bluuebunny/crossref_metadata_2025_split huggingface dataset:
693 Sleep Health in the Young Adult Clinic: A retrospective observational cohort study
Authors: Eissa Mohamed , Bansal Shikha , Bosma Rachael , Sheffe Sarah , Law Yen Shuang , Mcloone Mary , Di Renna Tania , Singh Mandeep 
Published: May 2021

Abstract

Introduction
The Toronto Academic Pain Medicine Institute (TAPMI) Young Adult Clinic (YAC) was developed to offer transition services for clients aged 17–25 with persistent pain. It was noticed that YAC patients had significant problems with their sleep and the program was expanded in January 2019 by including a sleep medicine specialist for systematic evaluation of sleep health. Long-term sleep disruption has been associated with increase sensitivity to pain, prolonged pain duration, and predicts chronic pain. The degree of pain relief can directly impact the quality and disruption of sleep.

Methods
After approval from institutional review board, we reviewed YAC medical charts from March 2018 to April 2019 and extracted information pertaining to demographics, chronic pain and sleep. We present here the preliminary data of our multidisciplinary clinic

Results
55 medical charts were reviewed which included 40 females, 13 males, 2 nonbinary individuals, with a mean age of 20.3±2.4 years. 53% of the patients had chronic widespread pain. Symptoms of or disorder of sleep were reported in 72.7% of the patients. The various nighttime disorders of sleep were trouble falling asleep, insomnia, problems with sleep initiation, difficulty in maintaining sleep, poor sleep continuity, frequent night awakenings due to pain, restless leg syndrome (RLS), obstructive sleep apnea, parasomnic behavior, circadian rhythm disorder such as delayed sleep phase disorder. As assessed by Epworth Sleepiness scale, 7% of the patients had mild, 7% had moderate and 2% had severe daytime sleepiness. 42% of the youths demonstrated a low self-efficacy score as per Pain Self Efficacy Questionnaire (PSEQ). Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression which showed that 5.5%, 27%, 18%, 14.5%, 22% of the YAC patients suffered from minimal, mild, moderate, moderately-severe and severe depression respectively. The information collected on Pain Catastrophizing scale (PCS) suggested that 24%, 29% and 31% were at low, moderate, and high risk respectively in having catastrophizing thoughts and feelings related to pain. There was no statistical difference in the means PSEQ, PHQ-9 and PCS scores of young adults.

Conclusion
Sleep disturbances may be an important modifiable risk factor for alleviating distress in young adults with chronic pain.
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698 Sleep quality, depression and anxiety in a community sample of Habana, Cuba during the 2020 COVID-19 pandemic
Authors: González Justa , Rodriguez Alcibiades 
Published: May 2021

Abstract

Introduction
The 2020 Coronavirus disease 19 (COVID-19) pandemic has infected and killed millions of persons. To avoid virus spread, stay-at-home orders and social distancing measures were implemented worldwide. These measures have caused changes in work schedules and, subsequently, sleep habits. This study aims to examine sleep disturbances, anxiety and depression in a random community in Havana, Cuba during the pandemic lockdown period.

Methods
This a descriptive cross-sectional study performed in a randomly selected neighbourhood, via direct door-to-door survey. We applied four different surveys:1) Pittsburgh Sleep Quality Index (PSQI);2) Insomnia Severity Index (ISI);3) Epworth Sleepiness Scale (ESS) and 4) Hospital Anxiety and Depression Scales (HADS) questionnaire. Descriptive statistics will be applied using StatSoft, Inc. (2011) STATISTICA (data analysis software system), version 10. HYPERLINK “http://www.statsoft.com” www.statsoft.com

Results
A total of 366 adult subjects were surveyed and abnormal values were observed in the following percentages: 60.65% in the PSQI, 34.51% in the ISI, 14.74% in the ESS and 36.61% in the HADS for depression and 40.43% in the HADS for anxiety. Poorer sleepers and depression were more common women and elderly (p&lt;0.05 for all comparisons). Anxiety and insomnia were seen mostly in subjects with higher education and working during this period (p&lt;0.05 for all comparisons). Poor sleep correlated with insomnia, depression and anxiety (p &lt; 0.001 for all comparisons).

Conclusion
There were sleep quality disruption in large percentage of subjects during the COVID-19 pandemic lockdown. Poor sleep and depression were worse in women and the elderly. Insomnia and anxiety were seen more in younger subjects that continue to work during this time.
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704 The Association of Sleep Disorders in Patients with Chronic Pain Disorders
Authors: Khachatryan Marine , Kay Jenna , Jain Sejal 
Published: May 2021

Abstract

Introduction
Sleep and pain are interrelated and have a bidirectional relationship. The study was performed to identify the impact of sleep disorders on pain perception.

Methods
The institutional review board approved the study. Patients evaluated in the Pain Clinic between 1/1/2014 and 12/31/2017 who had polysomnography done were identified by database search. Chart review identified demographics, initial pain score, pain treatments, sleep disorder diagnosis, treatments of sleep disorder and pain scores after sleep treatments. Numerical pain score (NPS) and insomnia severity index (ISI) were used as a measure of pain and sleep quality, respectively. The descriptive statistics were presented by percentages, mean and standard deviations. Regression analysis was performed between initial NPS and ISI. T-test compared change in NPS for compliant and non-compliant subjects, before and after sleep treatments. Linear regression model identified factors associated with changes in pain perception after sleep treatments.

Results
Of the 320 participants identified, complete data was available for 180 subjects. The average age was 55.9±13.9; 51.41% were female; 60.2% were Caucasian and 26.64% were Hispanic. Initial NPS was 8.8±1.7, average ISI was 15.00±6.41, average BMI was 35.4±10.2. Ninety-five percent had a diagnosis of obstructive sleep apnea (OSA), 27.81% had restless leg syndrome, and 7.19% had complex sleep apnea. Since most patients had OSA, details of positive airway pressure (PAP) treatments were also investigated. Of 84% of subjects treated with PAP, compliance data were available for 53%, which showed 69% (n=55) being complaint with PAP. Initial NPS correlated positively with ISI (R2: 0.064±0.024, p&lt;0.01). No difference in NPS was found in groups based on compliance, before and after PAP treatments. Regression model identified that BMI was the most significant factor in the change in NPS following sleep treatment (R2: 0.083±0.034, p = 0.03).

Conclusion
The study identified that the severity of pain is associated with poor quality of sleep. While this study failed to identify improvement in pain perception after successful OSA treatment, limited number of subjects in our study were compliant with PAP treatment which may have impacted the results. Future prospective studies are needed to understand the complex association between improvement in sleep quality and pain perception.
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708 Rapid Adoption of Telemedicine during COVID-19 Pandemic: Impact on PAP Adherence and Health Care Utilization
Authors: Stothard Ellen , Hickey Mark , McCarty David , Wertz Adam 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has required rapid reconfiguration of healthcare services from in-person to telemedicine. Positive Airway Pressure (PAP) is the gold-standard treatment for sleep apnea, but success requires substantial clinical support, which has traditionally been provided in-person. In this quality analysis, we examined the impact of PAP initiation (PAPI) via telemedicine on adherence and subsequent health care utilization, compared to the conventional, in-person model.

Methods
Patients who completed PAPI and initial adherence period between April-August 2020 were included. During this window, telemedicine visits were encouraged, but not required. Adequate adherence status was considered met if 21/30 consecutive days with use &gt;4h was achieved by day 90 therapy. Health care utilization was represented by the number of follow-up visits, stratified by provider type (Physician, Physician Assistant (PA), or PAP Technologist).

Results
839 patients (54% telemedicine, 46% in-person), 38.0% female, aged 54.2±0.5 years, BMI 32.4±0.3 (±SEM) were included. Adherence was similarly achieved following both initiation methods: 78.8% (telemedicine) and 76.4% (in-person) (p&gt;0.4). Clinical follow-up was lower after in-person PAPI compared to telemedicine, regardless of adherence status (p&lt;0.05). Non-adherent patients also had less clinical follow-up than adherent patients after both initiation methods (p&lt;0.0001), though this differed by provider type. Non-adherent patients in both initiation methods were less likely to follow-up with a PA or PAP Technologist (p&lt;0.01), though follow-up rate with Physician providers was similar (p&gt;0.1). Clinical follow-up with PAP Technologist was increased after telemedicine compared to in-person PAPI (p&lt;0.01).

Conclusion
Implementation of a telemedicine PAP initiation protocol during the COVID-19 pandemic resulted in similar rates of adherence compared to the conventional in-person method, which suggests that telemedicine is an appropriate alternative to in-person PAPI. However, clinical follow-up was lower after in-person PAPI compared to telemedicine regardless of adherence status. Further, non-adherent patients had less follow-up with PAs and PAP Technologists, but similar follow-up with Physicians. This may indicate that provider type plays a role in supporting patients through the adherence process and should be considered. Further research is needed to understand the relationship between care teams, adherence, and healthcare utilization in the age of telemedicine.
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711 Changes in Healthcare Visits and Sleep Medication Use in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Debian Ahmad , Arentson-Lantz Emily , Kokanda Manasa , Shaib Fidaa , Nowakowski Sara 
Published: May 2021

Abstract

Introduction
Patients may be experiencing increased stress and sleep disturbance due to healthcare changes during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and sleep medication use on sleep disturbance and insomnia severity.

Methods
Between June-November 2020, 81 sleep medicine clinic patients (54.8 ± 15.9 y, 44% male, 69% Caucasian) completed an online survey that included questions about COVID-19 (tested for coronavirus, test results, willingness to be vaccinated for COVID-19, changes in health care visits and sleep medications during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). Stepwise linear regression was performed using SAS to determine if changes in healthcare and sleep medications predicted poorer sleep.

Results
Among participants, 32% were tested for coronavirus, out of those 8% tested positive for COVID-19. 74% were willing to get vaccinated and 65% were willing to get their children vaccinated. 35% changed their healthcare office appointments to telephone visits, 54% changed to video visits; whereas 26% cancelled and 32% rescheduled their healthcare appointments. Changes in health care visits during the pandemic had a significant increase on ISI score (3.98 ± 1.66, p=0.019). Changes in sleep medication during the pandemic had significant effect on Sleep Disturbance (7.15 ± 2.51, p=0.005), Sleep-Related Impairments (8.69 ± 2.68, p=0.001) and ISI (6.04 ± 1.66, p=0.001) measures.

Conclusion
Sleep medicine patients who reported changes in sleep medication reported higher insomnia severity, sleep disturbance, and sleep-related impairments. Patients who reported changes in healthcare visits during the pandemic reported higher insomnia severity. Assessing sleep medication changes and preference for healthcare visit format is advised when treating sleep medicine patients during the pandemic.

Support (if any)
This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).
712 COVID-19 Risk Perception, Sleep Health and Peritraumatic Distress Among New Yorkers: The NYU COVID-19 Mental Health Study
Authors: Blanc Judite , Seixas Azizi , Bubu Omonigho , Briggs Anthony , Compas Alain Claude , Williams Yolette , Jean-Louis Giardin 
Published: May 2021

Abstract

Introduction
Long-term exposure to pandemics like COVID-19 may increase psychological distress (e.g., peri-traumatic and post-traumatic distress) and sleep problems. Little is known about the effects of COVID-19 on peritraumatic distress, a well-documented risk factor for post-traumatic stress disorders (PTSD). The aim of this study was to investigate the association between COVID-19 risk perception and peritraumatic distress, and whether this relationship is moderated by sleep quality among individuals located in NY.

Methods
We examined data from 541 individuals (69% were female, mean age (SD) = 40.9 (15.3)] recruited online during summer and fall 2020 in New York for the NYU-COVID-19 Mental Health Study. Data were gathered on sociodemographic, COVID-19 risk perception (yes or no items), peri-traumatic distress measured by Peritraumatic Distress Inventory (PDI), and sleep quality measured by the Pittsburg Sleep Quality Index (PSQI). Descriptive, regression analysis and interaction terms were conducted using SPSS v. 25 to examine associations between COVID-19 risk perception with symptoms of peritraumatic distress and sleep quality.

Results
Of the 541 participants, 311(57.5%) reported they felt at risk for contracting COVID-19. PSQI was positively correlated with PDI (r =.38, p =0.01). An independent sample t student test indicated, on average, that the symptoms of PDI [(mean (SD)=27.3 (7.63), t = 7.07, n =307)] and PSQI [mean(SD)=10.62(3.57), t=4.31 n=311)] of our participants who felt at risk for contracting the COVID-19 significantly exceeded those who did not [(PDI mean(SD)=22.7(7.13), n =228); PSQI (mean(SD) =9.25(3.72), n=229]. Results of multiple linear regression analysis shown that COVID-19 risk perception was the strongest predictor of PDI [B(t) = −.630(12.7); p &lt; .001]. Furthermore, the interaction effect of PSQI scores and COVID-19 risk perception revealed that sleep quality significantly reduced the association between COVID-19 risk perception and PDI [B(t) = .319(5.71); p &lt;.001], such that poorer sleep and feeling at risk of contracting COVID-19 resulted in more severe PDI scores.

Conclusion
COVID-19 risk perception was associated with peritraumatic distress and poorer sleep quality, and sleep quality attenuated this relationship.

Support (if any)
NIH (T32HL129953, K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453)
725 Serious Illness, Sleep Quality, and Spirituality: an exploratory study in a multicultural inpatient setting
Authors: Castro Laura , Peteet John , Balboni Tracy , Koenig Harold , Cintra Fatima 
Published: May 2021

Abstract

Introduction
Spiritual well-being can impact quality of life and survival among diseased populations, similarly to sleep. Despite beneficial effects of spiritual-based practices on sleep, few studies have investigated an association between these attributes. Our goal was to explore correlations between measures of sleep quality and spirituality among severe medical inpatients hospitalized for different reasons, testing whether sleep could be a mechanism by which spirituality influences clinical outcomes.

Methods
Patients (18+ years) admitted in two units of the University’s hospital between Oct/2018 and Aug/2019 were invited to participate. Semi-structured interviews included the Duke Religiousness Index, the Belief into Action Scale, the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being, the Pittsburgh Sleep Quality Index (PSQI), and the Short Form Six-Dimension (SF-6D) health index. Diagnoses were defined by the International Classification of Diseases. We used the Chi-square test, bivariate correlations, and Generalized Linear Models.

Results
A total of 146 consecutive patients were included (46.8±15.9 years, 51% men), 28% admitted for cardiovascular diseases, 26% for cancer, 20% rheumatologic disorders, and 26% for other conditions including hematological, nephro-urological, infectious, among other diseases. The mean PSQI was 10.1±4.7 and 55% of patients rated their sleep as poor. Average sleep duration was 6.5±1.9 hours. Insomnia (64%) was the most frequent sleep complaint, followed by nocturia (43%), pain (42%), and discomfort breathing (29%). There was a modest correlation between sleep quality and spiritual well-being (-0.23; p&lt;0.01). Maintenance insomnia correlated with less spiritual peace/meaning (-0.27; p&lt;0.01) and faith (-0.21; p=0.01), whereas pain, with more social (0.21; p=0.01) and private (0.24; p&lt;0.01) religious activities. Initial insomnia also correlated with private activities (0.18; p=0.04). Seep quality (0.43; 0.25–0.62), spiritual peace/meaning (-0.21; -0.40-[-0.01]), and social religious activities (0.18; 0.04–0.32) were independent indicators of higher SF-6D scores, additional to an interacting effect between sleep quality and spiritual well-being predicting better quality of life.

Conclusion
Subjective sleep quality is associated with spiritual well-being and quality of life, independently of the nature and severity of the medical disease. Our findings also suggest that patients suffering from nocturnal pain and trouble falling asleep might be more engaged with religious activities.

Support (if any)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
726 Relationships Between Sleep and Psychological Adjustment During the COVID-19 Pandemic
Authors: Gilles Allyson , Qeadan Fares , Baron Kelly 
Published: May 2021

Abstract

Introduction
Disruption of daily routines (employment, social interaction, health behaviors) during the COVID-19 pandemic has contributed to psychological distress (worry, rumination), likely impacting sleep-related behaviors. This study evaluated change in psychological adjustment and insomnia symptoms during the COVID-19 pandemic.

Methods
The sample included 192 adults from Utah who completed three data collection cycles across 9 consecutive months to assess self-reported depressive, anxiety, and insomnia symptoms. Anxiety and depressive symptoms were assessed via the Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire depression scale (PHQ-8). Insomnia was measured by the Insomnia Severity Index (ISI). Data were analyzed using mixed-effect modeling and adjusted for anxiety and depression to determine their independent effects on insomnia symptoms. Spaghetti plots examined mean changes over time and significance was set at p&lt;0.05. Average anxiety, depression, and insomnia severity scores were aggregated for each month.

Results
As participants’ symptoms of anxiety and depression increased in severity, insomnia symptoms increased similarly. Over half of participants reported clinically significant ISI scores (59.38%). In both the random intercept and random slope models, there were significant independent effects of anxiety on insomnia severity (F=20.69; p&lt;0.0001) and significant effects of depression on insomnia severity (F=87.44, p&lt;0.0001). While the change in insomnia severity over time was on the boundary of statistical significance (F=3.54; p=0.0618), dropping from 15.17 (April) to 12.58 (December), our longitudinal analyses revealed no significant difference for the effect of anxiety or depression in predicting insomnia severity over time. Participants’ monthly averages varied for sleep and psychological scores (ISI) from 12.58 to 16.07 (SD=3.76 to 6.34 for December and September, respectively), (GAD-7) from 3.47 to 6.39 (SD=3.36 to 5.26 for December and June, respectively), and (PHQ-8) 4.47 to 6.10 (SD=4.65 to 4.39 for December and June, respectively).

Conclusion
Results demonstrate high prevalence of insomnia symptoms during the COVID-19 pandemic and underscore the importance of examining mental health functioning and psychological resiliency on sleep in order to enhance prevention efforts in response to a significant stressor.
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732 A daily diary study of nightmare reports among combat-exposed Veterans
Authors: Miller Katherine , Goldstein Elly , Barilla Holly , Carroll Rain , Ross Richard , Kling Mitchel , Bhatnagar Seema , Gehrman Philip 
Published: May 2021

Abstract

Introduction
Nightmare occurrences may, in part, result from prior-day arousal (e.g., the continuity hypothesis), and that they then influence next-day symptoms. Recent ecological momentary assessment (EMA) studies in samples of civilian trauma survivors found that elevated PTSD symptoms, pre-sleep cognitive arousal, and greater sleep onset latency predicted nightmare reports. This study adds to these works by using EMA in a sample of combat-exposed Veterans.

Methods
Data were analyzed from a study examining neurobiological and neuropsychological factors associated with PTSD in a sample of 27 combat-exposed OEF/OIF Veterans, with and without PTSD. Participants engaged in EMA for 6 days, with assessments across the day inquiring about mood, activity, and stressful events. Morning reports also included the consensus sleep diary and prompts on nightmare experiences. Those reporting nightmares were asked about nightmare disturbance and the level of replicability to a traumatic event (replays or symbolic/unrelated). Multi-level modeling analyses were used.

Results
A total of 113 morning reports were acquired, in which 40 included a report of having a nightmare and 73 did not. Main effects were found for baseline PTSD symptom severity (OR=1.13, p=0.02), prior day time spent alone (OR=0.01, p=0.01) and prior day level of distraction (OR=0.25, p=0.02) on morning reports of nightmares. However, when accounting for the previous night’s nightmare report (OR=15.9, p&lt;0.001), these effects were no longer significant. No other effects on nightmare reports were observed. Additionally, no factors predicted replicability of nightmare content or level of nightmare disturbance. Regarding daytime impact, nightmare reports were associated with greater levels of stress associated with events later that day (OR=2.48, p=0.04).

Conclusion
Greater baseline PTSD symptom severity, less daytime spent alone, and greater daytime attentiveness were significant predictors of nightmare reports. While daily social interactions and attentiveness may be beneficial, these factors also may be associated with hypervigilance, a known risk for sleep disruption. However, these data also suggest that day-to-day levels of stress may have less influence when a chronic nightmare pattern is present.

Support (if any)
Defense Advanced Research Projects Agency under a grant from the U.S. Army Research Office (W911NF1010093). U.S. Department of Veterans Affairs, Veterans Health Administration (CSR&D- IK2 CX001874).