bluuebunny/crossref_metadata_2025_split huggingface dataset:
602 Sleep Moderates Improvements in Mental Health Outcomes in Youth: Building Resilience for Healthy Kids
Authors: Kaar Jill , Ware Meredith , Bowen Anne , Chandrasekhar Jessica , Lee Joey , Shomaker Lauren , Simon Stacey 
Published: May 2021

Abstract

Introduction
To examine the role of sleep health in a school-based health coaching resiliency intervention for 6th grade students. We hypothesized that participants with insufficient sleep would have poorer mental health outcomes and that the intervention would be less successful for youth with poor sleep health.

Methods
A total of 285, 11-12-year-old students (72% white, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth completed electronic surveys at baseline and 6-week follow-up assessing mental health parameters and self-reported bed and wake time. Participants were categorized as having insufficient sleep opportunity if they reported time in bed of &lt;9 hours per night. General linear models examined differences between groups for each mental health parameter, as well as change in mental health parameters from baseline to follow-up.

Results
A third of participants (31%) reported time in bed &lt;9 hours per night. Youth with insufficient sleep were less often white (58% vs 73%; p&lt;0.001) or Hispanic (26% vs 15%; p=0.04) and were more likely to be classified with mild to severe depression and anxiety (55% vs 35%; p=0.004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.

Conclusion
Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency and mental health interventions. Addressing sleep health may be an important consideration for future school-based mental health interventions.
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611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome
Authors: Patel Nisha , Morgenthaler Timothy , Baughn Julie 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS.

Methods
A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded.

Results
94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis.

Conclusion
Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs.
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621 Association of E-cigarette and Tobacco Use with Adolescent Sleep Quality
Authors: Malhotra Clare , Gunge Deepti , Advani Ira , Boddu Shreyes , Nilaad Sedtavut , Crotty-Alexander Laura 
Published: May 2021

Abstract

Introduction
Recently, targeted marketing has encouraged teen e-cigarette vaping. Although e-cigarettes are often presented as a safe alternative to conventional tobacco, their toxicity is unclear. In adults, we have previously observed a link between dual usage of e-cigarettes and tobacco with increased sleep latency. We hypothesized an association between dual usage and increased sleep latency.

Methods
Participants were recruited to complete social media surveys. We performed three surveys: Survey 1 (n=47) in 2018, Survey 2 (n=1198) in 2019, and Survey 3 (n=564) in 2020. Surveys 1 and 2 had three sections: past and current inhalant use, the Pittsburgh Sleep Quality Index (PSQI), and the Leicester Cough Questionnaire (LCQ). Survey 3 did not include the LCQ, instead including the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ9). The adolescent data (aged 13–20 years; n=609) were isolated.

Results
Adolescents reported an increase in sleep duration with increasing age by one-way ANOVA. Males reported no change with increasing age, while, by Tukey’s multiple comparisons test, females got significantly more sleep at ages 19 and 20 than at age 14(p&lt;0.01). There was no significant correlation between inhalant use and sleep duration. When broken down by gender, female dual users slept more than female nonsmokers,(p=0.01; mean difference=43.8 minutes; CI=0.11 to 1.36), while there was no difference in males. We observed a significant association between inhalant use and sleep(p=0.0008), with dual use correlated with a longer sleep latency than nonsmokers (mean difference=6.27 minutes; CI=1.40 to 11.13. We saw no correlation between inhalant use and anxiety or depression, nor between inhalant use and cough severity and prevalence.

Conclusion
In female adolescents, we observed a peak in sleep hours at age 19 but significantly less sleep in fourteen-year olds. College-aged females may have a later wake time relative to middle-school and high-school aged females. Dual inhalant use in females was associated with a long sleep duration, raising concern for sleep disruption caused by dual use. Dual use’s association with increased sleep latency raises concern for nicotine-induced wakefulness. Further data are required in order to define public health strategies.

Support (if any)
LCA is supported by NIH.
642 A School-Based Health and Mindfulness Curriculum Improves Children’s Objectively Measured Sleep
Authors: Chick Christina , Anker Lauren , Singh Anisha , Buck Casey , Kawai Makoto , Gould Christine , Cotto Isabelle , Schneider Logan , Linkovski Omer , Matlow Ryan , Bradley Travis , Carrion Victor , O’Hara Ruth 
Published: May 2021

Abstract

Introduction
Children of low socioeconomic status (SES) experience shorter sleep duration and poorer sleep quality, as well as more daytime sleepiness, compared to children of higher SES. Early interventions teaching skills for managing stress may mitigate the effects of SES-associated stress on trajectories of physical and mental health. We examined effects of a school-based health and mindfulness curriculum, teaching stress management skills such as paced breathing, on sleep and stress in school-aged children. We hypothesized curriculum exposure would improve children’s ability to manage stress, and that this would improve objectively measured sleep (i.e., increase duration of total and REM sleep).

Methods
Using a prospective observational cohort design, we recruited 115 children (49 girls, ages eight to 11) from two Northern California school districts. Of these, 58 children attended a school district that delivered a health and mindfulness curriculum twice weekly during their physical education time. 57 children attended an SES-matched school district that delivered a traditional physical education curriculum. Ambulatory polysomnography and perceived social stress were measured at baseline (before curriculum exposure) and at one- and two-year follow-ups.

Results
Children receiving the curriculum gained an average of 74 minutes of total sleep and 24 minutes of rapid eye movement (REM) sleep per night during the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep of 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure. Children who reported higher curriculum engagement (e.g., using the breathing exercises at home) experienced larger changes in sleep architecture and perceived social stress. Social stress did not mediate effects of the curriculum on sleep.

Conclusion
We conducted the first study to examine effects of a school-based health and mindfulness curriculum on children’s objectively measured sleep. Children from a low-SES community who received the curriculum experienced increased total and REM sleep, compared to an SES-matched cohort not receiving the curriculum. Mindfulness training may have increased awareness of stress, while developing tools to reduce stress vulnerability. These results warrant additional investigation to assess whether benefits persist after curriculum cessation and/or generalize to other populations.
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651 Longitudinal, unobtrusive, and ecologically valid sleep metric estimation from a smart bed to predict the pathology of COVID-19
Authors: Guzenko Dmytro , Garcia Gary , Siyahjani Farzad , Monette Kevin , DeFranco Susan , Sikri Deepika , Chung Johnny , Van Cauter Eve , Somers Virend , Mushtaq Faisal 
Published: May 2021

Abstract

Introduction
Pathophysiologic responses to viral respiratory challenges such as SARS-CoV-2 may affect sleep duration, quality and concomitant cardiorespiratory function. Unobtrusive and ecologically valid methods to monitor longitudinal sleep metrics may therefore have practical value for surveillance and monitoring of infectious illnesses. We leveraged sleep metrics from Sleep Number 360 smart bed users to build a COVID-19 predictive model.

Methods
An IRB approved survey was presented to opting-in users from August to November 2020. COVID-19 test results were reported by 2003/6878 respondents (116 positive; 1887 negative). From the positive group, data from 82 responders (44.7±11.3 yrs.) who reported the date of symptom onset were used. From the negative group, data from 1519 responders (48.4±12.9 yrs.) who reported testing dates were used. Sleep duration, sleep quality, restful sleep duration, time to fall asleep, respiration rate, heart rate, and motion level were obtained from ballistocardiography signals stored in the cloud. Data from January to October 2020 were considered. The predictive model consists of two levels: 1) the daily probability of staying healthy calculated by logistic regression and 2) a continuous density Hidden Markov Model to refine the daily prediction considering the past decision history.

Results
With respect to their baseline, significant increases in sleep duration, average breathing rate, average heart rate and decrease in sleep quality were associated with symptom exacerbation in COVID-19 positive respondents. In COVID-19 negative respondents, no significant sleep or cardiorespiratory metrics were observed. Evaluation of the predictive model resulted in cross-validated area under the receiving-operator curve (AUC) estimate of 0.84±0.09 which is similar to values reported for wearable-sensors. Considering additional days to confirm prediction improved the AUC estimate to 0.93±0.05.

Conclusion
The results obtained on the smart bed user population suggest that unobtrusive sleep metrics may offer rich information to predict and track the development of symptoms in individuals infected with COVID-19.
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654 Potential Longitudinal Association Between COVID-19 Infection Outcomes and Insomnia Symptoms
Authors: Vargas Ivan , Muench Alexandria , Grandner Michael , Perlis Michael 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has had an unequivocal negative impact worldwide, including increases in stress related to social isolation, unemployment, grief, and fear of contracting the virus. This increased stress has likely led to a greater prevalence of sleep continuity disturbance (i.e., insomnia) in the general population. The goal of the present study was to assess the prevalence of sleep continuity disturbance (i.e., insomnia) in the United States during the initial months of the pandemic. In addition, longitudinal assessment is currently ongoing in order to further assess participant experiences with COVID-19. Specifically, these follow-up data will be used to assess whether, among those that contracted COVID-19, insomnia at baseline (Time 1) predicts worse outcomes (e.g., symptoms of greater frequency, duration, or severity) upon follow-up (Time 2).

Methods
A national survey was conducted from April-June 2020. Participants answered questions regarding social distancing practices, mood, sleep, physical activity, and COVID-19 symptoms. Insomnia symptom prevalence and severity were estimated with a retrospective sleep diary and the Insomnia Severity Index (ISI). A follow-up assessment is currently ongoing and will be completed in March 2021. The follow-up survey consists of similar questions and additional items regarding COVID-19 testing, symptoms [frequency, duration, and severity], and outcomes [outpatient treatment, incidence and duration of hospitalization, and incidence and type of respiratory assistance].

Results
4,133 adults (Mage = 45.8 years; range = 18 - 86 years; 78.7% female) completed the baseline survey. The prevalence of clinically significant sleep continuity disturbance (≥ 30 minutes) was 44.6% for sleep latency problems and 36.2% for wake after sleep onset problems. Nearly 34% of subjects reported average total sleep times of less than 7 hours. Over 17% of subjects (n = 719) reported total ISI scores in the clinical range (ISI total score ≥ 15).

Conclusion
The present study suggests the prevalence of clinically significant insomnia symptoms during COVID-19 remain high in the general population (17–45% depending on definition of insomnia). Similarly, the prevalence of short sleep is elevated. Whether these incident data are associated with COVID-19 outcomes remains to be determined and will be the subject of follow-up analyses in January/February 2021.

Support (if any)
Vargas: K23HL141581; Perlis: K24AG055602
657 Patient Perspectives on Telesleep Care in COVID Times: An Urban Teaching Hospital Survey
Authors: Munoz Tomas , Patel Palakkumar , Viswanath Shilpa , Prasad Bharati 
Published: May 2021

Abstract

Introduction
Telehealth is a relatively new tool for patient care, and to reach underserved areas where certain specialties are available. With the advent of the COVID19 pandemic, Telehealth has become a universal way to provide safe and quality patient care. However, Telehealth is a new experience for many providers and patients. We surveyed patients who received telehealth visits in sleep medicine between March and June 2020 to determine patient satisfaction and common technology-related barriers. The goal was to formulate actionable steps for improving patient’s experiences and determine the feasibility of long-term telehealth services for sleep medicine.

Methods
We interviewed 63 patients by phone, utilizing IRB approved surveys for telehealth satisfaction and technology. Responses were de-identified, tabulated, and analyzed in aggregate using Excel®.

Results
85% of respondents had a high-school diploma or a higher level of education (9.6% students, 39.7% employed, 15.9% unemployed, and 19% retirees). 62% of participants participated in Telehealth for the first time. 89% preferred Telehealth, and 76% rated telehealth experience as good or better than in-person visits. 92% did not require technical assistance during the visit. Long-term telehealth care was acceptable to 63% of participants. Approximately 33% had technology-related barriers (no computer or webcam), and 12% did not have email. However, 89% had smartphones (70% connected to personal internet). Other barriers cited were lack of private space (13%) and taking time off work (9%). No clear preference for phone versus video Telehealth was noted (approximately 40% each), but 7% expressed concern about bi-directional video communication. This may be related to the privacy and security concerns expressed by 20% of respondents. However, only 5% reported using the electronic health record (EHR) based secure communication portal.

Conclusion
Sleep care via Telehealth is preferred by most patients during the COVID pandemic and is acceptable to two-thirds of patients for the long-term. In addition to access to personal devices or the internet, privacy concerns were a barrier to Telehealth. We plan to increase patient enrollment in the EHR-based portal to deliver telehealth services and communication securely to mitigate these barriers.
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662 PAP Therapy: A Review of Resources for the Uninsured during COVID-19
Authors: Malinky Melissa , Oberla Abigail , Khan Meena , Melanie Lyons M 
Published: May 2021

Abstract

Introduction
In 2019, the United States Census estimated 8% (26.1 million) people were without health insurance. Further, an estimated 3.5 million people became/remained uninsured from COVID-19-related job losses. Patients with OSA that belong to a lower socioeconomic status (SES) are less likely to have access to healthcare and may be under or uninsured. Untreated OSA can lead to increased risk of symptoms and associated co-morbidities. Resources to help the uninsured to obtain PAP therapy were available pre-COVID, including two main sources, American Sleep Apnea Association (ASAA) and our local branch serving central Ohio, The Breathing Association. However, the COVID pandemic limited access or closed these programs. Our Sleep Medicine clinics saw 148 uninsured OSA patients between March-December, 2020. Given these difficulties, we re-evaluated available resources for the uninsured.

Methods
We conducted a search for current low cost ($100 or less) PAP therapy options for the uninsured, March 15, 2020-December 3, 2020, by: (1) contacting pre-COVID-19 resources, including Durable Medical Equipment (DME) providers, (2) consulting social work, and (3) completing a librarian assisted web-search not limited to PubMed, Embase, CINAHL for academic related articles and electronic searches using a combination of English complete word and common keywords: OSA, PAP, uninsured, no insurance, cheap, medically uninsured, resources, self-pay, low-income, financial assistance, US. Resources such as private sellers were not investigated.

Results
During COVID-19, assistance for PAP machines/supplies have closed or required a protracted wait-time. Options including refurbished items range from low, one-time fixed cost or income-based discounts from: one local charity (Joint Organization for Inner-City Needs) and DME (Dasco), and four national entities (ASAA, Second Wind CPAP, Reggie White Foundation, CPAP Liquidators). An Electronic Health Record-based tool was developed and distributed to increase provider awareness of pandemic available resources.

Conclusion
Untreated OSA is associated with increased risk of cardiovascular co-morbidities. Access and cost may limit treatment in OSA patients from a lower SES. The COVID-19 pandemic has shuttered programs providing discount PAP and supplies, leaving fewer resources for these patients, thus further widening this health care disparity. Alternatives are needed and current resources are not easily accessible for providers and patients.
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Social media for students sleep health promotion: A health intervention report during COVID-19
Authors: Lopes Maria-Cecilia , Gutierres Gabriela , Salmazo Henrique 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic affected sleep health. Students’ sleep health requires cognitive processes, mental and physical balance. We assume that the pandemic COVID-19 has modified some sleep habits by eliciting environmental and social interaction changes. According to the perspective that the students need health education interventions on sleep hygiene, we aimed to promote sleep health education based on social media in students using Instagram.

Methods
Students participated by answering an online questionnaire in Instagram platform. The sample was 300 students with internet access between two weeks of March/2020. This period refers to the second and third week of the social isolation policy enacted due COVID-19. The Snowball strategy was the dissemination method, a non-probabilistic sampling technique in which the participants invited new participants from their network of acquaintances.

Results
The valid responses were from students among 18–24 y.o. The sample was mostly female (61,7%), between 18 and 22 y.o., and they sleeped less than 8 hours. Also, 76,3% of the surveyed reported somnolence during the day, 70,2% anxiety and 87,8% worse sleep associated to stress and/or anxiety, which indicated the variables for an educational health intervention design in this context. Most of the sample did stipulate a schedule to wake up on the weekdays (96,6%), and 24,4% of the sample didn’t stipulate a fixed schedule for bedtime during the weekdays. More than 150 people (53,2%) didn’t make any effort to avoid screens before sleeping. The responses’ distribution showed that an average number of people (73,9%) try to avoid using the bed for work or watch television, and 83,1% seek to avoid heavy foods before sleeping.

Conclusion
The Instagram profile focused on the main sleep issues seen in the survey. The posts were created using subjects about sleep process, sleep hygiene practices for students; sleep stages, function and regulation; sleep-wake circadian rhythms. The creation of the @comodormimos profile on Instagram was based on the need for a subject understanding by the researched public. Coronavirus’ pandemic increased the harmful sleep behavior of students. Further studies should be done to understand the impact of COVID-19 pandemic in the student’s sleep health.
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