bluuebunny/crossref_metadata_2025_split huggingface dataset:
0864 Sleep Prior to Cardiac Arrest Is Associated with Physical Health-Related Quality of Life Early in Recovery
Authors: ten Brink Maia , Vargas William , Nieto Camila Dominguez-Imbert , Rojas Danielle , Cruz Gaspar , Shechter Ari , Agarwal Sachin , Birk Jeffrey 
Published: April 2024

Abstract

Introduction
Poor sleep increases risk of sudden cardiac arrest (CA). Survivors of hospital stays experience lasting sleep issues, and poor post-hospitalization sleep is associated with lower health-related quality of life (HRQoL) during recovery. It is unknown, however, whether better pre-CA sleep may serve as a premorbid asset that may prospectively predict HRQoL during early recovery beyond post-CA sleep.

Methods
In this interim analysis of an observational cohort study, 129 CA survivors were recruited from a large urban hospital. Upon discharge, patients reported on sleep in the month before their CA using the Pittsburgh Sleep Quality Index (PSQI). Post-CA physical function regarding activities of daily living was assessed via the Physical Self-Maintenance Scale. Demographic and CA severity variables were collected from medical records. A month later, patients reported on their HRQoL using the 36-item Short Form (SF-36) and post-CA sleep with the PSQI. We hypothesized that worse premorbid sleep quality (global PSQI score) would be associated with worse physical and mental HRQoL component scores (SF-36 PCS and MCS) at 1 month.

Results
Worse premorbid sleep (M = 8.67, SD = 4.03) was associated with worse PCS 1-month post- discharge (B = -0.68, p &lt; .01), after adjusting for sex at birth, age, ethnicity, and time from CA to return of spontaneous circulation, an index of CA severity. Premorbid sleep was still a significant predictor (B = -0.58, p =.02) after adjusting for patients’ physical function at discharge and sleep one month later (M = 7.67, SD = 4.62). However, worse premorbid sleep was not significantly associated with worse MCS after adjusting for the same covariates (B = -0.50, p = .07). This remained non-significant controlling for physical function at discharge and sleep quality after a month (B = -0.22, p = .49).

Conclusion
These results suggest that people’s sleep before suffering a CA may predict their post-CA physical HRQoL, in ways that are at least partially independent from CA severity, physical function at discharge, and post-CA sleep. Future research should identify mechanisms (e.g., inflammation) by which a reserve of quality sleep improves post-CA physical recovery.

Support (if any)
This research was supported by NHLBI grants R01-HL151850 and R01-HL153311.
0865 Sleep Symptoms Associated with Glycohemoglobin in the General US Population: Data from NHANES
Authors: Anthony Gaby , Kennedy Kathryn , Killgore William , Grandner Michael 
Published: April 2024

Abstract

Introduction
Previous studies have linked insufficient sleep duration and sleep apnea to the development of Type-2 diabetes but few studies have explored associations between objective diabetes risk and other sleep symptoms in a general population sample.

Methods
Data were obtained from adults age 20 or older from the NHANES 2017-2020 prepandemic waves. Glycohemoglobin (assessed as HbA1c%) was measured using standard procedures on blood specimens obtained from a nationally-representative sample. Sleep symptoms assessed included general daytime sleepiness, sleep disturbance (frequency of difficulty falling asleep or staying asleep or sleeping too much), daytime tiredness, snoring, and choking/gasping during sleep. Linear regression analyses with HbA1c% as dependent variable were weighted using NHANES population weights. Secondary analyses explored whether these relationships depended on a previous diabetes diagnosis.

Results
In population-weighted analyses adjusted for age and sex, elevated A1c% was associated with frequent sleepiness (B=0.16, 95%CI [0.04,0.27]), sleep disturbance (B=0.18, 95%CI [0.09,0.27]), daytime tiredness (B=0.11, 95%CI [0.01,0.21]), snoring (B=0.25, 95%CI [0.17,0.33]), and choking/gasping (B=0.25, 95%CI [0.11,0.39]). After further adjustment for race/ethnicity, education, BMI, smoking, and sedentariness, relationships were still significant but attenuated for sleepiness (B=0.14), sleep disturbance (B=0.13), snoring (B=0.11), and choking/gasping (B=0.15). After final adjustment for sleep duration, relationships were still significant for sleepiness (B=0.13), sleep disturbance (B=0.12), snoring (B=0.11), and choking/gasping (B=0.15). No significant sleep-by-diabetes interactions were found.

Conclusion
General sleep symptoms experienced by many in the population are associated with objective risk for metabolic disease. Sleep health interventions aimed at these symptoms in general population samples may reduce this risk.

Support (if any)
0866 Prevalence of Obesity in Obstructive Sleep Apnea Within a Large Community-based Cohort of Middle-aged/Older Adults
Authors: Esmaeili Neda , Gell Laura , Taranto-Montemurro Luigi , Messineo Ludovico , Imler Théo , Sands Scott , Yee John , Cronin John , Wellman Andrew , White David P , Heinzer Raphael , Redline Susan , Azarbarzin Ali 
Published: April 2024

Abstract

Introduction
Obesity is a well-known risk factor for obstructive sleep apnea (OSA), gaining interest due to the global rise in obesity and novel obesity drugs. The rationale behind this lies in the role of obesity in the pathophysiology of OSA. However, many OSA patients are non-obese, and the association between obesity and OSA may vary by age and sex. Past population studies largely reported the prevalence of OSA according to different obesity categories. In this study, we sought to determine the prevalence of obesity across different levels of OSA severity, age, and sex.

Methods
The analytic sample included individuals with OSA from the Sleep Heart Health Study (SHHS). OSA severity was quantified using the apnea-hypopnea index (AHI4; apneas plus hypopneas with at least 4% oxygen desaturation per hour). Individuals were stratified by the severity of OSA (mild: 5≤AHI4&lt; 15; moderate: 15≤AHI4&lt; 30; severe: AHI4≥30 events/hour), body mass index (BMI), age, and sex.

Results
A total of 2950 of 5749 participants in SHHS had OSA (AHI4≥5 events/hour; 1729/788/433 mild/moderate/severe). Of these, 40.6% were female; mean±SD age was 65.3±10.7 years; and median [interquartile range] BMI was 28.8 [25.8; 32.3] kg/m2. For those with any OSA, 60.6% were non-obese (BMI&lt; 30 kg/m2) and 39.4% were obese (BMI≥30 kg/m2). Across OSA severities, 34.1% of mild, 42.6% of moderate and 54.3% of severe OSA were obese. A greater proportion of younger adults (&lt; 65 years) with OSA were obese (48.3%) than older adults (≥65 years) with OSA (30.9%). In older adults 26.7% of mild, 34.5% of moderate and 40.3%of severe OSA were obese. Finally, a greater proportion of females with OSA were obese (43.6%) than males with OSA (36.5%).

Conclusion
The majority of middle-aged/older adults with OSA are non-obese. The association between obesity and OSA varies by age and sex, with a higher prevalence of obesity in younger adults and in females with OSA. Additional analyses of data from the Multi-Ethnic Study of Atherosclerosis, the Osteoporotic Fractures in Men study, and the HypnoLaus study are being conducted to establish the association between OSA and obesity within other community-based samples.

Support (if any)
NHLBI R01HL153874, R35HL135818 and unrestricted grant support from Apnimed.
0872 Sleep-Disordered Breathing Is Associated with Endothelial Dysfunction in Adults
Authors: Savin Kimberly , Erickson Alexander , Pandya Nishtha , Mungarwadi Monica , Zollner Sophia , Liu Peter , Martin Jennifer , Badr M Safwan 
Published: April 2024

Abstract

Introduction
Short sleep duration and obstructive sleep apnea (OSA) are associated with increased rates of cardiovascular disease. Vascular inflammation and endothelial dysfunction are potential mechanisms for this association but can be burdensome or impractical to measure in clinical settings. Other characteristics of sleep health, such as sleep quality, insomnia symptoms, and daytime sleepiness, are infrequently studied in relation to endothelial function. The current study investigated the association between multiple dimensions of sleep health (apnea hypopnea index (AHI), insomnia symptoms, sleep quality, and daytime sleepiness) and endothelial dysfunction using peripheral arterial tonometry (PAT; EndoPAT, Itamar Medical).

Methods
Participants (N=43) with mild-to-moderate OSA, completed a baseline assessment including demographics, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). OSA severity was measured with AHI from one night of PSG (home or in-lab). Microvascular endothelial function was assessed using EndoPAT. The hyperemic response was measured following upper arm occlusion and the reactive hyperemia index (RHI) was calculated. Cross-sectional associations of sleep (ISI, PSQI, ESS, AHI), demographic characteristics (age, sex) and BMI with the natural log of RHI (used due to non-normality) were examined using linear regression models.

Results
In the study sample, mean (SD) age = 54.4 (12.6) years, 63% were female and 77% identified as Black race. Higher AHI (b = -.015. SE = .01, p =.03) and older age (b = -.01. SE = .003, p =.005) were significantly associated with lower RHI, indicating worse endothelial function. ISI, PSQI, ESS, sex, and BMI were not significantly associated with RHI (p’s&gt;.05).

Conclusion
This study identified an association between OSA severity (higher AHI) and greater endothelial dysfunction, using the novel non-invasive EndoPAT, and null associations with other self-reported sleep characteristics. The study was underpowered to include covariate adjustment or interaction terms, but future studies with larger samples and studies examining potential benefits of OSA treatment on endothelial function are needed.

Support (if any)
R01HL146059, K24HL143055, K24HL13632. EndoPAT device provided by ZOLL Itimar.
0876 Obstructive Sleep Apnea Is Associated with Poor Cardiometabolic Markers in Type 1 Diabetes
Authors: Kessler Aleeza , Danyluk Alexandria , Tuna Kubra , Chagani Fatima , Hadigal Susheela , Leey Julio 
Published: April 2024

Abstract

Introduction
In patients with Type 2 diabetes (T2D), obstructive sleep apnea (OSA) is associated with worse cardiometabolic risk factors. Whether the same occur in Type 1 Diabetes (T1DM) has not been well established.

Methods
Retrospective cross-sectional study, we assessed T1D patients from our endocrinology clinic between 2015-2022, who had a sleep study done in the Sleep Center. We compared the groups for diabetes duration, glycemic control, complications, and metabolic profile. An unpaired t-test was performed for comparison of means, chi-square test for nominal data, and a p-value of P&lt; 0.05 was considered statistically significant.

Results
We identified 55 patients with T1D and a sleep study, 33 had OSA based on sleep report and 22 did not. Both groups had similar diabetes duration, BMI, micro and macrovascular complications. Hypertension and dyslipidemia were more frequent in the OSA group (P&lt; 0.05). A1C values were similar between OSA and non-OSA groups (7.5% vs 7.9%). Total daily insulin dose per kilogram was similar too (0.42 vs 0.30). Of the 14 patients with a follow up visit after initiation of PAP therapy, A1c levels remained unchanged before and 3-6 months after PAP initiation (7.7% vs. 7.0%, P=0.25), however, 57% of them improved their A1c level, and only 21% worsened. The OSA group had higher triglycerides (mean 142mg/dl vs 81.7mg/dl, P=0.003) and lower HDL (mean 44.5mg/dl vs 62.7mg/dl, P=0.06) despite similar A1c levels. In terms of liver fibrosis, an FIB-4 score &lt; 1.3 was considered low risk based on ADA guidelines, and we found 14 out of 33 patients in the OSA group (42%) and 4 out of 22 patients in the non-OSA group (18%) had &gt;1.3, (P=0.06).

Conclusion
In patients with T1DM, OSA is associated with metabolic features consistent with insulin resistance: trends towards higher BMI, insulin needs and worse lipid profile, despite similar A1c levels. The glycemic impact of OSA treatment in T1DM requires further investigation.

Support (if any)
Supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0881 Impact of Statin Withdrawal on Sleep Quality
Authors: Peyrel Paul , Bergron Jean , Sériès Frédéric , Laflamme Nathalie , Mauriège Pascale , Joanisse Denis 
Published: April 2024

Abstract

Introduction
Statins are benchmark lipid-lowering drugs, reducing blood cholesterol by controlling its synthesis. There are side effects linked to statins use, including statin-associated muscle symptoms (SAMS). These symptoms typically include myalgia, stiffness, weakness, fatigue and/or cramps. SAMS can lead to a reduction in muscle performance, as well as an altered health-related quality of life. Nevertheless, the potential effects of SAMS on sleep remains poorly documented. The objective of this exploratory work was to assess if measures of sleep disturbances and its consequences improve after drug withdrawal in SAMS self-reporters.

Methods
Patients (5 men [M] / 3 women [W], 44.8±6.3 yrs.) in a primary cardiovascular prevention cohort composed two groups: statin users with (SAMS, 2M/2W) or without symptoms (No SAMS, 3M/1W). All patients were required to have a low cardiovascular risk over ten years (i.e. Framingham Risk Score &lt; 10%) and were using different types and doses of statins for more than two months. Sleep was measured objectively by actigraphy and subjectively using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Finally, a 10-point visual analog scale (VAS) was used to self-assess the intensity of SAMS, specifically at night. Measures were taken before and after two months of statins withdrawal.

Results
After withdrawal, we observed an improvement of objective sleep quality in the SAMS group (sleep efficiency: +3.79%, effect size [ES]: 0.33 [small effect]; wake after sleep onset: -15.6%, ES: -0.30 [small effect]; number of awakenings after sleep onset: -12.7%, ES: -0.45 [small effect]), concurrent with a decrease of subjective perception of SAMS intensity at night (VAS, from 4.5 to 1.0, ES: -0.79 [moderate effect]). A decrease of subjective daytime sleepiness (ESS, from 11.3 to 8.3, ES: -0.45 [small effect]) and an increase of subjective sleep quality (PSQI, from 7.66 to 6.33, ES: -0.31 [small effect]) were also seen in this group. On the other hand, the No SAMS group showed no change after drug withdrawal for any of the different objective and subjective sleep parameters (ES: -0.08 to 0.15 [trivial effects]).

Conclusion
Our preliminary data suggest that SAMS are associated with sleep disturbances and impaired sleep quality.

Support (if any)
0885 Exploring Sleep Health in the Context of COPD and Obesity: Insights from a Population-Based Cross-Sectional Study
Authors: Manuel Rachel , Khan Safia , Thakur Bhaskar 
Published: April 2024

Abstract

Introduction
Many individuals with obstructive lung disease such as COPD suffer from sleep disturbances. Poor sleep quality is related to disease severity. COPD has been associated with obesity in a bidirectional manner, though few studies have examined the interaction between COPD, obesity, and aspects of sleep health including quality and duration. This study aims to examine if decreased sleep duration and trouble sleeping are associated with increased risk of COPD and obesity.

Methods
Using data from three consecutive rounds of the National Health and Nutrition Examination Survey (2013-14, 2015-16, and 2017-18), a cross-sectional analysis was conducted. Sleep quality was assessed through the survey by inquiring if subjects experienced trouble sleeping. Sleep duration was categorized into normal (7-8 hours of sleep), short (&lt; 7 hours of sleep), and long (&gt;8 hours of sleep). Weight was categorized into normal weight, overweight, obese, and severely obese. Poisson regression and multinomial logistic regression analyses were used. Adjusted incidence rate ratio (aIRR) and adjusted relative Risk Ratios (aRRR) with their 95% CI were reported.

Results
The total sample size was 16,939, with females comprising the majority (52%), and ages ranging from 20 to 80 years. Those with COPD were more likely to report trouble sleeping (aIRR 1.48, p &lt; 0.001). Obese and severely obese groups were also associated with trouble sleeping (aIRR 1.27 and 1.50 respectively, p &lt; 0.001). An increased likelihood of trouble sleeping (p &lt; 0.001) was observed among individuals with COPD and overweight (aIRR 1.54), obesity (aIRR 1.89), and severe obesity (aIRR 1.97). COPD was also found independently associated with long sleep duration (IRR 1.50, p &lt; 0.004); however, in the same model, severely obese groups were significantly associated with shorter sleep duration (aRRR: 1.39, p: 0.002).

Conclusion
In the current study, COPD was associated with long sleep duration and trouble sleeping. Increasing obesity was associated with short sleep duration and trouble sleeping, consistent with previous findings that sleep deprivation likely contributes to obesity.

Support (if any)
0888 Characterization and Outcomes in Patients with Bronchiectasis and Obstructive Sleep Apnea with PAP Therapy
Authors: Baskaran Berty , Ahmed Nayla , Arias-Sanchez Pedro , Aksamit Timothy , Escalante Patricio 
Published: April 2024

Abstract

Introduction
Bronchiectasis (BE) is characterized by recurrent infections and dilated airways and has been associated with recurrent exacerbations and hospitalizations affecting quality of life. Approximately 40-60% of patients with BE have concomitant OSA, with an increased AHI (apnea-hypopnea index) in BE patients with Pseudomonas infections. We hypothesize that patients with BE are less tolerant of PAP therapies, contributing to worsening quality of life related to either condition. We aim to determine differences in PAP adherence and treatment response in patients with BE and OSA compared with a matched OSA-control group.

Methods
A retrospective cohort analysis was conducted on adult patients evaluated at Mayo Clinic Center for Sleep Medicine between January 2000 to December 2020. Inclusion criteria were patients greater than 18 years old diagnosed with BE and OSA per current guidelines and were prescribed PAP therapy. Control OSA patients were matched to BE/OSA patients by gender, BMI, and AHI severity. Exclusion criteria included cystic fibrosis, hospice enrollment, active lung transplant evaluation, and lack of sleep clinic follow-up. Follow-up visits determined PAP compliance and change in quality-of-life metrics over 3 years.

Results
We compared 50 patients with BE/OSA with 74 OSA matched controls. The etiology of BE in these cases included COPD (32%) or other etiologies (34%). Baseline characteristics were not statistically different in gender, BMI, and AHI severity across groups. Median treatment follow-up for the BE/OSA group was 3 years [IQR 2 to 4]. Importantly, there was no statistically significant difference in PAP adherence in patients with BE/OSA compared to OSA controls regardless of etiology of BE, but these patients more often required supplemental oxygen therapy. Interestingly, there was a statistically significant increase in MRC and decrease in FEV1 over time in BE patients compliant to therapy.

Conclusion
There was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence, except for need of oxygen supplementation in BE patients with OSA compared with matched non-BE OSA controls. FEV1 values decreased, and dyspnea score increased in BE patients compliant to PAP therapy; however, future larger studies should include longer-term follow-up to further assess the impact of PAP therapy on BE progression and outcomes.

Support (if any)
0897 The Relationship Between Marital Satisfaction and Sleep
Authors: David Michelle , Shurovi Sumayya , Cornelius Talea , Schwartz Joseph , Abdalla Marwah 
Published: April 2024

Abstract

Introduction
Relationship quality impacts health outcomes. Individuals with high marital satisfaction report having better health than those with low marital satisfaction (MS). How marital satisfaction may impact sleep health is unclear. We examined if MS is associated with subjective sleep quality and sleep duration among working adults.

Methods
The Worksite Blood Pressure Study is a multi-site study investigating psychological factors and ambulatory blood pressure. The study recruited 472 participants without major cardiovascular disease from 10 New York City worksites during 4 waves over 11 years. At Wave 4, participants completed the Dyadic Adjustment Scale (DAS), which assesses MS, and a sleep questionnaire derived from the Sleep Heart Health Study. Weekday sleep duration was reported using a one-time sleep diary. For this analysis, 20 items from the DAS were summed to create a sum score with higher scores indicating greater MS. Items assessing sleep quality were averaged (higher scores indicated worse sleep quality). The current analysis was restricted to 188 married participants at Wave 4 with complete data. Linear regression models were specified predicting (1) sleep quality and, separately (2) sleep duration from marital satisfaction. Covariates were age, sex, race/ethnicity, family income, and number of children in the home.

Results
Of the 188 participants, 91.0% were male, 7.5% were Black, and 4.8% were Hispanic/Latinx. Participants reported a median of 2 children living in the home and a median family income of $80,000-$89,999. Mean age was 53.0 years (SD = 8.0 years), mean marital satisfaction was 60.5 (SD = 13.2), mean sleep quality was 8.1 (SD = 4.2), and mean sleep duration was 6.5 hours/night (SD = 1.1 hours). Greater MS was significantly associated with better sleep quality (B = -0.09, 95% CI -0.13, -0.04, p &lt; 0.001) but not with sleep duration (B = -0.00, 95% CI -0.02, 0.01, p = 0.47).

Conclusion
Greater MS was associated with better sleep quality; however, MS was not associated with sleep duration. Whether targeted interventions focusing on improving MS lead to improvements in sleep quality and/or sleep health is an area of active research.

Support (if any)
P01HL47540, NIH/NHLBI K23HL141682