bluuebunny/crossref_metadata_2025_split huggingface dataset:
1025 The Impact of Depression on Neurocognitive Functions and Conversion in Isolated REM Sleep Behavior Disorder
Authors: Yoon In-Young , Lee Minji , Hong Jung Kyung , Moon Seock Hyeon , Han Sojung , Park Chae Rin , kim Hak hyeon 
Published: April 2024

Abstract

Introduction
Depression is frequently observed in patients with isolated REM sleep behavior disorder (iRBD). The aim of this study was to analyze cognitive function and quantified electroencephalography (QEEG) in iRBD patients according to the presence of depression, and to evaluate the impact of depression on the conversion to neurodegenerative diseases.

Methods
A total of 90 individuals with iRBD were included in this study. They were followed for up to 9 years, and 21 of them were converted to Parkinson's disease or dementia. Phenoconversion was defined when a definitive diagnosis of parkinsonism by neurologists or any form of dementia by geriatric psychiatrists was established based on evident clinical symptoms. The diagnosis of depression (27 among 90 iRBD) was made based on the initial interview or taking antidepressant medication.

Results
The depressed group showed poor performance in the executive function (p= 0.029, Stroop color test) than the non-depressed group. The depressed group tended to have lower z-scores than the non-depressed group in global cognition, attention, memory, and frontal/executive domains. The QEEG results, the relative gamma power in the temporal and parietal region, relative high gamma power in the parietal region were significantly increased (p=0.049; p=0.032; p=0.008) in the depressed than the non-depressed group. The conversion was significantly increased in iRBD patients with depression than iRBD without depression (p=0.013). The depression in iRBD patients had 3.319 of hazard ratio (p=0.011) for the risk of conversion to neurodegenerative diseases.

Conclusion
Depressive symptoms in iRBD patients should be monitored as aggravating cognitive dysfunction and a risk factor for conversion.

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1026 Validation of the Situational Sleepiness Scale
Authors: Lomba Sara , Sum-Ping Oliver , Mignot Emmanuel 
Published: April 2024

Abstract

Introduction
The Epworth Sleepiness Scale (ESS) is the gold standard measure subjective daytime sleepiness. Since the inception of the ESS 25 years ago, modern life has evolved considerably and the situations posed by the ESS have become dated. This interim analysis introduces the Situational Sleepiness Scale (SSS) which focuses on common activities occurring in the modern world.

Methods
A group of sleep physicians and staff between Stanford and the UK Biobank developed the questionnaire. An initial set of questions were distributed to subjects, and through multiple iterations of subject feedback and subsequent revision, were refined into its current form of eleven situations. To explore further the scale as a replacement for the ESS, the SSS and the eight situation ESS were given in tandem to patients and visitors of the Stanford Sleep Clinic.

Results
A correlation coefficient between the ESS and SSS was run on 121 completed questionnaires. Our result to date indicates a strong correlation between both scales (R2=0.74, p&lt;.0001). The mean score for the SSS was 7.74 and 7.36 for the ESS. The standard deviation for the SSS was 5.11 compared to 4.74 for the ESS. A test of variance produced a value of 25.9 for the SSS and 22.3 for the ESS. Thirty-four subjects scored ≥ 10 in this sample using the ESS and 26 of these subjects had a value ≥ 10 for the SSS. Most of the subjects who scored ≥ 10 on the ESS scored ≥ 10 on the SSS and vice versa suggesting that a similar cutoff could be used for defining daytime sleepiness on the SSS.

Conclusion
In this interim analysis, we found the Situational Sleepiness Scale to be easily administered and to correlate well with the ESS. In future studies we will examine consistency of scores across item, stability over time/ repeatability, and explore psychometric properties. Additional studies aiming at gathering several hundred subjects with various diagnoses are ongoing. As the SSS goes up to 33, but has a similar cutoff of ten on the correlation, we believe the SSS could be more discriminative than the ESS for very sleepy patients such as narcoleptics.

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1030 APOE Genotype and Sleep Architecture
Authors: Cho Gawon , Buxton Orfeu , Pan Yulu , Miner Brienne 
Published: April 2024

Abstract

Introduction
APOE4 genotype, a robust genetic risk factor for Alzheimer’s Disease, is associated with reduced functional connectivity of the basal forebrain, one of the key regulators of sleep and wakefulness. The objective of this study was to examine the association between APOE4 genotype and sleep architecture.

Methods
This study included 1,793 participants aged 65-85 from the Sleep Heart Health Study (SHHS) who completed in-home, overnight polysomnography. Primary predictor was APOE4 allele carrier status: non-carriers (reference), heterozygotes and homozygotes. Outcomes included the following three characteristics of sleep architecture: time spent in slow wave sleep (SWS), time spent in rapid eye-movement sleep (REM) and the number of arousals per hour. We used linear regression to examine the association between APOE4 carrier status and each sleep architecture characteristic, adjusting for age, sex, marital status, and educational attainment.

Results
The sample included 9.5% people of color and 52.7% women. Median age was 73 (interquartile range = 69,77). Average duration of SWS and REM (minutes/night) by APOE4 genotype was: 62.7 and 68.7 (non-carriers); 63.0 and 67.6 (heterozygotes); and 63.0 and 70.7 (homozygotes). Average number of arousals among non-carriers, heterozygotes, and homozygotes was 18.5, 17.2, and 16.2 times/hour, respectively. Linear regression models showed that APOE4 carrier status was not associated with time spent in SWS or REM. The number of APOE4 alleles showed an inverse linear trend with arousals/hour, (β=-0.77 [95%CI=-1.96,0.42] in heterozygotes; β=-4.25 [95%CI=-8.01,-0.50] in homozygotes). Additional analyses using other sleep architecture measures, including the proportion of time spent in SWS or REM, SWS or REM duration/hour, wake after sleep onset (WASO), total sleep duration, and time spent in non-SWS sleep, all yielded non-significant results, except for total arousals/night, which exhibited an inverse linear trend with the number of APOE4 alleles (β=-3.64 [-10.44,3.16] in heterozygotes; β=-22.52 [-43.97,-1.07] in homozygotes).

Conclusion
Contrary to our expectations, APOE4 carriers did not show reduced sleep quality across various indices, including time spent in SWS, REM or WASO. They also showed reduced number of arousals. Our findings suggest that non-respiratory sleep problems may not be the primary pathway leading to an increased burden of Alzheimer’s disease in APOE4 carriers.

Support (if any)
SHHS was supported by: UOIHL53940, UOIHL53941, UOIHL53938, UOIHL53916, UOlHL53934, UOIHL53931, UOIHL53937.
1034 Attenuated Heart Rate Change as Potential Sleep Digital Biomarker in Lewy Body Dementia
Authors: Cho Yeilim , Brown karl , Wilson Katie , Levendowski Daniel , Tsuang Debby 
Published: April 2024

Abstract

Introduction
Differentiation of Lewy body Dementia (LBD) from Alzheimer’s disease (AD) is challenging due to overlapping clinical presentation. Symptoms associated with autonomic nervous system dysfunction are common in patients with LBD, likely associated with the accumulation of α-synuclein aggregates in the neurons and glial cells. We investigated whether spontaneous heart rate acceleration or deceleration measured by autonomic activation index (AAI) with a portable home sleep test can differentiate LBD from AD. We hypothesized that individuals with LBD will have attenuated AAI compared to those with AD.

Methods
We enrolled patients with LBD (n= 10) and AD (n=6), all of whom underwent a portable home sleep test for two consecutive nights. AAI was defined based on a 6 beats per minute increase or decrease in pulse rate compared to the previous or subsequent 10th second. Each participant’s mean AAI was calculated after weighing the total sleep duration. Mean AAI, sleep efficiency, REM stage, and N3 were compared between the two groups.

Results
The mean (SD) age for the AD group was 78.5 (2.4) years old, and for the LBD, it was 70.4 (7.6). AAI was higher in AD than LBD group but differences were not statistically significant [24.1 (23.1) and 11.2 (10.6), p=0.3]. Percentage time spent in REM sleep was significantly higher in AD than LBD [18.3(4.3) and 8.4(8.2), p=0.007]. While N3 sleep state (%) was lower in AD than LBD [9.7(19.2) and 18.4(24.6), p= 0.4] and sleep efficiency (%) was higher in AD than LBD 72(0.1)and 70(0.2), p=0.8], these differences were not significant.

Conclusion
Heart rate change during sleep measured by AAI was lower in LBD patients (vs. AD) as hypothesized, but the differences were not significant, likely due to the small sample size. Percentage time spent in REM sleep was lower in LBD compared to AD. Future studies are necessary to determine if attenuated heart rate change during sleep can be a used as a digital sleep biomarker to differentiate between LBD from AD.

Support (if any)
This work was supported by grant funding from: NIA-NIH grant R21AG064271
1040 Improved Care in Neuromuscular Multidisciplinary Clinic with Sleep Medicine Incorporation
Authors: Clay Collin , Cocozza Victoria , Scheuller H Samuel , Fullam Timothy , Walter Robert , Brock Matthew , Tchopev Zahari 
Published: April 2024

Abstract

Introduction
Neuromuscular multidisciplinary clinical care models are becoming common in the management of the neuromuscular disease. Updated clinical practice guidelines emphasize the role of polysomnography (PSG) in determining the need for early non-invasive ventilation (NIV) in these patients to improve quality of life and disease course. Despite this and the high prevalence of comorbid sleep disorders, sleep medicine is not included in the standard model for these clinics. We sought to (1) define and improve the rate of PSG acquisition, and (2) improve detection of sleep-related comorbidities in this high acuity population with the addition of sleep medicine to an established neuromuscular multidisciplinary clinic.

Methods
Sleep medicine physicians joined a pre-established multidisciplinary clinic aimed to treat neuromuscular disease and related comorbidities. The multidisciplinary clinic was attended monthly from January to December 2023. Patients were evaluated for sleep disorders using clinical interviews and standardized sleep questionnaires. Patients were referred to the sleep disorders center to obtain diagnostic in lab video PSG with carbon dioxide monitoring. When sleep disordered breathing was detected, patients were offered therapy and followed clinically.

Results
A total of 12 neuromuscular patients (6 male (50%), average age 52) were evaluated, with75% (n=9) having no prior sleep medicine encounter. Only 50% had completed a PSG prior to sleep medicine evaluation. After sleep medicine evaluation, PSG acquisition rate improved to 100%. Obstructive sleep apnea (OSA) was detected in 83.3% (n=10, average AHI 26.6) of patients, with 8 meeting criteria for moderate-severe OSA, and 2 having nocturnal hypoventilation despite normal pulmonary function testing. The average sleep efficiency was 70%. The average Insomnia Severity Index was 8.25 and 58.3% (n=7) were diagnosed with chronic insomnia disorder. The average Epworth Sleepiness Scale was 7.6, with 41.6% (n=5) reporting excessive sleepiness.

Conclusion
Acquisition of clinically recommended PSG improved to 100% from our intervention. The detection of previously undiagnosed OSA, insomnia, and nocturnal hypoventilation is clinically meaningful. Sleep medicine incorporation into the neuromuscular multidisciplinary clinical care model contributes to improved patient care.

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1044 Relationship Between Core Autism Symptoms and Sleep Disturbances in Youth with Autism: A Latent Class Analysis
Authors: Lenker Kristina , Calhoun Susan , Fernandez-Mendoza Julio , Mayes Susan 
Published: April 2024

Abstract

Introduction
Previous studies have used cluster analysis to clarify diagnostic heterogeneity of autism, but have been limited to identifying subgroups of autism on the basis of core symptoms rather than sleep problems. The present study examined the relationship between core autism symptoms and sleep problems in children and adolescents with autism spectrum disorder (ASD).

Methods
1466 patients (1–18y, M=6.4±3.6; IQs of 8–146, M=88.9±27.25; 81.2% male, 89.0% white) diagnosed with ASD. Dimension reduction via principal component analysis (PCA) was performed on the 10 sleep items from the Pediatric Behavior Scale. Latent class analyses (LCA) was used to determine phenotypes characterized by core ASD symptoms (social interaction, perseveration, somatosensory disturbance, atypical communication/ development, mood, and selective attention/safety awareness), and sleep dimensions accounting for age, gender, IQ, and medication use.

Results
Three clusters with distinguishable sleep factors were retained from the PCA, with eigenvalues &gt;1, with adequate goodness-of-fit (TLI=0.91;RMSEA=0.075); disturbed sleep (trouble falling asleep, restless sleep, wakes often, nightmares, and talks/walks/or cries in sleep), insufficient sleep (sleeps less, wakes early), and, hypersomnolence (drowsy/sleepy, sluggish/slow-moving, sleeps more). LCA revealed a 3-class (AIC=29164.00;BIC=29594.00;sBIC=29334.00) and 4-class model (AIC=28986.00;BIC=29489.00;sBIC=29184.00), with adequate fit. Based on IC measures, the 4-class model yielded the best model fit, with acceptable entropy (0.856). Based on conceptual grounds and considering all model fit statistics, the 4-class model was chosen. Using Class 3 (N=708;50.7%) as the reference group, Class 1 (N=71;5.1%) was categorized by more problems with social interactions, disturbed sleep, hypersomnolence, older age and increased medication use. Class 2 (N=367;26.3%) was categorized by less severe autism symptoms, particularly problems with selective attention/safety awareness, overall sleep problems, older age and higher IQ. Class 4 (N=251;18.0%) was categorized by more problems with perseveration and somatosensory disturbance, disturbed and insufficient sleep, younger age and increased medication use. Gender was not a significant covariate.

Conclusion
Using LCA we found four distinct patterns of core autism symptoms and sleep problems differing in terms of age, IQ, and medication use. This study provides strong evidence for phenotyping and targeting sleep as a standard part of therapeutic intervention in individuals with autism.

Support (if any)
Department of Health and Human Services, Health Resources and Services Administration, R4349152
1049 Are the AASM Scoring Rules Fitting for the Sleep of Patients with Chronic Disorders of Consciousness?
Authors: Marelli Sara , Sattin Davide , Castelnuovo Alessandra , Ippoliti Camilla , Magnani Francesca Giulia , Cacciatore Martina , Barbadoro Filippo , Leonardi Matilde , Sebastiano Davide Rossi , Strambi Luigi Ferini 
Published: April 2024

Abstract

Introduction
From a neurobiological perspective, consciousness and sleep are strictly related. It is known that regular sleep patterns may reflect the preservation of brain functions. Detailed sleep assessment Disorders of Consciousness (DOC) patients is a controversial issue.

Methods
Twenty-two patients (11 females and 11 males, mean age 52.2 + 14.5 years) with prolonged or chronic DOC were consecutively enrolled as part of a national, multicentric clinical trial aimed at evaluating the tolerance and the efficacy of treatments for sleep disorders in DOC patients. All the patients underwent to a 24h polysomnography (PG) visually inspected in order to assess their sleep stages on the basis of the AASM scoring rules.

Results
All the patients except one slept for at least 4 hours. Ten out of 21 (47.6%) patients showed a sleep lacking the features necessary for scoring; nor spindles neither K-complexes were present, the delta waves, if present, were localized; the polygraphic features of REM stage were absent. In our cases, sleep differed from wakefulness only by the decrease in muscle tone and by the reduction of eye movements and muscle artifacts on the EEG, as well as by the modification in the heart rate and heart-rate variability. Furthermore, in 4 out of 10 DOC patients with “indistinct” sleep, EEG pattern was characterized by very low voltage activity (&lt; 20 microV), similar to what is observed in cases of deep sedation.

Conclusion
Our data push in the direction that a standardized sleep assessment procedure in DOC should be stabilized.

Support (if any)
This research was funded by the Italian Ministry of Health GR-2016-02365049—Pilot Study on sleep pathologies treatments in patients with Vegetative and Minimally Conscious State diagnosis for improving Consciousness level: the STRIVE project.
1054 Should Non-sleepy Patients Screened Positive for Sleep Apnea During Hospitalization Be Treated?
Authors: Srinivasan Priyanka , Rojas Edward , Olgers Kassandra , Knollinger Scott , Stansbury Robert , Sharma Sunil 
Published: April 2024

Abstract

Introduction
Studies have shown that unrecognized sleep apnea in hospitalized patients results in increased hospital readmissions. However, it is unclear if poor outcome is limited to sleepy patients (ESS&gt;10) or non-sleepy patients (ESS&lt; 10) as well. In a formal hospital sleep medicine program, we evaluated the outcome of hospitalized patients diagnosed with OSA by monitoring their 6-month emergency department (ED) visits, hospital readmissions and mortality.

Methods
Patients were chosen based on two criteria: report of an ESS score and diagnosis of OSA through gold-standard outpatient polysomnography (PSG). During the period of August 2019 and June 2023, a total of 123 consecutive patients from a hospital sleep medicine service who were determined to have OSA and ESS ³ 10 were compared with a control of 123 patients with OSA and ESS &lt; 10. Over the next 6 months, patients’ ED visits, hospital readmissions and mortality were monitored. Demographics, comorbidity, and medication information were also recorded for these patients.

Results
The sleepy cohort had a mean ESS of 14 (SD 3) compared to the non-sleepy cohort of 6 (SD 2). The mean age and BMI for the sleepy versus non sleepy cohort were 57.6 (SD 12.8) versus 59.9 (SD 12) and 42 (10.8) and 39.6 (10.9), respectively. The sleepy cohort had an AHI from PSG of 26.2 (26.3) and the non-sleepy cohort had an AHI from PSG of 28.4 (23), the severity of sleep apnea was also similar. For patients with OSA and ESS &gt; 10, the adjusted odds ratio for emergency department visits was 0.74 (95% CI 0.41-1.33). Similarly, the OR for the sleepy cohort for hospital readmission and mortality was 1.07 (CI 0.66-1.73) and 1.0 (CI 0.99-3.63).

Conclusion
Hospitalized patients who were diagnosed with OSA did not display significant differences in 6-month readmission, ED visit and mortality based on their ESS score. Given OSA’s prevalence in the community, additional measures in addition to ESS scores must be taken to manage potential cases of OSA, thus improving clinical outcomes.

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1057 A Tale of Two Languages: Evaluating Caregiver Satisfaction with Telemedicine in a Pediatric Sleep Medicine Clinic
Authors: Vaziri sanaz , Church Gwynne , Panek David 
Published: April 2024

Abstract

Introduction
The COVID-19 pandemic highlighted the ability need of telemedicine to provide comprehensive and quality care to patients remotely. Sleep medicine has been one of the subspecialties that has seamlessly integrated telehealth into its practice. However telehealth may hinder access to care and disproportionately impact vulnerable populations. owing to a growing body of research that supports its efficacy in diagnosing and managing sleep disorders. Although studies have established the similarity in quality of care between telemedicine and traditional in-person visits, there still exists a gap in our understanding of caregiver satisfaction, especially among Spanish-speaking caregivers. This study aims to assess the experiences of English and Spanish- speaking caregivers who received telemedicine services in our pediatric sleep clinic.

Methods
This was a cross-sectional anonymous one-time survey performed at the pediatric sleep clinic at University of California (UCSF) Benioff Children’s Hospital Oakland. The survey included caregivers who spoke English or Spanish and whose child had a sleep medicine appointment over Zoom. Responses were collected using Research Electronic Data Capture (REDCap), and descriptive analyses were conducted.

Results
34 participants completed this survey. 71% (n=24) were English speaking and 29% (n=10) were Spanish speaking. Among Spanish-speaking participants (n=10), 60% were satisfied compared to 92% (n=22) of English-speaking participants. The main reasons cited were decreased time missing school or work and decreased travel time. Of those who were Spanish speaking, 40% (n=4) were dissatisfied with telehealth in comparison to 8% (n=2) of English-speaking participants. The main reasons for dissatisfaction included connectivity issues and preference for in-person appointments. Spanish-speaking participants experienced more difficulties with Zoom, such as receiving the wrong Zoom ID, not receiving instructions beforehand, and not knowing who to call for help.

Conclusion
Our study suggests that while the majority of families are satisfied with telemedicine and are interested in continuing with a hybrid model of in-person and telehealth visits in the future, Spanish-speaking families were less satisfied with telemedicine than English-speaking families. Having knowledgeable and supportive staff to troubleshoot problems with connectivity, access to interpreters, and offering at least one in-person appointment can improve satisfaction with telemedicine for Spanish-speaking patients.

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