bluuebunny/crossref_metadata_2025_split huggingface dataset:
0498 Effect of Lavender Essential Oil on Sleep in Postmenopausal Women with Insomnia: Double-Blind Randomized Controlled Trial
Authors: Lucena L R , Santos-Junior J G , Tufik S , Hachul H 
Published: May 2020

Abstract

Introduction
Sleep is essential for women’s health and its deprivation leads to serious physiological consequences. In addition, insomnia is a common complaint in postmenopausal women. Thus, the present study aimed to evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia.

Methods
Experimental, double-blind, randomized controlled trial composed by 33 women (48 - 65 years) with clinical diagnosis of insomnia divided in two groups that inhaled different oils before sleep during 29 days: Placebo Group - PG (sunflower oil) and Aroma Group - AG (Lavandula angustifolia essential oil). Both groups received sleep hygiene guidelines and were followed weekly. To assess the effect of the intervention on menopausal symptoms the Menopause Rating Scale (MRS) and the Hospital Anxiety and Depression Scale (HADS) were used and for sleep evaluation the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) were used. Additionally, polysomnography were used to assess sleep pattern. All outcomes were evaluated before and after intervention. Statistical analysis was performed using SPSS 22 through Generalized Estimed Equations test with significance set at p≤ 0.05.

Results
Comparing the pre and post-intervention periods, AG participants had a significant decrease in sleep onset latency, depression level, hot flashes, menopausal symptoms and a significant increase in sleep quality. Polysomnography data showed increased sleep efficiency and decreased wakefulness after sleep onset on AG participants. After the intervention, all volunteers presented improvement in all outcomes of sleep and menopausal symptoms measured by questionnaires.

Conclusion
The intervention was effective in improving the sleep pattern of AG participants, but was not significant when compared to PG participants. In addition, sleep hygiene instructions were essential to improve the sleep pattern of all volunteers. Therefore, inhalation of lavender essential oil is a safe, low-cost practice that should be considered as a complementary option to conventional treatments, whether medical, psychological or other integrative and complementary practices.

Support
This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001 and Conselho Nacional de Pesquisa (CNPq).
0501 Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia “Nitecapp” in Rural Dementia Caregivers: A Mixed-Methods Study
Authors: McCrae C , Curtis A F , Nair N , Deroche C B , Shenker J , Rowe M 
Published: May 2020

Abstract

Introduction
Informal caregivers (CGs) of persons with dementia frequently experience insomnia. The time consuming and unpredictable schedule of CGs, and associated emotional/physical exhaustion emphasize the need for brief, easily accessible interventions to treat insomnia. Internet-based behavioral insomnia interventions hold promise, particularly for rural CGs who have limited access to traditional in-person treatments. This study aimed to 1) translate an efficacious 4 session cognitive behavioral therapy for insomnia (CBT-I) to web-based “NiteCAPP” for dementia caregivers, and 2) conduct NiteCAPP usability testing/evaluate acceptability of content and features.

Methods
NiteCAPP is an online CBT-I that incorporates guided delivery through weekly therapist moderator feedback. A stepwise approach was implemented in order to explore user needs and validate NiteCAPP content in a focus group of rural dementia caregivers (n=5) and primary care providers (PCPs; n=5). Participants conducted usability testing and provided ratings of program content (1-least favorable to 5-most favorable) regarding ease of use, amount of information, website maintaining interest, adequate font size, videos maintaining interest/easy to understand/helpful. Participants also indicated whether they had at home internet access, method of internet access, and provided open ended feedback on NiteCAPP. Feedback transcripts were compiled and analyzed independently (C.S.M., A.F.C.) through deductive content analysis. Topics mentioned frequently were categorized and merged into common themes during consensus meeting, and NiteCAPP was subsequently adapted.

Results
Average ratings for NiteCAPP features were high, ranging from 4.1/5 to 4.7/5 across all items. All participants had access to internet through both phone and computer. No barriers to use identified. Feedback themes were largely positive (e.g., comprehensive written material, promotes independence, excellent visual tools for therapy moderator feedback, good pacing, use of visual contrast). Negative themes for improvement/adaptation included adding font size options, a light/dark mode, tab with all videos, reducing amount of scrolling, adding a glossary of terms.

Conclusion
Rural dementia CGs and PCPs evaluated NiteCAPP as easy to use with acceptable features and program content and no barriers to access. Improvement themes were used to adapt NiteCAPP. Next steps are to evaluate feasibility and preliminary efficacy of NiteCAPP in rural dementia CGs with insomnia.

Support
none
0593 Hypoxemia During Sleep Disordered Breathing and Cardiovascular Disease: A Comparison of Different Oxygen Desaturation Measures
Authors: Mazzotti D R , Leppänen T , Sands S , Töyräs J , Wellman A , Kulkas A , Redline S , Karhu T , Azarbarzin A 
Published: May 2020

Abstract

Introduction
The apnea-hypopnea index has been used to characterize obstructive sleep apnea (OSA) severity. However, this metric is limited in providing information about cardiovascular disease (CVD) risk. Recent studies proposed alternative metrics that capture frequency, duration, depth, and combinations of duration and depth of hypoxemia. This study provides a systematic evaluation of the association between conventional or novel nocturnal hypoxemia metrics and the incidence of CVD and CV mortality in the Sleep Heart Health Study (SHHS).

Methods
We used data from 5,042 participants of the SHHS. Over 10.7 years, there were 1,312 (26.0%) incident CVD events and 359 (7.1%) CV deaths. We calculated standardized (z-scored) values of eight nocturnal hypoxemia indices, including conventional (e.g., oxygen desaturation index) and novel metrics (e.g., hypoxic burden, respiratory event-related area under desaturation curve and desaturation severity, corresponding to alternative quantitative measurements looking at the shape of each desaturation event). The association between each metric and incidence of CVD or CV mortality was evaluated using Cox proportional hazards models. Age, sex, body mass index, race, ethnicity, smoking, total sleep time, number of respiratory events, and prevalent CVD at baseline were used as covariates. Hazard ratios (HR) are presented as the effect of one standard deviation increase in each correponding metric.

Results
In unadjusted models, all nocturnal hypoxemia indices were associated with increased incidence of CVD and CV mortality. In adjusted models, longer average desaturation duration was associated with lower CVD incidence (HR[95%CI]=0.93[0.86-0.99];p=0.034), higher hypoxic burden with increased CV mortality (HR[95%CI]=1.22[1.04-1.43];p=0.017), and higher % sleep time with oxygen saturation less than 90% (Tlt90%) with increased CV mortality (HR[95%CI]=1.12[1.00-1.26];p=0.040).

Conclusion
Different metrics of nocturnal hypoxemia derived from polysomnography were associated with CV risk in the SHHS. However, after covariate adjustment, only shorter average desaturation duration, and higher hypoxic burden and Tlt90% were independent CV risk factors.

Support
AASM Foundation (194-SR-18,188-SR-17); American Heart Association (19CDA34660137); NIH (U01HL53940,U01HL53941,U01HL63463,U01HL53937, U01HL53938,U01HL53916,U01HL53934,U01HL63429,U01HL53931,HL114473, P01HL094307,HL134015,R35HL135818,1R21HL145492-01,R01HL102321,R01HL128658); The State Research Funding (KUH: 5041767, 5041768; TUH: VTR3242, VTR3228, EVO2089), Academy of Finland (313697, 323536), Business Finland (5133/31/2018), Respiratory Foundation of Kuopio Region, Tampere Tuberculosis Foundation, Research Foundation of Pulmonary Diseases, Foundation of Finnish Anti-Tuberculosis Association.
0604 Comorbidities and Admission Rates in Inpatients Undergoing Sleep Studies
Authors: Johnson K G , Ravikumar N , Scuderi N , Sharma A , Rastegar V , Visintainer P 
Published: May 2020

Abstract

Introduction
Uncontrolled sleep-disordered breathing (SDB) and hypoventilation, which are common in COPD, CHF and obesity hypoventilation patients can lead to death and readmissions. It is unknown whether inpatient sleep studies to diagnose and optimize treatment improve care and prevent readmissions.

Methods
All patients &gt; 18 years old with sleep studies while inpatient at Baystate Medical Center between October 2015 and September 2017 were included. Patient characteristics, comorbidities, sleep study diagnoses, and treatment recommendations were evaluated. Admission (inpatient or observation) and death rates were determined for 1-year before admit date and 1-year after discharge date of index admission.

Results
326 adult inpatients had 120 portable and 304 in-laboratory tests performed. Average age was 62.9±14.4, mean BMI was 37.2±12.3 and 56% were male. Principal diagnoses were CHF (50%), COPD (39%), both COPD and CHF (20%) and obesity hypoventilation (27%). 31 used PAP and 71 used oxygen prior to admission. Sleep diagnoses included OSA (73%), central sleep apnea (CSA) (29%), treatment emergent CSA (8%), hypoxia (48%), hypoventilation (41%), and normal or non-diagnostic (6%). Treatment recommendations included CPAP (25%), BiPAP (18%), BiPAP ST (3%), ASV (4%), iVAPS (22%), oxygen only (5%) and further titration (20%). The average length of stay was 11.6 ± 9.6 days. There was no difference in the percentage of patients who had an admission before or after their sleep study (53% vs 56%, respectively). In addition, no difference was seen in the median number of admissions before and after the sleep study (median=1.0, IQI=0-2, p=0.77). 90-day readmission rate was 19%. 14% died.

Conclusion
SDB, hypoxia and hypoventilation were common in inpatients evaluated with sleep studies with PAP therapy recommended in most patients. Further research is needed to determine whether inpatient testing and subsequent treatment can result in decreased readmissions and death.

Support
None
0612 Validation of NEMS-BG Score in Screening of Patients with Obstructive Sleep Apnea
Authors: Gharraf H , Baess A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is one of the most prevalent diseases worldwide. Diagnosis of OSA is still a dilemma despite our well known disease-related impact on human body health. Under-diagnosis of OSA is still a problem despite the well-established clinical and laboratory criteria of diagnosis. Over-diagnosis may lead to exhaustion of our limited health-care resources. Therefore, an efficient screening tool that is well validated and easily applied, will be an ideal solution for the over or under-diagnosis of OSA. NAMES-BG score was suggested to efficiently screen for OSA depending on neck circumference, airway classification, comorbidities, Epworth sleepiness scale, snoring score, body mass index and gender

Methods
The aim of the work was to validate NEMS-BG score in screening of patients with obstructive sleep apnea (OSA).

Patients and Methods
This is a retrospective single center clinical study. Records of patients with documented obstructive sleep apnea were collected. Those records were collected from the database of department of chest diseases in Alexandria Main University Hospital (AMUH). The records of included patients included demographic data, clinical findings, anthropometric measures and polysomnographic records. Statistics were formulated to validate the sensitivity and specificity of this score in our cohort of patients. The significance of the results were at the 5% level of significance.

Results
The cutoff value for the composite NAMES tool was calculated at ≥3 points. In the validation group, NAMES demonstrated similar test characteristics to the Berlin questionnaire, and sensitivity was statistically significantly better than that seen with the Epworth scale. The addition of BMI and gender to the tool improved screening characteristics

Conclusion
The NAMES assessment is an effective, inexpensive screening strategy for moderate to severe OSA.

Support
no support
0615 The Prevalence of Common Sleep Disorders In Young Adults: A Population-Based Study
Authors: Eastwood P R , Ward S V , Bucks R S , Maddison K , Smith A , Huang R , Pennell C E , Hillman D R , McArdle N 
Published: May 2020

Abstract

Introduction
Adult sleep disorders are associated with adverse health effects including reduced quality of life and increased mortality. However, there is a paucity of data on sleep disorders in young adulthood.

Methods
We undertook a cross-sectional observational study of 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012-2014) to describe the prevalence of common sleep disorders in young adults. We used in-laboratory polysomnography (PSG) and validated survey methods, including the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Symptom Questionnaire-Insomnia and International Restless Legs Syndrome Study Group criteria. 1,146 completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analysable PSG data.

Results
Participants had a mean age of 22.2 years and male to female ratio of 1 to 1.1. The prevalence of OSA [apnoea hypopnoea index (AHI): ≥5events/hour] was 20.8% (95%CI: 18.2 to 23.6) and this was usually of mild severity (AHI:≥5 to&lt;15events/hour, 17.1%). OSA syndrome (AHI≥5 events/hour and ESS≥11) was found in 2.8% (95%CI: 1.9 to 4.1). Chronic insomnia was present in 16.6% (95%CI: 14.7 to 19.4). Restless legs syndrome was present in 2.9% (95%CI: 2.0 to 4.0) and abnormal periodic leg movements during sleep (&gt;5 movements/hour) in 9.1% (95%CI: 7.3 to 11.1). In those participants who had complete data on all sleep-related assessments (n=841), at least one sleep disorder was present in 42.6%.

Conclusion
Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.

Support
0658 The Effect of Text Message Reminders on Positive Airway Pressure Adherence in Veterans With Obstructive Sleep Apnea
Authors: Al Saleh Q , Kim D , Jordan K , Balish M , Kataria L 
Published: May 2020

Abstract

Introduction
Adherence to positive airway pressure (PAP) therapy continues to be a challenge. The main objective of this study was to determine whether mobile text-message reminders increased PAP adherence in veterans with obstructive sleep apnea.

Methods
This is a retrospective study of 25 patients with poor adherence to PAP therapy who used the Veterans Affairs ANNIE app to receive nightly mobile text message reminders. PAP adherence was measured at baseline, 1,and 3 months. A one-way repeated measures ANOVA was used to compare the effect of time on PAP adherence, specifically the percentage of overall days used and percentage use &gt;4 hours. A two-way repeated measures ANOVA without replication was used to determine the effects of AHI severity and time on PAP adherence.

Results
Our sample demographics included a mean age of 59 ±12 years, mean BMI of 33.5% ±5.4, and mean AHI of 26.3 ±25.4. The mean PAP overall percentage use and mean use &gt;4 hours respectively were 32% ± 27 and 18% ± 19 at baseline, 66% ± 27 and 45% ± 30 at 1 month, and 54% ±32 and 37% ± 30 at 3 months. After three months of receiving nightly text-message reminders, there was a statistically significant effect of time on percentage overall PAP use, F (2, 48)=21.54, p=2.10E-07, as well as in the percentage PAP use &gt;4 hours, F (2, 48)=22.05, p=1.61E-07. A two-way repeated measures ANOVA without replication yielded a main effect of the interaction of time with PAP adherence, F (2, 48)=22, p=&lt;0.0001. AHI severity was not a significant factor.

Conclusion
Nightly text message reminders significantly improved PAP adherence from baseline to 3 months. Though PAP adherence was not optimal, it doubled initially in our sample. Further studies are warranted to determine how text-messages can be used long term to improve adherence.

Support
Nil
0668 Identifying Risk Of Positive Airway Pressure Therapy Non-Adherence Before Beginning Therapy: The Importance Of First Impressions
Authors: Shaughnessy G F , Morgenthaler T I 
Published: May 2020

Abstract

Introduction
Prior studies established that compliance during the early days of positive airway pressure (PAP) therapy predicts long-term adherence, which in turn relates to outcomes. However, patient impressions gathered immediately after PAP titration may be the earliest indication of adherence and could help focus efforts at improving compliance. The aim of this study was to examine whether a survey on PAP experience during polysomnography predicts adherence.

Methods
This prospective cohort study included PAP naïve adults with obstructive sleep apnea who had PAP titration during polysomnography and had 30 day adherence data available. Patients answered a pre-existing 5-question survey with dichotomous answers (yes/no) regarding their PAP experience (improved sleep, general discomfort, PAP related discomfort, mask discomfort, willingness to use PAP). Primary outcome was 30 day adherence (average time used per night, percent of nights used, percent of nights with &gt;4 hours use).

Results
We enrolled 47 patients (68% male) with average age of 62.4 years, body mass index 32.6 kg/m2, and apnea-hypopnea index 27.8/hr. Patients answered an average of 3.4±1.3 survey questions favorably. The number of favorable answers correlated with percent of nights used and percent of nights with &gt;4 hours use (P&lt;0.05). Patients with improved sleep during PAP titration had a greater percent of nights with &gt;4 hours use (82.4% vs 60.3%; P &lt;0.05). In addition, successful titration during polysomnography (less than 5 events per hour) correlated with improved adherence and less leak after 30 days.

Conclusion
Initial PAP titration experience influences future PAP adherence. Although there was a correlation between answers on our pre-existing questionnaire and outcomes, some questions did not contribute much for this use. We believe a next step would be to develop questions that help predict future usage and better guide therapy.

Support
None
0682 Evaluation Of An Incentive-based Intervention To Improve 90-day Adherence In Pap-naive Patients
Authors: Merchant G , Valentine K , Hevener W , Willes L , Ta D , Hernandez R , Gagnon R , Chen K , Blase A 
Published: May 2020

Abstract

Introduction
Although PAP therapy is the gold standard treatment for obstructive sleep apnea, adherence to treatment is suboptimal. Without sustained therapy adherence, patients are at risk of serious negative health outcomes. The objective of this study was to test whether a digitally delivered monetary and social reward program helped patients new to PAP therapy. Financial incentive schemes are effective in helping patients adhere to difficult medication or therapy plans. Additionally, there is an abundance of evidence that social support is a critical component to long-term health behavior change.

Methods
This prospective, randomized, single site pilot is evaluating the effectiveness of an app-based intervention in helping patients adhere to PAP therapy. The financial incentive design leverages loss aversion, and the social incentive design leverages the strength of close ties and variable reinforcement. The primary endpoint is mean PAP usage at 3 months. Secondary endpoints include Medicare compliance, change in functional status, and baseline scores of perceived disease severity, claustrophobia, coping skills, and health literacy as moderators of the intervention’s effectiveness. Study recruitment is ongoing, with an expected sample size of 150 subjects.

Results
Of the 132 subjects enrolled, 56% are male, 61% are Caucasian, and 65% are married. The mean age is 49.6 ± 12.0 years and mean BMI is 32.4 ± 8.4 kg/m2. Additional demographics such as income level, education level, and number of children along with the primary and secondary endpoints will be presented. A subgroup analysis of the primary endpoint will be generated for subjects identified as strugglers within the first 3 days of usage.

Conclusion
The results of this study will provide insight into methods such as financial and social incentives delivered via a smartphone on initial compliance with PAP therapy, as well as provide more information on the behavioral change associated with beginning PAP therapy.

Support
ResMed
0686 Diabetes Sleep Treatment Trial: The Effect Of Treatment Of OSA With CPAP On Glycemic Control In Type 2 Diabetes
Authors: Chasens E R , Sereika S M , Kortykowski M , Stansbury R , Burke L , Strollo P J , Bizhanova Z , Atwood C W 
Published: May 2020

Abstract

Introduction
Evidence remains unclear whether treatment of OSA with CPAP results in improved glycemic control. This study evaluated if CPAP improved glucose control compared to sham-CPAP and the effect of adherence to active CPAP on glucose control after 6 and 12 weeks of treatment.

Methods
This was a multi-center, double-blind clinical trial. Participants were adults with type 2 diabetes (T2D), A1C≥6.5%, apnea + hypopnea index (AHI)≥10, and naïve to CPAP. All participants received diabetes education. Glucose control was evaluated with frucostamine and A1C levels; CPAP adherence with a wireless modem system. Statistical analysis followed an “intent-to-treat” approach with linear mixed modeling. The dose of active CPAP was calculated as the percentage of days with active CPAP use≥4 hours and the average adherence of active CPAP with sham coded as “0”dose”.

Results
Randomized participants (N=98, CPAP=50; sham-CPAP=48) were primarily middle-aged (age=58.7±9.8 years), White (75%), males (57%) obese (BMI=36.2±6.6), suboptimal glucose control (A1C=7.9%±0.9) and OSA (AHI=23.9±14.4). There were no significant baseline differences except in A1C (Active CPAP=7.7%±0.8; sham-CPAP=8.1%±1.0). There was no significant difference in use of their devices at 6 or 12 weeks. Based on linear mixed modeling, participants on active CPAP had improved A1C (b (SE): -.76 (.24), P&lt;.01) and frucostamine (-21.8 (10.5), P=.04) at 6 weeks with A1C trending to significance at 12 weeks (p=0.10). Both the % of cumulative days of active CPAP usage (≥4 hours/day) (.002 (.003), P=.09) and cumulative hours of active CPAP use (.03 (.03), P=.08) showed a trend being associated with greater change in A1C but not in frucostamine (P=.61, P=.51). The rate of change in A1C varied by time, increasing the % of cumulative days of CPAP use (≥4 hours/day) at week 6 predicted greater change in A1C (.006 (.002), P=.01) than week 12 (.002 (.003), P=.38). Higher average hours of CPAP usage were associated with greater change in A1C (.08 (.03), P=.01) at week 6 compared to week 12 (.03 (.03), P=.47).

Conclusion
In our study, individuals with T2D and OSA, adherence to active CPAP use improved glycemic control over 6 weeks.

Support
NIDDK grant R01DK096028; CTRI grant UL1TR001857 and UL1TR000005.