bluuebunny/crossref_metadata_2025_split huggingface dataset:
0121 Discrimination Attributed to Personal Characteristics and Sleep Health Among Black/African American Young Adults
Authors: Collie Angel , Dadzie Adwoa , Master Lindsay , Reichenberger David , Mathew Gina , Chang Anne-Marie , Hale Lauren , Buxton Orfeu 
Published: April 2024

Abstract

Introduction
Perceived discrimination is associated with sleep health problems. This association is even stronger among Black/African Americans, who are typically exposed to more frequent discrimination in the US. Limited research examines how perceptions of discrimination impact young adults’ sleep health, particularly using objective measures. The current study investigated the association between perceived discrimination experiences and sleep health among Black/African American young adults.

Methods
Data from age 22 wave of the Future of Families and Child Wellbeing, Young Adult Sleep Study (YASS) included Black/African American young adults (n = 221) who self-reported experiences of discrimination due to their race/skin color, gender, and age. Wrist-worn actigraphy measures across ~2 weeks included sleep duration, sleep maintenance efficiency, and wake after sleep onset (WASO). Multiple linear regression models examined the association between perceived discrimination experiences based on personal attributes and dimensions of sleep adjusting for age, gender, and educational attainment.

Results
Among this sample of Black/African American young adults, perceived experiences of discrimination in their life were not associated with actigraphic sleep duration. Perceived discrimination attributed to race/skin color, age, or gender were not associated with sleep duration. Perceived experiences of discrimination in their life were also not associated with actigraphic sleep maintenance efficiency. Perceived discrimination attributed to age was associated with lower sleep maintenance efficiency (-3.01%, p&lt;.001) and more WASO (+10.64 minutes/night, p=.004) compared to young adults who did not perceive age discrimination. Perceived discrimination attributed to gender was associated with lower sleep maintenance efficiency (-2.12%, p=.023) and more WASO (+9.47 minutes/night, p=.019), and were not different between women and men. Gender did not modify associations of sleep measures with perceived discrimination attributed to race/skin color or age.

Conclusion
Black/African American young adults’ perceived discrimination due to specific personal attributes (age and gender) are linked to lower sleep maintenance efficiency and more WASO. Future longitudinal research should examine whether perceived discrimination in young adulthood predicts poorer sleep health across time.

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R25-HL147668, R01HD073352, R01HD36916, R01HD39135, and R01HD40421
1216 Resolution of Headaches Related to Idiopathic Intracranial Hypertension After Treatment with Lemborexant
Authors: Sabbagh Riad Al , McCann Peter , Arjyal Sushrusha 
Published: April 2024

Abstract

Introduction
The orexin (hypocretin) system has attracted interest for its role in the regulation of multiple behavioral processes including feeding, sleep-wake cycle and reward-related behaviors. Dual orexin receptor antagonists (DORAs) target both orexin receptors 1 and 2 and these drugs currently have FDA-approval for insomnia treatment. The orexin system has also been implicated in pain processing through modulation of nociceptive pathways at the periaqueductal gray. Idiopathic intracranial hypertension (IIH) is characterized by evidence of raised intracranial pressure with or without papilledema without an underlying cause. Symptoms include chronic headaches, visual disturbance, and pulsatile tinnitus as well as back and neck pain. Management of IIH can be challenging and includes weight loss, carbonic anhydrase inhibitors and CSF shunting procedures all of which can have variable success in reducing headache frequency. Here we present a case of Lemborexant treatment for chronic insomnia with subsequent resolution of headaches related to IIH.

Report of case(s)
A 68-year-old male with a 25-year history of headaches secondary to IIH presented to the sleep medicine clinic for chronic insomnia. He had persistent headaches despite treatment with acetazolamide, zonisamide, nortriptyline and therapeutic lumbar punctures. He reported a history of insomnia for over 20 years. Polysomnography showed no evidence of OSA and actigraphy was consistent with his self-reported insomnia. He was started on mirtazapine for insomnia which was discontinued due to intolerance, and he was started on Lemborexant. When he was seen at follow up one month later, he reported improved sleep, achieving 7-8 hours of restful sleep per night. He also noted complete resolution of his daily headaches and had since stopped all medications required for his IIP treatment. This improvement in his IIH symptoms persisted during his two-month follow-up visit.

Conclusion
This is the first case report to our knowledge showing an improvement in headaches related to IIH in a patient prescribed lemborexant. The relationship between chronic pain and sleep disturbance is complex and there may be a subset of patients with chronic pain including headaches and insomnia who experience improvements in their pain through treatment of their sleep disturbance with DORAs.

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0122 Development and Initial Validation of the Danieli-Arizona Border Intergenerational Transmission of Stress Scale
Authors: Valencia Dora , Begay Tommy , Rasmussen Elizabeth , Ochoa Sylvia , Hernandez Edlin , Molina Patty , Carrillo Ivan , Grandner Michael A 
Published: April 2024

Abstract

Introduction
Intergenerational transmission of stress is an underrecognized potential contributor to sleep and mental health disparities among at-risk populations. No existing tool captures this construct as experienced at the US-Mexico Border.

Methods
The DABITSS was originally developed based on the Danieli Inventory of Multigenerational Legacies of Trauma developed for families of Holocaust survivors and was adapted to the border region through a series of focus groups. The end result is a scale in both English and Spanish that consists of 3 subscales: Parents (46 items, parental behaviors indicating transmission of stress), Adaptations (25 items, thoughts, feelings, and behaviors that represent internalization of stress), and Experiences (35 items, events that may induce intergenerational stress). Total scores for the Parents and Adaptations subscales range from 0-100, for a total score of 0-200. The Experiences scale ranges from 0-35. Scale and total scores were evaluated relative to insomnia (Insomnia Severity Index), depression (PHQ9 scale), and adverse childhood experiences (ACEs questionnaire). Models were adjusted for age, sex, ethnicity (Mexican or White), survey language (English or Spanish), immigrant status, and acculturation.

Results
DABITS scores on the Parents subscale ranged from 0.54-63.98 (M=28.99, SD=15.31); scores on the Adaptations subscale ranged from 5-65 (M=33.90, SD=14.51); scores on the Experiences subscale ranged from 0-20 (M=5.11, SD=3.57), and total scores [(Parents+Adaptations)/2] ranged from 10.54-123.06 (M=62.89, SD=26.27). Insomnia severity was associated with Parents (B=0.85, 95%CI [0.10, 1.60]), Adaptations (B=1.16, 95%CI [0.50,1.81]), and total score (B=2.01, 95%CI [0.76,3.25]). Depression was associated with Parents (B=1.09, 95%CI [0.25,1.93]), Adaptations (B=1.29, 95%CI [0.55,2.02]), Experiences (B=0.25, 95%CI [0.06,0.45]), and total score (B=2.38, 95%CI [0.99,3.77]). ACEs score was associated with Parents (B=2.91, 95%CI [1.15,4.67]), Adaptations (B=1.87, 95%CI [0.24,3.51]), Experiences (B=0.99, 95%CI [0.61,1.36]), and total score (B=4.79, 95%CI [1.78, 7.79]). Additional analyses are planned for other sleep (duration, quality, disorders, sleepiness) and mental health (anxiety, stress) measures.

Conclusion
The DABITSS scale represents multiple dimensions of intergenerational stress (how it was passed on, how it is experienced, and what may have triggered it). These dimensions are related to sleep and mental health.

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R01MD011600
1228 The Impact of Modified Uvulopalatopharyngoplasty as a Bridge to Hypoglossal Nerve Stimulation Eligibility
Authors: Norooz Sheeva , Levri John 
Published: April 2024

Abstract

Introduction
Severe Obstructive Sleep Apnea (OSA) presents a significant challenge, particularly in cases where patients exhibit intolerance to conventional treatments like Continuous Positive Airway Pressure (CPAP). When the Apnea-Hypopnea Index (AHI) remains markedly high, individuals often seek advanced interventions, such as Hypoglossal Nerve Stimulation (HGNS). However, some individuals face elevated AHI scores that surpass the threshold for qualification for HGNS. This narrative documents a patient's journey through a series of interventions, starting from failed CPAP therapy to undergoing Modified Uvulopalatopharyngoplasty (UPPP), which played a pivotal role in reducing their AHI. Subsequently, the placement of an HGNS implant led to the resolution of their OSA.

Report of case(s)
Our patient, a 65-year-old man battling severe OSA, experienced CPAP intolerance with an initial AHI of 88. Despite weight loss, his AHI remained above the acceptable range (15-65) for HGNS. Seeking alternatives, the patient underwent a transformative Modified UPPP, resulting in a significant reduction of his AHI. This improvement enabled his eligibility for HGNS. Post-implantation, marked improvements ensued: cessation of snoring, enhanced sleep quality, and substantial overall well-being. Despite transient swallowing difficulties post-surgery, the patient’s overall course was without complications and largely successful. His journey highlights UPPP’s pivotal role in lowering AHI to qualify patients for advanced therapies, suggesting a promising strategy for managing severe OSA in individuals with refractory AHI levels.

Conclusion
In conclusion, our patient's journey showcases the transformative impact of Modified UPPP, not only in reducing AHI and enabling eligibility for HGNS but also in revealing a pathway for tailored interventions in severe OSA cases. This emphasizes the importance of personalized treatment strategies, and prompts consideration for the integration of multi-tiered interventions in managing complex cases of OSA.

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1229 Dual Neurostimulator Therapy for CSA and OSA in an Elderly Gentleman with Native Pacemaker
Authors: Wasim Alina , Singh Supriya 
Published: April 2024

Abstract

Introduction
We describe a case of severe central sleep apnea with concomitant obstructive apnea treated with a stepwise approach with Transvenous phrenic nerve stimulation and Hypoglossal nerve stimulator.

Report of case(s)
70 yo male with medical history of diabetes, chronic kidney disease stage 3, coronary artery disease with coronary artery bypass in 1997, aflutter with failed ablation (2015, persistent atrial fibrillation, bradycardia with pacemaker implantation (2016), lymphocytic leukemia, treated with methotrexate, underwent a home sleep study in 2018 which showed severe sleep apnea (AHI 55% and O2 nadir 72%). This was followed by a titration study which showed predominant CSA not amenable to CPAP, BPAP or BPAP ST. Echo was performed which showed LVEF 40%. Baseline in lab PSG was performed which showed AHI of 89.5/hour (225 central,36 mixed and 15 obstructive events). REM AHI: 65, REM RDI 65, Supine AHI 90/hour and supine RDI 90.1. Cheyne stokes breathing was observed throughout the study along with significant sleep hypoxia. Medical management failed and patient was not a candidate for ASV given low EF. Remede device was implanted in 2018 for management of CSA. For obstructive apnea, APAP was prescribed however patient tolerance remained poor with suboptimal control of OSA. Repeat PSG showed resolution of CSA and CCB with persistent severe obstructive events AHI 72. With control of CSA, patient underwent DISE which showed Anteroposterior collapse of the vellum qualifying the patient for Inspire.

Conclusion
Traditional treatment for CSA involves optimization of any underlying medical conditions and positive-pressure ventilation with certain limitations. In a subset of patients, CSA remains refractory to medical management and failure rates of PAP therapy remain high. Transvenous PNS significantly improves CSA severity, sleep quality, ventricular function, and QOL regardless of HF status and should be considered in patients with high CSA burden. Once CSA management is optimized, patients with high OSA burden and PAP intolerance can then be considered for HNS. Most of these patients with underlying heart failure may have native ICD or pacemaker, requiring careful assessment of device-device interaction.

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1230 Management of Severe OSA with HGNS: Importance of In-Lab Sleep Studies for Accurate Assessment-bA Case Report
Authors: Cassimere Crystal , Khan Safia 
Published: April 2024

Abstract

Introduction
Continuous positive airway pressure (CPAP) therapy is gold standard treatment for obstructive sleep apnea. Compliance issues and CPAP/BPAP intolerance have paved the way for alternative interventions such as the Hypoglossal Nerve Stimulation (HGNS) device. HGNS works by directly stimulating the hypoglossal nerve in synchrony with respirations to open the airway via tongue stiffening and protrusion, ultimately preventing airway collapse during sleep.1

Report of case(s)
This case report is about a 70-year-old male who has history of severe OSA with significant hypoxemia, being managed with a HGNS implant due to CPAP intolerance. Sleep study after HGNS device activation, showed adequate treatment of OSA, AHI improved to normal range, however, persistent hypoxemia (SpO2 less than 88% for 90 min) was noted. An overnight pulse oximetry study again revealed significant hypoxemia with SpO2 less than 88% for 121 minutes. A home sleep study showed ongoing moderate OSA and hypoxemia with an AHI 26.2 per hour based on 3% desaturation hypopneas and AHI 16.0 per hour based on 4% desaturation hypopneas, in association with significant hypoxemia (SpO2 less than 88% for 54 min) despite using the HGNS implant. He was tested with an in-lab sleep study for the purpose of initiation of supplemental oxygen for management of significant hypoxemia. This study showed significant improvement of AHI to normal range of &lt; 5/hour at setting of 2.7 V, and no significant hypoxemia was noted.

Conclusion
The case highlights a potential discrepancy in evaluating sleep apnea severity using home sleep apnea tests in patients with HGNS device. Most insurance companies approve home sleep apnea tests, but it is advised that patients with HGNS devices showing persistent significant OSA or hypoxemia on a home sleep study undergo a repeat in-lab sleep study for a more accurate estimation of sleep apnea severity and hypoxemia.

Support (if any)
References 1. Olson MD, Junna MR. Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea. Neurotherapeutics. 2021 Jan;18(1):91-99. doi: 10.1007/s13311-021-01012-x. Epub 2021 Feb 8. PMID: 33559036; PMCID: PMC8116425. 2. Punjabi NM, Aurora RN, Patil SP. Home sleep testing for obstructive sleep apnea: one night is enough! Chest. 2013 Feb 1;143(2):291-294. doi: 10.1378/chest.12-2699. PMID: 23381307; PMCID: PMC3566993.
1232 Shall We Hold or Shall We Sleep
Authors: Truong Khanh , Khan Safia 
Published: April 2024

Abstract

Introduction
Nocturia is a common symptom among individuals with untreated and undiagnosed obstructive sleep apnea and is described as waking up from sleep two or more times to void. Interestingly, nocturia is not included in the American Academy of Sleep Medicine clinical practice recommendation to evaluate OSA in adults. Women's OSA symptoms differ from men's, and they are sometimes ignored or attributed to depression or insomnia, leading to an underestimation of OSA diagnosis. Especially nocturia in women is more frequently disregarded as a cause for sleep disturbances. A recent systematic analysis found a lack of data on the prevalence of OSA in Asians, particularly Asian women.

Report of case(s)
A 65-year-old Asian female with a history of osteoporosis who presented to the clinic with a chief complaint of nocturia. Historically, patient went to bed at 11 P.M. and awoke at 6 A.M. She denied history of any other sleep disorders. She complained of frequent nocturia which occured 3-4 times per night, requiring her to wake up every 1 or 2 hours to use the bathroom affecting sleep maintenance. She tried oxybutynin and mirabegron without much improvement. She did not report snoring, having witnessed apneas, or daytime fatigue. Her BMI was 21 and her neck circumference was 13 inches. A home sleep study was done resulting AHI 21.6, showing evidence of moderate obstructive sleep apnea. Patient was recommended to start Auto-CPAP. At 6-month follow up, she reported improvement in her nocturia symptom.

Conclusion
OSA has received increased public attention in recent years, and it is recognized to have serious health consequences if left untreated. Current screening standards in primary care include BMI, sex, age, pharyngeal anatomy, snoring, excessive daytime sleepiness, and the presence of hypertension. However, nocturia isn't included despite the fact that it is frequently reported and related with OSA. Nocturia is improved by treating OSA with PAP treatment or a mandibular advancement device. As a result, more research needs to be done on screening for OSA when nocturia is present, particularly in Asian women, in order to increase the efficacy of the screening method.

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1234 Managing Idiopathic Hypersomnia in a Patient Following Sleeve Gastrectomy
Authors: Uy Roma Balbin , Hershner Shelley 
Published: April 2024

Abstract

Introduction
Sleeve gastrectomy (SG) is a weight loss surgery removing approximately 80% of the stomach1 resulting in a narrower, tubular stomach “sleeve”. It's considered a restrictive procedure wherein weight loss is achieved by limiting the volume of food intake by diminishing the stomach’s capacity. In Roux-en-Y(RYGB), parts of the small intestine is bypassed and the remaining portion is connected to a newly created smaller stomach. By surgically bypassing regions of the small intestine, RYGB limits nutrient absorption leading to weight loss. It’s considered both a restrictive and malabsortive procedure; thus RYGB is associated with more pharmacologic/metabolic concerns compared to SG. Although there is minimal literature comparing drug absorption between SG vs RYGB, some data proposes both SG and RYGB lead to nutrional deficiencies suggesting SG may also be a malabsorptive procedure altering drug pharmacokinetics by increasing transit time, altering gastric pH and reducing bioavailability for extended-release formulations.

Report of case(s)
A 41-year-old female with past medical history of sleeve gastrectomy is seen for management of idiopathic hypersomnia (IH). IH was confirmed after a polysomnogram ruled out obstructive sleep apnea (OSA). The MSLT revealed a mean sleep latency of 6.8 minutes without SOREMPs, and excluded central causes. She has tried multiple combination of medications: dextroamphetamine and amphetamine immediate (IR) and extended release (XR), modafinil, and armodafinil. Currently, she is taking dextroamphetamine and amphetamine IR 30 mg in the morning and 15 mg in the afternoon and modafinil 200mg in the morning. She reports significant sleepiness 2-3 hours after taking her medications.

Conclusion
While SG primarily impacts the stomach, it's crucial to note that the procedure can influence drug absorption with effects such as increased drug transit time, and changes in pH. In bariatric surgery patients, utilizing dosage forms that allows drug disintegration, resistant to acidic environments, and has increased bioavailability—such as liquids or even transdermal formulations—may mitigate altered drug absorption. For this patient, we have discussed smaller and more frequent doses of dextroamphetamine and amphetamine IR formulations e.g 20 mg IR every 3-4 hours (maximum 60 mg today daily dose). If this is not effective, calcium, magnesium, potassium & sodium oxybate can be considered.

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0136 Diurnal Patterns in Suicidal Thinking Among Young Adults
Authors: Tubbs Andrew , Hawkins Emma , Gorovoy Suzanne , Fernandez Fabian-Xosé , Grandner Michael , Perlis Michael 
Published: April 2024

Abstract

Introduction
Suicide is the second-leading cause of death among young adults. Disrupted sleep and circadian rhythms may contribute to the risk of suicide in this age group. Nocturnal wakefulness, for example, may create changes in brain function that contribute to increased incidence of suicide. However, there are limited data on whether suicidal cognitions vary across the day.

Methods
A sample of N=143 individuals aged 18-25 were recruited to participate in a week-long ecological momentary assessment study of sleep and suicidal thoughts. Sleep was sampled daily using a sleep diary, and suicide-related cognitions were sampled five times per day using automated text messages. Text surveys were scheduled across 24 hours (roughly at 2AM, 7AM, 12PM, 5PM and 10PM) and grouped into 6-hour bins (2300-0459, 0500-1059, 1100-1659, 1700-2259). Individuals with unusual or elevated levels of suicidal ideation were followed-up by study personnel for safety.

Results
A total of N=3442 text surveys were collected from N=134 participants. Participants provided an average of 26 surveys each (SD=8.3). A total of N=93 (2.8%) of surveys reported suicidal ideation. As a proportion of all surveys, suicidal ideation was most prevalent from 2300-0459 (N=18, 3.2%) and least from 0500-1059 (N=20, 2.2%). Among suicidal ideators, the desire to die was most elevated from 1100-1659 (1.8 out of 4, SD = 1.19), the intention to die was greatest from 1100-1659 (0.9 out of 3, SD=0.8), and the ability to resist the urge to die was lowest in the 0500-1059 (3.1 out of 4, SD=1.12). However, there were no statistical differences across time categories for the presence of suicidal ideation or severity/intensity of these thoughts.

Conclusion
Suicidal ideation was measured in nearly every hour of the 24-hour day, and severity of suicidal ideation appeared to fluctuate over time. Nevertheless, the presence of suicidal ideation and its severity did not differ statistically across the day, likely due to the small number of reported suicidal cognitions across the sample. Additional work will examine how sleep continuity and/or regularity may influence these findings.

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