bluuebunny/crossref_metadata_2025_split huggingface dataset:
354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US
Authors: Kale Hrishikesh , Khandker Rezaul , Shah Ruchit , Botteman Marc , Meng Weilin , Jootun Murvin , Qureshi Zaina 
Published: May 2021

Abstract

Introduction
Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients.

Methods
The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time.

Results
A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines.

Conclusion
The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings.

Support (if any)
This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
355 Predictors of Longitudinal Sleep Outcomes in a Statewide Randomized Trial of Telephone Cognitive Behavioral Therapy for Insomnia
Authors: McCurry Susan , Pike Kenneth , Von Korff Michael , Morin Charles , Vitiello Michael 
Published: May 2021

Abstract

Introduction
We examined the relationship between treatment process measures and 12-month insomnia outcomes from a large clinical trial of telephone-delivered CBT-I.

Methods
A statewide sample of 327 Kaiser Permanente Washington members aged 60+ with OA, Insomnia Severity Index (ISI) scores of 11+ and Brief Pain Inventory scores of 9+ were randomized to six sessions of individual telephone-delivered cognitive-behavior therapy for insomnia (CBT-I) vs. education-only control. Participants rated their perceptions of treatment credibility and perceived effectiveness on a 7-point Likert scale after session 1 and at 2-month post-test. They also completed the Sleep Hygiene Index (SHI), the 8-item Sleep Problem Acceptance Questionnaire (SPAQ), and the 8-item Chronic Pain Acceptance Questionnaire (CPAQ) at baseline, post-treatment, and 12 months. Insomnia outcome was measured using the ISI.

Results
Participants (mean age=70.2 years [SD=6.81], 74.6% female, 87.8% with sleep problems for over 1 year) were randomized to the two treatment arms. Regression analyses controlling for baseline age, opioid use, depression, pain, and ISI showed that lower 12-month ISI scores were associated with CBT-I group membership and lower baseline ISI (both p&lt;.001), higher session 1 ratings of treatment credibility (p=.004), higher baseline CPAQ activity engagement (AE) subscale scores (p=.04), and lower baseline SPAQ AE scores (p=.016) when predictors were simultaneously entered. Lower 12-month ISI scores were also associated with post-test ratings of treatment perceived effectiveness (p=.004) and higher SPAQ AE (p=.038) scores. Improvements on the SHI at post-test were significantly associated with lower 12-month ISI scores when variables were entered singly into regression models, but not when all predictors were entered simultaneously. SPAQ and CPAQ sleep and pain willingness subscale scores were not significantly related to ISI outcomes in any model.

Conclusion
People with less severe baseline insomnia levels who received telephone-delivered CBT-I were more likely to have lower 12-month ISI scores. Participant perceptions of treatment credibility and effectiveness, and engagement in life activities despite pain and sleep symptoms were also associated with long-term improvements in insomnia, but willingness to experience sleep and pain symptoms were not contributing factors.

Support (if any)
This work was supported by PHS grant 5R01AG053221.
371 Insomnia and Metacognitive abilities: a new treatment target?
Authors: Sforza Marco , Scarpellino Alessandro , Salibba Andrea , Galbiati Andrea , Zucconi Marco , Casoni Francesca , Ferini-Strambi Luigi , Castronovo Vincenza 
Published: May 2021

Abstract

Introduction
Metacognition is defined as the ability to reflect on one’s mental state. Literature showed that dysfunctional metacognitive activity (such as worry and rumination) plays an important role in insomnia genesis and maintenance. The aim of this study is (i) to evaluate metacognition differences between insomnia disorders (ID) patients and good sleepers (GS)and (ii) to assess Cognitive-Behavioral Therapy for Insomnia (CBT-I) effectiveness on both insomnia and metacognitive abilities.

Methods
We compared 27 GS (Insomnia Severity Index, ISI&lt;10) (63.0% female, mean age 33±13.7yrs) and 27 ID patients (51.9% female, mean age 46.4±13.7yrs) evaluated both by ISI and Metacognition Insomnia Questionnaire (MCQ-I). ID patients underwent 7-session of group CBT-I and were evaluated pre- (T0) and post- (T1) treatment.

Results
GS and ID patients differed in MCQ-I total score (GS=105.6±20.5 vs ID= 138.1±26.2). All ID patients’ scores were above the clinical cutoff of 110. ID patients showed significant improvements both at ISI (T0=14.67±4.67 vs T1=7.07±4.37, p&lt;0.001) and Sleep Diary parameters (T0 vs T1, p&lt;0.05) as sleep latency, wake after sleep onset and sleep efficiency at T1. ID patients also showed an improvement of MCQ-I scores at T1, nevertheless, maintaining MCQ-I the mean score above the clinical cutoff level (MCQ-I_T0=138.1±26.2 vs MCQ-I_T1=123.7±28.6; p&lt;0.05). Indeed, 29.6% of ID patients maintained equal or worse MCQ-I score at T1 compared to T0; 63% of ID patients still had a MCQ-I score above the clinical cutoff at T1.

Conclusion
CBT-I results effective on insomnia symptoms. Metacognitive dysfunctions appears to be a core feature in ID patients compared to good sleepers. Although the score reduction was significant after CBT-I, metacognitive dysfunction did not show remission after treatment possibly indicating the need of a specific intervention on this aspect. Metacognitive dysfunction in ID needs to be further investigated and may represent a new treatment target, in order to improve CBT-I effectiveness.

Support (if any)
None
374 Cognitive Behavioral Therapy with Exercise in Adults with Insomnia and Short Sleep: Daytime Function Outcomes from a Pilot Study
Authors: Kubala Andrew , Egeler Mara , Buysse Daniel , Hall Martica , Barinas-Mitchell Emma , Kline Christopher 
Published: May 2021

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) is efficacious, but there is mixed evidence as to whether improvement is blunted in adults with insomnia and short sleep duration. Exercise training can reduce physiologic hyperarousal and may increase homeostatic sleep drive, which could potentiate CBT-I treatment effects. This pilot study explored changes in self-reported outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and objective short sleep duration.

Methods
Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (mean actigraphic TST &lt;6.5 hr) completed a 12-week single-arm trial. Participants self-administered the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program with additional staff guidance while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 days/wk of strength training). Participants completed assessments of self-reported sleep and daytime function pre- and post-intervention, including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), Ford Insomnia Response to Stress Test (FIRST), Perceived Stress Scale (PSS), and Epworth Sleepiness Scale (ESS). Differences between timepoints were analyzed using paired t-tests and Cohen’s d effect size calculations.

Results
Insomnia severity significantly decreased after the intervention (ISI: p&lt;0.001, d=2.99), with 75% reporting post-intervention ISI ≤ 7. Likewise, fatigue significantly decreased after the intervention (FFS: p=0.032, d=0.95). Symptoms of stress-related sleep reactivity and stress were also reduced (FIRST: p=0.012, d=1.19; PSS: p=0.014, d=1.14). Though nonsignificant, large reductions in sleepiness were additionally observed (ESS: p=0.058, d=0.80).

Conclusion
In this pilot trial among patients with insomnia and short sleep duration, online CBT-I plus a supervised exercise program resulted in a significant reduction in insomnia severity. The intervention also produced large and meaningful reductions in fatigue and stress, which are common daytime impairments in patients with insomnia. Future research should attempt to disentangle the independent contributions of CBT-I and exercise on outcomes in this population.

Support (if any)
NIH: K23HL118318
375 Thought Control Strategies and Insomnia Severity in young-adult urban residing African Americans
Authors: Stokes Alicia , Bell Kimberly , Mellman Thomas 
Published: May 2021

Abstract

Introduction
Poor sleep is common in our society, particularly for African Americans. Unwanted, intrusive thoughts at bedtime contribute to sleep disturbances, and the nature of intrusive thoughts may be influenced by perception of threat among people living in stressful urban environments. Research has suggested that strategies to control intrusive thoughts vary in their adaptiveness and may be modifiable. These findings need to be confirmed in populations residing in stressful urban environments where perceived threats contribute to intrusive thoughts.The present study attempts to replicate prior research examining the relationship between thought control strategies and insomnia in urban residing young-adult African Americans.

Methods
Sixty-three young-adult African Americans completed the Thought Control Questionnaire for Insomnia-Revised and the Insomnia Severity Index (ISI).

Results
Thought control strategies previously associated with insomnia were significantly correlated with the ISI (aggressive suppression r=0.51, p&lt;0.01 social avoidance r=0.32, p&lt;.01, behavioral distraction r=0.386, p&lt;0.01 and worry r=0.51, p&lt;0.01). We did not find significant associations between the thought control strategy previously associated with healthy sleep and the ISI (cognitive distraction r= 0.20, p&gt;0.05). In a grouped comparison between good sleepers and those with insomnia worry was the only subscale that was endorsed significantly greater among those with insomnia (t(61)=-2.91, p&lt;.05)

Conclusion
These preliminary data replicate prior findings that suggest that aggressive suppression and worry are maladaptive thought control strategies. in a young-adult African American sample. Future research with a larger sample is needed to identify strategies that can improve sleep in this population.

Support (if any)
5R01HL136626 from the National Heart Lung and Blood Institute
377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings
Authors: Godzik Cassandra , Sorscher Adam 
Published: May 2021

Abstract

Introduction
Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia.

Methods
We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months.

Results
Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%).

Conclusion
Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting.

Support (if any)
Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553
387 The moderating effect of emotion regulation strategies in the relationship between insomnia severity and bedtime procrastination
Authors: Jeon Huisu , Jeoung Sonhye , Kim Goeun , An Hyeyoung , Nam Hyojin , Suh Sooyeon 
Published: May 2021

Abstract

Introduction
Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, despite the absence of external factors. Bedtime procrastination is also prevalent among insomnia patients, and is associated with various sleep problems. Recent studies suggest emotional regulation as a mechanism of the procrastination behavior that is the conceptual foundation of bedtime procrastination. Emotional regulation difficulties are also associated with insomnia, but there is still a lack of research on the relationship between insomnia, emotional regulation strategies and bedtime procrastination. Thus, the study assumed that severity of insomnia would affect bedtime procrastination, and examined the moderating effect of the emotional regulation strategies in this relationship.

Methods
This study was conducted in 376 adults (mean age 23.73 ±2.14 years, 84.6% females). Participants were asked to answer Bedtime procrastination scale (BPS), an emotional regulation strategy checklist, and the Insomnia severity scale (ISI).

Results
As a result, a significant positive correlation was found between insomnia severity and bedtime procrastination (r=.286, p&lt;.01), and avoidant/distractive regulation style (r=.101, p&lt;.05). active regulation style (r=-.172, p&lt;.01) and support seeking regulation style (r=-.102, p&lt;.01) showed a significant negative correlation with the severity of insomnia. Bedtime procrastination behavior showed significant negative correlation only with active regulation style (r=-.151, p&lt;.01). Support seeking regulation style moderated the relationship between insomnia and bedtime procrastination behavior (B=.0165, 95%, CI=.0014, .0316). The interaction effect between insomnia and support seeking regulation style was also significant (∆R^2=.0112, p&lt;.05), indicating that the effect of insomnia on bedtime procrastination depends on the level of use of the support seeking regulation style.

Conclusion
These findings suggest that the level of support seeking regulation style is meaningful in terms of how insomnia affects bedtime procrastination.

Support (if any)
This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea(NRF-2018S1A5A8026807)
389 The Association between Arousals and Neurochemical Biomarkers Accumulation in Obstructive Sleep Apnea with Low Arousal Threshold
Authors: Liu Yi-Shin , Tsai Cheng-Yu , Majumdar Arnab , Lin Shang-Yang , Lin Yin-Tzu , Ho Shu-Chuan , Cheng Wun-Hao , Liu Wen-Te , Wu Dean , Lee Hsin-Chien , Kuan Yi-Chun , Wu Cheng-Jung , Lo Chen-Chen 
Published: May 2021

Abstract

Introduction
Previous studies indicated the accumulation of neurodegenerative protein may be caused by higher Obstructive sleep apnea syndrome (OSAS) severity. However, the association between arousal-related parameters induced by OSAS and the amyloid burden remains unclear. The aim of this study is to investigate the association between arousal threshold (ArTH) and neurochemical protein accumulation in OSAS patients.

Methods
Suspected OSAS participants were performed Mini-mental status examination (MMSE) and full-night polysomnography (PSG) in the sleep center of Taipei Medical University Shuang Ho Hospital, Taiwan. On the same morning, the blood samples were obtained from the participants. The concentrations of total Tau (T-Tau) and amyloid beta peptide 42 (Aβ42) were quantified by ultra-sensitive immunomagnetic reduction assays. An overall of 23 participants were enrolled and classified into Low ArTH group (n=12) and High ArTH group (n=11) based on low ArTH criteria. Regarding the statistical methods, for categorical variables and continuous variables, Fisher’s exact test and Mann-Whitney U test were performed to investigate the differences between groups, respectively. The associations between biomarkers concentrations and PSG parameters were assessed by Spearman’s correlation.

Results
Regarding the demographic characteristics in two subgroups, significantly lower body-mass index and OSAS severity were noted in Low ArTH group (p&lt;0.05). The MMSE was in normal range in both groups and had no significant differences in subgroups. For PSG parameters, there were significantly lower desaturation index, AHI and higher spontaneous arousals index in each sleep stage in Low ArTH group (p&lt;0.01). Nevertheless, in the plasma neurochemical biomarkers, Aβ42 and Aβ42 X T-Tau were significantly higher in Low ArTH group (p&lt;0.05). Moreover, in Low ArTH group, T-Tau was positively correlated with respiratory arousals index (r=0.61, p&lt;0.05) and all arousals index (r=0.76, p&lt;0.01), respectively. The positive correlations between Aβ42 X T-Tau and respiratory arousals index (r=0.62, p&lt;0.05), all arousals index (r=0.75, p&lt;0.01) could also be observed. There were no significant correlations noted in High ArTH group.

Conclusion
OSAS patients with low ArTH have higher neurochemical biomarker levels. Also, the significantly positive correlations between arousals and biomarkers were observed in that group.
Support (if any):
394 A convolutional neural networks model for the detection of cortical arousals from heart rate
Authors: Lockyer Brandon , Wellman Andrew , Zitting Kirsi-Marja 
Published: May 2021

Abstract

Introduction
Cortical arousals are transient events of disturbed sleep that occur frequently in sleep disordered breathing (SDB) and can be used as an indicator of sleep quality. While cortical arousals are typically scored from the electroencephalogram (EEG), arousals are associated with increased sympathetic activity and could therefore be detected from measures of sympathetic activity such as heart rate. Most home sleep test and consumer wearable devices enable continuous recording of heart rate via the electrocardiogram (ECG) or optical heart rate sensors without the inconvenience of EEG electrodes. In this preliminary study, we developed a deep learning-based convolutional neural networks (CNN) model to detect arousals from heart rate.

Methods
This study included 1,083 polysomnograms (PSGs) from five independent studies (Tucson Children’s Assessment of Sleep Apnea, Mechanisms of Pharyngeal Collapse in Sleep Apnea, Impact of the Arousal Threshold in Obstructive Sleep Apnea, Predicting Successful Sleep Apnea Treatment with Acetazolamide in Heart Failure Patients, Combination Therapy for the Treatment of Obstructive Sleep Apnea) that were scored for arousals according to American Academy of Sleep Medicine scoring rules. These studies included PSGs from both children and adults (ages 6 and above), with most data coming from participants with evidence or diagnosis of SDB. We used the Pan-Tomkins algorithm to detect R-peaks from the raw ECG signal, transformed the peaks into normalized instantaneous heart rate at 1 Hz frequency, and produced arousal probability in 1-second resolution using a simple CNN model. Due to slight asynchrony between the appearance of arousals in the EEG versus the heart rate, all overlaps between model-predicted arousals and manually scored arousals were considered true-positives.

Results
We evaluated the model on a validation set (n=216). The model achieved a gross area under precision-recall curve score of 0.67 and a gross area under receiver operating characteristics curve of 0.91 Correlation between the number of model-detected and manually scored arousal events was r=0.76.

Conclusion
This preliminary study demonstrates that a deep learning approach has the potential to accurately detect arousals in home sleep tests and consumer wearable devices that measure heart rate.

Support (if any)
The study was supported by grant #207-SR-19 from the American Academy of Sleep Medicine Foundation.