bluuebunny/crossref_metadata_2025_split huggingface dataset:
0858 Impact Of Actigraphic Sleep Measures On Ambulatory Cognitive Performance In A Community-Based Sample Of Older Adults
Authors: Buxton O M , Zhaoyang R , Jiao J L , Sliwinski M J , Derby C A 
Published: May 2020

Abstract

Introduction
Few longitudinal studies link objectively assessed sleep and cognition, especially day to day differences in sleep as they relate to daily cognitive performance in ecologically-valid, natural environments. We examine the associations of sleep (actigraphy) with ambulatory ecological momentary assessments (EMA) of cognitive performance.

Methods
Analyses involved 225 participants enrolled in The Einstein Aging Study, a community based longitudinal cohort of older adults free of dementia at enrollment (Mage=77.27 years; 33% males; 47% Caucasian, 39% African American, 13% Hispanic). We examined between-person associations between actigraphic sleep duration and wake after sleep onset (WASO) with mean and variability across the day in cognitive performance. Cognitive performance was assessed via validated, smartphone-based EMA over a mean of 18 days. Six assessments/day included Symbol Match (processing speed), Color Dot (working memory), and Color Shape (memory binding). Models controlled for age, gender, ethnicity, education (years), clinically assessed mild cognitive impairment, and learning effects. Actigraphy data was collected throughout the study period.

Results
Sleep duration had a significant effect on within-person variability on ambulatory cognition: Color Dot, Symbol Match, and Color Shape (all p’s &lt;0.001). Older adults with longer mean nightly sleep duration exhibited more stable cognitive performance over time versus those with shorter sleep duration; sleep duration did not predict mean levels of daily cognitive performance. Person-level means of WASO (0.99±0.45 hours/night) predicted mean levels on cognitive tests, independent of sleep duration. Older adults with less WASO/night exhibited better cognitive performance. One half hour less nightly WASO predicted 175ms shorter Symbol Match response time (p=0.004), 1.5% lower Color Dot error proportion (p=0.048), 0.07 points higher Color Shape accuracy (p&lt;0.001). Older adults with less WASO/night also had less within-person variations in Color Dot (p&lt;0.001), Symbol Match (p&lt;0.001) and Color Shape performance (p=0.01).

Conclusion
Ambulatory cognitive performance assessed using EMA was related to actigraphic sleep. Poor sleep health may be a target for prevention of early cognitive changes that may precede onset of cognitive impairment and AD.

Support
Research was supported by the National Institute on Aging (NIA) award numbers P01AG003949 and R01AG056538.
0865 Menstrual Regularity And Bleeding Associated With Sleep Duration, Sleep Quality, And Daytime Sleepiness In A Community Sample
Authors: Onyeonwu C , Nowakowski S , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A 
Published: May 2020

Abstract

Introduction
Female menstrual health and its relationship to sleep duration, quality, fatigue and other factors is an understudied subject in the field of sleep and women’s health. Few studies examined sleep in relation to menstrual regularity and bleeding.

Methods
Data were obtained from N=579 women who have had a menstrual period in the past 12 months who participated in the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study, a community-based sample of adults age 22-60 living in southeastern Pennsylvania. Participants were asked, “How regular is your period?” with response choices of “Very Regular,” “Mostly Regular,” “Fairly Regular,” and “Not Regular.” They were also asked, “How much bleeding do you usually experience during your period?” Responses were “Very Heavy,” “Medium,” “Light,” or “Very Light.” These were evaluated as ordinal outcomes. Sleep-related predictors included sleep duration (&lt;=6h [Short], 7-8 [Normal], and &gt;=9 [Long]), Insomnia Severity Index (ISI) score, Pittsburgh Sleep Quality Index (PSQI) score, Epworth Sleepiness Scale (ESS) score, and Fatigue Severity Scale (FSS) score. Covariates included age, education, income, race/ethnicity, and body mass index.

Results
Short sleep duration was associated with a greater likelihood of heavier bleeding (OR=1.46, p=0.026) and greater irregularity (OR=1.44, p=0.031), compared to Normal sleep. Higher PSQI score was associated with more irregularity (OR=1.05, p=0.022). FSS score was associated with both heavier bleeding (OR=1.02, p=0.003) and more irregularity (OR=1.02, p=0.008). Long sleep, ISI, and ESS were not associated with either outcome. A sleep duration by FSS score interaction was found for irregularity (p=0.1). Among Normal sleepers, FSS was associated with greater irregularity, but not among Short sleepers.

Conclusion
There is a relationship between short sleep and heavier and irregular menses. These findings have implications for treating sleep problems among women. Also, mechanisms of these associations should be explored further.

Support
Dr. Grandner is supported by R01MD011600
The SHADES study was funded by R21ES022931
0870 Medicare 4% Desaturation Criteria Lead To Significant Underdiagnosis Of Gestational Obstructive Sleep Apnea
Authors: Bazalakova M , Rice L , Wiedmer A , Mourey H , Antony K 
Published: May 2020

Abstract

Introduction
Use of 4% criteria in non-pregnant populations significantly underestimates obstructive sleep apnea (OSA) prevalence and severity (Budhiraja et al, JCSM 2019). Women are significantly more likely than men to not meet Medicare 4% diagnostic criteria for OSA (Khalid et al, Sleep Vol 42 supplement, 2019). We investigated how use of 4% desaturation criteria affects the diagnosis of gestational sleep apnea (gOSA) in pregnancies complicated by obesity.

Methods
We retrospectively reviewed respiratory event index (REI) and pregnancy outcomes in 56 pregnancies with prepregnancy BMI&gt;30 kg/m2, where home sleep apnea tests (HSATs, Alice PDx) were scored using both 4% and 3% criteria.

Results
33 out of 56 HSATs met 4% diagnostic criteria for OSA (REI4% &gt; 5/hr). In 4 out of 33 cases (12%), use of 3% rather than 4% criteria changed the REI from 5-15/hr to the 15-30/hr range. An additional 11 studies were negative for gOSA by 4% criteria (REI4% &lt; 5/hr), but met diagnostic criteria for gOSA by 3% criteria (REI4% &gt; 5/hr). All 11 cases were in the “mild” category of REI 5-15/hr. Thus prevalence of gOSA was 58.9% by 4% but 78.6% by 3% diagnostic criteria. In an ongoing analysis of pregnancy outcomes in the two groups, the gestational age at delivery was lowest in the 4%gOSA group (35.9 weeks), but similar and no longer in the preterm range in the 3%gOSA and no gOSA (REI3%&lt;5/hr) groups (38.7 and 38.3 weeks respectively). However the average baby weight at delivery was lower in the 3%gOSA compared to no gOSA group (3061g and 3580g respectively), suggestive of a potential pathophysiological significance of gOSA defined by &lt;4% desaturation.

Conclusion
The use of 4% desaturation criteria leads to underestimation and missed diagnoses of gOSA complicating pregnancy. As the pathophysiological mechanisms of gOSA have not yet been elucidated, and are likely to differ from those of non-pregnant women and, certainly, men, examination of associated pregnancy morbidity is merited in gOSA defined by 4% versus 3% criteria.

Support
None.
0877 Impact of Sleep-Disordered Breathing on Quality of Life in Pediatric Cystic Fibrosis
Authors: Shakkottai A , Nasr S Z , O’Brien L M , Chervin R D 
Published: May 2020

Abstract

Introduction
The frequency of sleep-disordered breathing (SDB) may be high among children with cystic fibrosis (CF), a life-shortening, genetic disease that affects 1/3400 Caucasian live-births. Yet, the potential impact of SDB on their quality of life has not been well-studied.

Methods
The Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders (PSQ-SRBD) Scale, a well-validated SDB screening tool, and two validated quality-of-life questionnaires, the Pediatric Quality of Life Inventory (PedsQL™) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were administered to children 6-17 years of age with CF consecutively during a 2-week period during routine pulmonary clinic visits.

Results
Twenty-two children with CF and their parents completed the questionnaires. Mean age of the participants was 11.6±3.8(sd) years. Mean body mass index (BMI) percentile was 54.8±27.1%. Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was 86.6±22.5%. Five subjects (23%) showed high risk for SDB (PSQ-SRBD Scores &gt; 0.33). Seven additional subjects had PSQ-SRBD Scores of 0.3. Mean BMI percentile was higher among subjects with vs. without positive PSQ-SRBD Scores (66% vs. 42% respectively, p=0.03). The groups did not differ with regards to FEV1. Pearson/Spearman correlation identified negative associations between PSQ-SRBD Scores and functioning in multiple parent PedsQL domains: physical (R=-0.45, p=0.03), social (R=-0.53, p=0.01), school (R=-0.56, p=0.008); two child PedsQL domains: physical (R=-0.41, p=0.06), school (R=-0.41, p=0.06); multiple parent CFQ-R domains: physical (R=-0.44, p=0.08), respiratory (R=-0.45, p=0.07), emotional (R=-0.54, p=0.02), school (R=-0.70, p=0.002); and one child CFQ-R domain: physical (R=-0.51, p=0.01). None of these domains were associated with FEV1.

Conclusion
Children with CF may have SDB symptoms independent of the extent of lung dysfunction. Although the current cross-sectional data cannot prove a causal effect, they raise the possibility that the SDB itself may have adverse impact on physical, emotional, social, and school functioning.

Support
NIH Training Grant (F32HL145915)
0887 Diaphragm Pacer Malfunctions Requiring Surgical Repair in CCHS Patients
Authors: Kiang J B , Kun S S , Shin C , McComb G J , Keens T G , Perez I A 
Published: May 2020

Abstract

Introduction
Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disorder that results in the loss of autonomic ventilatory control, and patients require ventilatory support during sleep or both sleep and wakefulness. One method of ventilatory support is diaphragm pacing (DP), where electrodes surgically placed on the phrenic nerve are connected to subcutaneously implanted receivers that communicate with external antennas and transmitter. There are limited data on the frequency of DP malfunctions that require surgical revision.

Methods
We reviewed the records of 24 CCHS patients ventilated by DP followed at CHLA from 1990-2019. Records were examined for demographics, PHOX2B mutation, pacing duration/day, date and type of malfunctions, age and time since implantation at malfunction occurrence, and repair success rate.

Results
All 24 patients had thoracoscopic electrode placement. 17/24 (71%) of patients used DP while asleep; 3/24 (13%) during wakefulness only. 4/24 (17%) were not currently using their pacers. 10/24 (42%) patients required at least one surgical intervention (Age at implantation 9 ± 4.6 (SD) years; age at malfunction 12.5 ± 7.4 years). The average time from pacer implantation to malfunction was 3.8 ± 3.5 years. Malfunctions included defective receivers (6), insulation leaks (1), defective electrodes (4), and hardware infection (1). Of 12 unique component repairs, 6/12 (50%) involved changing receivers, 1/12 (8%) involved repairing an insulation leak, 4/12 (33%) involved replacing the electrodes and receivers, and 1/12 (8%) involved hardware extraction. Of the 12 malfunctions, 10 (83%) had successful surgical revision. 2/12 (17%) repairs were not attempted. While awaiting surgical revision, patients were successfully ventilated by unilateral DP.

Conclusion
Nearly half of CCHS patients on DP experienced malfunctions within 11 years of implantation. The most common DP repair was receiver replacement. Patients who are waiting for repair often successfully ventilate while pacing unilaterally.

Support
None
0889 Utility of Pulse Wave Amplitude in Detecting Arousals in Children
Authors: Al-Shawwa B , Cruz J , Ehsan Z , Ingram D G 
Published: May 2020

Abstract

Introduction
Identifying and scoring arousals are crucial to score hypopneas and respiratory efforts related arousals (RERAs). At the same time, children’s sleep architecture appears to be more stable compared to adults which makes it more difficult to score arousals. Pulse wave amplitude (PWA) is a signal obtained from finger photoplethysmography which is directly and positively correlated to finger blood flow. It is also used as a marker for finger vasoconstriction reflected by decreased signal amplitude and as a surrogate for autonomic and cortical arousals. Our aim was to study the effect of scoring arousals based on PWA on scoring of respiratory events in pediatric patients.

Methods
Ten polysomnograms for patients between the ages of 5-15 years who had apnea-hypopnea indices between 1 and 3 events/hour were identified. Patients with syndromes were excluded. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify subcortical/autonomic arousals. Arousals were rescored based on this criteria and subsequently respiratory events were rescored. Paired t-tests were employed to compare PSG indices scored with or without PWA incorporation.

Results
The sample of 10 children included 2 females, and the average age was 9.8 +/-3.1 years. Overall, polysomnography revealed an average total sleep time of 464.1 +/-25 mins, sleep efficiency of 92% +/-4.2, sleep latency of 19.6 +/-17.0 mins, rapid eye movement (REM) latency 143 +/-66 mins, N1 3.9% +/-2.0, N2 50.3% +/-12.0, N3 28.2% +/-9.1, REM 16.7% +/-4.0, and wakefulness after sleep onset (WASO) 18.1 +/-7.5 mins. Including arousals from PWA changes, respiratory indices significantly increased including total AHI (2.3 +/-0.7 vs 5.7 +/-2.1, p&lt;0.001), obstructive AHI (1.45 +/-0.7 vs 4.8 +/-1.8, p&lt;0.001), and RDI (2.36 +/-0.7 vs 7.6 +/-2.0, p&lt;0.001). Likewise, total arousal index was significantly higher (8.7 +/-2.3 vs 29.4 +/-6.5, p&lt;0.001).

Conclusion
Pulse wave amplitude is a useful marker for arousals that are not otherwise easily identified in pediatric polysomnography. This in turn would lead to a more accurate scoring of respiratory events and severity assessment of sleep disordered breathing. This likely will have clinical and therapeutic implications.

Support
None
0902 The Use Of Auto-titrating Continuous Positive Airway Pressure (auto Cpap) For Obstructive Sleep Apnea In Children With Neurological Disorder
Authors: Platter L , Urbano G , Roberto L , Sudhakar R , Tablizo M 
Published: May 2020

Abstract

Introduction
Multiple studies have demonstrated the effectiveness of auto-titrating continuous positive airway pressure (auto CPAP) in the adult population, but there is limited literature on the use of auto CPAP in the pediatric population. Specifically, the use of auto CPAP in children with neurological disorder(s) has not been established. Thus, we conducted a study to review the use of auto CPAP in children ages 18 years old and younger with Obstructive Sleep Apnea Syndrome (OSAS) and associated neurological disorder to document its effectiveness, adverse events and outcomes of its use.

Methods
A retrospective chart review was performed on patients 18 yo and younger diagnosed with OSAS and associated neurological disorder(s) who have good compliance with auto CPAP use. Good compliance was defined as &gt;4 hours/night and &gt;20/30 days of auto CPAP use. Compliance from the most recent 30 days was downloaded.

Results
5 children met our criteria for inclusion, with a mean age of 11 years (6-18 years old). All had initial baseline sleep studies performed without PAP titration polysomnography. Associated neurological disorders were cerebral palsy, Arnold Chiari Malformation, seizure disorder and intellectual disability. The average length of use of auto CPAP was 4 months. Auto CPAP was used on average of 24/30 nights, with a mean of 7.35 hours/night. The mean baseline obstructive apnea-hypopnea (OAHI) index was 42 (8.2-94.4). The mean AHI on a 30 day download report showed a mean decrease in AHI to 2.9 (0.5-5.2) while on auto CPAP. Review of patient charts did not reveal any adverse outcomes associated with the use of auto CPAP in these patients.

Conclusion
This study showed that auto CPAP significantly improved the AHI in pediatric patients treated for OSA with associated neurological disorder. There were no reported adverse outcomes. Further research is needed to establish the effectiveness and safety of auto CPAP use in the pediatric population, specifically those with neurological disorder. The use of auto CPAP will help decrease the wait time for treatment in children with OSA. These patients can use auto CPAP while waiting for a titration study and for long term use.

Support
none
0914 Sleep Disordered Breathing In Pediatric Patients Before And After Intrathecal Baclofen Therapy
Authors: Sobremonte-King M , Chen M , DelRosso L M 
Published: May 2020

Abstract

Introduction
Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement.

Methods
Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete.

Results
Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI &gt;1 but &lt; 5) and 7/25 (28%) with moderate-severe OSA (oAHI &gt; 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy.

Conclusion
Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB.

Support
None
0917 Designing a Wearable Technology-Based Sleep Intervention To Support Sleep Health Among Adolescents: Using a Participatory Design Approach
Authors: Beck A J , Duffett-Leger L , Raffin Bouchal S , Ferber R , Ward T 
Published: May 2020

Abstract

Introduction
Sleep problems during adolescence are increasingly common and have been associated with adverse physical and psychological health outcomes. Efforts to improve insufficient sleep among adolescents have resulted in increased sleep knowledge and temporary enhancements in sleep hygiene. Good sleep hygiene is established through the development of daily routines that support healthy sleep. Wearable technology offers a potential solution whereby adolescents can acquire and manage healthy sleep habits. In this study, we are co-designing with adolescents a prototype intervention using wearable technology to promote sustained improvements in their sleep hygiene.

Methods
Guided by participatory design approaches, the ongoing multi-phase mixed methods study is currently being conducted in a metropolitan area in western Canada. In phase 1, sleep data is being collected from a sample of 30 adolescent-parent dyads using wearable sensors (Actigraphy watches) and self-report sleep measures (questionnaires about sleep quality, hygiene, and beliefs and attitudes, as well as their general health) over a 10-day period. In phases 2 and 3, individual interviews and iterative user interface design sessions will be conducted with 25 adolescents.

Results
To date, thirteen adolescents-parent dyads (13-17 years, 9 females; 39-56 years, 11 females) have completed phase 1 of our study. Data analysis is currently being conducted to evaluate sleep onset/offset, total sleep time, wake after sleep onset, sleep efficiency, and sleep schedule differences between adolescents and their parents. Ten adolescents have completed individual interviews in phase 2 of the study. Preliminary qualitative data suggests that youth are aware of the importance of sleep to their overall health. However, they struggle with identifying credible information to act on from the various and sometimes conflicting sources (e.g. online, friends, family).

Conclusion
We anticipate that co-designing a wearable solution with adolescents will lead to a sleep intervention that is more relevant, persuasive, and useful in supporting their sleep health.

Support
This work is supported by the Sensor Technology in Monitoring Movement STiMM Program.
0920 Behavioral Profiles Associated with the Development of Insomnia Symptoms in Children with Known Mental Health Disorders
Authors: Bourchtein E , Calhoun S L , Puzino K , McQuillen A , He F , Vgontzas A N , Liao D , Bixler E O , Fernandez-Mendoza J 
Published: May 2020

Abstract

Introduction
Mental health disorders (MHD) are a known risk factor for the development of insomnia symptoms in youth. However, a number of children with MHD do not go on to develop insomnia symptoms later on in life. Little is known about possible childhood factors that exacerbate or mitigate the risk of developing adolescent insomnia symptoms (AIS) among children with MHD. The present study examined, in an at-risk group of children with MHD, the behavioral profiles associated with the development of AIS.

Methods
The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y), of whom 421 were followed up as adolescents (12-23y). Absence of childhood insomnia symptoms was ascertained by parent-reports (n=312), while presence of AIS in this subgroup was ascertained by self-reports (n=97). Presence of MHD was ascertained based on the clinical history and physical exam at baseline (n=52). The Pediatric Behavior Scale (PBS) assessed multiple parent-reported behavioral domains.

Results
Children with MHD at baseline had greater levels of difficulty across a variety of internalizing (e.g., anxiety, depression) and externalizing (e.g., impulsivity, hyperactivity) behavioral domains than those without MHD, regardless of whether they developed AIS. However, children with MHD who went on to develop AIS had significantly greater levels of aggressive (p&lt;0.001) and oppositional (p=0.006) behaviors relative to children with MHD who did not develop AIS. In fact, these latter children did not differ from peers without any history of MHD or AIS on levels of aggressive (p=0.820) or oppositional (p=0.436) behaviors.

Conclusion
Children with MHD who present with normative aggressive and oppositional behaviors are less likely to develop AIS. Healthcare providers should consider providing preventative sleep interventions to youth with MHD who are exhibiting comorbid externalizing behaviors.

Support
National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)