bluuebunny/crossref_metadata_2025_split huggingface dataset:
673 Did the COVID-19 pandemic increase insomnia?
Authors: Stanley Neil , Gardiner Alison , Sunter Nicola 
Published: May 2021

Abstract

Introduction
COVID-19 has been an unprecedented health event with far-reaching health and economic consequences. There have been numerous surveys published that have suggested that insomnia has increased during the pandemic. However, there have been no comparisons of data from the pandemic with that from other years. Here we present baseline data from people signing up to an online CBTi course to investigate the impact of COVID-19 on sleep.

Methods
We investigated the difference in age; diary-reported Sleep Efficiency (SE%) and Total Sleep Time (TST); sleep quality and disturbances as measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale (ESS); between the first wave of COVID-19 in the UK (1st March -31st July 2020) as compared to the same period in 2019.

Results
In 2019 n=2231 patients were assessed as compared to n=6173 in 2020. There were no significant differences in the age of the two cohorts (47.1 years v 46.3 years, NS). SE% was significantly lower in the 2019 cohort (66% v 67.6, p &lt;0.001) as was their total sleep time (5.71 hrs v 6.05 hrs, p&lt;0.0001). PSQI scores were also higher in 2019 (13.13 v 12.72. p&lt;0.0001). The level of daytime sleepiness was lower in the 2019 cohort (5.4 v 5.6 p &lt;0.001)

Conclusion
Our results show that there was no evidence of an increase in the severity of sleep disturbance during the 1st wave of the COVID-19 pandemic in the UK in contrast to what numerous surveys have suggested. Indeed, we found that people signing up to Sleepstation’s online dCBTi course during the 1st wave of the pandemic had statistically significant better subjective sleep, although they had a higher level of daytime sleepiness than those in the same period a year previously. Although statistically significant, our results do not demonstrate a clinically relevant difference between the two cohorts. It is also interesting that despite the age-related impact of COVID-19, there was no significant difference in the age of the patients. Thus, in contrast to the survey data, we found no evidence for a worsening of sleep during the 1st wave of the pandemic.
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680 Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes
Authors: Hwang Dennis , Chen Aiyu , Arguelles Jessica , Kim Joseph , Becker Kendra , Woodrum Rosa , Benjafield Adam , Cole Kate , Shi Jiaxiao 
Published: May 2021

Abstract

Introduction
We explore the impact of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on novel coronavirus (COVID-19) infection rate and severity.

Methods
Retrospective analysis was performed utilizing a database of patients evaluated by Kaiser Permanente Southern California sleep medicine between 2015–2020 (includes sleep study, daily PAP, and electronic health record data.) Adult patients were analyzed if: on March 1, 2020 patient was alive, had ≥1 month health-plan enrollment, and had sleep diagnostic or PAP data. PAP adherence was calculated between March 1, 2020 to COVID-19 confirmation, death, disenrollment or study end date (July 31, 2020), whichever came earlier. COVID-19 outcomes were evaluated based on OSA status and PAP adherence: patients with PAP &lt;2 hours/night were considered “untreated”; ≥2 hours/night were “treated”; 2–3.9 hours/night were “moderately-treated”; ≥4 hours/night were “well-treated”. Apnea hypopnea index (AHI) defined OSA severity. Multiple logistic regression evaluated the association of various demographic/clinical factors.

Results
Of 81,932 patients (39.8% female, age 54.0±14.9 years) analyzed, 1493 (1.8%) had COVID-19 with 224 (0.3%) hospitalizations and 61 (0.07%) resulting in intensive care or death. Increased severity of “Untreated” OSA was associated with higher COVID-19 rate and lower when “treated” [No OSA 1.7%; Mild 2%; Moderate 2%; Severe 2.4%; OSA unknown severity 2%; Treated 1.4%; p&lt;0.0001]. Better PAP adherence was associated with reduced infection rate [“untreated” 2.1%; “moderately-treated” 1.7%, “well-treated” 1.3%, No OSA 1.7%; p=&lt;0.0001]. Multivariable analysis confirmed increased infection rate with OSA versus no OSA [OR 0.82(0.70,0.96)] and the benefit of good PAP adherence versus “untreated” [“moderately-treated” OR 0.82 (0.65, 1.03); “well-treated” OR (0.69 (0.59, 0.80)]. Increased infection rate was also associated with obesity, higher Charlson Comorbidity score, Black and Hispanic ethnicities, and Medicaid enrollment; increasing age was associated with reduced infection rate. Separate multivariable analysis showed dose-response association of OSA severity on infection rate [Mild OR 1.21 (1.01,1.44 95%CI); Moderate-Severe OR 1.27 (1.07,1.51) versus no OSA]. Neither OSA presence nor PAP adherence significantly impacted rate of hospitalization nor intensive care or death.

Conclusion
Significant associations emerged with OSA increasing and PAP therapy reducing COVID-19 infection rate. Findings support continued PAP use during the pandemic.

Support (if any)
AASM Foundation SRA: 205-SR-19
695 Cannabinoids and Sleep Health in Patients with Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis
Authors: McParland Aidan , Daniel Kapustin , Bhatia Anuj , Clarke Hance , Aditya Trivedi , Brull Richard , Singh Mandeep 
Published: May 2021

Abstract

Introduction
Neuropathic pain (NP) syndromes are debilitating conditions which can impact sleep health and overall quality of life significantly. Pharmacological treatment with cannabinoids has not been evaluated for its impact on sleep health. The objectives of this systematic review and meta-analysis were to determine the effect of cannabinoids on sleep quality, pain control, and patient impression of treatment efficacy.

Methods
We reviewed randomized controlled trials comparing synthetic and natural cannabinoids (CB) to placebo in patients with central and peripheral neuropathic pain syndromes. A systematic search of the standard literature databases was conducted, including randomized controlled trials evaluating the pharmacological treatment of NP syndromes using cannabinoids. Data on NRS pain scales, sleep quality, daytime somnolence, nausea, dizziness, and patient global impression of change (PGIC) scores were recorded. Meta-analysis using the random effects model was conducted where appropriate.

Results
Of the 3536 studies screened, a total of 8 randomized controlled trials including 1051 patients (placebo: 478 patients; CB: 573 patients) with neuropathic pain were included. Cannabinoids included in the studies were Sativex (GW-1000–02), Nabilone, and medical cannabis preparations with THC dose ranging from 1mg to 130mg per day. Pain scores were significantly reduced in the CB group (standardized difference in means (SDM) = -0.236, 95% CI=-0.375 to -0.100, p-value = 0.001) compared to placebo (Figure 1). Significant improvement in sleep quality (Figure 2) was also observed in the CB group (SMD 0.389, 95% CI, 0.233 to 0.546, p&lt;0.013). Additionally, patients in the CB group were more likely to report improvement in PGIC scores (OR=2.3, 95% CI 1.37 to 3.9, p=0.002) compared to patients treated with placebo (Figure 3). Notably, CB-treated patients were more likely to experience daytime somnolence (OR=2.2, 95% CI 1.3 to 3.9, p=0.004), nausea (OR=1.7, 95% CI 1.1 to 2.5, p=0.02), and dizziness (OR=3.8, 95% CI 2.6 to 5.7, p&lt;0.001).

Conclusion
Cannabinoids are useful agents for NP as evidenced by significant improvement in pain, sleep quality, and PGIC. With the advent of new agents and more refined cannabis derivatives, further research is needed to comprehensively explore treatment effectiveness. Future work should incorporate clinically validated measures of sleep health to better evaluate this outcome.
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714 Sleep Disordered Breathing Polysomnographic Measures and COVID-19 Risk of WHO-7 Clinical Outcomes in a Large Health Care System
Authors: Pena Orbea Cinthya , Wang Lu , Shah Vaishal , Jehi Lara , Milinovich Alex , Foldvary-Schaefer Nancy , Chung Mina , Mashaqi Saif , Mehra Reena 
Published: May 2021

Abstract

Introduction
There is lack of clarity of sleep disordered breathing (SDB)--including the role of nocturnal hypoxia and confounding influence of obesity--on the clinical course of human coronavirus disease 2019 (COVID-19). We postulate that SDB portends increased risk of adverse COVID-19 clinical outcomes even after accounting for confounding factors.

Methods
A retrospective cohort analysis of COVID-19 and sleep laboratory observational registries March-November 2020 within the Cleveland Clinic health system was performed. Ordinal logistic regression assessed the association of SDB indices and World Health Organization (WHO)-7 COVID-19 clinical outcome (hospitalization, use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ECMO and death) in an unadjusted model and adjusted for age, sex, race, body mass index(BMI,kg/m2),diabetes mellitus, hypertension, coronary artery disease, heart failure, asthma, chronic obstructive pulmonary disease (COPD), cancer and smoking using SAS software.

Results
Of 19,449 (32%) patients positive for SARS-CoV-2,2,290 (6%) had an available sleep study. The analytic sample included 1788 of which 1,484(64%) had an apnea hypopnea index (AHI, 3–4% hypopnea oxygen desaturation)≥5. The median duration from sleep study to COVID test was 5.8 years (IQR:3.3–9.0). Age was 56.5±14.4 years,50.4% female,28% African American with BMI=35.9±8.9kg/m2. Nine percent of patients were hospitalized,10% with supplemental oxygen,6% used non-invasive ventilation,2% required ECMO or mechanical ventilation and 2% died. For every AHI increase of 5, the odds of a higher WHO-7 level increased 2% (OR=1.02,95%CI1.01-1.04,p=0.005),but the association was mitigated in the adjusted model (OR=1.00,95%CI:0.98,1.02,p=0.80). Per 5% increase in time spent with SaO2&lt;90%, the odds of a higher WHO-7 level increased 10% (OR=1.10,95%CI1.06-1.13,p=&lt;0.001) persisting in the adjusted model(OR=1.06,95%CI:1.02–1.10,p=0.002). For every decrease of 5% mean SaO2, the odds of a higher level WHO-7 increased 56% (OR=0.56,95%CI:0.46–0.67,p&lt;0.001) persisting in the adjusted model(OR=0.72,95%CI:0.58–0.89,p=0.003).

Conclusion
Even after adjustment for obesity, underlying cardiopulmonary disease and smoking, sleep-related hypoxemia was a potential key pathophysiologic mechanism associated with increased morbidity and mortality in COVID-19. Elucidation of sleep-related hypoxemia as a risk stratification measure, particularly given the silent hypoxia inherent to early COVID-19, is critical for future investigation, as is the role of sleep-related hypoxia reversal as a target to improve COVID-19 outcomes.

Support (if any)
Cleveland Clinic Neurologic Institute Resource Development Award
724 Does colorectal cancer site influence sleep quality?
Authors: Ton Mimi , Watson Nathaniel , Labadie Julia , Malen Rachel , Sillah Arthur , Reedy Adriana , Cohen Stacey , Burnett-Hartman Andrea , Newcomb Polly , Phipps Amanda 
Published: May 2021

Abstract

Introduction
Understanding sleep quality among colorectal cancer (CRC) patients could contribute to improved survivorship care in terms of sleep recommendations.

Methods
We ascertained sleep quality within an ongoing population-based study of CRC patients identified through the Puget Sound SEER cancer registry. We assessed sleep quality using components of the standardized Pittsburg Sleep Quality Index. Differences in sleep quality by CRC site were analyzed using chi-square and ANOVA tests. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of tumor site (rectal vs. colon) with sleep quality concerns. ORs were adjusted for age at diagnosis, sex, BMI, education, cancer stage, and time since diagnosis.

Results
Of the 1,454 CRC patients included in analyses, 37% (N=543) had rectal cancer compared to 63% (N=911) with colon cancer, and the stage distribution was as follows: 37% localized, 43% regional, and 18% distant stage. Overall, participants with rectal (vs. colon) cancer were more likely to report problems related to trouble sleeping (OR [CI]: 1.63 [1.23, 2.16]), but were also less likely to report trouble sleeping specifically due to issues with breathing, coughing, or snoring (OR [CI]: 0.51 [0.27, 0.96]. However, rectal cancer patients were more likely than colon cancer patients to report changes in sleep patterns after cancer diagnosis (OR [CI]: 1.33 [1.02, 1.73]), and to report trouble sleeping specifically due to getting up to use the bathroom (OR [CI]: 1.49 [1.17, 1.90]) or pain (OR [CI]: 1.50 [1.10, 2.04]). There were no significant differences between rectal and colon cancer cases in terms of amount of sleep, problems staying awake, bad sleep quality, and use of sleep medication.

Conclusion
Overall, rectal cancer patients are more likely to have sleep complications due to potential physical consequences compared to colon cancer patients. This suggests that survivorship care may be adapted according to CRC site to ensure patients receive appropriate support in terms of sleep recommendation.
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729 Daily stress and nightmares are bidirectionally associated among nurses
Authors: Garcia Odalis , Slavish Danica , Dietch Jessica , Messman Brett , Contractor Ateka , Haynes Patricia , Pruiksma Kristi , Kelly Kimberly , Ruggero Camilo , Taylor Daniel 
Published: May 2021

Abstract

Introduction
Nurses may experience frequent nightmares due to stressful work environments. Some studies estimate that 35% of nurses experience nightmares related to experiences at work. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmare occurrence and severity, and whether posttraumatic stress disorder (PTSD) symptoms moderated those relationships.

Methods
392 nurses (mean age = 39.54 years; SD = 11.15; 92% female; 78% White) were recruited for a larger study on sleep and vaccine response. For 14 days, upon awakening, nurses completed daily sleep diaries to assess previous-day stress severity (0 = not at all, 4 = extremely), as well as nightmare occurrence (0 = no nightmare, 1 = nightmare occurred) and nightmare severity (0 = not at all, 3 = very). PTSD symptoms were assessed at baseline using the PTSD Checklist of DSM-5 (PCL-5). Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms.

Results
Approximately 10.5% of nurses met criteria for PTSD based on PCL-5 scores. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress severity were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity that night (b = 0.09, p = 0.033). Nightmare occurrence (b = 0.15, p &lt; 0.001) was associated with greater next-day stress severity. PTSD symptoms did not moderate daily stress and nightmare associations.

Conclusion
Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Our results indicated nightmares and stress may occur in a bidirectional fashion among nurses. Results were similar regardless of nurses’ PTSD status. Future studies should explore whether targeting nightmares and stress may improve nurses’ health and well-being. Given the essential role that nurses play in maintaining patient health and safety, it is critical to understand the causes and consequences of their sleep-related disturbances.
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731 Who is most at risk for nightmares? Demographic and psychosocial differences in nightmare prevalence among nurses
Authors: Martinez Jaylin , Santiago Bianca , Slavish Danica , Dietch Jessica , Messman Brett , Kelly Kimberly , Ruggero Camilo , Taylor Daniel 
Published: May 2021

Abstract

Introduction
Nurses are subject to stressful work environments, which may negatively impact their sleep and increase their risk for nightmares. Previous studies have shown that women, night shift workers, and individuals with comorbid psychological conditions are more likely to report nightmares. Yet no studies have comprehensively examined demographic and psychosocial factors of nightmares among nurses.

Methods
To address this gap, we examined demographic (age, gender, race, ethnicity, number of children, marital status, shift work status) and psychosocial (chronotype, PTSD, anxiety, depression, perceived stress) correlates of nightmares in a sample of 462 nurses (91% female; mean age = 39.03, SD = 11.07; 78% White; 10% Hispanic/Latinx). Nightmares were determined two ways: 1) using a newly validated retrospective survey measure, the Nightmare Disorder Index (NDI), and 2) using aggregated prospective reports of daily nightmare frequency across 2 weeks (nurses who reported any nightmares in the past 2 weeks were classified as having nightmares).

Results
Nurses experiencing nightmares as determined by the NDI (n = 236; 51%) were younger, more likely to be female, less likely to have children, more likely to be an intermediate chronotype, less likely to be a morning chronotype, and had higher mean levels of PTSD, anxiety, depression, and perceived stress than nurses without nightmares. Nurses experiencing nightmares as determined by daily surveys (n = 191; 41%) were not different in terms of any demographic characteristics, but had higher levels of PTSD, anxiety, depression, and perceived stress than those nurses without nightmares.

Conclusion
Demographic and psychosocial differences in nightmare prevalence may differ based on how nightmares are assessed (i.e., retrospective vs. prospective measures). Overall, nurses with higher stress, PTSD, depression, and anxiety may be at greatest risk of having nightmares. Future studies should examine if targeting these factors results in improvements in sleep and well-being among nurses.

Support (if any)
NIH/NIAID R01AI128359-01
738 Effects of exogenous melatonin on sleep, circadian rhythms, and mood in women with premenstrual dysphoric disorder
Authors: Moderie Christophe , Shechter Ari , Lespérance Paul , Boivin Diane 
Published: May 2021

Abstract

Introduction
Most women with premenstrual dysphoric disorder (PMDD) report sleep disturbances. Our group found normal polysomnographic (PSG) sleep efficiency and increased slow wave sleep (SWS) across the menstrual cycle in women with PMDD and insomnia compared to controls. Reduced melatonin levels were found in PMDD women compared to controls, with reduced secretion during their luteal phase (LP) compared to follicular phase (FP). Here, we investigated the effects of exogenous melatonin in the patients we previously studied.

Methods
Five patients (age, mean: 33.6, SD: 2.7) diagnosed prospectively with PMDD and insomnia participated in the study. Following a baseline assessment, patients took 2 mg of slow-release melatonin 1h before bedtime during their LP for three consecutive menstrual cycles. At baseline (treatment-free condition), patients spent every third night of their menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual symptoms (PRISM), subjective sleep and ovarian hormones (estrogen and progesterone). Participants also underwent two 24-hour intensive physiological monitoring (during the FP and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration.

Results
In the intervention condition compared to baseline, we found increased urinary aMt6 (p&lt;0.001), reduced objective SOL (p=0.01), SWS (p&lt;0.001) and increased Stage 2 sleep (p&lt;0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p&lt;0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p&lt;0.001).

Conclusion
We have shown normalization of SWS and reduction in self-reported mood and somatic symptoms after administrating exogenous melatonin in women with PMDD. These findings support a role for disturbed melatoninergic system in PMDD that can be partially corrected by exogenous melatonin.

Support (if any)
This study was supported by the Canadian Institutes of Health Research (CIHR)
739 Association of hospital-diagnosed sleep disorders with suicide: A nationwide cohort study
Authors: Høier Nikolaj , Spira Adam , Erlangsen Annette 
Published: May 2021

Abstract

Introduction
Sleep disorders and psychiatric disease are closely related, and psychiatric diseases are associated with elevated suicide risks. Yet, it is not clear if sleep disorders are associated with suicide as previous studies were limited by self-reported measures. The aim of this study was to examine whether people with a hospital-diagnosis of sleep disorders had higher suicide rates than people with no diagnosis.

Methods
Using a retrospective cohort design, national data on all persons aged 15 years and over who lived in Denmark during 1980–2016 (males: 3,674,563, females: 3,688,164) were obtained. People with sleep disorders were identified in somatic hospital registers. The main outcome was death by suicide as recorded in the Danish Cause of Death register. Incidence Rate Ratios were obtained using Poisson regressions while adjusting for relevant covariates.

Results
Out of 23,927 male and 11,556 female suicide deaths, 299 and 117 had been diagnosed with a sleep disorder, respectively. Males with sleep disorders had a suicide rate of 47.4 (95% CI, 42.0–52.7) per 100,000 person-years compared to 29.9 (95% CI, 29.5–30.3) among those with no sleep disorders. For females the respective rates were 42.3 (95% CI, 34.7–50.0) versus 13.9 (95% CI, 13.6–14.1). An adjusted IRR of 1.6 (95% CI, 1.4–1.7) and 2.2 (95% CI, 1.8–2.6) was noted among males and females with sleep disorders, respectively, when compared to those with no disorders. Excess rates were noted with respect to insomnia, narcolepsy and, in males, sleep apnea. A difference with respect to age and sex was observed (p&lt;0.001). Furthermore,IRRs of 4.1(95% CI, 3.1–5.5) and 7.0 (95% CI, 4.8–10.1) were noted for males and females, respectively, during the first 6 months of diagnosis when compared to those not diagnosed. The association between sleep disorders and suicide remained significant when adjusting for psychiatric disorders, although those with psychiatric disorders also had elevated rates, particularly amongst females.

Conclusion
In this study, individuals with sleep disorders had an increased suicide rate when compared to those with no sleep disorders. Higher suicide rates were found for individuals suffering from narcolepsy, insomnia and sleep apnea. More attention towards risks of suicide among people with sleep disorders might be needed.
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