bluuebunny/crossref_metadata_2025_split huggingface dataset:
0846 Development of a Pediatric Sleep Routine Questionnaire for Black Families: A Human-centered Design Approach
Authors: Chung Alicia , Iruka Iheoma , Brotman Laurie , Jean-Louis Girardin , Huang Keng-Yen 
Published: April 2024

Abstract

Introduction
Bedtime routines are the hallmark for sleep guidance in young children. Yet, Black children have an 80% increased likelihood of not having a bedtime routine, compared to white children. To promote healthy bedtime routines, a comprehensive assessment tool that capture children’s bedtime routine behaviors and relevant bedtime environment and context is needed to guide the targeting areas for intervention. However, existing sleep routine questionnaires do not capture sleep contexts that are relevant to Black families. Thus, the objective of our study was to develop a comprehensive sleep routine questionnaire that captures child’s bedtime routine behaviors, and household adult-child interaction and bedtime environment that support health bedtime behaviors. As the first step of the measurement development, we focused on study cultural relevance, salience and appropriateness of the three bedtime measures: 1. the Parent-Child Sleep Interaction Scale, 2. Bedtime Routines Questionnaire, and 3. Child Routines Inventory scales, prior to formal administration.

Methods
A human-centered design process, Ecological Theory (considering individual, home, black community contexts), and qualitative formative research methods were applied to guide sleep routine questionnaire adaptation. A convenience sample of five Black caregivers with preschool-aged children were interviewed and provided feedback for the bedtime routine surveys. Interview questions were guided by human-centered design, centering the lived experience of the caregivers, as well as multiple-domains of sleep contexts and behaviors to understand child sleep routine practices, household structure, child sleep environment, social-family connection, social support and child sleep decision-making.

Results
Thematic areas of caregiver feedback fell into the following three areas: 1. deficit-based and focused on punitive discipline, 2. Do not capture child weekend sleepovers at Grandparent’s house, 3. Two-home households were not reflected, 4. Racial options for mixed children were not reflected and 5. age-appropriate activities were not reflected in the measures.

Conclusion
Current pediatric bedtime routine sleep measures are not culturally tailored for Black families of preschool aged children. Future steps include holding caregiver focus groups to glean relevant survey items/domains for the development of a new comprehensive culturally tailored measure for Black preschool-aged children that can be used to guide the intervention and intervention theory of testing.

Support (if any)
NIH K01HL169419-01
0851 Sleep Moderates Behavioral Difficulties and Quality of Life in Autistic Children
Authors: Martin Annie , Stearns Melanie , McGovney Kevin , Curtis Ashley , Mazurek Micah , Davis Beth Ellen , Sohl Kristin , Beversdorf David , McCrae Christina 
Published: April 2024

Abstract

Introduction
Research indicates a relationship between increased behavioral difficulties (e.g., irritability, social withdrawal, stereotypic behaviors, noncompliance, inappropriate speech) and poor quality of life (QoL) in autistic children. However, little is known about how sleep may be associated with this relationship. To assess the mechanistic role of sleep, we examined whether autistic school-age child sleep moderated the relationship between behavioral difficulties and QoL.

Methods
Children with autism spectrum disorder (N=65; Mage=8.95, SD=2.01, range 6-12; 74% male), verbal IQ &gt;70, and parent reported sleep complaints completed 14 days of sleep diaries (with parental assistance) and their parents completed surveys (Child Sleep Health Questionnaire-CSHQ, Pediatric Quality of Life-PedsQoL, Aberrant Behavior Checklist-ABC). Multiple regressions (SPSS PROCESS Model 1) examined whether sleep (subjective diary total sleep time-TST; CSHQ total score) moderated associations between behavioral difficulties (irritability, inappropriate speech, stereotypic behaviors, hyperactivity) and QoL (health, social, emotional, school) in baseline data. Analyses controlled for age.

Results
CSHQ moderated associations between irritability and social QoL (β=.34, p=.04). In children with the best overall sleep health, less irritability was associated with better social QoL, β=-6.32, p=.002. CSHQ also moderated associations between hyperactivity and school QoL (β=.25, p=.02). Similarly, in children who had the best overall sleep health, less hyperactivity was associated with better school QoL β=-3.84, p=.001. TST moderated associations between inappropriate speech and social QoL (β=-.12, p=.02). At the longest TST, less inappropriate speech was associated with better social QoL, β=-3.45, p=.001. TST moderated associations between stereotypic behaviors and social QoL (β=-.10, p=.04). At the longest TST, less stereotypic behaviors were associated with better social QoL β=-15.14, p=.004.

Conclusion
The present findings suggest that, in autistic children, the relationship between behavioral difficulties and school/social QoL depends on overall sleep health, particularly TST. It is possible that improving sleep through behavioral sleep treatments may change the relationship between problematic behaviors QoL in this population. However, more research using longitudinal, experimental, and trial methodology and perhaps even examining other aspects of TST (e.g., variability) are needed.

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0854 Obstructive Sleep Apnea with Obesity Hypoventilation Syndrome: Deep Vein Thrombosis Risk After Bariatric Surgery
Authors: Fowler Cosmo , Makadia Briana , Chism Lauren , Pastores Stephen , Auckley Dennis 
Published: April 2024

Abstract

Introduction
Morbidity and mortality in patients with untreated obesity hypoventilation syndrome (OHS) is significant. The vast majority of OHS patients have concomitant obstructive sleep apnea (OSA), known to be associated with worse cardiovascular outcomes following bariatric surgery. However, there is limited data on the post-bariatric surgery outcomes of patients with OHS.

Methods
We queried TriNetX Analytics, a federated health record and claims-derived database of &gt;115 million patients across 5 countries. We established two cohorts of patients with OSA (ICD-10-CM G47.33) who underwent laparoscopic bariatric surgery (CPT 1007387) between 5/1/2008-5/1/2023: one with superimposed OHS (E66.2) and one without. We examined the 30-day incidence of deep vein thrombosis [DVT (I82)], pulmonary embolism [PE (I26)], stroke [CVA (I63)], and myocardial infarction [MI (I21)]. We then re-examined these outcomes following extensive in-platform propensity score matching (PSM) to account for demographic and comorbidity antecedents.

Results
A total of 66,085 bariatric surgery patients were isolated, all in the US. Of these, 26,392 (40%) were diagnosed with OSA prior to surgery, of which 1,176 (1.8%) also carried a diagnosis of OHS. Prior to PSM, the OSA+OHS cohort experienced a significant excess incidence of all outcomes besides CVA when compared to the cohort with OSA alone: DVT risk was 3.9 vs 1.1% (OR 3.5, CI 2.6-4.4), PE risk 2.6 vs 0.9% (OR 3.0, CI 2.1-4.5), composite DVT/PE risk 5.4 vs 1.8% (OR 3.2, CI 2.4-4.1), CVA risk 0.9 vs 0.6%, MI risk 1.4 vs 0.4% (OR 3.3, CI 2.0-5.5), composite CVA/MI risk 2.0 vs 1.0% (OR 2.0, CI. 1.3-3.2). Following PSM, which generated two like sub-cohorts of 1,167 each, significant risk excess was retained only for DVT incidence: DVT risk was 3.8 vs 2.0% (OR 1.9, CI 1.2-3.2), but not for PE risk 2.4 vs 2.1%, DVT/PE risk 5.1 vs 3.7%, CVA risk 0.9 vs 1.2%, MI risk 1.5 vs 1.5%, and CVA/MI risk 2.0 vs 2.4%.

Conclusion
Our findings suggest that patients with OSA and OHS undergoing bariatric surgery experience similar rates of adverse cardiovascular events in the first postoperative month as those with OSA alone. The exception is DVT risk, which appears greater in the OHS-OSA cohort despite matching.

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0855 Investigate Factors That Modulate Temporal Risk for Developing New Hypertension Among Patients with Sleep Apnea
Authors: Te Tue , Fung Constance H , Boland Mary Regina 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder, often occurs in the context of multimorbidity. The primary purpose of our study was to investigate the temporality of comorbidity that modulate the risk for developing hypertension (HTN) among patients with OSA without pre-existing HTN at baseline OSA diagnosis.

Methods
Our cohort consisted of cases with OSA and the 20 most common comorbidities defined using our previously validated EHR-based algorithm. We then constructed a survival model, controlling for age, sex, and BMI. In our survival model, the index date was date of first OSA diagnosis and we estimated time-to-first HTN diagnosis. Because our survival analysis requires accurate dates of diagnosis both for OSA and HTN, we also performed a validation of the dates of diagnosis of OSA and HTN identified from our algorithm by utilizing clinical chart reviews in 400 randomly chosen EHR-defined cases.

Results
We identified 76,519 OSA cases, among 53,035 cases diagnosed from 2012 to 2021. 31,741 cases (59.8%) without pre-existing HTN diagnosis at the date of OSA diagnosis met our inclusion criteria. Within our survival cohort, 15,830 (49.9%) OSA cases did not develop HTN. Age, Black race, BMI, atrial fibrillation, coronary atherosclerosis, pure hyperlipidemia, hypercholesterolemia, GERD, type 2 diabetes, tobacco use, other anemia, osteoarthrosis increased risk of HTN development. Female sex, allergic rhinitis, malaise and fatigue, joint pain, vitamin D deficiency were observed not to increase risk of HTN development. Moreover, clinical chart review demonstrated that OSA diagnosis and HTN diagnosis were documented in notes a median of 38 days and 738 days (respectively) prior to being coded in the EHR.

Conclusion
Our study, which used a large sample of patients, demonstrates the power of leveraging the EHR to identify factors that modulate risk for developing HTN among patients with OSA. In addition, we described differences between the true diagnosis dates of OSA and HTN and diagnosis dates based on our EHR-based algorithm. Overall, this study provides new insights into disease heterogeneity and potential personalized medicine approaches.

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0856 Association of Naturally Occurring Mild Intermittent Hypoxemia and Health Outcomes in Sleep Apnea
Authors: Jawde Samer Bou , Esmaeili Neda , Sands Scott , Redline Susan , Mateika Jason , Azarbarzin Ali 
Published: April 2024

Abstract

Introduction
Hypoxic conditioning, or the intentional exposure of mild intermittent hypoxia (MIH), has been shown to have protective cardiovascular outcomes. We investigated if naturally occurring MIH exposure during sleep has the same effect as controlled exposure. We hypothesized that larger number of respiratory events with MIH is associated with lower risk of adverse outcomes in OSA participants (apnea-hypopnea index ≥ 5 events/hour).

Methods
Participants from the Sleep and Heart Health Study cohort were analyzed. Respiratory events that were associated with MIH included all those accompanied with a 2-4% desaturation. Those with an oxygen desaturation &gt; 4% were called non-MIH. For each participant, the frequency of MIH (AHI-MIH) and non-MIH (AHI-nonMIH) were calculated. Participants were categorized into 5 groups: those 1) without OSA (AHI 3% or arousal &lt; 5 events/hour; reference group), 2) with OSA and high AHI-MIH (≥ median) but low AHI-nonMIH (&lt; median), 3) with OSA and low AHI-MIH(&lt; median) but high AHI-nonMIH(≥median), 4) with OSA and low AHI-MIH(&lt; median) and low AHI-nonMIH(&lt; median), and 5) with OSA and high AHI-MIH(≥ median) and high AHI-nonMIH(≥ median). Several logistic regression models examined the subgroups’ association with hypertension, diabetes, and Epworth Sleepiness Scale after adjusting for age, gender, race, and body mass index as confounders. In secondary analyses, we adjusted for the “hypoxic burden” as a measure of cumulative event-related intermittent hypoxia.

Results
5634 participants were analyzed (means and standard deviations – age: 63.1±11.2 years; BMI: 28.2±5.1 kg/m2; gender: 52.5% females; AHI 17.9±16.1 events/hour). Compared to participants without OSA, individuals with low AHI-MIH but high AHI-nonMIH were at increased risk of hypertension (odds ratio [95% Confidence Interval]: 1.57 [1.25-1.96]). This risk was lower in participants with high AHI-MIH and high AHI-nonMIH(1.19 [0.99-1.43]) followed by the high AHI-MIH/low AHI-nonMIH subgroup (1.06 [0.85-1.31]) and the low AHI-MIH/low AHI-nonMIH subgroup (0.97 [0.82-1.15]). Similar findings were observed for diabetes and sleepiness. After adding hypoxic burden, hazards ratios were reduced, but the same pattern was observed across these groups for all outcomes.

Conclusion
Presence of MIH events appear to dilute health outcome risks associated with more severe desaturation events. This warrants further investigation to the role of MIH during sleep.

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0857 Evidence for an Independent Association of Cardiovascular Disease in Patients with Narcolepsy
Authors: Kaufmann Christopher , Riaz Munaza , Park Haesuk , Lo-Ciganic Wei-Hsuan , Wilson Debbie , Malhotra Atul , Wickwire Emerson , Bhattacharjee R 
Published: April 2024

Abstract

Introduction
Narcolepsy is a lifelong disabling disorder causing profound daytime sleepiness. Symptoms present as early as childhood and result in marked disturbances in the life course of many persons with narcolepsy (PWN). Further, PWN experience several health conditions, including cardiovascular disease (CVD). Importantly, PWN often present with several co-occurring sleep disorders, including obstructive sleep apnea, which is a prominent risk factor for CVD. This study examined the association between narcolepsy and CVD comprehensively accounting for potential confounders predisposing PWN to CVD.

Methods
This retrospective cohort study used the 2005-2021 IBM® MarketScan® Commercial and Medicare supplemental databases to identify newly diagnosed PWN from at minimum 2 outpatient claims using the International Classification of Diseases–Clinical Modification (ICD-9/10-CM) diagnosis codes. In addition, we identified a comparison cohort of persons without narcolepsy or other hypersomnolent disorders, using propensity score (PS) matching [1: up to 3 ratios] to balance groups based on underlying demographics, the presence of relevant health conditions, including sleep apnea and diabetes, and other confounders. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (95%CI) to estimate CVD risk outcomes (including major adverse cardiovascular events [MACE], heart failure, stroke, atrial fibrillation, and myocardial infarction [MI]) for PWN compared to non-narcolepsy. Patients were censored at the end of enrollment or up to December 13, 2021.

Results
Among 134,067 patients included (mean age=40±16.8 years; 62% female), 34,562 were PWN and 100,405 were matched non-narcolepsy patients. Compared to non-narcolepsy patients, PWN were associated with a 77% increased risk of any CVD (HR=1.77, 95%CI=1.65-1.89) and an 82% increased risk of MACE (HR=1.82, 95%CI=1.66-1.99). PWN also were associated with an increased risk of heart failure (HR=1.64, 95%CI=1.47-1.83), any stroke (HR=2.04, 95%CI=1.82-2.29), atrial fibrillation (HR=1.58, 95%CI=1.40-1.77), and MI (HR=1.64, 95%CI=1.37-1.96) compared to non-narcolepsy patients.

Conclusion
Using a large representative commercial insurance claims database, our study provides evidence that narcolepsy is an independent risk factor of CVD after comprehensive matching and adjustment for relevant confounders, including sleep apnea.

Support (if any)
This study was supported by the Sleep Research Society Foundation (Grant #: 23-FRA-001).
0859 Impact of Social Determinants of Health and Sleep on Cardiometabolic Health in Pregnant African American Women
Authors: Irsheed Ghada Abu , Steffen Alana , Quinn Laurie , Chen Pei , Meinel Monya , Burke Larisa , Izci-Balserak Bilgay 
Published: April 2024

Abstract

Introduction
Cardiometabolic Disease disproportionately impacts African American (AA) women with higher gestational diabetes risk compared to their White counterparts, often progressing to post-partum type 2 diabetes across the United States. Thus, pregnancy is a critical period to assess cardiometabolic health (CMH) in this population. This study aimed to explore the impact of Social Determinants of Health (SDoH) and sleep-related outcomes on insulin resistance.

Methods
Data from 70 AA pregnant women enrolled in the BETTER lifestyle counseling study (NCT05234125) who completed surveys and provided blood samples were analyzed. SDoH factors encompassed stress level (Perceived Stress Scale), social support perceptions (Multidimensional Scale of Perceived Social Support), and demographic indicators such as income and education. Sleep assessments included evaluations of sleep quality (Pittsburgh Sleep Quality Index), sleep apnea risk measuring the apnea-hypopnea index (Watch-PAT One), insomnia symptoms (Insomnia Severity Index), and sleep hygiene (Sleep Hygiene Index). Insulin resistance was quantified using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) as the outcome variable. Multiple regression analyses including demographic variables with a p&lt; 0.2 in bivariate analyses were performed to determine the predictive capacity of SDoH and sleep variables on HOMA-IR.

Results
The mean age was 30.4 (SD 5.72; range:18.5-42 years); mean gestational weeks (GWs) was 18.03 (SD 3.021; range:10.6-23.1); and mean body mass index (BMI) was 33.09 kg/m2 (SD 5.63; range:16.2-47.1). After controlling for covariates (age, GWs, BMI, income, and education), higher stress (β=.251, p&lt;.05), poor sleep quality (β=.279, p&lt;.05), and higher insomnia symptoms (β=.248, p&lt;.05) were significantly associated with higher insulin resistance. These results contribute important insights into the impact of both SDoH and sleep-related outcomes on insulin resistance among AA women during pregnancy.

Conclusion
SDoH and sleep, particularly stress and sleep disturbances, are linked to CMH, highlighting the importance of comprehensive assessment to address cardiometabolic disease risks for AA women during their pregnancy. Further research is needed to understand the causal aspects of these associations and develop targeted interventions to optimize the CMH, and enhance maternal and child health outcomes in this population.

Support (if any)
The National Center on Minority Health and Health Disparities at The National Institute of Health of the United States, R01MD015724.
0860 Sleep Fragmentation Is a Robust Independent Predictor of Diastolic BP Among Blacks in a Real-World Context
Authors: Montalvo Jessica , Blanc Judite , Bernard Mark A , Rogers April , Gallop Erin-Leigh , Oliveira Bruno , Seixas Azizi , Jean-Louis Girardin 
Published: April 2024

Abstract

Introduction
Sleep quality is a critical determinant of cardiovascular health, and its influence on blood pressure regulation has been extensively explored. However, there remains a notable gap in research concerning the relationship between sleep fragmentation and blood pressure among Black in a naturalistic setting.

Methods
A total of 195 Black adult participants (75% Female; mean age 48 years) were enrolled in the NIH-funded ESSENTIAL and MOSAIC studies and underwent a 7-day home-based sleep study. Sleep fragmentation, a key variable of interest, was quantified using SleepImage ring devices, which amalgamate various cardiopulmonary disturbance metrics into a comprehensive Sleep Fragmentation score. Diastolic blood pressure (DBP) was measured six times during the study using the iHealth BP monitor, and the average DBP was employed in our subsequent analyses. Our research approach encompassed t-tests and correlation matrices to explore the associations between DBP and a wide array of factors, including sociodemographic characteristics, cardiovascular disease risk diagnosis, age, sleep fragmentation, psychosocial factors, and health behaviors.

Results
The results of our regression analysis revealed several important findings. Age exhibited a small positive coefficient but was not statistically significant, indicating a weak association with DBP. Depression, while displaying a positive coefficient, was marginally significant (p = 0.056), suggesting a potential moderate impact on DBP. Similarly, alcohol consumption exhibited a positive coefficient, marginally significant (p = 0.051), implying a potential moderate effect on DBP. However, the most striking finding was the robust association between sleep fragmentation and DBP. Sleep fragmentation exhibited a positive coefficient (B = 0.303) and was statistically significant (p = 0.005), firmly establishing it as the strongest independent predictor of diastolic blood pressure among Black adults.

Conclusion
This study contributes valuable insights into the relationship between sleep fragmentation and diastolic blood pressure among Black individuals, in a real-world context. Our findings underscore the significance of addressing sleep quality and fragmentation as a potential modifiable risk factor in cardiovascular health management, particularly within Black communities. Further research in this area may have implications for targeted interventions and strategies to mitigate the adverse cardiovascular effects of sleep fragmentation among at-risk populations.

Support (if any)
NIH R01HL142066 and R01AG067523