bluuebunny/crossref_metadata_2025_split huggingface dataset:
537 Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?
Authors: Zaheed Afsara , Spira Adam , Chervin Ronald , Zahodne Laura 
Published: May 2021

Abstract

Introduction
Alzheimer’s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations.

Methods
Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., “baseline”) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values.

Results
Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed.

Conclusion
Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD.
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543 EEG-Based Deep Neural Network Model for Brain Age Prediction and Its Association with Patient Health Conditions
Authors: Nygate Yoav , Rusk Sam , Fernandez Chris , Glattard Nick , Arguelles Jessica , Shi Jiaxiao , Hwang Dennis , Watson Nathaniel 
Published: May 2021

Abstract

Introduction
Electroencephalogram (EEG) provides clinically relevant information for personalized patient health evaluation and comprehensive assessment of sleep. EEG-based indices have been associated with neurodegenerative conditions, psychiatric disorders, and metabolic and cardiovascular disease, and hold promise as a biomarker for brain health.

Methods
A deep neural network (DNN) model was trained to predict the age of patients using raw EEG signals recorded during clinical polysomnography (PSG). The DNN was trained on N=126,241 PSGs, validated on N=6,638, and tested on a holdout set of N=1,172. The holdout dataset included several categories of patient demographic and diagnostic parameters, allowing us to examine the association between brain age and a variety of medical conditions. Brain age was assessed by subtracting the individual’s chronological brain age from their EEG-predicted brain age (Brain Age Index; BAI), and then taking the absolute value of this variable (Absolute Brain Age Index; ABAI). We then constructed two regression models to test the relationship between BAI/ABAI and the following list of patient parameters: sex, BMI, depression, alcohol/drug problems, memory/concentration problems, epilepsy/seizures, diabetes, stroke, severe excessive daytime sleepiness (e.g., Epworth Sleepiness Scale ≥ 16; EDS), apnea-hypopnea index (AHI), arousal index (ArI), and sleep efficiency (SE).

Results
The DNN brain age model produced a mean absolute error of 4.604 and a Pearson’s r value of 0.933 which surpass the performance of prior research. In our regression analyses, we found a statistically significant relationship between the ABAI and: epilepsy and seizure disorders, stroke, elevated AHI, elevated ArI, and low SE (all p&lt;0.05). This demonstrates these health conditions are associated with deviations of one’s predicted brain age from their chronological brain age. We also found patients with diabetes, depression, severe EDS, hypertension, and/or memory and concentration problems showed, on average, an elevated BAI compared to the healthy population sample (all p&lt;0.05).

Conclusion
We show DNNs can accurately predict the brain age of healthy patients based on their raw, PSG derived, EEG recordings. Furthermore, we reveal indices, such as BAI and ABAI, display unique characteristics within different diseased populations, highlighting their potential value as novel diagnostic biomarker and potential “vital sign” of brain health.
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592 Objective vs. Subjective Sleep Data in Early Childhood: Implications for Health Disparities Research
Authors: Cicalese Olivia , Williamson Ariel , Mindell Jodi , Meltzer Lisa 
Published: May 2021

Abstract

Introduction
Given limited psychometric research with families of lower socioeconomic status (SES) and/or non-White backgrounds, this study explored the feasibility of and discrepancies between actigraphy and maternal-reported nightly child sleep in preschoolers of lower-SES and primarily Black backgrounds.

Methods
Twenty-seven children (Mage=3.3 years, SD = 1.2 years; 59.3% girls; 85.2% Black; 100% family income &lt;125% of the US poverty level) were asked to wear an actigraph for 14 days while mothers completed telephone-based sleep diaries. Bedtime, wake time, nighttime sleep duration, nap duration, and 24-hour sleep duration were collected by both measures. Paired t-tests examined actigraphic versus mother-reported child sleep.

Results
Twenty-six percent of dyads (n=7) were excluded due to insufficient data (1-hour difference between measures on &gt;50% of nights). There were no significant demographic differences between dyads with and without discrepant data. Diary-derived sleep onset was calculated by adding caregiver-reported bedtime and caregiver-reported sleep onset latency. There was no significant difference between actigraphy-derived sleep onset (M=10:20PM, SD=69min) and diary-derived sleep onset (M=9:59PM, SD=51min). Average actigraphy sleep offset (M=7:27 AM, SD=62 min) was 42 minutes earlier than diary-derived wake time (M=8:09 AM, SD=84 min), p&lt;.05. Actigraphy-estimated nighttime (M=8.38 hours, SD=.80) and 24-hour sleep duration (M=9.31 hours, SD=1.13) were 0.92 and 0.85 hours shorter, respectively, than diary-derived nighttime (M=9.30 hours, SD=1.07) and total sleep duration (M=10.16 hours, SD=1.17), p&lt;.005. There were no significant differences in average nap duration. The primary mother-reported barrier in completing diaries was limited awareness of child sleep due to work schedules.

Conclusion
Study results highlight some of the challenges of collecting and scoring actigraphy and diary data in preschoolers of lower-income backgrounds, in particular missing diary data and discrepancies between actigraphy and diaries. These findings suggest a need to incorporate both subjective parental report and objective measurement of child sleep in clinical and research contexts, as well determine ways to enhance feasibility and scoring procedures.

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K23HD094905 (AAW)
604 The Relationship between Birth Order and Sleep Patterns in 6-Month-Olds
Authors: Kenny Samantha , Lannes Émilie M , Dubois-Comtois Karine , Beliveau Marie-Julie , Pennestri Marie-Helene 
Published: May 2021

Abstract

Introduction
The influence of birth order has been investigated in many areas of child development, but few studies have examined its relationship with infant sleep; those that have yield contradictory findings. Moreover, nocturnal parental practices may differ depending on the number of children, but these characteristics are rarely studied. This study aimed to compare nocturnal parental practices and sleep patterns of first-born to non-first-born 6-month-olds.

Methods
The mothers of fifty-two 6-month-olds completed a 14-day sleep diary to record their infant’s sleep. The following variables were averaged: total nocturnal sleep duration (in minutes), longest consecutive sleep duration (without interruption; in minutes) and number of nocturnal awakenings. Independent t-tests were used to compare each sleep variable between first-borns (n = 21) and non-first-borns (2nd, 3rd or 4th born, n = 31). Chi-square tests were used to compare parental sleep practices (breastfeeding frequency and infant sleep location) between first-borns and non-first-borns.

Results
First-borns had a longer consecutive nocturnal sleep duration (417.83 ± 142.42 vs. 310.08 ± 118.23; p &lt; .01) and fewer nocturnal awakenings (1.69 ± 1.07 vs. 2.57 ± 1.09; p &lt; .01) than non-first-borns. However, first-born and non-first-born infants did not differ in terms of total nocturnal sleep duration (p &gt; .05). Breastfeeding frequency and sleep location differed as a function of birth order: 57.9% of first-born infants were exclusively breastfed, compared to 89.7% of non-firstborn infants (χ2 (1, N = 52) = 6.56; p &lt; .05). Furthermore, 20.0% of first-borns slept in the parents’ room, compared to 56.7% of non-first-borns (χ2 (1, N = 50) = 6.62; p &lt; .05).

Conclusion
First-born infants had longer periods of consecutive sleep and fewer nocturnal awakenings than non-first-borns; however, birth order was not associated with maternal reports of total nocturnal sleep duration. These results suggest that non-first-borns have more fragmented sleep. Moreover, sleep-related practices also differed between mothers of first-born and non-first-born infants. A study conducted in a larger sample and using objective sleep measures could clarify whether these different sleep patterns reflect specific nocturnal parental sleep-related practices, or if the presence of other children in the home play a role in infant sleep consolidation.

Support (if any)
SSHRC, FRQS
618 Qualitative analysis of bedtime challenges and parental interventions in foster care children
Authors: Nogales Josefina Muñoz , Valentine Madeline , Rigos Priscilla , Kim Josephine , KIm Jinu , Alfano Candice , McGlinchey Eleanor , Ripple Carol , Wolfson Amy 
Published: May 2021

Abstract

Introduction
Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties.

Methods
Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedtime?

Results
483 foster care parents responded. Responses to bedtime difficulties were coded using 27 categories (e.g., parasomnias, bedtime resistance, trouble self-soothing); responses to what helps your child sleep well were coded based on 22 categories (e.g., comfort items, melatonin, TV as in intervention, communication to reassure safety). The most prevalent sleep/bedtime difficulties were fear/anxiety (23.2%), nightmares (19.6%), environment (18.4%). For example, one parent responded: “He fears never waking up. He fears that the sun is not going to come back up. He fears that the bad guys will come get him.” Difficulties varied by age-- 4–5: fear/anxiety, destabilization from call/visit biological parent, nightmares; 6–9: nightmares, fear/anxiety, environment; 10–11: fear/anxiety, nightmares, emotional/behavioral difficulties. Most frequent parenting approaches were bedtime routine (63.0%), reading before bedtime (36.5%), physical reassurance (26.6%). Interventions also varied according to age-- 4–5: routine, reading, physical reassurance; 6–9: routine, reading, noise control; 10–11: routine, technology regulation, reading.

Conclusion
Foster caregivers reported fear/anxiety as most common bedtime difficulty and physical reassurance as most frequent parenting strategy for healthy sleep. Findings suggest that anxiety and fear often interfere with sleep and, in turn, physical reassurance as a helpful bedtime strategy. Undoubtedly, there is a need for sleep research and preventive interventions for children in foster care.

Support (if any)
Summer Student Research Support, Loyola University Maryland, College of Arts and Sciences
624 The association of circadian rhythms with cognitive functioning in children with attention-deficit hyperactivity disorder
Authors: Li Xiao , Shea Ka Sin Caroline , Wong Ching Kwong Dino , Chiu Waiyan Vivian , Lau Lok Fan , Yu Wai Man Mandy , Li Albert Martin , Wing Y K , Lai Yee Ching Kelly , Li Shirley Xin 
Published: May 2021

Abstract

Introduction
Disrupted circadian rhythms is associated with impaired cognitive function. Although circadian rhythm disturbances are commonly seen in individuals with attention-deficit hyperactivity disorder (ADHD), whether their cognitive functioning is thus affected remains unclear. This study aimed to examine the associations of circadian-related parameters with different cognitive abilities in children with ADHD.

Methods
Fifty-seven children with ADHD were recruited into this study (age range: 6–12 years, 66.7% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. Cognitive functioning was assessed with Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span test and N-back task for working memory, Tower of London test for planning skills and Bergs Card Sorting Test for set-shifting ability. The relationship between circadian parameters and cognitive performance was analyzed using multiple regression while controlling for age, sex, ADHD medication, the day of cognitive assessment (school days vs non-school days), total sleep time, and CSHQ total score.

Results
Increased activity during the most active 10-h period of the day (St. β = 0.39, p = 0.012) was related to more omission errors on CPT, and later onset of the least active 5-h period of the day (St. β = 0.44, p = 0.004) was associated with longer correct reaction time on CPT. Lower relative amplitude was associated with poorer performance on Digit Span (St. β = 0.33, p = 0.042). No significant associations were found between the circadian-related parameters and the performance on other tasks measuring processing speed and executive functions.

Conclusion
Circadian rest-activity rhythms (blunted rest-activity rhythms, higher daytime activity, and later onset of nocturnal rest) were associated with cognitive functioning in ADHD children. Future longitudinal studies are needed to explore the long-term impact of circadian rhythm disturbances and the effects of circadian-focused intervention on cognitive functioning in ADHD children.

Support (if any)
This work was supported by the Health and Medical Research Fund (Project No.: 30160604).
681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim Analysis
Authors: Mansour Wissam , Knauert Melissa 
Published: May 2021

Abstract

Introduction
Millions worldwide have been infected with COVID-19. Risk factors for poor outcomes include older age, obesity, cardiovascular disease, diabetes, COPD, and minority ethnicity. The impact of sleep apnea (OSA) on COVID-19 illness remains a topic of ongoing research. The association seems plausible as OSA shares common risk factors with COVID-19 comorbidities. The aim of our study is to investigate if the severity of OSA correlates with COVID-19 hospitalization outcomes.

Methods
The study is an observational retrospective electronic medical chart review of patients admitted to the Yale Health system for COVID-19 illness, who have an ICD medical history diagnosis of sleep apnea. Subjects with an available sleep study were grouped based on AHI severity. Composite outcome was determined by mortality or critical illness (ICU admission, mechanical ventilation, High-Flow nasal cannula or noninvasive ventilation). Interim analysis was conducted with data from 256 patients. Logistic regression was performed to calculate OR associated with the primary outcome comparing mild versus moderate-severe OSA groups.

Results
The sample of 256 patients included 50% females, with a median age of 64 (IQR,55–73) and BMI of 36 (IQR,30–41). Race distribution composed of 45% Whites and 40% African-Americans with 18% identifying as Hispanic. Overall mortality rate was 16%. Median length of stay (LOS) was 9 days (IQR,5 -15). 155 patients had a recorded AHI with a median of 26/hour (IQR,11–51) grouped into mild (34%), moderate (20%) and severe (45%) disease. Severe sleep apnea had the highest mortality rate of 19% and median LOS of 10 days (IQR,5- 16) compared to moderate (6% mortality,9 days (IQR,6–14)) and mild (17% mortality,6 days (IQR,4–11)) disease; differences were not statistically significant. Univariate logistic regression analysis demonstrated no significant difference in the composite outcome for mild versus moderate-severe OSA groups (OR=1.2; 95% CI:0.58–2.32).

Conclusion
Severe OSA appeared to have a trend towards an association with higher mortality versus moderate but not mild disease. Comparing moderate-severe disease to a reference group of mild disease did not demonstrate a significant difference in our composite outcome of death or critical illness. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support (if any)
N/A
687 Changes in adolescent sleep habits during the COVID-19 pandemic
Authors: Ham Grace , Fobian Aaron , Stager Lindsay , Morriss Skylar 
Published: May 2021

Abstract

Introduction
During the COVID-19 pandemic, adolescents have experienced significant lifestyle changes. With an increase in technological dependency and changes in school formats, sleep behaviors may be altered. As individuals with overweight or obesity (OWOB) already report higher rates of sleep issues, they may be particularly at risk during this time. However, to date, there are no data on changes in sleep behavior in adolescents with OWOB during the COVID-19 pandemic.

Methods
Participants included 10 adolescents with BMI ≥85th percentile (Mage=16.30 years, SDage=1.06; 60% male; 70% African American). Prior to the COVID-19 pandemic, participants completed sleep diaries twice per day for one week, noting caffeine intake, bedtime, naps, perceived sleep quality, and media use in bed. Participants then completed sleep diaries again during the COVID-19 pandemic. Five separate paired-samples t-tests assessed differences in sleep behaviors and quality.

Results
A paired-samples t-test demonstrated significantly earlier average bedtime before (M=11:20 PM, SD=55.16 minutes) than during (M=12:29 AM, SD=71.27 minutes) COVID-19 (t(9)=-3.0, p=0.015). A second paired-samples t-test demonstrated lower average media use in bed before (M=11.67, SD=10.97 minutes) than during (M=32.13, SD=27.28 minutes) the COVID-19 pandemic (t(9)=-2.3, p=0.050). No other significant differences were found.

Conclusion
Adolescents engaged in later bedtimes and increased media use in bed during the COVID-19 pandemic. This suggests adolescents’ sleep schedules have shifted later during the COVID-19 school year, due to either later wake times associated with virtual schooling or disruption in typical daily schedule as a result of the pandemic. However, no differences were found regarding caffeine intake, number of naps, and sleep quality. The significant findings regarding later adolescent bedtimes may reflect delayed sleep phase or possibly improved circadian alignment due to delayed school start times and at-home classes. The null findings regarding naps and caffeine intake may be reflective of the stability of daytime sleepiness. While we would expect daytime sleepiness to improve with increased circadian alignment, the effects may be diminished by increased media use in bed and decreased energy expenditure during the day. Given the observed relationships, current sleep hygiene interventions may require a focus on stimulus control and reducing time with media in bed.
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718 Investigating Decreased Positive Airway Pressure Compliance in a Veteran Affairs Sleep Medicine Clinic During the 2020 Pandemic
Authors: Earl David , Cutrufello Nicholas , Kern Joseph , Begay Melissa , Grigg-Damberger Madeleine , Ianus Vlad 
Published: May 2021

Abstract

Introduction
Positive airway pressure (PAP) compliance for the treatment of sleep apnea at the Albuquerque Veterans Affairs (VA) Sleep Medicine clinic has been observed to be lower in new setup patients after the onset of the COVID-19 pandemic. The reasons for decreased PAP compliance during the COVID-19 pandemic are unclear. The primary outcome will be to identify if there is a common reason that patients at the Albuquerque VA were less compliant with PAP after the onset of the COVID-19 pandemic.

Methods
Compliance data for 4/1/2020 through 9/30/2020 was compared to compliance data for 4/1/2019 through 9/30/2019. Compliance after PAP machine setup was confirmed to be lower during the 2020 time period. Noncompliant patients will be selected by setup type, new versus machine replacement, and surveyed for reasons for noncompliance. The survey will be conducted at the Albuquerque VA Sleep Center and will include questions regarding beliefs, barriers, and challenges with the use of PAP therapy during the coronavirus pandemic. The definition for initial PAP compliance will be the use of PAP therapy for greater than or equal to four hours per night on at least 70% of nights.

Results
For the 6-month time period of 4/1/2019 through 9/30/2019, there were 758 PAP setups at the Albuquerque VA. The 30-day compliance for the 758 setups was found to be 61.4%. Comparatively, for the six-month period of 4/1/2020 through 9/30/2020, there were 462 setups with a 30-day compliance result of 49.7%. A survey consisting of questions designed to elicit barriers to use as well as beliefs regarding PAP and COVID-19 will be administered to 20% (n = 46) of the non-compliant patients who were set up with a PAP machine during the 2020 study period.

Conclusion
PAP compliance after machine setup was lower at the Albuquerque VA sleep center in 2020 versus 2019 (49.7% versus 61.4%). The reasons for the lower observed compliance are attributed to the effects of the coronavirus pandemic. A random sampling of the non-compliant patients during the 2020 time period will be performed and the results will be presented once available.

Support (if any)
None