bluuebunny/crossref_metadata_2025_split huggingface dataset:
0636 Using AI To Predict Future CPAP Adherence and the Impact of Behavioral and Technical Interventions
Authors: Hevener W , Beine B , Woodruff J , Munafo D , Fernandez C , Rusk S , Nygate Y , Glattard N , Piper D , Sheedy C , Simpson M , Turkington F , Shokoueinejad M 
Published: May 2020

Abstract

Introduction
Clinical management of CPAP adherence remains an ongoing challenge. Behavioral and technical interventions such as patient outreach, coaching, troubleshooting, and resupply may be deployed to positively impact adherence. Previous authors have described adherence phenotypes that retrospectively categorize patients by discrete usage patterns. We design an AI model that predictively categorizes patients into previously studied adherence phenotypes and analyzes the statistical significance and effect size of several types of interventions on subsequent CPAP adherence.

Methods
We collected a cross-sectional cohort of subjects (N = 13,917) with 455 days of daily CPAP usage data acquired. Patient outreach notes and resupply data were temporally synchronized with daily CPAP usage. Each 30-days of usage was categorized into one of four adherence phenotypes as defined by Aloia et al. (2008) including Good Users, Variable Users, Occasional Attempters, and Non-Users. Cross-validation was used to train and evaluate a Recurrent Neural Network model for predicting future adherence phenotypes based on the dynamics of prior usage patterns. Two-sided 95% bootstrap confidence intervals and Cohen’s d statistic were used to analyze the significance and effect size of changes in usage behavior 30-days before and after administration of several resupply interventions.

Results
The AI model predicted the next 30-day adherence phenotype with an average of 90% sensitivity, 96% specificity, 95% accuracy, and 0.83 Cohen’s Kappa. The AI model predicted the number of days of CPAP non-use, use under 4-hours, and use over 4-hours for the next 30-days with OLS Regression R-squared values of 0.94, 0.88, and 0.95 compared to ground truth. Ten resupply interventions were associated with statistically significant increases in adherence, and ranked by adherence effect size using Cohen’s d. The most impactful were new cushions or masks, with a mean post-intervention CPAP adherence increase of 7-14% observed in Variable User, Occasional Attempter, and Non-User groups.

Conclusion
The AI model applied past CPAP usage data to predict future adherence phenotypes and usage with high sensitivity and specificity. We identified resupply interventions that were associated with significant increases in adherence for struggling patients. This work demonstrates a novel application for AI to aid clinicians in maintaining CPAP adherence.

Support
0643 Daytime Intra-Oral Neuromuscular Stimulation Therapy on Patients With Mild Obstructive Sleep Apnoea
Authors: Kotecha B 
Published: May 2020

Abstract

Introduction
Upper airway muscle stimulation can improve pharyngeal muscle tone and thus could be considered for treatment of obstructive sleep apnoea (OSA). We present a novel device SnooZeal® that uses daytime awake neuromuscular electrical stimulation (NEMS) as an application to induce oropharyngeal muscular training. This study demonstrates objective and subjective usefulness of SnooZeal® in improving Mild OSA.

Methods
Prospective cohort study of 40 patients with Mild OSA (Apnoea-Hypopnea Index of 5-15/hour) was conducted. Objective respiratory parameters were recorded with two consecutive WatchPat sleep studies before and after treatment with the SnooZeal® device. The device was used by the patients for 20 minutes every day for 6 weeks. Furthermore, visual analogue scale for the snoring was completed by the partner as was the Epworth Sleepiness Score (ESS) as secondary outcome measures over the duration of the study.

Results
A statistically significant improvement was demonstrated in this cohort with mean AHI (Apnoea-Hypopnea Index) dropping from 9.91/hour prior to treatment to 5.2/hour following the treatment. The Oxygen desaturation index also reduced from a mean of 7.9 to 4.7 and similarly, there was also a statistically significant drop in the ESS from 8.86 to 5.43.Objective reduction in snoring was also demonstrated on the sleep studies in 95% of patients with an average reduction of 48% which was reflected subjectively by 40%reduction as recorded on visual analogue scale by partners.

Conclusion
SnooZeal® device study in this cohort of mild OSA patients demonstrates encouraging results. It offers the advantage of not requiring a device in situ whilst asleep which many patients find annoying and intolerable and thus a useful treatment option in patients with snoring and mild OSA. The device improves the muscle tone of the tongue and hence the upper airway dimensions during sleep.

Support
0702 Phrenic Nerve Stimulation Improves Oxygenation And Quality Of Life In Patients With Central Sleep Apnea And History Of Cerebrovascular Accidents
Authors: Schwartz A R , Khayat R , Sundar K M , Germany R , McKane S , Costanzo M 
Published: May 2020

Abstract

Introduction
Central sleep apnea (CSA) is a recognized complication of cerebrovascular accidents (CVA), although CSA treatment in this setting is of uncertain benefit. A recent randomized clinical trial showed that transvenous phrenic nerve stimulation (TPNS, remedē system, Respicardia Inc.) treats CSA. The clinical impact of TPNS on CSA outcomes in the subgroup of patients with prior CVA was studied.

Methods
Six subjects with predominantly CSA and history of CVA &gt;6 months prior to enrollment in the remedē System Pivotal Trial were analyzed. Patients underwent attended full-night polysomnography prior to TPNS implantation and 6, 12 and 18 months on TPNS therapy. Apnea-hypopnea index (AHI) and sleep metrics were evaluated. The Epworth Sleepiness Scale (ESS) and Patient Global Assessment (PGA) questionnaire were completed at 12 months. Treated patients and former controls (therapy was turned on after 6 months) with 18 months of TPNS therapy were pooled for analysis based on months of therapy.

Results
Apnea-hypopnea index decreased from a median of 47 events/hour [interquartile range: 23, 71] at baseline to 15 [4,24], 17 [6,48], and 12 [8,27] at 6, 12, and 18 months. Comparable improvements were also seen in oxygen desaturation index (4%) and arousal index. Central apnea index decreased from 30 [21,61] to ≤3/hour at each follow up. Compared to baseline, ESS decreased by 5 [-10,-3] and 4 [-8,-4] points at 6 and 12 months, while moderate or markedly improved overall health per the PGA was reported by 4/6 and 3/6 patients, respectively. No patient reported recurrent CVA or transient ischemic attack.

Conclusion
Transvenous phrenic nerve stimulation improved sleep, daytime somnolence and quality of life in patients with CSA and prior CVA. Transvenous phrenic nerve stimulation is a novel therapy that may be an option for treating patients with CSA and prior CVA.

Support
Respicardia and NIH R01 HL 144859
0751 Epworth Sleepiness Scale Test-Retest Reliability Analysis In Solriamfetol Studies
Authors: Rosenberg R , Babson K , Menno D , Morris S , Baladi M , Hyman D , Black J 
Published: May 2020

Abstract

Introduction
The Epworth Sleepiness Scale (ESS) measures excessive daytime sleepiness. This analysis examined test-retest reliability of ESS scores in participants with narcolepsy or obstructive sleep apnea (OSA) in solriamfetol studies.

Methods
Intraclass correlation coefficient (ICC) estimates and 95% confidence intervals (CIs) for ESS scores from two 12-week, placebo-controlled trials (1 narcolepsy; 1 OSA), and one long-term open-label extension (OLE) trial (narcolepsy or OSA) were calculated separately for each trial, based on assessments (at time-point pairs) when scores were expected to be stable (at weeks 4 and 8, 8 and 12, and 4 and 12 in the 12-week trials, and weeks 14 and 26/27, 26/27 and 39/40, and 14 and 39/40 in the OLE). ICCs were analyzed for the overall population in each trial and by treatment and adherence to primary OSA therapy. An ICC &gt;0.7 has been recommended as a quality criterion for acceptable test-retest reliability.

Results
In the 12-week narcolepsy trial, ICCs (95% CI) were 0.83 (0.79, 0.87) for weeks 4 and 8 (n=199), 0.87 (0.83, 0.90) for weeks 8 and 12 (n=196), and 0.81 (0.76, 0.85) for weeks 4 and 12 (n=196). In the 12-week OSA trial, ICCs (95% CI) were 0.74 (0.69, 0.78) for weeks 4 and 8 (n=416), 0.80 (0.76, 0.83) for weeks 8 and 12 (n=405), and 0.74 (0.69, 0.78) for weeks 4 and 12 (n=405). In the OLE trial, ICCs (95% CI) were 0.82 (0.79, 0.85) for weeks 14 and 27/26 (n=495), 0.85 (0.82, 0.87) for weeks 27/26 and 40/39 (n=463), and 0.78 (0.74, 0.81) for weeks 14 and 40/39 (n=463). Treatment (solriamfetol combined/placebo) or adherence to primary OSA therapy did not impact reliability.

Conclusion
In 3 large clinical trials of participants with narcolepsy or OSA, the ESS demonstrated an acceptable level of test-retest reliability.

Support
Jazz Pharmaceuticals
0765 Reliability And Validity Study Of The Chinese Version Of Narcolepsy Severity Scale For Adult Patients With Narcolepsy Type 1
Authors: Li C , Zhang C , Han F 
Published: May 2020

Abstract

Introduction
Narcolepsy is a chronic sleep disorder that can affects significantly patient functioning, involving social, work, and affective life. At present, many drugs have been developed to treat narcolepsy efficiently. But there is no Chinese version of Narcolepsy Severity Scale (NSS) available yet, for that the aim of this study is to translate the NSS into Chinese and evaluate reliability and validity of the NSS in adult patients with narcolepsy type 1 (NT1).

Methods
NSS was translated according to the standard procedures of double-back translation and cross-cultural adaptation steps. The NSS was administered to 62 adult patients (42 males, 20 females; mean age 34 years; range 19 to 67 years) with NT1 from April 2019 to December 2019. The validity of the scale was assessed by the exploratory factor analysis, discriminant validity and convergent validity. The reliability was assessed by the Cronbach’s α coefficient and test-retest reliability.

Results
Three common factors were extracted and 15 items explained 57.4% of the total variance. Cronbach’s α coefficient for total scale was 0.767 and Cronbach’s α for three dimensions ranged from 0.729 to 0.787. Scores were significant difference between treated and untreated group in dependent samples (p=0.036), but no differences in the independent samples (p&gt;0.05). The NSS had good correlations with Epworth Sleepiness Scale (r=0.302, p=0.017) and Insomnia Severity Index (r=0.526, p=0.000). The NSS showed good test-retest reliability (r=0.72, p=0.029).

Conclusion
The Chinese version of NSS was proved to be valid and reliable and can be used to evaluate the severity and consequences of symptoms in Chinese adult patients with NT1.

Support
0832 Physical Exercise Improves Sleep and Muscle Function in Sarcopenic Patients: A Randomized Controlled Trial
Authors: De Sá Souza H , Piovezan R D , Chagas Miranda R E , Silva B M , Tufik S , Poyares D , D’Almeida V 
Published: May 2020

Abstract

Introduction
Sarcopenia is a multifactorial condition that, like sleep debt, affects the elderly and is related to metabolic, endocrine, inflammatory alterations and risk to mortality. Resistance training (RT), in turn, can improve both factors. Aim: investigate the effects of 12-week RT on sleep and muscle function in the sarcopenic elderly.

Methods
28 sarcopenic elderly were equally distributed in 2 groups at random: CTL: who participated in weekly lifestyle change lectures or; RT: who did the progressive load RT. Sleep was assessed by polysomnography, actigraphy and questionnaires. Isokinetic and isometric of peak torque (PT) of skeletal muscle, anabolic and catabolic hormones, pro and anti-inflammatory cytokines concentrations were also evaluated. For intention to treat analysis (Δ) the generalized linear/non-linear for absolute variables or Wilcoxon rank-sum (Mann-Whitney) test. Data are expressed as mean±standard deviation or median, minimum and maximum values and difference witch p&lt;0.05.

Results
The RT reduced the time to sleep onset (16.09±15.21) compared to CTL (29.98±22.57) group after the intervention. The Δ shows that RT had more N3 sleep (median:0.90, min:-13.40, max: 25.00) than CTL (median:-3.35, min:-15.20, max:19.10). The RT increases TTS (median:57.55, min:-204.75, max:220.91 vs median:-9.63, min:-120.98, max:185.57) and improved self-reported sleep quality (median: -1.50, min: -9.00, max: 4.00 vs median: 0.50, min: -3.00, max: 6.00) and sleep efficiency (median: 9.50, min: -15.00, max: 34.00 vs 0.00, min: -28.00, max: 18.00). For all muscle function parameters (extension and flexion knee in isokinetic or isometric PT) RT had higher values compared to CTL group after 12 weeks of intervention (p&lt;0.05). IL-1ra concentrations were higher in RT (median: 0.04, min: -0.02, max: 0.36) vs CTL (median:-0.01, min:-0.12, max:0.07).

Conclusion
Progressive load resistance training improves sleep parameters associated to muscle recovery in elderly people with sarcopenia, along with positive changes in physical performance.

Support
Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).
0964 Out Like a Light: Preliminary Results of Parent-Child Dyad Use of an Audio-Based Mobile Application Aiding Bedtime Routine and Sleep Health
Authors: Chung A , Chanko N , Blanc J , Donley T , Robbins R , Brotman L , Jean-Louis G 
Published: May 2020

Abstract

Introduction
Adequate sleep is essential for a child’s growth and development. However, a growing number of children are experiencing trouble falling asleep. Smartphone audio-based mobile applications with soothing melodies and calming nighttime stories may improve sleep onset. Our study examined the efficacy of Moshi Twilight, an app designed to improve sleep onset, among children ages 3-8 years old using a parent-child dyadic approach.

Methods
Our within-subjects pre-post study design focused on healthy children studied over 10 days, spanning 3 weeknights and 2 weekend nights. During the baseline (Days 1-5) and exposure (Days 6-10) conditions the Child Sleep Health Questionnaire was used to measure children’s sleep behavior. The PROMIS and Pittsburgh Sleep Quality Index were used to assess parents’ sleep quality. Parents exposed their child to 1 story per night (15-20 minutes) during the exposured condition. Statistical analysis was based on paired t-tests, independent t-tests, and correlations.

Results
On average, participating parents were 37 (SD +9.6) year-old mothers. The sample was: 60% Black; 20% White, 20% other race/ethnicity. On average, children were 4 (SD + 0.78) years old and 50% male. Paired t-tests showed significant differences in children’s sleep onset within 20 minutes (t=2.582, 95% CI 0.116, 2.634, p= 0.036). Significant correlations were noted for children’s bedtime consistency (r = -0.755, p = 0.030), falling asleep in own bed (r = 0.735, p=0.015) and sleep duration (r = -0.715, p=0.046,) Significant correlations and paired t-test in parents’ sleep onset were also found (r = 0.744, p = 0.014); (mean= -1.2, t= -3.674, 95% CI -1.939, -0.461, p=0.005)

Conclusion
Our results showed that the audio-based sleep app, Moshi Twilight, might be useful in improving sleep health among both children and parents. This could be included in enhance bedtime routine among preschool-aged children.

Support
Bezos Grant and Community Service Plan grant.
0991 The Effect Of Extending Total Sleep Time And Weighted Blankets On Teenage Swimmers Performance
Authors: Zarrouf L R 
Published: May 2020

Abstract

Introduction
Effectiveness of sleep extension on performance and cognition in adult athletes has been studied extensively. Effectiveness of weighted blankets on sleep extension in children has been studied with mixed results. The effect of sleep quantity on teen competitive swimmers has not been evaluated extensively. This study investigated the effects of sleep extension and weighted blankets on performance, as well as daytime sleepiness in competitive teen swimmers. The principal investigator is a high school student and a teen-swimmer herself.

Methods
Study Design: Using an open label prospective approach, the pilot study will investigate swimmer’s event time changes, actigraphy findings and daytime sleepiness with sleep extension and weighted blankets. Setting/ Participants: 12 healthy swimmers on the MAKOS swim team will maintain their habitual sleep-wake schedule for a one-week; baseline period followed by a one-week sleep extension period, combined with weighted blankets use. Procedure/Protocol: The head-coach will assign event type to each participant of the study, 2 participants of the same type of event, will do the baseline timed race and initial evaluation, followed by one week of regular sleep (control). Another timed event will be done at the end of the 1st week and followed by a 2nd week of extended sleep (one hour/day) and weighted blanket. Final timed event race will be at the end of the 2nd week. Participants will fill initial, weekly questionnaires and wear a sleep tracker during the two weeks of the study. Detailed sleep and activities analysis will be obtained.

Results
12 swimmers were recruited, 8 females and 4 males. All participants have been consistently with the team for more than 2 years. Age range of participants is 11- 17 years. Members of the team practiced 5 days every week with each practice lasting for 2 hours. The first timed race is scheduled to be done the first week in January.

Conclusion
This is the first research study to evaluate the effect of two important variables on sleep and performance in teenage swimmers.

Support
The authors report no financial support related to this study.
The Origin of the Legumes is a Complex Paleopolyploid Phylogenomic Tangle Closely Associated with the Cretaceous–Paleogene (K–Pg) Mass Extinction Event
Authors: Koenen Erik J M , Ojeda Dario I , Bakker Freek T , Wieringa Jan J , Kidner Catherine , Hardy Olivier J , Pennington R Toby , Herendeen Patrick S , Bruneau Anne , Hughes Colin E 
Published: May 2020

AbstractThe consequences of the Cretaceous–Paleogene (K–Pg) boundary (KPB) mass extinction for the evolution of plant diversity remain poorly understood, even though evolutionary turnover of plant lineages at the KPB is central to understanding assembly of the Cenozoic biota. The apparent concentration of whole genome duplication (WGD) events around the KPB may have played a role in survival and subsequent diversification of plant lineages. To gain new insights into the origins of Cenozoic biodiversity, we examine the origin and early evolution of the globally diverse legume family (Leguminosae or Fabaceae). Legumes are ecologically (co-)dominant across many vegetation types, and the fossil record suggests that they rose to such prominence after the KPB in parallel with several well-studied animal clades including Placentalia and Neoaves. Furthermore, multiple WGD events are hypothesized to have occurred early in legume evolution. Using a recently inferred phylogenomic framework, we investigate the placement of WGDs during early legume evolution using gene tree reconciliation methods, gene count data and phylogenetic supernetwork reconstruction. Using 20 fossil calibrations we estimate a revised timeline of legume evolution based on 36 nuclear genes selected as informative and evolving in an approximately clock-like fashion. To establish the timing of WGDs we also date duplication nodes in gene trees. Results suggest either a pan-legume WGD event on the stem lineage of the family, or an allopolyploid event involving (some of) the earliest lineages within the crown group, with additional nested WGDs subtending subfamilies Papilionoideae and Detarioideae. Gene tree reconciliation methods that do not account for allopolyploidy may be misleading in inferring an earlier WGD event at the time of divergence of the two parental lineages of the polyploid, suggesting that the allopolyploid scenario is more likely. We show that the crown age of the legumes dates to the Maastrichtian or early Paleocene and that, apart from the Detarioideae WGD, paleopolyploidy occurred close to the KPB. We conclude that the early evolution of the legumes followed a complex history, in which multiple auto- and/or allopolyploidy events coincided with rapid diversification and in association with the mass extinction event at the KPB, ultimately underpinning the evolutionary success of the Leguminosae in the Cenozoic. [Allopolyploidy; Cretaceous–Paleogene (K–Pg) boundary; Fabaceae, Leguminosae; paleopolyploidy; phylogenomics; whole genome duplication events]
Male meiosis in sweet cherry is constrained by the chilling and forcing phases of dormancy
Authors: Fadón Erica , Herrera Sara , Herrero María , Rodrigo Javier 
Published: May 2020

AbstractMale meiosis in temperate fruit trees occurs in the anthers once a year, synchronized with the seasons. The alternation of dormant and growth cycles determines the optimum moment for the male gametophyte formation, a process sensitive to both cold and warm temperatures. This ensures pollen viability and subsequent reproduction success that guarantee fruit production. In this work, we explore how male meiosis is framed by seasonality in sweet cherry. For this purpose, the dormant phases, male meiosis and blooming dates were established in four cultivars with different flowering dates and chilling requirements over 7 years. The chilling and heat requirements for each cultivar were empirically estimated, and chilling and heat temperatures were quantified according to the Dynamic and Growing Degree Hours (GDH) models, respectively. Endodormancy was overcome approximately a fortnight earlier during the colder winters than during the milder winters. Against our initial hypothesis, these differences were not clearly reflected in the time of male meiosis. The period between chilling fulfillment and meiosis lasted several weeks, during which a high amount of GDH accumulated. Results showed that male meiosis is conditioned by endodormancy but especially by warm temperatures, during the forcing period. This differs from what has been described in other related species and creates a framework for further studies to understand the strategies of synchronizing dormancy with seasons.
Treating asthma in the age of biologics
Authors: Prabakaran Anisha 
Published: May 2020

ABSTRACT
Many patients with severe asthma continue to have high symptom burden despite maximization of conventional therapy. As the understanding of asthma pathophysiology has evolved, however, more personalized therapy options have become available. Asthma biologics are a new class of medications that target the specific pathways that underlie a patient's disease and can reduce the frequency of asthma exacerbations and improve patient quality of life. Clinicians should refer potential candidates to a specialist for further evaluation.