bluuebunny/crossref_metadata_2025_split huggingface dataset:
498 It Makes Relationships Harder: The Role of Narcolepsy in Social and Romantic Relationships in Young Adults
Authors: Davidson Ryan , Biddle Kelsey , Scammell Thomas , Nassan Malik , Zhou Eric 
Published: May 2021

Abstract

Introduction
Narcolepsy typically begins during adolescence/young adulthood – a crucial period for developing relationships. As symptoms would be expected to impact social interactions, we studied how narcolepsy impacts social, romantic, and sexual relationships in young adults.

Methods
Young adults (18–39 years; N=262) with a self-confirmed narcolepsy diagnosis were recruited through national narcolepsy patient organizations. Participants completed an online survey, including open-ended questions, to evaluate their social, romantic, and sexual relationships and communication with medical providers.

Results
Participants (mean=28.5 years old; SD=5.6) were primarily female (87%), White/Caucasian (92%), employed (75%), and had Narcolepsy Type I (56%). All participants indicated that narcolepsy made social life or entering relationships somewhat or a lot more difficult. Rates of cohabitation and marriage were comparable to nationally representative samples. On the Couples Satisfaction Index, most participants reported feeling satisfied with their romantic relationships (mean=15.8; SD=4.3). On the Multidimensional Scale of Perceived Social Support, participants reported receiving greater support from their significant others (mean=4.5; SD=1.4) compared to both family (mean=3.7; SD=1.5; p&lt;.05) and friends (mean=3.9; SD=1.4; p&lt;.05). There was no difference between family and friends (p&gt;.05). Eighty-percent of participants indicated that narcolepsy impacted their sex life, including experiencing cataplexy or falling asleep during sex. Few participants indicated that their providers asked about their social (31%) and sex life (10%). In contrast, 73% of participants wanted providers to ask about social life and 45% wanted providers to ask about sex life.

Conclusion
Narcolepsy substantially impacts social functioning in young adults. They often prioritize the development of a single, meaningful romantic relationship as their disorder makes sustaining more social relationships challenging (“I do not go out and socialize at all, but spend all my time at home nurturing my romantic relationship because it’s the most important to me”). At a time of sexual development, there are considerable implications of narcolepsy symptoms on their sexual experiences. Though many participants were interested in discussing their social, romantic, and sexual relationships with medical providers, only a small proportion of providers inquire. Effective treatment of narcolepsy in young adults should include support for the impact of the disorder on relationship health.

Support (if any)
Jazz Pharmaceuticals.
505 Efficacy of Pitolisant in the Treatment of Cataplexy in Adults With Narcolepsy
Authors: Davis Craig , Zarycranski Donna , Doliba Markiyan , Dayno Jeffrey , Schwartz Jean-Charles 
Published: May 2021

Abstract

Introduction
Pitolisant was initially approved by the FDA in 2019 for the treatment of excessive daytime sleepiness in adult patients with narcolepsy; in 2020, the indication was expanded to include the treatment of cataplexy.

Methods
Cataplexy data from 7- or 8-week, randomized, placebo-controlled studies (HARMONY-CTP, HARMONY-1) are reviewed and summarized. In HARMONY-CTP, all patients were required to have ≥3 cataplexy attacks per week at baseline; HARMONY-1 enrolled patients with narcolepsy with or without cataplexy. Pitolisant was individually titrated to a maximum potential dose of 35.6 mg/day. The weekly (WRC) or daily (DRC) rate of cataplexy attacks was calculated from patient diaries.

Results
In HARMONY-CTP (pitolisant, n=54; placebo, n=51), mean baseline WRC was 11.7 in the pitolisant group and 9.6 in the placebo group. In the subset of HARMONY-1 patients with cataplexy (pitolisant, n=17; placebo, n=11), mean baseline DRC was 1.5 and 1.2, respectively. In HARMONY-CTP, least-squares (LS) mean change in WRC was significantly greater for pitolisant versus placebo at Week 2 (-4.1 vs 1.2; P=0.004) and continued through end of treatment (Week 7; -6.5 vs -0.1; P&lt;0.001). In HARMONY-CTP, treatment response was observed in 66.7% of pitolisant-treated versus 25.5% of placebo-treated patients (P&lt;0.001) for WRC reduction ≥50%, and 77.8% versus 33.3% of patients (P&lt;0.001) for WRC reduction ≥25%. In HARMONY-1, LS mean change in DRC was significantly greater for pitolisant versus placebo at Week 5 (-1.04 vs 0.17; P=0.047) and continued through end of treatment (Week 8; -0.96 vs 0.35; P=0.035). In a pooled analysis of patients with high burden of cataplexy (≥15 attacks/week) at baseline (pitolisant, n=20; placebo, n=11), LS mean change in WRC at end-of-treatment assessment was significantly greater for pitolisant (-14.5; baseline, 23.9; final, 9.4) versus placebo (-0.1; baseline, 23.1; final, 23.0; P=0.004). There was no evidence of rebound cataplexy after a 1-week placebo washout period.

Conclusion
Pitolisant, at once-daily doses of up to 35.6 mg, demonstrated a statistically significant and clinically meaningful reduction in the frequency of cataplexy attacks in adults with narcolepsy, including patients with a high symptom burden. Onset of response was observed within the first few weeks of pitolisant treatment.

Support (if any)
Bioprojet Pharma and Harmony Biosciences, LLC.
520 A Cone-Beam Computed Tomography Study on the Impact of Bruxism in Craniomandibular Morphology of Adults. Preliminary findings
Authors: Leite Irene , Rode Sigmar , Lopes Sérgio , Meira e Cruz Miguel , Oliveira Wagner 
Published: May 2021

Abstract

Introduction
Although bruxism, either during awake and during sleep is still a controversial topic in contemporary Medicine, its prevalence and its putative relationship with several conditions interfering with health and wellbeing make it relevant as a target to be studied in distinct scientific domains. Histological and morphological on the craniomandibular complex (CC) have been documented with different techniques. However, there is a lack of high quality imaging studies showing structural changes among the different anatomical structures therefore leading to a misinterpretation of the real impact of bruxism on such elements.The aim of this clinical retrospective comparative study was to investigate whether there are structural differences on the craniomandibular complex of bruxers in face to non-bruxers evaluated by a cone-beam computed tomohraphy (CBCT). We present the preliminary findings of this still ongoing study.

Methods
A retrospective analysis of CBCT imaging exams from patients with ages between 18 and 44 years old, were distributed among 1) bruxism group:BG (n=31); 2) Non-bruxism/Control group (n=21). Bruxism diagnosis followed non-instrumental approach suggested by the bruxism consensus 2013. To the craniomorphological evaluation, 3D CBCT SYM Diagnosis protocol was implemented by a calibrated expert at an adequate local with reduced light. Photograpic parameters were analyzed according to standard procedures.

Results
Female gender prevailed without differences between groups (61,3% in BG and 66,7 in CG; p=0,91). Age of BG was significantly higher than CG (40,1 yo versus 28,4;p=0,002). Mandibular structure as inferred by its shape was significantly higher in BG compared with CG.

Conclusion
In this preliminary study the CBCT 3D image showed important and significant changes in mandibular structure in bruxers compared with non-bruxers.
Support (if any):
527 Patient-Reported Treatment Outcomes in the Mayo Clinic REM Sleep Behavior Disorder Registry: Efficacy of Melatonin and Clonazepam
Authors: Grayson Kammi , Gossard Thomas , Teigen Luke , Feemster John , McCarter Stuart , Timm Paul , Sandness David , Carvalho Diego , Junna Mithri , Lipford Melissa , Olson Eric , Tippmann-Peikert Maja , Boeve Bradley , Silber Michael , St. Louis Erik 
Published: May 2021

Abstract

Introduction
REM sleep behavior disorder (RBD) is characterized by disruptive, violent dream enactment behaviors (DEB), necessitating symptomatic treatment to prevent injury and reduce DEB frequency and severity. Melatonin and clonazepam are regarded as RBD therapeutic mainstays, although outcomes data remains limited. We surveyed RBD patients to determine their outcomes following melatonin, clonazepam, and melatonin-clonazepam combination therapy.

Methods
Mayo Clinic RBD Patient Registry participants received an electronic survey concerning treatment type(s) and dose(s), efficacy, and adverse effects. The primary outcome was treatment efficacy, determined by comparing DEB frequency/severity ratings on a visual analog scale (VAS). Adverse effects severity was assessed by Likert scales. We comparatively analyzed VAS before and after treatment and adverse effects between treatments using non-parametric statistical tests.

Results
Sixty-eight of 109 patients responded (62.3%; 64 had analyzable data) with a mean age of 67.7 years. Fifty-seven (85%) were men, with mean RBD symptom duration of 13.9 years. Patients receiving each treatment were: melatonin=30, clonazepam=8, and combination=12; 14 received other or no treatment. Baseline VAS ratings were similar between groups. Only melatonin (p=0.003) and combination therapy (p=0.039) improved VAS ratings; clonazepam monotherapy did not improve VAS. Only melatonin monotherapy was reported to lower VAS compared to untreated patients (p=0.02). Optimally effective mean dosages were melatonin 9.95±5.06 mg and clonazepam 0.81±0.48 mg. Patient frequencies reporting one or more moderately-severe side effect(s) were similar between melatonin (15%), clonazepam (7%), and combination therapies (9%). Twenty-five (36.8%) patients had received only one medication trial, while 41.2% required more than one medication. Of these, 15 (22.1%) tried 2 and 13 (19.1%) tried 3 or more treatments.

Conclusion
Melatonin therapy at an approximate mean 10 mg dosage improved patient-reported DEB frequency/severity on VAS, compared between both previous intraindividual baseline ratings and with untreated patients, while clonazepam monotherapy did not, without differential adverse effects. Clonazepam monotherapy data were limited. These data inform future prospective melatonin symptomatic therapy trials for RBD. Additionally, 41.2% required more than one RBD pharmacological treatment, suggesting a current therapeutic gap and unmet need for future development of biologically-informed, evidence-based symptomatic RBD therapeutics.
Support (if any):
538 Sleep and Self-Efficacy: The Role of Domain Specificity in Predicting Sleep
Authors: Ghose Sarah , Dzierzewski Joseph , MacPherson Ashley , Sabet Sahar , Williams Claire , Reid Morgan , Dautovich Natalie 
Published: May 2021

Abstract

Introduction
Poor sleep occurs across the lifespan and has a number of consequences across biopsychosocial life domains. As such, it is important to identify modifiable psychobehavioral mechanisms contributing to sleep disturbance as potential targets for research and intervention. Self-efficacy may play a significant role in sleep behavior outcomes. The present study aimed to determine the differential associations between general and sleep self-efficacy and sleep among a lifespan sample of adults.

Methods
Data from the Investigating Sleep Longitudinally Across Normal Development (ISLAND) study were utilized for the present investigation. Participants were 3,284 adults (48.5% female, 6.4% other-identifying, Mage= 43 yrs., SD=16.72 yrs.) who completed self-report sleep, general-, and sleep self-efficacy measures as part of their study involvement. A Structural Equation Model (SEM) was estimated to investigate whether general or sleep self-efficacy were significant predictors of a latent sleep disturbance variable, which was comprised of the presence of insomnia symptoms (Insomnia Severity Index) and the absence of sleep health (RU-SATED). Invariance tests were utilized to determine whether the model held across age and sex.

Results
The structural model evidenced good fit to the data and indicated that general self-efficacy did not have a significant, direct impact on the latent sleep construct (b=-.01, p=.33); however, sleep self-efficacy did display a significant, negative association with sleep disturbance (b=-.82, p&lt;.001), whereby increased sleep self-efficacy was associated lower levels of disturbed sleep. The model was largely invariant across age and sex.

Conclusion
Sleep self-efficacy surfaced as an important predictor of sleep disturbance above and beyond general self-efficacy. Findings highlight the importance of domain specificity in the predicting sleep outcomes. Additionally, findings suggest the need for increased research into and application of interventions targeted toward increasing sleep self-efficacy in individuals with sleep disturbance as a potential avenue to improve sleep health.
Support (if any):
549 Associations of Bedtime, Wake-time and Employment Status by Gender and Race
Authors: Lyu Xiru , Dunietz Galit Levi , O’Brien Louise , Chervin Ronald , Shedden Kerby 
Published: May 2021

Abstract

Introduction
Poor sleep quality has been reported in the unemployed compared with employed. How sleep varies by employment status has been rarely examined at a population level. Therefore, we investigated sleep-wake patterns among employed, unemployed but actively seeking a job, and not-in-the-labor-force participants by gender and race/ethnicity.

Methods
Methods We used data from the American Time Use Survey (ATUS), a nationally representative sample of US residents aged ≥15years, which records weekday/weekend activities in a 24-hour period (4:00am-4:00am). This sample was restricted to participants aged 25–60 years (n=130,062). This analysis utilized functional nonparametric regression based on dimension reduction and neighborhood matching. We modeled the relationship between participant-specific sleep-wake trajectories, coded by minute, and employment status. Implementing the counterfactual approach, we estimated the effects of each employment scenario on participant-level expected sleep trajectory. This approach allowed the examination of hypothetical sleep-wake trajectories for each participant if their employment status differed from the observed. We then marginalized these findings to gender and race/ethnic subpopulations, controlling for confounders and secular trends.

Results
Mean age was 42□0.01 years, nearly half (51%) of participants were women and 68% were Whites. The proportions of employed, unemployed, and not-in-the-labor-force were 79%, 16.5% and 4.5%, respectively. On average, unemployed and not-in-the-labor-force participants had a later bedtime and wake-time compared with employed. With the exception of Whites, each individual race/ethnicity group showed pronounced differences in sleep-wake patterns by employment status. Of note, the likelihood of still being asleep up to 9:00am was greater when unemployed in comparison to had they been employed. Compared with employed, differences in sleep-wake patterns were pronounced among Blacks and Hispanics had they been unemployed, but attenuated if they were out-of-the-labor-force. Gender alone was not a strong moderator of the relationship between sleep-wake patterns and employment status. Unemployed participants had bedtime after 11pm, regardless of gender or race/ethnicity.

Conclusion
Using the counterfactual approach, we predicted sleep-wake patterns among individuals had they been employed, unemployed, or out-of-the-labor-force by gender and race/ethnicity. Though cross-sectional, our data suggest that the sleep schedules of racial/ethnic minorities in comparison to Whites may be more affected by employment status.
Support (if any):
551 Outcomes of Sickle Cell Crisis in Relation to Pediatric Obstructive Sleep Apnea in the United States: A US Population cohort study
Authors: Patel Palakkumar , Munoz Tomas , Adavadkar Pranshu 
Published: May 2021

Abstract

Introduction
This study aimed to quantify the impact of obstructive sleep apnea (OSA) on the mortality, morbidity, and resources utilization among children admitted with Sickle cell crisis (SCC)

Methods
This is a retrospective analysis using the 2016 and 2017 National Inpatient Sample Database. The Inclusion Criteria was a principal Diagnosis of SSC and age &lt;18 years. OSA, as a Secondary Diagnosis, was identified using the appropriate ICD-10 CM codes. The Primary Outcomes were Inpatient Mortality, and secondary outcomes were: In-Hospital Length of Stay(LOS), Total hospitalization Cost, Blood transfusion (BT) requirement, and a requirement for Invasive mechanical ventilation (IMV). We used Multivariate Linear/ logistic regression to adjust for confounders including age and sex.

Results
Out of 36,484 children with SSC included in the study, 1450 children had OSA (SCC+OSA). SSC-OSA and SSC+OSA groups did not differ in gender, household income, and hospital characteristics, but did so in age (11.3 vs 12.4; p &lt;0.001). OSA was most common in the age group of 13–18 (54%) and lowest in 0–4 (2.4%). Compared to SSC-OSA, the SCC+OSA cohort had significantly higher odds of mortality (adjusted OR= 11.9, [95% Confidence Interval: 1.02- 138.8],p=0.04). Additionally, SSC+OSA cohort was associated with increased odds of IMV (aOR=5.24 [CI: 1.84 – 14.8], p=0.002), longer LOS (adjusted mean difference (aMD)=0.67 [CI-0.32 – 1.02], p=&lt;0.001), and higher hospitalization Cost (aMD=2818.76 [CI-1680- 4157], p=&lt;0.001). No difference in BT (aOR=0.94 [CI: 0.68 – 1.29], p=0.71) was noted.

Conclusion
This study demonstrates that the presence of OSA is associated with detrimental outcomes in SSC with higher in-hospital mortality, higher morbidity (Invasive mechanical ventilation rate), and higher resource utilization (LOS, total hospitalization cost). More attention to the screening, early diagnosis, and appropriate treatment of OSA is imperative to improve health outcomes in children with sickle cell disease.
Support (if any):
553 Assessment of sleep disorders in children and adolescents with obesity
Authors: Zarpellon Raquel Simone Maccarini , Vilela Regina Maria , Radominski Rosana Bento , de Souza Crippa Ana Chrystina 
Published: May 2021

Abstract

Introduction
When studying the inherent aspects of sleep it is important to assess how the quality and quantity of sleep in the last two decades may be one of the reasons for the increase in childhood obesity, which has been growing rapidly worldwide. This study aims to assess the presence of sleep disorders in overweight children and adolescents.

Methods
An descriptive study was conducted with data collection from 43 patients between 6 and 13 years old diagnosed as overweight. They were patients of a specialized service for children and adolescents with obesity that is part of the Hospital de Clínicas of the Federal University of Paraná, located in Curitiba, Brazil. To investigate the presence of sleep disorders, the Sleep Disturbance Scale for Children (SDSC) questionnaire was administered. The factors assessed were: Disorders of Initiating and Maintaining Sleep, Sleep Breathing Disorders, Disorders of Arousallnightmures, Sleep Wake Transition Disorders, Disorders of Excessive Somnolence and Sleep Hyperhydrosis.

Results
The mean age of the patients that took part in the research was 10 years and 7 months (± 1.95). The mean BMI of the participants was 29.57 kg/m2 (± 4.38), the majority being diagnosed with obesity. The sum of all SDSC factors demonstrated the presence of pathological sleep in 58.1% (25) of the sample, whereas 51.2% (22) of the patients had Sleep Breathing Disorders and 58.1% (25) had the Sleep Wake Transition Disorder.

Conclusion
The present study demonstrated the presence of sleep disorders in overweight children and adolescents. As for Sleep Respiratory Disorder, a situation has already been advocated in the current literature for this audience. In relation to the Sleep-Wake Transition Disorder and pathological sleep, further research is needed to prove the presence of the disorder in other groups studied. Here is the suggestion that future research be done with subjective and objective data collection on sleep within a larger sample, in order to confirm the association between sleep disorders and childhood obesity.
Support (if any):
554 Utilization of Pediatric Sleep Questionnaire to Screen for Obstructive Sleep Apnea in a Difficult-to-treat Asthma Cohort
Authors: Lin Nancy , Hantragool Sumalee , Huang Guixia , Hossain Md Monir , McDowell Karen , Guilbert Theresa , Kercsmar Carolyn , Simakajornboon Narong 
Published: May 2021

Abstract

Introduction
Early detection and management of obstructive sleep apnea(OSA) could improve asthma control in children with difficult-to-treat(DTT) asthma. The purpose of this study was to assess the effectiveness of the pediatric sleep questionnaire(PSQ) to screen for OSA in children with DTT asthma, and to compare clinical characteristics between those with positive and negative PSQ scores.

Methods
A prospective study of 81 children with DTT asthma was completed from 2015–2017. The PSQ, Epworth sleepiness scale(ESS), Pediatric Quality of Life(PQL), and the academic performance questionnaires(APQ) were administered during clinic visits. Polysomnography(PSG) was recommended for PSQ score&gt;0.33. Medical records were reviewed for asthma clinical characteristics. The cohort was separated into positive(PSQ&gt;0.33) and negative PSQ score(PSQ≤0.33) groups for analysis.

Results
The mean age of the cohort was 11.3±4.5 years and the mean body mass index was 22±7.6 kg/m2. Sixty-two percent were male and 68% were African-American. Forty-nine(53%) subjects had positive PSQ (0.5[0.4 – 0.7]). The positive group had higher ESS score (10.5[8 – 13] vs. 6[2 – 8], p&lt;0.0001) and lower total PQL score (58.7[47.8–72.8] vs. 79.4[70.7 – 87], p&lt;0.0001) than the negative group. There was no difference between APQ scores(p=0.07). The positive group had lower asthma control test(ACT) scores than the negative group (17.5[15 – 20.5] vs. 21[19 – 22], p&lt;0.0001). Furthermore, the positive group was more likely to have gastroesophageal reflux (OR: 3.97, 95%CI: 1.7 to 9.1, p=0.0018). Twenty-nine(59%) subjects in the positive group had subsequent PSG, and 17(58.6%) subjects were diagnosed with OSA (14 mild OSA, 1 moderate OSA, 2 severe OSA). The mean obstructive index in the positive group was 3±5.5 events/hour. There was 1 subject with central apnea and alveolar hypoventilation. Of the 17 subjects with OSA, all received treatment with nasal steroids, 3 were treated with non-invasive positive pressure ventilation, and 4 had surgical intervention.

Conclusion
Children with DTT asthma who have positive PSQ have higher degree of daytime sleepiness, lower quality of life and worse asthma control. The positive group was more likely to have GERD, which may suggest a relationship between nighttime asthma symptoms and OSA. Further studies are needed to evaluate the effects of OSA treatment on asthma control.
Support (if any):