bluuebunny/crossref_metadata_2025_split huggingface dataset:
1219 A CASE OF A NIGHT TIME AFFAIR
Authors: Ali Hamed , Stevens Suzanne 
Published: May 2020

Abstract

Introduction
Sleep associated seizures especially Nocturnal Frontal Lobe Epilepsy (NFLE) represents a spectrum of challenging clinical manifestations presenting as complex nocturnal movements/behaviors, making the diagnosis often difficult.

Report of Case
A 64 y/o male, with history of ongoing complex movements occurring during his sleep, with no history of strokes or neurological deficits. Had extensive neurologic workup (all negative) including routine electroencephalogram (EEG), prolonged inpatient EEG (12 hours), and MRI of the brain. Home sleep study showing moderate obstructive sleep apnea (OSA) AHI 24/hour successfully treated with CPAP therapy (residual AHI 1.7/hour) with improved nighttime symptoms initially. Wife recalls events as happening only at night while sleep, as patient often confused upon waking up in the morning, at times appear to sit up and smack his lips. No nighttime hallucinations, sleep paralysis, or acting out dreams were reported. Had two episodes associated with tongue biting and loss of bladder control. Another episode happened after a daytime nap, patient went outside and was mowing his lawn, went “completely blank “, appeared confused. No daytime or nighttime seizures were ever noticed. Patient do not recall any of the above events. Repeat EEG was normal. MRI/MRA of the head /neck showed small tiny focus in left frontoparietal lobe, suggesting remote cortical ischemic injury. Polysomnography (PSG) with seizure montage showed Interictal epileptic discharges (IEDs) foci recorded in the frontal/frontopolar leads without accompanying body movements. Interictal spike and wave activity seen during stage N2.
Initially treated with carbamazepine (had skin reaction) switched to levetiracetam with complete resolution of his symptoms.

Conclusion
This case illustrates the importance of reviewing the clinical history, behavior semiology, and diagnostic ancillary testing such as polysomnography with EEG monitoring in distinguishing nocturnal epileptic seizures from other nocturnal complex behavior disorders and parasomnias.
1256 Narcolepsy Type 2 in a Pediatric Patient with Auto-Immune Disease
Authors: Madhavarapu Sumith , Patel Amee 
Published: May 2020

Abstract

Introduction
We present a case of Narcolepsy Type 2 in the setting of concomitant auto-immune disease.

Report of Case
At 9 years of age, an African-American female was referred to a sleep center for fatigue, excessive daytime sleepiness (EDS), and snoring. Polysomnogram (PSG) at an outside facility recorded a total sleep time (TST) of 408 minutes, 92% sleep efficiency (SE), sleep onset latency (SOL) 22 minutes, REM latency 70 minutes, and apnea-hypopnea index (AHI) of 0.3. Multiple Sleep Latency Test (MSLT) was not done at that time. Due to her daytime sleepiness, methylphenidate was initiated empirically twice daily with improvement in daytime sleepiness and sleep maintenance. Over time, methylphenidate was steadily increased due to increasing daytime sleepiness. Between 14 to 15 years of age, she developed increased fatigue, skin changes, arthralgias, myalgias, and presented to our hospital in respiratory distress secondary to severe pulmonary hypertension. Clinical exam and workup indicated scleroderma. Methylphenidate was discontinued due to pulmonary hypertension. At 17 years of age (after receiving treatment for scleroderma and pulmonary hypertension), she had an overnight PSG followed by MSLT. PSG recorded TST 309 minutes, 67% SE, SOL 1.5 minutes, REM latency 48 minutes, AHI 0.2. The MSLT recorded a mean SOL of 2.4 minutes with 2 out of 4 sleep onset REM periods - diagnostic of narcolepsy. She does not endorse cataplexy, hallucinations or sleep paralysis.

Conclusion
While the link between Narcolepsy Type 1 and an auto-mediated process is more supported given consistent human leukocyte antigen findings, the link between Narcolepsy Type 2 and auto-immune mediated process is less clear. Patients with autoimmune disease may have symptoms of narcolepsy; therefore, they may benefit from screening for EDS.
1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation
Authors: Nuzhny V , Kleerup E C , Zeidler M R 
Published: May 2020

Abstract

Introduction
Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia.

Report of Case
This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask.

Conclusion
This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.
1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia
Authors: Manetta I , Almeida A , Schwartz D , Meira e Cruz M 
Published: May 2020

Abstract

Introduction
Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care.

Report of Case
We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3)

Conclusion
This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.
0129 Association of Sleep Quality with Serum Lipids in Obese Adults
Authors: Mehta B , Ankita A , Raghav P , Chambial S , Dutt N 
Published: May 2020

Abstract

Introduction
Sleep disturbances have been associated with metabolic dysregulation and have known to contribute to weight gain, obesity, type II diabetes, and cardiovascular disease risk. Obesity due to sleep fragmentation is mediated by multiple pathways like upregulation of orexin neurons and changes in appetite-regulating hormones like Leptin, Ghrelin, which affect food intake and hedonic feeding. Conversely, body mass index (BMI) is associated with alterations in sleep and with high circulating lipids and incidence of coronary heart disease. We hypothesized that poor sleep quality is associated with an adverse serum lipid profile.

Methods
In this cross-sectional study, till date, 27 obese adult participants were recruited after informed consent. The obesity criterion was taken as BMI ≥ 25 kg/m2. Anthropometric parameters, waist circumference, neck circumference, hip circumference, and BP were measured. Sleep quality was assessed by the “Pittsburgh Sleep Quality Index” (PSQI) questionnaire. A score of 5 or more was considered to be adverse sleep. The fasting blood sugar and lipid profile of each participant was determined.

Results
The average age, BMI and waist circumference of the subjects were 48.96 ±13.9 years, 32.41± 6.18 kg/m2 and 107.4 ±12.18 cm respectively. The Spearman correlation test revealed a significant correlation between the PSQI scores and triglyceride levels of the participants (p=0.033, r = 0.420). The correlation with BMI (p=0.33, r=0.192), fasting blood sugar (p=0.26, r=0.241), HDL (p=0.27, r = -0.221) and waist circumference (p=0.69, r = -0.082) were not found to be statistically significant.

Conclusion
We conclude that high triglyceride levels are associated with poor quality of sleep in adults. Although other biochemical parameters did not show a significant correlation, a greater sample size may give us a clear insight into it.

Support
The study is an intramural project supported by AIIMS, Jodhpur.
0157 The Relationship Between Reaction Time, Insomnia Severity, Sleepiness, and Dysfunctional Beliefs About Sleep
Authors: Gencarelli A M , Zurlinden T , Nicoletta A , Winters A , Sorrell A , Corbett Q , Everhart E 
Published: May 2020

Abstract

Introduction
Poor sleep quality has adverse effects ranging from decreased focus to increased work-related injuries. The Perceptual Vigilance Task (PVT), a measure of reaction time (RT) used to assess alertness is commonly used in sleep research. This study focuses on the relationship between dysfunctional sleep-related cognitions (Dysfunctional Beliefs and Attitudes About Sleep Scale [DBAS]), insomnia severity (Insomnia Severity Index [ISI]), and sleepiness (Epworth Sleepiness Scale [ESS]) and their association to PVT RT.

Methods
162 participants were recruited from East Carolina University. Inclusion criteria: right-handed adults; exclusion criteria: history of brain injury, seizure disorder, or vision impairment. Age range 18–39 (M = 20.15; SD = 3.01); 81 (49.1%) females.

Results
ISI was correlated with PVT RT for inter-stimulus interval delay times of 1000ms r(162) = .155, p =.05, 2000ms r(162) = .204, p = .009, 5000ms r(162) =.164, p = .04, and 6000ms r(162) = .181, p = .02. DBAS was correlated with PVT RT for delay times of 2000ms r(162) = .204, p =.021, 3000ms r(162) = .160, p = .04, 4000ms r(162) = .170, p = .03, 6000ms r(162) = .171, p = .030, 7000ms r(162) = .219, p =.005, and 8000ms r(162) = .158 p = .045. ESS was not correlated with PVT. A regression was calculated to predict reaction time at 7000ms delay based on the DBAS (F(1,151) = 2.51, p = .01), with an R2 of .12.

Conclusion
There is a diminishing association found between insomnia severity and RT during inter-stimulus delay times (&gt;6000ms). Dysfunctional beliefs about sleep correlate with RT through 8000ms delay, eventually predicting RT. Regardless of severity of sleep disturbance, sleep-related bias may affect subjective feelings of wakefulness and objective levels of alertness (e.g., one who believes they are not obtaining sufficient sleep may act accordingly).

Support
N/A
0181 Stressor Reactivity to Insufficient Sleep in Oncology Nurses: Does Work Shift Matter?
Authors: Vigoureux T F , Lee S 
Published: May 2020

Abstract

Introduction
Individuals generally perceive more stressors on days following nights with shorter-than-usual sleep duration. Recent research shows that this daily sleep—stress relationship (i.e., stressor reactivity to insufficient sleep) is stronger for some than for others. Workers in certain occupations, such as oncology nurses, may be more prone to insufficient sleep and/or more stressors. Given the impact of work schedule on sleep, this study examined whether stressor reactivity to insufficient sleep differed between day and night shift nurses working at a cancer hospital.

Methods
Participants were 39 day-shift and 19 night-shift nurses at a cancer hospital (Mage=35.36±12.00). Using ecological momentary assessments for 14 days, we asked participants about their previous night’s sleep characteristics and their daily stressor frequency and severity before lunch, during afternoon, and before bedtime. Using multi-level modeling, we tested whether previous night’s sleep duration, quality, or sufficiency predicted next day’s total stressor frequency or severity. For analyses with significant within-person effects, we extracted a reactivity slope for each participant. We used t-tests to examine whether day and night shift nurses differed in reactivity.

Results
There were significant within-person associations of sleep duration with (a) stressor frequency (b=-.07, p&lt;.001) and (b) stressor severity (b=-.76, p&lt;.001), but no associations of sleep quality or sufficiency with stressor frequency or severity. Day and night shift nurses did not differ in either of these operationalizations of stressor reactivity to insufficient sleep, or on any stressor or sleep variables except for average sleep duration (Mnight=6.87±2.57 vs. Mday=8.02±1.84, p&lt;.001).

Conclusion
These findings suggest that the phenomenon of perceiving more stressors in response to insufficient sleep exists regardless of work shifts. Given the previously found association between stressor reactivity to insufficient sleep and body mass index in middle-aged workers, further analyses will test how this reactivity is associated with health outcomes in oncology nurses.

Support
This work was supported, in part, by the University of South Florida College of Behavioral & Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).
0203 To and From the Night Shift: Risky On-the-Road Driving in Night Shift Workers
Authors: Murugan N , Sagong C , Cuamatzi Castelan A S , Moss K , Roth T , Drake C L , Cheng P 
Published: May 2020

Abstract

Introduction
Drowsy driving is a common occupational hazard for night shift workers (NSWs). While sleep loss is commonly identified as the primary culprit of drowsy driving, another critical factor to consider is circadian phase. However, the role of circadian phase in driving safety has not been well characterized in NSWs. This study examined if dim light melatonin offset (DLMOff, i.e. the cessation of melatonin secretion) is also a relevant phase marker of susceptibility to four different subtypes of risky on-the-road driving behaviors.

Methods
On-the-road driving was monitored over 8 weeks via a mobile application that tracked risky driving behaviors using accelerometer and GPS data from cell phones (N=15; 3052 total driving events recorded). Risky driving behaviors included: 1) frequency of hard-braking events, 2) frequency of aggressive-acceleration events, 3) duration of excessive-speeding, and 4) duration of phone-usage. At week 2, participants spent 24 hours in-lab where hourly saliva samples were collected and assayed for melatonin, and DLMOff was calculated. Phase angle of driving events relative to DLMOff was used as the predictor in nested mixed-effects regressions, with risky driving behaviors as the outcome variables.

Results
The most common occurrences of risky driving were phone-usage and hard-braking. On average, NSWs had 46.7% and 42.0% of driving events with at least one occurrence of phone-usage and hard-braking, respectively. Rates of aggressive-acceleration and speeding were 24.4% and 20.4%. Positive phase angles (i.e. driving after DLMOff) were associated with reduced rates of hard-braking and aggressive-acceleration, but not of phone-usage and excessive-speeding. Specifically, rates of hard-braking and aggressive-acceleration decreased by 4.5% (p&lt;.01) and 3.4% (p=.05) every two hours following DLMOff, respectively.

Conclusion
The study suggests DLMOff appears to be an important variable for predicting accident risk in NSWs. If replicated, circadian phase should be considered in recommendations to increase occupational health and safety of NSWs.

Support
Support for this study was provided to PC by NHLBI (K23HL138166).
0219 Subjective Sleep Quality Measured Before, Predicts Psychological Safety After Simulated Combat Training. Testing the Bidirectional Link Between Sleep and Social Processes in the Military Operational Context
Authors: Sowden W , St. Pierre M , Mickelson C , Mantua J 
Published: May 2020

Abstract

Introduction
The research on sleep in the social-psychological domain is sparse. Gordon and colleagues (Gordon, Mendes, & Prather, 2017) proposed a bidirectional relationship between sleep and social processes. The current research tests this model in the military by examining the relationship between subjective sleep quality and an important social cognitive process in the contexts of military teams - psychological safety (i.e., an individual’s perceptions of interpersonal threat in their work environment; Edmondson, 1999).

Methods
One hundred and twenty-eight U.S. Army tank crewmen were surveyed prior to (T1), and immediately after (T2), participating in a two-week simulated combat training exercise. Each survey included the seven-item Insomnia Severity Index (ISI; Bastien et al., 2001), which served as a measure of subjective sleep quality (SSQ), and Edmonson’s seven-item Psychological Safety Questionnaire which measured team psychological safety (TPS). A cross-lagged panel model tested the effects of SSQ and TPS over the course of the training.

Results
Both SSQ and TPS were stable over the two time points, SSQT1: M=2.83, SD=.85, α=.83; SSQT2: M=2.63, SD=.83, α=.83; B=.387, SE=.08, β=.397, p&lt;.001, and TPST1: M=3.7, SD=.72, α=.79; TPST2: M=3.67, SD=.75, α=.77; B=.619, SE=.07, β=.600, p&lt;.001, respectively. Although SSQ and TPS were weakly related to one another at both time points, rT1=.122, p=.086 and rT2=.171, p = .028, only the cross-lagged path between SSQT1 predicting TPST2 was significant, B=.129, SE=.06, β=.147, p=.038. The cross-lagged path between TPST1 predicting SSQT2 was not significant, B=-.098, SE=.094, β=-.086, p=.296. Approximately 40% of the variance in CPS, R2=.4 as opposed to 17% in SSQ, R2=.17, was accounted for by the predictors in the model.

Conclusion
These results provide support for a directional (vs bidirectional) link between SSQ and TPS, insomuch that, in the context of military training, SSQ influences TPS, as opposed to the other way around. Elucidating the directionality of this relationship is not only important for advancing theory, but more importantly, it helps practitioners develop programs and policies that precisely address the right mechanism at the right time to maximize team effectiveness and wellbeing.

Support
This work was supported by the Military Operational Medicine Research Program (MOMRP).
0231 Sleep Behaviors of Female Collegiate Athletes
Authors: Frisco D J , Goodrich J A , Holliday M , Kroeker K A , Whiting C , Byrnes W C , Wright K P 
Published: May 2020

Abstract

Introduction
Sleep is critical to cognitive and physiologic function. It is likely being a female collegiate student athlete places unique demands upon sleep behavior. Therefore, we aimed to study the sleep behavior of female collegiate athletes versus a female collegiate control group.

Methods
Full time female students from the University of Colorado Boulder (Altitude = 1,624 m) were recruited from NCAA Division I athletic teams: Cross Country (XC, n=10), Lacrosse (LAX, n =17), Soccer (SOC, n=15), Golf (GOLF, n=6), Tennis (TENN, n=9). 31 female full-time students were recruited as Controls (CONT). Sleep was monitored with wrist actigraphy (Spectrum Actiwatch, Phillips) for a minimum of one week. Subjects were instructed to wear actigraphs at all times except during competition. Outcome variables included nightly sleep duration, total 24h sleep duration, sleep efficiency, sleep midpoint, social jet lag (SJL) and nap duration/frequency.

Results
On weekdays, XC, LAX and SOC had greater nightly sleep durations ~8.5h compared to TENN, GOLF and CONT (p&lt;0.05). Relative to other groups, XC had the earliest sleep midpoint (3:34 AM ± 1:20 vs. 3:53 AM ± 1:15) while SOC and LAX had the lowest sleep efficiency (~87.3 ± 3.2% vs. ~89.6 ± 3.4%) (all p&lt;0.05). There was significant SJL among CONT, LAX and SOC (difference of sleep midpoints on weekdays and weekends; p&lt;0.05). While nightly sleep duration varied significantly between different groups, there were no significant differences in total daily sleep duration when naps are included. A greater percentage of CONT (87 %) napped compared to athletes (64.2 %) (p&lt;0.05); napping duration/frequency of naps per week were not different between groups.

Conclusion
Variations in sleep behavior exists between collegiate student athletes based upon varsity sport with some sports being similar to controls and others being significantly different. Additional research is needed to determine the significance of these findings to academic and athletic performance.

Support
PAC-12 Student-Athlete Health and Wellbeing Initiative, Grant #1554240