bluuebunny/crossref_metadata_2025_split huggingface dataset:
0548 Overnight Memory Consolidation in Insomnia versus Normal and Experimentally Disrupted Sleep
Authors: Omlin X , Reid M J , Sharman R , Schneider J , Espie C A , Kyle S D 
Published: May 2020

Abstract

Introduction
Healthy sleep is assumed to play an important role in the consolidation of newly acquired memories. Evidence suggest that periods of sleep after learning facilitates memory consolidation relative to wakefulness. Insomnia is associated with cognitive impairment but few studies have assessed overnight memory consolidation. We compared overnight consolidation in people with insomnia to a group of good sleepers who were randomised to either a normal night of sleep (uninterrupted sleep, US) or one night of sleep continuity disruption via forced awakenings (FA).

Methods
51 good sleepers (37 female; mean age: 24 years, SD: 3.63), randomised to either one night of US (n=24) or one night of FA (n=27), were compared to 27 participants meeting criteria for insomnia disorder (23 female; mean age: 53 years, SD: 8.34) who were assessed at baseline as part of a randomised controlled trial of digital cognitive-behavioural therapy. Overnight memory consolidation (difference in correctly recalled word pairs between evening and morning recall) was assessed using the same word-pair task and protocol in the two lab-based studies.

Results
Overnight memory consolidation was significantly lower in the insomnia (mean: 5.4, SD: 5.8, p=0.001) and the FA (mean: 6.7, SD: 4.1, p&lt;0.001) group compared to the US group (mean: 11.6, SD: 5.3). However, when adjusted for age only the FA group, but not the insomnia group, showed significantly lower memory performance than the US group.

Conclusion
While our findings suggest that overnight memory consolidation is impaired in insomnia relative to normal sleep we cannot rule out an age-related explanation given the difference in ages between the study samples. Future work will assess whether overnight consolidation improves following cognitive behavioural therapy.

Support
The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) and the Dr Mortimer and Theresa Sackler Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
0554 Insomnia Disorder Predicts Stressful Life Events in Individuals Who Have Recently Experienced Involuntary Job Loss
Authors: Skobic I , Howe G , Haynes P L 
Published: May 2020

Abstract

Introduction
The stress generation hypothesis posits that depressed (versus non-depressed) individuals generate more stressful life events, especially events for which they are at least partly responsible (i.e., dependent events). Insomnia disorder interferes with emotion regulation, potentially leading to impaired decision-making and increased stress generation. We hypothesized that insomnia disorder would lead to an increased number of stressful life events in our sample of adults who have recently experienced involuntary job loss.

Methods
Assessing Daily Activity Patterns through Occupational Transitions is a longitudinal study examining linkages between job-loss, sleep, obesity, and mental health. We used baseline and 3-month follow-up data from 137 participants who completed the Life Events and Difficulties Schedule, a contextual life event measure. Insomnia disorder was coded yes if participants met ICSD-3 criteria for a current chronic or acute insomnia disorder on the Duke Structured Interview for Sleep Disorders. Covariates included age, gender, and race. Linear and logistic regression were employed to assess changes in number of events over time. Secondary analysis examined the relationship between insomnia and dependent stressful life events specifically.

Results
When controlling for covariates, insomnia disorder at study baseline predicted the number of stressful life events generated between baseline and 3-month follow-up (β =.60, se=.30, t=1.99, p=.05). Conversely, events at baseline did not predict insomnia disorder at follow-up when controlling for baseline insomnia disorder (OR=.98, CI=.82-1.17). Secondary analysis revealed a trend toward increased generation of dependent events among individuals with insomnia disorder (β =.37, se=.23, t = 1.6, p=.11).

Conclusion
Our analyses provide preliminary evidence for a causal relationship between insomnia disorder and stress generation. Additional research is needed to replicate and examine the mechanisms behind this relationship. This extension of the stress generation hypothesis may have important implications for harm reduction interventions for insomnia disorder.

Support
#1R01HL117995-01A1.
0560 The Effect of Smoking on OSA Endotypes: A Retrospective Cohort Study
Authors: Al-Azzawi S , Orr J E , DeYoung P , Owens R L , Malhotra A , Schmickl C N 
Published: May 2020

Abstract

Introduction
Smoking is a purported risk factor for obstructive sleep apnea (OSA), but the mechanisms through which smoking may cause OSA are largely unclear. Our goal is to assess the effect of smoking on the pathophysiological traits (“endotypes”) underlying OSA.

Methods
Based on a chart review we are creating a retrospective cohort of consecutive patients who were newly diagnosed with OSA based on an inlab polysomnogram between 1/2016 and 6/2018 and who have a documented smoking status. For each subject we are quantifying the endotypes (e.g. arousal threshold, loop gain, upper airway muscle recruitment) via a validated polysomnography-based algorithm. Additionally, we are estimating the arousal threshold based on a clinical prediction score. We are comparing OSA endotypes (primary outcomes), sleep apnea severity (apnea-hypopnea index, SpO2 nadir) and sleep parameters (e.g. total sleep time, sleep efficiency, sleep stages) in current vs former vs never smokers using Kruskal-Wallis tests (+Dunn’s test for post hoc comparisons).

Results
To date we have screened 334 of 2,138 subjects and identified 99 eligible subjects (5 current smokers at the time of polysomnography, 37 former smokers, and 57 never smokers). The clinical arousal threshold was similar across groups (P=.69); polysomnography-based endotype measures are pending. Further, there was no significant difference in sleep apnea severity or sleep parameters across groups, except stage N2 which was less in current vs former smokers (median-percentage 48.5 vs 66.3%, P&lt;.05) and less in never vs former smokers (61.6 vs 66.3%, P&lt;.05).

Conclusion
Overall, former vs never smokers appear to be similar with regards to sleep and sleep apnea parameters. Prevalence of current smokers appears to be low (5%) in our cohort; larger sample size and polysomnography-based endotypes are needed before firm conclusions about the effects of smoking on OSA mechanisms can be reached (data collection continues).

Support
This study had no specific funding. Christopher Schmickl is supported by NIH T32 grant HL134632.
0563 Inspiratory Flow Limitation in Non OSA Individuals: Risk Factors and Clinical Complaints After 8 Years of Follow in a General Population
Authors: Palombini L , de Godoy L B , Andersen M L , Poyares D , Tufik S 
Published: May 2020

Abstract

Introduction
Inspiratory flow limitation (IFL) indicated by the flattening of inspiratory curve, is a respiratory pattern in polysomnography (PSG) suggested as a parameter used to identify individuals with sleep breathing disorder. The cutoff value is still not well defined. The purpose of this study was to evaluate the frequency and clinical impact of IFL after 8-year follow up ingeneral population.

Methods
MethodsBaseline sample was derived from a prospective population-based study (Epidemiologic Sleep Study, EPISONO). A total of 1,042 subjects completed the study assessments in 2007 and 712 from these participants were reassessed in 2016.Full night PSG at baseline and follow-up was performed and clinical outcomes were analyzed. IFL was manually scored and TST spent in IFL during sleep was calculated.

Results
In 2007 and 2016, IFL in non OSA individuals′ mean value was 10.1% and 17.7 % of TST and 95th percentile was 37.8 % and 49.9 % respectively. OSA patients had higher BMI than nonOSA in 2007 (p = 0.01), however, BMI and age were not risk factors to develop OSA or to increase IFL after 8 years. Individuals with IFL that became OSA after 8 years had a higher BMI, regardless of time, than those that did not develop OSA. Individuals who presented &lt;15% of TST with IFL in 2007 and changed to &ge;15% in 2016demonstrated significantly worse Beck depression score compared to group that maintained IFL &lt; 5%. Individuals with &ge; 15% of TST with IFL in 2007 and in 2016 also increased depression severity score and Whoqol social relationship and environment domainscompared to the group with &lt;15%.

Conclusion
Non OSA individuals presented 10.1% in 2007 and 17.7% in 2016 of TST in IFL. After 8 years, individuals with &ge;15% of IFL presented worsening of depression severity and sleep quality.

Support
The authors would like to thank for the support by grants from Associação Fundo de Incentivo a Pesquisa (AFIP), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
0564 Assessment of Tongue and Soft Palate Muscles Mechanical Properties in Patients with OSA
Authors: Li W , Gakwaya S , Sériès F 
Published: May 2020

Abstract

Introduction
Soft palate muscles are crucial in the maintenance of UA patency. Different contraction tasks have been used to investigate tongue mechanical properties, but not to soft palate muscles. This study aimed to investigate the mechanical consequences of tongue and soft palate muscles fatigue in moderate-severe OSA patients.

Methods
12 moderate and 8 severe patients with OSA were enrolled. Measurements include strength, endurance, and fatigue indices. During the soft palate fatiguing protocol, subjects were asked to develop repetitive intra-oral positive pressure during cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened. Tongue mechanical properties were also assessed using protrusion tasks with similar protocol. Subjects were encouraged to develop sustained maximal bulging pressure or tongue protrusion force for 5 sec every 10 sec until the peak pressure did not reach 85% of baseline maximal pressure for 2 consecutive times. The influence of age and BMI were also investigated.

Results
The sex, age were not significantly different between the 2 OSA groups. BMI was significantly higher in severe OSA patients (p&lt;0.05). Overall, the tongue maximal voluntary contraction force (MVC), endurance time and total muscle work were respectively positively associated with the ones obtained from the soft palate fatiguing task (rs=0.51, 0.43, 0.66, respectively). The MVC of both tongue and soft palate muscles were positively correlated with BMI in all subjects (rs=0.43, 0.5 respectively). The recovery time from soft palate fatigue was significantly longer in moderate than severe OSA patients (270s ± 192.3s and 120s ± 0, p =0.02). Interestingly, the recovery time was positively correlated with AHI in tongue fatiguing task, while negatively correlated with supine AHI and age in soft palate fatiguing task (p&lt;0.05). In both tasks, MVC was negatively correlated with the endurance time (p&lt;0.05).

Conclusion
Moderate patients are less likely to recover from soft palate muscle fatigue. A more severe apneic disease is associated with longer recovery time from tongue fatigue, but with shorter recovery time from soft palate fatigue. Our results suggest that alteration in tongue and velopharyngeal muscles function may differ according to the severity of disease.

Support
SBD from IUCPQ Foundation.
0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users
Authors: Zhu R , Carlson G , Kelly M , Song Y , Fung C H , Mitchell M N , Josephson K R , Zeidler M R , Badr M S , Alessi C A , Washington D L , Yano E M , Martin J L 
Published: May 2020

Abstract

Introduction
Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment.

Methods
A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests.

Results
1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p&lt;.001), likely to be employed (p=.013), more likely to snore loudly (p&lt;.001) and to have breathing pauses while asleep (p&lt;.001). They also had higher ISI (p&lt;.001), were more like to report RLS (p&lt;.001) nightmares (p=.027), and had higher PHQ-4 (p&lt;.001) and PC-PTSD (p&lt;.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p&lt;.001) and those with observed breathing pauses were more likely to use PAP (p&lt;.001).

Conclusion
One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans.

Support
Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).
0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study
Authors: Xue J , Zhao R , Li J , Zhao L , Zhou B , Dong X , Han F 
Published: May 2020

Abstract

Introduction
To evaluate the utility of the ring pulse oximeter for screening of OSA in adults.

Methods
87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15).

Results
Among the 87 participants, 18 cases were AHI&lt;5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P&gt;0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p&lt;0.05). Although MSpO2 correlated significantly (r=0.448, P&lt;0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p&lt;0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively.

Conclusion
The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA.

Support
The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).
0589 Arrhythmia Detection in Obstructive Sleep Apnea (ADIOS)
Authors: Geil E S , Ramos A R , Abreu A R , Lambrasko L K , Dib S I , Wallace D M , Junco B , Torre B C , Chediak A D , Chaturvedi S 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a recognized risk factor for ischemic stroke; however, there is a paucity of studies devoted to modifying stroke risk factors in patients with OSA. We aimed to evaluate the prevalence and treatment of stroke risk factors in newly diagnosed OSA patients.

Methods
We evaluated consecutive patients with an OSA diagnosis made within 12 months and CHADS2 score of &gt;2, consistent with high risk for atrial fibrillation. The patients completed polysomnography, sleep questionnaires, and systematic assessments for demographic variables, vascular risk factors, and medication use. Participants also completed up to four weeks of ambulatory cardiac monitoring. A six-month follow-up visit screened for new hospitalizations associated to vascular events and use of new anticoagulants or antiplatelet therapy.

Results
The sample consisted of 87 patients, mean age 59±8 years, 53% women, and 69% of Hispanic/Latino background. The mean BMI was 35±9. Hypertension was seen in 57% and diabetes mellitus in 33% of the sample. The mean apnea-hypopnea index was 41±27 events/hour. Atrial fibrillation was detected in 3% of the sample through prolonged monitoring. At six-month follow-up, 9% of the sample was hospitalized due to stroke, transient ischemic attack, or coronary artery disease, while 13% reported use of anticoagulants and 38% antiplatelet therapy.

Conclusion
In this high risk sample of OSA patients, there was a high prevalence of cerebrovascular events and use of medical treatment for secondary stroke prevention. Future studies evaluating the treatment of vascular risk factors in OSA can provide strategies to minimize stroke occurrence.

Support
Boehringer Ingelheim
0620 Characteristics Distinguishing Special Operational Forces (SOF) Personnel from Non-SOF Peers with TBI: Retrospective Analysis From the VA TBI Model Systems
Authors: Kretzmer T , Bajor L , Silva M A , Eapen B , McKenzie-Hartmann T , Garcia A , Belanger H , Richardson R 
Published: May 2020

Abstract

Introduction
Special Operations Forces (SOF) is an umbrella term which encompasses over a dozen specialized communities across all military branches. Little is known about potential differences in demographic and health characteristics, including sleep, between SOF vs. non-SOF service members. We leveraged existing longitudinal studies of those with history of TBI to examine differences between SOF and non-SOF in the dataset.

Methods
We conducted a retrospective analysis of data from the VA TBI Model Systems, a multi-center longitudinal study of outcomes following TBI rehabilitation. Participants were included if SOF status was known (N = 261). Differences between groups on variables of interest were then classified as “Immaterial”, “Minor,” and “Important” based on either prevalence (categorical data) or degree of difference (continuous data).

Results
Of included participants, 68 (26%) were identified as SOF and 193 (74%) as non-SOF. SOF were more highly educated and more likely to have history of mild TBI. There were multiple “important” differences in co-morbidity prevalence. SOF participants were more likely to be diagnosed with sleep apnea (36% SOF vs 12% non-SOF). They were also more likely to have been diagnosed with chronic pain, a cardiac condition, high blood cholesterol, and/or osteoarthritis.

Conclusion
SOF participants differed from non-SOF in a multiple important ways, suggesting this is a different and medically complex population. The most striking finding was that SOF personnel had a significantly greater rate of sleep apnea, relative to non-SOF. The mechanism underlying this difference is not known but may relate to training, blast exposure, weapons use, and mission demands. Further investigation regarding mechanisms, prevalence, and treatment of OSA in the SOF community is needed.

Support
This research was sponsored by VHA Central Office VA TBI Model Systems Program of Research; Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015; HT0014-19-C-0004).
0635 Effects of Donepezil in Patients with Residual Excessive Sleepiness of Obstructive Sleep Apnea: A Double Blind; Randomized Placebo; Controlled Study
Authors: Sousa K M , Piovezan R D , e Silva L , De melo C , Poyares D , Tufik S 
Published: May 2020

Abstract

Introduction
Residual excessive sleepiness (RES) is presented by 6% of obstructive sleep apnea patients despite effective CPAP therapy. Few interventions have been tested for this condition and are focused on daytime stimulants. Recently, cholinergic activity decline was suggested as a potential mechanism in the pathophysiology of RES. This study aimed to investigate the effects of donepezil, an anticholinesterase inhibitor, in patients with RES.

Methods
This double-blind, randomized, placebo-controlled crossover study included participants with RES (35-65 years). Neuropsychiatric disorders, alcoholism, smoking, shiftwork, psychoactive drugs, other sleep disorders were exclusion criteria. Participants were assigned to one intervention arm (donepezil 5 mg for 15 days followed by donepezil 10mg for 15 days or placebo in the morning). After a 20-day wash-out, the same procedure was repeated following the crossover design. Somnolence measured by the Epworth sleepiness scale (ESS) and Maintenance of Wakefulness Test (MWT) were the primary endpoints. PSG, cognitive (trail test, continuous performance test) and Beck’s depression scale parameters were secondary endpoints. General Linear Models for repeated measures compared interventions responses. Cohen’s d measured effect sizes. Adverse events (AEs) were assessed by questionnaire.

Results
The study enrolled eight individuals. ESS was lower in the donepezil arm than in the placebo arm (8.9±4.4 vs 15.7±4.1, p&lt;0.05). Effect size for ESS was high (d 1.61). Other endpoints were not different among study arms. Randomization order didn’t affect the results. No AEs were reported.

Conclusion
Donepezil improved subjective sleepiness in individuals with RES. To our knowledge, this is the first study to report the effects of a cholinergic intervention in patients with RES. Effect size was high for self-reported sleepiness, which may impact on quality of life and risk of disability in people with RES. Agents acting on the cholinergic system are potential targets for treating RES.

Support
Acknowledgements Brazilian National Council for Scientific and Technological Development (CNPq) This study is supported by AFIP (Associacao Fundo Incentivo a Pesquisa).