was characterized as incident mild cognitive impairment (MCI) diagnosis during UDS follow-up. Logistic mixed-effects model with random intercept and slope examined associations between the NSD and longitudinal cognitive decline. All models included age at baseline, sex, years of education, APOE ε4 status and their interactions with time. Time was operationalized as years from baseline for each participant.

Results
Of the 10,600 cognitively normal participants at baseline, 1,017 (8.6%) had NSD. The proportion of males versus females with sleep problems was 10.1% vs. 9.3% respectively. For participants with NSD and no NSD, the mean (SD) age was 71 (7.3) and 70 (5.7) years and average follow-up time was 5.2 (2.6) and 4.9 (2.7) years, respectively. Participants with NSD were significantly more likely to develop incident MCI during UDS follow-up (OR: 1.42, p =.003). The interaction of NSD with time was significant (p&lt; .001) suggesting an increase in the likelihood of conversion to MCI increased over time. Furthermore, there were significant differences in mean conversion rates to MCI in the NSD group when the previous time-point was compared to the next (p&lt;01), with a time dependent dose response in the risk of conversion to MCI observed.

Conclusion
In elderly cognitive-normal individuals, nocturnal sleep disturbance is associated with a time-dependent progression risk to MCI. These findings are consistent with the role of disturbed sleep in the development of Alzheimer’s Disease.

Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01HL118624, R21AG049348, R21AG055002, R01AG056031, R01AG022374, R21AG059179, R01AG056682, R01AG056531, K07AG05268503, K23HL125939)
1166 Investigating Social Workers’ Sleep Health Knowledge: Opportunities to Promote Sleep Health Among Underserved Populations
Authors: Spadola C E , Groton D , Lopez R , Burke S L , Hilditch C , Pandey A , Littlewood K , Zhou E S , Bertisch S M 
Published: May 2020

Abstract

Introduction
Social workers are often front-line psychosocial providers working with underserved populations, many of whom struggle with sleep. They are uniquely positioned to promote sleep health among individuals experiencing health inequities. However, U.S. accredited social work programs do not require sleep health training. We used both quantitative and qualitative methodologies to investigate social work students’: a) sleep health knowledge; b) self-reported sleep quality; c) prior sleep health education; and d) client discussions about sleep, in order to inform the development of a sleep health training for social work students.

Methods
Twenty-five social work students were recruited via a listserv email sent at a Florida university. Participants were asked to complete the Sleep Beliefs Scale (SBS) and the Pittsburgh Sleep Quality Index (PSQI) and then to participate in a one-hour long focus group (3 groups with 6-11 students/group) conducted by experienced qualitative researchers.

Results
Mean age was 27.0±11.5 yrs, 92.0% were female, and 48.0% were non-Hispanic white, 28.0% African American, 16.0% Hispanic, 8.0% other. Only 28.0% indicated that they had ever discussed sleep with clients. Knowledge of healthy sleep behaviors (assessed via the SBS) was moderate on a 0-20 scale (13.88, S.D.= 2.7). Participants had an average PSQI score of 8.8 (SD.=4.0), reported sleeping an average of 6.0 hours (SD=1.6), and mean sleep efficiency of 87.0% (SD=12.0). Themes from focus group data highlight students’ lack of exposure to sleep health training and a dearth of sleep discussions in clinical practice.

Conclusion
Though social work students acknowledged the importance of sleep health promotion, they reported feeling ill-equipped to promote healthy sleep practices due to lack of sleep education. Sleep health training could allow social workers to confidently promote healthy sleep practices among their clients, recognize when appropriate to refer clients for evaluation for sleep disorders, and improve social workers’ own sleep health. An online educational program was subsequently created by study investigators to meet these aims.

Support
American Academy of Sleep Medicine Foundation
1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider
Authors: Levri J M , Jobe S , Albrecht J , Scharf S , Johnson A , Wickwire E 
Published: May 2020

Abstract

Introduction
Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers.

Methods
Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI).

Results
A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses.

Conclusion
Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients.

Support
This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).
1180 The Use Of Natural Language Processing To Extract Data From Psg Sleep Study Reports Using National Vha Electronic Medical Record Data
Authors: Nowakowski S , Razjouyan J , Naik A D , Agrawal R , Velamuri K , Singh S , Sharafkhaneh A 
Published: May 2020

Abstract

Introduction
In 2007, Congress asked the Department of Veteran Affairs to pay closer attention to the incidence of sleep disorders among veterans. We aimed to use natural language processing (NLP), a method that applies algorithms to understand the meaning and structure of sentences within Electronic Health Record (EHR) patient free-text notes, to identify the number of attended polysomnography (PSG) studies conducted in the Veterans Health Administration (VHA) and to evaluate the performance of NLP in extracting sleep data from the notes.

Methods
We identified 481,115 sleep studies using CPT code 95810 from 2000-19 in the national VHA. We used rule-based regular expression method (phrases: “sleep stage” and “arousal index”) to identify attended PSG reports in the patient free-text notes in the EHR, of which 69,847 records met the rule-based criteria. We randomly selected 178 notes to compare the accuracy of the algorithm in mining sleep parameters: total sleep time (TST), sleep efficiency (SE) and sleep onset latency (SOL) compared to human manual chart review.

Results
The number of documented PSG studies increased each year from 963 in 2000 to 14,209 in 2018. System performance of NLP compared to manually annotated reference standard in detecting sleep parameters was 83% for TST, 87% for SE, and 81% for SOL (accuracy benchmark ≥ 80%).

Conclusion
This study showed that NLP is a useful technique to mine EHR and extract data from patients’ free-text notes. Reasons that NLP is not 100% accurate included, the note authors used different phrasing (e.g., “recording duration”) which the NLP algorithm did not detect/extract or authors omitting sleep continuity variables from the notes. Nevertheless, this automated strategy to identify and extract sleep data can serve as an effective tool in large health care systems to be used for research and evaluation to improve sleep medicine patient care and outcomes.

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).
1187 What Types Of Organizations Provide Sleep-focused Workplace Health Promotion Programs For Their Employees? An Analysis Of The 2017 CDC Workplace Health In America Survey
Authors: Robbins R , Rosenberg E , Barger L K , Weaver M , Quan S F , Zeepvat J , Czeisler C A , Grandner M A 
Published: May 2020

Abstract

Introduction
There has been a rise in workplace health promotion programs (WHPP)’s in the U.S., designed to improve a variety of employee health behaviors such as exercise and nutrition. Yet, relatively few focus on the third pillar of health: Sleep.

Methods
The CDC collected data from a nationally-representative cohort of companies in 2017. Participants in this Workplace Health in America study completed online surveys reporting the type of WHPP offerings at their worksite and characteristics of their worksite, including occupational field (e.g., agriculture, management, wholesale/retail), workforce size (i.e., small: &lt;100; moderate: 100-499; and large: 500+) and company type (e.g., non-profit, profit-private, profit-public, government). We identified factors associated with an increased likelihood of sleep-focused WHPP using logistic regression adjusted for company size and type. Analyses were weighted for nationally-representative estimates.

Results
Of the N=2,843 companies that provided information, N=261 (11.74%) reported having a sleep program. Worksites with large workforces (OR=4.8, p&lt;0.0005), for-profit public companies (OR=9.0, p&lt;0.0005), in wholesale/retail (OR=3.8, p&lt;0.0005), and those with employer-subsidized full health insurance (OR=12.7, p&lt;0.0005) were more likely to have a sleep-focused WHPP. Other predictors included more long-standing WHPP programs (6 years, OR=4.4, p&lt;0.0005), the presence of employee health in the company’s mission (OR=4.5, p&lt;0.0005), leadership buy-in (OR=3.5, p=0.007), and an annual health promotion budget &gt;$50,000 (OR=11.3, p&lt;0.0005).

Conclusion
In general, workplaces with higher budgets, more well-established health promotion programs, and a mission to promote workplace health are more likely to include a sleep program. Also, publicly-traded companies and government were more likely than private companies to have a sleep program. Future research may consider defining barriers among small business and non-profit organizations for implementing sleep-focused workplace health programs.

Support
T32HL007901
1209 Effect Of Wearables On Sleep In Healthy Individuals: A Randomized Cross-over Trial And Validation Study
Authors: Berryhill S , Morton C J , Dean A , Berryhill A , Provencio-Dean N , Patel S I , Estep L , Combs D , Mashaqi S , Gerald L B , Krishnan J , Parthasarathy S 
Published: May 2020

Abstract

Introduction
To determine whether a wearable sleep-tracker improves perceived sleep quality in healthy subjects. To test whether wearables reliably measure sleep quantity and quality compared to polysomnography.

Methods
A single-center randomized cross-over trial of community-based participants without medical conditions or sleep disorders. Wearable device (WHOOP, Inc.) that provided feedback regarding sleep information to the participant for 1-week and maintaining sleep logs versus 1-week of maintaining sleep logs alone. Self-reported daily sleep behaviors were documented in sleep logs. Polysomnography was performed on one night when wearing the wearable. PROMIS Sleep disturbance sleep scale was measured at baseline, 7, and 14 days of study participation.

Results
In 32 participants (21 women; 23.8 + 5 years), wearables improved nighttime sleep quality (PROMIS sleep disturbance; B= -1.69; 95% Confidence Interval -3.11, -0.27; P=0.021) after adjusting for age, sex, baseline, and order effect. There was a small increase in self-reported daytime naps when wearing the device (B = 3.2; SE 1.4; P=0.023) but total daily sleep remained unchanged (P=0.43). The wearable had low bias (2.5 minutes) and low precision (5.6 minutes) errors for measuring sleep duration and measured dream sleep and slow wave sleep accurately (Intra-class coefficient 0.74 + 0.28 and 0.85 + 0.15, respectively). Bias and precision error for heart rate (bias -0.17%; precision 1.5%) and respiratory rate (bias 1.8%’ precision 6.7%) were very low when compared to that measured by electrocardiogram and inductance plethysmography during polysomnography.

Conclusion
In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables.

Support
WHOOP Inc.
1218 Obstructive Sleep Apnea Due To Oromandibular Dystonia And Treated With Botulinum Toxin
Authors: Hsieh Caleb , Hsu Nancy , Thomas Aaron , Chang Melisa , Ryden Armand , Zeidler Michelle 
Published: May 2020

Abstract

Introduction
Abnormalities of the upper airway are an underrecognized cause of obstructive sleep apnea (OSA). Oromandibular dystonia (OMD) is characterized by involuntary contractions of the masticatory, facial, pharyngeal or laryngeal muscles usually resulting in pain, dysarthria, dysphagia, or impaired mastication. We present a patient with OMD manifest as episodic OSA and sleep maintenance insomnia treated effectively with botulinum toxin injections of the temporalis and masseter muscles.

Report of Case
A 51-year-old man was referred for fatigue and insomnia. History was notable for prior facial trauma requiring jaw surgeries with titanium prostheses and chronic OMD requiring periodic botulinum toxin injections of the temporalis and masseter muscles.
An initial home sleep test (HST) 43 days after the last botulinum toxin injection showed a respiratory event index of 6.5 events/hour. Given severity of symptoms, positive airway pressure (PAP) was initiated; however, due to poor tolerance and persistent symptoms, he was referred for attended polysomnography (PSG). The PSG was done 13 days after an injection and showed apnea-hypopnea index (AHI) of 0 events/hour. Because the patient continued to endorse episodically severe symptoms that he felt paralleled the severity of OMD and waning of botulinum toxin effect, a repeat PSG was performed at a subjective botulinum toxin effect nadir. This PSG done at 83 days post-injection demonstrated AHI of 84 events/hour. PAP therapy was thus resumed, and the patient’s symptoms improved with increased frequency of botulinum toxin treatments.

Conclusion
To our knowledge, this is the first report of OSA due to chronic dystonia of the facial muscles. Botulinum toxin has demonstrated benefit in the treatment of OMD with efficacy generally lasting three to six months. While PAP remains the first-line treatment for OSA, in patients with structural or functional abnormalities of the upper airway, it is important to also consider treatment of the underlying anatomical defect.