bluuebunny/crossref_metadata_2025_split huggingface dataset:
1139 The Association Between Sleep and Coronavirus disease-19 Severity
Authors: Yeh An-Yun , Chao Ying-Yu , Strauss Shiela 
Published: April 2024

Abstract

Introduction
Sleep disturbances are key symptoms of long-COVID syndrome, particularly in patients with severe COVID-19. It is therefore critical to understand the sleep characteristics and the association between sleep and COVID-19 severity in patients diagnosed with COVID-19. The study’s purpose is to investigate 1) self-reported sleep characteristics in patients diagnosed with COVID-19 and 2) the association between sleep characteristics and COVID-19 severity after controlling for depressive symptoms and age.

Methods
In this correlational and cross-sectional study, data were collected via an online survey posted on social media. The sample included 90 patients diagnosed with COVID-19 (female: 47.8%; mean age= 36.6 ± 10.1 years). The survey was completed by participants 308.95 ± 164.7 days after their COVID-19 infection. Self-reported sleep characteristics were measured by the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). COVID-19 severity was measured by hospitalization, use of oxygen therapy, and use of ventilation. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). Descriptive statistics and multiple regression were used to analyze the data.

Results
A total of 66.7% were hospitalized; 57.8% used oxygen therapy, and 66.7% used ventilation. In all, 6.7% and 4.4% had sleep time &lt; 6 hours and &gt; 9 hours, respectively; 17.8% had sleep efficiency &lt; 85%; 54.4% had poor sleep quality (total score of PSQI &gt; 5); and 38.9% had excessive daytime sleepiness (total score of ESS &gt;10). After controlling for depressive symptoms and age, COVID-19 severity (i.e., hospitalization, use of oxygen therapy, and use of ventilation) significantly predicted self-reported sleep time [F(5, 84)= 4.16, p= 0.002, Δ R2= 0.1], self-reported sleep efficiency [F(5, 84)= 2.5, p= 0.037, Δ R2= 0.09], sleep quality [F(5, 84)= 9.23, p &lt; 0.001, Δ R2= 0.04], and daytime sleepiness [F(5, 84)= 14.41, p &lt; 0.001, Δ R2= 0.03].

Conclusion
Poor sleep quality and excessive daytime sleepiness are common in patients diagnosed with COVID-19. COVID-19 severity was significantly associated with self-reported sleep characteristics, but the effect size is small. A further understanding of sleep problems and the relationship between COVID-19 severity and sleep in patients diagnosed with COVID-19 is required to design interventions to improve sleep.

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1140 The Influence of Daily Rest and Activity on Mental Health Among Japanese Adults During the COVID-19 Pandemic
Authors: Miyata Seiko , Iwamoto Kunihiro , Kawai Keita , Fujishiro Hiroshige , Ozaki Norio , Ikeda Masashi 
Published: April 2024

Abstract

Introduction
The global COVID-19 pandemic has not only presented an unprecedented threat to physical health but has also cast a shadow over the mental well-being of individuals worldwide. Various sleep disturbance symptoms have been reported, including a sense of nonrestorative sleep and poor sleep quality. Promoting the mental health of community residents is critical in their lives. This study examined the relationship between sleep habits, activities of daily living, and mental health symptoms in young to middle-aged Japanese adults.

Methods
The participants were 76 adults not currently attending a psychiatric clinic. Participants kept a sleep diary for at least five days (including two days off), recorded daily activity using Fitbit Sense, and answered questionnaires regarding psychiatric symptoms and sleep. The Patient Health Questionnaire-9 (PHQ-9), State-Trait Anxiety Inventory-S (STAI-S), Beck Depression Inventory (BDI), and Temperament and Character Inventory Harm Avoidance (HA) were used to assess psychiatric symptoms. The Insomnia Severity Index (ISI), Hyperarousal Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were used to assess subjective symptoms. Sleep diary records were averaged over five days and rated for bedtime, waking time, time in bed, sleep duration, sleep satisfaction, and sleepiness upon awakening. The study was approved by the Bioethics Review Committee of Nagoya University School of Medicine.

Results
Daily wakefulness, sleepiness, and subjective sleep efficiency were significantly related to psychiatric symptoms such as PHQ-9, STAI-S, BDI, and HA (Fatigability). Participants with a higher total HA score and HA (Fatigability) score had a significantly lower amount of active time in their daily lives, as recorded by Fitbit.

Conclusion
Daily rest and activity levels have an impact on mental health during the COVID-19 pandemic in Japanese community residents.

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1141 Long-Term Efficacy of Acetazolamide in Treating Central Sleep Apnea After Traumatic Brain Injury
Authors: Manahil Naila , Shukri Ghaith , Mayo Meagan , Agudelo Christian , Dib Salim , Ramos Alberto , Geil Eric 
Published: April 2024

Abstract

Introduction
Central sleep apnea (CSA) is characterized by recurrent cessation of breathing during sleep due to a failure of the physiological mechanisms responsible for the respiratory drive. Risk factors include congestive heart failure, high altitude, opioids, and traumatic brain injury (TBI), particularly brainstem injury. Current mainstay treatments are positive airway pressure (PAP) and oxygen therapy. Medications such as acetazolamide are presumed to enhance respiratory drive or modulate chemosensitivity. Given the high degree of nonadherence to PAP therapy, medications are an appealing alternative treatment for CSA.

Report of case(s)
A non-verbal 39-year-old man with spastic quadriplegia, intractable epilepsy, and static encephalopathy secondary to a TBI from a motor vehicle accident at age 10 was evaluated in the sleep clinic due to his caregiver’s concern for loud snoring, witnessed apneas, and daytime hypersomnolence. The caregiver denied the use of opioids, sleep aids or a history of parasomnias. Overnight home oximetry results demonstrated nocturnal hypoxemia with a SpO2 nadir of 71%. The initial in-laboratory polysomnography showed an apnea-hypopnea index (AHI) of 144.2 with a central apnea index (CAI) of 131.6 and no Cheyne-Stokes respiration. A subsequent in-laboratory PAP titration was difficult due to the patient’s inability to follow commands. He was then started on treatment with auto-titrating CPAP 5-10 cmH2O with a full facemask. However, the therapy was ineffective due to the patient chewing on several different masks, so he was transitioned to supplemental oxygen therapy. Due to the potential choking hazard, other options such as tracheostomy and medications were considered. Because a tracheostomy would only address the obstructive component of his sleep apnea, the patient was started on acetazolamide 250 mg per G-tube daily. Reevaluation at two months with a repeat in-laboratory polysomnography demonstrated complete resolution of sleep-related respiratory events with an AHI of 0.0 and the caregiver reported improvement in daytime hypersomnolence. Repeat polysomnography 9 months later showed continued efficacy of the therapy with an AHI of 1.7 and CAI of 0.0.

Conclusion
Current literature demonstrates improvement of CSA with short-term use of acetazolamide. This case highlights the potential long-term efficacy of acetazolamide for chronic management of CSA in patients with TBI.

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1142 Atypical Cataplexy and Post LP Headaches in POTS with Features of Narcolepsy Type I
Authors: Kewalramani Anjali , Molina Courtney , Avidan Alon 
Published: April 2024

Abstract

Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) consists of orthostatic intolerance upon standing resulting in lightheadedness or fainting. Narcolepsy type I (Narcolepsy with cataplexy) is a disorder of hypersomnolence categorized by cataplexy and impaired hypocretin levels in the hypothalamus. The diagnostic criteria for type 1 narcolepsy include the presence of cataplexy or cerebrospinal fluid orexin-A/hypocretin-1 ≤ 110 pg/mL. Recent data reveals the increased prevalence of POTS in narcolepsy, particularly NT1 phenotype. We present two patients with POTS and features of cataplexy with a normal orexin level.

Report of case(s)
Patient 1: A 19-y/o Caucasian female presented with excessive daytime sleepiness with the onset of symptoms occurring 5 years before her initial evaluation. The patient describes episodes of “feeling weak” and experiencing symptoms of lightheadedness when “laughing a lot.” A lumber puncture (LP) was conducted by an experienced neurologist using a 22G spinal needle drawing 15cc of CSF The patient described severe headaches lasting for 4 days following the LP, which improved with caffeine, hydration, and analgesics. CSF Orexin= 248 pg/mL. Patient 2: A 22 y/o female presented with severe fatigue, EDS, and POTS against a history of Ehlers-Danlos Syndrome despite a total sleep time of 7-8 hours per night. The patient noted a “loss of coordination” and “sudden muscle weakness when she felt excited and upset while standing, Due to the presence of serotonergic agents and suicidality, a CSF orexin level was drawn using a 24G spinal needle drawing 15cc of CSF. The patient also described severe headaches lasting for a week following the LP, which improved with a blood patch. CSF Orexin= 281 pg/mL.

Conclusion
Our experience illustrates two important findings about patients with POTS who presented for narcolepsy evaluation: (1) reports of atypical cataplexy may be related to autonomic intolerance compared to cataplexy triggers and is positional in nature, and (2) The prevalence of post-LP headaches in POTS might require prophylactic blood patch and conservative measure to prevent CSF leak/spontaneous intracranial hypotension.

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1143 Nuclear Narcolepsy
Authors: Jordan Melissa , Bliton Kyle , Patterson Patricia , Aulakh Puneet 
Published: April 2024

Abstract

Introduction
The sleep -wake mechanism is a complex network of structures of the brain and numerous neurotransmitters. Notably, the hypothalamus produces a powerful wake promoting peptide, orexin, which lack thereof results in narcolepsy. Moreover, studies have demonstrated that the thalamus,although not fully elucidated, plays a dichotomous role in the sleep -wake cycle. This case highlights an interesting iatrogenic cause of hypersomnia.

Report of case(s)
Patient is a 49 year old male who presents for evaluation of hypersomnia. He had some sleepiness throughout his adult life but worsened significantly in the recent years prior to presentation. His Epworth Sleepiness Scale is 21. No hypnagogic/hypnopompic hallucinations, cataplexy, sleep attacks, sleep paralysis reported. Mild snoring is present. His BMI is 24kg/m2. His PMH is notable for essential tremor treated with stereotactic radiosurgery thalamotomy four years prior to presentation. He underwent polysomnography that was overall unremarkable with no evidence of sleep disordered breathing or periodic limb movements, but the study had sleep onset REM of 13 minutes. The following day, an MSLT was performed and demonstrated sleep latency of 3 minutes and 26 seconds and one sleep onset REM. He was diagnosed with secondary narcolepsy and started on pharmacotherapy with modafinil.

Conclusion
The patient in this case underwent stereotactic radiosurgery to the thalamus for treatment of essential tremor. Given the proximity of the thalamus to the hypothalamus, it is thought that damage to this structure resulted in loss of orexin causing secondary narcolepsy. Furthermore, excessive daytime sleepiness is a consequence of thalamic lesions such as thalamic stroke further demonstrating the role of the thalamus in the sleep -wake mechanism.

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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis. 2021 Apr 1;12(2):570-585. doi: 10.14336/AD.2020.0707. PMID: 33815883; PMCID: PMC7990374. Cheng P, Roehrs T, Roth T. Daytime Sleepiness and Alertness. Principles and Practice of Sleep Medicine. 7th Edition. Elsevier. 2022. Chapter 4, 35-45.e5.
1144 Unique Use of PAP Download Data to Identify Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD) in Sighted Individual
Authors: Usman Abira , Irfan Muna 
Published: April 2024

Abstract

Introduction
N24SWD is a circadian rhythm sleep disorder (CRSD) in which there is misalignment between the 24-hour light dark cycle and the non-entrained endogenous circadian rhythm of sleep wake propensity. We present case of a sighted individual, incidentally noted to have FN24SWD upon review of his PAP download data.

Report of case(s)
A 75-year-old sighted, single male with major depressive disorder (MDD), generalized anxiety disorder (GAD), obstructive sleep apnea (OSA), restless leg syndrome (RLS), insomnia and hypertension presented to sleep clinic. Patient after retirement spent most of his time working on small engineering projects and programming. He reported regular use of PAP with average daily use of 7 hours and 11 minutes. PAP data review revealed well controlled OSA with residual apnea-hypopnea index of 3.1/ hour. His time in bed delayed approximately 1 to 2 hours each night and would cycle around every 20 days with 1 to 2 days in a month without any sleep. His Epworth Sleepiness Scale score was 3/24. Medications included gabapentin and ropinirole for RLS, trazodone, melatonin for insomnia, buspirone, citalopram. Based on the patient’s history, corroborated by PAP device data, diagnosis of behaviorally induced Non24SWD was made. Patient reported intermittent insomnia managed by above stated medications and thus reported no impact on his social life. Thus, he deferred treatment to entrain the rhythm.

Conclusion
Treatment for CSRDs comprises of melatonin in sighted individuals and melatonin receptor agonists in blind. In our patient, melatonin was used ad lib as a sleep promoting agent. Lack of regular daytime bright light exposure and light exposure from screens at night contributed to lack of entrainment . It is usually noted in blind individuals due to lack of photic input to circadian pacemaker. In sighted individuals, delayed sleep phase, decrease light exposure, psychiatric disorders, TBI or dementia is noted. In our case anxiety and depression were noted. This case highlights the unexpected discovery of Non 24SWD on detailed review of PAP download data in case of good PAP adherence, essentially replacing actigraphy. Thus, in CPAP compliant patient, detailed PAP review can help identify circadian disorders especially where actigraphy may be difficult to obtain.

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1145 Stride Along with Stridor in the Setting of CSA: An Unusual Presentation of Pediatric Cervicomedullary Ganglioma
Authors: Wasim Alina , Musso Mary , Petitto Lacie , Revana Amee 
Published: April 2024

Abstract

Introduction
We describe an unusual presentation of a cervicomedullary ganglioglioma secondary to findings of stridor despite positive airway pressure (PAP) therapy and the presence of treatment emergent central sleep apnea in a pediatric patient.

Report of case(s)
Patient is an 8 year old male with a history of congenital subglottic stenosis and no history of neurologic problems who presented to the sleep clinic for stridor despite adequate adherence to CPAP. Split night polysomnogram (PSG) showed moderate OSA (OHI 8.3/h) and treatment emergent central sleep apnea. Patient was unable to tolerate BPAP ST and wanted to go back to CPAP. Drug induced sleep endoscopy findings were significant for mild collapse of upper airway with no snoring. Repeat PSG - 6 months later - was significant for severe obstructive and central sleep apnea (OAHI 10.4, CAI 19, REM CAI 54, AHI of 30). MRI of the brain showed cervicomedullary tumor with marked effacement of the foramen magnum. Further workup showed right vocal cord paralysis. Biopsy confirmed ganglioglioma. Tumor was not amenable for surgical resection hence proton radiation therapy was pursued. Repeat titration study was performed which showed BPAP ST settings of 12/6 with BUR of 12 to be effective with residual AHI of 0.7. Patient developed radiation induced tumor psuedoprogression and tumor necrosis with worsening ataxia and recurrence of central and mixed apneas requiring AVAPS for further respiratory support due to progressive neuromuscular weakness. Stridor resolved after AVAPS support.

Conclusion
Stidor in a pediatric patient can involve various anatomical abnormalities of the upper airway. However, in the setting of central sleep apnea, abnormalities of the brain stem can lead to stridor. We present a patient with a prolonged period of central sleep apnea of unknown etiology and persistent stridor despite adequate adherence to PAP therapy that ultimately led to a diagnosis of a cervicomedullary ganglioma before neurologic symptoms developed.

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1146 Polysomnographic Description of Hemifacial Spasm
Authors: Aristy Catherine Fernandez , Greenough Glen 
Published: April 2024

Abstract

Introduction
Hemifacial spasm is characterized by sudden, involuntary, irregular, tonic or clonic motor discharge of the facial nerve (seventh cranial nerve), leading to muscular contraction. Its etiology may be idiopathic or secondary to an irritation of the facial nerve. Possible sources of irritation include vascular malformations, infections, trauma, and tumors. Hemifacial spasms may be a temporary or a permanent sequela from Bell’s palsy. This disorder typically presents unilaterally, although it may be seen bilaterally in about 5% of the cases. This condition affects women more often than men in a 2:1 ratio. To this day, there is minimal information describing hemifacial spasms during sleep using a polysomnogram (Incirli et al. 2019, Montagna et al. 1986 article). The previous studies documented the persistence of hemifacial spasms in sleep but did not offer illustrative polysomnographic images. In this case report, we illustrate the polysomnographic characteristics of hemifacial spasms in order to improve a sleep medicine provider’s ability to identify and recognize these events.

Report of case(s)
We are able to provide polysomnographic images demonstrating both sustained and intermittent paroxysmal left-sided facial muscle activity in the left mastoid, left EOG, as well as left central and left frontal EEG leads. The occipital EEG leads bilaterally did not demonstrate this finding. Chin EMG also revealed this activity. The muscle activity was most notable during wake but persisted during both NREM and REM sleep (Images will be provided in the poster).

Conclusion
We were able to document paroxysmal left-sided facial muscle activity during wake and sleep in a patient who carries a diagnosis of left hemifacial spasm. This description can be used as a visual reference for sleep medicine providers when encountering this unusual polysomnographic appearance.

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1148 Narcolepsy with Cataplexy in a Pediatric Patient with a Thalamic Mass: A Case Report
Authors: Pietrapiana Stefano , Sabogal Carlos 
Published: April 2024

Abstract

Introduction
A female adolescent patient with gradual hypersomnolence.

Report of case(s)
The patient is a 16-year-old with gradual onset of parasomnias, leg cramps, headaches and history of gastroesophageal reflux, and asthma. Her ferritin was low, and a diagnosis of restless legs was made, the patient was started on oral iron supplements without improvement. Intravenous iron replacement therapy was tried with laboratory improvement (&gt;50 ng/ml) but not clinical. Clonazepam and gabapentin were tried without success. Over time, she developed more tiredness and started to fall asleep in class. A sleep study was done which showed primary snoring without evidence of sleep disorder breathing, PLMD index was 4.4, and REM sleep latency was 120 minutes. The headaches got worse, and she was seen by neurology, MRI showed a hyperintense 6mm rounded lesion on the left side of the thalamus. She started pregabalin and remained stable for almost a year. Sleepiness got worse with sleep attacks. She was sleeping 12-14 hours at night with a 1–2-hour nap in the afternoon. A Multiple sleep latency test (MSLT) showed no evidence of sleep-onset rapid eye movement periods (SOREMPs), and the mean sleep latency was 9.6 minutes. She was diagnosed with primary hypersomnolence. Modafinil and methylphenidate were tried for hypersomnolence and added duloxetine for headaches without improvement. A repeated sleep study and MSLT, showed a mean sleep latency of 4.9 minutes without SOREMPs, Epworth Sleepiness Scale (EPS) of 20. Later she started with jerky legs and tripping/falling in gymnastics practice, diagnosis of narcolepsy with cataplexy was made. Sodium oxybate was started with improvement of hypersomnolence (EPS: 8) and cataplexy.

Conclusion
The patient presented with insidious onset of restless legs, migraines, and hypersomnia. In pediatric patients classic narcoleptic symptoms are not always present. Interestingly restless legs and migraines can precede the diagnosis of narcolepsy. Our patient had no SOREMPs on the MSLT on two different occasions but in her last MSLT her mean sleep latency was 4.4 minutes and soon after developed cataplexy. Due to the presence of a thalamic mass, we conclude that this patient has secondary narcolepsy type 1.

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1149 Unravelling the Mysteries of Pediatric Central Sleep Apnea (CSA): A Unique Case Report
Authors: Phanthok Tenzing , Yori Tiffany , Malhotra Sonal 
Published: April 2024

Abstract

Introduction
CSA in pediatric patients is characterized by pauses in breathing during sleep that result from a lack of drive to breathe. It is estimated to be about 10% of all pediatric sleep-disordered breathing cases. The most common type is primary, also known as idiopathic CSA, unrelated to another medical cause. Other causes include, CSA of prematurity, CSA in certain medical conditions such as congenital heart defects or neurological disorders, and CSA related to medications. We report a case of CSA in the setting of an acute neurological impairment secondary to atypical hemolytic uremic syndrome (HUS) in a pediatric patient.

Report of case(s)
A 3-year-old female with chromosome 3p deletion syndrome presents after a recent hospitalization with acute hypoxic respiratory failure status post tracheostomy, for a baseline PSG with capped tracheostomy to evaluate for decannulation. During this hospitalization, the patient developed acute neurological impairment with brain swelling and abnormal signaling in bilateral basal ganglia and thalami, findings consistent with HUS. A baseline PSG (table 1) with capped tracheostomy showed an AHI of 16 events per hour of sleep. She was uncapped per protocol but continued to have worsening AHI of 128 events per hour, predominantly central apneas. An interval brain imaging showed evolving parenchymal injury with encephalomalacia and some resolution of prior swelling, indicating the cause of her CSA to be neurological. She was placed on BIPAP ST with set rate 12, IPAP 10 cm H2O and EPAP 5 cm H2O during sleep. Tracheostomy remained capped during the day but decannulation was deferred due to intolerance of BIPAP via nasal mask on further attempts.

Conclusion
The prognosis for pediatric patients with CSA depends on the underlying cause and how well the patient responds to treatment. Mild CSA may require just observation or medications such as acetazolamide or specific respiratory stimulants to stimulate breathing during sleep. In severe cases, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy may be used to provide mechanical support for breathing during sleep. A multidisciplinary approach involving Pulmonary and Sleep specialists would thus be ideal to manage the complex nature of pediatric CSA.

Support (if any)
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