bluuebunny/crossref_metadata_2025_split huggingface dataset:
0694 Positive Airway Pressure Use In The Context Of Total Sleep Time
Authors: Saconi B , Watach A J , Sawyer A M 
Published: May 2020

Abstract

Introduction
Positive airway pressure (PAP) adherence definitions are independent of total sleep time (TST). When PAP efficacy is examined by biophysiologic outcomes in adults with obstructive sleep apnea (OSA), sensitivity and specificity of the measurement of PAP adherence/non-adherence is important.

Methods
A post-hoc analysis of experimental data: 1) investigated agreement among concurrently-measured objective PAP use, objective and subjective TST; 2) assessed untreated TST among adherers and non-adherers defined by CMS PAP adherence criterion and separately by proportion of TST on PAP criteria (≥65%, ≥75%, ≥85%). Objective TST was measured with wrist actigraphy and concurrent sleep diary on the first five days of PAP use. Objective five day PAP use (hours/night) was abstracted from full record. Analyses included descriptive and exploratory correlations.

Results
PAP-naïve adults (n=36; 76% male, 84% white) were middle-aged (51±10 years), with severe OSA (median AHI 31.1 events/hr), mean PAP use (371.5±85.4 min), mean objective and subjective TST (417.5±50.6 min, 439.6±58.1 min, respectively) from a single sleep center. Objective TST was correlated with concurrent objective PAP use (r=0.46) and with subjective TST (r=0.78). Eight percent (39mins) of objective TST was untreated among CMS-defined adherers, and 54.1% (216.8mins) of TST was untreated among CMS-defined non-adherers. When TST-on-treatment criteria were imposed (≥65%, ≥75%, and ≥85%, respectively), the percentage of untreated TST decreased among adherers, 5.2% (23 min), 4.3% (19 min), 0% (0 min) and among non-adherers, 42.8% (168 min), 41.2% (162 min), and 28.7% (118 min). From CMS to ≥85% of TST-on-treatment criteria, categorization as an adherer decreased from 89% (n=34) to 58% (n=22); non-adherer categorization increased from 5% (n=2) to 37% (n=14).

Conclusion
In the context of understanding biophysiological responses to PAP treatment, more sensitive and specific criteria for adherence and non-adherence is necessary. PAP use based on untreated TST is an opportunity to address this gap.

Support
The parent clinical trial was supported by NIH/NINR (R00NR011173; Sawyer PI)
0717 Peer-intervention Can Reduce Health Disparities In Patients With Obstructive Sleep Apnea
Authors: Patel S I , Combs D , Provencio-Dean N , Mashaqi S , Bhattacharjee S , Quan S F , Morton C J , Wendel C , Parthasarathy S 
Published: May 2020

Abstract

Introduction
In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response system (PDI-IVR) can improve CPAP adherence, whether such an intervention can improve adherence to sleep study testing is unknown. Also, there remain health disparities with greater levels of CPAP nonadherence disproportionately affecting individuals of lower socioeconomic status. We aimed to determine whether PDI-IVR can improve adherence to sleep study testing and CPAP adherence in a lower income population.

Methods
We performed a prospective, randomized, parallel group, controlled trial wherein patients with suspected OSA were randomly assigned to receive PDI-IVR or provided with educational information regarding OSA and CPAP therapy (attention-control group) while both groups received usual care. The PDI-IVR interactions aimed at promoting adherence to sleep study testing and in patients diagnosed with OSA the peer-intervention was focused on improving CPAP adherence. In the PDI-IVR group, trained peers (peer-buddies) with OSA were paired with randomized patients over a 6-month period combined with an ability to meet in-person, email, text message, or phone an inter-disciplinary team of providers.

Results
In this pilot study, there were 63 patients (48.4 ± 12.5 years; 30 men) who were randomized to intervention (n=31) and attention-control (n=32) arms. There were 36 peer-buddies who mentored the patients in the intervention group. Intention to treat analysis revealed that failure to undergo sleep study testing was 15.6% of patients in the attention-control arm and 9.7% in the PDI-IVR arm (P=0.7). Per protocol analysis revealed that failure to undergo sleep study testing was 18.4% of patients in the attention-control arm and 4% in the PDI-IVR arm (P=0.13). At 6 months, CPAP adherence was greater in PDI-IVR arm (290 ± 45 min [SE]) than attention-control arm (181 ± 43 min; P=0.01).

Conclusion
In a lower income population, PDI-IVR improved CPAP adherence with a tendency for better adherence to sleep-study testing. Peer-intervention can reduce sleep health disparities.

Support
HL138377
0728 Impulsivity Is Related To Osa Severity But Not With Excessive Daytime Sleepiness
Authors: Marelli S , Somma A , Castelnuovo A , Mombelli S , Gialdi G , Barranca M , Fossati A , Ferini Strambi L 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with cognitive deficits in vigilance, attention, and executive functions (EFs). To date, the mechanisms that characterize the impairment cognition in OSA remain partially uncertain. The dominant theories have mostly concentrated on hypoxia/hypercarbia, and sleep disruption and consequent excessive daytime sleepiness. Moreover, hypoxemia affects global cognitive functioning, but it is not clear whether and how the severity of the disease influences the EFs.

Methods
The current study aimed at assessing the relationships among OSA severity, daytime sleepiness, and EFs and self-reported impulsivity in a sample of OSA subjects who were classified according to Apnea-Hypopnea Index (AHI) in mild/moderate OSA (AHI&lt;30) or severe OSA (AHI≥30). All OSA participants were consecutively admitted to the Sleep Disorders Center of the San Raffaele Turro Hospital. After OSA assessment, patients were administered the Italian translation of the Psychology Experiment Building Language EFs tasks and the Epworth Sleepiness Scale (ESS) and UPPS-P Impulsive Behavior Scale (UPPS-P). Participants’ sleepiness was considered severe if a score of 10 or higher on the ESS was observed.

Results
Confirming and extending previous reports, daytime sleepiness affected both attention performance (U=239.00, p&lt;.05; Vargha & Delaney A=0.66), and inhibition performance (U=199.00, p&lt;.05; A=0.70). No effect of AHI was observed on both variables (U=326.00, p&gt;.05; A=0.55; U=330.00, p&gt;.05; A=0.53, respectively). Conversely, self-reported impulsivity was associated with OSA severity (U=30.50, p&lt;.001; A=0.86), but not with daytime sleepiness (U=84, p&gt;.05; A=0.63).

Conclusion
Our findings showed the importance of considering both OSA severity and sleepiness in order to better understand EFs and impulsivity related to OSA.

Support
none
0736 Self-reported Sleep In OSA Patients: Roles Of Polysomnographic Measures And Depressive Symptoms
Authors: Dubrovsky B , Weingarten J A , Cunningham J , Howladar A , Chin W , Gikashvili L 
Published: May 2020

Abstract

Introduction
Sleep fragmentation is typical in OSA, which is commonly co-morbid with insomnia and depression. A complex interaction between these conditions may be also gender-dependent. Moreover, self-report measures of sleep quality and insomnia, such as PSQI and ISI, may relate to depression symptoms more than polysomnographic sleep disturbance. The present aim is to ascertain relative contributions of polysomnographic variables and depression symptoms to PSQI and ISI in a large sample of OSA patients. The interaction between depressive symptomatology and gender in their relationships with subjective sleep is also analyzed.

Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI and PSQI. ISI and PSQI were separately regressed onto age, sex and BMI, followed by PSG variables meeting p&lt;0.1 criterion when tested individually, followed by CESDR and CESDR-by-sex interaction.

Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% of patients had AHI≥5. The PSQI final model included total sleep time (TST), sleep efficiency (SEF), WASO, PLM index, CESDR and CESDR-by-sex. Only CESDR and CESDR-by-sex were significant (p&lt;0.001, p=0.023, respectively). Higher CESDR predicted higher PSQI in both sexes (both p&lt;0.001), accounting for a greater portion of PSQI variance in men (R2=39%) than in women (R2=29%). The ISI final model included TST, N3%, REM%, SEF, WASO, total arousal index, AHI, PLM index, CESDR and CESDR-by-sex. Higher ISI related to lower TST (p=0.042, R2&lt;1%), higher REM% (p=0.016, R2&lt;1%), and higher CESDR (p&lt;0.001, R2=42%). CESDR-by-sex was not significant.

Conclusion
In this large sample, after controlling for demographic variables, PSG parameters had only minimal relationship with self-report insomnia and sleep quality measures. Higher depressive symptomatology was associated with higher subjective sleep disturbance on PSQI and worse insomnia symptoms on ISI in both sexes, accounting for 29-42% of the variance.

Support
none
0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea
Authors: Neill S E , Majid R 
Published: May 2020

Abstract

Introduction
The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs.

Methods
A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented.

Results
429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA.

Conclusion
Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP.

Support
N/A
0749 Case Simulations in Obstructive Sleep Apnea and Narcolepsy: Patients That Keep You Up at Night
Authors: Bogan R K , Rorie K , Faler W E , Gross T , Perez J , Tordoff S A , Salinas G 
Published: May 2020

Abstract

Introduction
3 CME interventions used online case simulations to facilitate the recognition of residual EDS in patients with narcolepsy and OSA and to improve decision-making when developing strategies for long-term management of residual EDS.

Methods
Outcomes data were obtained from 3, 30-minute case simulations on residual EDS. Surveys assessing knowledge, confidence, and behavior were administered pre- and post-activity. A separate evaluation provided demographics and other variables used in the model. Data from a 2-month follow-up survey were analyzed to determine performance effects on the learner population (n = 30) compared to matched controls (n = 30). Statistical comparisons of data from baseline to post-intervention were made using McNemar’s tests and paired t-tests.
Additionally, predictive modeling was applied to evaluate variables predictive of evidence-based decisions. A longitudinal analysis of results was conducted to evaluate knowledge and performance changes in sleep-related initiatives between 2016 - 2019.

Results
Learners outperformed controls in utilizing the Epworth Sleepiness Scale (ESS) and are more likely to interpret ESS scores to confirm EDS diagnosis and select appropriate treatment options in managing patients with EDS. Further, learners are more likely than controls to engage in shared decision-making with patients.
When given a real-world case, learners are more likely than controls to identify symptoms and order correct tests. Learners were also more likely to select best treatment options for the patient more often than non-learners. Continued education needs to focus on treatment options for patients with narcolepsy.

Conclusion
Follow-up assessments were conducted to understand lasting performance in learners attributable to this education. Using data from learners compared to matched controls, we found the education had an effect size of 23% (Cohen’s d = 0.33). This indicates that for every 100 clinicians exposed to this education, 23 will perform more according to evidence than if they were not exposed.

Support
The educational activity described in this abstract was supported by an educational grant from Jazz Pharmaceuticals, Inc.
0754 Cognitive Behavioral Therapy for Hypersomnia (CBT-H): A Feasibility Study for Improving Health-Related Quality of Life
Authors: Ong J C , Dawson S C , Mundt J M , Adkins E , Moore C 
Published: May 2020

Abstract

Introduction
The purpose of this study was to conduct a feasibility trial for a novel cognitive behavioral therapy (CBT-H) aimed at improving health-related quality of life (HRQoL) in people with hypersomnia.

Methods
Participants were 35 adults (32 female, mean age=32.0 years, SD=12.9) with an established diagnosis of Narcolepsy Type 1 (n=12), Type 2 (n=11), or Idiopathic Hypersomnia (n=12). Participants were assigned to individual (n=19) or group (n=16, 3-5 per group) format of a 6-session, manualized CBT-H, delivered using live videoconferencing. Key components of CBT-H included structuring daytime behaviors (e.g., planned naps), emotion regulation techniques, and energy management strategies. Outcome measures for HRQoL included PROMIS measures for depression, anxiety, self-efficacy, and social isolation. Other clinical outcome measures included the Patient Health Questionnaire (PHQ) and Epworth Sleepiness Scale (ESS). Exit interviews were used to collect qualitative data to inform acceptability of the intervention.

Results
Intent-to-treat analyses were conducted on the entire sample with the last observation carried forward for 3 participants who did not provide post-treatment data. Paired-samples t-test revealed a significant reduction on PROMIS depression (t[34]=2.05, p=0.0486, d=-0.35), and significant increases on PROMIS general self-efficacy (t[34]=3.64, p=0.0009, d=0.62) and self-efficacy managing social interactions (t[34]=2.14, p=0.0396, d=0.36). Significant reductions were also observed on the ESS (t[34]=2.07, p=0.0458, d=-0.35) and PHQ (t[34]=4.42, p&lt;.0001, d=-0.75). Mixed-design ANOVAs revealed no significant differences on hypersomnia diagnosis or treatment format. Qualitative data supported the acceptability of telehealth delivery with mixed opinions regarding the format and number of sessions.

Conclusion
These findings support the acceptability of a novel CBT-H delivered using a telehealth model and the feasibility of reducing excessive sleepiness and improving HRQoL, particularly in the domains of self-efficacy and depression, in people with narcolepsy and idiopathic hypersomnia.

Support
This study was supported by grant 185-SR-17 from the American Sleep Medicine Foundation.
0782 Duration Of Sun Exposure In Medical Students Impactschronotype
Authors: Geoca A , Dowling M , Jain V 
Published: May 2020

Abstract

Introduction
Timing of the human sleep-wake cycle is determined by social constraints, biological processes (sleep homeostasis and circadian rhythmicity) and environmental factors, particularly natural and electrical light exposure. However the effect of environmental factors, especially duration of sun exposure, on circadian rhythmicity remains unknown. We aimed to study the relationship between duration of sun exposure and chronotype among medical students.

Methods
Eighty-six GW medical students (62 F [71%], 24 M [29%]; ages 21-33 y [mean 24.4 y]) completed the Munich Chronotype Questionnaire (MCTQ). Mid points, the middle of the participants reported bedtime and wake time on workdays, were used to determine chronotype. Two independent groups based on the mean split (mean = 45) of the distribution of minutes of sun exposure were created: 45 minutes or more (n=31) vs less than 45 minutes (n = 55) of sun exposure. Independent samples t-test was performed to compare the measured midpoint with the following pairs of groups of reported work day sunlight exposure (in minutes): less than 45 min (n = 55) versus 45 min or more (n = 31).

Results
In the total sample (n = 86), no significant association between duration of sun exposure and midpoints was found using Pearson correlation. However, medical students with reported sun exposure of greater than or equal to 45 minutes a day had a significantly earlier chronotype compared to students reporting a sun exposure of less than 45 minutes a day [mid point 2.196 (SD 0.085) versus a mid point 3.386 (SD 1.084); t(69) = 2.021; p = .047].

Conclusion
We found that, in GW medical students, greater amounts of sun exposure during the day was advancing the circadian rhythm. This may have implications on sleep duration and quality.

Support
NA
0813 Circadian Rest-activity Rhythm In Isolated Rem Sleep Behavior Disorder
Authors: Stefani A 
Published: May 2020

Abstract

Introduction
Isolated REM sleep behavior disorder (iRBD) is a parasomnia characterized by abnormal behaviours occurring during REM sleep. Several studies showed that iRBD is a prodromal stage of synucleinopathies. Therefore identifying iRBD in the general population is of utmost importance. Aim of this study was to explore whether the assessment of circadian rest-activity rhythm features, measured by actigraphy, can distinguish iRBD patients from patients suffering from disorders characterized by other pathological motor activity during sleep and healthy controls.

Methods
Nineteen subjects with video-polysomnographic (v-PSG) diagnosis of iRBD, 39 subjects with other disorders with motor activity during sleep (19 restless leg syndrome -RLS- and 20 untreated sleep apnea syndrome patients -SAS) and 16 healthy controls underwent 2-week actigraphy, v-PSG, and completed RBD screening questionnaires. Nonparametric analyses were applied to assess rest-activity rhythm features; daytime napping was also evaluated. The diagnostic value of nonparametric measures has been assessed through ROC curve.

Results
iRBD patient showed lower sleep efficiency, increased WASO and increased frequency of prolonged activity bouts compared to RLS and controls, while no difference emerged with SAS patients. Moreover, iRBD patients presented increased occurrence of estimated nap in comparison to RLS, SAS and controls. The nonparametric measure I&lt;O distinguished iRBD patients from RLS, SAS and controls with an area under the curve greater than that of RBD screening questionnaires.

Conclusion
The nonparametric index I&lt;O is able to distinguish iRBD patients from patients with other pathological motor activity during sleep and controls, confirming its potential use as an objective measure suitable to screen large at-risk populations.

Support
This study was supported by a grant from the Austrian Science Fund (FWF) to Birgit Högl, I 2120-B27.
0816 Sleep Correlates Of Nightmares Among Veterans
Authors: Patel R K , Schwartz S W , Sebastiao Y V , Andrews A , Foulis P R , Anderson W M 
Published: May 2020

Abstract

Introduction
There is an increased prevalence of Nightmare disorder (ND) among patients with obstructive sleep apnea (OSA). A further investigation of objectively measured sleep parameters among patients with and without ND could inform on potential comorbidities. We hypothesize ND correlates with Epworth sleepiness scale (ESS), apnea hypopnea index (AHI), Trough 02% (Sp02 nadir), and periodic limb movement (PLM) index.

Methods
Data presented herein are interim results from an IRB approved study to determine correlates and sequelae of nightmares. A cohort of all patients with ND visiting James A Haley Veterans Hospital between 2007 and 2011 was defined along with a random cohort of control patients. Demographic and outpatient visit data between January 2006 and April 2016 was pulled from VISTA for both the ND and control cohorts, and patients who had undergone a sleep study were identified. To date, sleep summary data has been individually extracted for 111 ND patients and 835 control patients. Logistic regression (SAS 9.4) was used to compare ESS, AHI, Sp02 nadir, and PLM Index.

Results
Mean age for ND was significantly lower at 49.7 ± 14, compared to 58.4 ± 12 for controls. Other demographic measures were similar including gender, race, and marital status. PLM index was significantly lower in ND compared to controls, however this relationship disappeared after adjusting for age. There were neither significant differences between other polysomnographic (PSG) variables, specifically AHI and Sp02 nadir, nor did OSA severity significantly different between ND and controls.

Conclusion
Among veterans undergoing a PSG, there were no significant differences between measured sleep parameters. Our results contradict our hypothesis that ND correlates with ESS, AHI, Sp02 nadir, and PLM index.

Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.