bluuebunny/crossref_metadata_2025_split huggingface dataset:
1213 Sleepfect Tracker: A Crossplatform Mobile Researchkit App For Sleep Self-management
Authors: Menon P , Seixas A , Pathan Z , Suhail M , Jean-Louis G , Ayoub S , Naqeeb B , Wani B , Mishra S , Khan S 
Published: May 2020

Abstract

Introduction
We created Sleepfect Tracker, a researchkit-based cross platform app to explore the feasibility and acceptability of a sleep tracking app for sleep self-management.

Methods
We developed Sleepfect Tracker app on Appbakery, a DIY app making platform using ResearchKit for iOS and ResearchDroid for Android users. Sleepfect allows participants to track their sleep behavior (weekly via sleep diary) and environment (monthly), as well as their total sleep time and step counts data via Apple’s HealthKit, Android step count sensors, or Fitbit (wearable). Three hundred and ninety-five (395) individual from around the globe downloaded the app and 163 unique users answered surveys on their sleep behavior, environment, and architecture. In total we collected 6429 sleep and 2882 step data points and provided insights into user sleep behavior and sleep environment. We also analyzed whether sleep duration was associated with steps.

Results
Regarding immediate sleep environment and behavior, 11.1% worked or studied in bed, 27.0% reported having pets in bed, 39.7% red in bed prior to sleep, 40.3% watched TV in bed prior to sleep, 11.3% drank alcohol prior to bed, 9.8% smoked prior to bed or wake during night, 8.1% ate snack at bedtime, and 6.5% ate when they awake at night. 74.3% of the participants used electronic devices in their bedroom. Of the participants who used electronic devices in the bedroom, 52.1% had an average sleep duration of 6-8 hours and 29.8% reported sleeping 4-6 hours. Of the participants who did not use electronic devices in bedroom, 30.1% slept 4-6 hours, 31.8% slept 6-8 hours, and 32.45% slept 8-10 hours, on average. The relationship between steps count and sleep hours was trending, r=.16, p=.07.

Conclusion
Users can evaluate their sleep habits, monitor daily sleep-related behaviors through Sleepfect tracker. The app demonstrated initial usability and feasibility, but long-term usability and effectiveness must be evaluated. Further investigations on which functions will be more useful to help user to improve their sleep and engage users should be considered.

Support
K01HL135452, R01MD007716, R01HL142066, and K07AG052685
1215 Improving Sleep Disorders And Chronic Neck Pain By Adjusting Height Of The Pillow Through Cervical Posture Management
Authors: Yamada S , Yamada K 
Published: May 2020

Abstract

Introduction
Recent studies have suggested that chronic musculoskeletal system pain, including chronic neck pain, accounts for approximately 70% of all sleeping disorders. Simultaneously, sleeping disorders increase pain sensitivity and create a vicious cycle of chronic neck pain. Patients with chronic pain experience a variety of somatic symptoms (e.g., Stomach or bowel problems, Back pain, Pain in your joints, headaches, chest pain, shortness of breath, dizziness, fatigue, and Trouble sleeping) that are difficult to treat. However, treatment of both neck chronic pain and sleeping disorders through cervical posture management by adjusting height of the pillow used while sleeping has yet to be considered.

Methods
Patients who visited our hospital with chief complaints of chronic neck pain were rated according to the Numerical Rating Scale (NRS) and were asked to answer the Somatic Symptom Scale-8 (SSS-8), to ascertain the degree of somatic symptoms. Out of all the patients, only 84 scored at least 8 out of 32 in the SSS-8. Based on the individual results of the 84 respondents, they were given customized pillows to be used for 3 months. The pillows were adjusted using the SSS method developed at our clinic. We adjusted the height of the pillow by 5mm increments to check the cervical inclination angle at approximately 15 degrees in supine position, lateral position with the center line from face to neck at left-right symmetry and finally confirming smooth turning over. The respondents performed NRS and SSS-8 after 2 weeks and 3 months of using the pillow.

Results
The results of this study showed that at 0 weeks / 2 weeks / 3 months. NRS score was 6.8 / 5.1 / 4.1 (p &lt;0.01), and the overall SSS-8 score was 13.2 / 9.9 / 8.2 (p &lt;0.01), showed a marked improvement. By symptom, all symptoms except Stomach or bowel problems showed significant improvement. Trouble sleeping showed the highest improvement at 2.6 / 1.7 / 1.3 (p &lt;0.01).

Conclusion
Chronic neck pain and sleeping disorders improved in the patients. These results suggested that cervical posture management by adjusting height of the pillow is an effective treatment method.

Support
None
1236 A Case of Systemic Amyloidosis and Sleep-Related Hypoventilation
Authors: Castner Lauren M , Garwood Mark D 
Published: May 2020

Abstract

Introduction
Amyloidoses are a group of systemic diseases characterized by misfolded protein fragment deposition within the organs, including the heart, kidney, liver, gastrointestinal tract, nervous system, pulmonary system, and soft tissues1. Obstructive and central sleep apnea are known to occur frequently in those with cardiac amyloidosis. This case discusses a patient with systemic amyloidosis and chronic hypercarbic, hypoxic respiratory failure.

Report of Case
A 66 year old female with a history of systemic amyloidosis, non-ischemic cardiomyopathy, hypertension, and obstructive sleep apnea was admitted for acute on chronic heart failure. Despite intravenous diuresis, she remained hypoxemic, requiring 1 liter per minute of oxygen.
She was found to have bilaterally reduced diaphragmatic excursion and a restrictive ventilatory defect on spirometry. She had a preceding history of chronic carbon dioxide retention with elevated CO2 levels for greater than a year (52-74 mmHg).
Sleep medicine was consulted to assist in evaluation of the patient’s obstructive sleep apnea and hypoxic, hypercarbic respiratory failure. Baseline polysomnogram revealed sleep related hypoventilation with transcutaneous CO2 (TCO2) ranging between 77-86 mmHg without clear obstructive sleep apnea. A bilevel positive airway pressure (BPAP) titration was then performed (TCO2 54-69 mmHg) and while the patient’s obstructive sleep apnea was well treated, sleep-related hypoventilation and central apneas persisted. Average volume assured pressure support (AVAPS) was initiated for management of sleep related hypoventilation. In follow up, the patient is feeling well, off oxygen, with daytime TCO2 38 mmHg.

Conclusion
This case demonstrates a rare complication of systemic amyloidosis in the setting of respiratory failure attributed to amyloid infiltration of the diaphragm. In the few previously reported cases of neuromuscular respiratory failure in systemic amyloidosis there is rapid progression and high mortality3, which highlights the importance of assessing for sleep disordered breathing and additional causes of respiratory failure in a patient with a complex systemic disease.
1243 A Guinness Book Challenge in Upper Airway Stimulation Activation
Authors: Zakhary Nardine , Strohl Kingman 
Published: May 2020

Abstract

Introduction
Upper airway stimulation is a option for CPAP-intolerant patients. Device activation is typically ~4 weeks after the implant procedure.

Report of Case
A 61yo male with severe OSA had an upper airway stimulation device placed by ENT. At that time, stimulation produced bilateral tongue protrusion. In the immediate post-operative period, after closure, a hematoma, at the inferior chest incision, was discovered and drained with cauterization of the bleeding vessel. Seven weeks after implant, patient reported to our sleep clinic for activation of the device; and at that time, there was no sensation or activation up to the maximum amplitude of 5mV. The device reported an acceptable respiratory waveform, and triggering on and off sets but without sensory outcomes. Changing of the electrode configuration with advanced settings had no effect. Impedance values were acceptable. Tongue movements were grossly intact. At 2 months, ENT evaluation found mild hypoglossal nerve neuropraxia. To assess for a device related issue, x-rays of the neck and chest were performed and showed proper placement of the device. At 3.5 months, neuropraxia had resolved but device activation was unsuccessful, with no sensory or motor activation to 5mV stimulation. Plans were made for a procedure during which the lead electrode or implantable pulse generator would be assessed or replaced. At 4 months after implantation, in a multidisciplinary appointment with Sleep, ENT and the device representative, with a 3 electrode negative pole and the generator as the + pole, at 2.3mV, the device was activated. At the present time, the patient is exploring higher and lower mV settings and a PSG titration is scheduled.

Conclusion
This is the longest recorded duration (3.5+ months) of unsuccessful post-operative activation; and it occurred ~2 months after clinical signs of hypoglossal nerve neuropraxia had resolved.
1245 Cheyne-Stokes Respiration and Circulation Time—A Case to Add to the Mystery
Authors: Bhura Sajeer , Rupani Nawaz , Massoud Mona , Chowdhuri Susmita , Shamim-Uzzaman Q Afifa 
Published: May 2020

Abstract

Introduction
Lung-to-finger circulation time (LFCT), the time taken for the circulation to reach the fingertips from the lungs, has been shown to correlate inversely with cardiac function (Hosokawa et al. 2015). LFCT can be measured on PSG as the time from the start of rebreathing after a central respiratory event to the nadir of the oxygen desaturation on the SpO2 signal. Patients with congestive heart failure (CHF) have been found to have increased LFCT, with even longer LFCT in patients with Cheyne-Stokes Respirations (CSR). We are reporting a case where LFCT increased throughout a single night by more than 40%.

Report of Case
A 66-year-old diabetic male with ischemic cardiomyopathy (LVEF 25%), CVA with residual L-sided paresthesias, CKD-IV and hypertension was diagnosed with severe CSA and OSA (AHI 31.5, CAI 13.9, OAI 0.0, MAI 0.2, hypopnea index of 17.4, minimum SpO2 of 80%; supine AHI 56.1). CSR was not mentioned on this diagnostic study. On his titration study, CPAP and BPAP failed to treat CSA, but ASV effectively treated his sleep-disordered breathing; however, he could not be started on ASV due to HFrEF. On a repeat titration after ICD implantation, CSR was prominent in the supine position, on both CPAP and BPAP S/T therapy. Cycle length progressively increased from 40 seconds at the beginning to 57 seconds at the end of the recording, an increase of 42% throughout the night. Circulation time also increased from 31 seconds to over 40 seconds. Scorable central respiratory events resolved but periodicity persisted.

Conclusion
To our knowledge, this is the first case of CSR with such progressive prolongation in cycle length during a single night. It again raises the question of the role of BPAP S/T in CSR with heart failure, and clarification of the potential use of supplemental oxygen in such situations.
0126 Local Slow Wave Sleep and Post-Stroke Brain Repair
Authors: Landsness E C , Brier L M , Hua R X , Chen K , Rosenthal Z P , Culver J P , Lee J 
Published: May 2020

Abstract

Introduction
Recent evidence suggests that slow wave sleep (SWS) is important for synaptic plasticity and brain repair following stroke. Previous studies described a progressive increase in whole cortex and contralesional regional delta power during sleep after stroke, suggesting a global increase in SWS. However, these studies did not distinguish between the effects of global vs. local SWS. We hypothesized that local changes in SWS delta power would parallel changes in the functional remapping and circuit repair.

Methods
To study SWS in living mice we used Thy-1-GCaMP6f mice (n=12), serially imaged (baseline, 24 hours, weeks 1, 4,) during sleep following photothrombotic stroke of the left forepaw somatosensory cortex (S1FP). An optical fluorescence imaging system (OFI) was used to image whole-cortex neuronal activity. The evolution of local delta activity was compared across three ROIs: 1) infarct, 2) perilesional remapped, and 3) perilesional non-remapped left.

Results
The photothrombotic infarct encompassed the left S1FP stimulus map, resulting in significant attenuation of S1FP evoked responses at week 1; however, a small region of activation was retained in posterior left S1FP (peri-lesional remapped). The infarct region demonstrated a decrease in delta power during sleep; however, the perilesional region of future remapping exhibited a rebound in focal delta power at 1 week after an initial decline at 24 hours. In the perilesional non-remapped area delta power decreased, but did not increase until week 4. We also observed an early wide-spread increase in delta power at 24 hours and week 1 that decreased on week 4.

Conclusion
With the high spatial resolution of OFI, we find that SWS is disrupted throughout the brain following focal ischemia. These data suggest that local SWS selectively increases in the region of remapping prior to repair of that circuit and that local SWS may play a role in brain repair following stroke.

Support
AASM Foundation #183-PA-18, #201-BS-18
1247 Rare hypoventilation syndrome identified in obese adolescent
Authors: Dr. Minor Courtney 
Published: May 2020

Abstract

Introduction
With the obesity epidemic persisting in the United States today, it is no surprise that morbidly obese patients with poor sleep are often linked to the diagnoses of obstructive sleep apnea and/or obesity hypoventilation syndrome before testing is even completed. It is important to spread awareness among pediatric sleep providers of the rare hypoventilation syndromes for which most physicians likely have never seen a case. Missed diagnoses may lead to not only increased morbidity and mortality in patients, but under-reporting of cases will further delay crucial research needed to identify the precise pathophysiology that is currently unknown.

Report of Case
Authors encountered a 16 year-old male who had re-presented to pediatric sleep clinic after a two-year period of being lost to follow-up. The patient’s past medical history included Angelman’s syndrome, idiopathic central adrenal insufficiency, autonomic instability, seizure disorder, aggressive conduct disorder, morbid obesity, and hypoventilation without discrete obstructive sleep apnea as diagnosed on sleep study at age 10. Central hypoventilation was designated as idiopathic. The family had now returned to care due to concern for worsening episodes of bradypnea, bradycardia, and cyanosis requiring aggressive tactile stimulation. Review of records over the interim revealed multiple ER visits for stress dose steroids, as well as hospitalizations for hypothermia, bradycardia, and seizures. Consideration was taken that his multiple diagnoses were consistent with the unified diagnosis of Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD), and his hypoventilation thus could be accurately characterized as a syndrome of central hypoventilation rather than idiopathic or related to obesity. In addition, his progressive aggression and severe developmental delay could more accurately be attributed to chronic intermittent hypoxia, thus prompting more urgent need for non-invasive ventilation.

Conclusion
With approximately 100 reported cases, ROHHAD is a rare, clinically distinct entity from other etiologies of hypoventilation. Improved awareness of the diagnosis would hopefully lead to earlier diagnosis and improved anticipatory guidance able to be provided to the family.
1248 Hypersomnia with Pseudo-Cataplexy Associated with Schizoaffective Disorder: A Case Report
Authors: Khogeer Feras , Sachdeva Alok 
Published: May 2020

Abstract

Introduction
Psychiatric illness is an important potential cause of excessive daytime sleepiness (EDS), hypersomnia, and narcolepsy-like symptoms. We report a case of hypersomnia and pseudo-cataplexy associated with schizoaffective disorder.

Report of Case
A 28-year-old man with obstructive sleep apnea (OSA) and schizoaffective disorder presented to our sleep medicine clinic complaining of EDS, cataplexy-like attacks, sleep paralysis, depressed mood, and dream intrusion. Questions about cataplexy often provoked brief episodes of speech arrest, eye closure, and neck flexion lasting a few seconds.
An MSLT with CPAP showed a mean sleep latency of 3 minutes and 3 sleep onset REM periods (SOREMPs); however, actigraphy showed that the SOREMPs occurred during the patient’s habitual sleep period and the patient discontinued a REM-suppressing medication within a few days of the study. The HLA-DQB1*0602 allele was absent.
Following circadian adjustment, a repeat MSLT with CPAP showed zero sleep and no SOREMPs. The preceding polysomnogram showed a total sleep time (TST) of 7.8 hours, no epileptiform activity, adequately-treated OSA, and a REM latency of 53 minutes. Prior to these studies, two weeks of sleep diary and actigraphy showed a TST greater than 10 hours. Ultimately, treatment of the patient’s psychiatric disorder resulted in a reduction of his EDS and TST.

Conclusion
Patients with psychiatric illness can present with hypersomnia, EDS, and narcolepsy-like symptoms such as pseudo-cataplexy. Misdiagnosing such a patient with narcolepsy can lead to treatments capable of worsening the primary underlying psychiatric disturbance. MSLT results must be interpreted in the context of a patient’s clinical history and sleep schedule; if there is concern for a false positive result, repeat testing should be considered.
1250 Agrypnia Excitata in a Patient with Paraneoplastic Autoimmune Encephalitis
Authors: Sanchez J L , Saeed S , Battistini H 
Published: May 2020

Abstract

Introduction
Agrypnia Excitata (AE) is a syndrome characterized by loss of sleep with permanent motor and autonomic hyper activation. This case describes this peculiar syndrome in a patient with paraneoplastic autoimmune encephalitis.

Report of Case
DG is a 35 yr old male with a history of anti-Ma2 limbic encephalitis secondary to cystic teratoma of the left testis diagnosed 6 months prior to presenting in Sleep Clinic. His parents described significant sleep disturbances including short sleep and wake periods throughout the day and night with no apparent pattern, acting out dreams, motor activity during sleep including pulling at his clothes or using his hands to manipulate invisible objects. Additionally they described low-grade fevers, and severe hyperphagia. Polysomnogram showed absence of slow-wave sleep and what appeared to be an admixture of stage 1 non-rapid eye movement (NREM) with rapid-eye movement (REM) sleep. Multiple sleep-latency testing (MSLT) demonstrated a mean sleep latency of 5.2 minutes and four sleep-onset REM periods (SOREMPs). Magnetic resonance imaging of the brain revealed persistent inflammation of the mesial temporal lobes and hippocampal region. Cerebral spinal fluid testing showed persistent anti-Ma2 antibodies. Based on this clinical presentation we made a diagnosis of Agrypnia Excitata.

Conclusion
Agrypnia Excitata is a syndrome characterized by loss of the normal sleep-wake rhythm. Sleep consists of the disappearance of spindle-delta activities, and persistent stage 1 NREM sleep mixed with recurrent episodes of REM sleep. The second hallmark of AE is persistent motor and autonomic hyperactivity observed during wake and sleep. AE has been described in three distinct clinical syndromes: Morvan Syndrome (autoimmune encephalitis), Fatal Familial Insomnia, and Delirium tremens. The pathogenesis of AE consists of intra-limbic disconnection releasing the hypothalamus and brainstem reticular formation from cortico-limbic inhibitory control. In autoimmune encephalitis, antibodies that act on voltage-gated potassium channels within the limbic system have been implicated in the pathophysiology.
1252 Rapid-onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) Syndrome in a Patient on Stimulants and Normal BMI at the Time of Diagnosis: A Case Report and Literature Review
Authors: McGhee Vera , Viteri Ernesto , Schoumacher Robert , Relia Sachin , Harris Atia 
Published: May 2020

Abstract

Introduction
ROHHAD is a rare and complex pediatric disorder presenting in early childhood with rapid onset obesity, followed by central hypoventilation, hypothalamic dysfunction, endocrine disorders, and neurobehavioral disorders.

Report of Case
We present a unique case of a 6-year-old girl diagnosed with ROHHAD in the setting of normal Body Mass Index (BMI). Patient had a history of food-seeking behavior, hyperphagia, and rapid onset obesity at the age of 4 years old with subsequent development of autonomic dysregulation, hypoventilation, and neurobehavioral disorders. At the time of evaluation in Sleep Medicine Clinic for snoring and disrupted sleep the patient had been treated for hyperactivity with several appetite-suppressing stimulant medications leading to weight loss and causing her to have a normal BMI. The original polysomnogram demonstrated severe Obstructive Sleep Apnea (OSA) with obstructive Apnea-Hypopnea Index (AHI) of 11.2/hour and was concerning for hypoventilation based on the end-tidal CO2 values and morning blood gas. Despite improvement in OSA with CPAP therapy, the patient’s hypercapnia persisted. The overall clinical presentation resulted in extensive multispecialty workup, which ultimately led to the diagnosis of ROHHAD syndrome despite the patient’s normal BMI.

Conclusion
ROHHAD syndrome is a rare and complex pediatric disorder requiring multi-disciplinary approach, with early diagnosis and intervention being essential for management of the condition. Hypothalamic obesity is one of the diagnostic hallmarks of ROHHAD. However, about half of patients with ROHHAD develop neurobehavioral disorders, which might require treatment with stimulant medications. Literature review revealed several case reports addressing the effect of stimulant medications on hypothalamic obesity, however none focusing on patients with ROHHAD syndrome. This case raises questions about the role of appetite-suppressing medications in the management of obesity in patients with ROHHAD. It also suggests possible need for further specific workup in patients on stimulants with hypoventilation in the absence of obesity.