bluuebunny/crossref_metadata_2025_split huggingface dataset:
0705 High Incidence Of Inadequate Health Literacy In Adults With Obstructive Sleep Apnea Is Not Associated With Positive Airway Pressure Use
Authors: Watach A J , Saconi B , Sawyer A M 
Published: May 2020

Abstract

Introduction
Inadequate health literacy (HL) is associated with 1.5 - 3 times increased risk for poor health outcomes, nonadherence and lack of skills needed to manage one’s own health. Inadequate HL prevalence in adults with obstructive sleep apnea (OSA) may be as high as 30%. The relationship between HL and positive airway pressure (PAP) adherence has been rarely examined.

Methods
A secondary analysis of prospective observational data was conducted to: 1) examine the prevalence of inadequate HL in adults with newly-diagnosed OSA and 2) determine if inadequate HL is associated with 1-wk and 1-mo PAP use. HL was measured using a 3-item Health Literacy Screening Questionnaire. Descriptive statistics, multiple linear regression, and logistic regression were used.

Results
Participants (n=67) were white (85%), males (52%) and females (48%), middle-aged (50±12 yrs), 64.2% had a middle to high school education and severe OSA (mean AHI 38.2±21 events/hr). Mean PAP use was 4.62±2.43 hrs/night at 1-wk and 4.33±2.27hrs/night at 1-mo. Using a threshold of ≥4 hrs/night, 64% were adherent at 1-wk and 60% at 1-mo. Sixty two percent (n=42) screened positive for inadequate HL. A positive screen for inadequate HL (by individual screening items or by cumulative number of items screened positive) was not associated with PAP use (mean hr/night) at 1-wk or 1-mo (not retained in the final model). HL was also not associated with PAP non-adherence (&lt;4hrs/night) or PAP failure (&lt;2hrs/night) by logistic regression.

Conclusion
Inadequate HL may be prevalent in adults with OSA. OSA and PAP patient education content and design should align with HL abilities and skills. Disease and treatment education are influential on PAP adherence. Future research should consider adequacy of three generalized items to assess HL and disease-specific HL as more robust measures are available. Larger, heterogeneous sample sizes are needed to precisely estimate the relationship between HL and PAP adherence.

Support
Lead author receives support from NIH/NHLBI Award T32 HL07953.
0718 Hypoxemia and Pulmonary Hypertension in Patients with Concomitant Restrictive Ventilatory Defect and Sleep Apnea: The Overlap Syndrome
Authors: Xie J , Fan Z , Wang J , Li F 
Published: May 2020

Abstract

Introduction
Patients with severe restrictive ventilatory defect (RVD) have hypoxemia and a high risk of pulmonary hypertension (PHTN). Sleep apnea (SA) aggravates the severity of nocturnal desaturation significantly. The aim of this study was to investigate the severity of hypoxemia and prevalence of PHTN in patient with the overlap syndrome (OS) of RVD and SA.

Methods
Patients referred for both sleep test and spirometry for suspected SA and RVD or obstructive ventilatory defect (OVD) were recruited prospectively from January-December, 2018. SA was determined by an apnea-hypopnea index ≥5/h; mean nocturnal oxygen saturation (meanSaO2), minimum oxygen saturation (minSaO2), saturation lower than 90% (T90) were calculated automatically. RVD was diagnosed in the presence of forced expiratory volume in the first second/forced vital capacity (FVC) &gt;0.7 and FVC&lt;80% predicted value. PHTN was defined by systolic pulmonary arterial pressure (SPAP) ≥ 50mmHg, documented by noninvasive transthoracic echocardiography. Patients with PHTN secondary to extrapulmonary factors were excluded.

Results
Of 65 patients who completed the investigation, 16 (24.6%) subjects were diagnosed with isolated SA (without RVD or OVD), and 28 (43.1%) subjects were verified to have RVD, in which 22 (78.6%) were diagnosed with OS and 6 (21.4%) presented as isolated RVD. Patients with OS vs. those with isolated RVD had lower minSaO2 (78.3% vs. 88.7%, p=0.003) and meanSaO2 (91.5% vs. 95.8%, p=0.007) but higher T90 (37.2% vs. 0.3%, p=0.009). Patients with OS vs. those with isolated RVD or with isolated SA had higher SPAP (62.6 mmHg vs. 45.3 mmHg or 35.9 mmHg, p=0.334 or p=0.016 respectively). Higher proportion of patients with OS were diagnosed with PHTN than those with isolated RVD or isolated SA (8 [36.4%] vs. 1 [16%] or 1 [6.25%], p=0.360 or p=0.031, respectively). T90 was the only polysomnographic data associated with the prevalence of PHTN after adjusting for age and sex (OR 4.90, 95% CI 1.23-25.56, p=0.023).

Conclusion
Patients with the OS of RVD and SA had high odds of PHTN, which is probably associated with severe hypoxemia. Further investigation is needed to discern whether therapeutic strategies toward OS might eliminate PHTN in this cohort.

Support
0720 Study of Serum Adiponectin and Resistin in Patients with Obstructive Sleep Apnea
Authors: Gharraf H S , Zidan M H , Ayad M W 
Published: May 2020

Abstract

Introduction
The syndrome of OSA is a very common disorder with several important complications and is still under diagnosed. Obesity is considered to be a chronic disease rather than a life style b. Adipose tissue secretory function is disturbed by chronic intermitted hypoxia occurring in OSA. The aim of this study was to study the level of serum adiponectin and resistin in patients with OSA and we tried to assess their association to different parameters of SDB as well as concomitant co morbidities in each patient

Methods
This study contained two groups. Patients (group1) included 30 newly diagnosed OSA patients; controls (group 2) included 15 healthy volunteers. All patients were subjected to overnight polysomnography, routine laboratory investigations, Spirometry and fasting serum adiponectin and resistin

Results
Patients had statically significant lower serum adiponectin level than controls while serum resistin levels were statistically significant higher in patients than controls also serum adiponectin levels were significantly decreased with increase severity of OSA while serum resistin levels were increased significantly with increase severity of OSA, moreover there was a statistical significant decrease in serum adiponectin levels in patients group with increasing number of comorbidities existing in every patient a. There was a statistical significant increase in serum resistin levels in patients group with increasing number of comorbidities existing in every patient

Conclusion
this highlights the possible relationship of these hormones to the metabolic complications seen in OSA patients

Support
no conflict of interest
0735 Hyperglycemia Is Associated With An Altered Sleep Structure In Patients With Obstructive Sleep Apnea
Authors: Xue P , Gao Y , Zhou J , Tang X 
Published: May 2020

Abstract

Introduction
Although obstructive sleep apnea (OSA) is associated with abnormal glycometabolism, current evidence on the association between hyperglycemia and abnormal sleep structure is still limited among patients with OSA. We sought to evaluate whether hyperglycemia was associated with abnormal sleep architecture.

Methods
A total of 452 patients with OSA, who were free of previously diagnosed diabetes mellitus, were consecutively recruited. All participants underwent overnight polysomnography and 75-g oral glucose tolerance test. Patients were divided into normal glucose tolerance (NGT) and hyperglycemia (i.e. prediabetes and type 2 diabetes) according to the ADA criteria. The association between hyperglycemia and sleep architecture was examined using logistic regression model.

Results
Of 452 patients, 283 (63%) had hyperglycemia (age 43.9 ± 11.1) and 169 (37%) had NGT (age 40.1 ± 11.1). Compared to the NGT group, the hyperglycemia group had older age (P &lt; 0.05), higher body mass index (27.5 ± 4.1 vs. 26.33 ± 4.4; P &lt; 0.05) and higher AHI (apnea-hypopnea index) (57.41 ± 28.6 vs. 48.3 ± 28.2; P &lt; 0.05). There were no differences in total sleep time, the percentage of time spent in rapid eye movement (REM) or non-rapid eye movement (NREM) sleep between groups. However, patients with hyperglycemia had more microarousal events, especially during the NREM sleep (214 (range 19-662) events/h vs. 148 (range 37-600) events/h; P &lt; 0.05). In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤80%, were significantly greater during the REM sleep in patients with hyperglycemia (1.4 (total range 0-91.1) % vs. 1.1(0-78.6) %; P &lt; 0.05). After adjusting potential confounders, logistic regression analyses showed that the presence of hyperglycemia was independently associated with the number of microarousals in NREM sleep (OR = 1.01, 95% CI = 1.00-1.02, P = 0.02).

Conclusion
Hyperglycemia is independently associated with abnormal sleep architecture among patients with OSA. Patients with hyperglycemia have significantly increased sleep fragmentation in NREM sleep and significantly increased hypoxia in REM sleep.

Support
This work was supported by the National Natural Science Foundation of China (81700087).
0763 Effects Of Solriamfetol On Driving Performance In Participants With Narcolepsy
Authors: Vinckenbosch F , Lammers G , Overeem S , Chen D , Wang G , Carter L , Zhou K , Ramaekers J , Vermeeren A 
Published: May 2020

Abstract

Introduction
Patients with narcolepsy have an increased risk of automobile accidents. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the US (Sunosi®) for adults with excessive daytime sleepiness (EDS) associated with narcolepsy (75-150 mg/day). This study evaluated the effects of solriamfetol on on-road driving performance in participants with narcolepsy.

Methods
In each period of this randomized, double-blind, placebo-controlled, crossover study (NCT 02806908; EudraCT 2015-003931-36), driving performance during an on-road driving test (a 1-hour drive on a public highway) was assessed at
2 hours and 6 hours postdose following 7 days of treatment with solriamfetol (150 mg/day × 3, then 300 mg/day × 4) or placebo. For assessment of driving performance, the primary endpoint was standard deviation of lateral position (SDLP), a measure of “weaving,” at 2 hours postdose. Comparisons (solriamfetol vs placebo) used a Wilcoxon signed-rank test.

Results
The study included 24 participants (54% male; mean age, 40 years); 22 were included in the analyses of SDLP data. At 2 hours postdose, SDLP for solriamfetol (median, 19.08 cm) was statistically significantly lower than that for placebo (median, 20.46 cm; P=0.0022; incomplete driving tests: solriamfetol, n=4; placebo, n=7), indicating a better performance with solriamfetol. At 6 hours postdose, SDLP for solriamfetol (median, 19.59 cm) was not statistically significantly different from that for placebo (median, 19.78 cm; P=0.1245; incomplete driving tests: solriamfetol, n=3; placebo, n=10). Common adverse events (≥5%) were headache, decreased appetite, somnolence, sleep disorder, agitation, nausea, and palpitations.

Conclusion
Solriamfetol (300 mg/day) improved SDLP, an important measure of driving performance, at 2 hours after administration in participants with narcolepsy.

Support
Jazz Pharmaceuticals
0789 Decreased Sigma Band Power During NREM Sleep in REM Sleep Behavior Disorder
Authors: Lee Y , Lee B 
Published: May 2020

Abstract

Introduction
REM sleep Behavior Disorder (RBD) is characterized by dream enacting behaviors and a loss of atonia during REM sleep. Early detection of RBD is important because it is considered premonitory symptoms neurodegenerative disorders. In this study, we investigated the slow and fast sigma band power of patients with RBD using frequency analysis.

Methods
Twenty patients who were diagnosed as RBD according to the ICSD-3 criteria and 20 age-matched controls who underwent polysomnography (PSG) for other sleep disorders (insomnia, snoring) and showed normal to mild obstructive sleep apnea (OSA). NREM sleep EEG data was extracted and N1 sleep data was excluded to minimize arousal artifact. Fast Fourier transform-based spectral power analysis was used to compute the power spectral densities of the EEG in the MATLAB environment. The sigma bands were divided into 2 discrete bands: slow sigma (11 to 13 Hz) and- fast sigma (13 to 15 Hz). Mann-Whitney U test by SPSS was used.

Results
RBD patients (61.9 ± 7.1 years old; 12 men) had a significantly lower sigma band power than the control group (61.5 ± 1.1 years old; 11 men) in central region (p = 0.028). Particularly, the slow sigma band power showed a bigger difference in all regions except O1 (F3 = 0.017, F4 = 0.027, C3 = 0.004, C4 = 0.009, O2 = 0.017).

Conclusion
Sigma power was lower in the RBD patients than in the control. It suggests that RBD has impaired cortical activity. Thus, decreased spindle activity during NREM sleep may be a potential biomarker of RBD.

Support
0792 Mandibular Movement Monitoring with Artificial Intelligence Analysis for the Diagnosis of Sleep Bruxism
Authors: Martinot J , Le-Dong N , Cuthbert V , Denison S , Gozal D , Pepin J 
Published: May 2020

Abstract

Introduction
Sleep bruxism (BXM) is the result of rhythmic muscular masticatory activity (RMMA) and can be captured by masseters surface electromyography (sEMG). Despite the multiple adverse negative consequences of BXM, a simple reliable home diagnostic device is currently unavailable, with in laboratory audio-video polysomnography (type I PSG) remaining the gold standard diagnostic tool. Mandibular movements (MM) recordings during sleep can readily identify RMMA, are simple to set up and can be easily repeated from night to night. Here, we aimed to identify stereotypical MM in patients with BXM, and to develop RMMA automatic detection and BXM diagnosis using an artificial intelligence-based approach.

Methods
MM were recorded by a dedicated sensor (Sunrise, Namur, Belgium) in 12 patients with BXM during type I PSG. The Sunrise system consists of a coin-sized hardware that is comfortably placed on the subject’s chin. Its embedded inertial measurement unit communicates via Bluetooth with a smartphone and automatically transfers MM signals to a cloud-based infrastructure at the end of the night. Data processing and analysis are then performed in Python programming language.
A time series cluster analysis was applied to sequences of masseters sEMG and MM signals during BXM episodes (n=300) and during spontaneous micro-arousals (n=300). Then, a convolutional neuronal network (CNN) was developed to identify BXM and distinguish it from spontaneous micro-arousals while exclusively relying on MM signal.

Results
Based on the cluster analysis, BXM periods were characterized by a specific pattern of MM signals (higher frequency and amplitude), which was closely associated with the sEMG signals but clearly differed from the MM signal patterns during micro-arousals.
CNN-based classifier distinguished the BXM events from other RMMAs during micro-arousals and respiratory efforts with an overall accuracy of 91%.

Conclusion
Sleep bruxism can be automatically identified, quantified, and characterized with mandibular movements analysis supported by artificial intelligence technology.

Support
This work was supported by the French National Research Agency (ANR-12-TECS-0010), in the framework of the “Investissements d’avenir” program (ANR-15-IDEX-02). https://life.univ-grenoble-alpes.fr.
0797 Restless Legs Syndrome and Perceived Olfactory and Taste Dysfunction: A Community-Based Study
Authors: Zhuang S , Yuan X , Ma C , Yang N , Liu C , Na M , Winkelman J W , Wu S , Gao X 
Published: May 2020

Abstract

Introduction
Restless legs syndrome (RLS), an under-recognized sensorimotor condition worldwide, is thought to be a prodromal symptom of Parkinson’s disease as suggested by previous evidences. However, its association with prodromal chemosensory impairments, including olfactory or taste dysfunction, has remained largely unknown. Few studies of small sample sizes were conducted in predominantly Caucasian populations and results were inconsistent.

Methods
We performed a cross-sectional analysis including 90,337 Chinese adults free of neurodegenerative diseases in the Kailuan study in 2016. Presence of RLS was defined using revised RLS diagnostic criteria and further verified by Cambridge-Hopkins questionnaire for RLS. Perceived olfactory and taste dysfunction was collected via a questionnaire. The association between RLS and perceived olfactory and taste dysfunction was assessed using logistic regression model, adjusting for potential cofounders such as age, sex, smoking, alcohol consumption sleep conditions and medical history.

Results
RLS was associated with high odds of having perceived olfactory and/or taste dysfunction (adjusted odds ratio =5.92; 95% confidence interval, 3.11, 11.3). The significant association persisted when using Cambridge-Hopkins questionnaire for RLS (adjusted odds ratio =5.55; 95% confidence interval, 2.37-13.0) or when excluding participants with major chronic diseases.

Conclusion
RLS was associated with increased odds of perceived olfactory and taste dysfunction.

Support
This research was supported by start-up grant from the College of Health and Human Development and the Department of Nutritional Sciences, Pennsylvania State University, the Institute for CyberScience Seed Grant Program, Pennsylvania State University, and Natural Science Foundation of Hebei Province (H2018209318).
0802 To Examine the Effect of Gabapentin Enacarbil in Primary Restless Legs Syndrome Patients Who are on Dopaminergic Agents and Exhibiting Augmentation
Authors: Bollu P , Goyal M , Sivaraman M , Taylor N , Yin L , Thakkar M , Sahota P 
Published: May 2020

Abstract

Introduction
Augmentation is defined as worsening of the symptoms of Restless Legs Syndrome after a brief period of initial improvement with dopaminergic agents resulting in either an earlier onset, increase in severity, quicker onset, spread to other body parts. The exact prevalence of this phenomenon is not known and in patients experiencing augmentation, it can pose a difficult diagnostic and therapeutic challenge to the clinician. In our study, we found extended-release gabapentin to be an effective intervention in patients experiencing dopaminergic augmentation

Methods
This is an open-label single-arm study done in patients exhibiting augmentation while on dopaminergic agents. Patients who were enrolled in the study were initiated on oral extended-release gabapentin(Horizont) 600 mg at 5 pm at the beginning of the study. At day 90, attempts were made to reduce or discontinue dopaminergic agents. International Restless Legs Syndrome-Rating Scale (IRLS) and Augmentation Severity Rating Scale(ASRS) were recorded at each visit.

Results
A total of 10 patients were enrolled in the study while only 8 patients completed it. Compared to the baseline (visit 2), there is a significant improvement in both the augmentation severity(p= 0.0131) and the IRLS (p=0.0497). Wilcoxon matched-pairs signed rank test was used for statistical analysis.

Conclusion
Extended-release Gabapentin is an effective treatment option in primary RLS patients experiencing augmentation secondary to dopaminergic medication usage.

Support
The study is funded and medication is provided by Arbor Pharmaceuticals.
0822 Frail Older Men With Nocturia are Disproportionately Affected by Excess Nocturnal Urine Production
Authors: Monaghan T F , Wagg A S , Agudelo C W , Rahman S N , Michelson K P , Epstein M R , Everaert K , Lazar J M , Weiss J P , Bliwise D L 
Published: May 2020

Abstract

Introduction
Nocturia is a risk factor for falls and hip fractures in older adults. We determined whether the Frailty Index (FI), incorporating comorbidities, functional performance, and physical signs, was associated with nocturia frequency and/or overnight urine production.

Methods
We examined nightly (24-hour) voiding diaries (men ≥65 years) in an outpatient urologic clinic demonstrating ≥2 nocturnal voids (n=158). FI calculations followed Rockwood (CMAJ 2005;173:489-95). A total of 39 conditions were assessed. Three FI groups were established: Low (≤0.077) (n=59), Intermediate (&gt;0.077 and &lt;0.179) (n=58), and High (≥0.179) (n=41). We compared number of nocturnal voids (NV), nocturnal urine volume (NUV) (in mL), and 24-hr total urine volume (24-hr TUV) (in mL) across groups.

Results
NV did not differ by group (p=0.333) (median for all groups=3). However, NUV (916 [671-1419] vs. 690 [505-942] vs. 630 [500-1050] mL) differentiated the High, Medium and Low FI groups (p&lt;0.001 via Kruskal-Wallis with Bonferroni pairwise adjustments), respectively. Similarly, 24-hr TUV differentiated the 3 groups (2200 [1800-2550] vs. 1620 [1259-2119] vs. 1650 [1390-2517] mL, p=0.005). Differences in NUV remained significant (p=0.006) after eliminating Diabetes Mellitus cases (n=44). However, differences did not persist for 24-hr TUV (p=0.180).

Conclusion
Higher NUV, but not 24-hr TUV, was a robust correlate of frailty in these older men. Accounting for diabetes did not diminish the effect. Although undiagnosed sleep apnea remains a possible cause, recent chronobiologic data (Monaghan et al, Age Aging, 2020, in press) suggest that nocturia in the aged is characterized by excess free water clearance early in the sleep period. This argues against solute-driven urine production (as might be expected in sleep apnea) in accounting for the effect. Nocturia may represent a conspicuous and important change in circadian rhythm of urine production occurring in old age.

Support
N/A
0837 Well-Being Predicts Sleep Disturbance in a Prospective Cohort of Older Adults
Authors: Hershner S D , Swanson L M , Meng A , Jansen E C , Burke J F , Braley T J , Dunietz G L 
Published: May 2020

Abstract

Introduction
Lower well-being negatively impacts health among older adults. Optimal sleep - a determinant of health - has been associated with higher well-being. Several domains of well-being, e.g., mindfulness and purpose in life have been shown to improve sleep. But, whether well-being impacts sleep remains unclear. This study examined associations between well-being and sleep duration, sleep quality, and incident insomnia symptoms among a nationally representative sample of older US adults.

Methods
This study analyzed data from the 2011-2013 National Health and Aging Trends Study (NHATS), a longitudinal, annual survey of community-dwelling Medicare beneficiaries. The exposure, a validated scale of well-being used questions on purpose, emotion, and self-satisfaction and divided responses into quartiles. Sleep outcomes included sleep duration, sleep quality, and insomnia symptoms. Unadjusted and adjusted linear and logistic regression models examined relationships between the health characteristics and well-being score in 2012 and sleep outcomes in 2013. Covariates included demographics and health characteristics.

Results
Half of study participants (n=2,000) were women. The mean sleep duration was 7.2 and 7.3 (standard error(SE) ±0.1) for men and women. Poor sleep quality was reported by 30% of subjects and more frequently among Hispanic subjects, older adults, and those with less education. The mean well-being score was 17.2 (SE ±0.07). Higher well-being scores correlated with male gender, younger age, higher education, marriage, and increased physical activity. Well-being scores in the 2nd - 4th quartile had lower odds of poor sleep quality (4th quartile adjusted odd ratio 0.24 (95% CI 0.15, 0.38). The highest well-being quartile had a 4-fold lower incidence of insomnia symptoms. Well-being scores were not associated with sleep duration

Conclusion
Higher well-being may protect older adults against the development of insomnia and poor sleep quality. Strategies to improve well-being could offer an innovative way to improve the health of older Americans though better sleep.

Support
none