bluuebunny/crossref_metadata_2025_split huggingface dataset:
1158 Daytime Sleepiness, Depression, And Post-concussive Symptoms Improve Following Prescribed Morning Exposure To Blue Light
Authors: Raikes A C , Dailey N S , Alkozei A , Vanuk J R , Grandner M A , Killgore W D 
Published: May 2020

Abstract

Introduction
Long-term sleep disruption, fatigue, and depression are common after mild traumatic brain injuries (mTBIs). Efficacious treatments for these disturbances in the context of mTBIs are lacking. Morning blue light therapy (BLT) effectively treats sleep disruption and improves mood. This study evaluated the treatment effects of morning BLT on post-mTBI daytime sleepiness, depression, and post-concussion symptoms.

Methods
62 individuals (Boston: n=31; age: 23.11±7.20y; 17 females; days post-injury: 236.00±121.40; Tucson: n=31; age: 26.35±8.08y; 20 females; days post-injury: 272.94±167.69) received either BLT (n=30) or placebo amber light therapy (ALT; n=32). All participants completed the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Rivermead Post-concussion Symptom Questionnaire (RPQ3 and RPQ13 subscales) pre- and post-treatment. Treatment consisted of direct exposure to either blue or amber light (30 minutes each morning), delivered via tabletop light-box, over six weeks. Baseline and post-treatment values were compared to a non-mTBI, non-treated control sample (Tucson: n=32, age: 23.94±5.41y; 19 females).

Results
Baseline scores were higher in both mTBI light groups (BLT, ALT, respectively) than controls for the ESS (Cohen’s d=0.83, 0.83), PSQI (d=1.45, 1.71), BDI (d=1.46, 1.62), RPQ3 (d=1.72, 1.62) and RPQ13 (d=1.86, d=1.76). BLT resulted in lower within-group ESS (d=-0.58), BDI (d=-0.50), PSQI (d=-0.57), and RPQ13 (d=-0.45, p=0.005) scores. No improvements were seen following ALT. Minimal ESS score differences between the BLT and controls were observed after treatment (d=0.25).

Conclusion
Daily morning BLT resulted in moderate improvements in post-mTBI daytime sleepiness, sleep quality, depression, and post-concussion symptoms. These improvements may contribute to enhanced academic and job performance, post-mTBI quality of life, and general recovery. Future work is needed to clarify optimal dosage and precision medicine factors indentifying those most likely to benefit from morning BLT.

Support
This research was supported by multiple grants from the US Army Medical Research and Materiel Command (USAMRMC) to Dr. William D. S. Killgore, including W81XWH-11-1-0056 and W81XWH-14-1-0571.
1161 Tasimelteon Shows Persistence Of Efficacy In Improving Sleep Disturbances In Patients With Smith-Magenis Syndrome (SMS) In Open-Label Extension Study
Authors: Brooks J , Gibson M , Kite K , Czeisler E , Fisher M , Xiao C , Polymeropoulos C , Polymeropoulos M 
Published: May 2020

Abstract

Introduction
Smith-Magenis Syndrome (SMS) is a rare (1/15,000 - 25,000 births) neurodevelopmental disorder resulting from an interstitial deletion of chromosome 17p11.2, or from a point mutation in the RAI1 gene. Severe sleep disorder is almost universal in patients with SMS and poses a significant challenge to patients and their families. Tasimelteon improved sleep symptoms in a randomized, double-blind, two-period, crossover study; and here we show that this effect persists for up to four years in an open-label extension. To our knowledge, this is the largest interventional study of SMS patients to date.

Methods
Following the 4-week crossover study, all eligible participants had the option to enroll in an open-label extension. 31/39 (79.4%) of all individuals who participated in the efficacy study have continued on tasimelteon treatment. Participants in the open-label extension provided daily diary sleep quality (DDSQ), and daily diary total sleep time (DDTST) measures via parental post sleep questionnaire and characterized behavior using the Aberrant Behavior Checklist (ABC).

Results
In the open-label extension, tasimelteon continued to show improvement in the primary endpoints of 50% worst sleep quality (mean = 0.7, SD = 0.94) and 50% worst total nighttime sleep duration (mean = 53.3, SD = 59.01) when compared to baseline. Tasimelteon also improved overall sleep quality (mean=0.7, SD=0.83) and overall total nighttime sleep duration (mean = 51.9, SD=53.03). ABC scores also improved with tasimelteon (mean= -16.3, SD = 15.82).

Conclusion
Tasimelteon continues to demonstrate persistence in efficacy (longest approximately 4 years) with similar magnitudes observed in the 4-week crossover study for sleep quality and total sleep time. Interestingly, daytime behavior also demonstrates long-term improvement in patients with SMS treated with tasimelteon. These results further confirm tasimelteon as a novel therapy for the treatment of sleep disorders in patients with SMS and may provide benefit for behavioral symptoms.

Support
This work was supported by Vanda Pharmaceuticals Inc.
1170 Trends in Sleep Apnea Testing Among Veterans Participating in a Rural Health-Focused Telesleep Medicine Program
Authors: Atwood C W , Boudreau E , Folmer R , Kuna S T , Pineda L , Reichert J , Sarmiento K , Thompson W , Whooley M , Zhang N , Yarbrough W C 
Published: May 2020

Abstract

Introduction
The Department of Veterans Affairs has pioneered the use of home sleep apnea testing (HSAT) across many of its medical centers over the past 15 years. Here we report trends regarding diagnostic sleep apnea testing in rural and urban Veterans served by the TeleSleep Program, a VA telehealth initiative focused on increasing access to sleep care for rural Veterans. Rurality is a risk factor for use of polysomnography and is associated with longer wait times for testing and initiation of PAP therapy.

Methods
We used a VA administrative database search of patients enrolled in sleep medicine clinics from fiscal years (FY) 2016-2019 at 7 TeleSleep Hubs: San Francisco, Portland, Phoenix, Boise, Philadelphia, Spokane, and Pittsburgh. Individual encounters were coded locally and transmitted to VA’s corporate data warehouse. HSAT codes included 95800, 95801, 95806, G0398, G0399, and G0400. Polysomnography codes included 95807, 95808, 95810, and 95811.

Results
Total number of unique Veterans served increased between FY16 and FY19 from 28,941 to 43,044 (149%); rural Veterans served during this time increased from 9,386 to 14,329 (153%). The total number of annual sleep medicine encounters for all Veterans served increased from 89,870 to 138,127 (154%); rural Veteran visits increased from 29,825 to 50,342 (169%). Unique urban Veterans tested by HSAT increased from 2,158 in FY16 to 4,398 in FY19 (203%) while polysomnography decreased from 5,011 to 3,253 (35%). Unique rural Veterans tested by HSAT increased from 1,102 to 2,768 (251%) and polysomnography decreased by 42% (1,565 to 909 Veterans) during this same time.

Conclusion
Among VA sleep medicine programs with TeleSleep funding, HSAT became the most common approach to diagnostic sleep apnea testing, particularly in rural Veterans. Although polysomnography was widely used at the beginning of the TeleSleep Initiative, use declined as HSAT became more widely implemented.

Support
VA Office of Rural Health
1173 Reducing Cancellation and Improving the Patient’s Experience Through Quality Improvement Process
Authors: Mullen L , Cole A , Parsons J , Sabla G , Tiemeyer K , Simakajornboon N 
Published: May 2020

Abstract

Introduction
Sleep study volume in our system has increased by 23% from 2017 to 2019 which makes unfilled sleep beds a significant concern. Cancellation rate impacts our sleep bed access. We hypothesized cancellation can be improved through quality improvement process which could ultimately lead to improve patient satisfaction.

Methods
A multi-disciplinary team was assembled to examine potential contributing factors. Using the Model for Improvement we developed, tested and implemented interventions using tools such as PDSA cycles, process map and a simplified FMEA (Failure Modes and Effects Analysis). A Key Driver Diagram helped guide our journey to improve the cancellation rate. We developed a Parent Advisory Group to help us with ideas to identify how we could improve the cancellation rate.

Results
The cancellation was 21% prior to the implementation of our interventions. To improve these measures, we have implemented several interventions. The content of our sleep study preparation handbook was improved, increased distribution of the education handbook and developed a series of sleep study videos which are available for viewing prior to the study to prepare patients and families. In addition, we standardized our process of reminder calls in the call center and sleep lab by defining roles and responsibilities. This improved our ability to answer questions and identify and mitigate barriers they may have. We implemented transportation assistance to patients who have transportation barriers and created a waitlist protocol to assist families with a preferred date. After 2 years of interventions, the cancellation rate has decreased from 21% to 14.7%. Interestingly, as we improved our cancellation rate, the overall patient satisfaction has been improved from 83% to 88%.

Conclusion
Using the Model for Improvement, we improved education, communication and scheduling processes, which has reduced cancellation rate and consequently improved patient satisfaction.

Support
1176 Survey Of Knowledge Of Pediatric Trainees Regarding Obstructive Sleep Apnea In Children
Authors: Gummalla P , Lee S , Soriano S , Concepcion E 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) causes significant morbidity in children. Very few studies were conducted among pediatricians regarding sleep and sleep disorders in children and adolescents. They demonstrated significant gaps in knowledge in the recognition and management of OSA.

Methods
We conducted a survey among the pediatric residents in the screening and diagnosis of OSA. The survey consist of 15 questions related to OSA in children. It aimed at identifying gaps in their knowledge and educating them accordingly. Following the survey, core lectures were included in the pediatric curriculum which aimed at educating them with the causes, diagnosis, management and sequelae of untreated OSA.

Results
37 pediatric residents took part in the survey. They were from first, second and third year of the pediatric residency training program respectively in an university hospital. 45% of them belong to the first year, 29% of them belong to the second year and 24% of them belong to the third year of training.Only a quarter of them had completed rotations in Pediatric Pulmonology for at least two weeks at the time of the survey. Three questions related to identifying at risk groups, four questions related to identification of the signs and symptoms, and three questions related to the diagnostic criteria and five questions related to the treatment and follow up of OSA.
46% of the residents accurately answered the questions related to screening and identifying children at risk of OSA. 57% of them identified the signs and symptoms of OSA in children.41% of them answered the questions related to diagnosis appropriately and 49% had correct responses for the questions related to treatment of OSA and follow up.

Conclusion
Less than 50% of the pediatric trainees could accurately identify the at risk groups and symptoms of OSA. These pediatric trainees who are future pediatricians form the referral source for children with OSA and educating them is vital.This reemphasizes the need for the pediatric training programmes to include mandatory training modules related to Pediatric sleep disorders, OSA in particular in the pediatric core curriculum.

Support
None
1181 Community-based Organizations Seek Sleep Health Education
Authors: Fleshman C , Wolfson A , Ripple C H , Bonuck K , Hale L , Donskoy I , Robbins R , McGlinchey E , Jean-Louis G , Owens J 
Published: May 2020

Abstract

Introduction
Increasing attention to the importance of sleep among children raises questions about how to implement accessible, effective interventions. Part of answering those questions rests in determining interest in and demand for programming. Pajama Program (PJP), a 501(c)(3), works with nearly 4,000 community-based organizations (CBOs) nationally that work with children exposed to adversity, including: foster care/child welfare; shelters; low-income schools, after-school, and early care and education programs; and social-service providers. Anticipating its launch of sleep health education programs, PJP and its Good Night Advisory Council of sleep experts designed a CBO needs assessment.

Methods
The survey was distributed electronically to staff at 3,911 CBOs; 1,635 organizations responded (42%).

Results
Across respondents, 65% work with children birth to 18 in settings that were non-residential (39%), residential (18%), or both (43%); most (91%) worked with participants for over one month. CBOs included child welfare/foster care (20.6% of respondents); transitional housing/shelter (20.5%); social services (15.6%); and early care and education (12.7%). Interest in sleep health education was high across all program types: 80 to 89% of programs within each type wanted information for staff and/or caregivers, specifically handouts (among 93% of programs), articles (88%), videos (85%), and workshops (70%). At least 90% of respondents who provided early care and education, parenting, and crisis services were interested in sleep health education for program staff. These program types also had high interest in sleep health education for caregivers, as did child welfare/foster care, school/after school, and shelters (all at least 90% of respondents).

Conclusion
The CBOs in this sample recognize sleep is an issue among the children they serve, but most did not have access to information on sleep health. These results establish the need for sleep health education and suggest preferred modalities. The project is a model for partnerships involving researchers, nonprofits, and community-based organizations.

Support
Funding for this project was provided by Pajama Program, a national 501(c)(3) non-profit.
0120 Association Between Sleep Duration and Daytime Memory and Cognition Depends on Sleep Quality: Data from the 2017 Israel Social Survey
Authors: Wills C C , Rosenberg E A , Perlis M L , Parthasarathy S , Chakravorty S , Grandner M A 
Published: May 2020

Abstract

Introduction
This study examines the relationship between sleep duration, sleep disturbance, and cognitive problems in a representative sample of the Israeli population.

Methods
7,230 Israelis responded to an Israeli Bureau of Statistics population-based survey of households from the year 2017. All variables were self-reported. Outcome of interest was difficulty with memory/concentration (none, mild, or severe). Predictors included previous month sleep duration (&lt;=5hrs, 6hrs, 7hrs [reference], 8hrs, or &gt;=9hrs) and sleep disturbance (none [reference], mild [1/week], moderate [2–3/week], or severe [&gt;3/week]). Covariates included age, sex, ethnic group, and financial status. Multinomial logistic regressions evaluated the relationships between variables, and post-hoc testing identified relationships within specific subgroups.

Results
72.9% denied cognitive problems, 22.2% reported mild problems, and 4.9% severe problems. In adjusted analyses, Sleep &lt;=5hrs and &gt;=9hrs were associated with mild (RRR=1.39, p&lt;0.0005), (RRR=1.46, p=0.004) and severe (RRR=2.75, p&lt;0.0005), (RRR=3.24, p&lt;0.0005) cognitive problems, respectively. Mild, moderate, and severe sleep difficulties were associated with mild cognitive problems (RRR=2.09, p&lt;0.0005), (RRR=2.22, p&lt;0.0005), (RRR=2.44, p&lt;0.0005), and severe cognitive problems (RRR=1.77, p=0.001), (RRR=3.04, p&lt;0.0005), (RRR=4.22, p&lt;0.0005), respectively. There was an interaction between sleep duration and sleep difficulties (p&lt;0.05). Among those denying sleep difficulties, only &gt;=9hrs of sleep was associated with cognitive problems. Among those with mild, moderate, and severe sleep difficulties, both short and long sleep were associated with cognitive problems.

Conclusion
In an Israeli population sample, both sleep duration and quality were associated with cognitive problems. Among those with sleep difficulties, short and long sleep duration were associated with cognitive problems, but among those denying sleep difficulties, only long sleep was associated with cognitive problems. These results suggest that the impact of sleep loss on real-world cognition may also rely on the presence of poor sleep quality.

Support
Dr. Grandner is supported by R01MD011600
1193 Accuracy of a Commercial Wearable in Detecting Sleep Stages Compared to Polysomnography in Adults: Considering Sleep Classification Methods and Effects of Evening Alcohol Consumption
Authors: Menghini L , Alschuler V , Claudatos S , Goldstone A , Baker F , Cellini N , Colrain I , de Zambotti M 
Published: May 2020

Abstract

Introduction
Commercial wearable devices have shown the capability of collecting and processing multisensor information (motion, cardiac activity), claiming to be able to measure sleep-wake patterns and differentiate sleep stages. While using these devices, users should be aware of their accuracy, sources of measurement error and contextual factors that may affect their performance. Here, we evaluated the agreement between Fitbit Charge 2™ and PSG in adults, considering effects of two different sleep classification methods and pre-sleep alcohol consumption.

Methods
Laboratory-based synchronized recordings of device and PSG data were obtained from 14 healthy adults (42.6±9.7y; 6 women), who slept between one and three nights in the lab, for a total of 27 nights of data. On 10 of these nights, participants consumed alcohol (up to 4 standard drinks) in the 2 hours before bedtime. Device performance relative to PSG was evaluated using epoch-by-epoch and Bland-Altman analyses, with device data obtained from a data-management platform, Fitabase, via two

methods
one that accounts for short wakes (SW, awakenings that last less than 180s) and one that does not (not-SW).

Results
SW and not-SW methods were similar in scoring (96.76% agreement across epochs), although the SW method had better accuracy for differentiating “light”, “deep”, and REM sleep; but produced more false positives in wake detection. The device (SW-method) classified epochs of wake, “light” (N1+N2), “deep” (N3) and REM sleep with 56%, 77%, 46%, and 62% sensitivity, respectively. Bland-Altman analysis showed that the device significantly underestimated “light” (~19min) and “deep” (~26min) sleep. Alcohol consumption enhanced PSG-device discrepancies, in particular for REM sleep (p=0.01).

Conclusion
Our results indicate promising accuracy in sleep-wake and sleep stage identification for this device, particularly when accounting for short wakes, as compared to PSG. Alcohol consumption, as well as other potential confounders that could affect measurement accuracy should be further investigated.

Support
This study was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant R21-AA024841 (IMC and MdZ). The content is solely the responsibility of the authors and does not necessarily represent the official views the National Institutes of Health.
1194 An Open-Label Study of Treating Traumatic Nightmares With an Investigational Smartwatch Based System
Authors: Stephan J T , Davenport N , Evans-Lindquist M K , Hiltner R K , Karlin D R 
Published: May 2020

Abstract

Introduction
Nightmares are a common problem affecting 2-8% of the general population with the prevalence of comorbid nightmares in those with post-traumatic stress disorder (PTSD) being significantly higher at 72%. The negative sequelae of nightmares are myriad including impaired quality of life, sleep deprivation, insomnia, daytime sleepiness, fatigue, and suicidal ideation. This study investigated a novel approach for the treatment of nightmare disorder in military veterans.

Methods
All participants in this study were veterans receiving care at the Minneapolis Veterans Affairs Health Care System (VAHCS), diagnosed with PTSD, and had self-reported nightmares. At the baseline assessment, eligible participants were given a digital smartwatch preloaded with an application designed to arouse but not awaken the user out of the nightmare. Paired t-test analysis was used to compare the participants’ baseline and follow-up responses.

Results
A significant decrease in participant Pittsburgh Sleep Quality Index (PSQI) scores (13.6 to 7.4, p &lt; 0.001), PTSD Checklist for DSM-5 (PCL-5) scores (45.8 to 25.1, p &lt; 0.0025) and Patient Health Questionnaire (PHQ-9) scores (12.2 to 6.1, p &lt; 0.002) was observed over the sixty day trial. All 9 participants experienced a decrease in the Epworth Sleepiness Scale (ESS) upon completion of the trial, with an average decrease of -2.5 ± 1.4.

Conclusion
These results demonstrate that a novel digital therapeutic smartwatch application is effective in improving sleep quality, reducing the burden associated with PTSD symptoms, and lowering depressive symptoms in those with nightmare disorder within an open label study. These results have initiated further investigation into efficacy of digital therapeutic smartwatch applications in nightmare intervention and improved sleep quality.

Support
NightWare, Inc.
0121 Effect of Total Sleep Deprivation on Word Recognition of Previously Studied Words with Different Emotional Valence
Authors: Hudson A N , Whitney P , Hinson J M , Hansen D A , Van Dongen H , Honn K A 
Published: May 2020

Abstract

Introduction
Stimuli with an emotional valence tend to produce better recognition from memory than neutral stimuli. Sleep loss is believed to increase reactivity to negative stimuli, as compared to positive stimuli, which may comparatively enhance subsequent recognition from memory for negative stimuli. We investigated the impact of total sleep deprivation (TSD) on recognition accuracy for words with different emotional valence using the Affective Item Source Memory Task (AISM).

Methods
N=14 adults (ages 21–39; 7 females) completed a 4-day in-laboratory study with 9h baseline sleep (22:00-07:00), 39h acute TSD, and 9h recovery sleep. The AISM was administered at 16:30 during baseline and after 34h TSD. During a 5min study phase, participants heard a list, twice, of 20 positive, 20 negative, and 20 neutral words spoken with a male or female voice. During an immediately subsequent 8min recognition phase, participants heard 120 words (50% new) and judged whether each word had been presented in the study list (item memory). For words judged to have been presented previously, participants indicated whether those were presented by a female or male speaker (source memory).

Results
Mixed-effects ANOVA showed effects of session (p&lt;0.001) and valence (p&lt;0.001) on item memory. At baseline, accuracy was greatest for neutral and positive words compared to negative words. During TSD, accuracy declined for all three valences, and no interaction of session by valence was detected. No effects of TSD or valence on source memory were observed.

Conclusion
Sleep deprivation reduced item memory for words of all valence types. However, there was no comparatively greater impact on item or source memory for negative words nor any differential effect of TSD for different valences. Whether our results would hold with longer time intervals between task phases or an intervening sleep period remains to be determined.

Support
Jazz Pharmaceuticals