bluuebunny/crossref_metadata_2025_split huggingface dataset:
265 Blue Light Filtering Laptop and Tablet Screen Protectors Used After Sunset Improve Sleep
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Rodriguez Rodolfo , Raymann Roy 
Published: May 2021

Abstract

Introduction
Light exposure at night is associated with altered sleep behavior and impaired sleep satisfaction, in part due to suppressing the release of melatonin. According to a National Sleep Foundation poll, 90% of people report using electronic devices within an hour of bed at least a few times per week. This study aimed to examine how use of EyeJust, a blue light filtering screen protector applied to laptops and tablet devices, impacted sleep.

Methods
A within subjects, pre-post intervention design was implemented. Adults (n=24) who self-reported regular blue light exposure after sunset and eye strain participated in a 6-week study (3 weeks of baseline followed by 3 weeks of product use). Intervention consisted of the use of blue light filtering screen protectors on iOS devices used after sunset. Sleep was measured objectively each night using SleepScore Max and by self-report. Participants also reported level of eye strain each night. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
Across participants (75% female; age 21-50, avg. 37), there were 850 nights of sleep measured. When measured pre-post, many aspects of perceived sleep improved when using the screen protectors: sleepiness at bedtime, falling asleep in the preferred amount of time, ability to sleep through the night, feeling rested in the morning, sleep quality, and satisfaction with sleep (ps&lt;.05). When measured daily, improvement was seen in eye strain, perceived time to fall asleep, perceived awakenings, and time spent awake at night (ps&lt;.05). Objective sleep improvement was found in a subgroup of younger adults (age 21-35). They spent more time in bed (p=.03) and slept longer (6 hours, 40 minutes on average during baseline vs. 6 hours, 50 minutes during intervention; p=.04). This subgroup also had more REM sleep as reflected by a 2% increase in MindScore (measure of REM sleep; p=.04)

Conclusion
Using blue light filtering screen protectors helped improve sleep, measured by self-report and objectively, especially among younger adults. This intervention may help reduce the negative impact electronic devices have on sleep.

Support (if any)
EyeJust
273 Automatic sleep staging with photoplethysmography and accelerometer in a community-based population
Authors: Lee Pei-Lin , Ting Nettie , Lin Yu-Cheng , Chiu Hung-Chih , Liu Yu-Ting , Ku Bo-Wen 
Published: May 2021

Abstract

Introduction
The study aims to validate the automatic sleep staging system (ASSS) with photoplethysmography (PPG) and accelerometers embedded in smart watches in community-based population

Methods
75 healthy subjects were randomly recruited form 304 staffs in an industrial firm who volunteered for this study. A four-stage classifier was designed based on Linear Discriminant Analysis using PPG and accelerometers. To better validate the system performance, the leave-one-out approach was applied in this study. The performance of ASSS was assessed with the epoch-by-epoch and whole-night agreement for sleep staging against manual scoring of overnight polysomnography.

Results
The mean agreement of four stages across all subjects was 61.1% (95% CI, 58.9-63.2) with kappa 0.55 (0.52-0.58). The mean agreement for wake, light sleep (LS), deep sleep (DS), and REM was 53.4%, 84.1%, 40.3%, 75.6%, respectively. The whole-night agreement was good-excellent (Intra-class correlation coefficient, 0.74 to 0.84) for total sleep time, sleep efficiency, wake after sleep onset, and duration of wake and REM. The agreement was fair for sleep onset and LS duration, but poor for DS duration.

Conclusion
Our result showed that PPG and accelerometers based smart watches have proper validity for automatic sleep staging in the community-based population.

Support (if any)
“Center for electronics technology integration (NTU-107L900502, 108L900502, 109-2314-B-002-252)” from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan; MediaTek Inc (201802034 RIPD).
278 Understanding Perspectives on Artificial Intelligence Technologies for Sleep Self-Management
Authors: Kearns William , Laine Megan , Oh Esther , Thompson Hilaire , Demiris George 
Published: May 2021

Abstract

Introduction
Until recently, understanding one’s sleep activity relied on technology only available in sleep labs with data analyzed by experts. Transitioning this technology from the lab to natural environments results in noisy data. Fortunately, advances in signal processing through Artificial Intelligence (AI) have made these technologies accessible to consumers. This study seeks to provide recommendations that address user preferences and concerns related to sleep self-management devices and software that leverage AI, as they have the potential to increase both the quantity and quality of sleep data available to researchers.

Methods
We assigned adult participants (N=25) with Pittsburgh Sleep Quality Index scores ≥ 5 (indicating low sleep quality) to one of four focus group sessions based on their self-reported prior use of sleep technologies. After a short demonstration, the moderator solicited participant feedback on devices and software in each of the following four categories: • headbands (Beddr, Dreem 2, Muse S) • sleep tracking mats (Withings) • snoring detectors (Smart Nora) • mobile applications (Sleep Cycle Alarm Clock, Sleep Score, Do I Snore, Sleep Rate)

Results
Participants anticipated discomfort from wearing headbands and placing snoring detectors under their pillow, although a subset of participants indicated that they would be willing to sacrifice comfort in exchange for improved accuracy. Conversely, participants were interested in sleep tracking pads since they could passively collect sleep data without additional burden. Similarly, participants viewed mobile applications positively due to their ability to collect sleep data from a nightstand rather than being attached to the participant; however, there were concerns about remembering to activate these applications.

Conclusion
Based on these results, we recommend using sleep tracking mats to collect patient-generated sleep data due to their ease of use and relative comfort, the main concerns related to lab-based sleep study participation. As a passive sensor, these require the least setup and support consistent data collection. Other devices run the risk of participants forgetting to use the device or becoming removed during the night resulting in missing data. By leveraging these existing technologies for remote sleep studies, researchers can increase recruitment and accessibility to promote sleep research participant diversity.
Support (if any):
353 A Direct-to-Patient Mailing about Sedative-Hypnotics and Online CBT-I: Participant Reported Use of Study Materials
Authors: Mak Selene , Ulmer Christi , Kaufman Chritopher , Alessi Cathy , Martin Jennifer , Smith Jason , Mitchell Michael , Josephson Karen , McCarthy Michaela , Lum Hillary , Fung Constance 
Published: May 2021

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment for chronic insomnia disorder for all adults. Older adults are often prescribed sedative-hypnotics (e.g., benzodiazepine receptor agonists, BRAs) for insomnia, despite observational studies showing these medications increase risk of falls, fractures, and cognitive decline. In an ongoing randomized controlled trial, we are testing “Sleep EducatioN Information Sent Directly to Patients (SEND),” a novel program combining direct-to-patient mailing with information about access to an online CBT-I resource, compared to a similarly structured control condition. In the current study, we surveyed participants in both groups to examine their self-reported use of intervention or control materials.

Methods
In the larger trial, 1,672 Veteran participants (aged &gt;=65 years, receiving care from a Colorado VA facility, and prescribed a BRA) were randomized to receive the SEND intervention brochure with information on how to access a free, anonymous online CBT-I resource (n=836) or control condition brochure with information about general sleep education (n=836). Six months after the initial brochure mailing, all participants were mailed a blinded survey querying participants’ recollection and use of the mailed materials. We used chi-squared tests to compare survey responses for SEND versus control groups.

Results
354 surveys were returned by study participants (overall response rate: 21%; SEND: 172 [20%], control: 182 [22%]). Respondents were 94% male with mean age 71.7 years (no difference between groups). In the SEND group, 97 (56%) reported receiving the brochure, 18 (10%) visited the website, and 14 (8%) discussed the brochure with their provider. No significant differences between groups were observed in the number of participants who reported receiving the brochure (chi2=2.96, p=.085); visiting the website (chi2=0.0253, p=.874); or discussing the brochure with their provider (chi2=1.91, p=.167).

Conclusion
At 6-months follow-up, over half of participants recalled receiving a mailing about sedative-hypnotics. A modest number reported visiting the online CBT-I program and a similar number discussed the materials with their healthcare provider. Similar results between groups suggest successful blinding of the intervention and control participants. If successful, the SEND intervention may provide a low-touch, low-cost approach to address BRA over-use in some older adults.
Support (if any):
426 Clinical Validation of A.I. Analysis of Photoplethysmogram (PPG) Based Sleep-Wake Staging, Total Sleep Time, and Respiratory Rate
Authors: Watson Nathaniel , Fernandez Chris , Rusk Sam , Nygate Yoav , Turkington Fred , Mortara Justin 
Published: May 2021

Abstract

Introduction
The Photoplesthymogram (PPG) raw waveform is the basis for both the pulse rate and oximetry during polysomnography (PSG) and Home Sleep Apnea Tests (HSAT). The PPG has also recently become ubiquitous as a basis of continuous measurement for the most widely adopted consumer sleep technologies, particularly smart watches. In this study, we clinically validate AI performance for interoperable, PPG-based epoch-by-epoch Sleep-Wake staging (PPG-SW), Total Sleep Time (PPG-TST), and Respiratory Rate (PPG-RR), when compared to 1) PSG-based panel scoring by technologists (RPSGTs) and 2) PSG-based AI scoring (EEG-SW, EEG-TST, Effort Belt-RR).

Methods
We applied stratified random sampling with proportionate allocation to a database of N&gt;10,000 retrospective PSGs. We controlled for: 1) Obstructive sleep apnea severity, 2) Sleepiness, 3) Medical diagnoses including sleep, psychiatric, neurologic, neurodevelopmental, cardiac, pulmonary, metabolic disorders, 4) Medications including benzodiazepines, antidepressants, stimulants, opiates, sedative-hypnotics, 5) Demographics including sex, age, BMI, weight, and height, to establish representative adult (N=100) PSG studies from which PPG samples were obtained. Double blinded scoring was prospectively collected for each PSG by 3 experienced RPSGTs randomized from a pool of 6 scorers. RR was established by mode when two scorers agreed on RR value and median otherwise.

Results
AI EEG-SW demonstrated 96%/94%/95% Sensitivity/Specificity/Accuracy compared to 2/3 majority PSG staging, and AI PPG-SW demonstrated 90%/89%/90% Sensitivity/Specificity/Accuracy compared to the same PSG panel. AI EEG-TST achieved a Pearson Correlation Coefficient (R-value) of 0.968 and AI PPG-TST achieved 0.873 R-value compared to 2/3 majority PSG-TST. When compared to the RR panel consensus in N=282 one-minute RR scoring epochs of PSG, AI Effort Belt-RR performance was &lt;= 2 breaths-per-minute (brpm) in 93.6% of epochs with an average difference of 0.992 brpm, and AI PPG-RR performance was &lt;= 2 brpm in 92.2% of epochs with an average difference of 0.996 brpm.

Conclusion
The study shows interoperable AI analysis performs robustly in evaluating PPG-based epoch-by-epoch sleep-wake stages, total sleep time, and respiratory rate, demonstrating state-of-art accuracy when compared to a prospective, double-blinded PSG scoring panel. This work has implications for consumer sleep technology, HSAT accuracy, inpatient sleep monitoring, and may support the growth of HSATs by increasing total sleep time accuracy and reliability.
Support (if any):
473 Effectiveness of tailored peer-based sleep health education and social support in increasing home-based OSA screening among blacks
Authors: Jean-Louis Giardin , Seixas Azizi , Rogers April , Blanc Judite , Jin Peng , Ravenell Joseph , Ogedegbe Olugbenga 
Published: May 2021

Abstract

Introduction
Our Sleep Disparity Workgroup has investigated several approaches to reducing sleep health disparities. In the METSO trial, we observed phone-delivered sleep education addressing impediments to OSA care among blacks was successful in increasing OSA evaluation. We found in the TASHE trial web-based sleep education significantly increased OSA self-efficacy among blacks. In the present RCT, we examined the role of congruent peer sleep educators and social support (PEERS-ED) in navigating blacks seeking OSA care.

Methods
In the two study arms RCT, we ascertained PEERS-ED’s effectiveness in increasing OSA screening among 317 blacks at OSA risk (intervention=159 and control=158); the average age was 47±12.9 years, 41% were male. OSA risk was assessed with the ARES questionnaire, administered in barbershops, and places of worship. Data also included assessment of beliefs and attitude (DBAS), apnea knowledge (AKT), apnea beliefs (ABS), readiness to change, anxiety, depression, and social support. Participants in the intervention arm received quality-controlled, culturally and linguistically tailored OSA education by trained PEERS during a 6-month period. The present analysis focused on the PEERS-ED effectiveness in increasing physician-recommended home-based OSA screening. Analysis also considered the role of psychosocial factors in adherence to OSA screening. Analyses were performed using the R-studio software.

Results
Results showed no significant differences in baseline demographic and clinical measures contrasting patients in the arms. The adherence rates for OSA screening between the intervention and control arms were 45.9% and 45.6%, respectively. The average DBAS and ABS scores were significantly greater among blacks who had home-based screening (DBAS: 6.0±1.8 vs. 4.9±2.2; p=0.024 and ABS: 77.0±7.1 vs 73.2±7.4; p=0.041). Other measures did not show significant differences between patients who had OSA screening versus those who did not. We observed those who screened were likely to experience greater level of social support (8.23±2.36 vs 7.31±2.35; p=0.063).

Conclusion
Our previous METSO trial demonstrated tailored OSA education is critical to increase adherence to recommended OSA care. While delivery of health information is generally associated with enhanced adherence to medical care, results of the present RCT favored an important role of peer-based social support leading to behavioral change towards receipt of OSA care.

Support (if any)
K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
477 Association between Nocturnal Hypoxemic Burden and Glucose Metabolism
Authors: Thanaviratananich Sikawat , Cheng Hao , Chirakalwasan Naricha , Reutrakul Sirimon 
Published: May 2021

Abstract

Introduction
To evaluate the association between a novel integrated event-based and hypoxemia-based parameter of polysomnography (PSG), hypoxemic load or HL100, and fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels.

Methods
Adult patients, who underwent an in-lab PSG at University of Iowa Hospitals and Clinics with FBG or HbA1c levels were included. Event-based parameter and hypoxemia-based parameter data were derived. HL100, defined as an integrated area of desaturation under 100% oxygen saturation curve during the total sleep time divided by the total sleep time, was calculated by Python software version 3.8.5. Demographic data and glycemic parameters within 1 year prior to PSG(FBG and HbA1c) were retrieved from chart review Spearman correlation analysis and stepwise backward regression analysis were performed to determine independent predictors of FBG and HbA1c levels.

Results
Of the 467 patients underwent an in-lab PSG, 385 had FBG levels and 239 had HbA1c levels. All event-based and hypoxemia-based parameter; including HL100, were significantly correlated to FBG and HbA1c levels. Stepwise backward regression analyses, adjusting for age, sex, body mass index and diabetes status, revealed that log HL100 was significantly related to FBG (B=20.8, p=0.015), and log oxygen desaturation index was found related to HbA1c levels (B=0.273, p=0.037). Other parameters (e.g. apnea hypopnea index, minimum oxygen saturation) were not independently associated with glycemic parameters.

Conclusion
HL100 showed a significant positive correlation with FBG and HbA1c levels and only log HL100 was an independent predictor for FBG levels. This might imply that any degree of desaturation below 100% could result in adverse glucose metabolism. HL100 might be useful for interpretation of sleep studies, risk stratification and patient management purposes in the future.
Support (if any):
503 Cardio-Vascular Burden of Narcolepsy Disease (CV-BOND): a Real-World Evidence Study
Authors: Ben-Joseph Rami , Saad Ragy , Dabrowski Elizabeth , Taylor Ben , Gallucci Sophia , Somers Virend 
Published: May 2021

Abstract

Introduction
Narcolepsy is a rare, lifelong disorder that requires long-term treatment and is associated with multiple comorbidities, including cardiovascular conditions. Many available treatments have cardiovascular-related warnings and precautions in their labels. The objective of this study was to estimate the incidence of cardiovascular comorbidities in adult patients with a narcolepsy diagnosis in the US.

Methods
Claims from IBM® MarketScan®, an administrative claims database, between January 2014 and June 2019 were analyzed. Eligible patients were ≥18 years and had continuous medical and prescription coverage (gaps &lt;30 days allowed). The narcolepsy cohort was defined by ≥2 outpatient claims containing a diagnosis of narcolepsy type 1 or type 2 on separate days and no more than 6 months apart, with ≥1 non-diagnostic office-visit. Non-narcolepsy patients were matched 3:1 to narcolepsy patients by calendar date of cohort entry, age, gender, US geographic region, and insurance type. Each incidence calculation required a 6 month wash-out period prior to cohort entry. Differences between cohorts were evaluated using a Cox proportional hazard model adjusted for age, gender, region, insurance type, and relevant morbidities/comorbidities and medications in the baseline period.

Results
Of 54,239,110 adults in the database, 12,816 and 38,441 were included in the narcolepsy and matched non-narcolepsy cohort. Approximately 67% were female patients and mean age was approximately 38 years in both cohorts. Incidence rates (per 1,000 person-years) for newly recorded cardiovascular comorbidities or events in narcolepsy/non-narcolepsy were: CVD without hypertension (13.29/7.99), MACE+ (11.75/6.86), heart failure (5.72/3.41), stroke (4.28/2.17), ischemic stroke (3.69/1.91), edema (9.84/4.22), and a composite of stroke, atrial fibrillation, and edema (17.73/8.88).

Conclusion
Physicians should consider the increased cardiovascular risk when considering risk modification strategies and treatment options for narcolepsy patients. Further research is needed to understand treatment-specific risks.

Support (if any)
Jazz Pharmaceuticals
536 Is mothers’ perceived pressure associated with infant sleep-related parenting practices?
Authors: Lannes Émilie M , Kenny Samantha , Burdayron Rebecca , Dubois-Comtois Karine , Beliveau Marie-Julie , Pennestri Marie-Helene 
Published: May 2021

Abstract

Introduction
Studies suggest that feeling pressure about parenting practices is related to higher levels of stress. However, little is known about the pressure mothers feel about infant sleep-related parenting practices. This is surprising, considering that mothers are often exposed to contradictory information about infant sleep. This exploratory study aimed to 1) identify the proportion of mothers of 6-month-old infants who report feeling pressure about their sleep-related parenting practices and 2) assess the relationships between demographic factors and perceived pressure, and between parenting practices and perceived pressure.

Methods
Fifty-four mothers of 6-month-old infants completed a demographic questionnaire and the Sleep Practices Questionnaire (SPQ). Mothers were asked, “Have you ever felt pressure about your parenting choices and practices related to your child’s sleep?”. Responses ranged from never to always. Linear regressions were conducted to assess the concurrent associations between demographic factors (maternal age, maternal education, parity) and perceived pressure, and between sleep-related parenting practices (feeding method, frequency of bed-sharing, picking up or not picking up the infant when he/she cries at night) and perceived pressure.

Results
Analyses revealed that 5.6% of mothers reported feeling pressure constantly, 20.4% reported feeling pressure quite often, 46.3% reported feeling pressure sometimes, and about a quarter (27.7%) reported feeling pressure rarely or never. Lower maternal education and breastfeeding were associated with feeling more pressure about sleep-related parenting practices (p &lt; .05). Furthermore, mothers reporting that they (or their partner) pick up their infant when he/she cries at night were more likely to report feeling pressure (p &lt; .01). Maternal age, parity, and frequency of bed-sharing were not associated with feeling pressure (p &gt; .05).

Conclusion
The majority of mothers (72.3%) in our sample reported feeling pressure about their sleep-related parenting practices at least sometimes, suggesting that this experience is quite common. Lower maternal education, breastfeeding, and picking up the infant to comfort him/her during the night were associated with higher perceived pressure. Future studies should examine feelings of pressure about sleep-related parenting practices in larger samples of mothers and investigate whether fathers share similar concerns. Moreover, identifying the potential sources of these feelings would represent an interesting clinical avenue.

Support (if any)
SSHRC, FRQS