bluuebunny/crossref_metadata_2025_split huggingface dataset:
0883 Sleep and Circadian Health, Insulin Sensitivity, and Glycemic Control in Adolescents with Type 1 Diabetes
Authors: Simon Stacey , Cooper Emily , Brinton John , Bernard Angel , Bowen Anne , Snell-Bergeon Janet , Cree Melanie , Wright Kenneth , Nadeau Kristen 
Published: April 2024

Abstract

Introduction
Insulin resistance and poor glycemic control are significant risk factors for cardiovascular disease for individuals with type 1 diabetes (T1D). Adolescents with T1D are at heightened risk for poor sleep and circadian health due to behavioral and physiologic aspects of T1D in combination with biological, psychosocial, and environmental factors of adolescence. Emerging evidence suggests an association between sleep and circadian health with insulin sensitivity (SI) and glycemic control among adults with T1D and healthy adolescents, but this has not been explored in adolescents with T1D.

Methods
Twenty-three adolescents with T1D underwent a cross-sectional assessment during the academic year with one week of in-home actigraphy and continuous glucose monitoring (CGM) followed by in-laboratory serial salivary melatonin sampling and hyperinsulinemic-euglycemic clamp. BodPod assessed free-fat mass (FFM). SI was expressed as steady-state glucose infusion rate (“M”) in mg/kg/FFM/min. Sleep variability was calculated as the standard deviation of weekday actigraphy-estimated sleep metrics. Duration between dim-light melatonin onset (DLMO) and bedtime was calculated to determine circadian phase angle. Pearson correlations examined associations between sleep and circadian variables with SI and glycemic control.

Results
Adolescents with T1D (age=15.9±1.1 years, 48% female, 91% non-Hispanic White, HbA1c=7.6±1.1%) obtained 6.7±0.8h sleep on weeknights. Greater nightly variability of time in bed (TIB) and sleep midpoint timing across the monitoring period were associated with worse SI (M mg/kg FFM/min; r=-0.43, p=0.045; and r=-0.44, p=0.04, respectively). Greater nightly variability in the duration of wake after sleep onset (WASO) was associated with poorer CGM metrics, including higher mean sensor glucose (r=0.62, p=0.006), less time in range (70-180mg/dL, r=-0.56, p=0.016), and higher standard deviation (r=0.51, p=0.031). A longer duration (wider phase angle) between DLMO and bedtime was associated with a higher CGM coefficient of variation (r=0.91, p=0.002).

Conclusion
Nightly variability in TIB, sleep timing, and WASO, and circadian phase angle may represent contributing mechanisms of poorer SI and glycemic control in adolescents with T1D. Further research is warranted examining the health impact of sleep and circadian health interventions in adolescents with T1D.

Support (if any)
Ludeman Center for Women’s Health Research; JDRF 2-SRA-2019-848-S-B and 2-SRA-2022-1144-M-B; CCTSI Maternal & Child Health Pilot Award; NIH NCATS UM1TR004399.
0889 Association of U.S. Military Burn Pit Smoke Exposure with Objective Sleep Parameters Among Smoking Veterans
Authors: Nowakowski Sara , Kokonda Manasa , Razjouyan Javad , Sharafkhaneh Amir , Helmer Drew 
Published: April 2024

Abstract

Introduction
Burn pits (BPs) have been widely used by the U.S. military for waste disposal. Due to the obviously toxic nature of the BP emissions exposure (BPe) may contribute to diverse adverse health conditions, including sleep apnea. This study aimed to examine the association between self-estimated amount of BPe and objective sleep problems among smoking veterans.

Methods
Using polysomnography reports in the Veteran Affairs electronic medical records, sleep measures were extracted for 4940 Veterans and active-duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. Objective sleep parameters included Total Sleep Time (TST) and Sleep Efficiency (SE). Cumulative BPe variable was calculated by multiplying the response (in hours) to a question about BPe by number of deployment days, summing across deployments, and categorized into quartiles by ranking. Inverse probability treatment weighing method was used to adjust the imbalances of covariates age, BMI, sex, race, ethnicity, military branch, and duty status between treatment groups. We employed separate weighted logistic regression models to determine the association between cumulative BPe days and sleep outcomes among smoking veterans.

Results
Current smokers in prolonged BPe quartile predicted higher odds of shorter TST (OR:1.43, 95%CI: 1.08-1.89, p=0.02, with reference to never smokers), whereas no significance shown in SE (OR:0.97, 95%CI: 0.75-1.27, p=0.89).

Conclusion
Higher levels of self-estimated BPe was associated with shorter objective TST in current smoking veterans. Smoking may exert synergistic effect to BP emission exposure on sleep problems. Further research is needed to define the effects of BP emission exposure on sleep among deployed and non-deployed Veterans.

Support (if any)
This work is supported 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), Michael E DeBakey Veteran Affairs Medical Center Bridge Grant, and the VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant.
0890 Polysomnography Extracted Sleep Health Disparities Among Burn Pit Registered U.S. Military Veterans
Authors: Kokonda Manasa , Razjouyan Javad , Sharafkhaneh Amir , Helmer Drew , Nowakowski Sara 
Published: April 2024

Abstract

Introduction
Disparities are under-recognized factors for sleep health. Additionally, there are concerns about sleep health among Veterans with exposure to burn pit emissions during deployment. This study aimed to examine the association between age, sex, and race and objective sleep related problems in veterans and active duty personnel.

Methods
Using polysomnography reports between April 2000 and September 2022 in the Veteran Affairs electronic medical records, objective sleep problems were extracted to 4940 Veterans and active duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. We examined the association between sociodemographic variables (age, sex, and race) and objective sleep related problems (Total Sleep Time (TST), Sleep Efficiency (SE), Minimum SAO2, and Apnea-Hypopnea Index (AHI)) in separate logistic regression models.

Results
Middle age Veterans (41 - 50 y) predicted greater odds of shorter TST, lower SE, (ORs:1.26-1.36, p’s&lt; 0.03), and older age Veterans (&gt;50 y) predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.29-1.71, p’s&lt; 0.01). Male sex predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.22-1.97, p’s&lt; 0.04). African American race predicted greater odds of shorter TST (OR:1.25, p=0.04).

Conclusion
We observed a higher prevalence of objective sleep problems and sleep-disordered breathing problems among middle age compared to young Veterans and males compared to females. We also found a higher prevalence of shorter TST in Black compared to White Veterans and active duty personnel who completed the burn pit registry. This research address the importance of sleep health disparities of objective sleep related problems among Veterans with burn pit emission exposure.

Support (if any)
This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); Michael E DeBakey VAMC Bridge Grant, and VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).
0891 Sleep Quality Among Post-9/11 Veterans with Exposure to Airborne Hazards
Authors: Glick Danielle , Konikkara John , Sotolongo Anays , Alexander Thomas , Diaz-Abad Montserrat , So Jennifer , Arjomandi Mehrdad , Krefft Silpa , Osterholzer John , Richmond Bradley , Falvo Michael 
Published: April 2024

Abstract

Introduction
Disordered sleep, including insomnia and obstructive sleep apnea, is common among post-9/11 veterans returning from Southwest Asia and Afghanistan. Environmental exposures, such as elevated respirable particulate matter, may contribute to the development of sleep apnea. Additional occupational exposures sustained during military service may contribute to poor sleep, for example hyperarousal and resultant insomnia. We sought to describe sleep quality and prevalence of sleep disorders among a veteran population exposed to airborne hazards with unexplained dyspnea.

Methods
Veterans from across five sites of the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN) completed, as part of a more comprehensive evaluation, questionnaires inclusive of demographic information and the Pittsburgh Sleep Quality Index (PSQI). Limited polysomnography data was also available through chart review at the Baltimore site. Descriptive statistical analysis was performed, with means and standard deviations or medians and interquartile ranges reported for all questionnaire and PSG outcomes, as appropriate.

Results
In total, 168 veterans completed the PSQI and demographic questionnaires. The majority of respondents were aged 45±9 years, male (82%), and white (73%). Approximately half had served in the Army branch of the military. BMI was available for only 127 veterans, with mean 31.9±5.9 kg/m2. The group overall reported prolonged sleep onset latency (56±51 minutes) and reduced total sleep time (5±1 hours). Overall PSQI scores were elevated at 13±5. In Baltimore (N=38), PSQI data was similar. Sleep study data was available for 30/38 veterans, of whom 27 had a diagnosis of obstructive sleep apnea (OSA). Among those with OSA, the median AHI was 13.5 (IQR 14.5) events/hour and the mean BMI was 31.0±5.2 kg/m2.

Conclusion
Among a cohort of post-9/11 veterans with exposure to airborne hazards, insufficient and disturbed sleep was common. In a limited subset with sleep study data, the majority had at least mild OSA. Future work will evaluate the presence of comorbid medical and mental health conditions. This early descriptive data is consistent with prior reports among similar veteran populations, and highlights the need for further research to elucidate causes of sleep disturbances and possible relation to exposure to airborne hazards.

Support (if any)
Supported by the VA’s Airborne Hazards and Burn Pits Center of Excellence
0892 Roles of Pain Interference, Pain Intensity, and Sleep-partner in Insomnia and Daytime Sleepiness Among Veterans
Authors: Tsai Thomas , Krueger Mason , Wallace Douglas , Wohlgemuth William 
Published: April 2024

Abstract

Introduction
Insomnia and daytime sleepiness are prevalent in Veterans, many of whom have co-morbid pain. Although ample evidence suggests an association between sleep and pain, the differential roles of pain-related daytime dysfunction (hereafter, “pain interference”) and pain intensity in insomnia and daytime sleepiness are less known. These associations may also be influenced by the presence of a sleep-partner, who has been shown to provide psychological comfort but may also interfere with the physical comfort of one’s sleep environment. Thus, this study examined the unique associations of pain interference and pain intensity, as well as the moderating effects of sleep-partner, with symptoms of insomnia and daytime sleepiness among Veterans presenting to a sleep clinic.

Methods
Veterans presenting to the Miami VA sleep clinic for sleep apnea assessment (N=405, M age=50.3 years, 84.3% male) completed the PROMIS-29 (pain interference, pain intensity), Insomnia Severity Index, and Epworth Sleepiness Scale, and reported whether they sleep with a partner or not. Structural equation modeling was used to examine the study aims while controlling for age, gender, and apnea-hypopnea index.

Results
On average, Veterans reported moderate levels of pain interference, pain intensity, and insomnia severity, as well as mild levels of daytime sleepiness. Over half (59.0%) of the Veterans endorsed sleeping with a partner. Among Veterans who slept without a partner, greater pain intensity was associated with greater insomnia severity (b=.14, p=.002). Among Veterans who have a sleep-partner, greater pain intensity was associated with both greater insomnia severity (b=.09, p=.017) and greater daytime sleepiness (b=.53, p=.038). Pain interference was not associated with insomnia or daytime sleepiness in either group (b&lt;=.02, p&gt;=.084).

Conclusion
Findings indicated the unique and deleterious role of pain intensity in insomnia and daytime sleepiness in Veterans, particularly among those who sleep with a partner. Such evidence highlights the interdependent nature of sleep and suggests considerations of dyad-level factors in sleep interventions. Further investigations are warranted to elucidate the biopsychosocial factors underlying the current findings.

Support (if any)
0893 Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Comorbid Chronic Obstructive
Authors: Greig Danny , Rastogi Ruchi , Diaz Teresa , Johnston Ian , Mishra Poonam , Tovar-Torres Maria , Kushida Clete , Axelrod Bradley , Zhao Lili , Shamim-Uzzaman Qurratul , Chowdhuri Susmita 
Published: April 2024

Abstract

Introduction
Cognitive impairment in older Veterans is an independent predictor of subsequent mortality and disability. Pilot data indicate that patients with OSA-COPD Overlap Syndrome (OVS) have reduced sleep quality and quality of life (QoL). However, there are no prior systematic studies evaluating treatment paradigms in patients with OVS. Our ongoing clinical trial is investigating whether, compared with usual care, positive airway pressure (PAP) therapy alleviates sleep disturbances, sleepiness, and improves cognitive function and QoL in older adults with OVS.

Methods
The design is a prospective parallel group randomized controlled trial in Veterans 60 years and older, with moderate-to-severe OSA with concomitant COPD (OVS). 225 eligible participants will be randomized to two treatment groups (PAP and conservative care) in 2:1 ratio for a duration of 6 months. Participants on the conservative care arm are required to follow good sleep habits and sleep hygiene, and on the PAP arm, in addition, are required to be adherent to PAP treatment (CPAP or Bilevel PAP, as required). Sleep questionnaires are administered to evaluate sleepiness, sleep quality, and general and disease specific QoL. Cognitive function is evaluated using Trail Making Test Part A and B, Paced Auditory Serial Addition Test, Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R, Weschler Abbreviated Scale Intelligence II, Weschler Memory Scale IV, and Psychomotor Vigilance Test, respectively. All tests are administered at baseline visit, 3 months, and 6 months.

Results
We have enrolled 222 participants between Detroit and Ann Arbor VAMC locations, randomized 50 participants (48 males, 5 females; age: 70.5±6.5 years, BMI: 29.2±6.3kg/m2, AHI: 44.4±20.9events/hr, spirometry FEV1: 61.6±14.9% predicted, arterial blood gas (n=37) PaCO2:41.3±3.7 mmHg, ESS: 7.6±4.3, Six Minute Walk Test Total Distance Walked: 389.6±105.7 meters, FOSQ Total Score: 17.0±3.5, SGRQ Total Score: 45.6±22.6;30 participants have completed the study per the protocol. Group analysis will be available at the end of the trial. COVID pandemic has negatively impacted enrollment targets.

Conclusion
Final results from our study will determine the effects of treating a novel target (OVS) to maximize daytime function and QoL, while also providing a framework for early treatment of mild cognitive impairment in vulnerable older Veterans.

Support (if any)
VHA RR&D # 1I01RX003124-01
0895 Greater Sleep Reactivity and Poorer Sleep Efficiency Are Associated with Increased Medical Expenditures
Authors: Slavish Danica , Kotov Roman , Ruggero Camilo , Luft Benjamin 
Published: April 2024

Abstract

Introduction
Insufficient sleep costs the U.S. economy over $411 billion per year in lost productivity. However, most studies investigating the economic costs of sleep rely on flawed retrospective measures of sleep (e.g., typical sleep patterns in the past month). These measures are prone to recall bias and do not accurately capture daily variability in sleep patterns. To address these gaps, we examined how sleep metrics captured from prospective sleep diaries were associated with medical claims approximately one year later.

Methods
Participants were 452 World Trade Center 9/11 responders enrolled in the World Trade Center Health Program in 2017 (mean age = 52.22 years, SD = 8.73, 10.6% female). At baseline, participants completed 14 days of self-reported sleep and stress measures each morning. Mean sleep efficiency, variability in sleep efficiency, as well as a novel measure of sleep reactivity (i.e., how much people’s sleep efficiency changes in response to previous-day stressors) were used to predict total yearly medical claims, physical health claims, and mental health claims approximately one year later , covarying for participant age and sex.

Results
Greater sleep reactivity to stress was associated with more total medical claims (b = $7,742.63, p &lt; .001), more physical health claims (b = $1,421.87, p &lt; .001), and more mental health claims (b = $2,682.81, p &lt; .001). Lower mean sleep efficiency was associated with more total medical claims (b = -$7,669.63, p = .018), more physical health claims (b = -$2,103.42, p = .026), and more mental health claims (b = -$2,494.76, p = .011). Greater variability in sleep efficiency was associated with more total medical claims (b = $14,020.82, p = .010) and more mental health claims (b = $7,035.91, p &lt; .001).

Conclusion
Individuals with greater sleep disturbances engage in more healthcare utilization. Given the steep costs of insufficient sleep, it may be important to proactively address sleep problems to prevent downstream social and economic consequences.

Support (if any)
NIOSH U01OH011321 (PI: Kotov)
0900 Comparing a Lifestyle Plus Sleep Extension to a Lifestyle Intervention in Adults with Short Sleep and Prediabetes
Authors: Malone Susan , Patterson Freda , Grunin Laura , Goel Chitvan , Hu Jinyu , Sclafani Michelle , Saini Sara , Melkus Gail D'Eramo 
Published: April 2024

Abstract

Introduction
The purpose of this study was to evaluate the extent to which a sleep extension intervention optimized the well-established effects of a diet and physical activity lifestyle intervention on improved metabolic outcomes in adults with prediabetes (hemoglobin A1c ≥5.7% and ≤6.4%) and short sleep duration (≤6.5 hours/night actigraphy-estimated sleep).

Methods
157 eligible adults (mean age=52.16 years, 69% female, 66% White, 36% Black, 11% Asian, 7% other race) were randomized to an 8-week lifestyle plus sleep extension (n=88) versus lifestyle control (n=69) condition. Participants completed pre and post assessments of device-estimated glucose, sleep, and waist circumference. Self-reported sleep quality and daytime sleepiness were also assessed. Paired sample t-tests modeled pre to post-intervention changes in these measures.

Results
Device-estimated sleep duration increased significantly in both conditions [intervention condition 17.04 (SD=42.98) minutes; control condition 24.18 (SD=38.10) minutes]. Sleep onset time, sleep midpoint, and weekend sleep midpoint advanced in the intervention condition only [-16.71 (SD=52.48) minutes, -9.40 (SD=38.82) minutes, -20.83 (SD=54.30) minutes, respectively]. Sleep quality improved clinically and significantly in the intervention condition; mean Pittsburg Sleep Quality Index score decreased from 8.32 (SD=2.82) to 4.77 (SD=2.55). Sleep quality improved significantly in the control condition from 7.75 (SD=2.97) to 6.35 (SD=2.88). Between group differences in sleep quality change scores showed greater improvement in intervention versus control participants (p&lt; 0.001). Daytime sleepiness decreased significantly in both conditions (-3.15 intervention versus -1.18 control). Between group differences in daytime sleepiness showed greater improvement in intervention versus control participants (p&lt; 0.001). On average, waist circumference decreased by -0.74 (SD=5.19) cm. in the intervention and -1.56 (SD=5.21) cm. in the control condition; these changes scores did not differ significantly between conditions. There were no statistically significant improvements in devise-estimated glucose measures.

Conclusion
Adding sleep extension to a lifestyle change intervention improved several dimensions of sleep, beyond sleep duration, that have been associated with poor metabolic health (e.g. sleep times, sleep quality). The two conditions did not differentiate in terms of increasing sleep duration or decreasing waist circumference suggesting that individuals should at least have lifestyle interventions as a component of care. Neither condition improved glycemic outcomes.

Support (if any)
NIH (R00NR017416)
0904 The Prevalence of Insomnia and Fatigue in Cancer Patients Pre-Post Radiation Treatment
Authors: Lampe Elizabeth , Park April , Seewald Mark , Freedman Gary , Boyle Julia , Perlis Michael , Muench Alexandria 
Published: April 2024

Abstract

Introduction
Insomnia and Cancer-related fatigue (CRF) are highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing at least one of these at some point during treatment. Concerningly, insomnia and CRF have long-term effects on quality of life, daytime function, and are associated with medical and psychiatric morbidity. No studies to date have assessed concurrent change in CRF and insomnia with radiation therapy. Thus, the present analysis aimed to characterize insomnia & CRF prevalence and severity pre- and post-radiation.

Methods
Insomnia and fatigue were assessed pre- and post-radiation among 32 adults diagnosed with cancer (Mage=58.22 years, SDage=10.54, 46.9% female, 62.5% White). Subjects were asked to complete the Insomnia Severity Index, Functional Assessment of Chronic Illness Therapy – Fatigue Scale (FACIT-F), Brief Fatigue Inventory (BFI) and PROMIS-SF Fatigue 7A at each timepoint. Descriptive statistics are used characterize the severity of insomnia and CRF at each timepoint and exploratory t-tests examined whether sex was associated with change in insomnia and fatigue severity from pre- to post-radiation.

Results
The mean ISI total score was 8.25 (SD=5.01) pre-radiation, and 8.50 (SD=3.46) post-radiation. The mean FACIT-F total score was 40.34 (SD=9.01) pre-radiation and 34.67 (SD=8.69) post-radiation. There was one (3.12%) case of new-onset clinical insomnia and five (15.63%) cases of new-onset clinical fatigue from pre- to post-radiation. Females reported greater increases in fatigue from pre- to post-radiation compared to males (t(31)=-4.612, p &lt; 0.001, d=-1.44).

Conclusion
Insomnia and fatigue are highly prevalent in patients diagnosed with cancer at both pre- and post-radiation. Overall, insomnia stayed relatively stable while fatigue increased over treatment. This suggests that separate mechanisms may drive cancer-related fatigue and insomnia. Fatigue increased over treatment for both men and women, however this effect was stronger for women. A better understanding of mechanisms of insomnia and CRF may allow for earlier detection of insomnia and CRF as well as the use of targeted interventions for individuals struggling with CRF and/or insomnia during cancer treatment and recovery, especially among women.

Support (if any)
University of Pennsylvania, Radiation Oncology, Chair's Summer Research Grant