bluuebunny/crossref_metadata_2025_split huggingface dataset:
0707 Erectile Dysfunction in Restless Legs Syndrome
Authors: Kim Geun Yeong , Bang Sung Jo , Kim Keun Tae , Cho Yong Won 
Published: April 2024

Abstract

Introduction
Restless Legs Syndrome (RLS) is a sleep disorder characterized by uncomfortable dysesthesia and the urge to move the legs, particularly during sleep. Erectile dysfunction (ED) is a condition of inability to get or maintain sufficient firmness to have satisfactory sexual intercourse. This study aims to investigate the ED using the International Index of Erectile Function (IIEF) in RLS patients.

Methods
This is a prospective study at a university hospital in South Korea. From May 2021 to August 2023, all male subjects who underwent overnight polysomnography were asked to complete a series of sleep questionnaires including Insomnia severity index (ISI), Beck's depression inventory (BDI), Beck's anxiety inventory (BAI), Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Short-form 36 (SF-36), and IIEF.

Results
A total of 74 and 107 subjects of RLS and controls were included in this study, respectively. Excluding 29 who haven't had sex in the past month, 58 RLS and 94 controls were analyzed. There was no difference in mean age between RLS (52.38±14.39) and controls (53.21±15.07) (p=0.767). The total score of IIEF was 15.31±5.73 in RLS and 17.77±6.26 in control (p=0.010). RLS had lower body mass index than controls (25.39±3.41 vs. 27.54±4.23, p=0.010); however, no difference in BDI (14.22±7.71 vs.13.80±11.96, p=0.391), BAI (10.90±8.29 vs. 9.50±12.53, p=0.267), and apnea-hypopnea index (16.39±24.95 vs. 13.63±16.01, p=0.523). RLS had a higher score in insomnia (ISI: 15.62±6.79 vs. 5.70±5.04, p&lt; 0.001), more daytime somnolence (ESS: 7.97±4.33 vs. 4.58±2.71, p&lt; 0.001), lower quality of sleep (PSQI: 12.59±4.22 vs. 6.81±3.53, p&lt; 0.001). RLS showed lower mental health (SF-36 mental health: 62.91±17.75 vs. 73.75±11.05, p=0.014), although there was no difference in SF-36 total score.

Conclusion
This is the first study that evaluated ED in patients with RLS. The subjects with RLS showed poorer sleep quality and lower IIEF scores than the controls. This study suggests an association between RLS and erectile dysfunction.

Support (if any)
0708 Exploratory Cost-Effectiveness Analysis of TOMAC for Medication-Refractory RLS, Based on Longer-term Clinical Data
Authors: Ryschon Anne , Roy Asim , Pietzsch Jan 
Published: April 2024

Abstract

Introduction
Tonic motor activation (TOMAC) is a non-invasive neuromodulation therapy that provides a non-pharmacologic treatment alternative for patients suffering from medication-refractory restless legs syndrome (RLS). In the current analysis, recently reported longer-term clinical data were used to update prior exploratory cost-effectiveness work.

Methods
A previously published decision-analytic Markov model was utilized to project outcomes over a lifetime horizon. The cohort and treatment effects modeled were sourced from the extension cohort of the RESTFUL study (mean age 57.6, 43.8% male). Health-related quality of life (EQ-5D utilities) and symptom severity were derived from International RLS Study Group (IRLS) scores reported at baseline and 32-weeks after RESTFUL study entry and compared between the TOMAC (continued TOMAC for 24-weeks following RESTFUL study completion) and control arms. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), measured as the difference in quality-adjusted life years (QALY) gained divided by difference in costs, with costs and resource utilization derived from fee schedules and published data. Cost-effectiveness was evaluated against thresholds of $50,000/$150,000 per QALY, and extensive scenario analyses were performed.

Results
Study-observed IRLS scores were reduced by -11.3 from baseline to 32 weeks for TOMAC and -5.4 for control. The resulting treatment effect of -5.9 corresponded to a change in utility from 0.82 to 0.87 (0.77 to 0.87 vs. baseline). Over lifetime, TOMAC added 0.73 and 1.44 QALYs (12.98 vs. 12.25 and 12.91 vs.11.47) at incremental costs of $28,066 and $19,072 ($211,704 vs. $183,638 and $212,644 vs. $193,572), resulting in ICERs of $38,685 and $13,251 per QALY gained vs. control and baseline, respectively. TOMAC was found cost-effective or dominant across all tested scenarios, with ICERs ranging from -$29,558 to $48,266 and -$40,684 to $19,564, vs. control and baseline, respectively.

Conclusion
This updated analysis based on longer-term data confirms earlier findings and suggests TOMAC therapy can provide a high value treatment alternative for patients suffering from medication-refractory RLS. Further increased effect sizes in the longer-term data support assumptions about maintained effect size over time.

Support (if any)
Wing Tech Inc. received consulting fees from Noctrix Health. AR is an investigator in the RESTFUL study.
0714 Weight Loss in Patients Prescribed Methadone for Restless Legs Syndrome
Authors: Winkelman John , Kilty Adysn 
Published: April 2024

Abstract

Introduction
Weight loss is an underexplored side effect of methadone. While methadone is associated with weight gain when used to treat opioid use disorder, its impact on patients with restless legs syndrome (RLS) remains unclear. This study aims to assess the prevalence of significant weight loss in RLS patients prescribed methadone.

Methods
73 consecutive patients for whom at least 6 months of follow-up was available following initiation of methadone for RLS and who were not undergoing weight loss interventions were assessed. Clinical information was extracted from the initial visit and all subsequent visits conducted throughout the course of methadone treatment (mean duration=2.9 years). Examination of associations with weight loss &gt;10% and &gt;20% of body weight within the first 6 months of methadone initiation was performed.

Results
In the 73 patients, the mean age was 67.6, mean BMI=29.3 and 51.4% were female. At methadone initiation, 18.1% were taking dopamine agonists (DA), 30.6% alpha-2-delta calcium channel ligands (A2D), and 38.9% both DAs and A2Ds. Notably, 19.4% of patients experienced weight loss &gt;10%, and 6.9% lost &gt;20% of their body weight. Those who lost &gt;10% had higher rates of reducing or discontinuing DAs (71.4% vs 49.2%) and higher average BMI (31.9 vs 28.6) than those who did not, but had similar prevalence of reducing or discontinuing A2Ds (35.7% vs 42.4%). Other factors, such as 6-month methadone dose, use of antidepressants, diagnoses of obstructive sleep apnea, and prior opioid use were balanced between the two groups. 80% of those with &gt;20% weight loss (vs 11.8% with &lt; 20% weight loss) had nighttime eating diagnoses. Patients with substantial weight loss described a dramatic reduction in appetite with loss of interest and pleasure from normally desirable foods.

Conclusion
This study reveals significant weight loss in a subset of RLS patients prescribed methadone. Changes in A2Ds, an RLS medication known to increase weight, were not different in those with weight loss. Other opioid-related side effects, such as nausea or constipation, could impact appetite and also contribute to weight loss. Clinicians should monitor patient weight during methadone treatment to prevent potential health risks.

Support (if any)
Baszucki Brain Research Fund
0716 Longitudinal Associations of Weekend Catch-up Sleep and Sleep Ability with Mortality in Middle-aged Adults
Authors: Yoshiike Takuya , Kawamuraa Aoi , Utusumi Tomohiro , Matsui Kentaro , Kuriyama Kenichi 
Published: April 2024

Abstract

Introduction
The question remains as to whether and in which individuals weekend catch-up sleep (CUS) promotes health. The health effects of weekend CUS could differ depending on both the ability to obtain sufficient sleep during weekdays and the amount of weekend CUS required to compensate for sleep lost during the week. We examined the longitudinal association of these two aspects of sleep with all-cause mortality.

Methods
We used data from 3,128 middle-aged (40–64 years) participants of the Sleep Heart Health Study. We defined one’s weekend CUS as no, short (1 h), and long (2 h or more) according to self-reported sleep durations on weekdays and weekends. Polysomnography-measured total sleep time, representing the ability to obtain sufficient sleep, was classified into short (&lt; 360 min) or normal (≥ 360 min) sleep durations. We estimated multivariable-adjusted mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for six groups divided by the extent of CUS and sleep duration.

Results
A total of 232 deaths (7.4%) were reported over a median (interquartile range) follow-up time of 12.3 (11.3–13.5) years. Short weekend CUS with normal sleep duration (≥ 360 min) was associated with lower mortality compared to no CUS with normal sleep duration after adjustment for established risk factors for survival including self-reported habitual sleep duration and social jetlag (adjusted HR, 0.48; 95% CI 0.27–0.83). When stricter cutoffs were applied for short and normal sleep durations, while the protective effect of short CUS with normal sleep duration (≥ 390 min) was strengthened (adjusted HR, 0.36; 95% CI 0.17–0.78), the harmful effect of short CUS with short sleep duration (&lt; 330 min) emerged (adjusted HR, 1.84; 95% CI 1.08–3.14).

Conclusion
Our results emphasize the importance of balancing between the extent of weekend CUS required to compensate for sleep debt that accumulates during weekdays and one’s ability to obtain sufficient sleep that could minimize the accumulation of nightly sleep loss among middle-aged adults. Weekend CUS may substantially benefit individuals who maintain their sleep ability and thus require a small amount of CUS.

Support (if any)
This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #21FA1002 and #22FA2001).
0718 Latent Classes of Sleep Problems and Subjective Cognitive Decline Among U.S. Middle-Aged and Older Adults
Authors: Huang Jing , Spira Adam , Perrin Nancy , Ellis Aisha , Hsu Erh-Chi , Li Junxin 
Published: April 2024

Abstract

Introduction
Subjective Cognitive Decline (SCD) can be an early sign of Alzheimer’s disease. Previous studies have linked sleep problems to a higher risk of SCD using a variable-centered approach (e.g., adding sleep symptoms to form a score); however, sleep problems may cluster differently among people. Thus, we employed a person-centered approach to understand sleep problems and their association with SCD. We aimed to: 1) identify latent classes (profiles) of self-reported sleep problems among U.S. middle-aged and older adults; 2) investigate the cross-sectional association between the classes and SCD; and 3) investigate whether this association differs by age group.

Methods
For Aim 1, we studied 33,922 adults aged 45+ years from the 2017 U.S. Behavioral Risk Factor Surveillance System (BRFSS) with data on sleep problems, including short or long sleep duration, trouble falling or staying asleep, unintentionally falling asleep, snoring loudly, and observed breathing stopped. Latent class analysis classified participants based on their responses to sleep problems. For Aim 2, we studied a subsample from Oregon, the only state that administered both sleep and SCD modules (n=2,747). SCD was assessed by an item regarding worsened confusion or memory loss in the past 12 months. Logistic regression examined the association between class membership and SCD, adjusting for demographics, socioeconomics, health behaviors, and chronic conditions. For Aim 3, we added a class membership × age group (45-65 years; &gt;65 years) interaction term to the model.

Results
Among all participants, 51.5% were aged 45-65 years, 56.7% were females, and 85.1% were White. We identified and labeled four classes: “Combined Insomnia and Apnea” (8.6%); “Primarily Insomnia ” (17.6%); “Primarily Apnea ” (25.8%); and “Healthy” (48.0%). In adjusted models, compared to the Healthy class, participants in the Combined Insomnia and Apnea class had higher odds of SCD (OR=1.91, 95% CI =1.15-3.15). There was no significant age × class membership interaction.

Conclusion
U.S. adults aged 45+ years in the “Combined Insomnia and Apnea” latent class of sleep problems showed a higher risk for cognitive decline, compared to the “Healthy” class. The finding may help to facilitate more targeted and tailored sleep interventions to prevent cognitive decline in middle-aged and older adults.

Support (if any)
0719 How Weekly Sleep Fluctuations Affect Pain Perception: An Experimental Study in Healthy Females
Authors: Rouhi Shima , Brumley Natalia , Jordan Amy 
Published: April 2024

Abstract

Introduction
Acute experimental sleep deprivation is known to induce pain hypersensitivity, with a more pronounced impact on females than males. Sleep restriction or fragmented sleep result in distinct pain hypersensitivity profiles. However, the influence of weekly sleep fluctuations, particularly between working days and weekends, on pain perception remains unclear. This experimental study investigates how weekly sleep variations affect pain perception in healthy women recruited from a university community.

Methods
A DREEM headband was used to monitor sleep, and pain sensitivity was measured using quantitative sensory testing, including heat, cold, and pressure thresholds, as well as temporal summation and conditioned pain modulation on both Monday and Friday.

Results
26 healthy females with an average age of 25.53 (CI: 22.95 to 28.11) participated. A distinct sleep pattern was observed, with a shorter sleep onset latency (t = -1.58, df = 25, p = .033), a higher number of awakenings (t = 1.98, df = 24, p = .03), and a higher N1 sleep percentage (t = 1.72, df = 25, p = .049) on Sunday night compared to Thursday night. Sleep patterns throughout the week indicated a one-hour shift later in bedtime (F=2.45, p =.06, Observed power=.69) and wake-up time (F=4.48, p=.007, Observed power= .92), more awakenings (X2 (2) = 12.17, p = 0.05), and less N3 sleep duration (F=3.29, p = .022, Observed power=.82) over weekends than weekdays, highlighting more fragmented sleep during weekends. Paired-sample t-tests revealed pain hypersensitivity with increased heat pain summation (t= 3.353, CI: .57 to 2.39, p = .003) and a trend toward decreased pain inhibition (t=-.56, CI: -45.28 to 26.28, p&gt;.05) on Monday compared to Friday. No changes in pain thresholds were observed.

Conclusion
Although the sleep changes were somewhat unexpected, with poorer sleep observed over the weekend, the study underscores the potential role of weekly sleep fluctuations in modulating pain sensitivity,

Support (if any)
0722 Clinical, Demographic, Functional, and Symptom Correlates of COMISA in Stable Heart Failure
Authors: LaFleur Kelley , Jeon Sangchoon , Wang Zequan , Conley Samantha , Redeker Nancy 
Published: April 2024

Abstract

Introduction
Sleep disordered breathing (SDB: obstructive & central sleep apnea) and insomnia are common in heart failure (HF). However, most studies have not addressed the presence of combined SDB and insomnia (COMISA). The purposes of this study were to (1) describe COMISA among adults with stable chronic HF; (2) compare the clinical and demographic characteristics between groups with COMISA, insomnia, SDB, and normal sleep; and (3) examine the risk of COMISA in the presence of normal sleep, insomnia, SDB and other clinical and demographic characteristics.

Methods
Secondary analysis of an observational study of sleep among adults with stable HF. COMISA was defined as an apnea hypopnea index (AHI) &gt; 15 with difficulty initiating or maintaining sleep or waking too early in the morning (Insomnia). We measured self-reported (Pittsburgh Sleep Quality Index) and objective sleep characteristics (polysomnography – PSG), symptoms (depression, sleepiness); used chi-square and ANOVA; and calculated the risks of COMISA for normal sleepers and with insomnia or SDB under different conditions (depression, poor sleep quality, left ventricular ejection fraction, age, race, and sex).

Results
The sample included 170 [(M age = 60.3 ± 16.8 years; n = 60 (35%] female. They had normal sleep (n = 37/22%); insomnia only (n = 48/28%): SDB only (n = 46/27%); and COMISA (n = 39/23%). Those with COMISA were significantly more likely to be obese (32.1%) compared to others [13.6% -29.6%, p = 0.0128]. They had the shortest total sleep time (TST) (mean = 291 ± 109 mins) and poorest sleep efficiency (M = 65.8 ± 20.5%) (p = .05). Women with insomnia were less likely to have COMISA than men (36% vs. 51%), while 74% of adults with SDB who were depressed had COMISA, compared with 41% of those with insomnia.

Conclusion
Risk of COMISA is associated with depression and poor sleep among adults with stable HF and SDB. Future study is needed to better understand the risks of COMISA among adults with chronic HF outcomes and to address the need for intervention that addresses it beyond a focus on only SDB or insomnia.

Support (if any)
0723 Multidimensional Sleep and Mental and Physical Health Among Retired Workers: A Sex-stratified Analysis
Authors: tracy Eunjin , Lehrer Matthew , So Christine , Hasler Brant , Kanaley Jill , Manrique-Acevedo Camila , Chin Brian , Buysse Daniel 
Published: April 2024

Abstract

Introduction
Although individual sleep characteristics relate to mental and physical health among older adults, such sleep characteristics do not exist in isolation. Multidimensional sleep measures may better capture the comprehensive impact of sleep on health. However, few studies have examined multidimensional sleep health in relation to mental and physical health outcomes among retired older adults. Likewise, few studies have examined sex differences in these relationships. This study examined associations between multidimensional sleep and health outcomes (i.e., depressive symptoms, mental health, physical health, and overall perceived health) among retired older adults in models stratified by sex.

Methods
Older adults (n = 154; Mage = 68.4, 55.2 % assigned female at birth) reported depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12). The measurement of multidimensional sleep health involved utilizing wrist actigraphy to assess sleep efficiency, timing, duration, and regularity, alongside diary measures to evaluate alertness and satisfaction. Each component was dichotomized and summed to create a composite score (0-6); higher values indicated better sleep health. Hierarchical linear regressions were used to examine relationships between multidimensional sleep health and health outcomes. Covariates include race, age, years of education, subjective social status, and shiftwork exposure history.

Results
Compared to men, women had poorer multidimensional sleep health (t(135)=2.38, p=.028). In the full sample, poorer multidimensional sleep was associated with greater depressive symptoms (b = -.70, se = .31, p =.024, r2 = .39) as well as poorer physical (b = 1.03, se = .37, p = .006, r2 = .45), mental (b = 1.37, se = .40, p &lt; .001, r2 = .44), and overall perceived health (b = 1.42, se = .35, p &lt;.001, r2 = .52). Sex-stratified analyses showed that significant findings were exclusively evident in women and not in men.

Conclusion
Multidimensional sleep health influences the physical and mental health among older retired women. Future studies should identify the mechanisms underlying sex differences in multidimensional sleep and the links between multidimensional and health outcomes. Such information could provide valuable insights leading to tailored therapeutics that benefit each sex.

Support (if any)
This research was supported by the National Institute of Aging (R01AG047139; K01AG0751).
0724 Wake Intrusion Index During NREM Sleep Is Associated with Comorbid Insomnia and Sleep Apnea Exclusively in Men
Authors: Gratton Matthew , Younes Magdy , Hamilton Nancy , Gerardy Bethany , Mazzotti Diego 
Published: April 2024

Abstract

Introduction
Sex differences in the clinical presentation of obstructive sleep apnea (OSA) comorbid with insomnia (COMISA) exist. Men typically exhibit more severe OSA during NREM sleep, while women are more prone to insomnia. Yet, little is know about the physiological correlates likely explaining these differences. This study evaluated the association between sleep stage-specific wake intrusions, a measure of 3-second perturbations in the odds ratio product (ORP) during sleep, and insomnia, OSA, and COMISA, and assessed whether sex differences in these associations are observed.

Methods
Data from the Sleep Heart Health Study (SHHS1; N=5,771) was accessed via the National Sleep Research Resource. Stage-specific wake intrusions were defined as ORP spikes above 2.0, from within N1, N2, N3, and REM. Wake intrusion index (WII) for each sleep stage was calculated as the number of intrusions divided by total sleep time from each stage. Insomnia was determined based on self-report of insomnia symptoms (&gt;15 times/month) including delayed sleep onset, maintenance difficulty, or early morning awakenings (N=617). Obstructive sleep apnea (OSA) was defined by an apnea-hypopnea index (AHI) of ≥15 (N=1,225), and COMISA was defined as having both OSA and insomnia (N=147). Linear regression was used to assess the relationship between sleep disorders and stage-specific WII, adjusted for age and AHI, separately for men and women.

Results
Among men, adjusted analyses showed that WII during NREM was significantly higher in those with COMISA as compared to those with OSA (β[SE]=73.3[27.3] intrusions/h, p=0.008), with effects likely being driven by higher WII during stage N1 (β[SE]=126.4[39.7] intrusions/h, p=0.008). These associations were not observed among women. No other significant differences were found in WII during N2, N3, or REM sleep.

Conclusion
Our findings show a sleep stage and sex-specific association between wake intrusion and COMISA. We speculate that men with COMISA may experience more unstable N1 stage, when compared to those with only OSA. These findings suggest the need for sex-specific approaches to characterization and treatment of COMISA.

Support (if any)
NHLBI (U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL64360, U01HL53938, U01HL53940, U01HL53941, U01HL63463, R24HL114473, 75N92019R002).