bluuebunny/crossref_metadata_2025_split huggingface dataset:
1265 Severe Central and Obstructive Sleep Apnea in Teenager with Severe Obesity, Tonsillar Hyper-trophy, and Maxillary Constriction
Authors: Jaeger Mary-Alice 
Published: May 2020

Abstract

Introduction
Obesity in children escalated in the past 50 years. For American children 2-19 years old, Obesi-ty(BMI &gt;= 95th%) increased from 5% in 1971-4 to 19%(13.7 million children)2015-16. Severe Obesity(BMI &gt;=120th% or &gt;35) is less common with prevalences of 1% 1971-4 to 6% in 2015-16(1). Obesity increases risk for physical and mental illness.
Sleep apnea risk factors include obesity, maxillary restriction(3), and adenotonsillar hypertro-phy(4).

Report of Case
16 yo boy with snoring, gasping during sleep, witnessed apneas, mouth breathing, morning head-aches, EDS, and learning disability requiring an IEP. Past medical history of neonatal snoring, apneas, and reflux.
Physical exam revealed severe obesity(BMI 45.3), high arched/narrow palate, Class II bite, large tongue, Mallampati IV, Grade 3-4 tonsils, CricoMental Space +1cm. Inattentive with mildly de-pressed affect. No cardiovascular, pulmonary or neurologic findings.
PSG: CAI 31.2, OAHI 23.8. Average O2 sat 97% with 11 minutes&lt;88%. End-tidal CO2 average 50 during sleep and wake. 51% of total sleep time with ETCO2&gt;50 mmHg.
CPAP titration: CAI 1.8, OAHI 10.4. Average O2 sat 96% with &lt;1 minute&lt;88%. Events improved with CPAP 14 cm H20 to OAHI 3.5 with &gt;30 minutes of supine REM.

Conclusion
Severe Central Sleep Apnea with significant obstructive component associated with hypoxia and hypoventilation. With the diurnal hypoventilation, the likely etiology for central apneas is Obesity Hypoventilation Syndrome(5). The central apnea improved with CPAP. His management included CPAP therapy, ENT referral for adenotonsillectomy(5), bariatric referral, and further evaluation for learning/behavior concerns.
In retrospect, earlier diagnosis/intervention on behalf of this teenage boy with a history of neonatal snoring presenting now with Severe Obesity, tonsillar hypertrophy and maxillary constriction may have made a significant difference for his cognitive/mental/physical health outcomes.
1271 High-Density EEG Correlates During Confusional Arousals in a Child With a Long-Lasting History Of Sleepwalking
Authors: Castelnovo A , Amato N , Riccardi S , Pereno M , Miano S , Manconi M 
Published: May 2020

Abstract

Introduction
Sleepwalking belongs to a family of disorders (Disorders of Arousal - DOA) that are thought to derive from incomplete arousals out of Non Rapid Eye Movement (NREM) sleep. At yet, our knowledge about the specific neural dynamics occurring during clinical episodes is limited and relies on one SPECT case study, four stereo-EEG case reports/series and one single high-density electro-encephalography (hdEEG) case report. We herein describe a single case captured by hdEEG.

Report of Case
We collected two consecutive sleep recordings (using a 256-channel hdEEG coupled with standard video-polysomnography) of a non-medicated, otherwise healthy, 13-year-old male, with a history of recurrent daily sleepwalking episodes. We visually identified 17 behavioral events during sleep stage 3 and divided them into two groups: clear clinical episodes (n = 7) and simple movements associated with burst of delta waves (n = 10). Source power topography in the delta range (1-4 Hz) was computed using LORETA. Source images during selected episodes were compared to 30 second-windows of baseline stage 3 sleep. Comparisons were performed using statistical non-parametric mapping with supra-threshold cluster tests. Events were associated with an increase of delta power over the right frontopolar prefrontal cortex (rPFC) / Broadman area 10 (BA10) at their onset. This finding was clearly observable even when considering only clear-cut events, followed by the involvement of the right dorsolateral and medial prefrontal cortex / BA9 and of the left superior temporal gyrus/ BA 22.

Conclusion
We were able to replicate a recently published case report by our group, where we highlighted the putative role of rPFC and PFC and prefronto-temporal circuit in DOA episodes. Intriguingly, we observed a lateralization of this effect, with a prominent right frontal involvement. Novel research has shown a physiological asymmetry in the generation of large slow waves between the two hemispheres. An increased right-left unbalance might prime behavioral episodes in DOA patients.
0139 Associations of Actigraphic Sleep Parameters with Maximal Oxygen Consumption and Resting Metabolism in Well-Functioning Older Adults
Authors: Alfini A J , Wanigatunga A A , Schrack J A , Wanigatunga S , Li J , Rojo-Wissar D M , Mehta R , Okoye S , Zipunnikov V , Simonsick E M , Spira A P 
Published: May 2020

Abstract

Introduction
Both poor sleep and poor cardiorespiratory fitness are common in older age and associated with negative health outcomes. Additionally, among older adults, higher resting metabolic rate (RMR) has been associated with increased morbidity and mortality risk. To evaluate whether, and in what ways, sleep may affect these relationships, we investigated the association of actigraphic sleep indices with cardiorespiratory fitness and RMR in older adults.

Methods
We studied 393 community-dwelling participants in the Baltimore Longitudinal Study of Aging (mean age 73.5±10.3 years, 52% women) who completed 6.7±0.9 nights of wrist actigraphy, RMR testing, and a maximal graded exercise test. Primary predictors included mean actigraphic total sleep time (TST, minutes), sleep efficiency (SE, %), wake after sleep onset (WASO, minutes), and average wake bout length (WBL, minutes). Cardiorespiratory fitness, as measured by maximal oxygen consumption (V O2MAX; ml/kg/min), and RMR (kcal/day) were the primary outcomes.

Results
After adjustment for age, sex, race, body mass index, comorbidity index, and depressive symptoms, longer WBL was associated with lower V O2MAX (β=-0.12, 95% confidence interval (CI)=-0.20, -0.04), greater WASO was associated with lower V O2MAX (β=-0.09, 95% CI=-0.17, -0.01), and greater SE was associated with higher V O2MAX (β=0.12, 95% CI=0.03, 0.20). In addition, longer TST was associated with lower RMR (β=-0.10, 95% CI=-0.19, -0.01) and longer WBL was linked to higher RMR (β=0.12, 95% CI=0.04, 0.21).

Conclusion
In well-functioning older adults, indices of greater wakefulness after sleep onset are linked with poorer cardiorespiratory fitness and higher resting metabolism, while longer and more efficient sleep are associated with better fitness and lower resting metabolic rate. Our findings suggest that sleep disturbance may be linked to disrupted energy homeostasis, evidenced by excessive energy expenditure at rest and inefficient energy utilization in response to maximal demands. Prospective analyses are necessary to determine the nature of these associations.

Support
This study was supported in part by National Institute on Aging (NIA) grants R01AG050507 and T32-AG027668, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.
0148 Serotonergic Dorsal Raphe Neurons Regulate Hypercapnia Induced Arousal Through 5HT2A Receptors on the Parabrachial Neurons
Authors: Kaur S , Thomas R C , Saper C B 
Published: May 2020

Abstract

Introduction
Serotoninergic dorsal raphe neurons (DRSert) are CO2 responsive, and mice lacking serotonin have impaired arousal to CO2. We showed that the neurons in external lateral parabrachial nucleus containing calcitonin gene related peptide (PBelCGRP), are required for CO2-arousal. PBelCGRP neurons also receive serotoninergic innervation from the DRSert. 5HT2A agonist restores CO2 responsiveness in mice lacking serotonin, suggesting that DRSert may modulate CO2 arousal by acting on 5HT2A receptors possibly on the PBel neurons.

Methods
We used serotonin transporter (Sert)-Cre mice to optogenetically inhibit DRSert neurons and their terminals in the PBel. We injected AAV-FLEX-ArchT into the DR and implanted an optical fiber just above it in one set of Sert-Cre mice and bilaterally in the PBel in another set. All mice were instrumented for sleep and optogenetics and were tested for EEG arousals to 10% CO2. Latencies of arousal were compared with optogenetic inhibition of either the DR neurons or their terminals in the PBel with a 593nm laser light. We further tested whether a 5HT2A agonist (TCB-2) can reverse blockade of CO2 arousal in mice where DRSert terminals in PBel were inhibited. Finally, TCB-2 was injected in mice with PBelCGRP deletions and arousal latency to CO2 was compared.

Results
Compared to the control (Laser-OFF) condition, arousal latency to CO2 was significantly increased by photoinhibition of either the DRSert neurons (n=6; latency- 40.9 ± 6.4 vs. 13.81± 0.69 sec; F3, 17= 11.5; P&lt; 0.001) or their terminals in PBel (n=8; latency-34.9 ± 2.3 sec vs. 16.62 ± 0.97sec, F1, 14= 56.9; P&lt; 0.001). This was reversed by the 5HT2A agonist TCB-2 (5mg/kg), as it reduced the latency to CO2 arousal in mice with photoinhibition of terminals in PBel from 35.48 ± 7.31 sec to 16.24 ± 1.06 sec (F3, 9= 8.05; P= 0.006), but had no effect in mice with PBelCGRP neurons deletions.

Conclusion
The serotonin system modulate CO2-arousals by the DRSert input to the PBel. TCB-2 reversed the effect of inhibition of DRSert terminals in the PBel, but not in mice with PBelCGRP deletions, suggests that DRSert modulate PBelCGRP neurons through 5HT2a receptors.

Support
NIH- 2P01 HL095491 and NS112175
0162 Mental Stress Compromises Human Sleep Through a Biological, Not Psychological, Pathway
Authors: Brindle R C , Ahmad M , Evans K , Hatfield A , Holthouser S 
Published: May 2020

Abstract

Introduction
The extent to which mental stress causes sleep disturbance is unknown as experimental studies of stress and sleep have yielded mixed results. Potential mechanisms linking stress to poor sleep are also poorly characterized. The current study aimed to 1) assess the impact of experimentally-induced mental stress on daytime sleep and 2) test candidate mechanisms including physiological and emotional stress reactivity, stress rumination, attentional threat bias, and insensitivity to future consequences.

Methods
Participants (N=30) were randomized to a control (n=14) or stress group (n=16). Both groups were given a 60-minute nap opportunity at midday (≈13:30). Prior to sleep, participants in the stress group completed a socially evaluative mental arithmetic stress task and were instructed that they would be required to give a brief speech upon awakening. Sleep was monitored with polysomnography and scored according to standard AASM criteria. Measures of heart rate (HR), blood pressure (BP) and self-reported stress were recorded during the stress task. Self-reported stress rumination was measured upon awakening. Attentional threat bias was measured using an emotional dot probe and performance on the Iowa Gambling Task quantified insensitivity to future consequences.

Results
Acute mental stress significantly increased HR and BP (all p&lt;.001, all Cohen’s d&gt;1.24) and participants reported significant increases in self-reported stress (p&lt;.001). The stress group exhibited longer sleep latency (p=.038, d=.82), shorter sleep duration (p=.044, d=.78), and worse sleep continuity (p=.045, d=.79). Subjective sleep quality was not different across groups (p=.39, d=.32). Of all candidate mechanisms, physiological reactivity was the only one significantly related to sleep measures. Greater HR reactivity predicted longer sleep latency (r=.37), shorter sleep duration (r=-.59), and worse sleep continuity (r=-.59).

Conclusion
Acute mental stress caused significant disturbances in a single episode of daytime sleep. The degree of disturbance was, to an extent, predicted by the amount of physiological reactivity to stress.

Support
This work was supported a Washington and Lee University Summer Lenfest Grant and the Summer Research Scholars Program.
0172 Blue-Light Blockers and Sleep: A Meta-Analysis of Intervention Studies
Authors: Shechter A , Quispe K A , Mizhquiri Barbecho J S , Falzon L 
Published: May 2020

Abstract

Introduction
Sleep and circadian physiology are influenced by external light, particularly within the short-wavelength portion of the visible spectrum (~450–480 nm). Most personal light-emitting electronic devices (e.g., tablets, smartphones, computers) are enriched in this so-called “blue” light. Interventions to reduce short-wavelength light exposure to the eyes before bedtime may help mitigate adverse effects of light-emitting electronic devices on sleep.

Methods
We conducted a meta-analysis of intervention studies on the effects of wearing color-tinted lenses (e.g., orange or amber) in frames in the evening before sleep to selectively filter short-wavelength light exposure to the eyes. Outcomes were self-reported or objective (wrist-accelerometer) measures of nocturnal sleep. Databases (MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, AMED) were searched from inception to November 2019. PROSPERO Registration: CRD42018105854.

Results
Ten studies were identified (7 randomized controlled trials; 3 before-after studies). Findings of individual studies were inconsistent, with some showing benefit and others showing no effect of intervention. For objective sleep onset latency, there was a significant modest-sized combined effect (Hedge’s g=-0.52, 95% CI: -1.27-0.24, Z=-2.94, p=0.003, I2=16.6%, k=3). There was a minor but non-statistically significant combined effect for objective sleep efficiency (Hedge’s g=0.24, 95% CI: -0.16–0.64, Z=1.69, p=0.09, I2=23.7%, k=5). There were no significant combined effects for objective measures of total sleep time and wake after sleep onset. For self-reported total sleep time, there was a statistically significant medium-sized combined effect (Hedge’s g=0.61, 95% CI: 0.14–1.09, Z=5.56, p&lt;0.01, I2=0%, k=3).

Conclusion
There is mixed evidence that this approach can improve sleep. Relatively few studies have been conducted, and most did not assess light levels or melatonin. The “blue-blocker” intervention may be particularly useful in individuals with insomnia, delayed sleep phase syndrome, or attention-deficit hyperactive disorder. Considering the ubiquitousness of short wavelength-enriched light sources and the potential for widespread sleep disturbance, future controlled studies examining the efficacy of this approach to improve sleep are warranted.

Support
N/A
0179 Poor Sleep Quality Increases Odds of On-Duty Injuries in Policing
Authors: Riedy S M , Fekedulegn D , Vila B , Andrew M , Violanti J 
Published: May 2020

Abstract

Introduction
Shiftwork is inevitable in law enforcement. Officers are scheduled around-the-clock to protect and serve communities. Many police departments are also understaffed; consequentially, officers’ work schedules often include long work hours. Shift work and long work hours can result in sleep loss, poor sleep quality, and fatigue. In turn, these factors can impair police officers’ operational performance. We investigated whether sleep loss and poor sleep quality increase odds of on-duty injuries or disciplinary actions in policing.

Methods
Officers (n=113) that started their careers as police officers at the Buffalo Police Department between 1994–2001 were studied. Work and injury data were obtained for each officer starting with their hire date and continuing day-by-day for 15-years. Between 2004–2009, officers reported any disciplinary actions in the prior two years and their sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Survey Screen for Apnea. Data were analyzed using logistic regression with logit link functions (PROC GLIMMIX, SAS 9.4). Covariates included sex, ethnicity, experience, shift type, workload, and secondary employment.

Results
Seventy-four percent of officers had poor sleep quality (PSQI global score ≥ 5). Officers with poorer sleep quality had greater odds of injury (OR=1.3 [95% CI: 1.0–1.5], p=0.03). Officers’ sleep duration was not a significant predictor of injuries (OR=1.0 [95% CI: 0.3–3.2], p=0.96). Officers with sleep disturbances (OR=3.5 [95% CI: 1.0–11.8], p&lt;0.05) and/or using sleep medications (OR=15.7 [95% CI: 2.8–89.3], p&lt;0.01) had higher odds of injury. None of the variables were significant predictors of disciplinary actions.

Conclusion
Poor sleep quality was prevalent among the officers. The natures of the injuries were likely multi-factorial and complex. Notwithstanding, poor sleep quality was associated with higher odds of on-duty injuries. The source of officers’ sleep disturbances (e.g. shift work, insomnia, and/or policing-related stresses) remains to be determined.

Support
CDC/NIOSH grant 1R01OH009640-01A1; NIJ grant 2005-FS-BX-0004
0195 Social Determinants of Sleep: Inside Relationships with Significant Others
Authors: Mousavi Z , Tran M , Kuhlman K R 
Published: May 2020

Abstract

Introduction
Social relationships impact health through different mechanisms. Sleep problems are prevalent among adults in the USA, negatively impacting all-cause mortality, and increasing the risk for chronic diseases such as depression, cardiovascular disease, and cancer. This study aimed to assess whether the quality of an individual’s relationship with their significant other including support and strain, subjective relationship quality, joint decision making, marital risk, and conflict are associated with clinical, subjective, and objective measures of sleep.

Methods
Participants were selected from the Midlife in the United States (MIDUS) study if they had complete data on subjective sleep quality from the MIDUS II biomarker project and shared a bed with their partner (n=751, 49.5% female, Mage=53.4, SDage=11.2, range= 34–83). Subjective sleep quality was measured using the PSQI. A subset of these participants (n=246, 50.8% female) also completed 7-days of daily diary and actigraphy.

Results
Sleep disturbances were pervasive; 44.1% (n=331) of participants reported clinically meaningful sleep disturbances (PSQI&gt;=5). Among the smaller sample of participants with 7-day sleep data, sleep disturbances were even more prevalent (60.9%). There were significant bivariate associations between higher support and lower strain with better subjectively and objectively sleep outcomes. Better subjective relationship quality was also associated with better subjectively measured sleep outcomes. Higher marital risk and more disagreement with partner were associated with poorer sleep. When accounting for all marital relationship factors, participants with higher support and lower strain given to partner had a better long-term sleep quality, b= 1.93, SE= .54, p&lt;.001. Relationship quality was also associated with better daily sleep quality and daily reports of feeling rested, b = -.12, SE= .05, p=.023, and b= .11, SE = .048, p=.023, respectively. These relationships remained significant after accounting for age, current employment status, recent major health events, average daily caffeine, alcohol, exercise, and napping.

Conclusion
These findings support the importance of considering social determinants of sleep, suggesting that relationships with significant others may impact health through sleep quality. This highlights the importance of sleep as a transdiagnostic physiological mechanism that could be enhanced through improvements to relationships with significant others.

Support
N/A
0201 Medical Malpractice Payments Following Mild Sleep Loss and the Daylight Saving Time Shift
Authors: Lage C , Gao C , Scullin M K 
Published: May 2020

Abstract

Introduction
The national cost of the medical liability system exceeds $10 billion/year, but not all medical errors result in a malpractice claim or payment. Malpractice claims are more likely if the medical error is perceived as severe, if the physician is perceived as lacking empathy, and if negative emotional reactions are triggered in the patient (due to individual or contextual factors). In recent experimental work, participants who were mildly sleep restricted showed an increased propensity to want to punish physicians for medical errors and compensate patients the maximum allowed. Building upon this laboratory work, we evaluated 30 years of medical malpractice claims to determine whether the judgment of final compensation increased after the Spring daylight saving time (DST) shift.

Methods
We obtained medical malpractice payment data on 373,643 United States cases from the National Practitioner Data Bank (NPDB). We contrasted inflation-adjusted payments across states that have DST shifts relative to non-DST control states (e.g., Arizona, Hawaii). We compared post-Spring DST payments to payments during the two weeks before/after the DST, and averaged payments for the remainder of the year.

Results
The total number of claims was unrelated to Spring DST, however, the size of malpractice payments significantly increased the week following the spring DST shift relative to non-DST control states and relative to the averaged payments for the remainder of the year. Spring DST was associated with an inflation-adjusted relative increase in malpractice payments by $7,836 to $61,809 per case (depending on comparison). Malpractice payments did not change in relation to the Fall DST shift.

Conclusion
Mild sleep restriction alters the cognitive and emotional regulation processes that underpin perceptions of medical error severity, willingness to punish, and judgments of appropriate compensation for medical errors.

Support
N/A
0207 The Effect of Naps on Inhibitory Control and Sustained Attention in Early Childhood
Authors: Andre C J , Mendelevich E , Santiago A , Spencer R M 
Published: May 2020

Abstract

Introduction
Sleep in adults and school-age children has been shown to improve regulatory behaviors. Specifically, slow wave sleep (SWS) disruptions have been positively associated with decreased levels of sustained attention and inhibitory control in adults, while REM sleep has been associated with inhibitory control in typically developing children. However, it is unknown whether midday naps confer a similar benefit in preschool-aged children, particularly since REM sleep is often lacking in their naps. In this study, we used a Go/No-Go task to determine whether SWS during early childhood naps benefits sustained attention and inhibitory control. We also explored nap habituality as a factor given that habitual and non-habitual nappers have different sleep architecture in adults and children.

Methods
Preschool children (N=22, 38–69 months) completed a Go/No-Go task, after which they either napped with polysomnography (nap condition) or stayed awake (wake condition) for an equivalent amount of time (within subject; order counterbalanced; ~1 week apart). After their nap and wake sessions, they completed the Go/No-Go task again.

Results
When controlling for nap frequency, participant performance (accuracy) post-session did not differ across conditions. However, by examining only the habitual nappers (5–7 days/week, N=9), we found a moderate positive correlation between percent of sleep spent in SWS and post-nap accuracy (r=0.335, p=0.037). Interestingly, we did not see the same relationship with non-habitual nappers (0–4 days/week, N=13) and found a weak negative correlation with SWS (r=0.007, p=0.031).

Conclusion
The findings suggest that habitually napping children show a benefit of nap SWS on regulatory behaviors while non-habitual nappers do not. Such results have important translational significance for early education settings.

Support
NIH R01 HL111695.