bluuebunny/crossref_metadata_2025_split huggingface dataset:
676 Age is only a number: Treatment modality preferences in a randomized controlled trial of CBTI in older adults
Authors: Simpson Norah , Tully Isabelle , Dietch Jessica , Tutek Joshua , Manber Rachel 
Published: May 2021

Abstract

Introduction
Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed.

Methods
Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods.

Results
Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s &gt;.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s&lt;.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s&lt;. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s &lt;.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003).

Conclusion
These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults.

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1R01AG057500
677 Impact of Remote Continuous Positive Airway Pressure Set-up on Treatment Usage and Effectiveness
Authors: Donovan Lucas , Parsons Elizabeth , Epler Eric , McCall Catherine , He Ken , Sharma Rahul , Duan Kevin , Spece Laura , Feemster Laura , Kapur Vishesh , Au David , Palen Brian 
Published: May 2021

Abstract

Introduction
Initiating treatment with continuous positive airway pressure (CPAP) traditionally relies on in-person visits with trained therapists to provide hands-on instruction regarding CPAP usage and mask fit. To overcome geographic barriers and reduce COVID-19 transmission, health systems increasingly rely on remote set-ups of mailed equipment. Despite a strong rationale for the mailed approach, relative effectiveness is unclear.

Methods
Our VA medical center shifted from in-person to mailed CPAP dispensation during the COVID-19 pandemic in March 2020. Using VA administrative and wireless CPAP usage data, we assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP for the first time from July 2019 to August 2020. Our primary outcome was mean nightly usage over the first 90 days. We compared patients with in-person vs. mailed CPAP dispensation using generalized linear models adjusted for age, gender, race, and Charlson Comorbidity Index. Among patients with &gt;1 hour of overall usage, we compared secondary outcomes of leak, apnea hypopnea index (AHI), and obstructive/central apnea indices.

Results
We identified 693 patients with newly diagnosed OSA whose CPAP was provided in-person and 296 who had CPAP mailed. Nightly usage in the first 90 days was modest in both groups (in-person: 149.7, mailed: 152.9 min/night), and we did not detect a difference in adjusted models (+7.6 min/night, 95%CI -13.6–28.8). We also did not detect a difference in 95th percentile leak (-1.2 liter/minute, 95%CI -3.3-0.9). Device-detected AHI was relatively low overall (in-person: 3.2, mailed: 4.1 events/hour), but was greater in the mailout group (+1.0/hour, 95%CI 0.2–1.7). AHI differences appeared to be driven by obstructive (+0.5/hour, 95%CI 0.2–0.8) but not central events (-0.1, 95% CI -0.2–0.4). Risk of AHI&gt;5 was comparable between groups (in-person: 17.3%, mailed: 19.0%, OR 1.2, 95%CI 0.8–1.7).

Conclusion
We were able to switch from an in-person to a mail-based system of CPAP initiation without a change in CPAP adherence or mask leak. While AHI was slightly greater in the mailed group, the clinical significance of this finding is unclear. Future work will need to evaluate the impact of remote CPAP dispensation on patient-centered outcomes.

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VA Health Services Research and Development, CDA 18–187
679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis
Authors: Sun Yishi , Laksono Isabelle , Selvanathan Janannii , Saripella Aparna , Nagappa Mahesh , Pham Chi , Englesakis Marina , Peng Philip , Morin Charles , Chung Frances 
Published: May 2021

Abstract

Introduction
In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI).

Methods
Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain &gt;3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of &gt; 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores.

Results
The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p &lt; 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p &lt; 0.05).

Conclusion
In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain.
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682 How doctors sleep during the COVID-19 pandemic: A survey
Authors: Khara Nimit 
Published: May 2021

Abstract

Introduction
Sleep deprivation is known amongst doctors (working hours of doctors in developing countries are long and not tightly regulated) and the COVID-19 pandemic may make it worse. We conducted this survey to assess the quantitative and qualitative effects of this pandemic on the sleep of doctors.

Methods
A survey was created on Google Forms and it was circulated / sent through WhatsApp for voluntary participation amongst several groups of doctors and individually as well.

Results
We received 304 responses from doctors of various specialties, cadres and background. Our results showed that 52% of them were involved in direct clinical care of COVID-19 patients. 55.8% doctors reported changes in sleep pattern and 37.2% reported reduced duration of sleep, as compared to the time before the pandemic. More than 50% of them slept for less than 7 hours a night since the beginning of the pandemic. 37% had difficulty falling asleep and maintaining sleep. 30% had difficulty in concentration and functioning during day-time. Non-refreshing sleep was experienced by 36.3% of them and 18.8% of physicians had recollected having COVID-19 related dreams. 33% doctors’ last thought before sleep and first thought after waking up were about COVID-19. 36% doctors looked for information about COVID-19 on media immediately before going to sleep and immediately after waking up. More than 60% doctors started meditation, exercise, yoga or relaxation techniques for getting better sleep.

Conclusion
A further decline in duration and quality of sleep due to the COVID-19 pandemic amongst already sleep-deprived doctors may be detrimental not only to their own health but for patient-care also.
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685 Sleep Latency, Pre and Peri-COVID-19 Experiences and PTSD Symptoms: Results from the NYU COVID-19 Mental Health Study
Authors: Rogers April , Blanc Judite , Seixas Azizi , Nunes Joao , Casimir Georges , Jean-Louis Giardin 
Published: May 2021

Abstract

Introduction
An effective response to the COVID-19 pandemic has been the decision to subject individuals residing in New York City to quarantine rules in order to reduce the spread of the virus. As might have been expected, restriction of usual daily activities would affect individuals’ sleep-wake patterns. It is also known that exposure to traumatic experiences can also engender sleep disturbances, most notably in their ability to initiate sleep. This study investigated the associations between sleep onset latency (SOL), pre and peri-COVID-19 exposure and symptoms of posttraumatic stress disorder (PTSD) among New Yorkers.

Methods
541 individuals (female = 373(69%); mean age=40.9) were recruited during the summer and fall of 2020 in New York City to participate in the NYU-COVID-19 Mental Health Study. Participants provided sociodemographic data and were also asked to respond to the COVID-19 quarantine experiences, comprised of seven binary questions, the PTSD Checklist-PCL-5, and the Pittsburg Sleep Quality Index. Descriptive and linear regression analysis were performed to explore associations of scores on the COVID-19 quarantine experience with PTSD and sleep data. All analyses were performed using SPSS 25.0

Results
Regression analyses revealed that SOL emerged as the strongest independent predictor of PTSD symptoms [B(t) = −.630(12.7); p &lt; .001]; factors adjusted in the model included pre and peri-covid-19 factors such as age, sex, job type, and quarantine experience. Analyses assessing potential interaction effect revealed that quarantine experience did not affect the relationship between SOL and PTSD [B(t) = .086(.831); p = &gt;.005]. The other sleep factors in the model did not yield significance. sleep duration had a weak correlation with quarantine, it was not found to be a predictor of PTSD.

Conclusion
We observed that SOL was the most important determinant of PTSD symptoms among individuals exposed to COVID-19. This is consistent with other findings suggesting that a sizable proportion of individuals exposed to pandemics are likely to experience sleep disturbances. It is plausible that quarantine might lead to increased daytime naps, which may impact SOL. Further research is needed to better understand the association of SOL and PTSD as a result of Covid-19.

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K07AG052685, R01MD007716, R01HL142066, T32HL129953, K01HL135452, R01HL152453
686 Sleep Education and Sleep Outcomes in the Time of Covid-19 in Mexico
Authors: Baldwin Carol , Gamiño Sergio Marquez , de la Cruz Carolina Cabrera , Quan Stuart 
Published: May 2021

Abstract

Introduction
This study examines computer-mediated sleep education for health providers enrolled in a certified diabetes educator program in November 2020 in Mexico.

Methods
Data derived from pre/post ratings assessed knowledge of obstructive sleep apnea (OSA), insomnia, restless legs syndrome (RLS), short sleep duration (SSD), circadian rhythm disorders (CRD), and drowsy driving (DD) on a 5-point Likert-like scale, and five true/false questions regarding misconceptions about sleep. Outcomes included self-reported sleep problems among providers since the onset of the March 2020 Covid-19 surge in Mexico. Pre/post means were compared with paired t-tests using SPSS (V25) with significance set at p&lt;0.05.

Results
Volunteer participants (N=23; 83% women; 52% nutritionists; 48% health providers) were recruited from the fall semester 2020 diabetes educator certificate program. Means with standard deviations showed significant learning for all sleep disorders following the training (OSA: 3.1±1.0 to 4.4±0.78; Insomnia: 3.2±0.85 to 4.3±0.82; RLS: 2.1±1.2 to 4.2±0.95; SSD: 2.7 ±1.1 to 4.4±0.72; CRD: 2.6±1.2 to 4.4±0.73; DD: 2.6±1.1 to 4.4±0.78, all p&lt;.0001). The total pre- to post-scores (Range=0 to 30) for sleep disorders moved from 16.3±5.7 to 26.3±4.4, p&lt;.0001. Participants demonstrated improved, but borderline significant findings regarding misconceptions about sleep from pre-to post-testing, p=.07. Of the 23 respondents, 18 (78%) reported sleep problems specific to the onset of the Covid-19 pandemic in Mexico. Of the 18 providers, 13 reported insomnia symptoms, while five indicated short sleep due to double shift work, anxiety and depression, or poor sleep quality.

Conclusion
Participants (78%) reported sleep problems; particularly insomnia associated with anxiety, depression, poor sleep quality and extended shift work since the onset of the Covid-19 pandemic. Findings are consistent with global studies of Covid-19 and sleep of health care workers. Online participants’ significant learning for all sleep disorders was coherent with in-class learners (N=173). Pre-to-post analyses of misconceptions about sleep, particularly sleep needs for adults and that daytime sleep can make up for lack of nighttime sleep, however, were not significant for these learners compared to the in-class learning groups.

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N/A
694 Insufficient sleep linked with higher COVID-19 infection cases and deaths in the United States
Authors: Seixas Azizi , Pantaleo Nicholas , Adhikari Samrachana , Grandner Michael , Jean-Louis Giardin 
Published: May 2021

Abstract

Introduction
Causes of COVID-19 burden in urban, suburban, and rural counties are unclear, as early studies provide mixed results implicating high prevalence of pre-existing health risks and chronic diseases. However, poor sleep health that has been linked to infection-based pandemics may provide additional insight for place-based burden. To address this gap, we investigated the relationship between habitual insufficient sleep (sleep &lt;7 hrs./24 hr. period) and COVID-19 cases and deaths across urban, suburban, and rural counties in the US.

Methods
County-level variables were obtained from the 2014–2018 American community survey five-year estimates and the Center for Disease Control and Prevention. These included percent with insufficient sleep, percent uninsured, percent obese, and social vulnerability index. County level COVID-19 infection and death data through September 12, 2020 were obtained from USA Facts. Cumulative COVID-19 infections and deaths for urban (n=68), suburban (n=740), and rural (n=2331) counties were modeled using separate negative binomial mixed effects regression models with logarithmic link and random state-level intercepts. Zero-inflated models were considered for deaths among suburban and rural counties to account for excess zeros.

Results
Multivariate regression models indicated positive associations between cumulative COVID-19 infection rates and insufficient sleep in urban, suburban and rural counties. The incidence rate ratio (IRR) for urban counties was 1.03 (95% CI: 1.01 – 1.05), 1.04 (95% CI: 1.02 – 1.05) for suburban, and 1.02 (95% CI: 1.00 – 1.03) rural counties.. Similar positive associations were observed with county-level COVID-19 death rates, IRR = 1.11 (95% CI: 1.07 – 1.16) for urban counties, IRR = 1.04 (95% CI: 1.01 – 1.06) for suburban counties, and IRR = 1.03 (95% CI: 1.01 – 1.05) for rural counties. Level of urbanicity moderated the association between insufficient sleep and COVID deaths, but not for the association between insufficient sleep and COVID infection rates.

Conclusion
Insufficient sleep was associated with COVID-19 infection cases and mortality rates in urban, suburban and rural counties. Level of urbanicity only moderated the relationship between insufficient sleep and COVID death rates. Future studies should investigate individual-level analysis to understand the role of sleep mitigating COVID-19 infection and death rates.

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NIH (K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
697 Sleep Quality After COVID-19 Infection
Authors: Hackett Benjamin , Badami Varun , Sharma Sunil , Stansbury Robert 
Published: May 2021

Abstract

Introduction
COVID-19 has proven to be a novel virus with significant complications to an expanding number of body systems. Hallmark characteristics of COVID-19 include substantial inflammatory response which has been linked to sleep dysregulation in previous studies. We examined the change in sleep quality after acute COVID-19 infections requiring hospitalization.

Methods
We performed a retrospective, single-center observational study of 20 patients with acute COVID-19 infection requiring hospitalization. Eligible patients were contacted and completed telephone surveys of the Pittsburgh Sleep Quality Index (PSQI) prior to and 1 month after hospital discharge. A score of ≥5 was indicative of poor sleep quality. Secondary data were collected from EMR.

Results
The mean PSQI prior to COVID-19 infection was 6.1, worsening to 10.3 one month after acute infection, denoting a delta-PSQI of 4.2 (p = 0.0004). There were noted statistically significant differences in certain components of the PSQI including: subjective sleep quality 0.8 to 1.7 (delta 0.9, p = 0.0003), sleep latency 1.25 to 1.85 (delta 0.6, p = 0.03), sleep disturbance 1.05 to 1.5 (delta 0.45, p = 0.0009), and daytime dysfunction 0.3 to 1.45 (delta 1.15, p = 0.0005). Sleep latency and daytime dysfunction accounted for the most change. Two groups declared themselves with 6 of the 20 patients having improvement/no change in PSQI, and 14 having worsening. Between these groups certain differences were seen including: Pre-infection PSQI 9.67 vs 4.57 (p = 0.009), delta global PSQI -0.83 vs 6.36 (p &lt; 0.001), delta subjective sleep quality 0.17 vs 1.2 (p = 0.002), delta sleep latency -0.3 vs 1 (p = 0.01), delta sleep duration -0.3 vs 0.93 (p = 0.02), delta sleep efficiency -0.3 vs 0.71 (p = 0.02), and delta daytime dysfunction 0.17 vs 1.57 (p = 0.006).

Conclusion
In our study of patients hospitalized for COVID-19 infection specific components of sleep were different following infection. Sleep latency and daytime dysfunction contributed the most to PSQI change. Two groups declared themselves based on PSQI improvement vs worsening. Those with poor sleep prior to infection continued to have poor sleep, while those without prior sleep troubles developed worsened sleep quality.
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706 Sleep and Mental Health in College Students Before and During the Initial COVID-19 Shutdown
Authors: Okun Michele , Walden Allison , Feliciano Leilani 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has had an unparalleled impact on college students. Following the initial and abrupt shutdown of campuses in March 2020, several investigators assessed the immediate effects on University students. Early reports found that college students reported a higher prevalence of anxiety and depression, sedentary behavior, and sleep problems. Most were conducted outside the U.S. Data from U.S. college students are critical to identify which areas are should receive resources and interventions as the U.S. continues to experience exponential COVID cases along with continued remote learning, social restrictions and/or lockdowns.

Methods
Students enrolled in the Spring 2020 semester (18 years of age +) were invited to participate in an online survey (April – May 2020). A final sample of 491 completed the entire survey (length ~45 minutes) which asked about sleep quality, psychological stress, depression, and exercise.Paired t-tests were conducted to compare pre-COVID and during COVID data.

Results
There were significant differences in sleep onset latency (26.44 ± 23.53 min vs 32.06 ± 26.88 min; t = -3.81, P &lt; .001), sleep duration (7.30 ± 1.45 hours vs 7.63 ± 2.07 hours; t = -2.23, p = 0.027) and overall sleep quality (6.29 ± 3.29 vs 7.44 ± 3.86; t = -7.26, p &lt; .001), as well as depression scores (IDS no sleep questions) (5.61 ± 4.18 vs 17.59 ± 5.45; t = -54.9, P &lt; .001). There was no difference in perceived stress (28.03 ±5.27 vs 28.39 ±5.53, t = -1.49, p = .138). Exercise (vigorous, moderate and walking) all decreased with regards to days and time spent, (all P’s &lt; .001), whereas minutes sitting significantly increased (426.50 ± 239.88 vs 542.26 ± 249.63, p &lt; .001).

Conclusion
These data empirically support the claim that the pandemic is having a significant negative impact on physical and mental health among college students. In the best of times, college students have irregular sleep patterns and significant depression, but these behaviors are worsened under government restrictions. These findings underscore the need to prioritize prevention and intervention of modifiable behaviors, especially if the pandemic extends into 2021.
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