bluuebunny/crossref_metadata_2025_split huggingface dataset:
0444 A Digital Therapy Based on Real-time Sleep Sensing Data
Authors: Ha Tae Kyoung , Lee Ho Dong , Lee Young Jun 
Published: April 2024

Abstract

Introduction
CBT-I has been known to be effective in treating insomnia. However, CBT-I showed problems such as shortage of medical staff and the need to visit the hospital several times. Therefore, CBT-I had implemented as digital CBT-I to overcome those demerits. However, it takes about over 6 weeks and is very tedious. In addition, it requires daily sleep diary to evaluate the efficacy of CBT-I treatment. These lowered patient’s compliance. To overcome this, a new digital CBT-I with sleep sensing device is proposed.

Methods
The proposed digital CBT-I was developed based on four basic ideas: (1) 17h of activity and 7h of sleep (2) discrepancy between desired time in bed (TIB) and desired total sleep time -DBST index (3) TIB during 24h and (4) taking sleeping pills 7h before wake-up time. The digital CBT-I consists of four weeks sessions: (1) sleep hygiene education (W0), (2) 17h of activity and 7h of sleep (W1), (3) educating about DBST index (W2), (4) TIB during 24h (W3), (5) final evaluation (W4). The clinical trial was a double-blind, randomized with 30 participants (15 test and 15 control) who were over ISI &gt; 15 at W0. Conventional digital CBT-I were provided for control, and SOMNUM Scanning were used to record automatic sleep diary for all groups.

Results
ISI of test group were W0=18.9, W1=13.9, W2=12.0, W3=10.8, W4=10.2, and ISI of control group were W0=19.1, W1=16.1, W2=15.5, W3=14.2, W4=13.1. In terms of the proportion of participants whose ISI was reduced by &lt; 15 at each visit, there was a significantly higher proportion in the test group than in the control group at W2 (83% vs. 43%,).

Conclusion
The results showed a significant improvement in ISI scores in both test and control groups. However, the mean ISI score of test group was significantly lower and the proportion of participants with ISI score below 15 points was also significantly higher at W2. This means that insomnia may improve at a faster rate when patients use the proposed this solution. This result also showed that automatic sleep diary recording by SOMNUM Scanning will be helpful to increase patient’s compliance.

Support (if any)
0445 Comparing Adherence for a Prescription Digital Therapeutic for Insomnia Across Controlled and Real-world Settings
Authors: Thorndike Frances , Gerwein Robert , Edington Samantha , Ong Jason , Riney Heidi , Ritterband Lee , Wickwire Emerson , Morin Charles 
Published: April 2024

Abstract

Introduction
Digital Cognitive Behavioral Therapy for insomnia (dCBT-I) offers scalable first-line treatment versus face-to-face care, but a potential trade-off is lower treatment adherence. In clinical trials, adherence rates to dCBT-I have been variable, and there is no defined standard for acceptable adherence to dCBT-I. Further, the generalizability of adherence data from clinical trials to real-world settings is unknown. This study compared adherence data from two dCBT-I clinical trials to adherence within a real-world study.

Methods
The dCBT-I intervention was a prescription digital therapeutic (Somryst) that includes 6 treatment Cores (e.g., sleep restriction, stimulus control) delivered over 9 weeks. Participants must complete a Core and wait 7 days before starting the next Core. Clinical trial adherence data was derived from two RCTs previously submitted to FDA as part of its authorization (RCT-1 [USA; N=151, age 21-65 years] and RCT-2 [Australia; N=574, age 18-64 years]). Real-world adherence data was derived from a prospective, single-arm, pragmatic clinical study (DREAM [USA; N=991, age ≥18 years]). Adherence was defined as the percentage of participants with dCBT-I access who completed each treatment Core. Automated notifications prompt engagement with the therapeutic.

Results
Real-world adherence rates from the DREAM study were 94.1%, 71.1%, 60.7%, 55.7%, 49.1%, and 42.8% for Cores 1-6. For RCT-1, adherence rates of Cores 1-6 were 93.4%, 88.1%, 76.8%, 67.5%, 66.9%, and 60.3%, respectively, whereas adherence rates of Cores 1-6 in RCT-2 were 80.8%, 67.9%, 60.5%, 54.0%, 47.6%, and 40.8%.

Conclusion
Real-world adherence to dCBT-I appears comparable to RCTs, with the largest decrease occurring between Cores 1 and 2. These findings support the generalizability of adherence data from RCTs and potential opportunities to increase adherence early in treatment. Further work is needed to determine acceptable standards for adherence to dCBT-I in the real world.

Support (if any)
DREAM study: Pear Therapeutics, Inc. RCT-1: NIMH grant #R01 MH86758; NCT01438697. RCT-2: NHMRC project grant #1005867; ACTRN12611000121965. Additional support provided by Nox Health, Inc.
0447 Uptake of Fully Automated Digital CBT for Insomnia in the Henry Ford Healthcare System: The First 100 Patients
Authors: Miller Christopher , Hirata Mika , Bradley Danielle , Blaine Arianna , Henry Alasdair , Hall Shana , Thomson Greig , Wood Ian , Kalmbach David , Drake Christopher 
Published: April 2024

Abstract

Introduction
Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being first line treatment for insomnia, primary care physicians typically treat insomnia with sleep hygiene or pharmacotherapy, but are unsatisfied with these approaches (Ulmer et al., 2017). Physicians may also lack knowledge about CBT-I (Dyas et al., 2010), or find it difficult to refer patients to receive therapist-delivered treatment due to a lack of trained providers (Haycock et al., 2021). Fully automated (without therapist support) digital CBT-I provides a solution with immediate, standardized, and convenient access for patients. This implementation project aims to embed evidenced-based digital treatment (Sleepio) in real world clinical practice within a large health care system (Henry Ford Health) and evaluate a novel clinical workflow.

Methods
Patients with insomnia who may benefit from CBT-I determined by their treating practitioner are offered Sleepio via the Epic electronic health records system at HFH Academic Internal Medicine (AIM) and Sleep clinics. Normalization Process Theory (May et al., 2016) was used to provide a framework to help embed digital CBT-I access. We report rates of electronic orders and Sleepio sign-ups for implementation and workflow acceptability. Leaflets and digital assets were distributed. Training sessions were also provided for clinicians at both the AIM and Sleep clinics. Email reminders helped promote access over time.

Results
As of December 13, 2023, N=565 electronic orders were placed by treating practitioners, and n=214 (38%) patients signed-up to start Sleepio (n=140 female, mean age=52.9 [range: 18-88]). The majority (84%) of patients were from sleep clinics. Adapting the electronic order process enabled clinicians to provide immediate digital access for patients. Senior staff training sessions at the sleep clinics were associated with a higher order rate across the Sleep clinics compared with the AIM clinic.

Conclusion
Fully-automated digital CBT for insomnia can be delivered as part of routine clinical care and electronic workflows with limited disruption to clinical practice. Normalization Process Theory enabled low-lift non-disruptive changes to clinical workflow over time allowing patients to obtain access to Sleepio. Training and reminding clinicians on how to introduce patients to a digital treatment helped increase uptake.

Support (if any)
n/a
0450 Genioglossus Motor Control During Mandibular Advancement and Inspiratory Resistive Loading
Authors: Jordan Amy , Dawson Andrew , Avraam Joanne , Thornton Therese , Nicholas Christian 
Published: April 2024

Abstract

Introduction
High activity of the genioglossus muscle is thought to prevent/resolve upper airway collapse. The individual motor units that make up the overall genioglossal activity typically fire with one of five patterns: active only (IP) or at higher frequency (IT) during inspiration; active only (EP) or at higher frequency during expiration (ET); and constantly active without respiratory modulation (TT). Most experimental manipulations investigated thus far (hypoxia, hypercapnia, resistive loading and sleep onset/arousal) have largely influenced IP and IT motor units, with minimal changes in units with ET, EP and TT patterns. We hypothesized that IT/IP motor units respond to respiratory drive changes, whereas TT/EP/ET motor units will respond to manipulations of the airway anatomy.

Methods
Genioglossal motor units were assessed via four intramuscular electrodes in 20 healthy individuals during wakefulness. Genioglossal single motor units were quantified before and during mandibular advancement (MAD) to 80% of maximum with a myTAP device to change airway anatomy but minimally alter respiratory drive, as well as before and during inspiratory resistive loading (IRL) of 20cmH2O/l/s for 1-minute periods.

Results
201 motor units were identified from 55 MAD trials and 234 motor units were identified from 58 IRL trials. Ventilation did not differ between baseline and MAD or IRL. The proportion of motor units with different patterns did not differ from baseline (EP=0.6%, ET=12.6%, IP=14.9%, IT=48%, TT=24%) to MAD (EP=0%, ET=10.2%, IP=21.1%, IT=36.7%, TT=31.9%), χ2(7)=12.0, p=.213. However, the proportion of motor units with different patterns differed from baseline (EP=0%, ET=15.4%, IP=34.6%, IT=32.4%, TT=17.6%) to IRL (EP=1.7%, ET=14.1%, IP=44.9%, IT=29.1%, TT=5.1%), χ2(7)=15.8, p=.0013. The peak firing frequency of motor units did not change during MAD (baseline=20.9±4.7Hz, MAD=21.9±5.4Hz) but increased during IRL (baseline=20.4±5.5, IRL=22.8±5.6Hz, p&lt; 0.001).

Conclusion
While resistive loading increased the firing (rate and number) of inspiratory-phasic motor units as hypothesised, the firing of tonic and expiratory modulated motor units did not differ from baseline during mandibular advancement. What controls the non-respiratory/expiratory motor units of the genioglossus remains unclear.

Support (if any)
This work was funded by the Australian Research Council, DP170104375 and the Melbourne School of Psychological Sciences, University of Melbourne.
0452 C-reactive Protein Is Associated with Hypertension in Mild-to-Moderate Obstructive Sleep Apnea: Age Effect
Authors: Pejovic Slobodanka , Vgontzas Alexandros , Fernandez-Mendoza Julio , He Fan , Ellis John , Bixler Edward 
Published: April 2024

Abstract

Introduction
Mild-to-moderate obstructive sleep apnea (mmOSA) is highly prevalent in general population. It has been shown that mmOSA is a significant risk factor for the development of cardiovascular and cerebrovascular disease in young and middle-aged, but not in older adults. C-reactive protein (CRP) improves the ability to detect the individual risk for cardiovascular aberrations in young and middle-aged adults with mmOSA. However, it is unkown, whether CRP is also associated with hypertension risk in older patients with mmOSA.

Methods
Adults (n=208) of a wide age range (28-90 years old, mean age 52.88 ± 12.52) with mmOSA (5 ≤ AHI &lt; 30) completed an in-lab polysomnography or home sleep testing, a physical examination including measures of blood pressure (BP) and body mass index, a structured medical history questionnaire, and a blood draw for CRP.

Results
In logistic regression models adjusting for sex and BMI, lnCRP but not AHI was associated with greater odds for hypertension (OR = 2.34, 95% CI = 1.19-4.62, p = 0.014, OR = 1.00, 95% CI = 0.93-1.09, p = 0.926 respectively). In adults ≥60 years neither lnCRP nor AHI were associated with hypertension (OR = 1.56, 95% CI = 0.78-3.11, p = 0.207 and OR = 1.02, 95% CI = 0.94-1.10, p = 0.690, respectively). Also, in adults aged &lt; 60 years lnCRP was associated with greater average systolic (β = 0.214, p = 0.032) and diastolic BP (β = 0.230, p = 0.020) but not AHI (β = 0.026, p = 0. 826; β = 0.000, p = 0.998, respectively), while in adults ≥60 years neither lnCRP nor AHI were associated with greater systolic or diastolic BP.

Conclusion
These findings suggest that CRP is a stronger predictor of hypertension than AHI in young and middle-aged but not in older adults with mmOSA. Including a measure of CRP improves the ability for clinicians to detect cases of mmOSA at risk for hypertension in the younger group. It appears that inflammation is a primary pathogenetic mechanism in mmOSA in young and middle-aged adults but not in older ones.

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0453 Sleep Apnea-Specific Hypoxic Burden and Delta Heart Rate in Relation to Atrial Fibrillation in a Clinical Cohort
Authors: Heinzinger Catherine , Araujo Matheus Lima Diniz , Bena James , Thompson Nicolas , Milinovich Alex , Foldvary-Schaefer Nancy , Van Wagoner David , Chung Mina , Mehra Reena 
Published: April 2024

Abstract

Introduction
Mechanistic animal studies implicate intermittent hypoxia and autonomic dysfunction in the pathogenesis of obstructive sleep apnea (OSA) and atrial fibrillation (AF). Polysomnographic correlates of hypoxia and autonomic fluctuations in OSA may be useful biomarkers of AF development. However, to date, novel, reflective physiologic sleep apnea-specific hypoxic burden (SAHB) and delta heart rate (DHR) have yet to be examined in AF. We hypothesize these novel measures are associated with incident AF.

Methods
Cleveland Clinic patients (age≥18) without AF who underwent polysomnography 1/2/2000-12/30/2017 were retrospectively examined. Cox proportional hazards models evaluated time from sleep study to AF by diagnosis code. SAHB (area under the respiratory event-related desaturation curve), DHR (respiratory event-related oximetry-based heart rate difference), apnea hypopnea index (AHI), and percent time oxygen saturation&lt; 90% (T90) were examined as predictors adjusting for age, sex, race, body mass index(BMI), tobacco use, cardiopulmonary disease, anti-arrhythmic medications, and positive airway pressure. Signal analysis used Python. Statistical analysis used R and SAS.

Results
The sample included n=15,712 patients [age 50(40,60) years, 54% female, 74% White, BMI 32(28,38) kg/m2, AHI 12.8(5.6,26.6)] over 7.3±3.2-year follow-up. In unadjusted analyses, SAHB showed monotonic increases in incident AF across quartiles(p&lt; 0.001). In adjusted analyses, 10-unit increased SAHB was associated with 2% increased incident AF (HR=1.02,95%CI=1.01-1.03). Similarly, 10-unit increased AHI and T90 were associated with 3% (HR=1.03,95%CI=1.01-1.06) and 8% (HR=1.08,95%CI=1.05-1.11) increased AF, respectively. DHR was analyzed in a subset with available data [n=5,930, age 46(36,56) years, 52% female, 76% White, BMI 33(28,39) kg/m2, AHI 11.6(5.2,24.7)] over 6.7±.3.2-year follow-up. Low vs. mid-range DHR was associated with 39% increased incident AF (HR=1.39,95%CI=1.08-1.80), attenuated with covariate adjustment; high-range DHR did not differ.

Conclusion
In this clinical cohort, signal-based measures of OSA-specific hypoxic burden and autonomic responses were associated with increased incident AF after accounting for confounders. Findings suggest that degree of hypoxia and a dampened heart rate response are important physiologic OSA-specific AF risk factors and precision medicine phenotypes to consider for treatment responsiveness and inclusion in clinical trials.

Support (if any)
American Academy of Sleep Medicine Foundation Physician Scientist Training Grant, Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation Pilot Grant, Neuroscience Transformative Research Resource Development Award
0455 Sleep Duration and OSA Severity Is Related to Altered Limbic System Integrity in Cognitively Normal Older Adults
Authors: Gills Joshua L , Cesar Justin Oliver , Kovbasyuk Zanetta , Dharmapuri Anhiti , McBride Julian , Valkanova Elena , Mbah Alfred , Figueredo Luisa , Kam Korey , Mullins Anna , Parekh Ankit , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo , Bubu Omonigho 
Published: April 2024

Abstract

Introduction
Impairments in the microstructure of the limbic tracts are seen in early stages of the Alzheimer’s disease (AD) spectrum. Disrupted sleep has been linked with AD. We examined associations between measures of limbic white matter tracts and objective sleep parameters in cognitively unimpaired older adults.

Methods
This cross-sectional study included 170 community-dwelling cognitively unimpaired older adults (mean±SD: age=67.2±5.2y) participating in NYU studies of sleep, aging, and memory. Subjects completed polysomnography (NPSG) and brain MRI. Sleep measures of interest included total sleep time (TST), NREM stages 2, 3 and REM sleep duration, sleep efficiency and fragmentation, and AHI4% and REM AHI4%. Microstructural properties of the cingulum, uncinate fasciculus (UF), and fornix were estimated using diffusional tensor imaging (DTI) metrics including radial kurtosis (RK), radial diffusivity (RD), and fractional anisotropy (FA). Linear mixed-effects regression models examined associations between sleep variables and DTI metrics. Models were adjusted for age, race, education, sex, time between NPSG and MRI.

Results
Participants were 71.2% female, 44.1% Black/African-American, and had 16.8±2.5y of education. In the right cingulum, higher AHI4% in REM was associated with decreased RK(β[IV]= β[SE}; β[AHI4%] =-0.0014[0.00054], p=0.01) and shorter stage 2 sleep duration was associated with decreased RK (β [stage 2 sleep duration] =0.00062[0.00026], p=0.02). In both hemispheres of the cingulum, increased sleep fragmentation in stage 3 was associated with increased RD (β [sleep fragmentation, right] = 0.0017[0.00080], p=0.03; β [sleep fragmentation, left] = 0.0026[0.00087], p=0.003), and higher AHI4% in REM was associated with reduced FA (β [AHI4% left] =-0.00039[0.00019], p=0.048; β [AHI4% right] =-0.00055[0.00017], p=0.02). In the right UF, with increasing age, reduced TST was associated with lower RK(β[TST]=0.0000047[0.000002], p=0.02). In the right UF, reduced time in REM sleep was associated with increased RD (β [REM duration] =-0.0022[0.00078], p=0.006). In the fornix, higher AHI4% was associated with lower FA(β[AHI4%] =-0.00061[0.00029], p=0.04).

Conclusion
In this sample of community-dwelling cognitively unimpaired older adults, reduced sleep duration and OSA severity (NREM and REM) were associated with limbic white matter tracts alterations. Longitudinal studies are needed to investigate the role of disrupted sleep in limbic white matter microstructure alterations in early stages of the AD spectrum.

Support (if any)
AASM-BS-231-20, NIAK23AG068534, NIAR01AG082278, R01AG083975, AARG-D-21-848397, BrightFocus-A2022033S
0457 Altered Functional Connectivity of the Ascending Reticular Activating System in OSAS with Low Arousal Threshold
Authors: Shin Wonchul , Byun Jung-Ick , Hwang Seong-Taek 
Published: April 2024

Abstract

Introduction
A low arousal threshold (LAT) is a pathophysiological trait of obstructive sleep apnea (OSA) that may be associated with ascending reticular activating system (ARAS)-cortical functional connectivity (FC) changes. We evaluated resting-state FC between the brainstem ARAS nuclei and 105 cortical/subcortical regions in OSA patients with or without a LAT and healthy controls.

Methods
Twenty-five patients with moderate to severe OSA with an apnea-hypopnea index between 20 and 40/hr (15 with and 10 without a LAT) and 15 age- and sex-matched controls were evaluated. Participants underwent functional magnetic resonance imaging after overnight polysomnography. Three ARAS nuclei—the locus coeruleus (LC), laterodorsal tegmental nucleus (LDTg), and ventral tegmental area (VTA)—associated with OSA in our previous study were used as seeds.

Results
FC values of the two ARAS nuclei (LC and LDTg) significantly differed among the three groups. FC of the LC with the precuneus was stronger in OSA patients than in controls regardless of the concomitant LAT. FC between the LDTg and the posterior cingulate cortex (PCC) was also stronger in OSA patients regardless of the LAT. Moreover, OSA patients without a LAT showed stronger LDTg-PCC FC than those with a LAT (post hoc p=0.013), and this FC was negatively correlated with the minimum oxygen saturation in OSA patients (r=-0.463, p=0.023).

Conclusion
The LAT in OSA patients was associated with altered LDTg-PCC FC, which was negatively correlated with the minimum oxygen saturation. This result suggested that cholinergic activity may play a role in the LAT in OSA patients.

Support (if any)
0458 Cranial Blood Flow. Arteriovenous Anastomoses (AVAs) Shunting in Obstructive Sleep Apnea
Authors: Govindan Srini 
Published: April 2024

Abstract

Introduction
To analyze our data on the effect of CPAP on vascular shunt mechanisms involving intra and extra cranial blood flow.

Methods
Daytime testing. A) Intracranial rCBF (regional Cerebral Blood Flow, Xenon133 inhalation, hemispheric mean, ml/100 mg/minute). During rCBF for the integrity of the Xenon loaded spirometer EPAP was used. B) Extracranial face blood flow, infrared imaging, at baseline, post CPAP immediate, for temperature increase (vasodilation) or decrease (vasoconstriction). Temperature change of 0.5oC is significant. The protocols were in compliance with CARE and TISEM. Participants 12. Group 1: Intracranial. Seven (2 OSA patients, 5 nonapneic controls). Group 2: Extracranial. Five (3 OSA patients, 2 nonapneic controls).

Results
Group 1. Patient #1. PSG: 1) Pre-CPAP, 2) CPAP 10 cm 3) Post tracheostomy CPAP. AHI: 1) 83.3, 2) 98.25, 3) 0.00. SE%: 1) 70%, 2) 70%, 3) 74%. SaO2: 1) 56%. 2) 76%. 3) 90%. Pre tracheostomy EPAP 10 cm, rCBF flow increase of 4.35% Left and decrease of 0.62% Right hemisphere. Patient #2. PSG: AHI 48.5. SE 67%. SaO2 83%. CPAP 10 cm, PSG: AHI 0.00. SE 78%. SaO2 92%. EPAP 10 cm, rCBF increase 13.59% on Left. Increase 13.43% on Right hemisphere. In controls: 4 out of 5, EPAP increased rCBF by 21.43% left and increased 12.85% on the Right hemisphere. Group 2: Five (3 OSA patients on home CPAP and 2 non apneic controls). All given CPAP for 15 minutes. Patient #1. AHI moderate to severe. ETCO2: Baseline 37, CPAP 38 mm Hg. CPAP 12.5 cm caused face vasoconstriction. Patient # 2. AHI 63. ETCO2: Baseline 41 and during CPAP was 40. CPAP 15 cm caused face vasoconstriction. Control: Controls CPAP 10 cm caused face vasoconstriction. ETCO2 Baseline: 34 and during CPAP was 35.

Conclusion
In obstructive sleep apnea patients and controls: EPAP increased Intracranial blood flow. CPAP decreased external carotid/face blood flow/ vasoconstriction i.e., closing of AVAs- microvascular shunts. The term microcirculation applies to blood vessels smaller than 300 µm. Infrared technology images the effect of CPAP on extracranial/face blood flow in obstructive sleep apnea. This has clinical research applications.

Support (if any)
None.