bluuebunny/crossref_metadata_2025_split huggingface dataset:
745 Association of Longitudinal Sleep Profiles with Cognitive Functioning in Bipolar Disorder
Authors: Boland Elaine , Ramsey Christine , Goldschmied Jennifer , Gehrman Philip 
Published: May 2021

Abstract

Introduction
Emerging evidence suggests that some cognitive deficits in bipolar disorder may be attributed to sleep disturbance. However, current findings are limited by cross sectional analyses or longitudinal studies with sparse follow up on sleep quality. The current study examined longitudinal profiles of sleep as predictors of cognitive performance across a series of domains to better understand how sleep disturbance may impact in bipolar patients.

Methods
241 bipolar disorder and 103 control participants had their sleep measured at baseline, 6- and 12-months using the Pittsburgh Sleep Quality Index (PSQI). Individuals with a “poor” categorical PSQI sleep rating (PSQI total score &gt;5) at all time points were categorized as “Poor Sleepers” (n = 134). Those rated “good” at each time point were “Healthy Sleepers” (n = 107), and those with at least one discrepant sleep rating at any time point were labeled “Unstable Sleepers” (n = 103). Cognitive performance was assessed at 12-months, testing domains of memory, processing speed, and executive function. ANOVAs controlling for demographics, mood symptom severity, and diagnostic group examined effects of sleep profiles on cognitive function.

Results
Main effects for sleep group were found for the California Verbal Learning Test across all short and long delay recall conditions (F’s 4.45 – 5.8, p &lt;.02 for all). The poor sleep group performed the worst, while no main effects for diagnosis were observed. Main effects of sleep group were found for time conditions of the Trail making task (F = 4.18, p = .016), but not for errors.

Conclusion
Sleep quality was more strongly related to verbal and visual memory than bipolar diagnosis, with weaker effects for executive function. Some cognitive domains in bipolar disorder may be more closely related to sleep disturbance than endogenous factors. Future studies should explore how improvements in sleep functioning relate to neurocognitive outcomes, and whether cognitive performance varies as a function of sleep instability independent of mood instability.

Support (if any)
Support: Heinz C. Prechter Bipolar Research Fund at the University of Michigan Depression Center, the Department of Veterans Affairs (IK2-CX001501; PI: Boland), the VISN 4 MIRECC, and National Institute of Mental Health (K23MH118580; PI: Goldschmied).
757 Associations Between Sleep Complaints, Suicidal Ideation and Depression Among Adolescents and Young Adults in Greece
Authors: Basta Maria , Vgontzas Alexandros , Simos Panagiotis , Karakonstantis Stamatis , Micheli Katerina , Li Yun , Defaermos Vasilis , Papadakis Nikolaos 
Published: May 2021

Abstract

Introduction
Suicide risk begins to increase among adolescents and young adults representing the leading cause of death in this age group. The aim of this study was to assess associations between sleep complaints, suicidal ideation and depression in a large, representative sample of adolescents and young adults of the general population in Greece.

Methods
A structured telephone questionnaire was conducted in a representative sample of 2.741 young Greeks aged 15–24 years, including sociodemographic variables, life-style habits, and substance use. symptoms were assessed using the PhQ-9. Suicidal ideation and sleep complaints, i.e. insomnia/ hypersomnia symptoms, were assessed based on the relevant questions of the PhQ-9 questionnaire. We conducted a direct and indirect effect analysis between the modified PhQ-7 scale, sleep complaints and suicidality controlling for gender, family income, education and substance use.

Results
In our sample prevalence of suicidal ideation was 7.8%, while 47.9% reported sleep complaints. The mean PhQ-7 score was 6.15±4.11. The direct paths from depression to sleep, as well as from sleep to ideation were both statistically significant with p-values &lt;0.001. Indirect mediation analysis revealed a significant indirect effect of depression on ideation mediated by sleep complaints as indicated by the sobel test (z=3.59, p=0.0003). This is a partial mediation given that the direct effect of depression on ideation controlling for sleep (the mediator) remains significant (p&lt;.001). The percentage of the effect of depression on ideation accounted for by the indirect effect through sleep is estimated at 16.5%. The mediation remains significant (p&lt;.001) after controlling for income, gender, education, and substance use.

Conclusion
Our study supports that among youth there is direct associations between depression, sleep complaints and suicidal ideation. Furthermore, we found an indirect effect of depression on suicidal ideation mediated by sleep complaints. Our findings highlight the presence of complex interactions between subjective psychiatric symptoms and perceived sleep problems to account for suicidal ideation Therefore, treatment of sleep among youth with depression may significantly independently further reduce suicidal risk.

Support (if any)
EEA/Norwegian Financial Mechanism 2009–2014, under Project Contract n° EEA Grants/ GR07- 3757
766 Anxiety is a potential mediating factor in the insomnia-aggression association
Authors: Nielson Spencer , Dzierzewski Joseph , Kay Daniel 
Published: May 2021

Abstract

Introduction
Several recent studies have found an association between insomnia and increased aggression. Aggression may increase arousal, thereby predisposing individuals to sleep difficulties. Conversely, insomnia may impair brain circuitry involved in aggression. Ultimately, the relationship between insomnia and aggression remains poorly understood and understudied. This study sought to explore this association in a sample of individuals with a wide range of insomnia symptom severity, stratified from minimal to moderately severe.

Methods
Participants’ (N=66) insomnia symptoms were assessed using the Insomnia Severity Index. Participants also completed daily sleep diaries for 7–21 days followed by an ambulatory polysomnography overnight sleep study to characterize participants’ sleep and to rule out organic sleep disorders. The evening of the overnight sleep study, participants completed the 34-item Buss-Perry Aggression Questionnaire (AQ). Pearson’s correlation coefficient was used to assess associations between insomnia, AQ total score, and the AQ subscale scores (i.e., physical aggression, verbal aggression, anger, hostility, indirect aggression). Multiple regression was utilized to determine whether aggression was associated with insomnia severity while adjusting for demographic features, depression symptoms (Patient Health Questionnaire-9) and trait anxiety (State-Trait Anxiety inventory).

Results
In bivariate analyses, insomnia severity was significantly correlated with the AQ total score and with the anger and hostility subscales of the AQ (r=0.297, p&lt;0.05; r=0.266, p&lt;0.05; r=0.321, p&lt;0.05 respectively). When adjusting for the significant association between anxiety and insomnia in multiple regression analyses, anger and hostility were no longer significantly associated with insomnia severity(p&gt;.05).

Conclusion
Our investigation suggests that the association between insomnia and aggression is most specific to anger and hostility but that these associations may be better explained by their shared associations with anxiety.
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767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis
Authors: Marten Finja , Keuppens Lena , Baeyens Dieter , Boyer Bianca , Danckaerts Marina , Van der Oord Saskia 
Published: May 2021

Abstract

Introduction
During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables.

Methods
Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies.

Results
10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p&lt;.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p&lt;.001) and wake after sleep onset (z=13.50, p&lt;.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p&lt;.001) and subjective sleep satisfaction (z=3.50, p&lt;.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p&lt;.001), daytime sleepiness (z=26.68, p&lt;.001) and sleep disturbances (z=8.00, p&lt;.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included.

Conclusion
In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD.
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786 Trait Extraversion is Associated with Increased Suicidal Ideation During Total Sleep Deprivation and Insomnia
Authors: Killgore William , Capaldi Vincent , Grandner Michael , Kamimori Gary 
Published: May 2021

Abstract

Introduction
It is known that sleep disturbance is associated with increased suicidal thinking, and completed suicides are most common during the late night/early morning hours, but no studies have examined the role of trait-like individual differences in vulnerability to suicidal ideation during sleep deprivation or insomnia. In two separate studies, we examined whether the trait of extraversion is predictive of changes in suicidal thinking following two nights of sleep deprivation and among individuals meeting criteria for insomnia.

Methods
Study 1: Twenty-five healthy military personnel (20 males), ages 20–35 completed the NEO-PI-R Extraversion scale and the Suicidal Ideation (SUI) scale of the Personality Assessment Inventory (PAI). Participants completed 77 hours of continuous sleep deprivation. After 56 hours of sleep deprivation, participants completed the SUI scale a second time. Study 2: 1,011 adults aged 18–79 (470 males) were divided into two groups based on the clinical threshold (≥15) on the Insomnia Severity Index (ISI) and completed measures of extraversion and depression, including the suicide item of the Patient Health Questionnaire-9 (PHQ9).

Results
Study 1: After controlling for caffeine group and changes in PAI Depression, Extraversion scores were used to predict changes in SUI scores using stepwise multiple linear regression. Higher Extraversion was significantly associated with increased non-clinical suicidal ideation following sleep loss, β=.463, partial r=.512, p=.013. Study 2: After controlling for depression, extraversion was more strongly correlated with greater suicidal ideation, particularly for those meeting criteria for insomnia, β=.340, partial r=.387, p&lt;.0000001, compared to those below the threshold, β=.185, partial r=.218, p&lt;.0000001.

Conclusion
Higher trait extraversion was associated with increased vulnerability to suicidal ideation between rested baseline and total sleep deprivation, and was associated with greater suicidal ideation among those meeting criteria for clinically severe insomnia. These findings point to a potential trait-like vulnerability factor that may further our understanding of sleep disruption in the phenomenology of suicide.
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801 Obstructive Sleep Apnea Symptoms Predict Cognitive Function Following Mild Traumatic Brain Injury
Authors: Le Andrew , Dailey Natalie , Grandner Michael , Killgore William 
Published: May 2021

Abstract

Introduction
Sleep disturbances are commonly reported following mild traumatic brain injury (mTBI). Specifically, one of these disturbances is obstructive sleep apnea (OSA), which involves repeated episodes of reduced upper-airway flow during sleep. When compared to the general population, OSA is reported at a much higher rate among the mTBI population. However, little research has investigated the relationship between OSA and cognitive performance among the mTBI population. We predicted that in those who suffered a mTBI, symptoms of sleep apnea would be predictive lower cognitive processing.

Methods
We collected data from 37 healthy controls (Mean age = 24.3 □ 5.8) and 145 participants with mTBI (Mean age = 24.3 □ 6.8), ranging from 2 weeks to 12 months post-injury. Participants completed the Pittsburg Sleep Quality Index (PSQI) including questions indicative of OSA, such as “cannot breathe comfortably” and “cough or snore loudly” during sleep. We calculated the PSQI Sleep Disturbance (PSQI-SD) composite score, which ranged from 0 to 2. Participants completed the Automated Neuropsychological Assessment Metrics (ANAM4), a novel computer-based assessment, to measure reaction time (RT).

Results
When comparing the percentage of participants in each group endorsing sleep disturbances on the PSQI-SD, we found a significant difference in the proportion of individuals scoring a 2 on PSQI-SD between the groups (□2(2) = 13.55, p = .001). In healthy controls, 8% scored 0, 89% scored 1, and 3% scored 2 on the PSQI-SD. In contrast, following mTBI, 1.4% scored 0, 72.4% scored 1, and 26.2% scored 2 on the PSQI-SD. Furthermore, PSQI-SD significantly predicted RT (□ = .18, p = .03) in the mTBI group, a relationship not observed in the control group (□ = .30, p = .07).

Conclusion
mTBI increases the incidence of sleep disturbances and symptoms related to OSA. Furthermore, sleep disturbances and OSA-related symptoms were predictive of cognitive performance in individuals who sustained a mTBI, but not healthy controls. Increases in PSQI-SD scores were associated with increased RT, indicating greater deficits in cognitive function, specifically reaction time. These data provide evidence that higher severity in respiratory symptoms relating to sleep apnea hinders cognitive processing, particularly for individuals who have suffered a mTBI.
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818 A Ghost from the Past: Unmasked Insomnia Affecting Hypoglossal Nerve Stimulation Therapy Adherence
Authors: Stuewe Elena , Grover Aarti , Ostrow Peter , Schumaker Greg , Oster Joel , Zacharias Rajesh 
Published: May 2021

Abstract

Introduction
Hypoglossal nerve stimulation (HNS) is an efficacious option for treating moderate to severe obstructive sleep apnea (OSA). However, there is sparse evidence regarding tolerance and adherence to HNS therapy in patients with a diagnosis of insomnia.

Report of case(s)
A 57-year-old man with well-controlled depression presented for evaluation for HNS therapy. He had been diagnosed with moderate OSA with an apnea-hypopnea index of 22/hour, intolerant of continuous positive airway pressure and mandibular advancement device. He underwent uvulopalatopharyngoplasty without significant improvement. At the time of initial evaluation, he denied history of insomnia and prior sleep aid use. He subsequently underwent successful HNS device implantation and activation. One week after HNS initiation, the patient reported new symptoms of significant difficulty with sleep onset and inability to fall back asleep, which was worse than his untreated OSA symptoms. Device interrogation did not reveal any hardware problems. Adjustments to start delay, pause time and device configuration with awake endoscopy did not improve tolerance. Subsequently, the patient disclosed a remote history of insomnia, which was treated with multiple hypnotics in addition to cognitive-behavioral therapy for insomnia (CBTi) and had resolved. He was diagnosed with recurrent chronic insomnia, for which eszopiclone was initiated without significant improvement. He eventually agreed to CBTi, with partial improvement in device tolerance and improvement in insomnia symptoms.

Conclusion
This case highlights that HNS therapy adherence can be affected by prior history of, or a current diagnosis of insomnia. Our patient had a predisposition for insomnia that was well controlled prior to HNS therapy initiation. The onset of recurrent insomnia with HNS activation suggests that HNS was a precipitating factor for his now chronic insomnia. Although there is insufficient evidence to suggest whether history of insomnia should affect the decision to initiate HNS therapy, this case illustrates the importance of screening for insomnia at pre-implant evaluation. Our center is now routinely screening for a history of insomnia to identify patients who may benefit from treatment prior to HNS implantation. Larger studies are needed to explore a possible relationship between insomnia and HNS adherence.
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820 An Unusual Case of Post-Traumatic Brain Injury Kleine-Levin Syndrome with Anti-GAD-65 Autoantibodies
Authors: Tse Caroline , Mignot Emmanuel , Lim Miranda 
Published: May 2021

Abstract

Introduction
Kleine-Levin Syndrome (KLS) is a rare clinical syndrome, and is precipitated by traumatic brain injury (TBI) in 9% of cases. An autoimmune component to KLS has previously been suggested. Autoantibody profiles in KLS are diverse and its overlap with autoimmune encephalitis is still not well described or understood. Here, a case of KLS in a patient with autoimmune diabetes with very high levels of serum autoimmune GAD-65 antibodies is presented.

Report of case(s)
A 36-year-old male Veteran with a history of alpha-thalassemia minor, prior history of insomnia with nightly sleep of 6 hours, prior history of mild OSA with AHI of 5.8 on PSG in 2018, sustained a mild TBI on 11/13/2019 after a 50-pound box fell on his head. CT head and cervical spine were normal. One week later, he developed recurrent episodes of hypersomnia, sleeping up to 80 hours continuously, waking briefly only to urinate or eat, with hyperphagia, irritability, and derealization present during episodes. One month after the TBI, he was diagnosed with Latent Autoimmune Diabetes in Adults (LADA) after blood glucose was found to be elevated at 566. Serum GAD-65 antibody level was very elevated at 10,594 U/mL (ref range: 0–5 U/mL), hemoglobin a1c was 7.7%, and insulin was started. Six months later, he was evaluated in the VA Sleep Clinic for continued hypersomnia, despite controlled diabetes. Neurological examination, MRI brain, and sleep-deprived EEG were normal. Cerebrospinal fluid testing was normal, with the exception of a CSF autoimmune encephalitis panel with a positive GAD-65 titer of 0.24 nmol/L (range &lt;0.02 nmol/L) – non-diagnostic for autoimmune encephalitis. HLA-DQ1B status is pending.

Conclusion
Autoimmunity is an emerging topic of clinical significance in KLS. GAD-65 serum antibodies have both endocrine and neurologic significance, with high levels seen in autoimmune diabetes, encephalitis, stiff-person syndrome, and cerebellar ataxia. An autoantibody panel can be considered in patients with KLS, as the presence of autoimmune encephalitis may support the use of immunotherapy.

Support (if any)
Portland VA Research Foundation to Dr. Lim. The contents do not represent the views of the United States Government.
824 Case Series on the Use of Volume Assured Pressure Support in Patients with Chronic Pulmonary Disease and Progressive Hypercapnia
Authors: LeMaster William , Jun Dale , De Cruz Sharon , Zeidler Michelle , Saggar Rajan 
Published: May 2021

Abstract

Introduction
Chronic hypercapnia results from destruction of lung parenchyma which occurs in chronic lung diseases including interstitial lung disease (ILD), bronchiectasis, and chronic lung transplant rejection. Many patients with these diseases will experience progressive respiratory failure eventually requiring consideration of transplantation or re-transplantation. Due to physiologic changes in sleep including reduction in tidal volume, worsening air tapping, and REM atonia, hypoventilation can be exacerbated during the sleeping hours. We present four patients who were prescribed nocturnal Volume Assured Pressure Support VAPS for their progressive hypercapnia.

Report of case(s)
Subject 1 is a 72 year old female with severe bronchiectasis and restrictive lung disease due to TB pneumonia at a young age. Subject 2 is a 45 year old male with history of pulmonary cavitation due to extensive TB disease when he was younger. Subject 3 is a 45-year-old woman with rheumatoid arthritis related ILD with associated pulmonary arterial hypertension. Subject 4 is a 74 year old patient with a bilateral lung transplant for IPF complicated by bronchiolitis obliterans syndrome who presented with progressive dyspnea and hypercapnia. Despite optimal therapy, all of these patients were admitted for hypercapnic and hypoxemic respiratory failure requiring treatment with BPAP then transitioned to nocturnal VAPS on discharge. For all patients, dyspnea and pCO2 improved as outpatients although all patients did eventually experience an exacerbation of their lung disease requiring repeat admission.

Conclusion
Due to the physiologic changes that occur with sleep, patients with severe lung disease may experience worsening CO2 retention while sleeping. There is little data assessing the use of chronic nocturnal non-invasive ventilation (NIV) to treat the hypercapnia of chronic lung diseases other than chronic obstructive pulmonary disease, extra-thoracic restriction, and neuromuscular disease. In this case series, nocturnal VAPS stabilized and/or reduced pCO2 in patients with pulmonary parenchymal disease of various etiologies. Additional studies are needed to assess long term effects of VAPS in these patients, including exacerbations, symptoms, and overall mortality.
Support (if any):