bluuebunny/crossref_metadata_2025_split huggingface dataset:
1199 A Novel Approach to REM Sleep Behavior Disorder Safety Measures
Authors: Ballenberger Matthew , Koo Brian 
Published: April 2024

Abstract

Introduction
Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. Behaviors include yelling, punching, kicking, and complex or violent movements causing a fall out of bed and result in injury to the patient or their partner. The American Academy of Sleep Medicine recommends maintaining a safe environment for patients. For patients with uncontrolled severe symptoms, recommendations include having partners sleep separately from patients. This may not be practical for small living spaces, may result in loss of intimacy between partners, or delay response to injuries caused by RBD. We present the case of a patient devised novel approach to keep their partner safe while maintaining close-proximity while sleeping.

Report of case(s)
A 63-year-old man with a past medical history of moderate obstructive sleep apnea (OSA) on CPAP presented to sleep clinic with symptoms of dream enactment. Behaviors included yelling, punching, and kicking. He had kicked his wife and had fallen out of bed resulting in an injury. He underwent a polysomnogram that showed REM sleep without atonia and was diagnosed with RBD. He was advised on safety precautions and started high dose melatonin. Clonazepam was added, but symptoms were not eliminated. He and his wife did not want to sleep separately, so he pushed two twin beds together and separated them with a large sheet of plexiglass. He reported he had hit the plexiglass many times without inuring himself and prevented injury to his wife. The patient’s wife was able to safely sleep near him which helped maintain their sense of intimacy.

Conclusion
We report a novel approach to create a safe environment for patients with RBD while maintaining partner proximity and intimacy. As patients struggle with progressive neurodegenerative disease, it is important to have their partners nearby overnight when patients are at risk for falling and self-injury. With two twin beds separated by plexiglass, a patient can safely sleep next to their partner and significantly reduce the risk of injuring them. This may be a useful technique for patients with severe, refractory symptoms of RBD.

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0120 Sleep Patterns Among Haitians: “To Sleep at Night Then Wake up at 11 pm to Run”
Authors: Carrenard Niara , Mondestin Wilmar , Chery Maurice , Elvariste Stessie , Auguste Evan , Bigdeli Tim , Jean-Louis Girardin , Blanc Judite 
Published: April 2024

Abstract

Introduction
This study examines the effects of political and gang violence on the mental and sleep health of Haitians in the United States and Haiti.

Methods
In the Haitian Well-Being Study, we conducted four Zoom focus groups, involving 28 participants (20 Haitian women and 8 men) aged 23 to 60, located in both the United States and Haiti. These sessions, lasting approximately 60 minutes each, aimed to assess the mental health repercussions of traumatic events in Haiti. Qualitative analysis of the focus group transcripts was employed using thematic analysis.

Results
Our study identified six key themes: 1) Poor Mental Health: Participants reported persistent anxiety, chronic acute stress, and symptoms akin to post-traumatic stress disorder (PTSD), attributed to the deteriorating situation in Haiti and interpersonal traumas such as kidnappings and sexual assault. 2) Poor Sleep Health: Concerns about daily and nocturnal gang violence, traumatic experiences, and mobility restrictions disrupted sleep patterns and quality. 3) Lack of Access to Resources: Limited access to healthcare, especially mental health services, was a recurring concern, emphasizing the need for culturally appropriate support within Haitian communities. 4) Mental Health Stigma: Seeking help from psychologists was stigmatized, discouraging individuals from seeking mental health support. 5) Cumulative Trauma Exposure: Participants shared past traumatic experiences, including PTSD symptoms such as re-experiencing and nightmares triggered by specific images, which continued to impact their mental health. 6) Recommendations for Mental Health Programs: Participants emphasized the urgency of restoring security in Haiti, enabling those displaced by gang violence to return to safe housing and reunite with loved ones. They also suggested community-based interventions, raising awareness about mental health, and significant investments in mental health training to address the widespread impact of violence in Haiti.

Conclusion
This study highlights the profound and complex effects of political and gang violence on the mental and sleep health of Haitians. To address these challenges effectively, participants stressed the importance of restoring security in Haiti, expanding access to mental health resources, reducing stigma, and implementing community-based interventions to support those affected by violence. Additionally, this qualitative study underscores the role of sleep health in disaster relief and global health efforts.

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5R01HL142066-06
1206 Combination of Nasal Steroid and Nasal Oxymetazoline: A Way to Improve PAP Tolerance in OSA Patients with Rhinitis
Authors: Anokwute Akudo , Wallach Paul , Manchanda Shalini 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is the most common cause of sleep-disordered breathing, and positive airway pressure (PAP) therapy is the gold standard for treatment. PAP therapy adherence remains a challenge especially in patients with nasal disease. Our case is that of a patient with OSA and long-standing allergic rhinitis who had significant improvement in PAP adherence with the use of daily intranasal oxymetazoline and fluticasone.

Report of case(s)
A 62-year-old man with history of allergic rhinitis on intranasal fluticasone presented to our sleep clinic for discussion about OSA treatment options because he was intolerant of PAP therapy. He had OSA documented for 18 years and had twice attempted PAP therapy unsuccessfully despite high motivation. Baseline AHI was 25/hr. He had tried a mandibular assist device (MAD) with good control of snoring until he gained more weight and the MAD no longer controlled symptoms. He attempted PAP therapy again and tried nasal oxymetazoline with a nasal steroid and was able to tolerate the use of PAP machine for an entire night and so continued using the combination therapy. He has been tolerant of PAP for a year on this regimen without the development of rhinitis medicamentosa (RM). The presence of rhinitis before or after starting PAP therapy is a strong negative predictor of PAP adherence. Intranasal oxymetazoline is an option for treatment of sinusitis but has been known to cause rhinitis medicamentosa when used alone. Our index patient did not notice any improvement in tolerance of PAP while on intranasal fluticasone, but a combination of intranasal fluticasone and oxymetazoline led to better tolerability in our patient. There are limited studies for long-term use of oxymetazoline. Two studies showed that using oxymetazoline along with a nasal steroid once daily for 4 weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa.

Conclusion
PAP therapy compliance remains a challenge in patients with allergic rhinitis. Combination therapy of intranasal steroid and intranasal oxymetazoline may be helpful in improving PAP adherence in these patients, and further study is warranted.

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1222 These Boots Were Made for Walking, but Not Sleeping
Authors: Adesina Joyce , Khan Safia 
Published: April 2024

Abstract

Introduction
Somnambulism occurs during slow wave sleep, prompted by an arousal, followed by sitting up or walking, disorientation with no recollection of the event, and falling back asleep. While somnambulism/sleepwalking is a parasomnia that is not typically associated with Ehlers-Danlos syndrome (EDS), it was the presenting sleep disorder in a patient, with multiple etiologies of insomnia.

Report of case(s)
A 54-year-old female with a history of chronic insomnia, attention-deficit/hyperactivity disorder (ADHD), EDS, and osteoporosis presents with somnambulism. Patient reports sleepwalking since childhood and continuing to sleepwalk into adulthood. Fifteen years prior, she became a paramedic, worked 24-hour shifts, and developed insomnia. Patient started her first insomnia treatment with zolpidem 5 years ago, which increased her sleepwalking frequency from twice a week to daily and included more complex behaviors like preparing food. Patient retired with disability 4 years prior due to recurrent fractures and joint deformities secondary to her osteoporosis and EDS. She took cyclobenzaprine, methocarbamol, oxycodone-acetaminophen, and pregabalin for chronic pain, and dextroamphetamine-amphetamine for ADHD. Patient presented to Sleep Medicine clinic July 2023 where zolpidem was changed to clonazepam. At her follow up December 2023 visit, exam was notable for her wearing a left post operative short boot. Her sleepwalking had ceased, but insomnia worsened. It was taking her 3 hours to fall asleep after her 6PM bedtime, and 1 hour to fall asleep after nocturia-related awakenings 1-2 times per night. Since her surgery three weeks prior, she had been dozing off during the day, likely from her sedative pain medications. We recommended delaying her evening pain medications and bedtime and ordered a sleep study.

Conclusion
Chronic pain, fatigue, and pain medications used to treat EDS contribute to this population's higher rates of sleep disorders like insomnia. They also have higher rates of obstructive sleep apnea due to nasal-maxillary cartilage changes, that are successfully treated with nasal CPAP. Psychiatric disorders, including anxiety, mood disorders, and ADHD are also more common in this population, and carry their own sleep pathology. While the patient’s primary sleep complaint was somnambulism, it was important to evaluate for and treat underlying sleep disorders for optimal outcomes.

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1224 Management of Dopaminergic Augmentation of Restless Legs Syndrome with Concurrent High Dose Benzodiazepine Therapy
Authors: Ottra Sneha , Palmquist Aaron 
Published: April 2024

Abstract

Introduction
Restless Legs Syndrome (RLS) or Willis-Ekbom disease, is sleep related movement disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable and unpleasant sensations. Over the years, dopaminergic agonists (DAs) have served as the primary treatment for RLS. However, the emergence of dose-dependent augmentation has prompted a shift in the management approach. This change is marked by a growing emphasis on prioritizing alpha2-delta calcium channel ligands (A2D) as alternative therapeutic agents

Report of case(s)
We report a case of a 70-year-old woman with a 15-year history of RLS, with crawling and unpleasant sensation of her legs preventing from falling asleep, successfully managed initially with pramipexole 0.5mg at night and eventually started on clonazepam. With escalating symptoms, Pramipexole and Clonazepam gradually increased. Despite dose escalation of pramipexole to 0.75mg and clonazepam to 4mg nightly, symptoms persisted and even intensified. Abruptly discontinuing Pramipexole and transitioning to ropinirole at 1mg and continuing Clonazepam 4mg nightly failed to yield improvement. Patient presented for consultation at this time highlighting the severity of RLS augmentation as moderate. Recommendation in this situation is to introduce A2D or possible opiate medication to ameliorate symptoms before tapering DA. The patient's high-dose benzodiazepine regimen increases respiratory depression and fall risk, hindering the standard approach of introducing alternative agents. In response, a tailored strategy was implemented, gradually tapering clonazepam while initiating gabapentin therapy, RLS symptoms began to improve. Subsequent cautious tapering of ropinirole contributed to sustained relief. This case demonstrates the need for individualized approaches in managing dopaminergic augmentation in RLS, especially when high-dose benzodiazepines are involved.

Conclusion
In navigating the intricacies of RLS treatment, our case highlights the effectiveness of a nuanced approach when confronted with dopaminergic augmentation alongside concurrent high-dose benzodiazepine therapy. Tapering benzodiazepines and introducing gabapentin proved successful, emphasizing the importance of tailored interventions. This case contributes to the understanding of RLS management in complex scenarios.

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0130 Negative Peer Interactions Among Adolescents Are Associated with More Difficulty Sleeping
Authors: Winton John , Reichenberger David , Mathew Gina , Master Lindsay , Rodriguez Isaac , Hale Lauren , Chang Anne-Marie 
Published: April 2024

Abstract

Introduction
Adolescence is a turbulent time for sleep health and social and psychological well-being. Adolescents commonly experience negative peer interactions and relationships. Few studies have investigated the associations of physical bullying and social exclusion with sleep, and those that have done so are not generalizable across the United States. The aim of this study was to assess whether negative peer interactions were related to sleep problems among a national, diverse sample of adolescents.

Methods
Data were from the age 15 wave of the Future of Families and Child Wellbeing Study, a longitudinal birth cohort of adolescents from 20 US cities. Adolescents self-reported whether they experienced different forms of bullying (i.e., being picked on, hit or threatened with physical violence, or purposely excluded) and the number of nights they experienced having difficulty falling or staying asleep throughout the week (N=3,305). Poisson regression analyses for each sleep outcome were adjusted for age, sex, race/ethnicity, family socioeconomic status, family structure, and caregiver education level.

Results
About 16% of the sample reported experiencing some form of bullying, and about half reported no nights with difficulty falling or staying asleep. Adolescents who were picked on reported 30% more nights with difficulty falling asleep (p&lt; 0.001) and 39% more nights with difficulty staying asleep (p&lt; 0.001). Those who reported being hit or threatened with physical violence reported 27% more nights with difficulty falling asleep (p&lt; 0.001) and 44% more nights with difficulty staying asleep (p&lt; 0.001). Adolescents who were purposely excluded from activities reported 19% more nights with difficulty falling asleep (p&lt; 0.001) and 38% more nights with difficulty staying asleep (p&lt; 0.001).

Conclusion
Results support our hypothesis that negative peer interactions at schools across the US are associated with more nights with difficulty falling or staying asleep. If adolescents are already at risk for difficulty sleeping, experiencing bullying may further exacerbate risk. Schools should therefore identify and attempt to prevent negative peer interactions to protect adolescent sleep health and well-being.

Support (if any)
R01HD073352, R01HD36916, R01HD39135, and R01HD40421
0131 Depression, Anxiety, Stress, Sleep Quality, and Perceived Academic Performance in College Students
Authors: Walther Sam , Hughes Joshua , Holladay Cathryn , Reynolds Alexandria 
Published: April 2024

Abstract

Introduction
There is a significant amount of research which suggests that college students who exhibit poor sleep quality tend to have worse academic performance. Additionally, studies have shown correlations between stress levels and academic performance. In the current study, it was expected that college students with higher stress levels and lower sleep quality would report worse perceived academic performance.

Methods
Participants included 130 (male=21) full-time undergraduate students (mean age=19.65, SD=1.54 years). Participants completed an online survey that consisted of a series of questionnaires that examined demographics, perceived levels of academic performance, depression, anxiety, stress (Depression Anxiety Stress Scale; DASS-21), and sleep quality and duration (Pittsburgh Sleep Quality Index, PSQI).

Results
Preliminary data analyses were conducted. Average sleep duration (PSQI) was 7.00 hours per night (SD=1.36) and sleep quality (PSQI) was poor (M=6.86, SD=3.33). Mean depression (M=21.66) and stress (M=28.46) scores fell into severe categories, whereas anxiety scores (M=23.06) were extremely severe. Pearson correlations revealed that depression (r=.472, p&lt;.001), anxiety (r=.419, p&lt;.001), and stress (r=.527, p&lt;.001) were related to sleep quality. A One-Way ANOVA (F(4, 124)=2.507, p=.045) revealed that students who perceived making all A’s had the best sleep quality (M=5.22) compared to those who perceived making mostly A’s (7.00) or A’s/B’s (7.57). Depression, anxiety, and stress were not significantly related to perceived academic performance.

Conclusion
Higher rates of depression, anxiety, and stress were associated with poorer sleep quality. Students with better sleep quality perceived better academic performance compared to those with poorer sleep quality. A ceiling effect may have occurred with stress, potentially explaining the lack of relationship with perceived academic performance. Limitations include preliminary data analyses and the surveys were completed by participants within the last three weeks of the semester. The end of the semester likely contributed to high levels of stress and anxiety.

Support (if any)
None.
0137 Exploring the Nexus of Sleep Restlessness and Depressive Symptoms : A Study of Venezuelan Dyads in the U.S
Authors: Scaramutti Carolina , Seixas Azizi , Schwartz Seth 
Published: April 2024

Abstract

Introduction
Sleep is a critical component of overall well-being, influencing physical health, cognitive function, and emotional stability. In the context of mental health, sleep disturbances, particularly restlessness, have been identified as potential indicators of psychological distress. In the Venezuelan population, understanding the relationship between sleep, mental health, and familial dynamics is of paramount importance. The continued difficulties in Venezuela and the migration process for these immigrants may contribute unique factors influencing sleep patterns and mental well-being. This study aims to delve into the relationship between self-reported sleep restlessness, as indicated by responses to CES-D question 4, and depressive symptoms among Venezuelan parents and their children.

Methods
The investigation employed a two-wave design to capture the dynamics of these associations over time. Participants completed surveys at two distinct time points, Time Point 1 and Time Point 2, providing data on sleep restlessness (specifically, CES-D question 4) and overall depressive symptoms assessed by the Center for Epidemiological Studies Depression Scale (CES-D).

Results
In Wave 1, parental reports indicated that 17% experienced restless sleep moderately or all of the time (n=27), while 38% reported some or little restlessness (n=60). Among adolescents, 22% reported moderately restless or almost all the time (n=35), and 28% reported some or little restlessness (n=43). The CES-D scores revealed a concerning trend among parents, with a mean score of 19, surpassing the clinical depression cutoff. Approximately 75% of parents scored 26 or higher on the CES-D, indicating a substantial prevalence of depressive symptoms. Adolescent mean CES-D scores were 21, and a noteworthy 94.3% scored 16 or above, reflecting a significant proportion experiencing elevated depressive symptoms. Persisting into Wave 2, the scores and reported restlessness among both parents and adolescents remained consistent, suggesting that these symptoms endured over time without significant mitigation.

Conclusion
This study provides a comprehensive examination of the enduring relationship between sleep restlessness and depressive symptoms among Venezuelan parents and their children living in the United States. The findings underscore the significant prevalence of restlessness and depressive symptoms within this population, revealing a concerning pattern that persists over a two-wave study period.

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0142 Evaluating the Efficacy of Light and Odour for Mitigating Sleep Inertia Under Conditions of Sleep Restriction
Authors: Owen Mikaela , Yates Crystal , Grosser Linda , Shattuck Nita , Matthews Raymond , Matsangas Panagiotis , Sakovits Brooke , Banks Siobhan 
Published: April 2024

Abstract

Introduction
Sleep inertia (SI) poses challenges in safety-critical and high-performance environments. Sleep restriction is known to exacerbate SI. To minimise the experience of SI under conditions of sleep restriction, we assessed the role of two quick and easily implementable reactive countermeasures – light and odour – to increase alertness on waking.

Methods
N=31 (20F, 25.13±5.72y, 24.36±2.1kg/m2) were monitored at home for a week with actigraphy and then in the laboratory underwent an initial night of 7h, followed by 4 days where sleep was split across a 4h sleep opportunity at night and a 1h daytime nap, with a final night of 8h TIB for sleep. Participants were randomly allocated to one of three groups - control, light, or odour. The group allocation determined the countermeasure received on waking before commencing a battery of tests. Performance during SI was assessed using the Psychomotor Vigilance Test (PVT), and the Karolinska Sleepiness Scale (KSS) at 3, 18, 33, 48, and 63min after awakening. Outcomes included reciprocal median reaction time (RRT) and lapses (RT&gt;500ms) on the PVT, and KSS scores. Data were analysed with mixed-model ANOVAs with condition, time since awakening, time of day, and day as fixed factors, and participant as a random factor, and posthocs simple effects analysis.

Results
There were significant time awake by time-of-day interactions on PVT RRT and PVT Lapses p&lt;.05 and a main effect of time awake and time-of-day for KSS (p&lt;.05). Faster RRTs and fewer Lapses were found across the afternoon wake (i.e., afternoon nap) SI period compared to the morning wake (i.e., night sleep). The progress through the SI period was consistent across time of day for KSS. Condition had no significant main effect or interaction effect with time awake onto measures of SI (e.g., RRT, Lapses, and KSS) (p&gt;.05)

Conclusion
These findings indicate that light and odour for a short period at waking do not improve SI under conditions of sleep restriction. Instead, the findings indicate that a daytime nap may reduce the exacerbating effects of sleep restriction preventing the accumulation of SI during a 4-day simulated work week.

Support (if any)
Naval Postgraduate School