bluuebunny/crossref_metadata_2025_split huggingface dataset:
750 Sleep disturbances mediates the association between emotional labor and depressive symptoms among healthcare workers
Authors: Zhang Yuan , ElGhaziri Mazen , Siddique Sundus , Gore Rebecca , Kurowski Alicia , Nobrega Suzanne , Punnett Laura 
Published: May 2021

Abstract

Introduction
Depression is the second leading cause of disability worldwide. Healthcare workers report a higher prevalence of depressive symptoms than the general population. Emotional labor has contributed to poor health and work outcomes. However, the mechanism for the potential association between emotional labor and depressive symptoms has not been well studied.

Methods
In 2018, healthcare workers (n=1,060) from five public sector facilities in the northeast U.S. participated in this cross-sectional survey. The survey included questions on participants’ surface-acting emotional labor (masking one’s feelings at work), depressive symptoms, sleep duration and disturbances, and socio-demographics.

Results
Nearly a quarter (21.7%) of the participants reported depressive symptoms, over a half (53.6%) reported short sleep duration (≤6 hours per day), and nearly one third (32.2%) reported sleep disturbances. There was a significant association between emotional labor and depressive symptoms (β=0.82, p&lt;0.001) among these workers. Sleep disturbances, not short sleep duration, partially mediated this association by 17%. Both sleep disturbances and short sleep duration did not modify this association.

Conclusion
Depressive symptoms were prevalent among healthcare workers and were associated with emotional masking. Sleep disturbances play an important intermediate role in translating emotional labor to depressive symptoms in these workers. Effective workplace programs are needed to reduce healthcare workers’ emotional labor in order to improve their mental health. Sleep promotion should be emphasized to mitigate the negative effect of emotional labor and promote healthcare workers’ mental wellbeing.

Support (if any)
The Center for the Promotion of Health in the New England Workplace is supported by Grant Number 1 U19 OH008857 from the National Institute for Occupational Safety and Health (CDC). This work is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH. We are grateful to the CPH-NEW Research Team working together to collect the questionnaire data.
769 Is Alcohol Craving associated with Insomnia in Patients with Comorbid Insomnia and Alcohol Use Disorder?
Authors: Krouse Ryan , Aguiar Taylor , Mazur Rena , Makar Karen , Kampman Kyle , Rivera Louis 
Published: May 2021

Abstract

Introduction
A preliminary study showed the existence of a relationship between alcohol craving and insomnia symptoms. The current investigation aimed to further assess the relationship between obsessive and compulsive qualities of alcohol craving and insomnia disorder in a larger sample of subjects with Alcohol Use Disorder (AUD) seeking treatment for their drinking.

Methods
We used baseline cross-sectional data from a clinical trial of treatment-seeking patients with AUD (N=123). We used the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Obsessive Compulsive Drinking Scale (OCDS) scale scores for alcohol craving; Time-Line follow Back interview for computing the number of drinks per drinking day within the past 90 days; Hamilton Anxiety Rating Scale total score for the anxiety symptoms; and Addiction Severity Index for demographic variables. We used bivariate analysis to evaluate whether alcohol craving outcome measures (OCDS subscale scores and total score) were independently associated with the ISI total score. A multivariable model adjusted for sociodemographic and clinical covariates further evaluated this relationship between OCDS and ISI total scores.

Results
The mean (SD) age was 44.02 (10.37) years with 13.29 (3.10) years of education, 83.74% were males, 41.80% identified themselves as White, 17.21% were married, and 56.09% were employed. In a bivariate analysis, ISI total score was associated with the obsessive subscale (β=0.25, p&lt;0.0001), compulsive drinking subscale (β=0.24, p&lt;0.002), and OCDS total score (β=0.50, p&lt;0.0001). The OCDS total score showed a stronger association with the insomnia symptoms (ISI items 1a-1c) (β=0.99, p&lt;0.0001) than the manifestations of insomnia symptoms (items 2–5; β=0.83, p&lt;0.0001). In the multivariable model adjusted for covariates, the relationship between OCDS and ISI total scores continued to remain significant (β=0.37, R2=0.18, p=0.01).

Conclusion
This study not only confirmed that alcohol craving was associated with insomnia in a larger sample but also demonstrated that insomnia is linked to both obsessive thoughts about alcohol use and compulsive drinking behavior, especially its obsessive aspect. These findings add to the growing literature on the relationship between a pathologic drive for alcohol use and abnormal wakefulness.

Support (if any)
The study was supported by VA grant IK2CX000855 (S.C.) and NIH grants R01 AA016553 (K.M.K.).
776 Perceived sleep control and nightmares distinguish college students with suicidal ideation from past attempters
Authors: Bodicherla Krishna , Tubbs Andrew , Fernandez Fabian-Xosé , Perlis Michael , Grandner Michael 
Published: May 2021

Abstract

Introduction
Suicidal ideation is common in college-aged students, but this is limited as a risk factor because ideation rarely leads to suicide attempts. Disrupted sleep increases suicide risk, but it is unclear whether this relationship applies equally to both ideators and attempters. Therefore, the present study explored four different sleep variables as discriminators between past suicidal ideation and a past suicide attempt.

Methods
Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcomes, lifetime history of suicidal ideation or a suicide attempt, were assessed using self-report questions derived from the Columbia Suicide Severity Rating Scale. Predictors were weekday short sleep (≤ 6h; from a retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models tested whether these predictors distinguished ideators from attempters. Models were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness from the Interpersonal Theory of Suicide.

Results
A total of N=182 (36%) respondents endorsed lifetime suicidal ideation, while N=61 (12%) reported a prior suicide attempt. Attempters tended to be slightly older (p=0.016), in worse health (p&lt;0.001), and have more severe depression (p&lt;0.001) and anxiety (p&lt;0.001) than ideators. In unadjusted models, higher BRISC scores were associated with reduced odds of a suicide attempt (OR: 0.62 [0.42, 0.90]) while DDNSI scores of &gt;=10 were associated with greater odds of a suicide attempt (OR: 4.24 [1.28, 4.24]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate these relationships. Short sleep and ISI scores did not distinguish ideators from attempters.

Conclusion
Perceived sleep control and severity of nightmares, but not insomnia or short sleep, distinguished individuals with a history of suicidal ideation from those with a history of a suicide attempt. However, longitudinal research is needed to determine if poor sleep control or nightmares are proximal predictors of a suicide attempt.
Support (if any):
783 Early Life Adversity and Central Symptoms of Sleep Disturbance: A Network Analysis
Authors: Marquez Francisco , Decker Andrea , Taber Jennifer , Xia Mengya , Cribbet Matthew 
Published: May 2021

Abstract

Introduction
Individuals with early life adversity (ELA) experience a greater likelihood of sleep disturbance. Sleep disturbance is a hypothesized mechanism underlying the association between ELA and adverse health outcomes. However, it is unclear whether sleep disturbance presents differently in individuals with ELA when compared to individuals without ELA. Network analysis provides an analytic framework to examine the relationships and magnitudes of association between symptoms of sleep disturbance. Using a network framework, we investigated the differences in sleep disturbance symptoms between individuals with ELA and individuals without ELA.

Methods
College students (N=507; age=18±1, Female=72%) completed demographic measures, the Childhood Trauma Questionnaire (CTQ), and the Pittsburgh Sleep Quality Index using an online data collection platform from March-December 2020. Using clinical cutoffs, individuals with ELA were separated from individuals without ELA. Using the Pittsburgh Sleep Quality Index (PSQI; alpha=0.79), sleep disturbance was assessed. Two 7-node ELA-specific networks were generated using raw values for the 7 components of the PSQI. To assess network accuracy, stability coefficients were estimated using the ‘bootnet’ and ‘qgraph’ packages in R. The strength of association between each component and all other components of sleep disturbance were estimated using expected influence (EI). Network structures and measures of EI were examined for differences between exposure groups.

Results
Overall, the average global PSQI score was 7.50±3.37. Individuals with ELA had larger global PSQI scores when compared to individuals without ELA (8.18 versus 6.97, t=3.8, p&lt;0.001, d=0.37). For individuals with ELA, sleep quality, duration, and efficiency were most associated with other symptoms of sleep disturbance. For individuals without ELA, subjective sleep quality, sleep latency, and daytime dysfunction were most related to other symptoms of sleep disturbance. Individuals with ELA demonstrated a more interrelated network structure, with greater raw measures of EI in most components of the PSQI.

Conclusion
For individuals with ELA, duration and efficiency strongly underly sleep disturbance. Moreover, most symptoms had greater measures of EI in individuals with ELA when compared to individuals without ELA, suggesting that symptoms of sleep disturbance may be more likely to co-occur in individuals with ELA. Future research may explore the utility of these symptoms in predicting adverse health outcomes.
Support (if any):
795 Real World Challenges and Barriers for Positive Airway Pressure Therapy Use in Acute Ischemic Stroke Patients
Authors: Pascoe Maeve , Grigg-Damberger Madeleine , Walia Harneet , Andrews Noah , Bruton Monica , Wang Lu , Bena James , Katzan Irene , Uchino Ken , Foldvary-Schaefer Nancy 
Published: May 2021

Abstract

Introduction
Untreated obstructive sleep apnea (OSA) in patients with acute ischemic stroke (AIS) increases morbidity and mortality post-stroke. However, diagnosing and treating OSA in AIS is challenging. As such, we aimed to determine the feasibility of portable monitoring (PM) for diagnosis and positive airway pressure (PAP) therapy for treatment of OSA in an inpatient stroke population.

Methods
We recruited inpatients with AIS from the Cleveland Clinic. Those who consented underwent PM; participants with a respiratory event (REI) ≥10 were offered auto-titrating positive airway pressure therapy (APAP). Ease-of-use questionnaires were completed. We summarized categorical variables using n(%) and continuous variables using mean±SD or median [IQR].

Results
27 participants (age 59.8±11.8, 51.9% female, 51.9% African American, BMI 33.3±11.4) enrolled. The study ended early due to Medicare contracting that forced most patients to complete stroke rehabilitation outside the Cleveland Clinic health system. 69.6% had large vessel occlusions and 52% had moderate/severity disability (Modified Rankin score ≥2). PM was attempted in 23 participants and successful in 19. Nursing and patients rated the PM device as highly easy to use. 11 of 14 patients who had an REI ≥10 consented to APAP titration, but only 5 continued APAP after discharge. Four patients who initially said APAP was easy to use noted that their stroke interfered with their APAP use at home.

Conclusion
This study demonstrates the challenges in the assessment and treatment of OSA in an acute ischemic stroke population, highlighting the necessity for further research into timely and feasible screening and treatment.

Support (if any)
ResMed
804 A Multidisciplinary Approach to Investigating Sleep Practices and Sleep Disturbances on an Inpatient Neurology Unit
Authors: Kadura Sullafa , Lin Jennifer , Poulakis Alexander , Ibarra Michael , Cai Xueya , Roberts Debra 
Published: May 2021

Abstract

Introduction
Minimizing nightly disruptions in the inpatient setting requires a multidisciplinary, collaborative approach. Our aim was to assess staff perceptions and practices of sleep during hospitalization to help identify and prioritize improvement initiatives.

Methods
An online survey was distributed to inpatient staff (nurses, residents, attendings, APPs) on a neurology unit at an academic medical center. The survey assessed sleep disturbances, sleep knowledge and sleep practices. Responses across groups were analyzed using Cochran Armitage tests. Cumulative logit model was also performed.

Results
Among the 49 respondents, 75% reported not having the training to diagnose and treat sleep disorders. 51.2% rarely or never asked about sleep quality or duration prior to admission. 29.6% rarely or never tracked the amount and quality of sleep during hospitalization. Reasons for not tracking or considering sleep included “not being a priority”, “no place to document” and “not being there at night.” Overall, staff ranked noise, testing and vital sign checks as most disruptive to sleep quality and temperature as least disruptive. However, nurses perceived medication administration (p=0.0001) and testing (p=0.0296) more disruptive than the ordering providers. Multivariable analysis showed nurses ranked medication administration higher than providers when shift differences were controlled (p&lt; 0.01). Evening/night shift workers ranked pain (p=0.0324) and anxiety (p=0.0360) higher than day shift workers. Those comfortable with diagnosing and treating sleep disorders were more likely to track sleep during admission (p=0.009), allow patients to sleep during medication administration times (p=0.0189) and allow sleep during scheduled lab draws (p=0.0189).

Conclusion
Our findings indicate that differences in sleep knowledge and sleep perspectives exist across the healthcare team. Possible explanations include training differences, ordering providers not knowing what time medications are administered or when tests are done, teams not clarifying whether nighttime orders are critical and nurses lacking empowerment to notify providers that sleep is being disrupted. Hand offs may need optimization with regards to pain and anxiety. A multidisciplinary approach, particularly between providers/nurses and night/day teams is critical to improve sleep on inpatient units. Our next steps include surveying patients, tracking nightly disruptions using EMR and decreasing unnecessary overnight orders using a team based approach.
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823 Apparent seizure activity in a 9 year old female presenting as hypnopompic hallucinations
Authors: Rakita Jason , Judd Brooke 
Published: May 2021

Abstract

Introduction
The presence of hypnopompic hallucinations raises concerns for narcolepsy. However, sleep-related hallucinations may occur in other settings. Dreams at sleep-wake transitions may be difficult for patients to differentiate from sleep-related hallucinations. Sleep-related hallucinations are predominantly visual, although they can be auditory, tactile and/or kinetic. However, they are generally not olfactory in nature.

Report of case(s)
Here we present a case of a 9-year-old female with a history of tonsillectomy and adenoidectomy, ADHD, ODD, nocturnal enuresis, nocturia, aggressive behaviors and emotional outbursts who presented with EDS, frequent nocturnal awakenings, involuntary dozing, prolonged naps and a one year duration of hypnopompic hallucinations. Initially, the hallucinations occurred 2–3 times per week, but then decreased in frequency to 2–3 times per month. The frequency of episodes apparently decreased after tonsillectomy. She states that she wakes up and sees dots, and “she looks scary” when she looks at herself. She describes a variety of hallucinations including: seeing dots (including her mother being covered in dots), a cupcake, a strange woman walking, her hands looking strange--they had enlarged or hearing noises (a single loud bang). Pertinent physical exam findings included: BMI 66th percentile, Mallampati score 2/4, and a mildly enlarged tongue. The polysomnogram demonstrated mild obstructive sleep apnea by pediatric criteria, and, most notably, demonstrated an EEG with spike and wave formations in the central and frontal leads bilaterally. These were seen during NREM sleep and most prominently during sleep-wake transitions. There was also a more focal brief run of a regular 2 Hz rhythm in the central and frontal leads bilaterally. A referral was placed to Pediatric Neurology who ordered a full EEG which is pending at this time.

Conclusion
Sleep-related hallucinations may occur in narcolepsy, other sleep disorders, a mental disorder, a medical disorder, a medication effect or secondary to substance use. This case suggests that seizure activity may present as hypnopompic hallucinations as well.
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827 Central Sleep Apnea in a patient with Multiple Sclerosis
Authors: Dasgupta Rahul , Schütz Sonja , Braley Tiffany 
Published: May 2021

Abstract

Introduction
Sleep-disordered breathing is common in persons with multiple sclerosis (PwMS), and may contribute to debilitating fatigue and other chronic MS symptoms. The majority of research to date on SDB in MS has focused on the prevalence and consequences of obstructive sleep apnea; however, PwMS may also be at increased risk for central sleep apnea (CSA), and the utility of methods to assess CSA in PwMS warrant further exploration. We present a patient with secondary progressive multiple sclerosis who was found to have severe central sleep apnea on WatchPAT testing.

Report of case(s)
A 61 year-old female with a past medical history of secondary progressive multiple sclerosis presented with complaints of fragmented sleep. MRI of the brain, cervical spine, and thoracic spine showed numerous demyelinating lesions in the brain, brainstem, cervical, and thoracic spinal cord. Upon presentation, the patient noted snoring, witnessed apneas, and daytime sleepiness. WatchPAT demonstrated severe sleep apnea, with a pAHI of 63.3, and a minimum oxygen saturation of 90%. The majority of the scored events were non-obstructive in nature (73.1% of all scored events), and occurred intermittently in a periodic fashion.

Conclusion
The differential diagnosis of fatigue in PwMS should include sleep-disordered breathing, including both obstructive and central forms of sleep apnea. Demyelinating lesions in the brainstem (which may contribute to impairment of motor and sensory networks that control airway patency and respiratory drive), and progressive forms of MS, have been linked to both OSA and CSA. The present data illustrate this relationship in a person with progressive MS, and offer support for the WatchPAT as a cost-effective means to evaluate for both OSA and CSA in PwMS, while reducing patient burden. PwMS may be at increased risk for CSA. Careful clinical consideration should be given to ordering appropriate sleep testing to differentiate central from obstructive sleep apnea in PwMS, particularly for patients with demyelinating lesions in the brainstem.

Support (if any)
1. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155–62. doi: 10.5664/jcsm.3442. PMID: 24532998; PMCID: PMC3899317.
840 Obstructive to Central: A switch in sleep apnea type after arteriovenous malformation rupture
Authors: Greer Meredith , Trotti Lynn Marie , Collop Nancy 
Published: May 2021

Abstract

Introduction
Sleep apnea and stroke have long been shown to be linked, with sleep apnea increasing the risk for stroke and stroke leading to sleep apnea. When the latter occurs, it can present as central sleep apnea (CSA), often in the form of Cheyne-Stokes breathing (CSB), and has been shown to resolve over time. We present a patient with persistent CSA after severe hemorrhagic stroke secondary to rupture of a temporal/thalamic arteriovenous malformation (AVM).

Report of case(s)
A 33-year-old man with a history of obstructive sleep apnea (OSA) presented to our clinic for re-evaluation of his disease. He was diagnosed with OSA in 2006 at which time he was 270 pounds with a body mass index (BMI) of 36.7, thus the OSA was thought to be secondary to obesity. When he presented to our clinic 10 years later, he had lost approximately 80 pounds after suffering multiple strokes. In 2014, he had a left temporal lobe hemorrhage due to rupture of a left temporal/thalamic AVM and required decompressive hemicraniectomy. In 2015, he had a re-bleed of this AVM, with new hemorrhage extending inferiorly into the left cerebral peduncle and pons, and superiorly into the left parietal periventricular white matter anteriorly along the optic tract. Ultimately, he was treated with stereotactic radiotherapy to the AVM nidus with no residual AVM. However, he has chronic encephalomalacia of the left basal ganglia, thalamus, temporal, parietal, and occipital lobes with extension into the left cerebral peduncle and changes consistent with radiation necrosis. His residual symptoms are aphasia and right-sided hemiplegia and although his snoring resolved with weight loss, his mother noticed pauses in his breathing overnight. A repeat sleep study done in 2016 showed 27 central apneas and 0 obstructive apneas with an AHI of 5.4 events/hour. He was subsequently studied on ASV with residual AHI of 0.4 events/hour.

Conclusion
Although patients with OSA may be at higher risk for stroke, it is important to re-evaluate their sleep apnea after such an event to ensure appropriate diagnosis and treatment going forward.
Support (if any):