bluuebunny/crossref_metadata_2025_split huggingface dataset:
0537 Cognitive Functioning Before and After Insomnia Treatment in Women Veterans
Authors: Dzierzewski J M , Zhu R , Donovan E K , Perez E , Song Y , Kelly M R , Carlson G , Fung C H , Alessi C , Martin J L 
Published: May 2020

Abstract

Introduction
Women are at higher risk for cognitive impairment and dementia compared to men. Identifying potentially treatable risk factors such as insomnia is an important clinical goal. In a trial comparing two behavioral treatments for insomnia in women veterans, we hypothesized that 1) worse baseline insomnia severity would be associated with poorer cognitive function, and 2) improvement in insomnia severity with treatment would be associated with improvement in cognitive functioning.

Methods
347 women veterans with insomnia disorder [mean age 48.3 (12.9) years] completed baseline testing. Of these, 149 women were randomized to receive cognitive behavioral therapy for insomnia (CBT-I) or acceptance and commitment (ACT) based insomnia treatment (both treatments included sleep restriction, stimulus control, and sleep hygiene). Insomnia Severity Index (ISI) was assessed at baseline, post-treatment, and 3-month follow-up. Cognitive functioning was measured with Symbol Digit Coding (SDC) and Trail Making Test A and B (TMTA and TMTB). Pearson correlations were used to examine associations between insomnia severity and cognitive functioning at baseline and changes in both insomnia severity and cognitive functioning from before to after treatment.

Results
At baseline (N=347), mean ISI was 14.1 (5.3). Worse baseline ISI was associated with worse baseline cognitive functioning on TMTA (r=-.15, p&lt;.01) and SDC (r=-.12, p&lt;.05). In the randomized sample (N=149), ISI scores improved at post-treatment (mean ISI change= -9.0; p&lt;.001) and 3-month follow-up (mean change= -8.0; p&lt;.001) relative to baseline. Improvement in ISI from baseline to post-treatment was significantly associated with improvement in SDC from baseline to post-treatment (r=-.18, p&lt;.05), but not improvement in TMTA and TMTB. Change in ISI was not significantly related to change in cognitive tasks from baseline to 3-month follow-up.

Conclusion
More severe insomnia is associated with worse cognitive functioning in women veterans. The magnitude of improvement in insomnia symptoms may be associated with improvement in cognition.

Support
NIH/NIA K23AG049955 (PI: Dzierzewski); VA/HSR&D IIR-HX002300 (PI: Martin), NIH/NHLBI K24HL143055 (PI: Martin).
0545 Bi-Layer Melatonin Tablet Provides Immediate and Extended Absorption to Address Primary Sleep Issues
Authors: Mun J G , Wang D , Doerflein Fulk D L , Fakhary M , Gualco S J , Grant R W , Mitmesser S H 
Published: May 2020

Abstract

Introduction
Melatonin is a naturally-occurring hormone that functions in the regulation of the sleep-wake cycle. Exogenous melatonin has demonstrated utility for the induction and maintenance of sleep. Modulation of tablet dissolution rates can be achieved by strategically using binding agents in two layers to rapidly raise melatonin levels and sustain elevated levels over time to better emulate normal nocturnal melatonin secretion.

Methods
A randomized, double-blind, controlled cross-over study was conducted in healthy adults (n=18) to investigate the pharmacokinetics of a 4.5 mg melatonin bi-layer tablet with either prolonged-release (PR) or immediate-release (IR) characteristics. Blood samples were collected at 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 6, 8 and 10 h post-ingestion and melatonin concentrations were quantified.

Results
The PR formulation had a lower maximum concentration (Cmax, p&lt;0.002), but a longer time to reach maximum concentration (Tmax, p&lt;0.001). Absorption rate constant (Ka) and terminal disposition rate constant (λ) were both lower in PR melatonin than the IR formulation (p&lt;0.001), indicating slower absorption and elimination rates. These measures were consistent with significantly greater absorption (ta1/2, p&lt;0.002) and elimination half-lives (t1/2, p&lt;0.001) in the IR formulation compared to the PR formulation. Additionally, plasma melatonin concentrations reached pre-ingestion values by 8 h post-administration of the PR formulation, indicating that individuals sleeping for a recommended 7-9 hours will wake with normal melatonin levels, when taken an hour before bedtime.

Conclusion
Prolonged-release bi-layer melatonin tablet safely and effectively extends the absorption of exogenous melatonin compared to an immediate-release formulation.

Support
Pharmavite, LLC
0547 Insomnia in Veterans with COPD: Prevalence, Correlates, and Health Care Utilization
Authors: Luyster F S , Boudreaux-Kelly M Y , Bon J M 
Published: May 2020

Abstract

Introduction
Veterans with COPD are a vulnerable group for developing insomnia. The objectives of this study were to examine the prevalence and correlates of insomnia and its impact on health care utilization in a national sample of Veterans with COPD.

Methods
National data from electronic medical records of Veterans who utilized the Veterans Health Administration between FY2011 and FY2017 was accessed from the Veterans Affair Corporate Data Warehouse. COPD was based on International Classification of Diseases diagnostic codes (ICD-9/10). Insomnia was defined by ICD-9/10 codes or sedative-hypnotic prescription of &gt;30 doses in a given fiscal year. ICD-9/10 codes for other conditions were documented. Outpatient and inpatient health care service utilization included number of physician encounters and emergency room visits and hospitalizations with a primary diagnostic code for COPD or COPD exacerbation. Bivariate comparisons between veterans with COPD and insomnia and COPD only were made for sociodemographic, comorbidities, and health care utilization variables using t-tests and Chi-square tests, as appropriate.

Results
A total of 1,542,642 Veterans with COPD were identified during the 6-year period. Of those with COPD, 575,539 (37.3%) were identified as having insomnia. Veterans with COPD and comorbid insomnia were younger (64 years vs. 69 years) and more likely to be female (6.3% vs. 3.7%), Black (14.0% vs. 11.0%), be a current smoker (46.1% vs. 35.5%), and have comorbidities including obstructive sleep apnea, diabetes, asthma, stroke, depression, or posttraumatic stress disorder compared to those without insomnia (all p’s &lt;0.001). Compared to Veterans with COPD only, those with comorbid insomnia had a greater number of COPD-related outpatient (6.9 vs. 10.5) and emergency room (1.1 vs. 1.2) visits and hospitalizations (1.9 vs. 2.3) (p’s &lt;0.001).

Conclusion
Insomnia is highly prevalent in Veterans with COPD and is associated with greater COPD-related health care utilization. Future research is needed to determine if targeted treatment for insomnia can improve COPD outcomes.

Support
This study was funded by the VA Competitive Career Development Fund.
0571 Repolarization Variability Predicts Cardiovascular Death in Obstructive Sleep Apnea
Authors: Patel S I , Zareba W , Couderc J , Xia X , LaFleur B , Torabzadeh E , Woosley R , Parthasarathy S 
Published: May 2020

Abstract

Introduction
Patients with untreated obstructive sleep apnea (OSA) have a 2-3—fold increased risk of cardiovascular mortality (CVD) compared with individuals without OSA. QTc prolongation and increased QT variability among OSA patients may contribute to this association.

Methods
Patients with OSA from the Sleep Heart Health study were identified based on polysomnography criteria and their continuous electrocardiograms (ECG) analyzed for QTc duration and QT variability. Both Fridericia’s and Bazett’s heart rate corrections were used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and normalized QT interval variance (QTVN) at 1- and 5-minute intervals and short-term interval beat-to-beat QT variability (STVQT) was measured at 5-minute intervals. Lasso with elastic-net regularization was used as the variable/covariate selection method. Cox proportional hazards regression models were used to determine predictors of CVD.

Results
Data from 365 patients with OSA were screened. Ninety-seven patients were excluded from analysis due to low quality ECG data (n=50) or extremely high (&gt; ln (10)) variability in QT/QTc and/or QT variability (n=12). Fifty two percent of the sample was male with mean age 65 years (±10). Fifty-six of these patients died of CVD. The mean (SD) QTc in the group that died was 411 (30) ms and 416 (34) ms compared to 406 (24) ms and 411 (25) ms using Fridericia (Cox LR p-value 0.055) and Bazett (p=0.090), respectively. Gender, age, race, diabetes, SDQT and STVQT were significant predictors for CVD. We fit models with the covariates and SDQT (at both 1 and 5 min) and STVQT as three models and demonstrate that both SDQT and STVQT are significantly associated with CVD death (p-values of 0.0048, 0.0089, and 0.0113, respectively) and all models had high area under the curve (0.8095, 0.8085, and 0.8125, respectively).

Conclusion
In patients with OSA, QT variability was associated with CVD.

Support
American Academy of Sleep Medicine Foundation
0572 Using Anthropometric Measures to Screen for Obstructive Sleep Apnea in the Sleep Heart Health Study Cohort
Authors: Vana K D , Silva G E , Carreon J D , Quan S F 
Published: May 2020

Abstract

Introduction
Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group quickly. We compared the sensitivities (SNs), specificities (SPs), and receiving operator curves (ROCs) of the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) in predicting moderate and severe OSA (apnea-hypopnea index [AHI] ≥15/hr) with the SN, SP, and ROC of the derived Stop-Bang Questionnaire (dSBQ), which was created from proxy variables from the Sleep Heart Health Study (SHHS).

Methods
Data from the SHHS baseline evaluation were used and included participants (N=5431) who completed polysomnograms and had neck and waist circumferences, height measurements, and the SHHS proxy variables. This data then was divided randomly into 1/3 for derivation and 2/3 for validation analyses.

Results
No statistical differences were seen for gender, age, or ethnicity between the derivation and validation samples. In the validation sample (n=3621), the NHR cut-point of 0.21 resulted in a SN of 91% and a SP of 26% for AHI ≥15/hr. The WHR cut-point of 0.51 resulted in a SN of 91% and a SP of 21% for AHI ≥15/hr. Comparing the validation NHR and the dSBQ ROC curves showed no significant difference (AUCs=0.69 and 0.70, respectively; p=0.22). However, the ROC curve for WHR was significantly lower than for the dSBQ (AUCs=0.63 and 0.70, respectively; p&lt;0.0001). Comparing the derivation and validation ROCs showed no significant differences between NHR ROCs, p=0.81, or between WHR ROCs, p=0.67.

Conclusion
The NHR is a viable screening tool, independent of witnessed apneas and BMI, that can be used for different body types and is statistically comparable to the dSBQ.

Support
This work was supported by U01HL53938 and U01HL53938-07S (University of Arizona).
0585 C-Reactive Protein Improves the Ability to Detect Cardiometabolic Risk in Mild-to-Moderate Sleep Apnea
Authors: Vgontzas A N , Puzino K , Fernandez-Mendoza J , Criley C , He F , Krishnamurthy V B , Basta M , Bixler E O 
Published: May 2020

Abstract

Introduction
Mild-to-moderate obstructive sleep apnea (OSA) affects 15-40% of the adult general population. However, it remains unclear when and how best to treat mild-to-moderate OSA. It has been shown that mild-to-moderate OSA in general random samples is associated with incident hypertension. The aim of this study was to compare the relative utility of apnea/hypopnea index (AHI) versus a biomarker of inflammation, C-reactive protein (CRP), in identifying the presence and severity of hypertension and insulin resistance (IR).

Methods
A clinical sample of 148 adults (53.79±12.45) with mild-to-moderate OSA (AHI between 5 and 29 events per hour) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure, body mass index (BMI), fasting blood glucose, insulin and CRP plasma levels. Hypertension was defined by previous diagnosis, past or present treatment, or blood pressure ≥140/90. IR was defined by homeostatic model assessment. Individuals with diabetes and/or on diabetes medication were excluded from analyses with IR. All analyses were conducted controlling for age, gender and BMI.

Results
CRP levels (OR=2.62, 95% CI=1.35-5.04, p=0.004), age (OR=1.75, 95% CI=1.11-2.75, p=0.016), and BMI (OR=2.74, 95% CI=1.20-6.26, p=0.017) were independently associated with greater odds for hypertension, whereas AHI (OR=1.33, 95% CI=0.61-2.92, p=0.477) was not. Additionally, CRP levels (β=0.21; p=0.04) and BMI (β=0.24; p=0.02) were independently associated with higher IR, while AHI (β=-0.03; p=0.75) was not. There was a trend for this association to be stronger in non-obese patients.

Conclusion
These preliminary findings suggest that including a measure of inflammation improves the ability for clinicians to detect cases of mild-to-moderate OSA with true cardiometabolic risk. CRP may be a simple, easy-to-use biomarker that can improve prognosis assessment and clarify which treatment option is best for patients with mild-to-moderate OSA.

Support
Department of Psychiatry, Penn State College of Medicine
0596 Providers Rarely Assess Obstructive Sleep Apnea Symptoms Among Patients with Chronic Obstructive Pulmonary Disease
Authors: Donovan L M , Keller T , Stewart N H , Spece L J , Au D H , Feemster L C 
Published: May 2020

Abstract

Introduction
Professional societies recommend providers assess sleep symptoms in COPD, but it is unclear if this occurs. We aimed to evaluate OSA symptom assessment and documentation among patients with COPD, and the patient and provider characteristics associated with this assessment.

Methods
We conducted a cross-sectional study of adults aged ≥40 years with clinically diagnosed COPD and no prior diagnosis of OSA. We selected patients receiving care at two academic general internal medicine clinics between 6/1/2011 - 6/1/2013. We abstracted charts to assess how often OSA symptoms such as snoring, somnolence, witnessed apneas, or gasping/choking arousals were documented as present or absent. We performed multivariable mixed-effects logistic regression to assess associations of patient and primary care provider (PCP) factors with assessment of OSA symptoms. Patient factors included demographics, body mass index, comorbidities, healthcare utilization, and severity of COPD, and PCP factors including demographics, degree, and years of experience.

Results
Of 523 patients with COPD, only 26 (5.0%) had documentation of OSA symptom assessment within a one-year period. In mixed effects models, only referral to general pulmonary clinic was associated with the assessment of OSA symptoms (OR: 4.56, 95% CI 1.28-15.52). Among the 26 individuals who had OSA symptoms assessed, 9 (34.6%) reported snoring, 15 (57.7%) reported daytime somnolence, 2 (7.7%) reported gasping/choking arousals, and 5 (19.2%) reported witnessed apneas. Among those assessed for OSA symptoms, providers referred 11 (42.3%) for formal sleep consultation.

Conclusion
Providers rarely document OSA symptoms for patients with COPD in primary care clinic, but assessment is greater among those with pulmonary specialty consultation. Given time constraints in primary care, external facilitation of sleep symptom assessment may improve symptom recognition and receipt of appropriate services.

Support
NIH 5K23HL111116-05, VA Center of Innovation for Veteran-Centered and Value-Driven Care.
0597 Precision of Sleep-Disordered Breathing Event Classification Using Simulated Home Sleep Apnea Testing in Patients with Spinal Cord Injury, or Disease
Authors: Zeineddine S , Sankari A , Arvai k , Salloum A , Abu Awad Y , Martin J L , Badr M S 
Published: May 2020

Abstract

Introduction
Sleep-disordered breathing (SDB) is highly prevalent among patients with spinal cord injury or disease (SCI/D). In-laboratory polysomnography (PSG) is difficult for these patients due to functional limitations and the physical construction of most sleep laboratories. Our objective was to evaluate the concordance between simulated HSAT and PSG in identifying SDB severity and subtypes of respiratory events in this patient population.

Methods
Within a larger study, 33 Veterans with SCI/D completed one night of in-laboratory PSG. Limited-channel HSAT was simulated by extracting 5 channels from PSG signals to include nasal pressure, thermistor, thoracic and abdominal belts, and oxygen saturation.

Results
Mean age of patients was 59.8 ± 10.9 years; 87.9% were male, and the average BMI was 28.1 ± 6.3. The mean Apnea-Hypopnea Index (AHI) from PSG was 35.5 ± 22.7. The mean Respiratory Event Index (REI) based on simulated HSAT was 22.5 ± 18.6. Thirty-one patients (93.9%) had SDB defined as AHI ≥5/hour. Simulated limited-channel HSAT accurately identified 32 out of 33 patients (96.96%). When SDB was further classified into mild (AHI 5-15 events/hr), moderate (AHI 15-30 events/hr), and severe (AHI&gt;30/hr), simulated HSAT consistently underestimated the severity of underlying SDB. Spearman correlation between estimating AHI (PSG-HSAT) and subtypes of respiratory events was primarily accounted for by the difference in the number of hypopneas (r=0.72, -0.021 and -0.001 for hypopneas, obstructive and central apneas, respectively).

Conclusion
Our findings support the diagnostic utility of HSAT in SCI/D patients with SDB; however, HSAT underestimation of SDB may lead to difficulties in optimizing therapy. The misclassification of SDB severity is mainly driven by the number of hypopneas. Classification of hypopneas as obstrcutive or central may shed further light on the nature of this difference. Further research on the usability of HSAT devices in this patient population is needed.

Support
VA Rehabilitation Research and Development Service (RX002116; PI Badr and RX002885; PI Sankari) and NIH/NHLBI (K24HL143055; PI: Martin)
0618 What are the Benefits of Remote Monitoring Polysomnography
Authors: Yagi T , Chiba S , Ito H 
Published: May 2020

Abstract

Introduction
The use of information and communication technology (ICT) for sleep testing is mainly aimed at improving the accuracy of out-of-center sleep testing (OCST) by remote monitoring. In this study, as the first achievement in Japan, we report the results of our sleep medical clinic and hospital unit. For the diagnosis of sleep disorders, monitoring polysomnography (PSG) attending sleep technologist is the gold standard and is positioned as Type I. On the other hand, diagnosis using OCST has become acceptable because many patients can be diagnosed quickly and cost can be reduced.When using Type II devices that measure electroencephalogram at home, the measurement accuracy is inevitable, including poor recording, because it is performed in a non-monitoring situation. As an attempt to improve this situation, our clinic and hospital unit have established a remote monitoring PSG system that can be upgraded from Type II to Type I level by remote monitoring by a sleep technologist to ensure recording accuracy.

Methods
During the period from April 2004 to December 2017, a total of 286 remote monitoring PSGs were performed by dedicated sleep technologists at the Ota Memorial Sleep Center for patients admitted to a private room at Ota General Hospital.

Results
The breakdown of the reasons for requesting remote monitoring tests is about 30% of patients scheduled to undergo surgerysuch as palatine tonsillectomy or soft palate plastic surgery the next day, and 24% of hospitalized patients with risky complications %, 17% of patients expected to have a high probability of nighttime seizures and abnormal behavior, and 15% were physically disabled or paralyzed.

Conclusion
Our remote monitoring PSG system is effectively used in the clinic for the general hospital for patients who need nighttime safety management and nursing management.

Support
non
0619 To Rely or No to Rely: Understanding the Demographics and Polysomnographic Features of False Negative Home Sleep Apnea Testing
Authors: Bollu P , Gurung P , Mehta T , Monegro A , Manjamalai S , Goyal M , Thakkar M , Sahota P 
Published: May 2020

Abstract

Introduction
The current gold standard for a definitive diagnosis of OSA is an in-center Polysomnography (PSG). Home Sleep Apnea Testing(HSAT) has become an important tool in identifying high-risk populations. One of the limitations of the study is the lack of Electroencephalographic (EEG) data. This prevents the inclusion of Respiratory Effort Related Arousals (RERAs). We attempted to identify the patients whose HSAT showed an REI of less than 5 but are at risk for having sleep apnea based on the presence of airflow and thoraco-abdominal fluctuations.

Methods
Patients in this study were those that underwent HSAT from September 2016 till June of 2019. The studies reviewed and interpreted by board certified Sleep Specialists. Studies were done using nox-T3 sleep monitor and Nomad portable Home Sleep Testing type III devices-Both are type 3 Portable Monitors. Only those patients whose REI in their HSAT less than 5 were included in this study. All these patients had multiple airflow fluctuations in their HSAT that raised the suspicion for the presence of RERAs. None of these patients had significant hypoxemia in the HSAT.Airflow fluctuations were defined by the presence of fluctuations in the signal in the airflow channel along with increasing thoracoabdominal channels. Those patients with REI of less than 5 and without airflow fluctuations were excluded from the study.

Results
A total of 178 patients were recommended to undergo an in-center polysomnogram. Of those, 92 patients completed their polysomnogram with 59 patients ending up with a diagnosis of sleep apnea while 33 did not suggesting a false negative rate of 64.13%. Of those who were positive, 39 were females while 20 were males. Both groups did not differ significantly. Females had a median BMI of 32.9(28.19 for males), a median ESS of 11(8 in males) and a median RDI of 14.8(13.25).

Conclusion
Our study shows that both Home Sleep apnea testing can have a high proportion of false-negative results in patients exhibiting thoraco-abdominal and airflow fluctuations. The interpreting physicians should understand the limitations of the HSAT and should have a low threshold to recommend an in-center polysomnogram.

Support
None.