bluuebunny/crossref_metadata_2025_split huggingface dataset:
1158 Sleep Disorders in a Female with Hypermobility Spectrum Disorder Inclusive of Hypermobile Ehlers Danlos Syndrome
Authors: Damia Carla , Koothirezhi Rupa , Bhamrah Paul , Hall Catherine , Monceaux Brittany , Liendo Cesar , Ho Minh Tam , Ghildiyal Naomi , Chernyshev Oleg 
Published: April 2024

Abstract

Introduction
Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are conditions characterized by joint hypermobility and musculoskeletal complications including pain, atraumatic joint dislocations and joint instability. They are often associated with other comorbidities including but not limited to dysautonomia, GI disturbances, anxiety, depression, sleep disorders and chronic fatigue. There are no known genetic markers for HSD/hEDS, they are clinical diagnoses. The nomenclature for these conditions has evolved recently and there are ongoing discussions regarding the best way to characterize these populations. Data on the prevalence of HSD and hEDS are still limited. We are reporting a case describing multiple, long-standing sleep concerns in a young woman with recent evaluation by a geneticist.

Report of case(s)
Patient is a 25-year-old Caucasian female with initial past medical history notable for anxiety, depression, asthma, irritable bowel syndrome, POTS, scoliosis and vasovagal syncope. On presentation at age 24, the patient reported a family history of hEDS in an aunt and reported multiple family members with joint hypermobility. She had not seen a geneticist for evaluation but reported symptoms concerning for HSD/hEDS. Patient presented to clinic with multiple sleep concerns including sleep paralysis that had started in childhood, sleep-related hallucinations, snoring, witnessed apneas, unrefreshing sleep, fatigue and crawling sensations in legs that improved with movement. Patient had a home sleep study and was diagnosed with mild obstructive sleep apnea. Patient was initiated on PAP therapy but did not tolerate the mask. She reported some benefit to sleep concerns when she was able to utilize therapy. Lab work showed low ferritin. Patient has not been initiated on iron therapy yet. Patient established care with a geneticist and was informed that her past medical history, symptoms and exam were consistent with HSD inclusive of hEDS.

Conclusion
This case focuses on sleep disorders and sleep concerns in a patient with a clinical diagnosis of HSD/hEDS. Diagnosis of these hypermobility joint disorders is evolving and with that sleep disorders in these patients are becoming better characterized. Management of HSD/hEDS is symptomatic at this time and patients would benefit from thorough evaluation so as to improve their sleep and overall quality of life.

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0116 Multidimensional Perfectionism and Sleep: The Role of Self-Compassion
Authors: Assar Arash , Diaz Anjolii , Lee Tayla , Fletcher Kathryn 
Published: April 2024

Abstract

Introduction
Prior studies have indicated that perfectionistic behavior among college students is linked to sleep difficulties. However, there is currently limited research on conditions and protective factors that might help elucidate this association. The current study examined whether self-compassion moderated the association between the two higher-order dimensions of perfectionism and sleep difficulties in a sample of college students.

Methods
A total of 178 college students (M = 19.88, SD = 1.50) completed self-report measures assessing perfectionism, self-compassion (Self-Compassion Scale), and sleep (Pittsburgh Sleep Quality Index). This study took a multi-measure approach to capture the two higher-order dimensions of perfectionism – perfectionistic strivings (PS) and perfectionistic concerns (PC). Specifically, subscales from the three most common measures of multidimensional perfectionism (Frost Multidimensional Perfectionism Scale, the Hewitt-Flett Multidimensional Perfectionism Scale, and the Revised Almost Perfect Scale) were combined to form composite scores of PS and PC. Sleep was also measured objectively via wrist-actigraphy (ActiGraph GT3X+), which participants wore for three continuous weekday nights. Sleep diary data were collected to score and validate the actigraphy data.

Results
Moderation analyses were performed to examine the interaction of perfectionism and self-compassion on sleep outcomes. Findings indicated a significant and moderate interaction between PS and self-compassion when predicting poor sleep quality. Simple slope analyses indicated that the negative association between PS and poor sleep quality was significant at high levels of self-compassion (β = -.29, SE = .10, 95 % CI [-.49, -.09], t = -2.82, p = .005) followed by average levels of self-compassion (β = -.17, SE = .07, 95 % CI [-.31, -.02], t = -2.24, p = .026). Findings also indicated that college students with higher PC or lower self-compassion tendencies self-reported sleep difficulties despite having observable actigraphic sleep disturbances.

Conclusion
This study expands the current perfectionism and sleep literature by examining whether the moderating role of self-compassion can explain previous heterogeneous findings. Furthermore, the discrepancies between sleep methods observed in the current study highlight the importance of incorporating objective sleep measures as an adjunct to subjective and self-report measures of sleep to provide a more comprehensive assessment of sleep in relation to perfectionism and self-compassion.

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1160 Examining Criteria in Hypoglossal Nerve Stimulation: A Case Insight
Authors: Bean Steven , Mukkavilli Venkata 
Published: April 2024

Abstract

Introduction
Introduced in 2001, the hypoglossal nerve stimulator (HGNS) is an implantable device designed to treat moderate to severe obstructive sleep apnea (OSA). FDA-approved on May 1, 2014, it offers an alternative for patients unable to benefit from continuous positive airway pressure (CPAP) therapy. However, not all patients may benefit, leading to the establishment of exclusion criteria based on factors such as body mass index, central and/or mixed apnea index &gt;25%, complete concentric palatal collapse, patient age, and certain comorbidities such as neuromuscular and cardiac diseases. It is important to consider these criteria when screening patients to ensure the appropriate use of the device. Here, we present a case illustrating a patient who received a HGNS device according to established criteria but may not have been an ideal candidate.123

Report of case(s)
A 55-year-old male with a history of hyperlipidemia, depression, and hypothyroidism status post (s/p) thyroidectomy to treat multinodular goiter, moderate OSA (AHI 16.2 events/hr) s/p uvulopalatopharyngoplasty and failed CPAP tolerance, underwent HGNS implantation. Post-procedure, an abnormal electrocardiogram led to a referral to cardiology, where he was found to have heart failure with a reduced ejection fraction of 20%. A follow-up titration polysomnography showed central events, presumed treatment emergent, following HGNS implantation. He is currently being monitored by cardiology for the optimization of his heart failure. Upon re-evaluation of his initial pre-implantation study, we felt that several of the hypopnea events may have been central hypopneas. Although his OSA is controlled with the HGNS, the patient still has central sleep apnea that is not being treated.

Conclusion
There is a lack of routine differentiation between central and obstructive hypopneas in current assessments, which poses a potential oversight in patient selection, impacting treatment planning. Central hypopneas should be included when assessing the 25% threshold of central events that would otherwise exclude a patient from receiving treatment. This case highlights the need for more stringent scoring criteria, specifically incorporating central hypopneas, to better screen high-risk patients and identify optimal candidates for hypoglossal nerve stimulation.

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1164 Sleep Conversion of Atrial Bigeminy to Sinus Rhythm and Using Oximetry for Heart Rate
Authors: Lisio Catherine Di , Strohl Kingman 
Published: April 2024

Abstract

Introduction
Patient presented for PSG with initial wake, N1 period showing bigeminy on ECG that converted to sinus rhythm during N2, N3, and REM. SR persisted despite periods of hypoxemia until the end of the study. Furthermore, the heart rate, as generated using oximetry and Polysmith, would not recognize the bigeminal beat underestimating heart rate by half.

Report of case(s)
A middle-aged female was referred to Sleep Medicine for difficulty falling asleep, staying asleep, snoring, witnessed apneas. Epworth Sleepiness Scale score (ESS) was 9/24. PSG was performed using Polysmith software. Epochs showed: Wake: bigeminy on EKG and corresponding plethysmography with one large peak (the visible P wave) and one small peak (where P is hidden in the preceding T wave). Only the first P wave is used to generate heart rate. A clear transition can be seen within a single epoch in N1: EKG changes from bigeminy to SR with corresponding plethysmography showing two peaks (as in wake) that convert to a single peak in sinus rhythm. Heart rate is then correctly accounted for midway through the epoch. N2 and REM: SR, single peak on plethysmography, accurate heart rate continue. ECG approximately one week prior to PSG showed sinus bradycardia.

Conclusion
While there has been no mention of atrial bigeminy and sleep in cardiovascular or sleep medicine literature, one hypothetical reason for its resolution in sleep is the reduction of sympathetic and cholinergic tone. As for the spurious heart rate on oximetry, software did not recognize the smaller plethysmography peak, underestimating heart rate by half during periods of bigeminy. Atrial bigeminy is associated with heart failure, alcohol, electrolyte derangement, caffeine and usually left untreated in asymptomatic patients. Patients with symptoms, such as palpitations, dizziness, near syncope, or syncope can be treated with β-blockers, calcium-channel blockers, or catheter ablation. While this patient did not complain of symptoms, recent labs did show hypomagnesemia and hypokalemia.

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1168 Snoring Cessation in a Case of Vagal Nerve Stimulator Induced Obstructive Hypopnea
Authors: McFarlane Robin , Nguyen Andrea , Chaung Matthew , Lee-Iannotti Joyce 
Published: April 2024

Abstract

Introduction
Vagal nerve stimulators (VNS) have been found to induce sleep disordered breathing and many patients will seek sleep evaluation after the development of symptoms. Snoring is a common reason patients may present. Once therapy is initiated, the lack of snoring is often used as a clinical marker for reduced apnea. Here we present the counterintuitive case of a VNS patient who had treatment-refractory obstructive sleep apnea with snoring that halted during apneic episodes.

Report of case(s)
A 24-year-old male, past medical history of medically refractory epilepsy w/ VNS, developmental delay with minimal verbal output, sleep apnea treated with CPAP (Continuous Positive Airway Pressure), presented for a split night polysomnogram based on reports of witnessed nocturnal apneas despite treatment with CPAP. To find new CPAP settings for worsening apnea we performed a split night polysomnogram. During the baseline diagnostic portion of the study the apnea hypopnea index was 40.9 events/hour with severe obstructive sleep apnea consisting of 12 obstructive apneas and 32 hypopneas. Respiratory events were noted to have remarkable chronicity, lasting 30 seconds every 1 min and 10 seconds. The obstructive events were also seen during wake cycles. We discovered his VNS settings were programmed for a 1 minute and 10 second OFF cycle with 30 second ON cycle, coinciding with the periodicity of his apneic events. Additionally, snoring occurred throughout the study but ceased during the hypopneas. VNS artifact was noted in the EKG lead during the 30 second periods of hypopnea in a dramatic time locked obstructive pattern, suggesting VNS induced collapse of the upper airway during VNS ON phase.

Conclusion
This is a report of VNS induced cessation of snoring with paradoxical worsening of hypopneas, as well as awake hypopnea events. VNS can induce sleep apnea and our study shows lack of snoring is not a reliable indicator of lack of hypopnea due to the adduction of vocal cords and resultant laryngeal collapse. We suggest that all patients with a VNS implanted device undergo a sleep study to evaluate for VNS induced OSA after implantation of VNS, and a follow up with a sleep study titration of VNS in select cases.

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1177 The Patient Who Never Stopped Dreaming
Authors: Gupta Shalini , Avidan Alon 
Published: April 2024

Abstract

Introduction
Sleep-related hallucination (SRH) is a parasomnia that may be encountered in the form of altered dream mentation in α-synucleinopathies, particularly in the setting of dementia with Lewy bodies (DLB). Visual hallucinations (VH) are complex, well-formed, episodes that represent a core diagnostic criterion for DLB. We report a patient who presented with REM sleep behavior disorder (RBD), VH, and perceiving the world as if he were in a persistent dream-like state coinciding with new cognitive deficits.

Report of case(s)
A 74 y/o male presented with a subjective perception of “being in a constant dream-like state” for the past 2 years. He describes “atypical nightmares and hypnopompic visual hallucinations” The Patient describes that objects do not feel real, but appear drawn out as in a cartoon. He feels “disconnected” from the environment and perceives images as “distant, distorted, unreal, but also very colorful, vivid, saturated as a cartoon animation sequence. He no longer feels safe to drive and his wife reveals a failure to appreciate depth leading to an increased frequency of falls. Ophthalmologic exam was unremarkable including normal visual acuity, field testing, and color vision. ESS: 8, Sleep log: subjective total sleep- 7-8 hrs/night. Polysomnography conforms the presence of dream enactment behaviors and REM sleep without atonia meeting the diagnostic criteria for RBD. AHI-3, SaO2: 92%. REM latency: 92 minutes.

Conclusion
People with DLB experience a spectrum of sleep disorders, especially RBD, but also experience a range of sleep and wake-related complex visual hallucinations. The latter may reflect impairment in sensory integration, particularly during the transformation from mild cognitive impairment (MCI) to DLB due to alteration in visual sensory processing. Sleep clinicians serve a critical role in the evaluation of SRH, and differentiating these from other mimics, such as VH related to neuropsychiatric conditions. Due to their bizarre and perplexing presentation, visual-spatial processing disorders (VSP) in DLB may be stigmatized, dismissed, or attributed to RBD. Sleep clinicians must therefore include recognizing VSP in any patient presenting with SRH.

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1184 The Leptin Puzzle: Decoding Genes, Morbid Obesity, Sleep-Related Disorders and Its Influence
Authors: Colon-Soto Jose , Vega-Sanabria Bryan , Cardona-Quiñones Roberto , Balsalobre-Vélez Alexandra , De Jesus-Rojas Wilfredo 
Published: April 2024

Abstract

Introduction
The role of early-onset obesity-related genetic predisposition and leptin receptor variants have been studied in previous studies. However, sleep-related disorders related to a genetic predisposition, leading to obesity, and how leptin could play a role in sleep-related disorders have been limited. In this study, we explore a case of how leptin receptor variants could play a role in the relationship between obesity and sleep-related disorders.

Report of case(s)
Case of a 17-year-old Hispanic female presented with a history of frequent snoring, gasping for air while sleeping, daytime sleepiness, sleep onset, maintenance difficulties, and limb movements at sleep. Polysomnography (PSG) was performed and later diagnosed with Obstructive Sleep Apnea (OSA). Respiratory disturbances were associated with oxygen desaturation down to a nadir of 68 % during sleep and a mean oxygen saturation of 91%, with an AHI of 22.7 events/hr. Additional genetic studies were performed to assess the causes of obesity, presenting with BBS9 heterozygous gene for a sequence variant defined as c.396GC, which is predicted to result in the amino acid substitution p.Gln132His. Furthermore, this patient is heterozygous in the LEPR gene for a sequence variant defined as c.658GA, which is predicted to result in the amino acid substitution p.Val220Ile, which has been reported in the heterozygous state in severe obesity, which increases leptin levels due to mutations in its receptor.

Conclusion
Leptin dysregulation has been associated with an increased predisposition to obesity, which could lead to sleep-related disorders, such as OSA. What is novel in our case is that our patient has an LEPR gene heterozygous variant, leading to an increase in leptin levels, a greater increase in metabolic dysregulation, and increased body weight, thus worsening her OSA. At the same time, research has shown that conditions such as OSA also increase leptin levels, which could worsen her OSA and prognosis. Further research is needed to assess LEPR and its role in OSA, especially in Hispanic populations, where research is limited.

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1186 Phrenic Nerve Stimulation to Improve Central Sleep Apnea and Quality of Life in Palliative Patients: A Case Report
Authors: Chaung Matthew , Nguyen Andrea , Thacker Stacy , Lee-Iannotti Joyce 
Published: April 2024

Abstract

Introduction
Central sleep apnea (CSA) is a devastating disease and occurs in approximately 40% of patients with a history of stroke, neurological conditions, and heart failure(Joseph et.al). Typical symptoms include disrupted sleep or paroxysmal nocturnal hypoxemia. The gold standard for diagnosis is polysomnography and treatment is typically positive airway pressure (PAP)(Ishikawa et. al). REMEDE stimulates the phrenic nerve transvenously, providing innovative therapeutic alternatives for patients who cannot tolerate PAP therapies(Joseph et. al).

Report of case(s)
A 77-year-old male with history of advanced Parkinson’s disease (PD) established with palliative care, was referred to the sleep clinic for additional management of severe central sleep apnea refractory to bilevel positive airway pressure (Bilevel PAP ST). Despite initial Bilevel PAP settings of 22/18 cm of water with a backup rate of 12 bpm, the patient faced difficulties using his machine. His apnea hypopnea index (AHI) remained in the moderate range at 18 events/hour despite PAP therapy. Attempts to adjust pressure settings, implement acclimation measures, and mask changes proved unsuccessful. Due to persistent symptoms and poor quality of life (QoL), the patient was subsequently considered for phrenic nerve stimulation, meeting inclusion criteria. Six months post-implantation, he experienced significant improvement in his reported QoL (improved mood, less sleepy during the day with improved Epworth Sleepiness scores), confirmed from his wife. Unfortunately, he passed away 11 months after implantation due to PD-related complications.

Conclusion
Phrenic nerve stimulation emerges as a novel and effective treatment for CSA, particularly for patients intolerant to Bilevel PAP therapy. This case study highlights the positive impact of phrenic neuromodulation on QoL and sleep improvement, even in patients with palliative conditions and advanced neurodegenerative diseases. Even in patients with end-stage Parkinson disease neurosurgery to replace deep brain stimulation generators is low risk(Carlson et. al). Moreover, nutrition and swallowing can be difficult in end stage Parkinson disease and there is a role for percutaneous endoscopic gastrostomy (PEG) tube to also improve QoL(Schindler et. al). We assert that methods aimed at enhancing sleep, albeit invasive and surgical, should be considered viable options for patients categorized as palliative or terminal, with the overarching goal of improving their remaining days(Lilley et. al).

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0119 Symptoms of Post-Traumatic Stress Disorder and Self-Rated Multidimensional Sleep Health
Authors: Cassell Jack , Marquez Francisco , Piechota Amanda , Decker Andrea , Halvorson Emily , Cribbet Matthew 
Published: April 2024

Abstract

Introduction
Sleep disturbances are common among individuals with posttraumatic stress disorder (PTSD). Individuals with PTSD experience heightened sensitivity in brain regions involved in fear and emotion regulation, which may impair sleep onset, maintenance, depth, duration and quality. This suggests that PTSD may be influencing multiple aspects of sleep at once. Thus, the goal of this study was to examine associations between symptoms of PTSD, and self-rated multidimensional sleep health.

Methods
A community sample of midlife adults living in the deep south (N=70; Age=52.93±9.05; Female=75.7%; 11.42% African American) completed a demographic measure, the PTSD Checklist for DSM-5 (PCL-5), and a self-rated measure of multidimensional sleep health (created by summing scores on items assessing satisfaction, duration, regularity, alertness, efficiency and timing). Bivariate correlations were conducted to test the association between symptoms of PTSD and sleep health. Follow-up multiple regression analyses were used to examine the association between sleep health and symptoms of PTSD, while adjusting for sex, age, and BMI. Exploratory analyses were conducted to determine which aspects of sleep health were driving any significant associations with PTSD symptoms.

Results
Bivariate correlations revealed significant negative relationships between symptoms of PTSD and self-rated multidimensional sleep health (r=-0.349, p=0.003). After accounting for age, sex, and BMI, regression analyses demonstrated a significant inverse relationship between symptoms of PTSD and sleep health, such that a one unit increase in PTSD symptoms corresponded to a 0.09 decrease in a multidimensional measure of sleep health (b=-0.099, t=-3.24, p=.002, R2=0.144). In separate multiple regression models, accounting for BMI, age and sex, greater PTSD symptoms were associated with poor sleep satisfaction (b=-0.021, t=-2.49, p=.015, R2=0.137) and poor sleep efficiency (b=-0.029, t=-2.90, p=.005, R2=0.131), but unrelated to other aspects of sleep health (ps &gt; .05).

Conclusion
Symptoms of PTSD were significantly negatively associated with self-reported multidimensional sleep health. These results were driven primarily by poor sleep efficiency and satisfaction with sleep. These findings add to growing literature on PTSD and sleep and suggest specific targets for interventions.

Support (if any)
Support was provided by the Deep South Resource Center for Minority Aging Research (RCMAR) P30 AG0301054 from the NIA.