bluuebunny/crossref_metadata_2025_split huggingface dataset:
0902 Increased Sleep Disruption in Patients with Advanced Cancer Undergoing Immunotherapy
Authors: Bhyravabhotla Kshama , Ebinama Ugochi , Faiz Saadia , Bashoura Lara , Sheshadri Ajay , Naing Aung , Balachandran Dave 
Published: April 2024

Abstract

Introduction
Sleep disruption is common in patients with advanced cancer. In addition to cancer-related factors, therapies such as chemotherapy, hormonal therapy and radiation may contribute to poor sleep. The role of immunotherapy in sleep disturbance is not well-studied; however, sparse evidence suggests that better sleep quality may improve clinical outcomes and reduce immunotherapy-related toxicity. We conducted a study to evaluate self-reported sleep in patients with advanced cancer receiving immunotherapy to better characterize their sleep quality.

Methods
We reviewed 250 patients sequentially undergoing immunotherapy in a single tertiary cancer center for advanced cancer from February 2020 to February 2022. The Pittsburgh Sleep Quality Index (PSQI) was used to quantify self-reported sleep quality. Individual components were assessed to gain a holistic picture of the patients’ perceptions of their sleep.

Results
The global PSQI score was greater than 5 in 75 of 250 patients (30%), signifying overall poor sleep. Mean global PSQI score was 6.97 with a standard deviation of 3.87 and a standard error of 0.24. Analysis of the other components of the PSQI revealed mild impairment of sleep efficiency, increased daytime sleepiness and decreased motivation. The mean score for sleep aid use was 0.94, indicating sleep aid use less than once a week. Notably, the mean score of self-reported sleep perception was 0.791 with a standard deviation of 0.716, indicating overall satisfaction with sleep quality.

Conclusion
To our knowledge, this is the largest series to characterize self-reported sleep disruption in patients with advanced cancer receiving immunotherapy. Our results show that there is significant sleep aid use and sleep disruption in up to 30% of patients receiving immunotherapy. There was notable discordance between self-reported perception of sleep and the global PSQI score. This may be due to lower expectations for quality sleep on the part of the patients, given cancer burden and other comorbidities. If so, routine sleep assessment and specialist evaluation is imperative to improve quality of life and assure these patients that a better quality of sleep is possible. Further studies are indicated to characterize sleep architecture in these patients and assess correlation with clinical outcomes such as tumor response and adverse event rates.

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0903 Physical Health Correlates of Subjective and Objective Sleep Markers in Patients with Cancer and Their Caregivers
Authors: Kim Youngmee , Tsai Thomas , Ting Amanda , Zeitzer Jamie , Ramos Alberto , Mendez Armando 
Published: April 2024

Abstract

Introduction
Sleep disturbance is frequently identified in patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraphy-derived sleep patterns correlate between patients and their sleep-partner caregivers, and how the two modes of sleep measurements are related to physical health. Also unknown is the degree to which different operationalizations of actigraphy-derived sleep markers associate with physical health.

Methods
Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads: on average 54 years old, 28% female patients, 60% Hispanic) completed sleep diaries daily and wore actigraphy continuously for 14 consecutive days, from which sleep duration and sleep onset latency (SOL) were calculated. Actigraphy-derived sleep markers were adjusted using sleep diary responses in two ways: One used the period participants intended to sleep (sleep intention method), and the other used the total period spent in bed (total bedtime method). Physical health was assessed via self-report and seven consecutive days of saliva collection, from which cortisol slope was quantified.

Results
Patients and their sleep-partner caregivers reported similar sleep patterns. Sleep duration, but not SOL had moderate level of agreement between self-report and actigraphy. Under the sleep intention method, caregivers’ longer SOL and longer self-reported than actigraphy-derived sleep duration and SOL were related to poorer self-reported physical health (|B|≥0.001, p&lt;.043); none of the associations were significant among patients. On the other hand, under the total bedtime method, patients’ longer self-reported than actigraphy-derived SOL were related to poorer self-reported physical health (B=-0.119, p=.024); and none of the associations were significant among caregivers.

Conclusion
Findings suggest the employment of multimodal sleep and physical health assessments and operationalizations to precisely understand the characteristics and associations of sleep among patients with cancer and their sleep-partner caregivers. Psychobehavioral sleep interventions may consider paying attention to the differential impact of non-sleep activities in bed on patients’ health. Investigation with other sleep indices (wake after sleep onset and sleep-wake rhythms), self-reported and biological health outcomes, and of the dyadic associations of the study variables between patients and their caregivers is warranted.

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0905 Effects of Benign Prostatic Hyperplasia Surgery on Positive Airway Pressure Therapy Compliance in Sleep Apnea
Authors: Wong Stephanie , Quach Alan , Deibert Christopher , Harrington John 
Published: April 2024

Abstract

Introduction
Despite the high efficacy of continuous positive airway pressure (CPAP) to reverse the upper airway obstruction in obstructive sleep apnea (OSA), one of the greatest barriers to treatment is CPAP nonadherence. Benign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population that causes lower urinary tract symptoms (LUTS). Nocturia results in nighttime awakenings which may interfere with CPAP adherence. There are a variety of surgical interventions for the BPH. The aim of this study is to assess CPAP adherence rates before and after surgical intervention for treatment of BPH.

Methods
A within-subject retrospective analysis was performed at a single institution. Thus far, a sample size of 33 patients were analyzed and 16 met inclusion criteria. The target cohort included male patients who have a diagnosis of OSA and underwent surgical intervention for BPH between October 2013 and October 2023. The subjects included were also started on positive airway pressure (PAP) therapy before surgery. CPAP adherence measures were obtained one to six months prior to surgical intervention and compared to CPAP adherence measures six months post-surgical intervention. The change in PAP compliance from before surgical intervention to six months after surgery will be calculated and compared to a null value of zero (ie, no change) using a paired t-test.

Results
The average age of patients was 69.3. BPH procedures included were transurethral resection of the prostate (TURP) (37.5%), laser TURP (25%), holmium enucleation (6.25%), prostatic implantation (31.25%). When comparing pre-procedural (92.4%) CPAP usage days (%) versus post-procedural (89.8%), there were no significant differences (p=0.6425). Similarly, pre-procedural (374.6) CPAP average usage (minutes) versus post-procedural (409.4) did not show a statistically significant difference (p=0.1153).

Conclusion
Our early findings are consistent with previous research indicating that the presence of BPH had no significant effect on CPAP adherence. Our study reviewed post-procedural effects on CPAP adherence. Surgical intervention for benign prostatic hyperplasia did not affect adherence with CPAP in OSA.

Support (if any)
None
0909 Cortisol Reactivity to Experimental Pain and Psychological Stress in Facial Pain: Moderating Effects of Sleep
Authors: Altier Heather , Hamilton Katrina , Reid Matthew , Joo Eunyeong , Buenaver Luis 
Published: April 2024

Abstract

Introduction
Approximately 60% of individuals with temporomandibular joint disorders (TMD) report sleep disturbance. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system is common in TMD, but less is known about the effects of stressor type on HPA response. The present study measured salivary cortisol reactivity to quantitative sensory testing (QST) and to the Trier Social Stress Test (TSST) in a sample of TMD patients. It was hypothesized that poor sleep would amplify the effect of each type of stressor on cortisol reactivity.

Methods
TMD patients (N=33) completed QST and the TSST on two separate afternoons. Testing order was randomized. Salivary cortisol responses were measured at baseline, immediately post-testing, 15-, 20-, 25-, 30-, and 45-minutes post-testing. Psychosocial measures, including the Pittsburgh Sleep Quality Index (PSQI), were completed at baseline. Data was assessed for normality and heteroscedasticity, and cortisol levels were log-transformed. Two-level linear mixed effects models were analyzed in R with package lme4 to assess the effect of task on cortisol levels, controlling for time of day, baseline cortisol, age, sex, race, and education level. PSQI global score, subscales, and sleep duration were examined as moderators in separate models.

Results
TMD participants (Mage=33.5 + 10.1 years, 70% female, 64% white) endorsed poor sleep quality (PSQI global: µ=7.4, SD=3.6) and short sleep duration (M=6.4 + 1.4 hours). Salivary cortisol reactivity was greater following the TSST (t(350)=7.69, p&lt;.001). PSQI sleep disturbance (t(348)=-2.36, p&lt;.05) and sleep duration (t(348)=-2.04, p&lt;.05) moderated the effect of task on cortisol reactivity; greater sleep disturbance was associated with greater cortisol reactivity to QST. Longer sleep duration was associated with lower cortisol reactivity for both tasks.

Conclusion
In our TMD sample, psychological stress produced greater stress reactivity than experimental pain. Greater sleep disturbance amplified stress reactivity to acute pain, but not to psychological stress. This finding is consistent with the literature on the deleterious effects of poor sleep on endogenous pain modulatory systems (i.e., hyperalgesia). Conversely, longer sleep duration attenuates the negative effects of both psychological and pain-related stress. Consequently, this study provides support for the importance of sleep as a protective factor in mitigating the harmful effects of stress in the context of chronic pain.

Support (if any)
CoEPEs; Blaustein Grant; T32NS070201
0915 Actual Condition Survey of Obstructive Respiratory Events in Convalescent Post-stroke Patients with Dysphagia
Authors: Miyachi Mai , Yamaguchi Kohei , Yanagida Ryosuke , Hino Takami , Yoshimi Kanako , Nakagawa Kazuharu , Tohara Haruka , Kisara Ayumi 
Published: April 2024

Abstract

Introduction
Sleep related breathing disorder is one of the risk factors for stroke. In addition, post-stroke patients often have dysphagia. Although sleep related breathing disorder and dysphagia occur in the oropharyngeal region, their relationship is not well defined and understudied, especially during the recovery phase. This study investigated the oral intake level and obstructive respiratory events in post-stroke patients with dysphagia.

Methods
Seventy post-stroke patients (36 men; mean age ± S.D., 72.1 ± 11.1) who were hospitalized in a rehabilitation hospital between August 2021 and October 2023 were recruited for this study. Age, sex, body height, body weight, and scores of the functional oral intake scale (FOIS) were collected from their medical record. The body mass index (BMI) was calculated from their height and weight. FOIS was used to evaluate swallowing function. The apnea hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), minimum oxygen saturation (min SpO2) was assessed to evaluate the severity of obstructive respiratory events using WatchPAT (Philips Japan, Ltd.), a portable device to test to diagnose sleep related breathing disorder. In the statistical analysis, we classified the FOIS into three groups: 7 points (no dysphagia), 6,5,4 points (ingestion of texture-modified diet), and 3,2,1 point (mainly feeding through tube). And Kruskal Wallis test was performed on AHI, 3%ODI, minSpO2.

Results
We obtained approval from our ethical committee before starting this study. According to the analysis, there was a significant difference between the groups in FOIS, AHI and min SpO2 (p &lt; 0.05).

Conclusion
We showed that poorer oral intake was associated with worse obstructive respiratory events. Our results suggest that clinicians should pay attention to sleep related breathing disorder in post-stroke dysphagia patients in rehabilitation hospitals, also to prevent stroke recurrence.

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0917 Excessive Daytime Sleepiness and Health-related Quality of Life in Adolescent Patients with PCOS
Authors: Chase Margaret , Kamboj Manmohan , Bonny Andrea , Kalra Maninder 
Published: April 2024

Abstract

Introduction
Patients with polycystic ovary syndrome (PCOS) have been reported to have an impaired quality of life (QoL). A high prevalence of sleep disorders has also been reported in this group. This study seeks to evaluate the degree of excessive daytime sleepiness and sleep related QoL in adolescent patients with PCOS.

Methods
Patients seeking treatment at our multidisciplinary PCOS clinic who were evaluated by Sleep Medicine from July 2023 to December 2023 and completed the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) and OSA-18 questionnaire were included in this study. The ESS-CHAD is an 8 question, validated measure of daytime sleepiness in children 12-18. Scores &gt;10 suggest excessive sleepiness. The OSA-18 is an 18-item questionnaire that uses a Likert-type scoring system to collect information about 5 subscales that are elements in QoL: sleep disturbance, physical symptoms, emotional symptoms, daytime function, and caregiver concerns. A summary score is calculated that ranges from 18 (no impact on QoL) to 126 (major negative impact). Scores lower than 60 suggest a mild impact on QoL, scores between 60 and 80 suggest a moderate impact, and scores greater than 80 suggest a large impact. Descriptive statistics include means (SD) and n (%).

Results
Sixteen subjects, mean age 16.68 years (SD 1.65), mean BMI 41.8 (SD 11.02) met inclusion criteria. Ten (62%) reported excessive daytime sleepiness as assessed by the ESS-CHAD. OSA-18 scores ranged from 23 to 84 with 2/16 (12.5 %) of subjects having a moderate or severe impairment and 14/16 (87.5%) subjects having a mild impairment.

Conclusion
Among adolescent patients seeking treatment at a multidisciplinary PCOS clinic, the majority reported excessive sleepiness with mild impact on their QoL as assessed by disease specific questionnaires. Future studies will further investigate the contribution of sleep disordered breathing and evaluate the impact of obesity and insulin resistance on excessive sleepiness and health related QOL as measured by ESS-CHAD and OSA-18 scores.

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0919 Shaking up the Night: PCD & Sleep-Related Movement Disorders
Authors: Quinones Roberto Cardona , Ramírez-Rivera Edicer , Alvarez-Torres Edwin , Hernandez Saidy Salem , Reyes Fabiola Guasp , Criado Maria Rivera , Vargas-Perez Noel , De Jesus-Rojas Wilfredo 
Published: April 2024

Abstract

Introduction
Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The literature on sleep movement disorders in PCD is limited, especially for Hispanics. This pilot study aims to assess the presence of sleep movement disorders and other comorbidities in patients with the RSPH4A PCD founder mutation [c.921 + 3_921 + 6delAAGT] in Puerto Rico. Our specific aim is to identify sleep-related movement disorders in PCD patients with the Puerto Rican founder mutation. Recognizing the importance of early diagnosis and prevention of PCD-related sleep disorders in pediatric and adult patients with PCD will help increase the knowledge of this condition and its comorbid manifestations.

Methods
We performed a prospective case series of fourteen PCD patients (n=15; seven pediatric and eight adults) at the Puerto Rico PCD Center and Neurosleep Sleep Laboratory in San Juan, Puerto Rico. Both pediatric and adult patients were interviewed for sleep disturbances and sleep-related movement during the night. Sleep questionnaires such as the Epworth Sleepiness Scale, and STOP-Bang (including the Pediatric Modified) were administered. Finally, polysomnography (PSG) was performed on every PCD patient to evaluate for sleep-related disorders.

Results
Our preliminary data showed that most patients with RSPH4A [c.921 + 3_921 + 6delAAGT] PCD founder mutation presented a high risk for sleep-related movement disorders or manifestations, including Sleep-Related Bruxism, Periodic Limb Movement of Sleep, Hypnagogic Foot Tremor, Rhythmic Movement Disorder. However, there were additional manifestations presented in both history-taking and PSG results such as Alpha-Delta Sleep, NREM Parasomnias, and others presented with Obstructive Sleep Apnea.

Conclusion
PCD is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The mechanism for the development of sleep-related movement disorders due to this ciliopathy is not well understood. Further research involving Multiple Sleep Latency Tests, Actigraphy, and additional comprehensive neurophysiologic testing and evaluation is needed to make an early diagnosis and prevent further clinical deterioration. Additional studies are needed in multicentric clinical trials to answer whether these sleep manifestations are related to a neurodevelopmental or neurodegenerative process due to this rare ciliopathy like PCD.

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0921 Pilot Cognitive Behavioral Sleep Health Randomized Controlled Trial for Young Adults with Type 1 Diabetes
Authors: Griggs Stephanie , Howard Quiana , Pignatiello Grant , Strohl Kingman , Li Chiang-Shan R , Grey Margaret , Crawford Sybil , Hickman Ronald 
Published: April 2024

Abstract

Introduction
Short sleep duration and inconsistent timing have been linked to poor glycemic target achievement and greater comorbidities in individuals with type 1 diabetes (T1D), particularly adults aged 18-26 years who achieve glycemic targets at the lowest rates (only 14%). Preliminary evidence supports cognitive behavioral sleep interventions (sleep extension + timing consistency) in improving the achievement of sleep and glycemic targets. The purpose of this pilot randomized controlled trial (RCT) was to determine the preliminary effects of a cognitive behavioral sleep health self-management intervention (CB-Sleep Health - sleep extension + timing consistency) on self-report and objectively derived sleep health dimensions (satisfaction, alertness, timing, efficiency, and duration) in young adults with T1D.

Methods
Young adults with T1D for at least 6 months with a hemoglobin A1C ≥ 7% or ≤ 80% time in glucose range were randomly assigned 1:1 stratified by sex at birth to a 12-week CB-Sleep Health (n = 21) or time balanced attention control (AC) condition (n = 18). Participants completed the Pittsburgh Sleep Quality Index (sleep satisfaction) and trail making test (daytime alertness) while concurrently wearing continuous glucose monitors and research grade actigraphy (timing, efficiency, and duration) for 14 days at baseline, post-intervention, and a 3-month follow up.

Results
Thirty-nine young adults (mean age 21, BMI 25.9 kg/m2, A1C 8.5% and 44% time in glucose range, 59% male, 26% Non-White - 18% Black/8% other race) participated. Baseline sleep health dimension values (mean + sd) were 5.4 + 0.7 vs. 5.3 + 0.5 score (satisfaction), 18.4 + 1.4 vs. 20.3 + 1.3 seconds (daytime alertness), 16:07 + 0.4 vs. 15:95 + 0.4 hours (timing), 85.6 + 4.1% vs. 84.7 + 4.5% (efficiency), and 6.4 + 1.0, vs. 6.9 + 1.0 hours (duration) for CB-Sleep Health vs. AC respectively. Sleep duration and alertness improved for CB-Sleep Health compared to AC post intervention (+18 minute vs. -25.8 minutes, p = .01 and -3.92 seconds vs. +0.71, p = .005) and were sustained at the 3-month follow up.

Conclusion
Preliminary effects of a CB-Sleep Health intervention on sleep duration and alertness without impairing efficiency for young adults with T1D are encouraging.

Support (if any)
National Institute of Nursing Research (R00NR018886)
0924 A 4-Week Morning Light Treatment Reduces Amygdala Reactivity and Clinical Symptoms in People with Traumatic Stress
Authors: Burgess Helen , Rizvydeen Muneer , Duval Elizabeth , Kim Hyungjin Myra , Phan K Luan , Liberzon Israel , Klumpp Heide , Abelson James , Horwitz Adam , Raglan Greta , Zalta Alyson 
Published: April 2024

Abstract

Introduction
Trauma exposure can result in anxiety, depression, and posttraumatic stress disorder. Although psychotherapies and pharmacotherapies exist for traumatic stress, many individuals remain symptomatic. New interventions for traumatic stress that target underlying mechanisms (e.g. amygdala reactivity) and are safe and acceptable are needed. Here we report on a randomized clinical trial in which we tested 3 doses of a 4-week morning light treatment in people with traumatic stress.

Methods
Forty-two adults (32 females, 19-57 years) with traumatic stress (experienced a DSM-5 Criterion A trauma, DASS score &gt;22, and ≥ 2 moderate hyperarousal symptoms) completed a 5-week protocol. In the first week each participant slept at home, ad lib, on their usual sleep schedule. Thereafter, they followed a fixed sleep schedule and a 4-week morning light treatment (randomized to 15 mins, 30 mins or 60 mins of light each morning). Amygdala reactivity (emotional faces task - fMRI), clinician rated symptoms (PSSI, HAM-A, HAM-D) and self-reported symptoms (PCL-5, DASS) were assessed at baseline, and after 4 weeks of morning light treatment.

Results
Amygdala reactivity (left and right, negative faces vs shapes) in all 3 morning light groups significantly reduced during treatment (ps&lt; 0.04). The 30 and 60 min groups had larger effect sizes in the reduction in amygdala reactivity than the 15 min group (ds=0.33-0.67 vs ds=0.11-0.16). All clinical symptoms significantly reduced during the treatment (ps&lt; 0.001). There was a trend for self-reported depression, anxiety and stress symptoms to decline the most in the 60 min group (DASS d=1.35, p=0.06). Similarly, clinician rated depressive symptoms declined the most in the 60 min group (HAM-D d=2.25, p=0.03). No significant side effects were reported. Treatment satisfaction (average 7/10) and adherence (average 91%) were similar between groups (ps&gt;0.05).

Conclusion
Results suggest that a 4-week morning light treatment can reduce amygdala reactivity and improve clinical symptoms in people with traumatic stress. The longest duration of morning light treatment, 60 minutes, produced some of the largest reductions in self-reported depression, anxiety and stress symptoms, and in clinician rated depressive symptoms. Morning light treatment should be further explored as a feasible, acceptable and effective adjunctive non-pharmacological treatment for traumatic stress.

Support (if any)
R61 MH117157