bluuebunny/crossref_metadata_2025_split huggingface dataset:
1059 Effects of COVID-19 on Sleep Services Use and Its Recovery
Authors: Ramezani Amin , Sharafkhaneh Amir , BaHammam Ahmed S , Kuna Samuel T , Razjouyan Javad 
Published: April 2024

Abstract

Introduction
The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU) (Home Sleep Apnea Testing [HSAT] and Polysomnography [PSG]) were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data.

Methods
A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age ≥ 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre-pandemic (Pre-Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre-vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and postvaccination (Pan-Post-Vax). We compared STU between intervals (Pre-Pan as the reference).

Results
Among 261,371 veterans (63.7±9.6 years, BMI 31.9±6.0 kg/m², 80% male), PSG utilization decreased significantly during Pan-Mor (-56%), Pan-Pre-Vax (-61%), Pan-Vax (-42%), and Pan-Post-Vax (-36%) periods all compared to Pre-Pan. HSAT utilization decreased significantly during the Pan-Mor (-59%) and Pan-Pre-Vax (-9%) phases compared to the Pre-Pan and subsequently increased during Pan-Vax (+6%) and Pan-Post-Vax (-1%) periods. Over 70% of STU transitioned to HSAT, and its usage surged five months after the vaccine introduction.

Conclusion
Sleep testing services utilization recovered differentially during the pandemic (PSG vs HSAT), including a surge in HSAT utilization post-vaccination.

Support (if any)
Supported by National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) K25 funding (1K25HL152006-01 [J.R.]); ZOLL Respicardia (31002 [A.S.]); Airborne Hazards and Burn Pits Center of Excellence (AHBPCE, Award #: FY2024-002 [J.R.]); and the use of facilities and resources at the Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the U.S. government, or Baylor College of Medicine.
1060 Implementation of a Two-Way Automated Text Messaging Program for Common PAP-Related Problems
Authors: Watach Alexa , Friday Sadie , Schwab Allison , Staley Beth , Schutte-Rodin Sharon , Balachandran Mohan , Schwab Richard , Bae Charles 
Published: April 2024

Abstract

Introduction
Without consistent PAP data monitoring, clinics struggle to identify issues with patients' PAP receipt and usage. To address this, we created PennPALS (Penn PAP Automated Learning System), a cloud-based platform that filters PAP data extracted from the electronic medical record (EMR) through algorithms to identify common PAP issues, such as non-adherence, mask leaks, elevated residual AHI, or delayed setups. Patients are contacted about issues through two-way text messaging.

Methods
PennPALS auto-enrolls patients based on an EMR PAP order. Patients can opt out at any time during the 90-day monitoring program. We conducted a retrospective evaluation of PennPALS for patients enrolled June 2023.

Results
In one month, 279 patients were enrolled (mean age 54.9 (14.5) years, 56.3% male, 48.8% white, 40.5% Black or African American and 6% Hispanic). One hundred eighty-nine patients entered a 90-day data monitoring window (mean age 54.1 (14) years, 57.7% males, 45.5% white, 41.8% Black or African American, 3.8% Hispanic, and 58.7% new to PAP). Ninety patients never had PAP data in EMR. Two patients were ineligible due to invalid phone number in EMR and 25 opted out (4 at enrollment; 21 during monitoring). During the 90 day monitoring, the following number of triggers were activated: 247 non-adherence (7 day avg. &lt; 4hrs), 571 adherence (7 day avg. &gt;4hrs), 314 mask leak (Phillips: avg % time in large leak ≥ 30% for ≥3 of 7 days; ResMed: leak ≥ 24 L/min for ≥3 of 7 days), 8 high residual AHI (7 day avg ≥ 10 events/hr), 62 no data triggers (no data for 5 days), and 9 continued no data triggers. Of patients that completed the exit survey (n=20), average “how helpful” score (scale 0-10) was 7.9 (3.9) and Net Promotor Score (e.g., likelihood to recommend) was 87.

Conclusion
PennPALS demonstrates real-word feasibility to monitor patients and identify issues with algorithms based on discrete PAP data within EMR. Identified issues triggered two-way text messaging to improve PAP communications. The high number of patients without PAP data requires further investigation (e.g., patient did not pursue PAP, modem not linked). Patients reported that PennPALS was helpful and they would recommend it.

Support (if any)
K12HS026372
1062 VR for Stress Reduction and Sleep Health Improvement Among Perinatal Women: Insights from the Nurturing Moms Study
Authors: Blanc Judite , Scaramutti Carolina , Carasco Mary , Dimanche Stacyca , Hollimon Laronda , Gabbay Vilma , Seixas Azizi 
Published: April 2024

Abstract

Introduction
This qualitative study explores the multifaceted experience of motherhood and its impact on mental wellness, sleep health, and resilience, as well as examines barriers and facilitators of virtual reality (VR) use for stress management among perinatal women of color.

Methods
Two focus groups were held with perinatal women [n = 13; average age 32 years] identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. This pilot project evaluates NurtureVR, a VR-based program for pregnancy-related education and maternal wellness that integrates mindfulness techniques, relaxation, and VR-enabled guided imagery for the pregnancy and post-partum periods. An inductive and iterative approach was employed in the qualitative analysis of the focus group transcripts to identify key themes.

Results
The qualitative analysis identified five primary themes, encompassing 19 nuanced sub- themes and a total of 94 references: 1) Navigating Motherhood, 2) Maternal Mental Wellness, 3) Embodied Therapy, 4) Postpartum, and 5) Resilience. These themes cover a range of topics including the complexities of motherhood in women from the global majority, maternal mental health, attitudes towards VR for therapy, discussions on postpartum care and medication, and diverse views on resilience as an essential trait among mothers. Participants shared a variety of challenging experiences related to household management, caregiving, financial stress, breastfeeding, finding relaxation time, and achieving adequate sleep. There was also a significant interest in learning about the connection between sleep and stress, with maternal sleep health being identified as a potential area for future VR-based interventions.

Conclusion
These findings highlight the numerous challenges and barriers faced by women of color during and after pregnancy, which can significantly impact their mental and sleep health. Holistic public health programs targeting maternal health should not only incorporate screening for mental health and sleep issues but also address social determinants of health comprehensively. Additionally, culturally responsive behavioral treatments, which consider the intersection of identities including VR interventions, demonstrate the potential in providing timely and tailored mental health support to perinatal women.

Support (if any)
NIH 5R01HL142066
1064 Perception of CBTI Treatment Modalities in Older Adults with Insomnia: Comparing Digital and Therapist-led Delivery
Authors: Tully Isabelle , Gumport Nicole , Tutek Joshua , Simpson Norah , Rosas Lisa , Zulman Donna , Dietch Jessica , Manber Rachel 
Published: April 2024

Abstract

Introduction
A shortage of trained providers limits access to cognitive behavioral therapy for insomnia (CBTI). Supplementing traditional in-person, therapist-led CBTI with telehealth delivery and fully automated digital CBTI (dCBTI) can improve accessibility. Characterizing perceived advantages and disadvantages of distinct delivery modalities among patients with insomnia can inform targeted resource allocation and clinical rollout of CBTI. Thus, the current study aims to describe patients’ pre-treatment preferences for therapist-led (in-person and telehealth-delivered) and automated dCBTI, as well as patient-identified advantages and disadvantages of these modalities.

Methods
Participants (N = 80) 50 years and older (M age = 64.2, SD = 7.9; female = 85.2%) were randomly selected from the RESTING Study, an RCT evaluating a triaged stepped-care model for treating insomnia disorder (DSM-5), to undergo a semi-structured interview at baseline, prior to study treatment assignment and exposure. Interviews were recorded, transcribed, and coded by three raters (inter-rater reliability: 85.0–93.0%). Response themes were identified inductively via qualitative thematic analysis.

Results
Approximately two-thirds of participants (n = 50, 62.5%) preferred therapist-led CBTI, delivered in-person or via telehealth, over automated dCBTI. The most common participant-identified advantage of dCBTI (n = 55; 68.8%) and telehealth-delivered CBTI (n = 65; 81.3%) was convenience. The most commonly reported disadvantages of dCBTI were limited customizability (n = 39, 38.75%) and lack of human connection (n = 40, 50.0%). However, some participants (n = 13, 16.30%) viewed lack of human connection as an advantage, citing the nonjudgmental nature of online programs and reduced social anxiety/fatigue. The main disadvantage identified for telehealth-delivered CBTi was loss of nonverbal communication (n = 20, 25%).

Conclusion
While participants identified advantages and disadvantages of both dCBTI and therapist-led CBTI, findings suggest a general preference for therapist-led treatment among middle-aged and older adults. This study is one of the first to examine participant preferences for and perceptions of CBTI delivery modalities prior to receiving study treatment(s). Findings can guide referring providers’ presentation of insomnia intervention options to patients and inform targeted discussions of perceived barriers to treatment. Moreover, results lay a foundation for future research examining the relationship between pre-treatment preferences/perceptions and longitudinal treatment adherence, engagement, and clinical outcomes.

Support (if any)
1R01AG057500
1066 Acceptability and Feasibility of Training to Integrate Digital CBTi in Routine Therapy: Evidence from Focus Groups
Authors: Gumport Nicole , Tully Isabelle , Stirman Shannon Wiltsey , Manber Rachel 
Published: April 2024

Abstract

Introduction
Over 31% of patients who enter treatment for mental health problems experience insomnia symptoms, which can be effectively treated using cognitive behavior therapy for insomnia (CBTi). However, routine psychotherapy for mental health problems does not adequately address insomnia symptoms. Integrating CBTi into routine psychotherapy in a feasible and acceptable manner could both extend the reach of CBTi and enhance mental health outcomes. Digital CBTi (dCBTi) is a promising and scalable option for integration. Supported dCBTi programs have better engagement, adherence, and clinical outcomes compared to unsupported programs. Hence, integrating dCBTi into routine psychotherapy, whereby the therapist introduces and provides support for dCBTi among patients receiving general psychotherapy for other mental health problems, may improve adherence and engagement. This study aims to determine the initial feasibility and acceptability of integrated dCBTi to providers.

Methods
Six virtual focus groups were conducted with licensed therapists with a range of graduate training. Each focus groups included 6-11 participants and lasted one hour. Inductive thematic analysis was used to extract themes. Therapists also completed a zoom poll at the end of the focus group.

Results
The sample included 52 licensed therapists (81% female, 81% White). Therapists had a range of graduate training (21 PhD/PsyD, 11 LCSW, 10 MFT, 9 LPC, and 2 MD). 83% of therapists indicated that they want training in integrated dCBTi. Two participants (5%) had some previous training in CBTi; they were the only individuals who indicated no interest in receiving the training. Six participants (12%) were unclear. Two training focused themes arose: desire for receiving CEs and a need for advanced notice to reserve the time required for a workshop. 88% reported seeing the potential value of integrated dCBTi (unclear=12%). Two themes arose regarding content of training: the need to know the contents of dCBTi and the value of consultation. As a feasibility theme, therapist highlighted that they could find 5-10 minutes of session time to provide the support for dCBTi.

Conclusion
Preliminary analyses indicate that integrated dCBTi is a feasible approach. Therapists are willing to be trained and see its potential value.

Support (if any)
AASM Foundation 300-BS-23
1073 Feasibility of Using Wearables to Track Surgeon Sleep: Results from a Pilot Study
Authors: Marquardt Matthew , Kang Ellison , Leahy Nicholas , Orr Morgan , Emerson Angela , Hagen Josh , Quatman Carmen 
Published: April 2024

Abstract

Introduction
It is well known that the sleep among surgeons is often of short duration and poor quality. Surgeons regularly wake up before dawn, and nighttime call can pull them out of bed at any time in the night. While limitations to resident and faculty surgeon work hours have been added in the past decades, it is unclear if surgeon sleep habits have subsequently improved. Furthermore, few studies have used objective trackers to monitor surgeon sleep.

Methods
Ten surgeons were recruited from a large midwestern academic center’s Department of Orthopedics to take part in the “Surgeons as Athletes” project. For this pilot study, surgeons were outfitted with various biometric sensors to measure their physiology before, during, and after operating. To monitor sleep-wake patterns, each surgeon was asked to continuously wear—except while operating—a commercially available sleep tracker (Oura ring) for a 14-day period. Descriptive statistics were used to understand compliance.

Results
The cohort consisted of seven residents and three faculty surgeons, four of whom identified as female and six as male. Out of 140 total nights, trackers were worn 66% of the nights (93 nights), with a median number of 9.5 nights recorded per participant. Only 30% of participants wore their tracker every night, while another 30% tracked their sleep for less than half of the nights. One participant did not wear their monitor at all during the study, despite follow-up from the researchers. Although not benchmarked against polysomnograms, 8 of the 93 wake up times (8.6%) were likely incorrect, suggesting either extremely early wake times when participants were not on call or extremely late wake times when participants were known to be operating.

Conclusion
This pilot study suggests that sleep tracking compliance among surgeons is poor, even when monitored passively by a wearable device. This could be due to the form factor of the device—a ring that must be removed while operating—requiring surgeons to remember to put it back on at the end of each day. Since surgeons are incredibly busy, an engaged study team and reminders each day has the potential to improve compliance.

Support (if any)
1083 Association Between Sleep Apnea and Health Service Utilization: Results from the Health and Retirement Study
Authors: Kaufmann Christopher , Albrecht Jennifer , Spira Adam , Malhotra Atul , Blinka Marcela D , Sekhon Vishaldeep , Amjad Halima , Roth David , Gross Alden , Tseng Chien-Yu , Wickwire Emerson 
Published: April 2024

Abstract

Introduction
Sleep apnea is associated with several health conditions known to increase the use of health services that may otherwise be preventable (e.g., hospitalization). We investigated the association of sleep apnea and the subsequent use of health services, independent of health conditions and other potential confounders.

Methods
We studied participants aged 50+ years in the 2016 and 2018 Health and Retirement Study (HRS), a nationally representative cohort of approximately 20,000 middle-aged and older adults in the United States. In 2016, participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder (which included sleep apnea). We categorized participants as with and without sleep apnea. In 2018, participants were asked to report on their use of health services, including hospitalization, home healthcare, and nursing home use. We used logistic regression to determine the association between sleep apnea, as reported in 2016, and the use of health services in 2018, after adjusting for demographics, BMI, health conditions, and depressive symptoms.

Results
We studied N=20,115 HRS participants, of whom 11.8% reported sleep apnea. Compared to those without sleep apnea in 2016, those with sleep apnea had a 21% higher odds of reporting future use of any health service (Adjusted Odds Ratio [AOR]=1.21, 95% Confidence Interval [CI]=1.02-1.43), after controlling for confounders. Specifically, those with sleep apnea had greater odds of hospitalization (AOR=1.21, 95% CI=1.02-1.44), and while not statistically significant, home healthcare services (AOR=1.23, 95% CI=0.99-1.54).

Conclusion
Participants with sleep apnea had increased odds for future health service utilization, including hospitalization and home healthcare. Findings highlight the importance of addressing sleep apnea to reduce their burden on the healthcare system.

Support (if any)
This study was supported by the National Institute on Aging (R01AG079391, K01AG061239, P30AG028740) and the Sleep Research Society Foundation (23-FRA-001).
1088 Sleep Resilience: A Dimension of Sleep Health Associated with Sleep Health Disparities
Authors: Sherriff Dustin , Ward Levi , Yang Chongming , Gnatiko Michael , Duraccio Kara , Wright Andrew , Calvin Danika , Klingonsmith Bryce , Kay Daniel 
Published: April 2024

Abstract

Introduction
Sleep health disparity refers to variations in sleep health that negatively impact disadvantaged and underserved populations. Sleep resilience is the ability to function emotionally, cognitively, and physically in the presence of sleep disturbance. In this study, we aimed to investigate whether self-reported sleep resilience in the face of future sleep disturbance is associated with current sleep disturbance and whether this association differed based on demographic variables.

Methods
A sample of 454 participants ages 18-85 (M=45) completed an online survey through Qualtrics that included demographic variables and a novel measure of projected sleep resilience. Participants also completed the PROMIS-Sleep Disturbance and the PROMIS-Sleep-Related Impairment questionnaires. The demographic variables included age, sex (male, female, non-binary), income level, race (white/non-white), relationship status (married/not married), number of dependents, and education level. Mixture modeling was used to examine whether sleep disturbance and sleep-related impairment predicted projected sleep resilience. A follow-up class analysis was used to determine whether these associations differed across demographic variables.

Results
Greater sleep disturbance and greater sleep-related impairment predicted lower projected sleep resilience. A latent class analysis revealed 2 classes (traditionally underserved and privileged) that had significant differences in the association between sleep disturbance and projected resilience. The underserved group (Class 1) included higher numbers of women who were more likely to be non-white with lower income, less educated, unmarried, fewer dependents, and more sleep disturbance. The privileged group (Class 2) included higher numbers of men who were more likely to be white with a higher income, highly educated, married, and have more dependents and less sleep disturbance. The underserved group projected lower future sleep resilience holding current sleep disturbance constant than the privileged group.

Conclusion
Sleep resilience is an important dimension of sleep health that is often overlooked and understudied. Our findings suggest that sleep resilience is lower in traditionally underserved individuals, which may compound sleep health disparities. Having lower projected sleep resilience in the face of future sleep disturbances may increase current stress levels and negatively influence sleep health behaviors. In an effort to rectify sleep health disparities, targeting the factors that contribute to lower projected sleep resilience may be a fruitful avenue.

Support (if any)
1089 Using Community Engagement to Increase Utilization of Primary Care for Sleep Concerns in Communities of Color
Authors: Berry Jasmine , Weiss Karen , McCrae Christina , Bell Debora 
Published: April 2024

Abstract

Introduction
Growing evidence suggests that there are sleep health disparities in the United States that disadvantage communities of color, and other socioeconomically marginalized groups in medical and mental health settings. Research in public policy indicates several points of intervention for increasing engagement with treatment services in communities of color at the primary care level, including individual beliefs about mental health/health issues, and perceptions of various points of treatment engagement, as well as community factors (e.g., neighbors and church; Davey & Watson, 2007). Accordingly, the current study implemented a community-level virtual intervention that targeted beliefs about sleep and perceptions of behavioral sleep treatment with the aim to increase willingness to engage with treatment at the primary care level.

Methods
We conducted 12 semi-structured qualitative focus groups with 35 individuals from communities of color about their awareness, perception of, and access to behavioral sleep treatment in healthcare settings. Transcripts were coded using the Rapid and Rigorous Qualitative Data Analysis method for themes relevant to the guiding question, 'What are people/persons of color experiences and perspectives of sleep, and specific areas of improvement to increase people/persons of color groups' utilization of behavioral sleep services?'.

Results
After a brief period of education (range = 15-20 minutes) about cognitive-behavioral therapy for insomnia (CBTi), participants perceived behavioral sleep treatment as a favorable option both over and in conjunction with pharmacological options. Medical mistrust was mentioned as the most significant barrier in each focus group, with participants highlighting that increased attention to collaborative care and comprehensive education about treatment options at the primary care level would be helpful for reducing mistrust. Pre- and post-group survey analysis indicated a significant increase in participants’ willingness to use primary care as an entry point to access/utilization of behavioral sleep treatment (pre-group willingness = 54.84%, post-group willingness = 91.42%, p&lt;.001).

Conclusion
Findings suggest that intervention at the community level can be powerful for increasing the willingness of communities of color to engage in treatment at the primary care level. It is paramount that future research continues to examine ways to increase engagement with behavioral sleep treatment to help reduce sleep health disparities.

Support (if any)