bluuebunny/crossref_metadata_2025_split huggingface dataset:
0755 Sleep Strategies and Sleep-related Adverse Events Experienced by Runners in 200-mile Ultramarathons
Authors: Lynch William , Ginell Keara , Whibley Daniel 
Published: April 2024

Abstract

Introduction
Sufficient sleep is essential for the athletic recovery process and is considered foundational for optimal sports performance. Participation in ultramarathons taking place over multiple days may benefit from specific sleep strategies to avoid sleep-related adverse events and injury. This study aimed to identify if and which types of sleep strategies were used by ultramarathon runners, whether these were associated with sleep-related adverse events or injury, and the types of sleep-related adverse events experienced during these races.

Methods
This cross-sectional study comprised an electronic survey distributed to ultramarathoners aged 18 years or above who had recently completed a 200-plus mile race. Survey distribution was facilitated by race directors between June and September 2023. The survey included questions about demographics, ultramarathon experience, training habits, sleep-related factors, sleep-related adverse events experienced during the race, and whether an injury was sustained. Continuous variables were summarized as mean (standard deviation) and categorical variables as N (%). Logistic regression was used to quantify associations between sleep strategies and sleep-related adverse events and injury.

Results
Of 115 survey respondents who competed in a 200-plus mile ultramarathon, mean (standard deviation) age was 47.5 (10.8) and 67.0% were men. Among 71 respondents (61.7%) who reported using a sleep strategy during the race, the most common was ‘sleeping when exhausted’ (N=31; 43.7%) and the least common was sleeping for 6-8 hours (N=3; 4.2%). Using a strategy of ‘sleeping when exhausted’ was significantly associated with having a sleep-related adverse event (odds ratio 3.5, 95% confidence interval 1.3-9.5, p=0.01) but was not associated with sustaining an injury during the race (odds ratio 0.7, 95% confidence interval 0.2-2.1, p=0.5). Of 42 people who reported experiencing a sleep-related adverse event, the most common was experiencing hallucinations (N=40; 95.2%).

Conclusion
Sleeping when exhausted during an ultramarathon was a common strategy associated with experiencing hallucinations during the race. Further investigation should determine whether this is perceived as problematic for runners or if this is an integral part of their ultramarathon experience. Longitudinal research into acute, sub-acute and chronic downstream sequalae of sleep deprivation in this athletic population is warranted.

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0760 Sleep Health Profiles Across Six Harmonized Cohorts and Their Association with Future Depressive Symptoms
Authors: Wallace Meredith , Hoepel Sanne , Oryshkewych Nina , Luik Annemarie , Butters Meryl , Buysse Daniel , Redline Susan , Stone Katie , Yaffe Kristine , Barnes Lisa , Lim Andrew , Ensrud Kristine 
Published: April 2024

Abstract

Introduction
Depression is a leading cause of disability in older adults, yet it remains underdiagnosed and undertreated. Establishing common multivariable sleep health profiles may eventually help to identify at-risk older adults and match them with appropriate treatments. However, profiles identified across cohorts often differ because of inconsistent measures and methods, hampering progress towards large-scale initiatives. We aimed to overcome this challenge using harmonized data across six cohorts.

Methods
We harmonized five self-report sleep health indicators across six epidemiologic cohorts of adults aged &gt;60 from the United States and Netherlands (N=613 - 3,123). We performed latent class analysis in each cohort. Generalizability and comparability of findings were assessed using several indices, including cluster stability and novel distance metrics. Generalized linear mixed-effects modeling was used to relate sleep health profiles to the risk of increased depressive symptoms over time in each cohort.

Results
Two sleep health profiles were common across all cohorts: ‘Good Sleep’ (GS; average sleep duration, high quality and efficiency) and ‘Poor Sleep’ (PS; short sleep duration, low quality and efficiency, high daytime sleepiness). Three cohorts indicated an ‘Inefficient Sleep’ profile (IS) and three cohorts indicated a ‘Long Sleep’ profile (LS). PS had high and sustained depressive symptoms over 3-15 years of follow-up, especially relative to GS and IS (Risk Ratios [RRs]=1.47-3.44 for PS vs.GS; 1.75-2.32 for PS vs. IS; and 1.10-1.15 for PS vs. LS).

Conclusion
GS and PS profiles were generalizable across cohorts. Older adults with the PS profile had heightened depressive symptoms over multiple years of follow-up, especially relative to GS and IS profiles. Next steps involve quantifying the impact of screening using sleep health profiles and gathering evidence that interventions targeting sleep health profiles reduce onset or severity of depression.

Support (if any)
Wallace (RF1AG056331); Rush Alzheimer’s Disease Center (R01AG017917, R01AG022018); Osteoporotic Fractures in Men Study (U01AG027810, U01AG042124, U01AG042139, U01AG042140, U01AG042143, U01AG042145, U01AG042168, U01AR066160, UL1TR000128, R01HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, R01HL070839); Study of Osteoporotic Fractures (R01AG005407, R01AR35582, R01AR35583, R01AR35584, R01AG005394, R01AG027574, R01AG027576, and R01AG026720); Rotterdam Study (Erasmus Medical Center and Erasmus University, Netherlands Organization for the Health Research and Development, Ministries of Education and Health, European Commission, Rotterdam Municipality).
0763 Association of Chronotype and Sleep Characteristics with Obesity Indexes in Korean Adults
Authors: Baek Younghwa , Kim Hoseok , Kim Jeonggyun , Lee Siwoo 
Published: April 2024

Abstract

Introduction
Insufficient sleep and circadian disruption are known modifiable risk factors for obesity. Chronotype reflects an individual's preferences in sleep timing and behaviors. This study examined the association between sleep characteristics and common obesity indicators, body mass index (BMI) and waist circumference (WC), according to chronotype in Korean adults.

Methods
This study used data from the Korean Medicine Daejeon Citizen Cohort study of 2,000 participants in their 30s to 50s from 2017 to 2019. The survey examined several sociodemographic and lifestyle factors. Sleep characteristics including time, quality, latency, and efficiency were investigated using the Pittsburgh Sleep Quality Index questionnaire. Chronotype was classified into morning (M), evening (E), and intermediate types based on single nucleotide polymorphisms in insomnia-related genes such as SYCE1L, IP6K3, PLCL1, APOE, and DPP3. Anthropometric measurements of BMI and WC were performed to assess obesity indices. General linear model adjusted for sex and age was performed to determine association between sleep and obesity index according to morning and evening types.

Results
Among the total 2,000 participants, the chronotype distribution was 5.3% morning type, 9.5% evening type, and 85.2% intermediate type. The evening type tended to have shorter sleep time (M: 6.75, E: 6.66 hr), poor sleep quality (M: 4.55, E: 4.68 score), longer sleep latency (M 19.7, E: 22.5 min), and low sleep efficiency(M: 95.1, E: 94.7%) than the morning type, but there was no statistically significant difference. The WC and BMI of the morning and evening types were similar. Morning type was associated with long sleep latency and increased WC (B= 0.12, 95% CI= 0.01 – 0.22, p=0.01). However, there was no association between them in the evening type. Additionally, morning types, being married and having less physical activity were associated with increased WC. Male was associated with increased WC and BMI, regardless of morning and evening types.

Conclusion
This study has demonstrated that the associations between sleep status and obesity indicators may vary in Korean middle-aged adults depending on chronotype, especially morning type. Future study will be needed on the causality between obesity considering chronotype, sleep status, and general characteristics.

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0764 Clinical Phenotypes of Patients with Obstructive Sleep Apnoea: A Retrospective Study
Authors: Wali Siraj , Alshumrani Ranya , Alhejaili Faris , Alghamdi Khalid , Alalwani Tariq , Halawani Ammar , Nowailaty Fares , Seiql Omar , Alshali Sultan , Fida Moufag 
Published: April 2024

Abstract

Introduction
The various clinical manifestations of Obstructive Sleep Apnoea (OSA) have not been officially depicted in clinical practise. The lack of clinical knowledge on the heterogeneity of OSA may present fundamental difficulties in its clinical recognition, resulting in missed conclusions for diagnosis. OSA symptoms frequently include higher airway narrowing, excessive sleepiness, sleep disturbances, and general fatigue. It is well known that the aetiology, symptoms, and consequences of OSA vary between patients.

Methods
Retrospective chart review of all patients who were evaluated at SMRC from 2017 to 2022. Data about patients' demographics, chief complaint (Excessive day time sleepiness (EDS), Insomnia, Co- morbidities with no symptoms), chronic diseases, STOP-Bang risk, CPAP adherence and values of ESS, RLS, ODI and AHI. The CPAP adherence was defined as using CPAP &lt; 4 hours per day at least for 5 nights per week or ≥ 70% of all recorded days.

Results
shows that participants whose chief complaint was EDS had a significant higher mean BMI, higher ESS value and a significant higher percent of having a high-risk STOP-Bang (p=&lt; 0.05). Participants whose chief complaint was insomnia had a significant older age (p=&lt; 0.05). While those patients had a significant lower BMI, lower ESS and lower ODI levels (p=&lt; 0.05). Participants whose chief complaint was referral from other services due to co- morbidities with no symptoms had a significant younger age and a significant lower value of ESS (p=&lt; 0.05). participants with poor CPAP adherence had a significant older age, higher BMI, and higher ESS (p=&lt; 0.05).

Conclusion
Different OSA phenotypes have different characteristics . Clustering OSA patients may lead to more individualized therapy with better compliance.

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0767 ICSD-3 TR Criteria for Nocturia: Is 3+ Nightly Episodes Too High a Bar?
Authors: Gupta Shalini , Mitchell Michael , Alessi Cathy , Martin Jennifer , Dzierzewski Joseph , Josephson Karen , Naeem Saadia , Der-Mcleod Erin , Ghadimi Sara , Zeidler Michelle , Badr M Safwan , Moore Alison , Fung Constance H 
Published: April 2024

Abstract

Introduction
Prior studies suggest that nocturia negatively affects sleep quality and daytime function. In the new ICSD-3 TR, nocturia is defined as three or more nightly episodes of urination arising from sleep. Previous studies suggest that two or more nightly episodes are bothersome and clinically meaningful. This study investigated the relationship between frequency of nocturia and symptoms of reported bother and sleep disturbance in a sample of middle-aged and older adults using hypnotics.

Methods
We performed secondary analysis of baseline assessment data collected for a multi-site trial testing hypnotic deprescribing programs. Participants aged &gt;=55 years who use hypnotics completed self-reported assessments of nighttime urination frequency, bother from nocturia (not at all [0] to a lot [3]), and sleep outcomes (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and Epworth Sleepiness Scale [ESS]). Adjusting for age, gender, and site, we regressed each outcome on nocturia frequency (one vs 0, two vs 0, three vs 0, four+ vs 0 episodes) and estimated differences in adjusted means.

Results
Among participants (n=335;72% male, 76% white, mean age 68.9 years, 21% diabetes, 26% enlarged prostate, 48% depression), the estimated differences (#nightly urination episodes versus 0 episodes) in adjusted means for each outcome were: bother (one episode of nocturia: 0.77, two: 1.07, three: 2.08, four+: 2.02; all P&lt;.001), worse PSQI (two: 1.64, three: 2.61, four+: 3.14; all P&lt;.05; one episode was not significant [NS]), and worse ISI (three: 3.38, four+: 5.36, all P&lt; .01; one, two episodes were NS). Only four+ episodes were associated with a difference in mean ESS (2.71, p&lt;.05).

Conclusion
As episodes of nocturia increased, bother from nighttime urination and sleep disturbance increased. When compared to zero nocturia episodes, nocturia at a threshold of two or more nightly episodes was associated with more bother and worse overall sleep quality. Only insomnia severity worsened at a threshold of 3 nightly episodes. These findings may not apply to women and minority populations, who were underrepresented. A nocturia frequency threshold requiring 3 or more nightly episodes may miss individuals suffering from significant adverse effects of nocturia on their overall sleep quality.

Support (if any)
NIAR01AG057929, VAIIR17-234, UL1TR001881
0770 The Impact of Acute Sleep Extension on Blood Pressure Is Dependent on Sleep Quality
Authors: Gonzales Joaquin , Clark Cayla , Dellinger Jacob 
Published: April 2024

Abstract

Introduction
About 30% of the U.S. population sleep less than 7-hours per night, with this proportion of adults having a greater prevalence of hypertension than adults that meet the recommended amount of sleep. Middle-aged to older adults are of particular interest as they have lower sleep durations than younger adults, and suffer from higher rates of cardiovascular disease. Therefore, more research is needed in this population to understand the impact of sleep duration on vascular health. The aim of this study was to determine the impact of one night of sleep extension on blood pressure and microvascular function in middle-aged to older adults.

Methods
Sleep and daily physical activity were objectively measured at home for two weeks using wrist actigraphy in 22 adults (60 ± 15y). Vascular measurements were made in the morning on the 8th and 15th day. Participants spent at least 10h in bed on the night prior to one of these testing days to extend sleep. Mean arterial blood pressure (MAP) and peak reactive hyperemia in the forearm were measured on each testing day.

Results
Reactive hyperemia and MAP were unaltered (P&gt;0.05) by sleep extension in the total sample. However, adults that experienced improved sleep efficiency during extended sleep (n=10, 4.2 ± 1.4%) exhibited reduced MAP (-5.5 ± 4.6 mm Hg, P=0.005) while adults that had little change or decreased sleep efficiency (n=12, -1.7 ± 2.9%) showed no change in MAP. The reduction in MAP was significantly different between sleep efficiency groups (P=0.005, Hedges’ g = 1.21) after adjustment for sex and moderate-to-vigorous physical activity.

Conclusion
These results suggest that one night of sleep extension has the potential to reduce blood pressure in midlife to older adults when the additional sleep time improves quality of sleep.

Support (if any)
This study was funded by the American Heart Association (19IPLOI34760579; J.U. Gonzales).
0772 OSA Improvement Due to Ato-oxy in Children with down Syndrome Predicts Improved Quality of Life
Authors: Combs Daniel , Edgin Jamie , Hsu Chiu-Hsieh , Bottrill Kenneth , Maxfield Kate , Gerken Blake , Matloff Daniel , La Rue Sicily , Dean Adam , Provencio-Dean Natalie , Parthasarathy Sairam 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS). Current OSA treatments for children with DS have limited effectiveness, as positive airway pressure therapy is poorly tolerated and adenotonsillectomy is not curative in most children with DS. We recently showed that the combination of atomoxetine and oxybutynin (ato-oxy) reduced OSA severity by 51% in a small trial of children with DS. Health-related quality of life (HRQOL) scores improved with ato-oxy, but the improvement was not statistically significant when examined across all trial participants. Therefore we evaluated if HRQOL improvements were greater in participants with more significant improvement in OSA.

Methods
We compared baseline characteristics and changes in HR-QOL in children with DS age 7-17 years old who had a response (defined as obstructive apnea-hypopnea index [oAHI] improvement of &gt;50% and reduction of oAHI to &lt; 5 events/hour) vs. those who did not respond to ato-oxy. Participants received 4 weeks of ato-oxy (0.5 mg/kg atomoxetine and 5 mg oxybutynin) with polysomnography and assessment of HR-QOL using the PedsQL along with behavioral assessment using the Conners at baseline and after 4 weeks of treatment. Paired t-tests or chi square tests were used to compare baseline participant characteristics and linear regression with adjustment for baseline was used to compare treatment outcomes.

Results
12 participants had data at both baseline and on ato-oxy. 42% of participants had a significant response to ato-oxy. There were no significant differences at baseline between treatment responders and non-responders in demographics, body mass index or OSA severity. Quality of life was significantly higher in ato-oxy responders compared to non-responders. Adjusted mean total PedsQL score was 75 (95% confidence interval: 64, 87) in responders compared to 61 (51, 70) in non-responders, p=0.048. Responders had better scores across Conners domains including attention and behavior, but these were not statistically significant compared to non-responders.

Conclusion
No characteristics predicted ato-oxy response for OSA treatment in children with DS. Children who had a significant response to ato-oxy had significant improvement in their quality of life.

Support (if any)
Funding provided by NIH (HL151254 and HD109777) as well as the Lumind-IDSC foundation.
0773 Anthropometric and Polysomnogram Findings in a Pediatric Cohort of Night Eaters and Non-night Eaters
Authors: Rani Seema , Strang Abigail , Chidekel Aaron , Levenbrown Aryeh 
Published: April 2024

Abstract

Introduction
As the prevalence of pediatric obesity increases, it is important to understand the relationship between chronotype, daytime sleepiness, eating times, sleep disorders and obesity. The objective of this study is to describe chronotype, eating timings, daytime sleepiness, and PSG findings in pediatric patients presenting for sleep evaluation and to investigate relationships between eating times on chronotype, daytime sleepiness, obesity, and PSG parameters (both respiratory and non-respiratory).

Methods
IRB-approved cross-sectional, survey-based study completed, between May-August, 2023 during sleep clinic visit, at Nemours Children's Hospital, Delaware. Eligibility criteria included age 11-17 years, English-speaking and developmentally appropriate. Validated surveys included: The Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), The Morningness Eveningness Questionnaire (MEQ), and the Night Eating Diagnostic Questionnaire (NEDQ). Demographic and PSG parameters were obtained from EMR. Descriptive and comparative statistics were performed to compare surveys, PSG findings and anthropometrics between night-eaters and non-night eaters.

Results
Study participants (n=35) were 60% male, mean age 14.9 years (1.8). The mean BMI was 37.8 kg/m2 (9.8), mean BMI Z-score was 4.3 (3.1), 89% were obese, 63% had increased daytime sleepiness, 71% had an intermediate chronotype, and 31% were night eaters. The cohort was split into night eating and non-night eating group. Among the night eating group (n=11), mean BMI was 39.8 (5.8), BMI Z-score 3.89 (2.1), 100% were obese, 55% were abnormally sleepy, and 55% had a moderate evening chronotype. Among the non-night eating group (n=25) mean BMI was 36.9 (11.1), and mean BMI Z-score was 4.6 (3.4), 83% were obese, 67% were abnormally sleepy, and 83% had an intermediate chronotype. PSG parameters were similar in both groups except duration of N2 sleep, which was significantly higher in night eaters 60.5% (7.5) compared with non-night eaters 54.3% (9.6), p=0.05.

Conclusion
Night eating is associated with evening chronotype in this unexpectedly obese pediatric population. There were no observed differences in daytime sleepiness, or respiratory parameters between night eaters and non-night eaters. Further studies with a more varied BMI are necessary. Night eaters had significantly higher duration of light (N2) sleep compared to non-night eaters.

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0775 Polysomnography Characteristics of Infants Presenting with BRUE: A Single Center Experience
Authors: Rao Harish , Bandyopadhyay Anuja , Jalou Hasnaa 
Published: April 2024

Abstract

Introduction
Brief resolved unexplained events (BRUE) commonly seen in infants, is not a specific diagnosis but a description of a sudden, brief, and now resolved episode. It includes one or more of the following presenting features: Cyanosis or pallor; absent, decreased, or irregular breathing, marked change in tone or altered level of responsiveness. Polysomnograms (PSG) are often performed as part of workup for infants presenting with BRUE. But the utility of PSGs in BRUE workup algorithm has not been well studied.

Methods
In this single center retrospective study, we reviewed clinical data from 100 consecutive infants (0-1 years) presenting with BRUE, of which 32 infants had PSG performed as part of workup.

Results
Age ranged from 12 days to 7 months: median age being 3 months. 23 out of 32 infants presented with apnea while 6 infants presented with change in color. 24 infants had obstructive sleep apnea (OSA); 3 infants had mixed sleep apnea; 3 infants had central sleep apnea (CSA) and 2 were normal. 10 infants had severe OSA, 9 had moderate OSA while 5 had mild OSA. Most common clinical diagnoses in our cohort were gastro-esophageal reflux disease (GERD) (17 infants) and laryngomalacia (8 infants). In our cohort, infants with GERD and laryngomalacia had higher AHI overall.

Conclusion
Though BRUE is a transient event, it is frightening to the observer leading to significant anxiety to parents. Because of the diverse presentations, causes, and prognoses of infants presenting with acute events, evaluation and management should be individualized. The clinical challenge is to identify the infants who may benefit from further testing and prolonged observation, while avoiding unnecessary testing. In our cohort, most of the infants presenting with BRUE did not undergo PSG. But among those who had PSG, it showed significant findings in infants which led to further intervention. PSG can be a useful non-invasive tool in the workup of selected infants with BRUE combined with clinical judgement. A normal PSG can also allay anxiety and be extremely reassuring for parents.

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