bluuebunny/crossref_metadata_2025_split huggingface dataset:
507 Clinical Impression of Excessive Daytime Sleepiness (EDS) at initial Sleep Medicine (SM) consultation and its clinical correlates
Authors: Rosenthal Leon , Roblero Raúl Aguilar 
Published: May 2021

Abstract

Introduction
EDS represents a cardinal symptom in SM. Use of subjective scales are prevalent, which have a modest correlation with the MSLT. While the Clinical Global Impression has been used in research, reports of clinical impression (CI) in medical practice are lacking. We report on the CI of EDS in a convenience sample of patients undergoing initial consultation.

Methods
Patients reported primary, secondary symptoms and completed the Sleep Wake Activity Inventory (SWAI) prior to Tele-Medicine consultation. A SM physician completed the assessment which included ascertainment of CI of EDS (presence S+ / absence S-).

Results
There were 39 ♂and 13 ♀. The CI identified 26 patients in each group (S+/S-). Age (52 [14]), BMI (33 [7]), reported time in bed, sleep time, sleep onset latency and # of awakenings did not differ. All identified a primary symptom (S-: 21, S+: 19 reported snoring or a previous Dx of OSA). Sleepiness as a 1ry or 2ry symptom was identified by 0 in the S- and by 13 in the S+ groups. Refreshing quality of sleep differed (χ2 &lt;0.05): un-refreshing sleep was reported by 7 (S-) and by 13 (S+). Naps/week: 0.7 [1.5] and 1.57 [1.5] for the S-, S+ groups respectively (p&lt;0.05). A main effect (p&lt;0.01) was documented on the SWAI. We report on the Sleepiness [SS] and Energy Level [EL] scales (lower scores on the SS reflect higher sleepiness while lower scores on EL denote higher energy). Higher sleepiness (p&lt;0.01) 43 [12] and lower energy levels 24 [6] (p&lt;0.05) were documented on the S+ group (S- 61 [17], and 18 [6] respectively). Available spouse’s Epworth score on 29 patients: S- patients 5.8 [4] and S+ 10.2 [6] (p&lt;0.05). Dx of OSA was identified among all but 1 in the S+ group. Also, Insomnia was diagnosed among 11 (S-) and 19 (S+) patients (p&lt;0.05) despite only 3 and 7 (respectively) identifying it as a presenting symptom.

Conclusion
While snoring or previous Dx of OSA were prevalent motivations for consultation, sleepiness and insomnia were clinically relevant among a substantial number of patients. Unrefreshing sleep, daytime naps, lower energy, and higher sleepiness were ubiquitous among S+ patients.
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514 Narcocataplectic patients, psychiatric symptoms and executive functions: is there a link?
Authors: Mombelli Samantha , Castelnuovo Alessandra , Marelli Sara , Gialdi Giulia , Somma Antonella , Zucconi Marco , Fossati Andrea , Ferini-Strambi Luigi 
Published: May 2021

Abstract

Introduction
Narcolepsy with cataplexy (NC) is a neurological disorder characterized by orexin deficiency in the hypothalamus with associations to areas implied in emotion. Several studies highlighted a deficit in executive functions in narcoleptic patients. Moreover literature reports a wide comorbidity between NC and psychiatric disorders, but the relationships in NC patients are still unclear. The aim of our study is to evaluate possible mood and anxiety disorders in NC patients and understand their relationship with cognitive performances.

Methods
We assessed 15 NC patients with questionnaires concerning degree of somnolence [ESS], depression [BDI-II], perceived stress [PSS], state and trait anxiety [STAY-Y I and II]. Furthermore, patients performed a battery test (PEBL - psychology experiment building language) to investigate executive functions through 7 tests (Berg’s Card Sorting Test [BCST]; Tower of London [TOL]; Continuous Performance Task [CPT]; Go / No-go Task; Victoria Stroop Test [VST]; Balloon Analogue Risk Task [BART]; Digit Span Forward).

Results
Descriptive analyses show that NC subjects have pathological daytime sleepiness (16,07±2,94), moderate perceived stress (19,73±3,95), mild state anxiety (48,67±15,77). However, subjects do not show pathological indexes in depression and in trait anxiety. We also found a positive correlation in both state and trait anxiety with failure to maintain set in the BCST test (r=0,644; p=0,010 and r=0,573; p=0,025, respectively). However, no significant correlations were found between PEBL scores and excessive daytime sleepiness, depression, and perceived stress.

Conclusion
Our data confirm that NC subjects show symptoms related to stress and anxiety, that can facilitate the change of the set during cognitive performances. Since the neurotransmission of hypocretin is involved in the regulation of stress and anxiety, it is important to understand whether these symptoms are primary pathological phenomena in NC patients. Our data suggest that sleep medicine experts should also consider psychiatric aspects during the cognitive assessment of NC patients.

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None
519 Restless Legs and Periodic Limb Movements in 86 patients with Multiple Sclerosis
Authors: Sparasci Davide , Ferri Raffaele , Castelnovo Anna , Gobbi Claudio , Zecca Chiara , Riccitelli Gianna , Disanto Giulio , Carelli Chiara , Miano Silvia , Tanioka Kosuke , Tachibana Naoko , Manconi Mauro 
Published: May 2021

Abstract

Introduction
The aim of this study was to assess the prevalence of restless legs syndrome (RLS), periodic limb movements during sleep (PLMS) and their overlap in a large population of patients with multiple sclerosis (MS), and to compare clinical and paraclinical findings between patients with and without RLS/PLMS.

Methods
In this cross–sectional, observational, instrumental study, eighty-six patients (M/F: 27/59; mean age 48.0 ± 10.8 years) with a diagnosis of MS underwent a structured telephone interview assessing the five standard diagnostic criteria for RLS. Seventy-six participants underwent Video-polysomnography and Maintenance of Wakefulness Test (MWT). Instrumental and clinical findings were subsequently statistically compared to investigate their association with RLS and PLMS index (PLMSI).

Results
RLS and PLMS (PLMSI ≥15/h) prevalence in patients with MS was of 31.4% and 31.6% respectively. Among patients with RLS, 37.5% had a PLMSI ≥15/h. In the group with PLMS, 37.5% met all diagnostic criteria for RLS. No differences were found between patients with and without RLS (F = 0.99, p = 0.45), and between patients with and without a PLMSI ≥15/hour (F = 0.32 p = 0.94) on the pool of clinical and instrumental variables.

Conclusion
RLS is highly prevalent and severe in patients with MS. The prevalence of PLMS is comparable to the general population. The low percentage of patients with RLS having a high PLMSI, together with the absence of correlation between RLS and female gender and older age, support the existence of a distinct symptomatic form of RLS in MS.
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523 Characteristics of Patients with REM Sleep without Atonia/Periodic Limb Movements of Sleep without Dream Enactment Behaviors
Authors: Barker Lina , Tippmann-Peikert Maja 
Published: May 2021

Abstract

Introduction
While REM sleep without atonia (RSWA) in REM sleep behavior disorder (RBD) is associated with male sex, age greater than or equal to 50 years, alpha-synucleinopathies, and narcolepsy, the characteristics of patients with RSWA/persistent periodic limb movements of sleep in REM sleep (RSWA/PLMS-REM) without dream enactment behaviors are unexplored. The aim of this study was to compare the demographics, comorbidities, and concomitant medication use between RSWA/PLMS-REM patients and non-RSWA/non-PLMS-REM controls. Based on anecdotal clinical observations, we hypothesized that these patients are more commonly young, women, have psychiatric or neurological diseases, and use antidepressants.

Methods
We conducted a retrospective review of the Mayo Clinic electronic medical record to identify all patients with RSWA/PLMS-REM between November 2018 and November 2020. After excluding all patients with RBD, restless legs syndrome, narcolepsy, and RSWA/non-PLMS-REM, we identified 27 patients. All in-lab polysomnograms (PSGs) were reviewed to calculate the periodic limb movement index per hour of REM sleep (REM-PLMI). We also identified a control group of 15 individuals without RSWA, reviewed their PSGs, and calculated the REM-PLMI.

Results
The mean REM-PLMI of patients with RSWA was 64 +/- 8.3 (standard error of mean (SEM)) per hour versus 1 +/- 0.6 (SEM) per hour in non-RSWA controls (p &lt; 0.001). Patients with RSWA/PLMS-REM and non-RSWA controls had similar age and gender, 62 +/- 3 (SEM) versus 58 +/- 3 (SEM) years and 81% versus 87% men, respectively. However, psychiatric diagnosis, neurological disorders, and antidepressants use were more common among RSWA/PLMS-REM patients compared to non-RSWA controls with p = 0.0002, p = 0.0035 and p = 0.0074 respectively (Fisher’s Exact Test).

Conclusion
Psychiatric diagnosis, neurological disorders, and antidepressant use are more common among RSWA/PLMS-REM patients compared to non-RSWA/non-PLMS-REM controls. Further research to determine the implications of a diagnosis of RSWA/PLMS-REM for the future development of alpha-synucleinopathies are needed and currently ongoing.
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530 Restless Legs Syndrome Prevalence and Severity Among Patients Treated with Buprenorphine and Naloxone for Opioid Use Disorder
Authors: Wipper Benjamin , Cooke Michelle , Winkelman John 
Published: May 2021

Abstract

Introduction
Restless Legs Syndrome (RLS) is a sensory-motor neurological disorder which is associated with sleep disturbance and emotional distress. Opioid medications are effective treatments for RLS, and a high percentage of patients undergoing opioid withdrawal exhibit symptoms of RLS. Despite the known connection between RLS and opioids, there has been no assessment of RLS in patients actively treated with buprenorphine and naloxone for opioid use disorder (OUD).

Methods
We conducted a study to determine the prevalence of RLS among patients with OUD at an outpatient buprenorphine and naloxone clinic at Lemuel Shattuck Hospital in Jamaica Plain, Massachusetts. With the help of nurses, participants completed questionnaires which inquired about demographic information, previous opioid use, current medications, and RLS. Patients were categorized as having RLS if, according to the Cambridge-Hopkins Questionnaire, they answered positively to the four essential RLS criteria and if common mimics were not endorsed. A final determination of RLS status in those with ambiguous answers to RLS mimics was made by a trained sleep medicine physician (JWW).

Results
Participants (n=129) were primarily male (n=86; 66.7%), white (n=101; 78.3%), and the median age was 37.5 years. Approximately half of the sample (n=59; 45.7%) used medications for depression and/or anxiety. The median duration of buprenorphine and naloxone use was 3 years. 13.2% were judged to have RLS. RLS symptoms tended to be of moderate severity, disturb sleep to a moderate degree, and occur 5–15 days per month. There were no significant demographic or clinical differences in those with and without RLS. Of the 103 participants without suspected RLS, 15.5% (n=16) were taking a non-opioid medication known to treat RLS symptoms (e.g. gabapentin). Only 1/17 people (5.9%) with RLS were taking a treatment that would control such symptoms.

Conclusion
Approximately 13% of this sample currently taking buprenorphine and naloxone for OUD had RLS. RLS can greatly interfere with sleep and quality of life, and those with untreated or partially treated symptoms may be motivated to use unprescribed opioids to control them. With this in mind, clinicians treating OUD should be aware that there are effective non-opioid medications that can treat RLS.
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532 Two-Year Longitudinal Data From the National Restless Legs Syndrome Opioid Registry
Authors: Winkelman John , Wipper Benjamin , Purks Julia 
Published: May 2021

Abstract

Introduction
Restless Legs Syndrome (RLS) is a sensory-motor neurological disorder which is associated with sleep disturbance and emotional distress. Low dose opioid medications are prescribed for treatment-refractory RLS. We now report two-year longitudinal data from the National RLS Opioid Registry, a national sample of patients using opioids for RLS.

Methods
Individuals (n=500) taking a prescribed opioid for diagnosed RLS were enrolled in the registry from 12/2017–9/2019. Information on initial and current opioid dosages, side effects, past and current RLS treatments, and RLS severity was collected by interview at baseline. Follow-up online surveys were performed at six-month intervals for two years.

Results
At the time of analysis, 325 participants had reached two years since enrollment and completed the two-year survey (retention rate=95.3%). There were no mean changes from baseline in RLS symptom severity, sleep, or mood measures. Opioid dose changes from baseline to one- and two-year follow-up were: unchanged (51.2%, 43.1%), increased dose (29.7%, 36.7%), decreased dose (19.1%, 20.2%). Only 7.9% of participants increased dose from baseline at both one and two years. The median dose increase from baseline to two-years was just 10 morphine milligram equivalents (MME). Dose increases of &gt;25 MME occurred in 7.3% of participants (vs 5.2% at one-year) and were independently associated with use of an opioid for a comorbid pain condition in addition to RLS (OR 5.91, p=0.02), discontinuing a non-opioid RLS medication (OR 4.26, p=0.01), and age of 55 or younger at baseline (OR 3.60, p=0.01). Being on an opioid medication for &lt;1 year at baseline was a predictor at one-year follow-up but not during year two of participation.

Conclusion
Prescribed opioid doses remained relatively stable over the two years following enrollment into the registry. Of the 37% of participants that increased dose, over half increased by 10 MME or less. Individuals at the start of opioid treatment for RLS do not see elevated rates of dose increase past the first year of use. Future longitudinal data will improve our understanding of the efficacy and tolerability of opioids for RLS.

Support (if any)
The RLS Foundation, Baszucki Brain Research Fund, Florence Petrlik Family Foundation, Diane and Richard Brainerd, and Steven Silin
542 Objective Sleep Duration, Sleep Timing and Completion of In Vitro Fertilization Cycles; a Prospective Cohort Study
Authors: Pimolsri Chawanont , Lyu Xiru , Goldstein Cathy , Fortin Chelsea , Mumford Sunni , Smith Yolanda , Lanham Michael , O’Brien Louise , Dunietz Galit Levi 
Published: May 2021

Abstract

Introduction
Sleep duration and circadian misalignment have been linked to fertility and fecundability. However, sleep in women undergoing IVF has rarely been examined. This study investigated the role of sleep duration and timing with completion of an IVF cycle.

Methods
Prospective study of women undergoing IVF at a tertiary medical center between 2015 and 2017. Sleep was assessed by wrist-worn actigraphy 1–2 weeks prior to the initiation of their IVF cycle. Reproductive profile, IVF cycle details, demographic and health information were obtained from medical charts. Sleep duration, midpoint and bedtime were examined in relation to IVF cycle completion using logistic regression models, adjusted for age and anti-Müllerian hormone levels. A sub-analysis excluded women who worked non-day shifts to control for circadian misalignment.

Results
A total of 48 women were studied. Median age was 33y (range 25–42), with 29% of women older than 35 years. Ten women had an IVF cycle cancellation prior to embryo transfer. These women had shorter sleep duration, more nocturnal awakenings, lower sleep efficiency, and later sleep timing in comparison to those who completed their cycle. Twenty-minute increases in sleep duration were associated with lower odds of an uncompleted IVF cycle (OR = 0.88; 95% CI 0.78, 1.00). Women with later sleep midpoints and later bedtime had higher odds of an uncompleted cycle relative to those with earlier midpoints and earlier bedtime; OR=1.24; 95% CI 1.09, 1.40 and OR=1.33; 95% CI 1.17, 1.53 respectively, per 20-minute increments. These results were independent of age, levels of anti-Müllerian hormone, or sleep duration, and remained unchanged after exclusion of shift-working women.

Conclusion
This study demonstrated the influence of sleep duration and sleep timing on the odds of an uncompleted IVF cycle prior to embryo transfer. Sleep is a modifiable behavior that may contribute to IVF cycle success.
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545 Actigraphic sleep parameters and anxiety symptoms among community-dwelling older adults
Authors: Ding Alice , Smail Emily , Alfini Alfonso , Spira Adam 
Published: May 2021

Abstract

Introduction
A number of cross-sectional studies have found that elevated levels of anxiety are associated with poor sleep among healthy older adults, but most have used self-reported sleep measures. We investigated the longitudinal association between objectively measured sleep (by wrist actigraphy) and subsequent change in anxiety symptoms in this population.

Methods
We studied 555 community-dwelling older adults (mean age 72.52±7.35, 77.48% white, 53.15% women) in the National Social Health and Aging Project (NSHAP) study who completed 3 nights of wrist actigraphy at wave 2 (2010–2011) and the Hospital Anxiety and Depression Scale at waves 2 and 3 (2015–2016). Actigraphic sleep parameters were averaged across nights and included: total sleep time (TST; minutes), percent sleep (%), wake after sleep onset (WASO; minutes), and sleep fragmentation. Change in anxiety was calculated as the difference between anxiety scores at wave 3 and wave 2.

Results
After adjusting for age, race, sex, education, body mass index, number of medical conditions, depression symptoms, and anxiety scores at wave 2, we found no significant associations between any actigraphic sleep parameter and subsequent change in anxiety symptoms (all p ≥ 0.390). Additional analyses revealed no significant cross-sectional associations at wave 2 (p ≥ 0.390).

Conclusion
We found no evidence for an association between actigraphic sleep and anxiety symptoms, or change in anxiety symptoms, in community-dwelling older adults. Additional studies using clinical anxiety disorder diagnoses are needed to evaluate the extent to which objectively measured sleep disturbance predicts clinically significant anxiety in older adults.

Support (if any)
American Academy of Sleep Medicine Foundation (#223-BS-19).
562 Adenoid Regrowth after Rapid Maxillary Expansion in Residual Pediatric OSA: Interim analysis of ERMES Randomized Clinical Trial
Authors: Fernández-Barriales Marcos , de Luzuriaga Montserrat López , Álvarez Ainoa , Guerra Lourdes , Aguirre-Urizar Jose Manuel , Santaolalla Carlos Egea 
Published: May 2021

Abstract

Introduction
Residual pediatric Obstructive Sleep Apnea (OSA) after gold-standard treatment with adenotonsillectomy occurs in nearly 20% of the patients. Treatment alternatives are scarce and based upon low-level evidence. Rapid maxillary expansion is an orthodontic-orthopaedic treatment of maxillary transverse hypoplasia that has shown promising results in pediatric OSA based upon nasal and oral cavity enlargement. Revision adenoidectomy of all-purpose adenotonsillectomies in population-based studies is 4,9%, and a three-fold risk in OSA patients has been reported. We present data from an ongoing randomized clinical trial (ERMES) highlighting the importance of nasofibroscopic control of the adenoid tissue in residual pediatric OSA patients.

Methods
According to the study protocol of our ongoing randomized clinical trial (Rapid maxillary expansion for treatment of residual pediatric obstructive sleep apnea; Acronym: ERMES; NCT02947464) patients aged 4 to 9 years old with polysomnographic evidence of OSA persistence after adenotonsillectomy were randomized to either rapid maxillary expansion or wahtchful waiting. They underwent fiberoptic nasopharingoscopy in order to stablish the amount of adenoidal tissue present at the time of inclusion and at polysomnographic control twelve months later. The nasopharyngeal occupation was measured in a 1 to 4 scale. Patients that graded 3 or 4 at the initial nasofibroscopy were excluded from the study due to their surgical revision indication; if they developed grade 3 or 4 adenoid hypertrophy and persistence of symptoms at the final assesment they were offered re-adenoidectomy.

Results
A total of 5 patients developed an adenoid regrowth amenable for revision surgery: 4 of them within the rapid maxillary expansion group and one in the watchful waiting group. All of them had experienced either worsening or very mild improvement in their apnea hypopnea index (AHI).

Conclusion
Adenoid regrowth is a known risk factor for pediatric OSA persistence. The anatomical enlargement of the nasal and oral cavity provided by means of rapid maxillary expansion may trigger such overgrowth in otherwise predisposed residual OSA patients. Fiberoptic nasopharyngoscopy is therefore mandatory in the follow-up of such complex cases, since adenoid regrowth may hinder resolution of OSA and its associated symptoms.

Support (if any)
ERMES Randomized Clincal Trial (NCT02947464) is funded by Departamento de Salud del Gobierno Vasco.
563 Effect of PHOX2B Genotype and Age on Heart Rate Variability in Pediatric Patients with Congenital Central Hypoventilation Syndrome
Authors: Khaytin Ilya , Winston Molly , Rand Casey , Strewart Tracey , Kitsis Leah , Reed Katherine , Menta Nikita , Brogadir Cindy , Slattery Susan , Weese-Mayer Debra 
Published: May 2021

Abstract

Introduction
Congenital Central Hypoventilation Syndrome (CCHS) is a rare neurocristopathy causing a wide array of cardiac autonomic nervous system (ANS) abnormalities (abnormal heart rate (HR) regulation, decreased HR variability (HRV), prolonged sinus pauses). CCHS is caused by mutations throughout the PHOX2B gene. Different types and locations of PHOX2B mutations have been associated with different levels of CCHS cardiac phenotype severity. We hypothesized that HRV in CCHS will be influenced by age and PHOX2B genotype.

Methods
PHOX2B mutation-confirmed CCHS patients in our cohort followed longitudinally with serial Holter monitoring were included. HRV measures were extracted from Holter monitoring reports and analyzed using linear mixed-effect models. Additional analyses explored which variables predicted sinus pauses and cardiac pacemaker implantation using linear and logistic regression. Only data preceding implantation of a cardiac pacemaker were included in analysis.

Results
97 patients (0–18 years old) were enrolled in the study: 21 with the 20/25 genotype, 21 with the 20/26 genotype, 26 with the 20/27 genotype, 7 with genotypes ranging from 20/28-20/33, and 22 with non-polyalanine repeat expansion mutations (NPARMs). There were 965 total observations (Holters). The following HRV metrics were analyzed: min- and max-HR, longest-RR, SDNN, ASDNN5, SDANN5, and RMSDD. Statistically significant differences were observed between PHOX2B genotypes for min-HR and longest-RR (ps&lt;0.05). Age by genotype interactions emerged such that certain metrics in HRV had different developmental trajectories by genotype (ps&lt;0.05). Min-HR and longest-RR predicted eventual cardiac pacemaker implantation (AUCs&gt;0.78). As for predictors of sinus pauses, different HRV metrics emerged as predictors across PHOX2B genotypes suggesting their utility in predicting cardiac pacemaker implantation dependent on genotype.

Conclusion
HRV in patients with CCHS is dependent on age and PHOX2B genotype, with significant differences in HRV metrics between patients with PHOX2B genotypes 20/25, 20/26, and 20/27 and the patients with 20/28-20/33 genotypes as well as those with NPARMs. Consistent with treatment guidelines, min-HR and longest-RR were predictive of eventual cardiac pacemaker implantation. Differences in the HRV metrics which predict sinus pauses as well as the overall group differences observed and trajectory-based differences may improve anticipatory management by earlier risk identification for prolonged sinus pauses in CCHS.

Support (if any)
None