bluuebunny/crossref_metadata_2025_split huggingface dataset:
1056 Medical Record Alert to Increase PAP Use in Hospitalized Patients on Home PAP for Sleep Disordered Breathing
Authors: Grom Jennifer , Johnson Karin , Rastegar Vida 
Published: April 2024

Abstract

Introduction
Many patients with sleep disordered breathing (SDB) on home positive airway pressure (PAP) therapy are not ordered for PAP treatment when hospitalized. Our quality improvement project evaluated whether establishing an electronic medical (EMR) alert to place PAP orders on patients with home PAP for SDB, could be successfully implemented and lead to an increase in PAP ordering in hospitalized patients.

Methods
In April 2021 the nursing intake assessment was changed to ask if patients had SDB and used PAP at home. In September 2021, an EMR alert was implemented and triggered when a physician or advanced practice provider opened the chart of a patient on home PAP use if PAP therapy was not already ordered. We conducted a retrospective chart review to compare rates of PAP ordering for hospitalized patients with SDB on domiciliary PAP before (August 2021), during (9/7/2021-9/11/2021), and after (October 2021) implementation of an EMR alert. We included all patients admitted to medical and surgical wards of Baystate Medical Center. We excluded patients admitted to ICU and patients who had contraindications to PAP therapy including encephalopathy or vomiting.

Results
The alert was discontinued after 4 days due to hospitalist feedback that receiving the alert when the chart was first opened was disruptive to workflow. We were unable to link the alert to later steps in the workflow. Rates of PAP orders were 61.4% (148/241, 95% CI: 54.9, 67.6), 66.7% (28/42, 95% CI: 50.5, 80.4), and 65.6% (168/256, 95% CI 59.4, 71.4), respectively. Patients admitted to observation unit were prescribed PAP 46.7% (21/45), 71.4%(5/7) and 55.6% (25/45), respectively. Patients on surgical units were prescribed PAP 63.0% (29/46), 75% (6/8), 70.2% (40/57), respectively. Patients on medical units were prescribed PAP 65,3% (98/150), 63.0% (17/27), 66.9% (103/154), respectively.

Conclusion
An EMR alert for providers to prescribe in-hospital PAP therapy for patients on home PAP therapy may increase rates of PAP ordering, but implementation must be congruent with provider workflow. Although surgical and observation units had larger increases in PAP ordering with the alert, variability may due to small sample size so further evaluation is needed. Further studies are needed to optimize alert type and timing and assess utility.

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0106 Cognitive-Emotional Features of Insomnia Phenotypes Based on Objective Sleep Duration in Young Adults
Authors: Atha Raegan , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio 
Published: April 2024

Abstract

Introduction
The association of insomnia with adverse mental health outcomes is well-established. Prior research has suggested that cognitive-emotional predisposition to mental health disorders is shared across insomnia phenotypes. However, no study to date has examined this association in insomnia phenotypes based on objective sleep duration in young adults.

Methods
We studied 270 young adults (median 25 years, 53% female, 24% racial/ethnic minority) from the Penn State Child Cohort who underwent a 9-hour polysomnography (PSG) recording, clinical history, and self-report surveys. Insomnia symptoms were defined as difficulties initiating or maintaining sleep, an insomnia diagnosis or complaint, and/or sleep medication use. PSG-measured short sleep duration was defined by the median of the sample (i.e., &lt; 7-h), identifying normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and insomnia with short sleep duration (ISSD). Participants completed the Ford Insomnia Response to Stress Test (FIRST), Arousal Predisposition Scale (APS), Personality Inventory for DSM-5 (PID-5-BF), Pre-Sleep Arousal Scale (PSAS), and Depression, Anxiety, and Stress Scale (DASS). A multivariate general linear model tested mean differences in cognitive-emotional outcomes across the four groups, while adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, medication and substance use.

Results
Compared to NSD or SSD, both INSD and ISSD showed significantly higher FIRST (Ps&lt; 0.001), APS (Ps&lt; 0.05), PID-5-BF (Ps&lt; 0.01), PSAS (Ps&lt; 0.001), and DASS (Ps&lt; 0.05) scores, except in the PID-5-BF antagonism and disinhibition trait domains. SSD showed significantly higher FIRST scores compared to NSD (P&lt; 0.05), but no other significant differences were observed on any other scale between SSD and NSD.

Conclusion
Sleep reactivity, cognitive-emotional arousability, internalization, and negative affectivity are trait features of insomnia, which help perpetuate its chronicity and put all phenotypes at risk of adverse mental health outcomes. These data also suggest that sleep reactivity may be a trait present in a subset of short sleepers at risk of developing insomnia.

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NIH (R01 HL136587, R01 MH118308, UL1 TR00127)
1061 Improving Access to Pediatric Sleep Service by Utilizing Unique Electronic Medical Record Based Informatic Tools
Authors: Shah Vaishal , Sulaj Holta , Hane Caprielle 
Published: April 2024

Abstract

Introduction
Fragmented scheduling processes, workforce shortage and limited resources affected patient care and hindered access to pediatric sleep services. Between 40-60% pediatric sleep consult orders remained unscheduled at the Cleveland Clinic's Sleep Disorder Center every month in 2019 and 2020. We aimed to reduce unscheduled pediatric sleep consult orders and improve access by utilizing unique automated electronic medical record (EMR) based informatics tools.

Methods
Several key steps were implemented via a systematic A3 project charter utilizing continuous improvement methods. Unique informatics tools including ticket schedule via my chart patient portal, automated calling and messaging system for scheduling prompts, simplified scheduling templates and efficient electronic monitoring system was developed and implemented via Epic Hyperspace EMR system between 2020-2022.

Results
Key outcomes accomplished: 1. Visual scheduling report system/dashboard 2. Electronic workflow for schedulers 3. Automated patient driven ticket scheduling via patient record portal and embedded EMR questionnaire. 4. By December, 2022, 88% of consult orders were scheduled at a scheduling rate of &gt;80% every month 5. By October 2023, 93% of order were scheduled per month 6. Up to 52% of all patients scheduled visits via automated scheduling system 7. Several patients/families subjectively reported positive experience and high satisfaction utilizing automated system or traditional scheduling 8. Significant amount of time spent on scheduling for patient and health care team was saved.

Conclusion
Despite several challenges during COVID pandemic including loss of personnel, limited resources, frustrating processes, and constant changes in the course this continuous improvement project achieved very high level of scheduling in unique and innovative manner and helped significantly improve access to much needed pediatric sleep care. Such tools can be replicated within and at other health care organizations with exponential impact on access to pediatric sleep services.

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None
1063 Predictors of Insufficient Treatment Response to Digital CBT-I: Results from the RESTING Study
Authors: Solomon Natalie , Gumport Nicole , Tully Isabelle , Simpson Norah , Manber Rachel 
Published: April 2024

Abstract

Introduction
Triaged stepped-care approaches start patients in either lower or higher intensity of treatment based on participant characteristics, switching patients who demonstrate insufficient progress in lower intensity treatment to higher intensity treatment. The purpose of the present study was to investigate characteristics of participants who were predicted to benefit from lower intensity treatment (digital CBT-I [dCBT-I]) and made insufficient progress following two-months of dCBTI, compared to similar participants who made sufficient progress.

Methods
Participants were 101 adults aged 50 or older who were triaged to begin treatment with dCBT-I as part of the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Specifically, these participants had to have taken sleep medications &lt; 4x/week, score below clinical cutoffs for moderate-severe mental health comorbidity and daytime sleepiness, and sleep &gt;4.5hrs/night on average. T-tests were used to compare baseline characteristics of participants who made insufficient progress after two months of dCBT-I to those who made sufficient progress. Sufficient progress was defined as ISI ≤ 10 or reduction of at least 50% in sleep medication use.

Results
Those with insufficient progress in dCBT-I (N= 74) had higher insomnia severity index (ISI) scores at baseline than those with sufficient progress in dCBT-I (p=.002, d=.70). There were no significant differences in terms of baseline Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scores (p=.39), chronotype (Morningness-Eveningness Questionnaire: MEQ; p=.32) or sleep medication use (p=.39); effect sizes for the differences were small (d=.19-.23). Further, there was no significant difference in the number of digital modules completed (p=.13, d= .35) between those who did and those who did not make sufficient progress.

Conclusion
Only greater insomnia severity at baseline was a significant predictor of insufficient treatment response among participants who were triaged to begin treatment with dCBT-I. Further research is needed to determine if insomnia severity alone or when combined with the RESTING study triage algorithm will improve the identification of those likely to benefit optimally from dCBT-I.

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R01AG057500
1065 Preliminary Findings of a Pilot Clinician Training Program to Integrate Digital CBTi into Routine Therapy
Authors: Gumport Nicole , Tully Isabelle , Stirman Shannon Wiltsey , Manber Rachel 
Published: April 2024

Abstract

Introduction
Many patients who enter treatment for mental health problems experience insomnia symptoms that may hinder their response to general mental health treatment. There is also a shortage of CBTi providers in the United States and worldwide. One method to address the paucity of CBTi providers is to integrate digital CBTi (dCBTi) into general psychotherapy, which, on its own, does not sufficiently address insomnia symptoms. This approach is likely to improve sleep and potentially also mental health outcomes. Integrated dCBTi provides the patient with support around adherence and engagement. This study aims to pilot test and refine a program for training licensed therapists to support their patients undergoing dCBTi. This integrated approach is novel and yet to be tested.

Methods
Licensed therapists participate in a 4-hour training. Therapists subsequently enroll 1-2 patients with insomnia symptoms and comorbid depression and/or anxiety to receive integrated dCBTi. Therapists complete measures evaluating the training. At each psychotherapy session, therapists complete a checklist documenting which elements of the integrated dCBTi support they provide and how much time they spend doing so. Patients complete the Insomnia Severity Index, the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders, and qualitative measures about their experience of integrated dCBTi after receiving integrated dCBTi.

Results
As of December 2023, 11 therapists are enrolled and patient enrollment is ongoing. After the training, therapists rated that they were “well-prepared” to integrate dCBTi into their routine practice, and 100% indicated that they would recommend this training. Regarding the content of dCBTi, therapists expressed understanding of the value of time in bed restriction and importance of monitoring the patient’s engagement and progress continuously. Therapists also noted an improved ability to present the rationale for CBTi components and to answer patient questions about dCBTi. Post training data, including patient data, will be available by June 2024.

Conclusion
The integration of dCBTi in general psychotherapy through brief training of licensed therapists may be a viable approach to improve access to CBTi for patients with comorbid depression and/or anxiety.

Support (if any)
Sleep Research Society Foundation Career Development Award 035-JP-22 and T32MH019938
1068 Sleep Education and Awareness Among Social Workers: A Nationwide Study
Authors: Spadola Christine , Raval Minjaal , Zhou Eric 
Published: April 2024

Abstract

Introduction
Social workers are frontline behavioral health clinicians and comprise the majority of the mental health workforce. As poor mental health often co-occurs with inadequate sleep and sleep disorders, social workers can play a pivotal role in promoting sleep health among their patients as well as provide referral and treatment options if a sleep disorder is suspected. However, the Council on Social Work Education (CSWE) does not mandate sleep education in the social work curricula. There is little knowledge about how much training social workers have received about sleep. This study aims to investigate the state of sleep health education and sleep health awareness among social workers.

Methods
Recruitment emails were sent to licensed social workers across the US, through national social work organizations and faculty listservs. Eligibility criteria included being a licensed social worker in the US and ability to read and write in English. Respondents were queried about the extent of their sleep health training and clinical practice in this domain using QuestionPro software.

Results
A total of 363 social workers, predominantly female (72.4%) and non-Hispanic white (76.2%) participated. Most (62.0%) reported not receiving any sleep education during their formal social work training. Among those reporting sleep education during their graduate studies, the average duration was 3.3 hours (SD=2.8). Many social workers (67.9%) reported receiving formal sleep education post-licensure (mean=7.0 hours; SD=6.5). Few participants (2.8%) reported confidence in recognizing insomnia disorder, and only half (50.2%) were aware that CBT-I is an evidence-based treatment for insomnia. Despite this, a majority (80.0%) reported discussing sleep with their patients during treatment. Most social workers (84.0%) reported interest in learning more about sleep health.

Conclusion
The majority of social workers did not receive sleep education during their formal graduate studies, with many seeking to address this deficit following professional licensure. Only a small fraction of social workers report confidence in recognizing sleep disorders, which can impact proper referral and treatment of sleep disorders. Considering the relationship between sleep and mental health, promoting sleep health education and awareness in educational programs for behavioral health clinicians can have important implications for overall health promotion.

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1069 The Effects of Formal Sleep Medicine Didactics on Family Medicine Residents’ Confidence with Sleep Disorders
Authors: Tripathi Poulomee , Gottschalk Ginny , Wani Anna , Alla Rupini 
Published: April 2024

Abstract

Introduction
Exposure to sleep medicine education in ACGME accredited parent specialties of sleep medicine is scarce and varied. Literature states sleep-related didactics average 4.75 hours per year; less than 10% of programs have graduates pursuing sleep medicine fellowship. In the last five years at University of Kentucky’s Family and Community Medicine residency (UK FM), only 4 of 1200 hours of didactics (less than 1%) have been dedicated to sleep. Lack of sleep education during residency leads to patient care gaps, and deficiency of exposure to this field dissuades trainees from pursuing sleep fellowship. To understand UK FM residents’ opinions of sleep medicine, a survey was distributed before and after a formal lecture series.

Methods
Google surveys were disseminated via text message to residents. Submissions remained anonymous. The pre- and post-lecture surveys had congruent questions about sleep education, sleep disorder management, and tested knowledge about sleep disorders. The lecture series had three one-hour lectures during didactics. One week after the last lecture, the post-survey was disseminated. Results were then compared.

Results
The current cohort is comprised of 17 residents. Response rate was 94% for the pre-survey and 76% for the post-survey. After lectures, 46% agreed they had adequate education and understanding of sleep medicine compared to 0% before. Regarding managing specific disorders, more residents answered they had higher comfort after the lectures. Majority of the residents (&gt;50%) answered 2/3 knowledge questions correctly after the lecture series. Overall trends indicated increased confidence and knowledge after the lectures.

Conclusion
By simply increasing sleep education didactics by 3 hours through this project, the total percentage of sleep didactics in resident education was tripled. This increased confidence and competency of residents in sleep education. Our study highlights the current gaps in resident education related to sleep, the need to increase sleep didactics in sleep medicine feeder residencies, and ultimately how this education increases resident confidence and competency in sleep management.

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0107 Bedtime Procrastination Mediates the Association Between Repetitive Negative Thoughts and Insomnia Symptoms
Authors: Carlson Steven , Williams Paula 
Published: April 2024

Abstract

Introduction
Introduction. Several studies have demonstrated that bedtime procrastination, or the tendency to delay bedtime in the absence of external obligations, is associated with insomnia. However, there is a lack of research on the role of bedtime procrastination in the development of insomnia symptoms. Consistent with the cognitive model of insomnia, bedtime procrastination may serve the purpose of avoiding repetitive negative thoughts associated with bedtime. Accordingly, the present study sought to evaluate the role of bedtime procrastination in the association between proneness to repetitive negative thoughts and insomnia using data from a daily diary evaluation of sleep in young adults.

Methods
Methods. 521 young adult participants (Mage = 24.6, SD = 6.9) completed baseline measures of worry (Penn State Worry Questionnaire) and rumination (Rumination-Reflection Questionnaire) tendencies, in addition to the Insomnia Severity Index. Participants additionally completed 14-days of experience sampling assessment, including self-report measures of nightly pre-sleep arousal and morning sleep diaries and ratings of prior-night bedtime procrastination. Structural equation models were constructed to identify the serial-mediation effect of worry and rumination on insomnia symptoms through pre-sleep arousal and bedtime procrastination.

Results
Results. Bedtime procrastination partially mediated the associations between rumination (β = 0.03, p = 0.006), worry (β = 0.02, p = 0.021), pre-sleep arousal (β = 0.06, p &lt; 0.001), and insomnia symptoms. Furthermore, pre-sleep arousal and bedtime procrastination serially mediated the associations between worry (β = 0.02, p = 0.001), rumination (β = 0.02, p = 0.001), and insomnia symptoms. Secondary analyses suggest that repetitive negative thought tendencies are associated with poor subjective sleep quality, whereas bedtime procrastination was associated with longer sleep onset latency, wake after sleep onset, and shorter sleep duration.

Conclusion
Conclusion. The current findings suggest that bedtime procrastination may be a relevant behavioral mechanism underlying the association between propensity for repetitive negative thoughts and insomnia symptoms. In these models, ESM-assessed bedtime procrastination, but not proneness to repetitive negative thoughts, was associated with poorer daily self-reported sleep outcomes. Individuals may procrastinate their bedtime to avoid sleep-related repetitive negative thoughts. Further research is needed to elucidate the role of bedtime procrastination in the development of insomnia symptoms.

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1072 Pulmonary Fellows Need More Sleep: A Sleep Disordered Breathing Curriculum for Pulmonary Fellows
Authors: Stone Blair , Newitt Jennifer , Strollo Patrick , Ali Mazen El , Maximous Stephanie 
Published: April 2024

Abstract

Introduction
Sleep medicine training in pulmonary and critical care (PCCM) fellowships varies widely. The lack of formal curriculum and local pilot data demonstrating limited mastery of sleep medicine concepts via typical clinical exposure prompted us to develop, implement, and evaluate a sleep disordered breathing curriculum for first year PCCM fellows.

Methods
This educational study utilizes a historical control pre-test post-test model. The intervention arm consists of first-year PCCM fellows (n = 7) who completed a 10-question evaluation prior to fellowship-level education. They participated in a novel curriculum and are completing the same test upon conclusion of the curriculum. The curriculum is based on five case vignettes covering obstructive sleep apnea, obesity hypoventilation and sleep disordered breathing in COPD, heart failure, and neuromuscular disease. The control arm is comprised of PCCM fellows (n = 6) who have not had exposure to the SDB curriculum. They completed the evaluation at the conclusion of first year and at the beginning of their third year of fellowship. The evaluation was developed by local and national pulmonary and sleep medicine educators with expertise in question-writing.

Results
Test scores amongst the control group remained low at the end of first year of fellowship, with a mean score of 6/10 (60% +/- 8.9) and have remained low at the beginning of their third year of fellowship with a mean score of 5/10 (50% +/- 11.5%). When asked using a 5 point Likert scale (1=totally uncomfortable, 5=totally comfortable), to assess their comfort with the diagnosis and management of obstructive sleep apnea, the overall average response of 3.08 +/- 0.63 suggests limited comfort with these concepts. In regards to the intervention group, the mean pre-test score prior to beginning the curriculum was 3.71/10, (37.1% +/- 26.3%). Post-curriculum testing and data collection is ongoing with the intervention group, but preliminarily suggests an improvement in comfort level.

Conclusion
We suspect that the intervention group will demonstrate improved knowledge and comfort in the management of SDB. These results would suggest that our curriculum offers an opportunity to increase the number of pulmonologists who are able to care for the growing population of patients with SDB.

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