bluuebunny/crossref_metadata_2025_split huggingface dataset:
0823 Age-Related Changes in Nocturnal Urine Composition
Authors: Bliwise D L , Monaghan T F , Lazar J M , Epstein M R , Agudelo C W , Weiss J P , Weedon J , Everaert K 
Published: May 2020

Abstract

Introduction
In humans sleeping nocturnally, nocturnal polyuria (NP) refers to high rate of overnight urine production. NP is a heterogeneous condition that may reflect both free water and/or sodium diuresis, but the influence of age on differential fluid handling remains poorly understood. This study examined diuresis rate, sodium clearance, and free water clearance (FWC) by age, time of day (nighttime vs. daytime) and NP status (positive/negative) in subjects under entrained conditions sleeping nocturnally.

Methods
Convenience samples (age range 18-91; 82 men, 148 women) recruited from a urology ambulatory care unit (n=135) or continence clinic (n=95) collected 8 urine samples at 3-hour intervals over a single 24-hr period. Three separate mixed linear models were constructed for diuresis rate, sodium clearance, and FWC using four predictors: NP status (present [&gt;90mL/h] vs. absent), time of day (night = 0100, 0400, 0700), age (as a continuous measure), and study source.

Results
Subjects with NP experienced both higher nighttime vs. daytime diuresis rate (1.89 vs. 1.44 mL/min, p&lt;0.001), sodium clearance (0.91 vs. 0.74 mL/min, p&lt;0.001), and FWC (-0.38 vs. -0.71 mL/min, p&lt;0.001), whereas subjects without NP demonstrated lower nighttime vs. daytime diuresis rate (0.94 vs. 1.06, p=0.004) and no difference in sodium clearance (0.59 vs. 0.64, p=0.120) or FWC (-0.80 vs. -0.86, p=0.268). Regardless of NP status, FWC increased with age (p=0.039), and older age (&gt;70) was accompanied by an increase in the ratio of nighttime/daytime diuresis rate and both nighttime and daytime sodium clearance.

Conclusion
Irrespective of NP, older adults experience proportionally greater nocturnal sodium clearance, as well as a complex surge in both daytime and nighttime FWC. The data imply that both nocturnal sodium clearance and FWC may reflect the relevant substrate underlying excess nocturnal urine production in elderly persons.

Support
N/A
0827 The Association Among Diagnosed and Suspected Sleep Disorders and Pain
Authors: Ravyts S , Dzierzewski J 
Published: May 2020

Abstract

Introduction
Poor sleep has increasingly been linked to adverse pain outcomes. Yet, the complex interplay between sleep apnea, insomnia, or comorbid sleep apnea and insomnia (COMISA), and pain are less well understood. The purpose of the present study was twofold: 1) assess pain intensity in individuals with diagnoses of insomnia, sleep apnea, and COMISA, and 2) examine pain intensity in individuals who are at a high risk for having either sleep apnea, insomnia, or both sleep disorders.

Methods
Participants included 3401 adults (mean age= 42.77, male= 45.6%) who participated in an online study investigating sleep across the lifespan. Sleep apnea and insomnia diagnoses were self-reported while participant risk profiles for these disorders were assessed via the Insomnia Severity Index and the STOP-BANG questionnaire respectively. Average pain intensity over the last two weeks was rated from 0 (no pain) to 100 (very severe).

Results
Participants with self-reported comorbid sleep disorders reported higher pain scores than individuals with one or no sleep disorder (F(2,3398) = 71.61, p &lt; .001). Among individuals with no previously diagnosed sleep disorder, participants with more insomnia symptoms reported greater pain intensity (F(3,3100) = 201.64, p &lt; .001), as did those with higher scores on the STOP-BANG (F(2,3125) = 46.79, p &lt; .001). Participants with suspected comorbid sleep disorders reported higher pain scores than individuals with either sleep apnea or no sleep disorder, but not insomnia (F(3,2887) = 110.15, p &lt; .001).

Conclusion
Results suggest that individuals with known sleep disorders report high levels of pain particularly in the context of comorbid sleep apnea and insomnia. Additionally, individuals with suspected, but untreated, sleep disorders also report increased pain. Future research should examine whether treating one of more sleep disorders can improve pain outcomes.

Support
This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).
0838 Sex Specific Changes in Sleep Macro-Structure With Obstructive Sleep Apnea in a Large Clinical Population of Older Adults
Authors: Mullins A E , Bagchi N , Parekh A , Kam K , Wang J , Williams M K , Rapoport D M , Ayappa I , Burschtin O E , Varga A W 
Published: May 2020

Abstract

Introduction
Sleep architecture is influenced by age and sex and is disrupted by obstructive sleep apnea (OSA) and periodic limb movements (PLM) of sleep. Although increasing OSA severity is thought to decrease both REM and slow wave sleep (SWS), it may do so in non-linear ways. Here, we aim to 1) compare sleep macrostructure between older men and women, 2) compare metrics of total and REM-specific OSA severity between older men and women, and 3) examine associations between metrics of OSA severity and REM sleep and SWS in a clinical sample.

Methods
Clinical in-lab diagnostic polysomnography (PSG) in adults ≥64 years of age from the greater New York area recorded between 2006- 2016 were collated including demographic and traditional sleep scoring metrics. Studies where TST &lt; 4 hours were removed. Demographic, sleep macrostructure, OSA (AHI4% & AHI3A criteria), pulse oximetry (SpO2) nadir and PLM measures were compared according to sex.

Results
PSGs from 1282 older adults (average age 70 years in both sexes, 41% female) were included in the analyses. Women had a significantly greater SWS% (14.5 vs 7.9, p&lt;0.001) and less N1% (18.2 vs 24.4, p&lt;0.001), without significant differences in TST, N2%, REM%, sleep efficiency or SpO2 nadir. Men had significantly higher all-sleep OSA (median AHI4% 8.8 vs 11.1, p=0.0004; median AHI3A 24.4 vs 27.9, p=0.003) and PLM’s (4.0 vs 7.6/hour, p=0.008) but women had significantly more OSA during REM sleep (median REM AHI4% 16.7 vs 14.0, p=0.01; median REM AHI3A 32.6 vs 27.4, p=0.0002). Inverse non-linear associations were observed between OSA severity and %SWS and %REM with a unique pattern for each sleep stage. The pattern between men and women within each stage appeared similar.

Conclusion
In this clinical sample of older adults, women exhibit a greater proportion of SWS and worse REM-related OSA then men. Increasing OSA severity is associated with non-linear reductions in %SWS and %REM, and we plan to further investigate these relationships and sexual dimorphism by using quantitative analysis of PSG signals for more precise measures of slow wave activity and breathing physiology than traditional sleep scoring metrics.

Support
R01AG056682
0841 Trajectories of Sleep Quality During the Perinatal Period in the “Life-ON” Study
Authors: Garbazza C , Castronovo V , Sforza M , Manconi M 
Published: May 2020

Abstract

Introduction
The perinatal period is characterized by poor sleep quality, with a worsening trend across pregnancy, peaking in the first month after delivery and often persisting during the postpartum. Consequences of perinatal sleep problems range from negative obstetric outcomes, to mood disturbances in the mothers and neurobehavioral deficits in the infants. Therefore, an early identification of at-risk women is highly relevant.

Methods
As part of the “Life-ON” project, a multicenter study on sleep and mood changes during the perinatal period, 120 women (aged 36.31±4.21 years) were repeatedly evaluated with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Edinburgh Postnatal Depression Scale (EPDS) and Montgomery-Åsberg Depression Rating Scale (MADRS), from the first gestational trimester (baseline) to 12-months postpartum. Using latent class analysis (LCA) we identified different subtypes according to baseline evaluation and analyzed their distinct trajectories of sleep quality based on PSQI.

Results
We chose 3 latent classes that were statistically different in all scales at baseline (p&lt;0.05), with lowest values in the stable-low class, followed closely by a mild class and highest values in the stable-high class (mean±SD for each class, respectively: EPDS 2.58±2.34 vs. 3.54±2.87 vs. 7.22±3.1, MADRS 1.75±1.83 vs. 4.08±2.67 vs. 7.17±3.74, PSQI 2.50±1.26 vs. 4.89±1.73 vs. 8.00±3.26, ISI 1.40±1.58 vs. 6.46±2.90 vs. 11.13±4.28). This trend remained significant for the whole observation period. Focusing on PSQI, the mild (n=37) and stable-low class (n=60) maintained a mean score below 5, only peaking above 5 around delivery. In contrast, the stable-high class (n=23) showed a constant mean PSQI&gt;5 throughout the perinatal period (first trimester=8.00±3.26; second trimester=8.26±3.41; third trimester=8.39±3.90; 20-days postpartum=8.39±3.33; 3-months postpartum=7.96±3.6; 6-months postpartum=7.35±3.79; 12-months postpartum=6.83±3.35).

Conclusion
We identified a latent class of women with a stable-high poor sleep quality (PSQI&gt;5) across the perinatal period. Determining baseline sleep and mood characteristics in early pregnancy can help predicting distinct sleep trajectory subgroups in the perinatal period and detecting at-risk women, who should be targeted by early preventive and therapeutic interventions.

Support
The “Life-ON” project is supported by the Swiss National Science Foundation (grant: 320030_160250/1) and the Italian Ministry of Health and Emilia-Romagna Region (grant: PE-2011-02348727).
0842 The Moderating Effects of Sleep and Sex on Physical Activity and Cognitive Functioning in African Americans
Authors: Beard B , Ramirez-Ruiz M , Mwendwa D T , Sims Wright R 
Published: May 2020

Abstract

Introduction
Research suggests modifiable lifestyle behaviors are associated with delayed cognitive decline. Identifying modifiable lifestyle behaviors in African Americans is critical because they are more likely to be diagnosed with Alzheimer’s disease and other related dementias. Evidence shows the positive effects of physical activity (PA) on cognitive functioning. Sleep quality also impacts cognitive functioning. Therefore, the purpose of this study examined how sleep quality and sex moderated the relationship between PA and cognitive functioning in African Americans.

Methods
A sample of 147 African Americans (mean age 59) completed the Pittsburgh Sleep Quality Inventory (PSQI) and a battery of cognitive tests (The Delis-Kaplan Executive Function System (DKEFS) Verbal Fluency Test, The Stroop Color Word Test and Trail Making Test). Participants completed a participant screener to determine PA frequency and intensity. Anthropomorphic measures were also obtained. A moderated moderation analysis was conducted.

Results
Poor sleep quality was associated with poorer performance on a verbal fluency task after controlling for age, BMI and years of education (B=-1.37, p=.012). There was a significant interaction between PA frequency and sleep quality on verbal fluency performance (B=0.42, p=.047). Additionally, there was a significant interaction between sleep quality and sex on verbal fluency performance (B=0.80, p=.016). Further adjustments revealed significant conditional effects such that more frequent PA per week improved verbal fluency performance among women, who reported better sleep quality (B=0.20, p=0.03).

Conclusion
The current study suggests sleep quality strengthens the relationship between PA and cognitive performance, specifically in African-American women. Consistent with previous studies, our findings support the need to target sleep quality and PA in women as modifiable lifestyle factors that may delay cognitive decline.

Support
This research was funded by the Office of the Provost at Howard University.
0846 Reports of Sleep Symptoms in Young Adults of College Age
Authors: Thatipelli S , Abbasi A A 
Published: May 2020

Abstract

Introduction
Young adults of college age in the United States often report inadequate sleep. The objectives of this study were to identify a) how often young adults of college age report symptoms of insomnia, fatigue and mood disorder and b) identify differences in symptom reporting based on their sleep duration.

Methods
This is a cross-sectional study, using data from 2013 through 2018 of the National Health Interview Survey (NHIS). 11,028 subjects, ages 18-22 years, for whom information was available on duration of sleep were included. We analyzed reports of trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder. Subjects were divided into 2 groups: ≤7 hours and &gt; 7 hours of sleep. Data was analyzed using Complex Sample Analysis of IBM SPSS version 26.

Results
Out of the 11,028 subjects 50.7% were male and 49.3% were female. Mean sleep duration for all subjects was 7.44 ± 0.02 hours (mean± SE). 13.5% subjects reported trouble falling asleep while 10.6% reported trouble staying asleep for ≥4 nights per week. Non-restorative sleep and frequent fatigue were reported by 33.8% and 12.4% respectively. Daily/weekly symptoms of anxiety and depression were reported by 23.9% and 8.6% respectively. There were 48.4% subjects with ≤7 hours and 51.6 % with &gt;7 hours of sleep. When compared to subjects with ≤7 hours to &gt;7 hours of sleep, trouble falling asleep, trouble staying asleep and non-restorative sleep were reported by 19.9% vs. 7.5%, 14.8% vs. 6.6% and 45.9% vs. 22.4% respectively. Symptoms of fatigue, anxiety and depression reported by subjects with ≤7 hours vs. &gt;7 hours of sleep were: 18.6% vs. 6.6%, 26.9% vs. 21% and 10.2% vs.7% respectively.

Conclusion
Young adults with ≤ 7 hours of sleep are more likely to report trouble falling sleep, trouble staying sleep, non-restorative sleep, fatigue and symptoms of mood disorder.

Support
None
0866 A Comparison Of Resting Cerebral Blood Flow And Sleep Quality In Older Adults
Authors: Hays C C , Almklov E A , Orff H J , Wierenga C E 
Published: May 2020

Abstract

Introduction
Sleep disturbances have been linked to a variety of health-related consequences, including clinically significant cognitive alterations. Older adults represent a particularly vulnerable population given that advanced age is associated with an increased risk for both sleep disorders, such as insomnia, and cognitive decline. Examining the relationship between resting cerebral blood flow (rCBF) and sleep quality in older adults will better our understanding of the neurophysiologic implications of poor sleep in aging adults.

Methods
Thirty-three cognitively normal older adults (15 males) between the ages of 65-85 (mean age=73) were administered the Pittsburg Sleep Quality Index (PSQI) and underwent assessment of rCBF using arterial spin labeling (ASL). Those who scored above 5 on the PSQI were defined as poor sleepers (n=17) and those who scored 5 or below were defined as good sleepers (n=16). Groups were then compared on voxel-wise whole-brain rCBF using independent samples t-tests statistically adjusting for age, sex, and the time interval between neuroimaging and sleep assessment.

Results
Compared to good sleepers, poor sleepers exhibited higher rCBF within bilateral thalamus and the left precuneus and lower rCBF within the left putamen (all ps&lt;.01, uncorrected).

Conclusion
In this preliminary investigation, poor sleepers exhibited a differential pattern of rCBF in several brain regions, including those involved in consciousness and other important cognitive abilities such as attention. Future research is needed to determine the short- and long-term implications of poor sleep on the aging brain.

Support
U.S. Department of Veterans Affairs Clinical Sciences Research and Development Service Merit Award 5I01CX000565 (CEW) & VA Rehabilitation Research & Development - Career Development Award - RX001512-01A2 (HJO)
0883 Impact of Implementation of a Comprehensive Positive Airway Pressure Program
Authors: Oppy K , Huffman B , Kalra M 
Published: May 2020

Abstract

Introduction
The American Academy of Sleep Medicine (AASM) guidelines for treatment of Obstructive Sleep Apnea (OSA) with Positive Airway Pressure (PAP) state good practice standards involve adequate follow up with a clinician tele-monitoring efficacy through objective usage data to ensure acceptable treatment and compliance is met, and provide education, behavioral and/or troubleshooting interventions. In 2016, Dayton Children’s Hospital’s pap compliance was 29% due to limited staff support.

Methods
To efficiently implement the AASM guidelines, one dedicated Respiratory Therapist (RT) was assigned to help manage OSA patients at Dayton Children’s Sleep Medicine. The RT responsibilities include, PAP therapy education, arranging home PAP system, and a follow-up call within 7 days of setup. Through the tele-monitoring system, the RT assesses compliance and addresses equipment issues and mask fitting at the 4 to 6 week clinic visit. To enhance compliance, a welcome postcard and gift card were implemented. Monthly clinic visits occur until compliance is met, wearing device greater than 4 hours 60% of the time, then appointments are scheduled every 6 months to 1 year.

Results
Since 2016, compliance rate increased from 29% to 58%. There was a year over year growth of number of patients starting therapy from 2017 to 2019, 86 patients were added to the PAP program. In 2019, 60% of 6 to 12 years old met compliance and 51% of 13 to 18 years old.

Conclusion
A comprehensive PAP program resulted in improved compliance and substantial growth. Referring providers and families are more likely to accept PAP therapy when made aware of extensive education and follow up by RT staff. To further improve compliance, especially in the 13 to 18 age range, a desensitization program has recently been implemented.

Support
No support provided.
0886 Changes in Parent Knowledge and Self-Efficacy and Association With Adherence Following the Steps Towards Achieving Restful Sleep (STARS) Pediatric PAP Therapy Desensitization Program
Authors: Crane S C , Taylor A , Wesley K L , Simon S L 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) presents in 2-5 % of youth and has been consistently linked to sleepiness, cognitive deficits, behavior difficulties, and cardiovascular morbidity. PAP effectively treats OSA, however, nonadherence is the most common cause of PAP treatment failure in children. Few adherence interventions have been empirically studied for youth with OSA. The STARS (Steps Towards Achieving Restful Sleep) Clinic is a behavioral program to optimize child tolerance to PAP therapy through a parent class, and in vivo practice. The goal of the study was to examine parent knowledge and self-efficacy following participation in STARS, and associations with subsequent PAP adherence.

Methods
A retrospective chart review was conducted for patients in the STARS program. Items queried included patient demographics, diagnostic and treatment characteristics, pre- and post- STARS responses to a parent self-efficacy and knowledge questionnaire, and polysomnography and PAP adherence data. Paired-samples t-tests examined changes in parent self-efficacy and knowledge pre- to post STARS, and regression analyses examined associations between self-efficacy and knowledge with demographics, treatment-related characteristics, and PAP adherence.

Results
130 patients completed the STARS program from October 2016 to February 2019. Participants were 8.3 years old ±6.3, 63% male, 57% white, 33% Hispanic, with severe OSA (OAHI =22 ±33). Most participants (87%) had at least one medical comorbidity (e.g, Down Syndrome, 41%). Both parent knowledge and self-efficacy increased significantly from pre- to post- STARS. Approximately 60% of patients were adherent following STARS (defined as ≥4 h use and ≥70% of days used). Higher post- knowledge, but not efficacy score, was significantly associated with better PAP adherence.

Conclusion
Parent knowledge and self-efficacy for PAP improved following the STARS program, and greater knowledge was associated with better adherence. Future research evaluating the efficacy and effectiveness of the STARS program is needed but preliminary evidence suggests it may be a promising model for improving youth PAP adherence.

Support
None
0888 A Peer-Based Social Media Intervention to Promote Continuous Positive Airway Pressure Adherence in Adolescents With Obstructive Sleep Apnea
Authors: Watach A J , Bishop-Gilyard C T , Ku H , Afolabi-Brown O , Parks Prout E , Xanthopoulos M 
Published: May 2020

Abstract

Introduction
Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive sleep apnea (OSA) is suboptimal. This study evaluated an innovative CPAP adherence intervention for adolescents and their caregivers delivered via private Facebook groups. Study aims: (1) determine feasibility and acceptability of the intervention and (2) assess CPAP use pre- and post-intervention.

Methods
A pilot cohort study design was employed (N=6 dyads). Intervention included psychoeducation, CPAP use downloads/feedback, promoting peer-engagement through posts, videos, and polls. Adolescent and caregiver groups ran separately and simultaneously over 4-weeks. Measures: demographics, engagement/participation data, CPAP use, semi-structured interviews. Analysis: descriptive statistics and thematic content analysis.

Results
Adolescents were Black/African American (100%), males (100%) with a median age of 16 years (range 13-17). Caregivers (n=6) were mothers (67%) and fathers (33%) with a median age of 47 years (range 38-55). Caregivers were more engaged with the intervention than adolescents, viewing content 65%, 75%, 85%, 90%, and 100% (n=2) of days versus adolescents who viewed content 0%, 20% (n=2), 40%, 75% and 100%. Semi-structured interviews revealed the intervention was perceived positively; learning/expanded knowledge, gaining a sense of community, and enjoyment in the opportunity to help others were commonly identified. Interview feedback revealed utilizing a different social media platform may be more beneficial for adolescent engagement. Participants noted the intervention promoted conversations between the adolescent and caregiver, and 4/6 teens cited increased motivation to use CPAP. Average CPAP use increased in 50% of participants (n=3); 33% (n=2) sustained their use, and one decreased use.

Conclusion
Participants consistently noted appreciation for knowledge gained and sense of community derived from the intervention. This study supports the potential utilization of social media platforms to not only provide reliable OSA/CPAP education but to also promote peer-engagement. Given the acceptability and increased CPAP use in this small sample, a larger trial is indicated.

Support
Lead author receives support from NIH/NHLBI Award T32 HL07953. Videos included in intervention supported by The Children’s Hospital of Philadelphia Metabolism, Nutrition and Development Research Affinity Group Pilot and Feasibility Grant.