bluuebunny/crossref_metadata_2025_split huggingface dataset:
1048 Ambulatory Sleep EEG in Post-Stroke Hospitalization
Authors: Lott Morgan , Romanowski Alan , Soto Valentine , Banik Nandita , Lynn Alexia , Sokoloff Greta , Blumberg Mark , Boes Aaron , Baran Bengi 
Published: April 2024

Abstract

Introduction
An important function of sleep is neuroplasticity, which is essential to functional recovery after stroke. However, inpatient acute care settings may not be conducive to restful and consolidated sleep. The goals of the present study were to test the feasibility of using wearable technology to objectively quantify sleep during inpatient stay in the first few days of hospitalization post stroke and examine relations of sleep quality and architecture with stroke severity.

Methods
Data collection is ongoing, preliminary analyses are based on 8 patients (5F/3M, 41-78 yrs, mean age=61.7 yrs). A headband style EEG acquisition device (Sleep Profiler) was used for one night (0-8 days following a first-ever stroke, mean=3 days) either in ICU or neurology inpatient floors. Sleep was scored based on standard AASM criteria. The National Institute of Health Stroke Scale (NIHSS) was administered to assess stroke/disability severity.

Results
We observed great variability in sleep duration (2.1-6.2 hrs, mean=4.1 hrs), sleep efficiency (29-81%, mean=51%) and increased time spent in N3 (compared to standard sleep architecture; 21.2-72.8%, mean=41.7% of total sleep time). Stroke severity correlated with WASO (r=.82, p=.02) and time spent in supine position after sleep onset (r=.83, p=.02).

Conclusion
While preliminary, these findings identify profound sleep restriction and fragmentation experienced by stroke survivors during the first few days of hospitalization. Further, stroke severity predicts increased sleep fragmentation, possibly due to more intensive medical care required. Future plans involve examining long-term cognitive and functional outcomes in patients to test the hypothesis that better sleep during the acute phase of stroke enhances recovery.

Support (if any)
Iowa Neuroscience Institute Research Program of Excellence
0105 The Impact of Lifetime Trauma Exposure Among Law-Enforcement on Actigraphically-Recorded Sleep
Authors: Krizan Zlatan , Strauel Caroline , Miller Anthony 
Published: April 2024

Abstract

Introduction
Law-enforcement officers have a critical mission to ensure public safety and investigate crime, yet frequently report sleep disturbances and mental health challenges. Exposure to trauma common during police duties may contribute to officers’ poor sleep, although research is lacking. Moreover, whether trauma exposure influences objective sleep characteristics and which ones may be especially vulnerable is unclear. To this end, this study examined whether cumulative exposure to traumatic events predicted multiple parameters of sleep health derived from actigraphically-recorded sleep among a sample of police officers during daily duties.

Methods
A sample of mostly day-shift police officers (n=77, 73% male, average age 42) participated in a two-week study where they reported trauma exposure (Life-Event-Checklist for DSM-5), sleep quality (PSQI), including other indicators of health (e.g., Berlin OSA Questionnaire). Subsequently, officers wore the Fatigue Science Readiband for two weeks, which yielded actigraphic estimates of sleep duration, wake-after-sleep-onset, sleep latency, and sleep quality, also producing biomathematical estimates of alertness. Analyses included correlations and regressions controlling for demographic covariates.

Results
In general, 36% of officers reported at least one traumatic event, 25% were at high risk for obstructive sleep apnea, and most officers reported significant sleep complaints. Critically, cumulative exposure to trauma was significantly associated with shorter sleep duration, lower sleep quality, and more frequent awakenings (marginally with PSQI reports). For example, officers who reported trauma slept on average around 20 minutes less per night. These effects were robust amid inclusion of critical covariates (age, sex, height, weight, sleep apnea risk, and generalized anxiety).

Conclusion
The findings provide novel and much needed evidence on the impact of trauma exposure on objectively-recorded sleep among police officers. Trauma exposure was found to impact multiple dimensions of everyday sleep including duration and continuity. Moreover, these effects could not be attributed to demographic differences or currently reported mental distress. The results underscore the presence and impact of trauma on sleep among law-enforcement (even day-shift). They also highlight the need for assessing sleep and fatigue more objectively, as well as sleep and fatigue management intervention efforts.

Support (if any)
This work was funded by a Federal Bureau of Investigation contract #15F06718C000253 to the first author.
1050 Supporting Patient Safety with Oxybate Therapy: A Survey of Patients and Prescribers
Authors: Macfadden Wayne , Whalen Marisa , Patodiya Vandana , Ward Danytza , Bronson Stefanie , Measey Thomas , Candler Shawn 
Published: April 2024

Abstract

Introduction
Low-sodium oxybate (LXB; Xywav®) and high-sodium oxybate (SXB; Xyrem®) are approved to treat cataplexy or excessive daytime sleepiness in patients ≥7 years of age with narcolepsy; LXB is also approved for idiopathic hypersomnia in adults. Both are available through the same manufacturer’s Risk Evaluation and Mitigation Strategy (REMS) program under the US Food and Drug Administration, where prescribers and patients receive training and educational materials containing important information about the significant risks, safe handling, and storage of LXB and SXB. The Knowledge, Attitude, and Behavior survey was conducted to document and assess their level of awareness regarding important information about LXB and SXB communicated through the REMS.

Methods
Internet, telephone, and paper surveys were conducted between October 27, 2022 and February 26, 2023. Survey questions and statements tested each group’s understanding of REMS Key Risk messages (risks associated with LXB and SXB, risk of abuse, dosing and safe handling). Surveys considered LXB and SXB jointly.

Results
Surveys were completed by 3152 patients and 273 prescribers. Most patient respondents correctly identified risks related to taking LXB and SXB at recommended doses (81.5%); most knew there is a risk of abusing LXB and SXB (89.6%) and correctly identified risks of taking too much of either (93.4%). Most prescriber respondents correctly recognized central nervous system depression (91.6%) and respiratory depression (79.5%) as risks associated with LXB and SXB; most were aware of patterns of misuse (99.3%) and drug-seeking behaviors (96.7%). For twice-nightly regimens, nearly all patients and prescribers, respectively, understood the first dose should be taken at bedtime (99.5%, 98.9%), the second dose should be taken 2.5–4 hours following the first dose (99.0%, 98.9%), and patients should remain in bed for both doses (99.4%, 95.9%). Most patients and prescribers responded correctly regarding proper storage (99.8%, 83.8%), reporting loss or theft (89.6%, 87.5%), and the legality of giving or selling LXB and SXB (98.9%, 99.6%).

Conclusion
Most patients and prescribers surveyed demonstrated understanding of the risks, dosing instructions, and safe handling of LXB and SXB communicated through the REMS to support safe and effective use.

Support (if any)
Jazz Pharmaceuticals
1051 A Novel Sleep Pilot Program to Streamline Care in Patients Undergoing Joint Replacement
Authors: Goldenberg Daniella , Rojas Edward , Devabhaktuni Sirisha , Santer Matthew , Matyus Valerie , Pincavitch Jami , Richmond Nathan , Battung Francis , Stansbury Robert , Sharma Sunil 
Published: April 2024

Abstract

Introduction
The presence of sleep disordered breathing can have a significant impact on a patient’s perioperative risk. Diagnosis and treatment of obstructive sleep apnea (OSA) with positive air pressure (PAP) may help prevent post-operative complications. In this pilot program we hope to identify high risk patients early to help mitigate these risks.

Methods
We created a pilot program to help streamline patients undergoing joint replacement. In this program we identified high risk OSA patients, set them up with evaluation with our sleep medicine team and had them undergo standard of care sleep apnea testing. Once testing was completed patients received treatment if indicated.

Results
A total of 49 patients were evaluated 53% (26) of patients completed evaluation with the sleep medicine team. 8 out of the 49 patients completed their perioperative sleep apnea testing and had undergone their surgery. 9 out of the 49 patients did not complete their perioperative testing and had undergone surgery. Of the 9 that did not complete testing 4(44%) had readmission/visit to the emergency department (ED) post-surgery. 1 out of 8 (12%) who did complete testing had a readmission/visit to the ED. The average AHI of patients who completed testing was 14.67.

Conclusion
Early identification and intervention of patients with OSA may lead to less post operative readmissions/ED visits in patients undergoing joint replacement. Of note only 53% of patients completed evaluation with the sleep medicine team. This further identifies the importance of discussing with patients the risks that certain comorbidities may have when undergoing procedures. Although the sample size was small due to this being a pilot study, there was a 44% readmission/ED visit rate in patients who did not undergo testing or treatment for OSA. Further studies are needed to see if we can identify which patients with high suspicion for OSA are at greater risk for developing post operative complications to help streamline care and reduce hospital costs.

Support (if any)
1053 Patients’ Sleep Perception and Its Correlation with Unattended Ambulatory Testing in the Inpatient Setting
Authors: Devabhaktuni Sirisha , Rojas Edward , Srinivasan Priyanka , Richmond Nathan , Goldenberg Daniella , Battung Francis , Knollinger Scott , Olgers Kassandra , Stansbury Robert , Sharma Sunil 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea is an increasingly prevalent condition today, with many cardiopulmonary consequences. In the ambulatory setting when a patient reports poor sleep quality on the night of the study, repeat testing is usually sought out. Here, we examine the differences in AHI, ODI and comorbidities among patients who perceived they slept well versus patients who perceived they slept poorly and compare it to outpatient PSG follow up.

Methods
A retrospective chart review of 1351 patients enrolled in a formal hospital sleep medicine program between September 2019 and October 2022, was conducted. The sleep medicine team asked each patient how they perceived they slept that night, using three options: slept well, slept but not well, or slept very poorly. Patients who slept but not well and patients who slept very poorly were combined to make a category of slept poorly. From there, each patient’s AHI, ODI, Stop-Bang score, ESS score and comorbidities were monitored.

Results
Of the 1351 patients 304 of these patients had outpatient follow up with PSG. The STOP-BANG score for patients who slept well and slept poorly was 5.17 and 5.48, respectively. In the patients who slept poorly, 73% had a mean AHI &gt;5 on confirmatory PSG compared to 79% while inpatient. The patients who slept well, 79% had a mean AHI &gt;5 on confirmatory PSG compared to 73% while inpatient.

Conclusion
The variables used to measure sleep apnea were not significantly different among patients who believed they slept well versus patients who believed they slept poorly. Current thought is that inpatient sleep medicine can lead to false positive results, as patients are sicker in the inpatient setting, leading to poorer sleep quality and disruption that could alter their unattended sleep study. In this retrospective chart review, there seemed to be little difference when comparing patients’ hospital sleep studies to their outpatient ones. Only 22% of patients completed outpatient follow up. This needs further evaluation to see if streamlined care for the patients leads to better outcomes and cost-effective care.

Support (if any)
1055 Development of a Provider and Patient-Based Sleep Improvement Resource for Inpatient Setting
Authors: Claudatos Stephanie , Simpson Norah , Eisen Katherine , Ma Flora , Manber Rachel 
Published: April 2024

Abstract

Introduction
Insomnia is common among hospitalized psychiatric patients and environmental challenges often increase the severity of sleep disturbances. Pharmacotherapy is often used to treat insomnia symptoms. Few studies have investigated ways to adapt CBT-I to inpatient populations.

Methods
A preliminary needs assessment was conducted at Stanford Hospital and Clinics Acute Inpatient Psychiatric units to identify barriers related to the use of non-pharmacological approaches to improve patients’ sleep. We conducted unstructured interviews with staff members, including nurses, occupational therapists, psychologists, and psychiatrists. Based on themes that emerged from the interviews, we developed sleep improvement resources and subsequently refined them based on input from behavioral sleep medicine providers and the inpatient team.

Results
We developed the following three resources (1) a provider training and education resource, (2) a patient-facing handout, and (3) recommendations on the environment in the inpatient unit. Both the provider- and patient-facing resource consisted of context-sensitive CBT-I recommendations: psychoeducation about sleep regulation, counter control, alerting strategies, strategic napping, daytime activities that support sleep, developing a wind down and morning routine, and optimizing the sleep environment (e.g., utilizing earplugs, eye masks or extra blankets). Additionally, several recommendations were included to address modifiable environmental factors at the unit-level. These included increasing consistency with unit light and wake time schedule, nursing staff to perform visual checks to minimize disrupting patients’ sleep, designated quiet time, dimmable lights in bedrooms, and additional unit-safe sitting areas in bedroom (e.g., bean bag chair).

Conclusion
Adapting CBT-I principles to specifically target sleep difficulties unique to psychiatric inpatients at all three levels (i.e., patient, staff, and environment) has the potential to support sleep in this vulnerable population. Future research is needed to test efficacy of this comprehensive approach.

Support (if any)
1058 Experience of VA Telesleep Medicine Following the COVID Pandemic
Authors: Atwood Charles , Boudreau Eilis , Sarmiento Kathleen , Williams Katherine , Totten Annette , Folmer Robert , Wholey Mary 
Published: April 2024

Abstract

Introduction
The VA Telesleep Enterprise Wide Initiative (EWI) operated from 2017 through 2023 and focused on increasing sleep medicine care to rural Veterans. Part of the Telesleep EWI was promotion of telehealth visits to improve access to sleep medicine care for rural Veterans. This report examines the significant growth of telesleep visits during the COVID-19 pandemic and the strong sustainment in Telesleep care in EWI sites post-pandemic. EWI sites participated in weekly clinical support meetings and best practices sharing to foster uptake and improvement of telesleep clinical work. Non EWI sites did not have access this support network.

Methods
Data regarding clinical visits for sleep medicine at a national level were obtained from the VA Corporate Data Warehouse by trained and experienced data analysts. Data from 2019 through fiscal year 2023 were obtained which spans the pre-pandemic to the post-pandemic time frame. The data were analyzed by medical center based on whether the site was part of the Telesleep EWI or not part of the EWI. In this report only rural Veterans were analyzed.

Results
From 2019 to 2023, for rural Veterans, the proportion of total sleep medicine visits performed using telehealth modalities increased from 25% to 56% for sites in the Telesleep EWI compared to 16% to 36% in the non EWI sites. Comparing Telesleep visits at the peak of pandemic in 2021-22 to post-pandemic 2023, Telesleep visits peaked at 61% and decreased to 56% in 2023 for the EWI sites and peaked at 52% and decreased to 36% in non EWI sites.

Conclusion
The COVID -19 pandemic resulted in rapid changes in healthcare delivery for many clinical services including sleep medicine. Post-COVID-19 many clinicians returned to previous care delivery models. In VA, where telesleep medicine virtual care was strongly supported in the EWI, sites showed greater sustainment of virtual care compared to non EWI sites. We speculate that ongoing support of clinicians through training and expert support in the EWI accounted for this better sustainment of virtual care.

Support (if any)
VA Office of Rural Health; VA Office of Connected Care; VA HSR&D Merit Review
1067 Increasing Access to Behavioral Insomnia Care: A Hybrid Implementation-Effectiveness Trial
Authors: Bramoweth Adam , Hough Caroline , Boudreaux-Kelly Monique , McCoy Jennifer , Youk Ada 
Published: April 2024

Abstract

Introduction
Chronic insomnia is common among Veterans and contributes to poor health and quality of life. To improve access to care, Brief Behavioral Treatment for Insomnia (BBTI) was developed for delivery outside of specialty care settings. BBTI is a brief, flexible, and effective adaptation of CBT-I. However, training alone is rarely sufficient for sustainable change and implementation strategies are needed for successful uptake and adoption.

Methods
This was a stepped wedge, hybrid 3 implementation-effectiveness trial at 4 VA Medical Centers. Primary Care Mental Health Integration (PCMHI) providers attended a 3-hour live online BBTI training followed by a pre-implementation phase prior to receiving implementation support. During the 12-month implementation phase, strategies and support were provided by the hub-site and assisted by each site’s implementation champion. After 12-months, support was withdrawn. Data from the VA Corporate Data Warehouse were extracted across four phases (pre-training, pre-implementation, implementation, post-implementation) and compared within and between sites. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework informed outcomes; reach data is presented here from pre-training to pre-implementation and pre-implementation to implementation. Analyses were conducted using logistic regression with a fixed effect for study phase.

Results
Sites 2, 3, and 4 saw significant increases in the proportion of Veterans engaging in BBTI from post-training to pre-implementation (8.37% - 24.16%; ps&lt; 0.00001); site 1 did not have a pre-implementation phase. From pre-implementation to implementation, sites 1 and 3 saw significant increases in Veterans engaged in BBTI (7.32% - 22.3%; ps&lt; 0.0001), site 2 had a non-significant increase in BBTI (4.14%; p=0.21), and site 4 had a non-significant decrease in BBTI (-0.89%; p=0.82). All four sites also saw significant reductions in sleep medications prescribed in Primary Care (-0.60% - -1.43%; ps&lt; 0.0001) from pre-implementation to implementation.

Conclusion
BBTI training alone plus implementation support resulted in mixed findings across the four sites. However, BBTI in PCMHI increased over time across the study phases. BBTI plus implementation support also contributed to sleep medication reductions in Primary Care. Contextual barriers and facilitators also need to be evaluated to determine their impact on efforts to implement BBTI in VA PCMHI clinics.

Support (if any)
VA HSR&D I01HX003096
1070 Awakening Insights: Increasing Sleep Medicine Education for Psychiatry Residents
Authors: Shaffer Nicholas , Peterson Telyn , Hentschel-Franks Karen 
Published: April 2024

Abstract

Introduction
Sleep is integral to mental health. For example, it is estimated that 40 to 50% of individuals with insomnia have co-occurring mental illness. Despite this, only ~3.31% of current sleep medicine fellows enter from a psychiatry residency, ~4.89% of sleep medicine fellowship alumni are psychiatrists, and 4.25% of sleep faculty members have a psychiatry background. At the present time, the Accreditation Council of Graduate Medical Education has no curriculum requirement for sleep education within psychiatry residency programs. A past study has shown that less than 40% of psychiatry programs have faculty with training in sleep medicine. If sleep medicine is not prioritized amongst psychiatry residents, psychiatry is at risk of losing representation in the field.

Methods
From November to December 2023, a voluntary & anonymous online 15-minute, 32 question survey was given to psychiatry residents in the third largest psychiatry residency program in the country. The survey evaluated psychiatry residents' knowledge on guidelines from the American Academy of Sleep Medicine, as well as attitudes, behaviors, and barriers towards sleep medicine.

Results
A total of 31 psychiatry residents completed the survey. Results show perceived and objective opportunities to improve sleep education amongst psychiatry residents. Residents demonstrated discomfort in counseling patients regarding topics including sleep related breathing disorders (43%), non-REM parasomnias (53%), and REM behavior disorders (45%). Barriers were identified regarding discussing sleep with patients included limited training (43%), lack of time (37%), and decreased prioritization (17%).

Conclusion
More can be done to promote sleep medication education for psychiatry residents. While analysis is ongoing, it is the hope that the results of this survey will lead to the development of applicable curricula with expected completion within 12 months. We anticipate identifying specific educational needs to inform the development of a standardized sleep medicine training protocol for residents in hopes of increasing the number of psychiatry residents willing to consider sleep medicine as a possible future career. With research establishing a bidirectional relationship between sleep and psychiatric disorders, it is imperative that curricular improvements are targeted, so that psychiatrists can continue to contribute to the field of sleep medicine.

Support (if any)
UT Health San Antonio Department of Psychiatry