bluuebunny/crossref_metadata_2025_split huggingface dataset:
0806 Prescription Correlates of Nightmare Disorder Among Veterans
Authors: Gross M , Patel R , Schwartz S W , Sebastião Y V , Foulis P , Scheer D , Taylor K A , Anderson W 
Published: May 2020

Abstract

Introduction
In the James A. Haley Veterans Administration (JAHVA) Vista database, the ICD-9 code 307.47 for Nightmare disorder (ND) is infrequently used and appears independently of codes for PTSD. We wanted to determine if certain drugs that may affect sleep are associated with ND.

Methods
All patients with ND visiting JAHVA between 2007 and 2011 were selected along with control patients who visited JAHVA on one of 20 random days, one day each quarter year. Controls were assigned an index date reflecting their selection quarter. Associations with prescriptions for opioids, antidepressants (SSRI’s, SSNI’s, Tricyclics), antihistamines and benzodiazepine/Z-drugs were initially investigated. Two analyses were performed: risk factor analysis- patients with ND diagnosis dates (cases) or index dates (controls) prior to 2008 were excluded and only prescription dates that preceded the ND diagnosis or index date were considered; treatment analysis- cases and controls with a ND diagnosis date or index date after 2010 were excluded and only prescription dates that were subsequent to the ND diagnosis or index date respectively were considered. Logistic regression adjusting for age, gender, race and Hispanic ethnicity was used to determine the association between drug groups and ND.

Results
In risk factor analysis (667 cases, 14,739 controls), opioids and antihistamines were significantly less prevalent among would-be ND patients than controls (OR=0.627 and 0.610 respectively); no drug group was predictive of ND. In contrast, all drug groups were significantly associated with ND in treatment analysis (803 cases, 15,530 controls). The strongest associations were seen with benzodiazepine (OR=3.026; 95% CI: 2.472, 3.703) and SSRI (OR=2.789; 95% CI=2.316, 3.358) prescriptions.

Conclusion
Our data suggest that some JAHVA providers may be treating ND with medication, most notably with benzodiazepines/Z-drugs and antidepressants. The role of anti-histamine and opioid prescriptions needs further elucidation. The ramifications of these treatment decisions should be explored.

Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
0820 Meta-Analysis of the Association of Age and Actigraphy-Assessed Sleep Across the Lifespan
Authors: Bowman M A , Buysse D J , Marsland A L , Wright A G , Foust J , Mehra R , Srinivasan S , Kohli N , Carroll L , Jasper A , Hall M H 
Published: May 2020

Abstract

Introduction
Sleep quantity and continuity vary across the lifespan. Actigraphy is reliable, ecologically valid, and is the most widely-used behavioral measure of sleep in research and personal health monitoring. The extent to which age is associated with actigraphy-assessed sleep has not been evaluated across the lifespan. The aim of this meta-analysis was to evaluate the associations between age and actigraphy-assessed sleep in relatively healthy individuals.

Methods
A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using “actigraphy” and “sleep” terms provided 7,079 titles/abstracts, which were screened to exclude studies of only individuals with mental health disorders, medical conditions, sleep disorders, or shift workers. We evaluated 1,379 full-text articles for reports on the association between age and actigraphy-assessed sleep duration, efficiency, timing, and/or regularity. Overall, 88 articles met these criteria (182 effect sizes; N=18,443). Four meta-analyses were conducted, examining sleep duration (k=86), sleep efficiency (k=58), bedtime (k=27), and wake-up time (k=11). There were insufficient numbers of studies (less than 5) to evaluate sleep midpoint or sleep regularity. We tested continent of the study, study design, actigraphy device type, and number of nights of data collection as moderators of meta-analytic associations.

Results
With increasing age, sleep duration was shorter (r = -0.13) and sleep efficiency was lower (r = -0.06). Bedtime was later with age for ages 6-21 (r = 0.31) and earlier for ages 22 and up (r = -0.65). Wake-up time was not associated with age for ages 6-21 (r = 0.20) but was earlier with increasing age for ages 22 and up (r = -0.71). The strength of these associations was modified by continent and study design, but not by type of actigraphy device or number of nights of data collection.

Conclusion
Weak associations between age and actigraphy-assessed duration and efficiency suggest that inadequate sleep quantity or poor sleep continuity should not be dismissed as typical consequences of aging. Large associations between age and sleep timing, despite a small literature, highlights a promising area for further study, particularly to determine the age at which sleep timing shifts from delaying to advancing.

Support
MAB was supported by T32 HL07560.
0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults
Authors: Tzuang M , Owusu J T , Huang J , Sheehan O C , Rebok G W , Kasper J , Spira A P 
Published: May 2020

Abstract

Introduction
Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults.

Methods
Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency &gt;30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits.

Results
Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p&lt;0.001), all-cause hospitalizations (OR=1.30, p&lt;0.01), preventable hospitalizations (OR=1.83, p&lt;0.05), 30-day readmissions (OR=1.73, p&lt;0.05), and home health care use (OR=1.27, p&lt;0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p&lt;0.05).

Conclusion
Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use.

Support
National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”
0873 Obstructive Sleep Apnea Impacts Brain Development in Obese Children and Adolescents: An MRI Study
Authors: Sarzetto F , Naik T , Narang I , Kassner A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a breathing disorder characterized by episodes of nocturnal hypoxia and chronic systemic inflammation, affecting more than 50% of obese youths. Both obesity and OSA independently have a negative impact on brain structure and function, but their combined effect on the developing brain is unknown. The purpose of this study was to assess MRI measurements of cortical thickness (CT) in obese youths with various degrees of OSA severity. We hypothesized that CT is abnormal in obese adolescents with OSA.

Methods
55 obese subjects (26 females, 29 males, mean 14.3 ± 2.4 years) were included in the analysis. All subjects were assessed with polysomnography (PSG) to evaluate presence and severity of OSA. T1-weighted MPRAGE images were acquired using a 3T MRI scanner following PSG. CT was extracted using the CIVET 2.1.1 pipeline, and statistical analysis was performed on SurfStat to examine global and regional CT in relation to age using a general linear model.

Results
Based on PSG outcome, subjects were divided into 3 groups, no OSA (OAHI &lt; 1.5 events/hr., n = 15), mild OSA (OAHI &lt; 5, n = 14), and moderate/severe OSA (OAHI &#8805; 5, n = 26). Cortical thickness analysis revealed a negative-trending correlation between global CT and age in no OSA (T = -0.49, P &gt; 0.6), as seen in typical development. This correlation weakened in the presence of mild OSA (T = -0.20, P &gt; 0.8) and became significantly positive in moderate/severe OSA (T = 3.87, P = 0.001), affecting several cortical areas.

Conclusion
These results indicate that brain development in obese adolescents with moderate/severe OSA significantly deviates from the typical trajectory of cortical thinning. This thickening could be due to exacerbated inflammation from the combined effect of both diseases, or a neurotrophic effect of leptin. More data is needed to validate these findings.

Support
None
0875 Interrelations Among Race, Socioeconomic Status, Sleep Duration Variability, and Neurobehavior in Children with Obstructive Sleep Apnea Syndrome
Authors: Williamson A A , Fan J , Xiao R , Tapia I E 
Published: May 2020

Abstract

Introduction
There are racial and socioeconomic status disparities in child obstructive sleep apnea syndrome (OSAS) and in sleep patterns, but research on sleep patterns in children with OSAS is limited. This project examined interrelations among race, socioeconomic status (SES), sleep duration variability, and neurobehavior in children with OSAS.

Methods
Baseline data were drawn from 464 children with OSAS (M age 7 years, SD 1.4 years; 49% male; 34% Black) participating in the Childhood Adenotonsillectomy Trial. Sleep duration variability was calculated as the coefficient of variation for 5-day sleep diaries. Linear regression was used to examine whether sleep duration variability was associated with child race (Black vs. non-black), SES (family income; maternal education; neighborhood distress index based on US Census data), z-scored body mass index, asthma, prematurity, and secondhand smoke exposure. We then examined whether sleep duration variability was associated with parent-and teacher-reported child neurobehavior including executive functioning (Behavior Rating Inventory of Executive Functioning) and inattention (Conners Rating Scale), adjusting for the variables included in the first regression analysis.

Results
Black race was correlated with increased sleep duration variability (p = .05), but this association was not significant in the adjusted regression model. Secondhand smoke exposure was significantly associated with sleep duration variability (p&lt;.001). Greater sleep duration variability was significantly associated with increased parent-reported neurobehavioral impairments (p=.004 for executive functioning and for inattention), adjusting for race, SES, secondhand smoke exposure, and the other covariates. Sleep duration variability was not associated with teacher-rated child neurobehavior.

Conclusion
In children with OSAS, sleep duration variability is greater in those exposed to secondhand smoke and is linked to increased parent-rated child neurobehavioral impairments. Findings suggest that clinicians should screen for secondhand smoke exposure and that treatment of pediatric OSAS should include a focus on promoting healthy sleep patterns.

Support
Sleep Research Society Foundation and K23HD094905 (AAW).
0884 The Effect of Bariatric Surgery on Sleep Disordered Breathing in Adolescents and Young Adults
Authors: Koirala A 
Published: May 2020

Abstract

Introduction
Childhood obesity is the major risk factor sleep disordered breathing (SDB). Severely obese young people may require bariatric surgery for correction of obesity, if other methods of weight loss have failed. We aim to assess the effect of bariatric surgery on SDB, in adolescents and young adults.

Methods
We conducted a retrospective chart review study of patients who underwent bariatric surgery between January 1, 2006 and August 31, 2019 at Cincinnati Children’s Hospital. Only patients who had pre-operative and post-operative polysomnograms were included in the study.

Results
Twenty-seven children and young adults (female: 59.2%) met the criteria for entry into analysis. The mean age of subjects at the time of weight loss surgery was 17.9 years (range: 12.9 to 32.5). Majority of the patients underwent laparoscopic partial gastrectomy (85.2%) and the remaining underwent laparoscopic gastric bypass surgery (14.8%). The average duration of follow up for post study measurements after the surgery was 10.4 months (Range: 0.4 to 57.5). The median Body Mass Index (BMI) was significantly lower at post-surgery (49.9 kg/m2[IQR: 45.4-55.9][pre] vs 39.3 kg/m2[IQR: 33.9-46][post], P&lt;0.001). The median obstructive AHI was significantly reduced at post-surgery (6.7/hr[IQR: 3.1-16.4][pre] vs 2.6/hr[IQR: 1.6-6][post], P= 0.03). Median heart rate (HR) during REM (79 bpm[IQR:67-90][pre] vs 67 bpm[IQR: 59.7-72][post], P&lt;0.0001) and NREM (81 bpm[IQR:65-91][pre] vs 65 bpm[IQR: 58-73][post], P&lt;0.0001) sleep were significantly lower at post-surgery. There was no statistically significant difference in sleep architecture (sleep latency, arousal index and percentage of REM, N1 and N3 sleep, P&gt; 0.05) except N2 sleep (53.1% [IQR:47.7-57.3] [pre] vs 55.7% [IQR:51.4-63.7] [post], P= 0.03) which was significantly increased at post-surgery.

Conclusion
There was significant improvement in BMI and SDB after weight loss surgery in children and young adults. Interestingly, there was a decrease in heart rate during both REM and NREM sleep after surgery which may suggest a decrease in sympathetic activation due to improvement if SDB. The sleep architecture remained unchanged after surgery, except the percentage of N2 sleep.

Support
Cincinnati Children’s Hospital Research Foundation
0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort
Authors: Fernandez-Mendoza J , Gao Z , Brandt K , Houser L , Calhoun S L , He F , Liao J , Vgontzas A N , Liao D , Bixler E O 
Published: May 2020

Abstract

Introduction
Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups.

Methods
The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood.

Results
SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p&lt;0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p&lt;0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively).

Conclusion
SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity.

Support
National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0891 Cardiovascular Control is Impaired in Children With Down Syndrome and Sleep Disordered Breathing
Authors: Horne R S , Sakthiakumaran A , Bassam A , Thacker J , Davey M J , Nixon G M 
Published: May 2020

Abstract

Introduction
Children with Down Syndrome (DS) are at increased risk for sleep disordered breathing (SDB). In typically developing (TD) children, SDB is associated with adverse cardiovascular effects including elevated heart rate and blood pressure and impaired autonomic control. The aim of this study was to compare the cardiovascular effects of SDB in children with DS to those of TD children with and without SDB.

Methods
44 children with DS (3-18 y) were age and gender matched with 44 TD children without SDB (TD-) and with TD children with matched severity of SDB (TD+). Height, weight and blood pressure were measured and BMI, systolic and diastolic z-scores calculated. Heart rate variability (HRV) was calculated for 2 min artefact free epochs overnight. Power spectral density for the low frequency (LF), high frequency (HF), total power (TP) and the LF/HF ratio (sympathovagal balance) were calculated. Data were compared between groups with Kruskal-Wallis one-way ANOVA.

Results
Wake heart rate, systolic and diastolic z-scores were not different between groups. LF/HF was higher in the DS group compared to both TD+ (p&lt;0.05) and TD- (p&lt;0.01) in wake and total sleep time. During total sleep HF power was lower in DS compared to TD+ (p&lt;0.01). In N2 TP and HF were lower and LF/HF higher in DS compared to both TD+ (p&lt;0.01) and TD- (p&lt;0.05). In N3 HF was lower in DS compared to TD+ (p&lt;0.05) and LF/HF was higher compared to both TD+ and TD- (p&lt;0.001 for both) and in REM LF/HF was higher compared to TD+ (p&lt;0.01).

Conclusion
In children with DS and SDB, autonomic cardiovascular control is impaired compared to TD children matched for SDB severity and to non-snoring TD children. Our findings demonstrate significantly reduced parasympathetic activity (reduced HF power) and increased sympathovagal balance, that may contribute to increased risk of cardiovascular disease later in life.

Support
This study was funded by the Jack Brockhoff Foundation.
0895 Pediatric Positive Pressure Therapy: Enhancing Education And Parent/guardian Confidence To Implement Therapy
Authors: Moore W R , Anderson S E , Burr L E , Clark P R , Peine N A , Sydejko D M , Wahl A M , Hale A M , Baughn J M 
Published: May 2020

Abstract

Introduction
Pediatric positive airway pressure (PAP) therapy can be challenging for children and their parent/guardian (PG). These challenges are complicated by the need to facilitate behavioral competency in the management of both device equipment and therapy.

Methods
As part of a larger quality management project aimed to improve PG and patient satisfaction we developed a targeted education visit provided by registered nurses prior to PAP trial initiation. Principle aims were to measure satisfaction with education and increase PG confidence in ability to manage therapy. The nurse session included: education on Obstructive Sleep Apnea (OSA) and PAP therapy, development of plan for first month of therapy, concepts of desensitization, regular practice, discussion and identification of concerns (assessment of barriers to implementation). A survey was administered pre-intervention to assess PG confidence in ability to manage therapy. Post-intervention, PG rated the interventions impact on baseline confidence, as well as an assessment of satisfaction with the education and content. Descriptive statistics were utilized to summarize the Likert survey questions.

Results
A total of 21of 25 (84%) participants completed surveys. 100% of PG that responded was either extremely satisfied or very satisfied with the educational intervention. Prior to the intervention, 19% (N4) indicated little to no confidence, 19% (N4) indicated some confidence and 62% (N13) indicated being very confident. 62% (N13) of PG’s indicated the information covered was new to them, while 24% (N5) indicated some information was new and 14% (N3) indicated none of the information was new. Regardless of baseline confidence, 100% (N21) responded that the intervention further improved confidence to a great degree.

Conclusion
The nurse visit resulted in high satisfaction with care and education and impacted PG confidence in ability to implement treatment. Future studies are needed to determine the impact on patient compliance.

Support
0904 Rapid Eye Movement Related Obstructive Sleep Apnea In The Pediatric Population: Case Series And Considerations
Authors: Petitto L , Musso M 
Published: May 2020

Abstract

Introduction
Rapid Eye Movement (REM) related Obstructive Sleep Apnea (OSA) can impact sleep quality and result in negative clinical consequences. There are limited pediatric studies evaluating potential consequences, looking at optimal decision making, and discussing best treatment options. Aims: 1: Describe clinical impact and potential negative consequences; 2: Discuss treatment management of REM related OSA; 3: Evaluate clinical effectiveness of treatment.

Methods
Case series: Retrospective review of 22 pediatric patients with REM related OSA at a tertiary care center. Clinical analysis of implemented treatment modality vs. observation was reviewed. Symptomatic response to treatment modality vs. observation including alteration of quality of life was examined.

Results
REM related OSA lead to negative clinical daytime symptoms which warranted consideration and implementation of further treatment.

Conclusion
Treatment considerations for REM related OSA include tonsillectomy and adenoidectomy, positive airway pressure, medical management, and watchful waiting. Further research is necessary to increase knowledge of clinical impact of REM related OSA and treatment.

Support
N/A