bluuebunny/crossref_metadata_2025_split huggingface dataset:
510 A Profile of Physical Performance Variables in an Out-Patient Adult Population with Narcolepsy
Authors: Tadrous Ragy , Broderick Julie , Murphy Niamh , Slattery Lisa , Quinn Gillian , O’Rourke Deirdre 
Published: May 2021

Abstract

Introduction
Narcolepsy can significantly impact the physical and mental wellbeing of people with narcolepsy, and has been associated with significant reductions in quality of life and physical performance. People with narcolepsy demonstrate many barriers to being physically fit and active, such as sleepiness and social isolation. Despite physical functioning and vitality being the most affected domains of health-related quality of life in this cohort, little is known about how physical performance variables are affected in people with narcolepsy.

Methods
This cross-sectional study profiled the physical performance of adults with narcolepsy attending the Narcolepsy Centre located in St. James’s Hospital. Participants underwent a physical performance test battery that investigated cardiopulmonary fitness, physical activity, muscle strength and endurance. Furthermore, health-related quality of life (HRQoL), symptom severity and sedentary behaviour was ascertained through self-report questionnaires.

Results
A total of 23 participants were recruited in this study. The majority of participants were female (n=13, 56.52%) and the mean age was 31.53 (± 13.17) years. Physical performance was generally found to be lower than age-and-gender matched normative values for cardiopulmonary fitness, physical activity and muscle strength and endurance. Participants’ completed 42.20 ± 21.41 minutes of moderate-vigorous physical activity daily as measured by actigraphy. Considerable sedentary behaviour was objectively measured in this sample (10.21 hours). Symptom severity was high as measured by the Epworth Sleepiness Scale and the Narcolepsy Severity Scale, and participants reported reduced quality of life when compared to general population norms (US, UK, France and Norway).

Conclusion
Markedly reduced physical performance was identified in this sample of people with narcolepsy, irrespective of participant age, gender and BMI. Future research should explore the role of exercise in improving the physical fitness in people with narcolepsy, and the influence of exercise on HRQoL and symptom severity in this cohort.

Support (if any)
This study was completed as part of Mr Ragy Tadrous’ Master of Science (MSc) degree in Trinity College Dublin. This degree was co-sponsored by the Physiotherapy Department in St. James’s Hospital, Dublin.
518 Preliminary report on the efficacy of behavioral therapy for insomnia in shift work disorder: a randomized control trial
Authors: Vallieres Annie , Garnier Severine , Pappathomas Alric , Mérette Chantal , Bastien Célyne 
Published: May 2021

Abstract

Introduction
Around 33% of shift workers suffer from shift work disorder (SWD). SWD includes insomnia and sleepiness related to the atypical work schedule. Most SWD treatments rely on light therapy or pharmacology. Few studies explored CBT-I efficacy for insomnia in shift work and reported promising results. The study aims to evaluate the efficacity of a behavioral therapy for insomnia adapted for SWD (BT-SWD).

Methods
Forty-three night shift workers meeting SWD criteria were recruited (mean age = 34 years old; 77% women) and randomized to either BT-SWD or waiting list control group. Eight participants dropped-out while waiting. Before and after treatment, participants completed questionnaires (ESS, ISI, STAI and BDI-II) and sleep diaries throughout the experimentation. BT-SWD involves sleep restriction therapy and stimulus control for insomnia as well as fixed sleep periods in the dark for shift workers. BT-SWD has been applied to night sleep, day sleep, and naps in this order. It consists of 6 sessions of 50 minutes delivered on 8 weeks. A mixed MANOVA was conducted on questionnaires scores with group (treatment or waitlist) as the between-subject factor and time as the within subject factor.

Results
A multivariate interaction effect was significant, F(6,21) = 8.24, p&lt;.001. A univariate interaction effect was observed for the BDI-II (p=.042), the trait scale of the STAI (p=.021) and the ISI, both for night sleep (p=.027) and day sleep (p&lt;.001), indicating that the scores of participants in the treatement group lowered significantly more than those of participants on the waiting group. The treatment group had a significantly less severe insomnia, both for day sleep during night work (p&lt;.001), and night sleep during days off (p&lt;.001). There was no significant difference between the control and the treatment group on sleepiness levels.

Conclusion
BT-SWD is effective at reducing insomnia severity as well as levels of trait anxiety and depression. Results are more equivocal for sleepiness. The waiting list control group design used has led to an important attrition in the context of shift work. Further analyses are needed to determine the BT-SWD efficacy on sleep variables.

Support (if any)
The study was supported by a CIHR grant (#110254) awarded to the first author
521 Prevalence and Impact of Restless Legs in Patients with Myasthenia Gravis
Authors: AlGaeed Mohanad , McPherson Tarrant , Lee Ikjae , Feese Michelle , Aban Inmaculada , Cutter Gary , Kaminski Henry , Karroum Elias 
Published: May 2021

Abstract

Introduction
Restless legs syndrome (RLS) is a sensori-motor disorder characterized by an urge to move the limbs during inactivity alleviated at least partially by walking/stretching. By contrast, myasthenia gravis (MG) is a neuromuscular disease with fluctuating weakness aggravated by continued muscle activity. Only a few studies addressed the prevalence of RLS in MG patients with limitations related to small sample size and/or usage of non-validated RLS screening tools. The aim of this study was to revisit the prevalence and impact of RLS in a large sample of MG patients using the validated 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq13).

Methods
The MG foundation of America patient registry was used to survey MG patients. Only patients aged ≥18 years, residing in the USA, and who answered “yes” to the question “Has your doctor diagnosed you with MG?” were included in this study. A survey including the CH-RLSq13, demographic information, disease related history, and patient reported outcomes including the MG15-item Quality of Life (MG-QOL15) and the MG-Activities of Daily Living (MG-ADL) instruments was sent to MG registry participants as part of the semi-annual follow up.

Results
A total of 630 MG patients (age: 62.8±13.2; 54.9% Women; 94.6% White) completed the survey and met eligibility criteria (22% of patients receiving the survey). The prevalence of RLS was 14.8% (93/630). Clinically significant RLS (moderately/extremely distressing RLS ≥2–3 days/week) was present in 53 (8.4%) MG patients. MG patients with (versus without) RLS were significantly younger (p=0.0061), more women (p=0.0440), with higher (worse) depression (p&lt;0.0001), MG-ADL (p=0.0001), and MG-QOL15 (p&lt;0.0001) scores.

Conclusion
Clinically significant RLS is prevalent in MG patients and is associated with a negative impact on mood, daily activities, and quality of life. Therefore, from a clinical practice it seems warranted to screen for RLS in MG patients.

Support (if any)
This study was not funded.
526 Characteristics of Augmented RLS Patients on Dopamine Agonists at a Tertiary Referral Center: Where Do We Go From Here?
Authors: Laiwah Jonathan Yeung , Winkelman John 
Published: May 2021

Abstract

Introduction
Augmentation is a management dilemma in RLS patients on dopaminergic therapy. Understanding the clinical characteristics of such patients may assist in better management strategies.

Methods
Consecutive new consultations for RLS from 4/2016-6/2020 were identified from a single tertiary referral center in Boston, USA. Patients were included in this analysis if they had augmentation and current treatment with a dopamine agonist. Clinical information from initial consultation was collected. RLS severity at time of consultation was determined retrospectively with a modified IRLSSG severity score (0–12), assessing RLS symptom frequency (0–4), duration (0–4), and severity (0–4).

Results
Out of 209 referrals with RLS, 105 patients had augmentation, of whom 88 were on dopamine agonists at initial evaluation. Average age was 67 years (SD 11 years, range 39–88); 62 were female (59%). Mean duration of RLS symptoms was 27 years (SD 20), and 91% had symptoms &gt; 10 years. Mean duration of dopamine agonist therapy was 11 years; 72% had previously been treated with pramipexole, 65% with ropinirole, 73% with rotigotine, and 16% with levodopa; 72% of patients had been treated with alpha-2-delta ligands, and 28% with opioids. Common comorbidities included obstructive sleep apnea (47%), obesity (49%), and depression (44%). Serotonergic medications were currently used by 25%. Of the 88 augmented patients on dopamine agonist therapy, 97% had earlier onset of symptoms and 33% had symptoms in both morning and afternoon; 53% reported anatomical extension. The mean modified IRLSSG score was 8.4 (SD 3.2). 66% of patients had either ferritin &lt;75 mcg/L or transferrin saturation &lt;20%. At the time of initial assessment, 49% were on pramipexole, 47% on rotigotine, 5% on rotigotine and 7% on levodopa: mean daily dopamine agonist dose was 1.23 mg (SD 1.20) of pramipexole equivalent. 37% were on alpha-2-delta ligands: mean daily dose 1014 mg (SD 830, median 700 mg) of gabapentin equivalent.

Conclusion
Higher than FDA-recommended dopamine agonist dosing and high prevalence of iron deficiency in patients with augmented RLS represent a treatment gap in the care of RLS patients in the community. Controlled studies of guideline-based therapy are indicated to determine optimal management of augmented RLS.

Support (if any)
Baszucki Brain Research Fund
528 REM Sleep Without Atonia in Idiopathic REM Sleep Behavior Disorder in the North American Prodromal Synucleinopathy Cohort
Authors: Feemster John , Timm Paul , Teigen Luke , Faber Sarah , Steele Tyler , McCarter Stuart , Boeve Bradley , Hedtkamp Kristina , Ju Yo-El , McCleland Jennifer , Postuma Ronald , Pelletier Amelie , Avidan Alon , Bliwise Donald , St. Louis Erik 
Published: May 2021

Abstract

Introduction
Idiopathic/isolated REM sleep behavior disorder (iRBD) is a prodromal alpha-synucleinopathy characterized by dream enactment behavior and REM sleep without atonia (RSWA). We sought to define quantitative RSWA diagnostic thresholds in the North American Prodromal Synucleinopathy (NAPS) Consortium cohort. We analyzed RSWA between iRBD patients across participating NAPS sleep centers, compared to normative controls, and hypothesized that previous diagnostic RSWA thresholds were overestimates.

Methods
All digital polysomnography files were converted to European Data Format and scored at a central laboratory (Mayo Clinic) which standardized display scoring montages, channel sensitivities, and filtering, and scripted computational analyses for visual scoring. RSWA was quantitatively analyzed in the submentalis (SM) and anterior tibialis (AT) muscles in iRBD (n=86) patients and controls (n=118) utilizing well validated visual (Mayo) and automated (RAI) methods. Parametric statistics were used to compare RSWA metrics, and RSWA thresholds were developed using receiver operating characteristic curves.

Results
RSWA was significantly higher for the RAI and all visual individual and combined muscle activity metrics in iRBD compared to controls (all p&lt;0.001). Average SM phasic measures were: 14.2% (Mayo), 17.9% (McGill), 18.5% (UCLA), and 9.4% (Washington University). Average AT phasic measures at each site were: 26.7% (Mayo), 17.1% (McGill), 23.3% (UCLA), and 17.4% (Washington University). Average SM/AT ‘any’ measures at each site were: 45.4% (Mayo), 35.9% (McGill), 53.4% (UCLA), and 23.5% (Washington University). Overall cohort RBD diagnostic thresholds (AUC, specificity/sensitivity) were: SM phasic 4.9% (90.0, 82.2%/83.7%); AT phasic 7.6% (88.7%, 82.2%/81.4%) and combined SM/AT ‘any’ 13% (94.6, 83.9%/96.5%).

Conclusion
RSWA thresholds in the NAPS cohort were substantially lower than previously reported, suggesting previously overestimated diagnostic RSWA thresholds due to smaller, enriched patient samples and overfit statistical modeling. Confirmation of these findings in the complete NAPS cohort (n=300 iRBD patients across all 10 NAPS centers) is planned.
Support (if any):
535 Associations between Multiple Stressors (Including Racism) and Sleep Health among Young African-American Women
Authors: Jackson Chandra , LaPorte Frankie , Gaston Symielle , Vines Anissa , McGrath John , Jackson W Braxton , Kubzansky Laura , Harmon Quaker , Baird Donna 
Published: May 2021

Abstract

Introduction
Stress contributes to poor sleep, and both are associated with adverse mental and physical health outcomes. African-American women are disproportionately burdened by multiple forms of stress as well as poor sleep, but few studies have investigated the stressor-sleep relationship in this population.

Methods
We investigated associations between multiple measures of both stressors and sleep among African American women participating in the Study of Environment, Lifestyle and Fibroids. Using principal components analysis, we summarized 43 items ascertaining self-reported stressors (e.g., racism) and potential mitigators (e.g., resilience). Components were extracted and factor scores generated. Self-reported sleep included short (&lt;7 hours) versus recommended (7–9 hours) sleep, waking unrested 4+ days/week, and insomnia symptoms (&gt;4 nights per month). Adjusting for demographics, health behaviors, and body mass index, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) for each factor score dichotomized at the median.

Results
Among 1,672 women, mean age was 29.2 ± 3.4 years and 45% had a household income &lt;$20,000. We extracted 9 stress factors accounting for 57% of the variance across the 43 items. In order of contribution to explaining the variance, stress factors included emotional distress (e.g., frequency of anger suppression and rumination); racism; social/emotional support; financial strain; medical/crime/family problems; faith/spirituality; resilience; job/home changes; and intimate partner changes/problems. Emotional distress (PR=1.52 [1.35–1.72]), racism (PR=1.28 [1.13, 1.44]), and financial strain (PR=1.14 [1.01–1.29]) were associated with insomnia symptoms. Emotional distress was also related to waking unrested (PR=1.36 [1.26–1.47]) while social/emotional support (PR=0.85 [0.79–0.92]) and resilience (PR=0.88 [0.82–0.95]) were protective. Short sleep was associated with a higher prevalence of emotional distress (PR=1.15 [1.06–1.25]) as well as medical/crime/family problems (PR=1.21 [1.03–1.42]); however, there was a protective association between resilience and short sleep (PR=0.88 [0.82–0.96]).

Conclusion
Multiple stressors were associated with sleep disturbances, but social/emotional support and resilience were associated with more favorable sleep.
Support (if any):
539 Interactions Between Cardiorespiratory Fitness and Sleep Apnea in Predicting Risk of Alzheimer’s Disease
Authors: Hagen Erika , Barnet Jodi , Ravelo Laurel , Plante David , Driscoll Ira , Edmunds Kyle , Gaitán Julian , Lose Sarah , Motovylyak Alice , Okonkwo Ozioma , Peppard Paul 
Published: May 2021

Abstract

Introduction
Several studies suggest a link between obstructive sleep apnea (OSA) and Alzheimer’s disease (AD). Additionally, frequent exercise is associated with more favorable AD biomarker profiles, and emerging evidence suggests greater cardiorespiratory fitness levels may be associated with lower risk of cognitive decline. We investigated whether cardiorespiratory fitness modifies the association of OSA and risk of AD.

Methods
A subset of the Wisconsin Sleep Cohort study participants with study visits starting in 2000 (n=1182, 46% female, mean [range] age at baseline=57 [37–82] years) completed multiple [range, 1–5] in-laboratory protocols that included overnight polysomnography, anthropometric measurements, and questionnaires. Additionally, the National Death Index was searched to determine cause of death among decedents. Cox proportional hazards models estimated relative hazards of AD (self-reported physician diagnosis or indication of AD on the death certificate) associated with the joint effects and the interaction of OSA – characterized by the base 10 logarithm of the apnea-hypopnea index (log10(AHI+1)) – and cardiorespiratory fitness (an index based on age, sex, BMI, self-reported physical activity, and resting heart rate). Additionally, the sample was stratified by fitness level at the 3rd quartile (&gt;75th percentile compared to &lt;75th percentile) and the hazard ratio for log10(AHI+1) was estimated for the lower and higher fitness-level groups. Results were adjusted for age, sex, BMI, and education.

Results
There were 10 incident cases of AD. The mean [range] fitness level was 7.1 [0–12.3]. 28% of the sample had moderate OSA (AHI 5–15); and 26% had severe OSA (AHI&gt;15). Higher log10(AHI+1) was associated with greater hazards (p=0.03) of AD and there was a significant interaction between log10(AHI) and fitness (p=0.04), such that at greater fitness levels, the effect of log10(AHI) on AD was mitigated. In stratified analysis, among the less fit, the hazard ratio for an increment of 1 in log10(AHI) was 12.8 (95% CI, 1.1–153.8, p=0.04); among those who were more fit, the hazard ratio was not significant.

Conclusion
More severe OSA is associated with higher risk of AD, and this risk is greater among those with lower levels of cardiorespiratory fitness.

Support (if any)
This work was supported by US NIH grants R01AG058680, R01AG062167, R01HL62252, 1R01AG036838 and 1UL1RR025011.
555 Role of X-Ray Soft Tissue Neck in Children with Obstructive Sleep Apnea with a Previous History of Adenotonsillectomy
Authors: Nguyen Quang , El-Kersh Karim , Gunaratnam Bakeerathan , Senthilvel Egambaram 
Published: May 2021

Abstract

Introduction
Adenoid recurrence in children after adenotonsillectomy can be an etiology for obstructive sleep apnea (OSA). The aim of this study was to assess the role of x-ray soft tissue neck (XR-STN) in evaluating adenoid recurrence from a sleep physician perspective and to assess the polysomnographic findings of pre and post revision adenoidectomy.

Methods
This was a single center retrospective study that included children &lt;18 years old with a history of adenotonsillectomy who underwent sleep study that confirmed the diagnosis of OSA and had XR- STN to evaluate for adenoidal tissue recurrence at the University of Louisville/Norton Pediatric Sleep Disorders clinic from July 2012 to September 2020. XR-STN level of adenoidal obliteration, baseline and post revision adenoidectomy PSG data were analyzed.

Results
A total of 160 subjects were included in the study with a mean age of 9.71±3.5 years, 59.4% were male, 54.4% were Caucasians, and the mean z-score was 1.77±1.15. XR-STN was normal in 39.4% of the subjects and it showed mild, moderate, and complete adenoidal obliteration in 20.6%, 32.5% and 7.5% of the subjects, respectively. Multiple regression analysis showed that the total AHI, the mean for the moderate and complete adenoidal obliteration are significantly higher than children with no obstruction (p-value=000). However, mild obliteration, Z score, age, gender, and race were not significantly associated with an increased total AHI. Pre- and post- adenoid revision PSGs were available in 20 subjects and they showed significant improvement in AHI (10.4±12.9 vs. 21.1±23.9, p=0.04), arousal index (15.4 ±10.6 vs. 21.1± 14.9, p=0.04), and nadir SaO2 (86.7%±8.1 vs. 76.58% ±18.44, p=0.04).

Conclusion
Soft tissue neck x-ray was useful in assessing adenoid recurrence in our study. Revision adenoidectomy resulted in an overall improvement in several PSGs parameters of OSA. Pediatric sleep physicians may consider XR-STN in the evaluation of children with OSA with a previous history of adenotonsillectomy.

Support (if any)
None
569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia
Authors: Araji Fayruz , Mujuruki Cephas , Ku Brian , Basora-Rovira Elisa , Wani Anna 
Published: May 2021

Abstract

Introduction
Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH.

Methods
The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected.

Results
Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed.

Conclusion
Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing.
Support (if any):