bluuebunny/crossref_metadata_2025_split huggingface dataset:
1112 Mental Health And Sleep Disorders Are Associated With Elevated C-reactive Protein In Returning Veterans
Authors: Straus L D , Colvonen P J , Bertenthal D , Neylan T C , O’Donovan A 
Published: May 2020

Abstract

Introduction
Mental health disorders and sleep disorders are associated with systemic inflammation, which may be a key element linking these highly co-occurring conditions to negative health outcomes. This study used national VA medical records to examine C-reactive protein (CRP) levels in Iraq/Afghanistan veterans based on presence of mental health and/or sleep disorder diagnoses.

Methods
We examined medical records for 16,576 Iraq/Afghanistan veterans under age 55 who had high-sensitivity CRP results reported. ICD diagnostic codes were used to compare CRP values for: a) veterans without sleep disorders or mental health diagnoses, b) veterans with mental health disorders only, c) veterans with sleep disorders only, and d) veterans with both conditions. In generalized linear models controlling for demographics, we examined the impact of diagnostic category on continuous CRP value as well as the risk of elevated CRP (&gt;3mg/L).

Results
Veterans with mental health disorders (coeff=.14, p&lt;.001) and comorbid sleep and mental health disorders (coeff=.21, p&lt;.001) had higher continuous CRP values compared to veterans without either condition. Veterans with comorbid sleep and mental health disorders had higher continuous CRP values than veterans with sleep disorders alone (coeff=.22, p&lt;.041); however, there were few patients in the current sample who were diagnosed with sleep disorders alone (n=401, 2.4%). Additionally, veterans with mental health disorders (ARR=1.12, p=.004) and comorbid sleep and mental health disorders (ARR=1.15, p=.001) were more likely to have CRP values &gt;3mg/L compared to veterans without either condition.

Conclusion
Sleep disorders were highly likely to co-occur with mental health disorders in this sample of Iraq/Afghanistan veterans. Mental health disorders and comorbid mental health/sleep disorders were associated with elevated C-reactive protein, indicating these patients are at highest risk for negative health outcomes. Future studies should investigate directionality of relationships among sleep disruption, mental health symptoms, and inflammation.

Support
VA Advanced Fellowship Program in Mental Illness Research and Treatment
1115 Sleep Misperception, Anxiety, And Sleep Quality
Authors: Weathers J , Moran E , Stiver J , Zimmerman M 
Published: May 2020

Abstract

Introduction
Sleep misperception is a phenomenon often identified in insomnia literature, in which individuals subjective reporting does not match objective measurements of their own sleep. Research indicates that anxiety symptoms may play a role in sleep misperception. This study assessed the relationship between sleep misperception, sleep quality, and anxiety in a young adult population with sub-clinical insomnia and anxiety symptoms. Linear regression models examined the relationships between sleep quality, anxiety symptoms, and sleep misperception.

Methods
This sample consisted of 130 young adults recruited from a University in the Bronx, NY. Anxiety was assessed using the Beck Anxiety Inventory (BAI), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective measures of sleep were collected via wrist-based actigraphy over a period of 7-14 days. Subjective sleep measures were collected via an online sleep diary. A misperception index was calculated to determine the discrepancy between subjective and objective sleep measures based on a formula established in previous research.

Results
Higher anxiety symptoms were associated with greater sleep disturbance. Higher sleep misperception was not associated with greater sleep disturbance. There was a significant, positive relationship between sleep misperception and anxiety symptoms (r=0.18, p=0.000). Gender emerged as an important covariate, with males exhibiting significantly higher sleep misperception and underestimating TST (M=-0.31, SD=0.22) compared to females (M=-0.18, SD=0.12).

Conclusion
Sleep misperception was not related to sleep quality, but was strongly related to anxiety symptoms in this population. In a sub-clinical young adult sample, sleep misperception is associated with anxiety but not sleep quality, and has significant gender differences. These findings contribute to sleep misperception literature with potential applications in diagnosis and treatment of insomnia and anxiety.

Support
n/a
0114 Morning Stimulant Administration Reduces Sleep and Overnight Working Memory Improvement
Authors: Tselha T , Whitehurst L N , Tina V , Benjamin Y D , Mednick S C 
Published: May 2020

Abstract

Introduction
The goal of cognitive enhancement is to improve mental functions using interventions including cognitive training, brain stimulation and pharmacology. Indeed, psychostimulants, commonly used for cognitive enhancement purposes, while preventing sleep, have been shown to increase working memory (WM) and attention. WM is widely believed play a core role in cognitive ability, and has been shown to correlate with broad measure of cognitive ability and fluid intelligence. Sleep, however, is also important for cognitive function; thus, understanding the interaction between stimulants, sleep and cognition may inform current approaches to cognitive enhancement.

Methods
We used a double-blind, placebo controlled, repeated-measure design to investigate the effect of morning administration (9am) of stimulant, dextroamphetamine (DEX, 20 mg), on within-day and overnight WM performance, and sleep in 46 (22 female) healthy young adults. We tested WM using an operation span task (OSPAN) as it engages and captures both the memory retention and online processing capacity of WM. WM was tested at 75 minutes post drug, 12 h post drug, and 24 h post drug over a night of sleep.

Results
Compared with placebo, DEX showed no changes to WM performance at 75min or 12-hr post-drug. After sleep, DEX performed worse than PBO and the overnight improvement in performance in the PBO condition was absent in the DEX condition. Moreover, sleep quality was negatively affected by DEX administration.

Conclusion
In summary, we found no cognitive boost from psychostimulants across a day of wake and a blockade of overnight WM increases with the stimulant, compared to PBO. Given the growing non-medical use of stimulants in young adults, these findings have important implications for assessing their benefit for cognitive enhancement.

Support
Office of Naval Research N00014-14-1-0513 (S.M.) and DoD Young Investigator Prize (S.M.)
1133 The Recovery of Sleep Oscillations in Acute to Chronic Traumatic Brain Injury
Authors: Sanchez E , Duclos C , Van Der Maren S , El-Khatib H , Arbour C , Baril A , Blais H , Carrier J , Gosselin N 
Published: May 2020

Abstract

Introduction
Slow waves and spindles are essential oscillations occurring during NREM sleep that may be disrupted by moderate to severe traumatic brain injury (TBI). We investigated these oscillations in the acute and chronic trauma stage.

Methods
Four groups were tested with whole-night polysomnography: hospitalized patients with acute TBI (n=10, 29.7±13.8y) or severe orthopedic injuries (n=15, 39.9±17.1y), chronic TBI including 9 returning from the acute TBI group (n=43, 31.9±13.5y), and healthy controls (n=36, 30.5±12.7y). Characteristics for slow waves (density, amplitude, slope, frequency, duration) and spindles (density, amplitude, frequency, duration) were quantified over N2 and N3 sleep for the first three sleep cycles, and groups were compared using one-way ANOVAs.

Results
One-way ANOVAs showed group effects only for slow wave density (F=4.11 to 6.04, p=0.009 to 0.0008)) and spindle density (F=3.3 to 8.8, p=0.02 to 0.00003). These effects were present for the 2nd and 3rd sleep cycles, but not the 1st. More specifically, slow wave density in acute TBI was higher than in controls, and returned to normal levels in the chronic stage. Conversely, spindle density in acute TBI was lower than in controls and returned to normal levels in the chronic stage. No group difference was observed for the orthopedic group.

Conclusion
Our results suggest that immediately after a severely disruptive event such as a TBI, the brain needs additional deeper sleep to recover, resulting in more slow waves but also in less spindles. These changes are only present in the 2nd and 3rd sleep cycles, reflecting an absence of the expected dissipation of slow waves, which may suggest increased homeostatic sleep pressure due to the brain injury. Limits to interpretation include the hospital environment and medication, but the absence of changes in the orthopedic group under similar conditions emphasizes the effect of the brain injury itself.

Support
Canadian Institutes of Health Research (CIHR) and Fonds de Recherche Québec-Santé (FRQS)
1138 OSA In A Patient With PFO, Is It The “Perfect Storm” For A Stroke? A Case Series Of 3 Patients With Stroke At Young Age, Due To PFO And Comorbid OSA
Authors: Wong J , Gupta D , Nadhim A 
Published: May 2020

Abstract

Introduction
Approximately 25% of all strokes are cryptogenic in nature, and about 50% of all young patients with cryptogenic stroke are found to have patent foramen ovale (PFO), which is known to be the most common cause of right-to-left shunting (RTLS). Studies have shown a 2.2-fold increase in right-to-left shunt in patients with OSA and PFO, compared to patients with PFO alone. Hence, increasing the risk of cardio-embolic stroke in such patients. We present a case series of 3 patients with PFO that had embolic stroke at a young age and were found to have comorbid OSA, the likely exacerbating factor of a RTLS.

Methods
A 38-year old female, a 59-year old male, and a 27-year old female presented with stroke-like symptoms without clear vascular pathology. Upon further work-up, all were found to have PFO with RTLS. Subsequently, these patients were referred for sleep evaluation, and each one was found to severe REM-related OSA with prominent oxygen desaturations. All three patients were started on PAP therapy for control of their OSA. Two out of the 3 patients opted for PFO closure, and the 3rd patient opted for anti-platelet therapy alone. He has had no recurrence of TIA/stroke after 12 years so far.

Results
These cases illustrate a correlation between right-to-left shunting and severe REM-related OSA, through possible elevation of right-sided pressure due to nocturnal desaturations/hypoxemia. Hence, it is worth consideration that the increased right-sided pressure induced by apneic events in sleep may be a potential exacerbating factor in producing stroke-like symptoms sooner in patients with PFO than in patients with PFO who are without OSA.

Conclusion
It may be beneficial to assess young patients with stroke due to PFO, for comorbid OSA as a cause of the RTLS. This would help to prevent recurrent stroke in such patients and improve quality of life.

Support
No financial support.
1139 Sleep Disturbances In Chronic Stroke Patients: Emotional And Cognitive Impact
Authors: Howell S N , Robinson S E , Griesbach G S 
Published: May 2020

Abstract

Introduction
The objective was to investigate the impact of sleep-wake disturbances (SWD) on cognition and quality of life in the post-acute phase of stroke.

Methods
Adult stroke (n=92) patients were assessed for SWD via overnight polysomnography. The mean age was 52 ± 1 years and mean latency from injury was 117 ± 10 days. Sleep measures included total sleep time (TST), sleep and REM latency, percent time in sleep stages, apnea/hypopnea index (AHI), wake after sleep onset (WASO), and arousal index. The primary cognitive/outcome measures were: Montreal Cognitive Assessment (MoCA), California Verbal Learning Test (CVLT-II), Neuro-QoL and Mayo Portland Adaptability Inventory (MPAI).

Results
Women had lower AHI (F(1,88)=9.360, p&lt;.01), fewer arousals (F(1,90)=4.53, p&lt;.05), and spent significantly more time in SWS (F(1,90)=11.525, p&lt;.001) than men; however, SWS was reduced in both sexes. SWS made up &lt; 3% of TST in 60% of patients and was not correlated with higher AHI. SWDs negatively impacted subjective quality of life (NeuroQOL). Longer latencies to sleep were associated with increased depression (p&lt;.05) and decreased positive affect (p&lt;.01). Increased sleep efficiency led to improved positive affect (p&lt;.05) and decreases in emotional/behavioral dyscontrol (p&lt;.05). Increased time in REM sleep decreased emotional/behavioral dyscontrol (p&lt;.05), while increasing satisfaction with social roles and activities(p&lt;.01). SWDs also negatively impacted cognitive/outcome scores. Increased TST and sleep efficiency led to higher scores on CVLT-II list B and long delay free recall (p&lt;.05), while higher AHI led to poorer performance on long delay and forced choice recognition trials (p&lt;.01). Additionally, non-REM AHI negatively impacted MPAI adjustment scores (F(1,69)=4.036, p&lt;.05).

Conclusion
Male stroke patients displayed significantly more arousals and spent less time in SWS than females. For both sexes, better sleep indicated improved quality of life. Sleep measures were correlated with cognitive/outcome measures. Non-REM AHI significantly predicted outcome at discharge from rehabilitation facility.

Support
1157 Comparison Of Polysomnography Total Sleep Time In Veterans With A Dementia Diagnosis, Incipient Dementia, And No Dementia
Authors: Razjouyan J , Nowakowski S , Naik A D , Sharafkhaneh A , Kunik M E 
Published: May 2020

Abstract

Introduction
Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined the total sleep time derived from overnight polysomnography (PSG) studies in veterans with a current dementia diagnosis at the time of PSG study (dementia), future diagnosis of dementia following the PSG study (incipient dementia), and no diagnosis of dementia at any time point (no dementia) over a 19-year period.

Methods
We identified 69,847 PSG sleep studies using CPT code 95810 and all-cause dementia diagnosis using ICD 9/10 codes (e.g., F03.90) from 2000-19 in the US Department of Veteran Affairs (VA) national database. To be included patients must have ≥ 1 VA visits in 12 months leading up to PSG. Dementia diagnosis must be documented on two separate visits between 12 months prior to 6 months following PSG for current dementia group and anytime after the PSG for incipient dementia. We used natural language processing to extract TST values from the patient free-text notes. Analysis of variance was used to compare PSG TST of the three groups.

Results
Patients had a mean age of 55.4±13.8 at the time of PSG study, 91.5% were male, and 64% were Caucasian. TST of dementia patients (N=1,031) was m=257±110m (d=0.33, p&lt;.05), incipient dementia (N=1,875) was m=253±116m (d=0.35, p&lt;.05) versus no dementia (61,871) m=292±104mins.

Conclusion
Patients with a diagnosis of dementia at the time of PSG study and patients that went on to receive a diagnosis following their PSG study had a significantly lower total sleep time compared to patients that have never received a dementia diagnosis. This is an important study that compares sleep duration during overnight PSG studies and dementia diagnosis across 19 years in the largest integrated healthcare system in the US.

Support
This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).
0119 The Role of Aging and Working Memory in Emotional-Long Term Memory Formation
Authors: Sattari N , Whitehurst L , Vinces K , Mednick S 
Published: May 2020

Abstract

Introduction
It is widely accepted that “offline” processes during sleep contributes to memory. Working Memory (WM) capacity, which reflects “online” memory processing, is an important factor influencing cognitive functioning, which declines with age. In younger individuals, a positive association is reported between WM-capacity and declarative memory improvement.

Methods
We examined the relation between WM and long-term memory consolidation, among younger [N=105, 18-25yr] and older adults (N=119, 60-85yr). Subjects completed an OSPAN WM task, encoded a Word-Paired Association (WPA) task in the morning (Test1), and were tested on the WPA in the afternoon (Test2) after a 90-minute polysomnographically-recorded nap or wake. Half of the subjects were exposed to negatively valenced word-pairs (EWPA) while the other half were exposed to neutral word-pairs (NWPA). Subjects rated valence of the word-pairs at Test1 and Test2. We compared the four groups (young-EWPA, young-NWPA, old-EWPA and old-NWPA) on WM and WPA in both wake and sleep.

Results
In both wake and sleep, in the WPA, ageXword-condition interaction was found (p=.004). Post-hoc analysis revealed that in wake, younger-EWPA had higher performance (p=.03) than younger-NWPA, however, older-EWPA had lower performance (p=.03) than older-NWPA. Additionally, we found an ageXword-condition interaction whereby youngers showed no change in ratings, while older adults rated word-pairs more positively both in wake (p=.03) and sleep (p=.002) at Test 2. Youngers had higher WM performance (p=.007), also their WM performance was positively associated with WPA both for Neutral (p=.03) and Emotional (p=.01). WM and WPA among older adults was not related. In younger-EWPA, Stage2-sleep-minutes was positively associated to WPA improvement (p=.03) where this association was negative among older-EWPA (p=.02). In older-NWPA, Stage2-sleep-minutes was positively associated with WPA (p=.004).

Conclusion
Our findings indicate an association between WM and emotionally-salient memory formation that is modulated by age. Older adults, but not younger, showed the emotional bias previously reported. WM was higher in younger adults related to memory improvement. Stage2-sleep was related to memory improvement in both groups, but in opposite directions. In sum, the role of sleep in memory consolidation changes with aging and WM may play a role in this process.

Support
Fenn et al.,2012
1186 Developing And Testing A Web-based Provider Training For Cognitive Behavioral Therapy Of Insomnia
Authors: Taylor D , Bunnell B , Calhoun C , Pruiksma K , Dietch J , Wardle-Pinkston S , Milanak M , Rheingold A , Simmons R , Peterson A , Morin C , Ruggiero K , Brim W , Dolan D , Wilkerson A 
Published: May 2020

Abstract

Introduction
Chronic insomnia is a common, debilitating disorder and a risk factor for significant medical morbidity, mental health problems, and workplace difficulties. Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia. However, few providers are trained in CBT-I, in part due to a bottleneck in training availability and the time and cost associated with current training platforms. To address this training deficit, our team developed and evaluated CBTIweb.org, a web-based provider training course for CBT-I.

Methods
Feedback from alpha- and beta-testing of CBTIweb.org was collected and used to optimize course content and functionality. Then, a comparison study was conducted in which licensed providers were randomized to complete either the online CBTIweb.org course (n=21) or an in-person CBT-I training (n=23). During all phases of development, providers completed a Computer System Usability Questionnaire (CSUQ), investigator-developed website usability and content questionnaires, and pre/post-training competency assessments.

Results
Independent samples t-tests indicated significant improvements in CSUQ, and website usability and content questionnaires responses from alpha- to beta-testing (all ps &lt; .05). Linear mixed-effects modeling revealed significant within-subject increases in knowledge acquisition (F(34.7) = 65.4, p &lt; 0.001; baseline = 69% correct, post-training = 92% correct) when collapsed across in-person and web-based groups. The interaction group by time interaction was non-significant (F(34.7) = 1.7, p = 0.204), indicating similar gains in knowledge (i.e., equivalence) between the in-person and the CBTIweb.org training formats.

Conclusion
Alpha and beta testers of CBTIweb.org reported high levels of satisfaction while also noting areas for improvement, which were used to update the site. Findings suggest the final CBTIweb.org product successfully trained clinicians compared to an in-person workshop, given knowledge acquisition improvements. CBTIweb.org is an efficient and effective training platform for clinicians to gain knowledge and competence in the most effective treatment for insomnia.

Support
W81XWH-17-1-0165
1188 Test Characteristics of a Machine Learned Electronic Medical Record Extractable Tool for OSA Case Identification in a Community-Based Population
Authors: Patel S I , Kukafka D , Antonescu C , Combs D , Lee-Iannotti J , Quan S F , Parthasarathy S 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a significantly underdiagnosed medical condition. A machine learning method known as SLIM (Supersparse Linear Integer Models) that can be extracted from the Electronic Health Record (EHR) has found to be superior to patient-reported sleep-related symptoms to diagnose OSA. Such an evaluation, however, was previously validated in a laboratory-based population. Our aim was to determine the test characteristics for the EHR-extractable SLIM tool in a community-based population.

Methods
Subjects who participated in the Sleep Heart Health Study (SHHS) were included in this analysis. Variable definitions of OSA were determined using an Apnea Hypopnea Index (AHI) threshold of 5 per hour, 15 per hour, or the presence of any comorbidity (hypertension, ischemic heart disease, stroke, mood disorders, impairment of cognition, or sleepiness) when the AHI was between 5 to 15 per hour. Variable hypopnea definitions based upon degree of oxygen desaturation and associated arousals were considered.

Results
In the SHHS dataset, the Receiver Operating Characteristics (ROC) for a SLIM score threshold of 9 for men and 5 for women was good when OSA was defined by AHI &gt; 5 per hour (hypopneas with either &gt; 3% oxygen desaturation or arousals). Specifically, the ROC was 0.72 (95% Confidence Intervals [CI] 0.70; 0.74) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (6.0) and PPV (0.92) were also good when an AHI of 5 per hour threshold was adopted with hypopneas scored using the minimum 3% oxygen desaturation alone. Similarly, the ROC was good 0.74 (95%CI 0.73; 0.76) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (8.9) and PPV (0.81) were also good in the presence of comorbidities when AHI was 5 to 15 per hour using &gt; 4% oxygen desaturation alone.

Conclusion
The EHR-extractable tool can be an actionable tool for case-identification of patients needing a referral for sleep study in a community-based population. Such an approach could facilitate an automated, rather than manual, OSA screening approach aimed at managing population health.

Support
HL138377