bluuebunny/crossref_metadata_2025_split huggingface dataset:
1124 Central Sleep Apnea and Traumatic Brain Injury: A NIDILRR and VA TBI Model System Study
Authors: Gulati G , Schwartz D J , Nallu S , Bell K , Wittine L , Fann J R , Nakase-Richardson R 
Published: May 2020

Abstract

Introduction
Sleep-related breathing disorders are common after TBI. To date, two single site studies have reported divergent findings in post-TBI patients with one reporting predominantly obstructive sleep apnea (OSA, Holcomb et al., 2016) and the other central sleep apnea (CSA, Webster and Bell, 1998). The purpose of this analysis is to explore prevalence, demographics, and injury characteristics of patients with a clinical diagnosis of CSA in a recently-completed multicenter comparative-effectiveness trial during inpatient rehabilitation following moderate to severe TBI.

Methods
Participants in a six-center diagnostic comparative effectiveness trial underwent Level-1 polysomnography (PSG) during inpatient rehabilitation for TBI. Studies were scored at a centralized scoring center by one of two certified PSG technicians with final interpretation by a board-certified sleep medicine physician.

Results
21 of 248 (8.5%) participants evidenced elevated CSA indices &gt;5. Predominant CSA was rare (n=3 [1.2%], age range: 36-59; 100% male; 33-52 days post-TBI). One participant was on opioid, anti-depressant and antiepileptic drugs, one was on an antiepileptic, and another was on an opioid. PAP therapy was not initiated during PSG thus there was no treatment-emergent CSA. All had a central apnea-hypopnea index (AHI) in the moderate to severe range (29-49). Two out of the three had a GCS &lt;8 and one participant had a GCS of 14.

Conclusion
In this multi-center clinical trial, predominant CSA was rare. The common practice of reducing polypharmacy in order to minimize sedation and optimize mental status in specialized inpatient brain-injury rehabilitation programs may contribute to the low CSA incidence in this cohort. Attention to medication side-effects and their influence on sleep-related breathing should be routinely considered.

Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015) for DVBIC, NIDILRR (90DPTB0008-03-00; 90DPTB0013-01-00).
1129 Sex Dependent Effects on Sleep Architecture After Traumatic Brain Injury: Impact on Outcome
Authors: Griesbach G S , Robinson S E , Howell S 
Published: May 2020

Abstract

Introduction
Traumatic Brain Injury (TBI) is frequently associated with problems with sleep and diurnal somnolence. After determining if subjective somnolence was associated with sleep disturbances, we investigated if alterations in sleep architecture were associated with cognitive, social and emotional health in a sex dependent manner. For patients receiving positive airway pressure (PAP) treatment, we determined if lack of compliance contributed to cognitive and quality of life issues.

Methods
Adult TBI subjects (n=57) were assessed via overnight polysomnography. Mean age was 41 years and mean TBI chronicity was 2.5 years. Overall level of disability was determined by the Mayo Portland Inventory II. Sleep measures included slow wave sleep (SWS), REM latency, percent time in all sleep stages, apnea/hypopnea index, wake after sleep onset (WASO), and arousal index. Outcome measures were the California Verbal Learning Test (CVLT), Montreal Cognitive Assessment (MoCA), Trails A and B, Beck Depression Inventory, and Neuro-QoL.

Results
No sex effects for reporting somnolence were found. Besides being associated with increased subjective anxiety and stigma, somnolence was associated with increased arousals, decreases in SWS and higher incidence of REM AHI. WASO and number of arousals had a negative impact on the amount of SWS and sleep efficiency. Men spent significantly more time in REM sleep, which was correlated with higher scores on the MoCA and CVLT. Women showed more disability. Longer latencies to SWS were associated with increased CVLT performance. AHI was associated with increases in emotional/behavioral dyscontrol, fatigue and self-reported sleep disturbance. All effects were statistically significant.

Conclusion
Female TBI patients show significant impairments in REM sleep, which may impact learning and memory. Sleep disturbances were associated with poorer cognitive performance and may ultimately affect outcome, as indicated by lower scores on quality of life measures.

Support
Centre for Neuro Skills
1149 A Pilot Quality Improvement (QI) Study To Assess Whether Bilevel Positive Airway Pressure (bipap) Support In Acute Ischemic Stroke Patients With Sleep Disordered Breathing, Can Improve Neurological Recovery During Acute Stroke Care
Authors: Nadhim A N , wong J , Gupta D , Suhan L , Siegel M , Bhat S , strauss S , Fourcard F , Pandya V 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) has been associated with adverse outcomes in patients with stroke. While data is limited, it suggests that treatment of OSA may improve neurological recovery. With this quality improvement (QI) project, we aim to develop an interprofessional-team workflow process for screening and correction of OSA in acute ischemic stroke, with the goal to improve outcomes of neurological recovery.

Methods
This is an ongoing study to screen all eligible patients admitted to JFK Medical Center stroke unit, with MRI-proven Supratentorial acute ischemic stroke. The patients are screened using an overnight Pulse Oximetry test. A 3% oxygen desaturation index (ODI) of ≥10/hr or 4% ODI of ≥ 5/hr is considered at high risk for OSA. Such Patients will receive nocturnal Auto-adjusting BIPAP therapy during their acute care stay, for up to 5 days, for at least 4 hours per night. Eligible Patients who refused BiPAP therapy or were non-compliant will be considered as a controls. Baseline NIH stroke scale (NIHSS), and bilateral MCA mean flow velocity (MFV) in the morning, by transcranial doppler (TCD) will be assessed at baseline for cases and controls, and after BiPAP therapy, for the case group. The two groups of patients will also be compared in terms of Modified Rankin Scale at time of discharge and at phone follow-up after 6 weeks.

Results
Between Oct 17th, 2019 to current, 15 patients were admitted to the stroke unit with MRI confirmed stroke. Ages ranged from 34 - 88 years (average age 66.5 years). 8 patients (60%) were female. Of those, 6 patients consented to being screened for OSA. Of these, 1 had 4%ODI &gt;5/hr, and therefore received treatment with BIPAP. However, compliance was &lt; 4 hrs on 2 consecutive nights.

Conclusion
This is ongoing QI project and results will be available after few more months of continued recruitment.

Support
Auto-adjusting BIPAP machines were provided by RESMED.
1165 Online CME-Certified Case Challenges Improve Competence for the Diagnosis and Management of Pediatric Narcolepsy Among Pediatricians
Authors: Finnegan T , Murray C F , Hughes S , Maski K 
Published: May 2020

Abstract

Introduction
Narcolepsy is a chronic neurologic sleep disorder that typically starts in childhood. Symptoms of narcolepsy in pediatric patients can differ from adult onset narcolepsy and few treatment options are approved for pediatric narcolepsy. Given the challenges of recognizing the condition in children and selecting an appropriate therapeutic intervention, we investigated whether a case-based educational activity was able to improve the competence of pediatricians to accurately diagnose and manage narcolepsy.

Methods
An online, text-based educational intervention comprised of 2 patient case scenarios was developed. Using a “test and teach” approach, clinicians were presented with multiple-choice questions to evaluate their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to teach. Educational effect was evaluated with a repeated-pairs pre- to post-assessment study design in which each individual learner acts as his/her own control. A chi-square test was utilized to identify whether proportions of correct answers at pre and post were significantly different. Cramer’s V was used to calculate the effect size of the intervention. Data were collected between April 20, 2019 and September 17, 2019.

Results
The education resulted in an extensive educational effect for pediatricians (n=125; V =.424). Significant improvements were observed in several topics (P &lt;.05 for all comparisons) including: the use of hypocretin cerebrospinal fluid testing as a diagnostic tool for patients with symptoms suggestive of type 1 narcolepsy; appropriate guidance to transition patients with type 1 narcolepsy from one therapeutic regimen to another; and therapeutic selection for a patient with type 2 narcolepsy. Overall, participation in the education resulted in 34% of pediatricians reporting increased confidence in diagnosing and managing sleep disorders in children.

Conclusion
This study demonstrated the success of a targeted, online, interactive, case-based educational intervention on improving awareness among pediatricians regarding the diagnosis and management of narcolepsy. The results indicated that pediatricians would benefit from continued education on the care of patients with narcolepsy.

Support
Support for this program came from an unrestricted educational grant from Jazz Pharmaceuticals, Inc.
1171 Commonly Encountered Yet Not Confident: Graduate Psychology Students’ Experience and Confidence Managing Sleep Disturbances
Authors: Meaklim H , Monfries M , Rehm I C , Junge M , Meltzer L J , Jackson M L 
Published: May 2020

Abstract

Introduction
Trainee psychologists receive minimal sleep education during graduate psychology training programs, despite the frequent co-occurrence of sleep disturbances in mental health conditions. This study aimed to explore graduate psychology students’ experience working with sleep disturbances and their perceived skills and confidence to assess and treat sleep problems in clinical practice.

Methods
Australian graduate psychology students (N = 163) completed a novel survey developed specifically for the study, inquiring about their experience, skills and confidence to manage sleep disturbances in clinical practice. Students perceived skills to manage sleep disturbances were recorded on a 7-point Likert scale, where 1 = ‘strongly disagree’ and 7 = ‘strongly agree’. Students’ confidence to treat specific sleep disorders was also recorded.

Results
Sixty-eight percent of students reported having already worked with a client who experienced a sleep disturbance as part of their training. However, students’ perceived skills to assess and treat sleep disturbances were low. Only 14.9% ‘agreed’ or ‘strongly agreed’ that they had the skills to assess and diagnose common sleep disorders (M = 3.22, SD = 1.75). Similarly, less than a quarter of students ‘agreed’ or ‘strongly agreed’ that they felt comfortable using common sleep-related assessments (23.7%; M = 3.56, SD = 1.96) or empirically-supported interventions for sleep disturbances (22.6%; M = 3.71, SD = 1.83). The majority of students reported they were ‘not confident at all’ to treat parasomnias (80.3%); hypersomnias (77.9%); OSA (71.3%); circadian rhythm disorders (50%) or insomnia (41%).

Conclusion
Graduate psychology students report low levels of confidence in assessing and managing sleep disturbances in clinical practice, despite over two-thirds of students already working with clients experiencing sleep difficulties. Clinical training in the management of sleep disturbances is required for graduate psychology students.

Support
N/A
1175 Sleep Disorders Screening in Primary Care: Prevalence of Diagnosis and Treatment in the EMR
Authors: Klingman K J , Morse A , Williams N , Grandner M , Perlis M L 
Published: May 2020

Abstract

Introduction
Undetected and untreated sleep disorders likely precipitate or exacerbate medical and/or psychiatric illnesses. Given this, primary care is an ideal point for managing sleep disorders, yet prior research shows that PCPs diagnose and/or treat sleep disorders at rates far below population prevalences. The purpose of this study was to determine the current rate of detection and treatment of sleep disorders within primary care settings.

Methods
EMR data from two health care systems was analyzed. The proportion of PCPs diagnosing and treating one or more sleep disorders was calculated (per year) for 5 years (2014-2018). Also calculated was the percent of PCP caseload diagnosed and/or treated for sleep disorders.

Results
The two systems comprised n=1021 PCPs. From 2014-2018, the proportion of PCPs diagnosing patients with sleep disorders fluctuated between 58-89%. The proportion treating sleep disorders fluctuated between 50-91%. Non-parametric one-sample run tests (SPSS) indicate these are random distributions (p&gt;0.05). PCPs’ use of medications to treat sleep disorders is trending downward over time within one system (per linear regression, p=0.03, R-squared=0.8). Other temporal trends were not evidenced. The average percentage of diagnosed and treated patients per PCP was around 2.5% of their caseloads. Between-system differences were observed.

Conclusion
There is a profound mismatch between percentage of PCPs identifying patients with sleep disorders (60-90%) and the percentage of patient caseload diagnosed and/or treated for sleep disorders (2.5%). This suggests that the majority of PCPs are willing to assess for sleep health but do so in only a small minority of patients. These data, along with our survey data (elsewhere in this volume) suggest that the intention-action gap could be closed if PCPs were appropriately resourced.

Support
There was no funding for this study.
0123 Sleep Duration and Cognitive Performance on the Stroop Color-Word Task and Simple Reaction Time Task
Authors: Mullins K M , Reynolds A M 
Published: May 2020

Abstract

Introduction
Studies examining sleep factors and cognition suggest that sleep impacts cognitive performance in college students. The focus of the current study was to examine normal sleep patterns in college-aged students and how their sleep affected their cognitive performance.

Methods
Participants were 51 undergraduate students (18 males), average age M=20.25 (SD=1.78) years, who wore actigraph watches to measure their sleep. After one week, participants completed the Multidimensional Assessment of Fatigue (MAF) to assess fatigue and performed a series of cognitive tasks on the computer, including the Stroop Color-Word test. Participants responded to the color of the word presented on the screen instead of the word itself. Stimuli where the color and word did not match were considered incongruent stimuli. Participants also performed a simple reaction time task, where they reacted to an “X” stimulus on the screen.

Results
Mean sleep efficiency was 82.55% (SD=5.70), mean sleep duration was 6.59 hours (SD=79.19 minutes), and the mean MAF score was 21.17 (SD= 7.64). A Pearson correlation indicated a significant negative association between sleep duration and Stroop congruent errors r(49) = -.467, p = .001. Furthermore, a Pearson correlation indicated a significant positive association between sleep duration and incongruent reaction time, r(49)= .290, p= .039 and a significant positive association between sleep duration and simple reaction time, r(49)= .277, p= .049. MAF scores were positively correlated with simple reaction times, r(49)= .376, p=.008. Sleep efficiency was not correlated with any of the cognitive measures.

Conclusion
As expected, participants’ sleep was short and inefficient. Results were expected in that participants made fewer errors with increased sleep, but, unexpectedly, reaction times also increased with more sleep. Fatigue may have played a role in this relationship. It is important to continue this research in order to learn more about sleep factors and cognitive function in college students.

Support
None
1220 A CASE OF HYPOGLOSSAL NERVE STIMULATOR CERVICAL LEAD CUFF DISLODGEMENT
Authors: Ali Hamed , Duthuluru Sowjanya 
Published: May 2020

Abstract

Introduction
Hypoglossal Nerve Stimulation (HGNS) has become an alternative therapy for moderate to severe obstructive sleep apnea (OSA) patients intolerant to PAP therapy. HGNS devices typically comprise of implantable pulse generator (IPG) placed surgically in an infraclavicular subcutaneous pocket. An electrode cuff attached to the IPG wraps around the distal portion of the of the hypoglossal nerve. This device has an implantable chest sensor that monitors the respiratory efforts.

Report of Case
A 76-year-old male with history of severe OSA (AHI 39 /hour) was intolerant to PAP therapy. HGNS was implanted in the right infraclavicular pocket under general anesthesia without any complications. Patient had successful tongue motion to stimulus per protocol intra- operatively in the OR. However, no tongue movement was noted despite maximum stimulation up to 4.5 V at follow up clinic visit. Follow up C spine x ray showed very low-lying HGNS cervical lead cuff, and possible dislodgement. Patient was taken back to the OR. Intraoperatively it was noted that the previously placed cervical lead cuff has folded back and was lying on the surface of the submandibular gland /digastric anchor site. It was dissected free and replaced on the distal inclusion branches of the hypoglossal nerve with loupe magnification and EMG confirmation (tongue deviation at 1.5 volts). Patient developed tongue neuropraxia with difficulty swallowing, difficulty speaking and right sided tongue deviation lasting for months, that gradually improved. Patient had successful HNS activation 6 months later using 2.2 V.

Conclusion
(HGNS) failure secondary to cervical lead cuff dislodgement is a rare complication and should be taken in consideration. Post-operative imaging and comprehensive clinical examination are crucial in detecting such problems. Temporary tongue neuropraxia post Hypoglossal nerve stimulator placement is another possible complication.
1222 Does Creativity & “Dose” Enhance Outcomes in Imagery Rehearsal Therapy? A Case of Successful IRT
Authors: Roth Alicia J , Drerup Michelle 
Published: May 2020

Abstract

Introduction
Imagery Rehearsal Therapy (IRT) is an efficacious treatment for Nightmare Disorder. In IRT, patients practice pleasant guided imagery techniques, then use these skills to re-script recurring nightmares, which lowers the frequency and intensity of overall nightmare activity. However, the most efficacious methods and dosage of guided imagery and nightmare re-scripting is undetermined.

Report of Case
The patient was a 70-year-old male with Nightmare Disorder. Patient denied any precipitating event or trauma associated with nightmare onset. He has a longstanding history of depression and OSA (uses CPAP). He was taking Seroquel, which reduced severity of nightmares but not frequency. Trials of other medications for nightmares had failed (including prazosin, Depakote, and trazodone).
Patient presented as highly distressed, exhibited distrust towards medical providers, and was skeptical about the effectiveness of IRT. Despite his skepticism, patient self-initiated very detailed and media-enhanced methods for pleasant guided imagery and nightmare re-scripting, including written narratives, voice recordings, and created a movie of his re-scripted nightmare with pictures set to music. He listened to the recordings 2-3x/day. Themes of nightmares included lack of mastery over problems; patient’s re-scripted dreams put him back in control of frightening scenarios.
Nightmare logs at baseline showed sleep quality=1.9/5; average=2.0 nightmares/night; average intensity= 6.2/10. At week 15 of treatment, sleep quality=3/5; nightmares/night average=0.25; average intensity=6/10. Sleep disturbance also improved (ISI=18-moderately severe clinical insomnia to 11-subthreshold insomnia); mood was stable (PHQ=5-mild depression).

Conclusion
Previous studies have suggested that IRT increases patients’ sense of mastery or perceived self-efficacy over nightmares (Rousseau et al., 2018). Additionally, higher verbal memory in persons with trauma-related nightmares has been shown to improve nightmare frequency and severity in IRT (Scott et al., 2017). In this case study, self-efficacy may have been activated by the highly detailed and media-enhanced imagery the patient created. Further empirical research on the mechanisms for enhancing IRT is warranted.
1227 A CASE OF A FEARFUL SLUMBER
Authors: Asis Aristotle , Wilson Annise Georgette , Alapat Philip Mani 
Published: May 2020

Abstract

Introduction
Isolated sleep paralysis (ISP) occurs when rapid eye movement (REM)-based atonia intrudes into wakefulness, outside the context of narcolepsy, substance abuse, mental disorder or other medical conditions. No “gold standard” assessment and diagnostic instrument currently exists.

Report of Case
A 63-year old female with hypersomnia and positive airway pressure (PAP)-controlled obstructive sleep apnea was referred for recurrent episodes of paralysis during sleep-wake transitions, lasting 15-20 seconds, occurring every 2-3 years since the age of 15, and associated with fear and anxiety. Episodes were more frequent in the last 2 years after significant sleep deprivation and starting a weight loss supplement, BIO-X4, which contains green tea and probiotics. No cataplexy, or history of traumatic brain injury and stroke were identified. Epworth Sleepiness Scale score was 14 on armodafinil. Reported sleep amounts were regularly scheduled 6-7-hour periods, with no suggestion of circadian dysfunction. In 2016, polysomnogram showed Apnea-Hypopnea index of 2.6/hour, Respiratory Disturbance Index of 13.8/hour with oxygen nadir of 92% in the setting of hypersomnia. Continuous PAP of 11 cmH20 was initiated after a successful titration with controlled residual AHI during follow-ups. Multiple Sleep Latency Test during the same time revealed mean sleep latency of 5.5 minutes and no sleep-onset REM with 5 naps. Brain imaging and electroencephalogram were both normal as well as drug panel, blood counts, metabolic profile and thyroid function. Decreased episodes and severity of recurrent ISP were reported after discontinuation of the supplement. Apart from anxiety related to the episodes, the patient denied any interference with daytime function.

Conclusion
Isolated sleep paralysis is an important sleep disorder that requires proper evaluation to rule out competing diagnoses and consideration of therapeutic interventions. Likely associated with a lack of understanding and available literature, the prevalence in the general population is likely higher than what is currently perceived.