bluuebunny/crossref_metadata_2025_split huggingface dataset:
0906 Free-text Documentation of Sleep Disturbance in Acute Myeloid Leukemia: A Natural Language Processing Study
Authors: Jeon Bomin , Chae Sena 
Published: April 2024

Abstract

Introduction
Sleep disturbance in acute myeloid leukemia (AML) patients is usually linked to cancer-related fatigue, affecting quality of life. Although addressing sleep disturbance might prevent fatigue, it is often overlooked. Limited knowledge about healthcare clinician’s observations of sleep disturbance in AML patients hampers evidence-based interventions. To address this gap, this study identified sleep disturbance documentation in patients with AML from free-text narrative notes in electronic health record (EHR) using a natural language processing (NLP).

Methods
The sample consisted of 692 patients with AML, who received 2,064 encounters at Midwestern academic hospital. We followed a stepwise process using NLP. 1) Identify a preliminary list of synonyms based on (a) 57 common symptoms from a previous study; (b) relevant literature; and (c) “synonyms” category of the Unified Medical Language System. We developed and validated algorithms using the publicly available NLP system, NimbleMiner, then an NLP algorithm was applied to extract sleep disturbance documentation using 316,038 EHR narrative notes of AML patients. The overall accuracy to identify documentation of sleep disturbance was high, with F score = 0.97.

Results
In general, this study involves older AML patients (average age, 59 years) and male (57%). When applying the NLP algorithm, 543/692 (78.5%) patients and 1,255/2,064 (60.8%) encounters in this sample were identified as having notes with language describing sleep disturbance. The most common language describing sleep disturbance was sleeping medication (40.5%), such as melatonin, olanzapine, zolpidem. Additionally, around 30% of languages mentioned sleep disorders including insomnia and obstructive sleep apnea (OSA).

Conclusion
We have demonstrated the feasibility of identifying sleep disturbance from EHR narrative notes with NLP in AML patients. While using sleeping pills are found as a common treatment option for sleep disturbance, it is important to consider the established first-line treatment for insomnia (cognitive behavioral therapy) and OSA (continuous positive airway pressure). Utilizing NLP-generated symptom indicators can assist in identifying high-risk patients for targeted sleep interventions. The impact of sleep disturbance on health outcome in AML patients should be further evaluated.

Support (if any)
This study was funded by Center for Advancing Multimorbidity Science: NIH/NINR 1 P20 NR018081-01 (MPI: Gardner & Rakel)
0908 Pain in OSA Patients Is Modulated by Chronic Pain History and Sex
Authors: Guttmann Maxine , Dubrovsky Boris , Weingarten Jeremy , Miryala Nandini , Cunningham John 
Published: April 2024

Abstract

Introduction
Altered pain perception was found in OSA. However, the relationship remains unclear, possibly due to differential effects on pain of apnea-related sleep disturbance and hypoxemia, or other factors. This study examines the relationship between retrospective pain reports and PSG variables, sex, age, BMI, depression and insomnia questionnaires in patients referred for OSA evaluation.

Methods
From all in-lab patients between 08/2017 and 04/2021, 420 (259 women) were selected without significant cardiac, pulmonary, neurological, endocrine or psychiatric conditions; 136 had chronic pain conditions (CPC, e.g., fibromyalgia, arthritis, sciatica, musculoskeletal pain and similar). Patients filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Chronic Pain Grade Scale measuring pain intensity (CPGS-PI) and functional disability (CPGS-FD) in the preceding 6 months. CPGS-PI and CPGS-FD were outcomes in hierarchical backward regression models. Blocks of explanatory variables were: (1) age, sex, BMI; (2) AHI, SpO2-nadir, time below SpO2-90%, respiratory-related arousal index, (3) total sleep time, sleep latency, sleep efficiency, #awakenings, (4) CESDR, ISI, ESS, (5) OSA(AHI≥5), CPC presence, and sex-OSA-CPC interactions.

Results
Higher CPGS-PI was unrelated to the presence of OSA (AHI≥5, n=248), but was predicted by higher BMI (p=0.008), higher CESD (p&lt; 0.001), higher ISI (p=0.006), CPC presence (p&lt; 0.001), and CPC-by-sex interaction (p=0.005). Higher CPGS-FD was unrelated to OSA, but was predicted by higher BMI (p&lt; 0.001), higher CESD (p&lt; 0.001), higher ISI (p&lt; 0.011), CPC presence (p&lt; 0.001), and interactions CPC-by-OSA (p=0.017), CPC-by-OSA-by-sex (p=0.002). Analyzing the interaction terms, in the absence of CPCs OSA was unrelated to CPGS-FD, although women reported higher CPGS-FD (M=2.5±3.1) than men (M=1.4±2.3). Among patients with CPC, OSA had a differential effect on pain: women with OSA reported higher CPGS-FD (M=5.3±3.5) than women without OSA (M=4.2±3.5), while men with OSA reported lower CPGS-FD (M=2.7±3.1) than men without OSA (M=4.2±4.0).

Conclusion
Demographic, mood and insomnia variables affect pain experience in OSA patients. Pain experience in men and women with CPC appears to be differentially affected by OSA.

Support (if any)
none
0910 Examining Relationships of Pain Chronicity and Sleep Disturbances in Adults with Skin Problems
Authors: Hogue Sarah , Gilles Allyson 
Published: April 2024

Abstract

Introduction
Patients with chronic pain report comorbid sleep challenges (sleep fragmentation/reduced duration). Research suggests sleep disturbance in individuals with skin/subcutaneous conditions, notably insomnia. Psychological/physiological symptomology with poor disease management can lead to self-medication, possibly exacerbated from compromised sleep. The objective of this study was to examine relationships between sleep, skin conditions, and pain chronicity relative to demographics and substance use.

Methods
Adult self-reported data (N=34,525; mean age 48; 55.8% female) from 2012 National Health Interview Survey(NHIS) were used. Sleep disturbance was categorized as &lt; 7hr sleep, insomnia/trouble sleeping, or excessive sleepiness in the past year. Skin problem type was classified as eczema/skin allergy only(n=1908), non-specified skin problem only(n=1517), eczema/skin allergy and non-specified skin problem(n=569), and none(n=30531). Chi-square test for association, Kruskal-Wallis H test, and logistic regression were performed.

Results
Individuals with skin problems(n=3994) reported chronic pain(21.5%) and sleep issues (insomnia(35.4%); excessive sleepiness(27.1%); sleep duration &lt; 7hr(33.7%) and &gt;9hr(5.3%)). There were significant relationships between skin problem type and chronic pain X2(3,N=34525)=564.87,p&lt;.001) and sleep disturbance (&lt; 7hr nightly, insomnia, or excessive sleepiness) X2(3,N=34,525)=391.04,p&lt;.001). Pain and sleep disturbance were significantly associated X2(1,N=34,525)=1184.84,p&lt;.001). Multinomial logistic regression was performed to examine effects of age, sex, race, smoking initiation age, excessive tobacco/alcohol use, skin problem type, and sleep disturbance on the likelihood that participants have chronic pain. The model was significant, X2(9)=816.14,p=.0001 and explained 10% (Nagelkerke R2) of the variance in chronic pain. Predictor variables of sex, excessive tobacco/alcohol use, sleep disturbance, and skin problem type were statistically significant. Individuals of increasing age, female, and having any skin problem type, especially multiple, were more likely to report chronic pain. Sleep disturbance didn’t predict chronic pain, even when duration, insomnia, and excessive sleepiness were replaced separately for sleep disturbance in the model.

Conclusion
Although adults with skin problems report various sleep disturbances and substance use, pain chronicity is better predicted by sex, comorbid skin issues, and age. The relationships between sleep and chronic pain in individuals with skin/subcutaneous disorders need further exploration to focus prevention efforts/treatments. Understanding whether various sleep issues, comorbid with pain, possibly signal development/presence of skin cancer is important, as research links melanoma with obstructive sleep apnea.

Support (if any)
0911 Characterizing Sleep, Pain, and Opioid Craving in People with Chronic Low Back Pain on Long Term Opioid Therapy
Authors: Abraham Liza , Giagtzis Alexandros , Wejbrandt Julia Camacho , Reid Matthew , Ellis Jennifer , Smith Michael , Finan Patrick 
Published: April 2024

Abstract

Introduction
Previous studies have demonstrated that long-term opioid use alters sleep architecture and continuity. Long-term opioid therapy (LTOT) is common amongst people with chronic pain, yet the interrelations of sleep and pain among patients on LTOT are poorly understood.

Methods
We characterized sleep amongst people with chronic low back pain (CLBP) on LTOT (n=53) using wireless sleep-electroencephalography (EEG), and ecological momentary assessment (EMA) in a naturalistic remote study. The relationships amongst the duration and percentages of rapid eye movement (REM) and slow wave sleep (SWS), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), pain, and opioid craving, measured using 14 days of EMA assessments were explored. Opioid craving was assessed through two questions which asked participants to rate how much they wanted to use opioids and the strength of their urge to use opioids. These items were averaged into one craving measure. Sleep-EEG data were averaged across two nights (when available) and separate linear regression analyses were used to determine the relationships between sleep predictors (architecture and continuity metrics) and 14-day averages of pain and opioid craving.

Results
Participants demonstrated poor sleep continuity, with substantial WASO (mean=148, SD=101 mins), short TSTs (mean=5.40, SD=2.16 hours), and low SE (mean=61.35%, SD=19.98%). However, REM% (mean=15.16%, SD=9.23%) and SWS% (mean=20.99%, SD=15.36%) were generally within normative ranges. Regression models demonstrated no significant relationship between the sleep architecture variables and pain or opioid craving. However, a strong positive correlation between pain and opioid craving (r=0.57, p&lt; 0.01) was present.

Conclusion
Participants with CLBP on LTOT demonstrate poor sleep continuity, despite sleep architecture within normative ranges. Although we observed no relationship between sleep and pain or opioid craving, there was a strong relationship between pain and craving. Future studies should evaluate the temporal dynamics of sleep, pain, and opioid craving in this population, as well as the potential role of opioid dose and use patterns.

Support (if any)
NIH/NIDA R01DA048206
0912 The Association Between Somatization and Sleep
Authors: Abdalla Marwah , Shurovi Sumayya , David Michelle , Cornelius Talea , Shechter Ari , Schwartz Joseph 
Published: April 2024

Abstract

Introduction
Somatization, the experience of having somatic symptoms (e.g., pain, fatigue, dizziness) with resultant psychological distress, has been described among working adults and contributes to work-related absences. Whether somatization affects employees’ sleep quality and sleep duration is unclear. We examined the association of somatization with sleep quality and duration.

Methods
Data came from the 4th wave of the multi-site Worksite Blood Pressure Study, which assessed psychological factors and ambulatory blood pressure. A total of 472 participants without major cardiovascular disease from 10 worksites in NYC were recruited across 4 waves and ~11 years. At Wave 4, participants completed the Brief Symptom Inventory (BSI) and a sleep questionnaire derived from the Sleep Heart Health Study. Items from the BSI were averaged and T-scored (normed to mean=50, SD=10). Items assessing sleep quality were averaged (higher scores indicated worse sleep quality). Weekday sleep duration was also reported using a one-time sleep diary. Analyses were restricted to participants providing complete data (N= 238). Linear regression models were specified predicting (1) sleep quality and, separately (2) sleep duration from somatization. Covariates were age, sex, race/ethnicity, body mass index, marital status, years of education, family income, employment status, and average work hours per week.

Results
Of the 238 participants, 79.8% were male, 11.8% were Black, 5.9% were Hispanic/Latinx, and 76.5% were married. Median family income was $70,000-$79,999. Mean age was 52.4 years (SD=8.1), mean years of education was 17.9 (SD=3.1), mean body mass index was 27.9 kg/m2 (SD=3.8), and mean hours worked per week (among those currently employed; n=191) was 42.0 (SD=10.9). Mean somatization score was 49.5 (SD=9.3), mean sleep quality was 8.4 (SD=4.3), and mean sleep duration was 6.5 hours/night (SD=1.1). Higher somatization scores were significantly associated with worse sleep quality, B=0.15, 95% CI 0.09, 0.20, p&lt; 0.001. The association of somatization with sleep duration was not significant, B= 0.01, 95% CI -0.00, 0.02, p=0.18.

Conclusion
There was an association between somatization and sleep quality but not with sleep duration. Future research should examine whether treatment modalities for somatization among working adults improve sleep quality and overall occupational health.

Support (if any)
P01HL47540, NIH/NHLBI K23HL141682
0913 Interaction Between Sleep Duration and Trouble Sleeping on Depression Among U.S. Adults, NHANES 2015-2018
Authors: Wang Shanshan , Rossheim Matthew , Nandy Rajesh , Nguyen Uyen-Sa 
Published: April 2024

Abstract

Introduction
To examine the interaction effects of sleep duration and trouble sleeping on depression among U.S. adults.

Methods
We used data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 (N=10,044). Trouble sleeping was self-reported. Sleep duration was determined as short (≤ 6 hours) or long (≥ 9 hours), compared with normal (&gt;6 and &lt; 9 hours). Depressive symptoms were defined as the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were assessed.

Results
A significant positive additive interaction between short sleep duration and trouble sleeping on depression was observed in the fully adjusted model (Relative excess risk due to interaction, RERIOR=4.42, 95% CI: 1.12, 7.73), with 43% of the association with depression attributed to the interaction (attributable proportion of interaction, AP=0.43, 95% CI: 0.22, 0.64). Similarly, there was a significant positive additive interaction between long sleep duration and trouble sleeping on depression after adjustment (RERIOR= 4.17, 95% CI: 0.96, 7.38), with 41% of the association with depression attributed to the interaction (AP=0.41, 95% CI: 0.21, 0.60). No multiplicative interaction between short or long sleep duration and trouble sleeping was detected.

Conclusion
Different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depression. It is crucial to simultaneously consider multiple dimensions of sleep health when examining their relationship with depression.

Support (if any)
0914 Retrospective Review of Sedative Use on Hospitalized Patients at Risk for OSA
Authors: Rojas Edward , Srinivasan Priyanka , Mudgal Mayuri , Olgers Kassandra , Knollinger Scott , Ecker Zachary , Seol Calvin , Stansbury Robert , Sharma Sunil 
Published: April 2024

Abstract

Introduction
There has been prevalent usage of sedatives and narcotics in the United States, specifically in the Appalachia. Obstructive sleep apnea (OSA) has proved to be associated with significant cardiopulmonary consequences. This study aimed to examine the effects that sedatives and/or narcotics have on the length of stay (LOS) and 6-month mortality rates of patients screened and diagnosed with OSA.

Methods
A retrospective analysis was conducted on hospitalized patients who were screened positive for OSA and had used some form of sedative. The patients were divided into three groups: patients with OSA and on sedatives chronically at home or in the hospital; patients with OSA not on sedatives; and controls with no OSA or use of sedatives. The variables studied included 6-month mortality rate and LOS. Demographics, comorbidity and medication information were also recorded for these patients.

Results
Of the patients screened from August 2019 to May 2021, 156 patients were with OSA and used sedatives, while 278 were diagnosed with OSA but no use of sedatives. There were 88 patients negative for OSA or sedatives. The patients who had OSA and used sedatives had the highest 6-month mortality rate of the three groups. Specifically, these patients had a 6-month mortality rate of 14%, compared to the other two groups, which both had 6-month mortality rates of 3%. Moreover, the patients who used sedatives had significantly longer LOS (10.06 days versus 5.97 days) than those who were diagnosed with OSA but did not use any sedative. Those without OSA had a LOS of 5.23 days. Both age-unadjusted and age-adjusted Charlson comorbidity were similar amongst all groups.

Conclusion
Hospitalized patients’ high risk for OSA and on sedatives have significantly higher 6-month mortality rates and LOS. To improve quality of care and healthcare utilization, practitioners should take caution when providing sedatives to patients with OSA and consider alternative therapies. To elucidate underlying mechanisms, further prospective studies would be necessary.

Support (if any)
0916 Sleep Diagnosis, Polysomnography Findings, and CPAP Adherence in People Living with HIV and Controls
Authors: DelRosso Lourdes , Walters Arthur S , Salamatina Alina , Yang Deacon , Mogavero Maria P , Ferri Raffaele 
Published: April 2024

Abstract

Introduction
Human Immunodeficiency Virus (HIV) infection remains a significant health challenge, particularly due to the global effects on health, social impact, and overall well-being. Studies on people living with HIV (PLWH) have identified that sleep disturbance interfere with quality of life, medication effect, comorbidities and disease progression, however, there is scarcity on sleep studies presenting objective polysomnographic (PSG) data and adherence to CPAP. In the current study we present clinical and PSG data in PLWH.

Methods
Observational, longitudinal study on PLWH and controls referred to a single sleep center due to suspicion of OSA. A home sleep apnea test (HSAT), full night PSG, or split night study. All PLWH were on combination antiretroviral therapy. Data obtained included clinical history, sleep study data, Epworth sleepiness and CPAP adherence at the first follow up visit.

Results
A total of 62 PLWH (48 male, 14 female) and 156 controls (91 male, 65 female) were included. In the PLWH, 30 patients underwent HSAT, 15 full diagnostic PSG, and 17 split night studies. In the PLWH group, 89% had OSA, 63% insomnia, 40% restless sleep and 21% restless legs syndrome. Data from the 32 lab studies showed statistically increased periodic limb movement index (PLMI) in PLWH (mean±SD) 33.8±31.73 than controls 10.7±17.41. A significantly higher number of PLWH had PLMI &gt;15 hour than controls in the titration part of the study (64.7% vs. 35.5%, respectively; chi-square 3.85, p &lt; 0.05). There were no other statistically significant differences in the sleep parameters. Adherence to CPAP was completed in 41 PLWH and 95 controls. Finally, pooling together all studies, PLWH showed lower adherence to CPAP (61.4±33.63% vs. 79.0±26.90%, respectively, t-value -3.248, p&lt; 0.0015) and shorter time of its use (4.9±2.44 hours vs. 5.7±1.93 hours, respectively, t-value -2.038, p &lt; 0.044) than controls.

Conclusion
This study shows that PLWH have elevated frequency of OSA, insomnia, restless sleep and restless legs syndrome. Objective data with in-lab studies surprisingly showed increased index of PLMS, not resolving with titration. Follow up on patients with OSA showed lower adherence to CPAP than controls.

Support (if any)
0918 A Cross-sectional Study on the Cytokine Profiles and Immunological Relationship Between Vitiligo and Sleep Quality
Authors: Xerfan Ellen , Facina Anamaria , Andersen Monica , Tufik Sergio , Tomimori Jane 
Published: April 2024

Abstract

Introduction
Vitiligo is an autoimmune skin disease. Psychological disruption can lead to clinical worsening and impact sleep quality of patients, in a bidirectional manner. Sleep regulates the immune system, and cytokines expression, including interleukin (IL)-6 and IL-17A (pro-inflammatory) and IL-4 and IL-10 (anti-inflammatory), which are linked to circadian rhythm and vitiligo immunopathogenesis. This study aimed to analyse cytokine profiles in a vitiligo sample; and verify any association with subjective sleep.

Methods
The study comprised 30 patients with vitiligo, and 26 healthy controls, following ethical guidelines. Quality of life and sleep questionnaires were completed: Dermatology Life Quality Index (DLQI), Short-Form Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Seven serum cytokines were measured through a 7-plex kit: IFN-γ, IL-4, IL-6, IL-10, IL-12 p40, IL-17A and TNF-α. Previous treatment with ultraviolet B phototherapy was registered. Generalized Linear Model test was used for statistical analysis.

Results
PSQI total score and domain 4 (sleep efficiency) were statistically worse in the vitiligo sample (both p=0.01). The PSQI means were 9.07 (vitiligo) and 6.66 (controls). Final scores of SF-36 and ISI were not statistically different between groups, although numerically worse in vitiligo group. The SF-36 domains “body pain”, “social aspects”, “physical limitation” and “emotional limitation” were statistically worse in vitiligo group. The DLQI mean (vitiligo group) indicated mild to moderate impact on quality of life (5.57). Cytokine levels were not different between groups, nor when analysed with PSQI. Regarding ISI, higher scores were related to increased IL-17A in vitiligo group (p=0.01). Increasing IL-4, IL-6 and IL-10 were associated with previous phototherapy (p=0.03; p=0.03 and p=0.04, respectively).

Conclusion
The vitiligo group presented worse sleep, as expected. Body pain predominated in vitiligo sample; hyperalgesia can occur in poor sleep, impairing quality of life. Emotional limitation can be enhanced by or aggravate physical limitation and pain. Elevated ISI scores (more severe insomnia) were related to increased IL-17A levels. The IL-4, IL-6 and IL-10, with circadian behaviour, were associated to phototherapy, which has immunomodulatory role. Poor sleep and impaired vitiligo may interact bidirectionally; cytokine regulation should be further investigated in this complex relationship.

Support (if any)
AFIP, CAPES, CNPq and FAPESP.