bluuebunny/crossref_metadata_2025_split huggingface dataset:
0765 Comparative Analysis of Sleep Measurement Methods: PSG vs. Actigraphy in Cognitively Normal Elderly Patients
Authors: Figueredo Luisa , Cesar Justin Oliver , Arthur Matthew , Jacobs Tovia , Gonzalez Moses , Gills Joshua L , Bernard Mark A , Bubu Omonigho , Osorio Ricardo 
Published: April 2024

Abstract

Introduction
Polysomnography (PSG) is the gold standard for sleep measurements, requiring individuals to sleep in a controlled environment. In contrast, actigraphy is more naturalistic, allowing at-home monitoring. While most studies comparing actigraphy to PSG have focused on healthy adults and individuals with sleep disorders, there has been limited research involving a well-characterized, healthy older adult population. Although actigraphy is convenient, it has been noted to differ from PSG in some aspects. Our study aims to assess the correlation between PSG and actigraphy in cognitively healthy older adults participating in NYU research on sleep, aging, and memory.

Methods
PSG recordings were conducted overnight at the bedside, while wrist-based data were collected on separate nights from individuals' homes. Actigraphs were worn on the non-dominant hand for seven consecutive days, validated by sleep logs. Statistical analyses, including t-tests, chi-square tests, and sensitivity-specificity assessments, were performed.

Results
Of the 151 subjects, 97 (64.2%) were female, 54 (35.8%) were male, 43 (28.5%) were Black/African American, and 108 (71.5%) were White. Mean age was 66 years (61-71). Mean Epworth Sleepiness Score was 5 (3-8) for women and 6 (3-9) for men. Total sleep time for PSG was 376 (332-418) with a mean difference with actigraphy of -67.4, 26, and 121 minutes (minimum, median, and maximum thresholds respectively, p&lt; 0.0001 for all) Sleep efficiency (%) was higher in the actigraphy group (mean difference 11.2 [SD12.7]) and sleep latency was shorter in the actigraphy group (p&lt; 0.001 for all). Sensitivity for short sleepers(&lt; 5h) was 0.7, increasing to 0.9 in females and 0.86 in Black or African Americans. Specificity corresponded to 0.95, decreasing to 0.87 in males, and to 0.48 in whites, while increasing to 0.96 in black patients. Both sensitivity and specificity for long-sleepers(&lt; 9h) corresponded to 0.5. Positive predictive value for short sleepers was 0.9, and 0.76 for long sleepers.

Conclusion
Overall, the study highlights the complexity of sleep measurements and the potential impact of conducting PSG and actigraphy on different nights. It underscores the need to consider nightly variability in sleep studies, the different diagnostic methods used, and the influence of sex and ethnicity on sleep patterns.

Support (if any)
0766 Current Sleep Hygiene Status in Non-clinical Population in Korea
Authors: Kim Jee Hyun , Kim Dongyeop , Lee Hye Ah , Yun Ji Young 
Published: April 2024

Abstract

Introduction
This study examines the difference in sleep hygiene status according to age and sex and the relationship between sleep hygiene and insomnia in the non-clinical Korean population using the Sleep Hygiene Practice Scale in Korean (SHPS-K), validated through this study.

Methods
We recruited non-clinical adults (Aged 18-65) without a history of neurologic, psychiatric, or medical disorders and diagnosed sleep disorders. An online survey was done using SHPS-K, the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS). The first survey enrolled 484 participants (242 women, mean age of 43.8 years), among whom 322 completed the second survey. SHPS-K was compared between each age group, sex, and group with or without insomnia symptoms (ISIS-K 15). Using receiver operating characteristic analysis in different age groups, we also determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K &gt; 5 and ISI-K 15).

Results
The average total SHPS-K score was 71.2, with no sex difference. Mean ISI-K, PSQI, and ESS were not different between sex and age groups. The older participants had lower SHPS-K than the younger groups, with a significant trend for ages ( =-3.01, p&lt; 0.001). This trend was significant in both men and women. Men had poorer eating and drinking behaviors among the four domains, and women had poorer sleep scheduling and timing behaviors. Young adults with insomnia symptoms showed the highest SHPS-K than other age groups with insomnia (p &lt; 0.001). A cutoff value of 76, 74, and 66 identified poor sleepers with insomnia (area under the curve = 0.818, 0.837, 0.849) in young, middle-aged, and older adults, respectively.

Conclusion
This study showed that sleep-disturbing behaviors were different between age groups and sex. The group with insomnia symptoms showed worse sleep hygiene practices. Furthermore, young adults had significantly worse sleep hygiene than middle-aged or older adults. Sleep hygiene education could contribute differentially to improving sleep quality in non-clinical populations.

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0768 Poor Sleep Quality Increases Mortality Risk. a Population-based Longitudinal Prospective Study in Adults
Authors: Khalil Melissa , Brutto Oscar Del , Mera Robertino , Rumbea Denisse , Sedler Mark , Castillo Pablo 
Published: April 2024

Abstract

Introduction
Sleep-related symptoms have been associated with adverse health outcomes, including increased mortality risk. Studies that analyzed the correlation between sleep and mortality focused on the single effect of self-reported sleep duration or relied on nonstructured questionnaires about sleep. In order to evaluate the detrimental effects of sleep disorders, studies should be based on well-structured and validated questionnaires that inquire about different components of sleep, including sleep quality. In addition, taking into consideration the fluctuations in sleep duration over the study period is essential. We aimed to assess the association between sleep quality and all-cause mortality in community-dwelling adults living in rural Ecuador.

Methods
Individuals aged ≥40 years enrolled in the prospective population-based Three Villages Study cohort were included. Sleep quality was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). Study participants were evaluated at baseline and at every annual door-to-door survey until they remained enrolled in the study. Mixed models Poisson regression for repeated PSQI determinations and multivariate Cox-proportional hazards models were fitted to estimate mortality risk according to sleep quality.

Results
Analysis included 1494 individuals (mean age: 56.6 ± 12.5 years; 56% women) followed for a median of 6.3 ± 3.3 years. At baseline, 978 (65%) individuals had good sleep quality and 516 (35%) had poor sleep quality. The effects of PSQI scores changing over time on mortality was confounded by the impact of the SARS-CoV-2 pandemic on both. One hundred ninety-five individuals (13%) died during the follow-up, resulting in a crude mortality rate of 1.58 per 100 person years (95% C.I.: 1.27-1.88) for individuals with good sleep quality, and 3.18 (95% C.I.: 2.53-3.82) for those with poor sleep quality at baseline. A multivariate Cox-proportional hazards model showed that individuals with poor sleep quality at baseline were 1.38 times (95% C.I.: 1.02-1.85) more likely to die compared to those with good sleep quality; in this model, increased age, poor physical activity, and high fasting glucose remained significant.

Conclusion
Poor sleep quality is associated with increase mortality risk among middle-aged and older adults.

Support (if any)
0769 Sleep Quality in Midlife Is Associated with Mobility and Balance in Later Life in the Wisconsin Sleep Cohort
Authors: Green Edith-Marie , Peppard Paul , Ravelo Laurel , Plante David , Hagen Erika 
Published: April 2024

Abstract

Introduction
Cross-sectional studies suggest that poor sleep quality predicts worse performance on tests of mobility in older persons; however, little is known about how objectively-assessed sleep quality in midlife is associated with declines in mobility and balance later in life. We examined the association of three objectively-assessed sleep quality measures in midlife adults as predictors of measures of mobility and balance assessed, on average, 8 years later in participants of the Wisconsin Sleep Cohort study.

Methods
Wisconsin Sleep Cohort participants (n=576, 47% female) had sleep (in-laboratory polysomnography) studies to assess sleep quality at midlife and, on average 8 years later, Timed Up and Go (TUG) tests to assess mobility and balance. There were some participants with repeat visits (n=378) yielding a total data set of 945 data points. Mean age (SD) at the baseline sleep study visits was 61(8) years. Sleep quality variables include percent N3 and percent REM sleep and sleep efficiency. The Timed Up and GO (TUG) test measures time in seconds to complete a walking task with 4 different variations: walking only, walking with an obstacle at midpoint, walking while counting backwards by 3’s, and walking with both an obstacle and while counting backwards by 3’s. Models were adjusted for age, sex, body mass index, total sleep time, and self-reported habitual sleep time. PROC MIXED in SAS was used to account for repeated measures.

Results
Less percent N3 sleep at baseline was significantly associated with reduced performance (greater time to complete) on 3 of the 4 variations of the TUG test, performed on average, 8 years after sleep assessment (all p&lt; 0.05 in adjusted models). A similar pattern of associations was observed with REM and sleep efficiency (less REM sleep and lower sleep efficiency were associated with reduced TUG performance), although these associations did not reach statistical significance.

Conclusion
Adequate sleep quality across midlife years may be an important modifiable contributor of improved mobility and balance in later life.

Support (if any)
This work was supported by the National Heart, Lung, and Blood Institute (R01HL62252) and the National Institute on Aging (R01AG058680) at the US National Institutes of Health.
0771 Sex and Racial Disparities in Obstructive Sleep Apnea Among Adolescents
Authors: Gutierrez Jeremy Landeo , Ryu Julie , Tantisira Kelan , Bhattacharjee Rakesh 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) gender dimorphism in the pediatric population has not been elucidated, while there has been a paucity in studies with adequate representation of adolescents. We hypothesize that OSA prevalence in adolescents undergoing polysomnography (PSG) is higher among male sex subjects than their female peers, even after adjusting for body mass index and other covariates.

Methods
Retrospective review of adolescents 11 to 18 years old who underwent a PSG at Rady Children’s Hospital between October 2016 and April 2022. Exclusion criteria: craniofacial and chromosomal anomalies, and neuromuscular disorders. Demographic characteristics included sex, age, BMI percentile, median income. The obstructive apnea hypopnea index (OAHI) was obtained from the PSG data. Moderate-Severe OSA was defined as OAHI³5 events/hour. Statistical analyses included chi-square tests, two sample t tests and non-parametric tests. Logistic regression was used for analysis of moderate-severe OSA and relevant predictor variables (age, sex, income and race/ethnicity)

Results
1745 adolescents with a mean age of 14.1±2.1 years were included, 56.1% were males and 43.9% were female. 58.2% Hispanic, 24.1% NH-Whites, 4.3% NH-Asians/Pacific Islander (Asian/PI), 4.2% NH-Blacks/African American (Black/AA) and 6.6% NH-Other. Male sex adolescents had higher OAHI (median 4.2 [IQR, 1.6-13.7] vs median 1.9 [IQR, 0.7-5.6], higher moderate to severe OSA than females (44.9% vs 27.2%, p-value&lt; 0.05) and higher BMI percentiles (median 97.5 [IQR, 82.1-99.2] vs median 95.1 [IQR, 73.9-98.5], p-value&lt; 0.01). Univariate logistic regression identified higher odds of moderate-severe OSA in Males (OR: 2.18, 95% CI: 1.78-2.66) compared to their female peers. This association persisted (OR: 2.24, 95% CI: 1.81-2.76) even after simultaneous adjustment for age, BMI percentile and median income. Finally, when stratifying by sex, we identified that Hispanic ethnicity (OR: 1.76, 95% CI: 1.19, 2.60) and NH-Asian race (OR: 2.36, 95% CI: 1.21, 4.59) were associated with increased odds of moderate-severe OSA only among males but not females, when compared to their NH-White peers.

Conclusion
In a sleep laboratory population, we identified higher moderate-severe OSA prevalence in male adolescents compared to females even when accounting for BMI and other relevant covariates. In addition, we found novel ethnic/racial disparities within the male sex population.

Support (if any)
NIMHD 1P50MD017344 and OT2 HL161847.
0774 Refining a Primary Care Navigation Intervention to Address Sleep Disparities: Caregiver and Clinician Perspectives
Authors: Uwah Eberechukwu , Abraham-Montgomery Michele , Nag Diya , Tapia Ignacio , Guevara James , Fiks Alexander , Williamson Ariel 
Published: April 2024

Abstract

Introduction
There are well-known racial, ethnic, and socioeconomic disparities in the incidence and treatment of pediatric sleep-disordered breathing (SDB). Addressing these disparities through culturally-tailored interventions could increase effectiveness and acceptability. As care navigation models have been beneficial in addressing modifiable patient and system-level barriers to care, we qualitatively explored participants’ perspectives of a sleep navigation (SN) program in primary care to inform future intervention refinement.

Methods
Thirty-three English-speaking caregiver-child dyads (child Mage= 7.1◻4.2 years; 51.6% girls; 100% Black, 3% Hispanic/Latinx; 93.5% maternal caregiver; 61.2% living ≤125% US poverty level) referred to SDB specialty care by their primary care provider were randomly assigned to clinical decision support (CDS) or to CDS with SN. SN was a 1-3 session program designed to support families in completing their SDB referral through motivational interviewing and care coordination strategies. Primary care clinicians (n=21) also participated in the study. We conducted semi-structured qualitative interviews with 10 caregivers (5 from CDS only, 5 from CDS + SN) and 9 clinicians to assess acceptability and perspectives on SN optimization. Interview data were coded and analyzed using thematic analysis.

Results
Overall, clinicians and caregivers that received SN reported strong acceptability. Participants also noted the benefits of racial concordance for families and navigators in transferring health knowledge to improve health literacy. Caregivers reported positive changes in their child’s sleep health and a better understanding of SDB. Themes related to SN refinement included adding tailored patient education such as audio-visual and written materials and enhancing strategic family-provider communication. Clinicians emphasized that SN could be enhanced beyond referral completion by including support for families needing additional SDB care (e.g., surgery) and through in-person, warm handoffs in clinics to build trust between families and navigators. Clinicians also recommended exploration of a broader navigation program that could integrate multiple primary care referrals and resource needs (e.g., food insecurity).

Conclusion
SN was perceived as highly acceptable by primary care clinicians and families of primarily Black and/or lower-income backgrounds. Sustainability of the resultant model requires additional refinement to determine optimal implementation strategies that integrate sleep navigation with other primary care needs.

Support (if any)
Children’s Hospital of Philadelphia Chair’s Initiative Round 8 (AAW).
0776 Polysomnography in Neonates with Myelomeningocele: Variability in Scoring and Interpretation
Authors: Mason Thornton , Hassan Fauziya , Shellhaas Renee , McCaffery Harlan , Lloyd Robin , Barks John , Chervin Ronald 
Published: April 2024

Abstract

Introduction
A prospective, longitudinal, multicenter study was designed to test the hypothesis that sleep-disordered breathing (SDB) is ubiquitous among newborns with myelomeningocele (MMC). We evaluated variability in polysomnography (PSG) scoring and interpretation.

Methods
Nine US pediatric centers participated. Neonates with MMC born at &gt;30 weeks gestation underwent bedside PSG at ≥35 weeks postmenstrual age, before hospital discharge. PSGs were scored by registered technologists (RPSGTs) at each site using AASM Scoring Manual infant criteria and interpreted by a board-certified sleep medicine physician (BCSMP). A single, central RPSGT blinded to clinical outcomes then re-scored all PSGs. One of two pediatric BCSMPs reviewed each study; the two BCSMPs jointly determined diagnoses for consensus central reports. Differences in scoring and overall PSG interpretation were evaluated with kappa and intraclass correlation coefficients (ICC).

Results
For 110 neonates with MMC, the median apnea-hypopnea index (AHI) was 26.5 [11.3-43.3] as reported by sites, and 23.0 [IQR 13.0-44.8] as reported centrally (к 0.81). The central apnea index (CAI) was also scored similarly by sites (3.3 [0.9-7.0]) and centrally (2.6 [0.6-7.3]; к 0.88), as were hypopneas (15.2 [7.5;26.9]) and 14.1 [6.4;27.9]; к 0.82). However, the obstructive apnea index (OAI) was reported to be much higher by sites (10.0 [1.9-29.1]) than centrally (1.5 [0.5 – 4.1]; к 0.29). Moreover, overall PSG interpretation differed between sites and central reviewers. Obstructive sleep apnea (OSA) was reported as a diagnosis by sites for 57.6% of neonates, vs. 10.9% by central review (ICC 0.06); central sleep apnea was reported by sites for 26.6% of neonates, vs. 14.5% by central review (ICC 0.50). When hypopneas were the most prevalent respiratory events, central review favored a less specific diagnosis of sleep-disordered breathing.

Conclusion
Considerable variability in scoring of obstructive apneas, and in polysomnography-based diagnoses, may exist for neonates. Sites may have designated hypopneas as obstructive, driving the diagnosis of OSA, while central review noted equivocal features of neonatal hypopneas, leading to a less specific diagnosis of sleep-disordered breathing. Further work to develop infant respiratory scoring rules, and diagnostic criteria, and to evaluate their clinical use may be warranted.

Support (if any)
This study is supported by NIH (R01 HL147261).
0777 Respiratory Sleep Phenotypes in Prader-Willi Syndrome: Does the Type of Mutation Matter?
Authors: Queiroga Thereza , Lopes Maria-Cecilia , Spruyt Karen , Passone Caroline , Bueno Clarissa , Franco Ruth , Damiani Durval , Soster Leticia 
Published: April 2024

Abstract

Introduction
Prader-Willi Syndrome (PWS) is a congenital disorder with three types of mutation: deletion (DEL), maternal uniparental disomy (UPD), and imprinting center defects (IMP). Sleep breathing disorders and sleep disruption may change the clinical evolution of these patients. The study aimed to evaluate the clinical characteristics of PWS patients according to genetic mutation, characterizing their sleep phenotypes and focusing on sleep respiratory measures.

Methods
From a cohort (January 2014 to July 2021) 55 patients of the same research university center with confirmed PWS genetic diagnosis consented. We applied questionnaires for sleep disorders, physical examination, nasolaryngoscopy, and overnight polysomnography

Results
Participants were aged between 2 and 22 years with genetic confirmation for PWS: 28 DEL, 21 UPD, and 6 IMP, and 24 (43.6%) were male participants patients with UPD and DEL mutations underwent polysomnography. They were divided into three quartiles (Q1, Q2, and Q3) for each respiratory parameter: the apnea-hypopnea index (AHI), the time of SpO2 (minutes) during sleep (SpO2min), and T&lt; 90%. The AHI values of Q3-DEL (AHI: 15.2) were higher than Q3-DUM (AHI: 10.3). The SpO2min in the DEL group was 62%, while in the UPD group it was 76%. Patients in the DEL group had a higher prevalence in longer quartiles with T&lt; 90%.

Conclusion
PWS patients showed specific respiratory sleep phenotypes according to genetic diagnosis. We found that PWS patients with DEL had worse polysomnographic respiratory patterns. Further studies are needed to recognize the clinical implications of the sleep respiratory findings in the clinical endophenotype of PWS.

Support (if any)
0778 A Novel Endotype of Pediatric Obstructive Sleep Apnea Syndrome Revealed Using K-Means Clustering
Authors: Kim Seung Soo , Jang Han Na , Moon Jin-Hwa , Jeon Jin Yong , Ahn Dong Hyun 
Published: April 2024

Abstract

Introduction
With the recent emergence of precision medicine, endotype / phenotype research for sleep disorders has been increasing. However, there were still few related studies on pediatric obstructive sleep apnea syndrome (OSAS). The authors conducted this study to cluster pediatric OSAS patients using polysomnography (PSG) parameters and find new endotypes.

Methods
We retrospectively investigated the medical records of children and adolescents who had been diagnosed with OSAS (apnea-hypopnea index, AHI &gt; 1/h on PSG) at the single sleep disorders center. We used age, total sleep time (TST), sleep latency (SL), REM sleep latency (RL), sleep efficiency (SE), wake time after sleep onset (WASO), and the percentage of stage N1/N2/N3/R (%N1/%N2/%N3/%R) for clustering. Prior to clustering, the dimensions of variables were reduced through uniform manifold approximation projection (UMAP). And then K-means clustering (KM) were used for clustering. We used average silhouette index (ASI) as evaluation metrics. After clustering, the differences among clusters were compared using one-way ANOVA.

Results
Total 306 subjects were enrolled (mean age 8.2 ± 4.1 years old, boy : girl = 194:112). There were statistical significant differences in pediatric daytime sleepiness scale (PDSS), children's depression inventory (CDI), and age (p-value &lt; 0.01, respectively) among clusters. Sleep architectures, such as TST, SL, RL, WASO, and %N1/%N2/%N3/%R also showed a significance difference among clusters. There was no statistical significance in total AHI, SE, and sex. KM showed ASI 0.42 and revealed 4 clusters. Cluster 3 (daytime sleepiness with depressive mood, n=72) showed the higher PDSS (mean 13.9 ± 7.2) and CDI (mean 12.0 ± 9.6) than other clusters. Cluster 3 also showed the older age (mean 12.3 ± 3.1) than other clusters.

Conclusion
The authors revealed the novel endotype of pediatric OSAS accompanied by excessive daytime sleepiness and depressive mood regardless of AHI and SE, which were previously used as indicators of sleep quality. Further research is needed to identify new endotypes of pediatric OSAS that cannot be identified by the classic indicators.

Support (if any)
A grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &Welfare, Republic of Korea (grant number : RS-2023-00267049)