bluuebunny/crossref_metadata_2025_split huggingface dataset:
1238 Central sleep apnea with Cheyne Stokes breathing in a pediatric patient with heart failure
Authors: Powell Weston T , Chen Maida , MacKintosh Erin 
Published: May 2020

Abstract

Introduction
Central sleep apnea due to Cheyne-Stokes breathing (CSA-CSB) commonly occurs in adult patients with chronic heart failure, but has rarely been described in children. We describe a case of CSA-CSB in a pediatric patient with dilated cardiomyopathy and acute heart failure.

Report of Case
A 12-year-old is admitted to the intensive care unit in the setting of new diagnosis of dilated cardiomyopathy leading to acute systolic and diastolic heart failure requiring inotropic infusions. After admission she is noted to have self-resolving desaturations on continuous pulse oximetry while asleep. Sleep medicine is consulted for further evaluation. She has desaturations during naps and night-time sleep that are not associated with any snoring, congestion, cough, choking, or gagging. She underwent adenotonsillectomy 7 years prior. Her father has dilated cardiomyopathy. Current medications are spironolactone, furosemide, ranitidine, loratadine, enoxaparin, milrinone and epinephrine infusion. Physical exam reveals an obese girl with absent tonsils, clear breath sounds, and tachycardia. Cardiac MRI showed severely dilated left ventricle with global hypokinesia and depressed function (EF 7%). Polysomnography reveals AHI 24.2/hr, with oAHI 0/hr and cAHI 24.2/hr. No snoring, flow limitation, or thoracoabdominal paradox is seen. Cheyne-Stokes respiration is present leading to diagnosis of CSA-CSB.
Supplemental oxygen is provided to blunt desaturations. While waiting for titration PSG she underwent placement of a left ventricular assist device and orthotopic heart transplantation. Following heart transplantation she had resolution of desaturations while asleep without supplemental oxygen; family declined repeat polysomnography.

Conclusion
Central sleep apnea with Cheyne-Stokes breathing is associated with increased mortality in adult patients with heart failure and provides important prognostic information if identified. The prevalence of central sleep apnea and its implications are unknown in pediatric patients and our case highlights the need to consider sleep disordered breathing as a cause of desaturations in patients with acute heart failure.
0127 Relationship Between Sleep Metrics with Free-Living Glucose Concentrations and Glycemic Variability in Non-Diabetic Adults
Authors: Sparks J R , Kishman E E , Wang X 
Published: May 2020

Abstract

Introduction
Insufficient sleep and poor sleep quality have been associated with impaired glucose metabolism at fasting and under experimental conditions. Continuous glucose monitoring (CGM) measures glucose concentrations over an extended, free-living period that can be used to assess glycemic health. Relationships between CGM-assessed glucose concentrations and glycemic variability, an emerging glycemic health marker, with sleep metrics have yet to be elucidated. The purpose of this study was to examine the relationships between sleep metrics with glucose concentrations and glycemic variability in non-diabetic adults.

Methods
Twenty-four non-diabetic adults (age=46.0±5.8 years; BMI=32.2±5.7 kg/m2) completed actigraphy, sleep diary, and CGM over 7 consecutive days. Time-in-bed (TIB), total sleep time (TST), wake duration after sleep onset, and sleep efficiency [(TST÷TIB)×100%] were determined using actigraphy assisted with sleep diary input. Nightly variability of each sleep metric was calculated as standard deviation (SD) across all nights. Glucose concentrations at waking in the morning, and 1, 2, and 3 hours prior to waking, and diurnal, nocturnal, and 24-hour means were determined. Intra-day glycemic variability, including mean amplitude of glycemic excursions and continuous overlapping of net glycemic action of 1, 2, and 4 hours, and inter-day glycemic variability, mean of daily differences, were calculated. Pearson product correlations between sleep metrics with glucose concentrations and glycemic variability were performed.

Results
Average TIB and TST were 462.6±61.7 minutes and 403.3±59.7 minutes, respectively. TIB negatively correlated with glucose concentrations at 2 and 3 hours prior to waking (r=-0.42, p=0.04 and r=-0.42, p=0.04, respectively). Nightly variability in sleep efficiency positively correlated with waking, and 1, 2, and 3 hours prior to waking glucose concentrations (0.44≤r≤0.48, p≤0.03 for all). No sleep metrics correlated with glycemic variability measures (p≥0.10 for all).

Conclusion
Findings suggest a longer amount of sleep opportunity and more consistent sleep efficiency relate to better glucose metabolism in non-diabetic adults.

Support
American Heart Association 14BGIA20380706 and University of South Carolina Support to Promote Advancement of Research and Creativity Grant #11530-17-43917.
1268 When scars don’t let you sleep- unusual case of Restless Legs Syndrome secondary to Keloids
Authors: Agarwal Abhishek , Chopra Nikki , Rives-Sanchez Marisela , Bae Charles 
Published: May 2020

Abstract

Introduction
Restless leg syndrome(RLS) is a common disorder which has been estimated to be present in 5 – 15% of the general population with 2.5 % requiring intervention. RLS can be primary or secondary. Secondary RLS usually develops later in life and is associated with another disorder like chronic kidney disease, iron deficiency, spinal cord disease, or varicose veins. Keloids have never been reported to be the cause of RLS.

Report of Case
50 y.o female with hypertension and diabetes presented for evaluation of loud snoring and witnessed apneas. Prior to the visit she underwent a sleep study that showed she had moderate sleep apnea (AHI 15). She also reported having a painful sensation in her legs mainly at night affecting the skin on her calves. The painful sensation gave her an urge to move her legs. Moving or rubbing her legs helped relieve the painful sensation partially. She did not have these symptoms during the day. The symptoms started in the summer of 2018 after she started having keloids on her calves. Keloids followed the course of her varicose veins and the keloids progressed over the last year. Her RLS symptoms were less bothersome when the keloids were smaller. When she has taken tramadol and oxycodone in the past for other pains, she noticed that her painful RLS symptoms were completely eliminated. She was taking gabapentin 600 mg at bedtime for neuropathic pain which hasn’t helped her RLS symptoms. On physical exam, major keloids were seen bilaterally on her calves. Her OSA with treated with CPAP and she was also asked to increase her gabapentin from 600 mg to 1200 mg for her restless legs.

Conclusion
This is one of the first reported cases of RLS secondary to keloids. Whether treatment of keloids would help relieve RLS symptoms is unknown.
0142 TAK-925, an Orexin 2 Receptor-Selective Agonist, Enhanced Cortical Arousal in a Narcolepsy Mouse Model Different from Effects of Modafinil
Authors: Kimura H , Ishikawa T 
Published: May 2020

Abstract

Introduction
Patients with narcolepsy type 1 (NT1) suffer from distressing symptoms such as excessive daytime sleepiness (EDS) and cataplexy. Modafinil is widely used as a therapy for NT1; however, it has limited efficacy for EDS and no efficacy for cataplexy. TAK-925 is an orexin 2 receptor (OX2R)-selective agonist which improves multiple symptoms of narcolepsy such as fragmentation of wakefulness and cataplexy-like episodes, and also reduces weight gain, in orexin/ataxin-3 mice, a narcolepsy mouse model. An early proof of concept study showed TAK-925 increased wakefulness compared to placebo in individuals with NT1; however, a head-to-head comparison between TAK-925 and modafinil in NT1 has not been performed to date. In this study, we carefully compared the wake-promoting effects of TAK-925 and modafinil in orexin/ataxin-3 mice.

Methods
TAK-925 or modafinil was administered to orexin/ataxin-3 mice at zeitgeber time 12, and the sleep/wakefulness states were evaluated based on electroencephalogram (EEG) and electromyogram measurements. EEG spectral analysis was performed by fast Fourier transform during wakefulness. EEG frequency band was divided into five frequency bands: delta, theta, alpha, beta, and gamma.

Results
Both TAK-925 and modafinil significantly increased wakefulness time, and ameliorated fragmentation of wakefulness, in orexin/ataxin-3 mice during active phase. In contrast, TAK-925, but not modafinil, significantly decreased delta power, and increased alpha and gamma power during wakefulness in orexin/ataxin-3 mice, suggesting a shift in EEG power density toward higher frequencies.

Conclusion
TAK-925, but not modafinil, enhanced cortical arousal and suppressed signs of somnolence and drowsiness. In a phase 1 study in individuals with NT1, TAK-925 was found to have pronounced effects on the maintenance of wakefulness test, reaching a total duration of 40 minutes wake time at some doses tested. Spectral analysis will be evaluated in future studies in NT1 patients.

Support
This work was conducted by Takeda Pharmaceutical Company Limited.
0145 Pre-Sleep Cognitive Arousal Decreases Following a 4-Week Introductory Mindfulness Course
Authors: Hassirim Z , Lim E C , Lo J C , Lim J 
Published: May 2020

Abstract

Introduction
Mindfulness-based training has shown potential in reducing anxious and ruminative thoughts before sleep, and improving sleep quality. However, traditional 8-week programs have limited acceptability and uptake. In this study, we aimed to test the effects of a short introductory mindfulness training course on pre-sleep arousal and sleep quality.

Methods
Enrollees in a 4-week Mindfulness Foundation Course were invited to participate in the study and were allocated to one of two groups: intervention (N = 57) and waitlist control (N = 39). 101 participants enrolled in the experiment and 96 completed the protocol (mean(sd) age = 49.5(1.5), 56 female). Participants completed the Pittsburgh Sleep Quality Inventory (PSQI) and the pre-sleep arousal scale (PSAS), and were monitored by actigraphy for a week at baseline and post-intervention. To test the effect of the intervention, outcome variables were subjected to repeated-measures ANCOVA with group as a between-subject variable, and age, gender, and years of education as covariates using intent-to-treat analysis.

Results
PSQI scores improved across both groups (treatment: t56=4.25, p&lt;.001, mean(sd) = 6.93(3.25)); waitlist: t38=3.27, p=.002, mean(sd) = 7.15(3.55)); however, there was no significant interaction between group and time. There was a significant group by time interaction in the cognitive arousal subscale of the PSAS (F1,90=4.71, p=.03), Post-hoc tests revealed a significant decrease in the treatment but not the waitlist group (treatment: t50=3.17, p=.001; waitlist: t30=0.20, p=.84). The decrease in cognitive arousal correlated with the decrease in PSQI scores in the treatment group only (r =.3, p=.007). Finally, a statistically significant interaction favoring the treatment group was also observed in actigraphically measured WASO (F1,82=6.18, p=0.015).

Conclusion
The study suggests that a 4-week introductory mindfulness course has moderate effects on reducing cognitive arousal prior to sleep, and that these effects are correlated with improvements in subjective sleep quality.

Support
This study was funded from a STaR investigator grant (NMRC/STaR/0015/2013) and the National Research Foundation (Singapore) Science of Learning Grant (NRF2016-SOL002-001).
0155 SUVN-G3031, A Potent and Selective Histamine H3 Receptor Inverse Agonist - Differentiating Features Over Current Treatments of Narcolepsy
Authors: Shinde A , Subramanian R , Palacharla R , Pandey S , Benade V , Jayarajan P , Bojja K , Nirogi R 
Published: May 2020

Abstract

Introduction
Majority of pharmacological agents used in the treatment of narcolepsy have several limitations. Both nonclinical and clinical evidences suggest usefulness of the histamine H3 receptor (H3R) inverse agonists for the treatment of narcolepsy and addressing several of the current limitations.

Methods
Extensive nonclinical studies were carried out for SUVN-G3031 and other pharmacological agents that are currently being used for the treatment of narcolepsy. Nonclinical parameters like inter-species binding affinity, selectivity profile, in vivo and in vitro ADME features, nonclinical efficacy, neurochemistry and safety were compared.

Results
SUVN-G3031 has no inter-species variation in binding affinity at H3R with less than 50% inhibition at 1 µM against 70 other targets. Unlike pitolisant, SUVN-G3031 has no significant binding affinity at sigma 1 and 2 receptor. SUVN-G3031 has no inhibition and induction liability towards major CYP enzymes and transporters. Pitolisant is reported to be a CYP3A4, CYP2B6, and CYP1A2 inducer and a CYP2D6 and OCT1 inhibitor. SUVN-G3031 has robust wake promoting effects. SUVN-G3031 showed negligible affinity towards hERG channel with IC50 &gt; 10 µM and had no effects on any ECG parameters in dog telemetry study. SUVN-G3031 did not show convulsion in rats up to the tested dose of 100 mg/kg, p.o. Most of the pharmacological agents used for the treatment of narcolepsy have abuse liability; SUVN-G3031 produced no change in the striatal and accumbal dopamine levels in rats suggesting no propensity to induce abuse liability. Unlike competing H3R inverse agonists, SUVN-G3031 has no effects on fertility and embryo-fetal development up to the highest tested doses.

Conclusion
Nonclinical studies demonstrate superiority of SUVN-G3031 over pharmacological agents currently used in the treatment of narcolepsy. SUVN-G3031 is being evaluated in a Phase 2 study as monotherapy for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380).

Support
None
0168 Effects of School Night Sleep Duration and Circadian Preference on Student Tardiness: An Investigation in a Middle-School Aged Sample
Authors: Tran K M , Cook J D , Blair E E , Peppard P E , Plante D T 
Published: May 2020

Abstract

Introduction
Sleep and circadian factors play an important role in school attendance, academic performance, and daytime behaviors among adolescents. This investigation assessed school night sleep duration (SNSD) and circadian preference (CP) association with first period tardies (FPT) using a middle-aged sample from the Madison (Wisconsin) Metropolitan School District (MMSD), prior to implementation of a planned district-wide delay in middle school start times.

Methods
4,175 middle-school aged students from 12 MMSD schools completed a sleep survey, which included SNSD and a validated 4-level measure of CP. Self-reported SNSD between 4-and-12 hours served as final sample inclusion criterion. Mixed effects modeling was employed with students nested within school. Linear regression determined SNSD and CP effect on student tardiness. Individual, year-long FPT served as outcome variable. Inclusion of SNSD quadratic term was not statistically indicated. Full model covariates included age, sex, race, parent educational level, homelessness, free and reduced lunch, and special education status.

Results
Final sample included 3,860 students. Univariate regression determined a significant CP association with FPT [β=1.20, 95% CI (0.54, 1.86), F(1,10.41)=13.7, p=0.004), but not SNSD [β=-0.31, 95% CI (-0.70, -0.09), F(1,10.21)=2.5, p=0.14]. SNSD and CP interaction was not significant. CP significance was maintained in the full model [β=1.24, 95% CI (-0.70, -0.09), F(1,11.21)=13.7, p=0.004]. Evening preference associated with 3.72 more FPT, relative to morning preference.

Conclusion
Results suggest evening preference is associated with increased risk of tardiness among middle school students. Future research that examines the relationships between delayed school start times, circadian preference, and impact on school tardiness is indicated.

Support
This research was generously supported by a grant from the Madison Education Partnership (MEP).
0175 Light Improves Alertness and Mood During the Sleep Inertia Period Following Slow Wave Sleep
Authors: Hilditch C J , Feick N H , Wong L R , Bathurst N G , Flynn-Evans E E 
Published: May 2020

Abstract

Introduction
Waking from sleep, especially slow wave sleep (SWS), is associated with reduced alertness known as sleep inertia. Light improves alertness during sleep deprivation and circadian misalignment. In this study, we assessed the efficacy of light to improve alertness and mood immediately after waking from SWS.

Methods
Twelve participants kept a sleep schedule of 8.5 h for 5 nights and 5 h for one night prior to the overnight laboratory visit (confirmed by actigraphy). Participants went to bed at their scheduled habitual bedtime in the laboratory and were monitored by standard polysomnography. After at least 5 min of SWS, participants were awoken and exposed to either red ambient light (control) or blue-enriched bright light (light) for 1 h. During this time, participants completed a subjective scale of alertness (Karolinska Sleepiness Scale, KSS) and visual analogue scales (VAS) of mood at 2 min, 17 min, 32 min, and 47 min after waking. Following this sleep inertia measurement period, all lights were turned off and participants were allowed to return to sleep. They were then awoken again from their subsequent SWS period and exposed to the opposite condition (control or light). A linear mixed-effects model with fixed effects of condition, time, and condition*time and a random effect of participant was used to determine the impact of light across the testing period. An average of baseline responses (pre-sleep) was included as a covariate.

Results
Compared to the control condition, participants exposed to blue-enriched bright light reported feeling more alert (KSS: F1,77=4.955, p=.029; VASalert: F1,77=8.226, p=.005), more cheerful (VAScheerful: F1,77=8.615, p=.004), less depressed (VASdepressed: F1,77=4.649, p=.034), and less lethargic (VASlethargic: F1,77=5.652, p=.020).

Conclusion
Exposure to blue-enriched bright light immediately after waking from SWS may help to improve subjective alertness and mood. Future analyses will explore whether these findings extend to effects on cognitive performance.

Support
Naval Postgraduate School Grant. NASA Airspace Operations and Safety Program, System-Wide Safety Project.
0199 Sleep and Risk Taking Behavior in United States Army Soldiers: A Four Study Mega-Analysis
Authors: Mantua J , Sowden W J , Mickelson C , Choynowski J J , Bessey A F , Burke T M , Capaldi V F , McKeon A B 
Published: May 2020

Abstract

Introduction
In military service members, high risk-taking behavior (RTB; e.g., looking to start a fight, reckless driving) leads to injury, judicial reprimand, and removal from military service. Consequently, reducing RTB has become a priority of the United States (U.S.) Army, and identifying modifiable antecedents of RTB has become critical. In non-military populations, in-lab studies have shown sleep restriction/deprivation leads to risky decision-making. We assessed whether sleep duration/quality and RTB are related in U.S. Army soldiers in operationally-relevant settings.

Methods
Sleep and RTB questionnaire data were collected in 4 unique samples: U.S. Army soldiers from an Armored Brigade Combat Team, Reserve Officer Training Corps (ROTC) Cadets, Special Operations infantrymen, and elite mountain warfare instructors. We aggregated data to conduct a mega-analysis, which is a combined analysis of original raw data. We assessed whether RTB (assessed with an in-house measure of soldier-specific RTB) was correlated with nightly sleep hours (n=2175), Insomnia Severity Index (n=1076), and Pittsburgh Sleep Quality Index scores (n=503). Next, using a linear regression, we assessed whether sleep duration was a predictor of RTB while controlling for relevant demographic factors (age, gender, marital status, combat experience, years of education, rank, years of service; n=1198).

Results
Higher RTB was correlated with lower sleep duration (r=-.23,p&lt;.001), more insomnia symptoms (r=.29,p&lt;.001), and poorer sleep quality (r=.20,p&lt;.001). In the full model, lower age (B=-.02,p=.03) and higher combat experience (B=.05,p=.006) predicted higher RTB. Sleep duration remained a significant (and the strongest) predictor of RTB (B=-.18,p&lt;.001).

Conclusion
Military leaders should work to build in more sleep opportunities and remove environmental sleep disruptors during training and deployment operations. Leaders should also monitor soldier behavior after military operations that require sleep loss in order to reduce RTB, and, consequently, increase the readiness of the force.

Support
This work was supported by the Military Operational Medicine Research Program (MOMRP). The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US Department of Defense. This abstract has been approved for public release with unlimited distribution.
0204 The Impact of Sleep on Well-Being and Diurnal Performance in Elite Australian Football League Athletes
Authors: Facer-Childs E R , Drummond S P , Rajaratnam S W 
Published: May 2020

Abstract

Introduction
The ultimate goal in the sports world is achieving optimal health and continuous high-level performance through an adequate balance of training load and recovery e.g. rehab, nutrition, well being and sleep. Athletes often encounter situations that negatively impact their ability to sleep well, disrupt their biological rhythms and increase mental stress e.g. late competition times, travel and high training load. Therefore, there is a need to increase our understanding of how individual variability could be impacting recovery and performance in elite sports.

Methods
This study examined the relationships between individual sleep and circadian patterns, well-being and performance variables in Australian Football League (AFL) athletes. Actigraphy combined with daily sleep diaries were used to gather objective sleep data over a period of 14 days. Performance tests were conducted in the morning (between 07:00 - 08:00am) and afternoon (between 14:00 - 15:00) on days 3, 5, 7, 10, 12 and 14. Performance measures included a strength test (force plate jump), a skilled based accuracy test (goal kicking) and a reaction time test (psychomotor vigilance task).

Results
Preliminary results show that sleep and circadian parameters differed significantly between individuals and were correlated with measures of well-being and diurnal performance.

Conclusion
The Australian Football League (AFL) is one of the largest growing sports industries in Australia and New Zealand with annual revenues reaching a billion dollars. These findings add to the growing literature showing how sleep impacts performance in elite athletes and highlights the need to take sleep and time of day into account. This is of critical importance to the global sports industry, who are constantly seeking marginal gains.

Support
n/a