bluuebunny/crossref_metadata_2025_split huggingface dataset:
1160 Improved Daytime Sleepiness Following Daily Morning Blue Light Therapy Is Associated With Altered Resting-state Network Connectivity
Authors: Raikes A C , Dailey N S , Vanuk J R , Alkozei A , Grandner M A , Killgore W D 
Published: May 2020

Abstract

Introduction
Light exposure, particularly blue wavelength light, has consistent positive effects on daytime sleepiness following mild traumatic brain injuries (mTBIs). While self-perceived improvements in daytime sleepiness are well-documented, the neurobiological underpinnings are not well understood. The purpose of this study was to localize changes in functional connectivity after daily morning blue light therapy (BLT) and to associate these changes with improvements in post-mTBI daytime sleepiness.

Methods
29 individuals with a history of mTBI were randomized to receive either BLT (n=13) or placebo amber light (ALT; n=16). All participants self-reported daytime sleepiness (Epworth Sleepiness Scale (ESS); lower is better) and underwent resting-state functional magnetic resonance imaging at pre- and post-treatment. Whole-brain functional connectivity (FC) was estimated as the correlations between 400 cortical regions of interest (ROIs) assigned to 7 resting-state networks. A two-sample T-test for post-treatment ROI-to-ROI FC identified target connections (FDR corrected p&lt;0.01). Post-treatment ESS scores and FC for these connections were correlated for treatment-related brain-behavior associations (uncorrected p&lt;0.05).

Results
Lower FC after BLT in 4 ROI-to-ROI connections linking the default mode and visual networks was associated with lower ESS scores. Higher FC after BLT in 9 ROI-to-ROI connections linking attention, cognitive control, and visual networks was also associated with lower ESS scores.

Conclusion
BLT resulted in decreased self-reported daytime sleepiness, which was associated with decoupling of the default mode and visual networks as well as increased connectivity between and within attention and cognitive control networks, suggesting potentially improved attention to relevant stimuli and cognitive processes and less internal mentation. These associations may contribute to improved alertness, attention, and cognitive performance following a mTBI. Further work is needed to identify the optimal timing and dosage of BLT to maximize these outcomes.

Support
This study was funded by an award to Dr. Killgore from the US Army Medical Research and Materiel Command (USAMRMC; award number: W81XWH-14-1-0571).
1164 Prospective Associations Between Sleep Duration, Variability and Timing and Diseases from an Electronic Health Record Biobank in 24,065 Individuals
Authors: Dashti H S , Cade B , Stutaite G , Saxena R , Redline S , Karlson E 
Published: May 2020

Abstract

Introduction
Implementation of electronic health records (EHR) across healthcare systems linking clinical to survey data has enabled systematic assessments of longitudinal relationships between sleep traits and diseases classified by PheWAS codes where ICD-9/10 codes are collapsed to categories based on clinical similarity. In the Partners Biobank, a hospital-based virtual cohort from Mass General Brigham in greater Boston, MA, we aimed to assess associations between sleep traits and incident diseases.

Methods
Self-reported weekday/weekend bed and wake times from a survey at consent were used to derive sleep traits. Incident diseases were defined as two incident PheWAS codes on separate dates ≥1y after consent. Cox proportional hazards models compared short (&lt;7h) and long (≥9h) sleep duration, with 7-8h (referent group), adjusted for age, gender, race/ethnicity, and employment status, then further adjusted for BMI. Similarly, sleep midpoint (midpoint between weekend wake/bed times), sleep debt (difference in weekend/weekday sleep duration), and social jetlag (difference in weekend/weekday sleep midpoint) were assessed.

Results
The analytical sample consisted of 24,065 adults (mean sleep duration =8.12h) seeking regular care with sleep data. Participants had a total of 7,513,649 ICD codes of which incident 323,946 ICD codes mapped to 137,137 PheWAS codes. Over a median follow-up of 2.73 years (interquartile range: 1.82-3.98), participants sleeping &lt;7h had a significantly higher risk of incident Acute pain [hazard ratio(95% confidence interval)=1.46(1.2-1.78)], Tobacco use disorder [1.42(1.18-1.71)], Sciatica [1.72(1.3-2.27)], and Edema [1.69(1.25-2.28)]. Each additional hour of later sleep midpoint and increased sleep debt and social jetlag associated with higher risk of incident Major depressive disorder [midpoint:1.30(1.14-1.49); debt:1.23(1.09-1.38); jetlag:1.54(1.27-1.84)]. Associations retained significance upon further adjustment for BMI, except for Edema, and no other associations were observed at the Bonferroni threshold (P=0.0125).

Conclusion
Our findings in a large hospital-based virtual cohort support unique inter-relationships between sleep duration/timing on somatic, behavioral, and mental health outcomes.

Support
H.S.D. and R.S. are supported by NIDDK grant R01DK107859. B.C. is supported by K01-HL135405-01. S.R. and R.S. are partially supported by R35 NHLBI HL 135816.
1169 Innovative Exposure to Sleep Medicine for Medical Students
Authors: Gupta S , Golden E , Howell M , Irfan M 
Published: May 2020

Abstract

Introduction
Lack of exposure to the field of Sleep Medicine at the medical student level hinders sleep training. Instead of the traditional didactic style, there is a need for innovative collaborative measures to spark interest in the younger generation of learners. The goal of this educational endeavor was to introduce medical students to the field of Sleep Medicine through the platform of Student Interest Group in Neurology (SIGN).

Methods
An interactive session was conducted for SIGN at the University of Minnesota. 24 second-year medical students were divided into 6 groups. The session consisted of introduction, videos of common sleep disorders and interactive briefing afterward. 5-point Likert scale pre and post-session surveys were administered to measure the level of knowledge regarding sleep, familiarity with diagnostic tools, available education, pathways to Sleep Medicine, learner’s interest and impact of the session. Wilcoxon matched-pairs signed-rank test was performed to compare pre- and post-surveys.

Results
There was a significant improvement in measures of students’ knowledge about sleep diagnostic modalities (p =7.8*10-5), education received (p= 3.2*10-5) and pathways to sleep medicine (p=4.1*10-5). Survey also showed improvement in students’ interest in pursuing a Sleep Medicine career (p=0.07). There was no difference in knowledge about the importance of sleep for health (p=0.69). All of the students found the session to be informative.

Conclusion
Early exposure to sleep disorders in interactive format was well received by the medical students with significant improvement in scores regarding sleep education, awareness of diagnostic modalities, career pathway and interest in sleep medicine (p=0.07). Integration of exposure to Sleep Medicine within the medical curriculum in an innovative format should be done to instigate interest in this field. Further larger studies are warranted to evaluate the changes in the students’ interest in the subspecialty with an introduction in the early stages of their career.

Support
1179 Barriers To Sleep Among Children Exposed To Adversity
Authors: Robbins R , Ripple C H , Fleshman C , Bonuck K , Jean-Louis G , Hale L , McGlinchey E , Donskoy I , Wolfson A , Owens J 
Published: May 2020

Abstract

Introduction
Children exposed to adversity (e.g., homelessness, poverty) are at risk of poor sleep. Community settings that serve these children, both residential (e.g., foster care group homes, shelters) and non-residential (e.g., early care and education, schools), hold important understandings to the barriers to sleep they experience. We surveyed a heterogeneous national sample of community-based organizations (CBOs) in our Pajama Program sample to explore these barriers.

Methods
Pajama Program, a national 501(c)(3) nonprofit, administered an online needs assessment in May 2016 to staff at 3,911 CBOs. This poster reports on qualitative responses to the question, What are the primary barriers to sleep and bedtime among children your organization serves? Responses from residential and non-residential CBOs were analyzed separately. Two trained coders independently used the constant comparative method to analyze transcripts.

Results
Survey respondents (1,635) provided services in non-residential (42%), residential (18%) and combined (43%) settings. Organizations provided child welfare/foster care (20.6% of programs); transitional housing/shelter (20.5%); social services (15.6%); and early care and education (12.7%) services. Responses to the target open-ended item were from 127 non-residential and 55 residential programs. Sleep barriers common to both settings included: late/irregular bedtimes; no bedtime routine; lack of sleep education; housing/food insecurity; stress; disrupted/uncomfortable sleep; and adapting to new environments. Trauma was a barrier among residential (vs. non-residential) programs. Non-residential providers noted unstable family situations, bedding insecurity, and poor sleep hygiene.

Conclusion
Our research highlights barriers to sleep among children exposed to adversity, a largely understudied yet high risk group. Barriers reported by residential and non-residential CBOs were more similar than different. was Across program types and settings, CBOs expressed a need for sleep health education interventions for children and caregivers.

Support
Funding for this project was provided by Pajama Program, a national 501(c)(3) non-profit.
1182 Using Home Delivery Of Home Sleep Tests To Improve The Diagnosis Of Obstructive Sleep Apnea
Authors: Sterner T , Yankowy L , Vesnaver D , Senft R 
Published: May 2020

Abstract

Introduction
OSA is a highly prevalent and co-morbid condition across the US and the world. Recent data shows between 14% and 49% of middle-aged men have clinically significant OSA and although the data shows OSA is less prevalent in women, the consequences of this condition is as severe as in men. Further studies suggest 80% of more than 25 million cases of OSA in the US are undiagnosed. At our institution, several factors contributed to the under diagnosis of OSA: knowledge deficit, complicated order process, inconvenience, fear and cost. We developed a plan to increase the diagnosis of OSA by increasing home sleep testing by 50% within 6 months of initiating a home delivery model.

Methods
Our multifaceted, multidisciplinary and comprehensive plan included a contractual agreement with the manufacturer of our preferred device, WatchPAT, to directly ship the HSAT device to the patient, receive the device back after testing and upload the data for physician interpretation. Integration was established between middle-ware and the HSAT software for flow of information. A collaborative effort with our marketing department to develop a health risk assessment tool specific to sleep apnea, targeted by health history, resulted in mailings to thousands of patients. A coordinated effort with our Call Center to explain delivery process and schedule testing was done. Paramount to our success was streamlining the ordering process for providers.

Results
2,122 HSTs were done in the initial 6 months of using home delivery compared to the same 6 month time frame the previous year - an increase of 71%.

Conclusion
Using a broad, collaborative effort among several disciplines within our health care system, we found the access and use of home sleep tests dramatically improved. This was cost effective, saving .5 FTEs, provided a high degree of patient satisfaction and resulted in increased diagnoses.

Support
1183 Board-certified Sleep Medicine Physicians See A Greater Proportion Of Complex Sleep Patients Than Non-specialist Providers
Authors: Jobe S L , Albrecht J S , Scharf S M , Johnson A M , Parthasarathy S , Wickwire E M 
Published: May 2020

Abstract

Introduction
Despite a growing literature regarding the impact of board-certification in sleep medicine, little is known about the complexity of patients seen by board-certified sleep medicine physicians (BCSMPs) relative to non-specialists. To address this gap, the purpose of the current study was to evaluate the differences in sleep complaints among Medicare beneficiaries seen by BCSMPs relative to individuals seen by non-specialists.

Methods
Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of sleep disorder diagnoses patients received by provider status. BCSMPs were identified using a cross-matching procedure based on National Provider Identifier (NPI).

Results
A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013. Of these, only 2.2% were seen by BCSMPs. Relative to beneficiaries seen by non-specialists, those seen by BCSMPs were more likely to be diagnosed with more than one sleep disorder (p&lt;0.001). Specifically, 91.0% of individuals seen by non-specialists received only one sleep disorder diagnosis, whereas 75.9% of individuals seen by BCSMPs received only one sleep disorder diagnosis. Among beneficiaries seen by non-specialists, the most common sleep disorders were insomnia (48.2%; n=26,967), obstructive sleep apnea (OSA; 31.4%; n=17,554), and restless legs syndrome (8.7%; n=4,871). Among those seen by BCSMPs, the most common sleep disorders were OSA, (70.4%; n=901), sleep apnea with hypersomnia (16.5%; n=211), and insomnia (11.7%; n=150).

Conclusion
BCSMPs see more complex sleep patients than do non-specialists. These results suggest the possibility that more complex patients are referred for sleep specialty care. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients.

Support
This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).
1190 Engaging Patients And Family Members To Understand What Matters Most Living With Obstructive Sleep Apnea
Authors: Mou J , Silva A , Figetakis K , Ho S S , Williams M , Mebust K A , Xia Y , Xie J , Wang J , Chin N , Vondran R , Vondran R 
Published: May 2020

Abstract

Introduction
As a common but modifiable chronic condition, obstructive sleep apnea (OSA) has been identified as the top secondary cause of many other diseases including cardiovascular diseases and type 2 diabetes. Diagnosing and managing OSA provides neurological, cardiovascular and metabolic benefits, however real-world studies indicate disconnections between evidence and outcomes. Using an engagement approach and qualitative design, this project aims to better understand care and research gaps in OSA in a community healthcare setting.

Methods: Methods
Patient and family representatives were identified and recruited through OSA support meetings hosted by MultiCare Sleep Medicine Centers, to form a board of 12, with three key patient advocates. Six meetings, each facilitated by one or two members of the board, were held to encourage focus group discussion and accommodate interactive conversations on the topic. Discussions were audio recorded and edited to exclude patients’ identifiable information, then transcribed. Manual open coding was completed by two coders for each transcription to develop a codebook, followed by auto-coding and inductive content analysis using Nvivo 11.

Results
All enrolled patients had diagnosed moderate-to-severe OSA and were prescribed with continuous positive airway pressure (CPAP) therapy. Two participants were African American and one was multiethnic. Patients’ age ranged from early 30s to 80s. Seven main themes were identified: OSA diagnostic issues; treatment experiences and options; comorbidities; patient community and support needs; long-term management challenges beyond “compliance”; knowledge of OSA, CPAP and care; and patient-driven research. The first few weeks after CPAP initiation appeared to be a critical time window that impacted patients’ adaptation and use.

Conclusion
Our study revealed barriers and facilitators in OSA diagnosis and treatment. Results showed highly prevalent chronic co-morbidities and the needs to care for patients in the comorbid scenario. It was highlighted that a paradigm of patient-centered care and research is lacking and warranted. Participants also called for better coordination between sleep medicine, primary care, other specialists, durable device suppliers and insurance. Key research efforts are expected to focus on the first 30-day post CPAP dispense to improve compliance.

Support
Patient Centered Outcomes Research Institute (PCORI) (Contract #: 7717241)
1203 Worth The Weight: Weighted Blanket Improves Sleep And Increases Relaxation
Authors: Danoff-Burg S , Rus H M , Cruz Martir L , Raymann R J 
Published: May 2020

Abstract

Introduction
Weighted blankets are designed to create deep touch pressure stimulation, to simulate the feeling of being held or hugged. The deep pressure provided by a weighted blanket, along with consistent sensory input from its weight, is thought to work by lowering stress and reducing physiological arousal, thereby improving sleep. We tested whether a weighted blanket would improve sleep.

Methods
30 participants with objectively measured sleep onset and sleep maintenance issues participated in a 6-week field study, using a non-counterbalanced pre-post intervention design. Intervention consisted of the use of a weighted blanket every night at home. The blanket was filled with microbeads and weighed approximately 10 percent of each participant’s body weight. Sleep was measured objectively using ResMed S+ every night and by daily self-report. Paired t-tests and multilevel regression were used to test for statistical significance.

Results
Objective sleep data from the 28 participants who completed all study requirements showed 7% improvement of Wake After Sleep Onset, 2% decrease in Light Sleep, and slight improvement in Sleep Efficiency (1.5%) and Sleep Maintenance (1.4%) during intervention (all ps &lt; 0.05). Additionally, participants felt they fell asleep faster (13% faster), experienced better sleep quality (14% better), felt more rested in the morning (17% more rested), and felt they slept better through the night without waking up (36% improvement). They also reported feeling 13% less stressed at bedtime and 17% more relaxed while trying to fall asleep.

Conclusion
Using a weighted blanket reduces self-reported feelings of stress, enhances feelings of relaxation, and can improve sleep and reduce time awake at night in people with sleep onset and sleep maintenance issues.

Support
Gravity Blanket
0122 Does Additional Training on an Implicit Motor Sequence Learning Task for Older Adults Improve Sleep-Dependent Memory Consolidation?
Authors: Rodheim K , Spencer R 
Published: May 2020

Abstract

Introduction
Previous studies show sleep dependent consolidation (SDC) for motor sequence learning with regular training in younger adults, whereas, in older adults, this sleep benefit is missing. If hippocampal engagement underlies age-related differences in SDC, then enhanced training should result in significant SDC in older adults. Thus, this study aims to look at younger vs. older adults with regular training and older adults with regular training vs. overtraining to determine if older adults show evidence of SDC. Alternatively, regardless of initial learning, older adults may fail to exhibit SDC because the sleep mechanisms supporting consolidation are impaired.

Methods
Seven younger adults (M=22 years) and seven older adults (M=68.5 years) completed the train condition, while ten older adults (M=67.6 years) completed the overtrain condition. In the encoding phase, participants either completed 5 blocks (train) or 10 blocks (overtrain). Between immediate and delayed recall, participants either slept with Polysomnography (PSG) in the lab or remained awake, and subsequently, completed the alternate condition one week later. Actigraphy was collected for 14 days and PSG (32-electrode EasyCap) was recorded for overnight sleep.

Results
Older adults significantly improved their skill learning from immediate to delayed recall, in both the train (p=0.005) and overtrain (p=0.013) conditions, regardless of sleep or wake. Younger adults did not improve their skill learning in the train condition (p&gt;0.05). However, there was a trending main effect, with younger adults performing the task better compared to older adults in the train condition, at both time points (p=0.061). No other main effects or interactions were significant.

Conclusion
These results suggest the alternative hypothesis that, regardless of initial learning, older adults fail to exhibit SDC. This result is of interest as the age-related differences in sleep, such as sleep spindle characteristics may play a role. Future analysis will include more participants and further exploration into the PSG-recorded sleep architecture and actigraphy-recorded measures of habitual sleep.

Support
This work was funded by NIH R01 AG040133 (PI: Spencer)
1207 Keep It Simple: Wireless Patches For Home Sleep Diagnostics
Authors: Zandieh S O , Reuveny A , Pearson S , Mordechai A , Wang C , Aesmani D , Backeris P , Ancoli-Israel S 
Published: May 2020

Abstract

Introduction
Despite growing use of home sleep testing for the diagnosis of obstructive sleep apnea (OSA), there are significant barriers including limited availability, high cost, and complex wires making it difficult for patients to use on their own. The objective of this study was to evaluate a new flexible, thin, and wireless adhesive patch (proprietor sensors, TatchSleep Pro [TSP]) for the detection of OSA and compare the validity to overnight polysomnography (PSG). The TSP transmits data wirelessly to a smartphone app which in turn uploads the data to a cloud server. Data is presented to a sleep professional via a dedicated interface to score and analyze the results.

Methods
Patients (n=9; mean age=47 (SD=10); mean BMI=33 (SD=6.6); 4 males) undergoing a PSG evaluation for OSA also wore 2 TSP patches applied on the chest and abdomen. The TSP patches detected respiratory effort, derived airflow, derived pressure, body position and movement. Two sets of respiratory data (with common SpO2 and heartrate as a reference from PSG) were created, one from PSG and one from the TSP. The data were then scored by a certified sleep technician, blinded to the conditions. Linear regression analyses were used to compare the two derived apnea-hypopnea indices (AHI). In the morning, all participants were asked about their experience using the TSP. The study was approved by the Western IRB.

Results
There was a significant correlation for AHI between the TSP and PSG (R2= 0.94; p&lt;0.01). All participants found the TSP comfortable to wear and indicated that removing the patches was ‘easy’ or ‘very easy,’

Conclusion
These preliminary results suggest the wireless TSP may be an effective, cost-efficient way to evaluate OSA. Despite small sample, results show promise as a new innovative product for home sleep testing.

Support
Supported by Tatch Inc.