bluuebunny/crossref_metadata_2025_split huggingface dataset:
1226 Shift Workers Acting Out? A Case of Shift Work Sleep Disorder Causing REM Behavior Disorder
Authors: Bhimineni Charishma , Mushlin Neil 
Published: April 2024

Abstract

Introduction
Rapid eye movement behavior disorder (RBD) is the manifestation of dream enactment with the failure of muscle atonia during rapid eye movement (REM) sleep. Shift work sleep disorder presents as sleep disruption and/or excessive sleepiness due to an atypical work schedule. Here we show a unique case of RBD provoked by a longstanding history of shift work sleep disorder.

Report of case(s)
67-year-old male with shift work sleep disorder, hypertension, and depression who presented for evaluation of RBD. Patient recently retired as a night shift worker and was taking melatonin and citalopram for more than 20 years. For the past several months, the patient has been having episodes of acting out his dreams, such as punching his wife if he was dreaming about punching someone in his sleep. Patient’s polysomnography showed REM sleep without atonia (RWA) in the chin and limb leads with 30% of the 30-s epochs having chin EMG activity with bilateral flexor digitorum superficialis (FDA) phasic EMG activity. Patient’s melatonin dose was increased and he was also started on benzodiazepine with control of his symptoms.

Conclusion
The common risk factors of RBD include Parkinson’s Disease, occupational toxin exposure, antidepressants, psychological stress (PTSD), or compromised health conditions (such as smoking or cardiovascular diseases). The patient has a chronic use of citalopram but antidepressant-induced RBD usually presents in the fourth/fifth decade of life. A review of literature indicates no cases of shift work disorder causing RBD. However, disruptions in the circadian rhythm put shift workers at an increased risk for conditions such as cardiovascular disease, metabolic syndrome, and psychological disorders, all exposures for RBD. Patient developed shift work sleep disorder causing sleep-onset and sleep-maintenance insomnia with a disturbance in the circadian rhythm, ultimately leading to an increased risk for developing RBD. Treatment for RBD includes melatonin as the first-line treatment with addition of low-dose clonazepam or cholinergic agents. With the increasing prevalence of shift work, it is imperative to understand the risks of shift work and identify sleep disorders that may arise, such as RBD, through more research.

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1227 Spinal Stenosis as a Rare Cause of Central Sleep Apnea
Authors: Rashed Albatol , Bedaiwi Nora 
Published: April 2024

Abstract

Introduction
Central sleep apnea is characterized by lack of drive to breathe during sleep, resulting in periods of insufficient ventilation and compromised gas exchange. CSA causes based on the awake Paco2 either hypercapnic and a nonhypercapnic group. Common causes include high-altitude, congestive heart failure, and chronic use of opioids and its very rare to be secondary to spinal stenosis.

Report of case(s)
49 years old male patient known to have hypertension and cervical spondylosis causing severe canal stenosis on epidural steroid injection. He was Referred to sleep medicine clinic for the assessment of possible obstructive sleep apnea, as he has interrupted sleep, history of snoring and witnessed apnea. Calculated STOP BANG 6. on examination, BMI 33, neck circumference 44 cm, micrognathia and malapati class 4, Split night sleep study showed severe respiratory events with AHI of 125.4 mainly central apneas with total 177 episodes, Frequent arousals related to events and oxygen desaturation were recorded to 82%. End tidal CO2 reached 57 mmhg during the study. CPAP titration was initiated and pressure gradually increased and ended at 12.0 cmH2O where all respiratory events were controlled with REM sleep supine position. Day time arterial blood gas showed PH 7.437 PaCo2 39mmhg, PaO2 86.9 mmhg and Hco3 26.2 mmol/ liter with base excess +2.1. Investigation for the cause of central sleep apnea were negative except for cervical MRI which showed multilevel degenerative disc disease at the level of C3-C4 ,C4-5, C5-6 and C6-7 causing different severity of neural foramen stenosis and nerve root compression. Based on the investigations the patient was diagnosed with severe central sleep apnea secondary to severe spinal stenosis, he was started on CPAP 12 cmh2o well tolerated and complaint to the PAP and his latest CPAP data showed AHI of 8/hour. For the spinal stenosis he is following with spine surgery and pain management team for pain control.

Conclusion
To diagnose the cause of central sleep apnea it is mandatory to exclude all other possible causes and consider spinal stenosis when facing a case with isolated central sleep apnea.

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0123 Family Economic Strain Is Associated with Parent-Child Sleep Interactions
Authors: Scheibner Hannah , Xu Wanli , Walsh Stephen , Condon Eileen 
Published: April 2024

Abstract

Introduction
Family economic strain is perceived financial hardship that can be experienced regardless of income level but is more prevalent among families of low socioeconomic status (SES). Low SES is an important social determinant of health and is associated with poor sleep in children, but pathways between financial hardship and child sleep are unclear. In this study, we examine the role of family processes in this relationship, including caregiver stress and parent-child sleep interactions (sleep location, praise, tantrums).

Methods
We conducted a cross sectional study of caregivers in the United States with children aged 3-5 years. Caregivers completed the Family Economic Strain Scale (FESS), Parent-Child Sleep Interactions Scale (PSIS), Perceived Stress Scale (PSS), and a demographics form via Qualtrics. Participants were recruited through social media and community flyers. Adjusting for child age, household size, and caregiver relationship status, we conducted multivariate linear regression to examine associations between economic strain, perceived stress, and parent-child sleep interactions. We then tested mediation using 5,000 bootstrap samples.

Results
111 caregivers completed all questionnaires. Higher family economic strain (β=.472, p&lt;.001) and perceived stress (β=.357, p&lt;.001) were associated with more problematic parent-child sleep interactions. Family economic strain was also associated with increased perceived stress (β=.559, p&lt;.001). However, perceived stress did not mediate the relationship between family economic strain and problematic parent-child sleep interactions (95% CI -0.46, 2.4).

Conclusion
Increased family economic strain is associated with increased stress in caregivers, and both economic strain and caregiver stress are associated with problematic parent-child sleep interactions. Therefore, supporting caregivers in promoting healthy bedtime interactions may be an important approach for intervention to promote sleep and reduce inequities related to financial strain and stress. Further, our findings suggest the relationship between family economic strain and parent-child sleep interactions is not attributable to increased caregiver stress. Additional research is needed to understand the relationship between family economic strain and child sleep, including the role of other social determinants such as caregiver shift work, employment, housing, and the neighborhood environment. Findings from this study and future research may inform multi-level and policy interventions to support children at risk for unhealthy sleep.

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1231 It Is All About the Mask
Authors: Shammah Alaa , Shah Sachin , Stahl Stephanie 
Published: April 2024

Abstract

Introduction
Positive airway pressure (PAP) therapy is the mainstay of treatment for adults with obstructive sleep apnea. One important factor for PAP therapy is choosing the optimal mask type. Multiple studies demonstrate a higher residual apnea-hypopnea index (AHI) and more leaks with the use of oronasal masks compared with nasal masks, yet oronasal masks are routinely chosen as the first-line option.

Report of case(s)
An 80-year-old man had a split polysomnogram with a diagnostic apnea-hypopnea index (AHI) 65.8/h, central apnea index (CAI) 0.4/h, and oxygen nadir 76%. During the study, on continuous positive airway pressure (CPAP) 10 cmH2O with an under-the-nose nasal mask, sleep-disordered breathing was resolved with a residual AHI of 0.7/h with supine REM sleep achieved. The patient was set up with CPAP 10 cmH2O; however, after 1 week of CPAP treatment, a notification indicated that his PAP-AHI was elevated in the 40s/h. After exploring several possible causes, we discovered that he was using an oronasal mask at home. A change to a nasal mask or pillows was recommended. While awaiting mask refit, he was also changed to auto-titrating PAP (APAP) settings of 10-20 cmH2O. PAP download data are as follows. On CPAP 10 cmH2O with an oronasal mask: 12/12 days used, 95th percentile leak 0.3 lpm, AHI 31.7/h (CAI 4.3/h). On APAP 10-20 cmH2O with an oronasal mask: 6/6 days used, median pressure 14.9 cmH2O, average maximum pressure 19.6 cmH2O, 95th percentile leak 0.0 lpm, AHI 26.0/h (CAI 3.6/h). On APAP 10-20 cmH2O with a nasal mask + chin strap: 45/45 days used, median pressure 10.4 cmH2O, average maximum pressure 12.5 cmH2O, 95th percentile leak 5.5 lpm, AHI 2.2/h. Average nightly use of PAP was &gt;6 h at all assessments.

Conclusion
Individuals involved in PAP management, including providers, sleep technologists, and durable medical equipment groups, need to be aware that oronasal masks may not provide the same level of benefit as nasal masks or pillows. Additionally, the type of PAP mask used during in-laboratory PAP titration compared to home use is also of importance as therapeutic pressures may be largely different as demonstrated in this case.

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1233 Delayed Sleep-Wake Phase Disorder: Your PCP’s Insomnia
Authors: Bhamrah Paul , Damia Carla , Hall Catherine , Ghildiyal Naomi , Monceaux Brittany , Bhamrah Malti , Bhamrah Manjit , Liendo Cesar , Chernyshev Oleg , Koothirezhi Rupa 
Published: April 2024

Abstract

Introduction
Delayed Sleep-Wake Phase Disorder (DSWPD) is commonly mistaken for sleep onset insomnia although it is one of the most frequently seen circadian rhythm sleep-wake disorders. These patients typically deal with comorbid depression that is more severe than the general population. Delayed diagnosis can lead to impaired cognitive function, metabolic changes, and a compromised quality of life. Hence, we report a case of a young adult referred to our clinic for management of DSWPD masked as sleep onset insomnia.

Report of case(s)
A 30-year-old female with past medical history of Ulcerative Colitis and Depression initially presented to PCP for “trouble sleeping”. Patient states she was given multiple medications including melatonin, Trazodone, and Seroquel. With no improvement of symptoms, the patient was referred to Sleep Medicine. On evaluation, a sleep log revealed the patient was consistently falling asleep around 830am and waking up between 330-630 pm with few mid sleep disturbances. She revealed the sleep problems started after a car wreck ten years prior and worsened significantly in the past two years. Of note, the patient dealt with snoring, daytime tiredness, and apneas for which a home sleep apnea test (HST) was done. HST revealed an AHI of 0.0 and oxygen nadir of 91%. Patient had significant strife with sleeping pattern as she was unable to socialize during the daytime and experienced worsening depression. A comprehensive plan was made to slowly advance the sleep phase with Melatonin 0.5mg-1mg to be started at 2am with plan for further advancement once new steady state was achieved; along with, light therapy upon awakening and cognitive behavioral therapy.

Conclusion
Although there has been improvement in sleep training, there is still a significant need for increased exposure to sleep pathology in residency programs. Our patient experienced a delay in diagnosis for over two years. The patient had worsening depression in this time and was improperly managed. DSWPD is a relatively common sleep disorder and thorough clinical assessment of sleep and wake up times can help elucidate a diagnosis. This case cries to our need to improve sleep education among trainees so that we can better serve our patients.

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1235 Sleep Architecture in School-age Children with Spastic Cerebral Palsy
Authors: Torres-Damian Yereth , Quintana-Vega Verónica , Vargas Ángel Daniel Santana , Millán-Rosas Gabriela , Gutierrez-Escobar Romel , Alarcón-Cabrera Ernesto , Palafox-Sánchez Arturo , Santana-Miranda Rafael 
Published: April 2024

Abstract

Introduction
10 cases of school-age children with a diagnosis of spastic cerebral palsy (CP) are described, which are within the APAC. Comprehensive Care Model. where diagnosis, rehabilitation, formal and alternative education are received in which polysomnography (PSG) with the international 10-20 system and simultaneous video was indicated, due to neurological risk factors and a recently implemented diagnostic protocol.

Report of case(s)
10 children (age: 8.3±1.8; females: n=7 [70%]. An increased sleep latency was shown (32.8 ± 32), with expected REM sleep latency (103.1 ± 37.7), without alterations regarding the sleep macrostructure, with an increased awakening rate (10.9 ± 4.8). Regarding the respiratory part, with a mean apnea-hypopnea index (AHI) of (5.5 ±4.7), 50% of the participants had more than 4 events per hour with a predominance of hypopneas during REM and supine position. Abnormal activity was recorded in 100%, with predominance in the left hemisphere (60%), with detection of motor manifestations in 80%; Only 70% of these patients have treatment for epilepsy. Finally, sweating artifact was detected in 60% of cases.

Conclusion
These are school-age children diagnosed with CP who have data on sleep fragmentation associated with the presence of abnormal electroencephalographic activity and obstructive sleep apnea-hypopnea syndrome. Multidisciplinary management of the detected nosological entities is recommended, with the aim of reducing sleep fragmentation, regulating EEG activity and respiratory events; Likewise, continue with rehabilitation plans in order to improve spasticity that would help change position and reduce nocturnal diaphoresis.

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1236 A Challenging Transition Between Volume Assured Modes in a Patient with Congenital Lung Abnormalities
Authors: Nuschke John , Judd Brooke 
Published: April 2024

Abstract

Introduction
The advent of volume-assured modes for non-invasive ventilation (NIV) has improved treatment of more complicated sleep-disordered breathing (SDB), although can present challenges in choosing ventilatory modes in patients with abnormal pulmonary anatomy.

Report of case(s)
Our Patient is a 44 year-old female with hypoplastic right lung, pulmonary hypertension and chronic hypercapnic/hypoxic respiratory failure on nocturnal NIV for complex sleep disordered breathing. She failed CPAP, BIPAP and BIPAP S/T. Average volume assured pressure support (AVAPS) NIV was initiated with stabilization in awake carbon dioxide levels, improved sleep quality and daytime energy . She was transitioned to an iVAPS (intelligent volume-assured pressure support) ventilator when eligible for new NIV. Initial settings were empiric, targeting Alveolar Ventilation 3.3 l/min to approximate similar minute ventilation set on previous AVAPS (Assumed dead space ventilation 1.05 l/min or 70 cc x 15rr). Despite relatively similar recorded pressures and respiratory parameters between the two volume-targeted ventilators, she experienced air hunger, palpitations and increased morning headaches after change from AVAPS to iVAPS. Alveolar ventilation target was increased to 4.5 l/min, yet symptoms persisted. She subsequently returned to AVAPS, with symptom resolution.

Conclusion
This case highlights the uncertainty in transitioning volume assured ventilator modes that use different algorithms to achieve ventilatory targets. We hypothesized incorrect dead space estimates in the setting of her abnormal pulmonary anatomy may lead to inequivalent respiratory targets between modes, but this does not appear to be the case based on available data. The sensation of dyspnea is complex, thus it is possible subtle changes in rise time, breath delivery, cycling and triggering may have contributed to air hunger. Furthermore, many assumptions are made when transitioning between intelligent ventilator modes and these assumptions are based on “normal” respiratory dynamics.

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Note- Chart would not transfer, abbreviated data placed below. Settings- (both modes) EPAP 6, Min ipap 17, max IPAP 30 AVAPS- Tidal volume 300, T insp max 2 second, rise time 200 ms iVAPS- Alveolar ventilation 3.3 l/min, T insp max 2 sec, rise time 200 ms Outcome AVAPS- RR 14-15, TV 301-313, MV 4.3, IPAP 20.6, triggered 36% iVAPS- RR 15-32, TV 300-480, MV 4.5, IPAP 20.6, Triggered 30%
0124 The Effects of Family Arguments on Parental Sleep Quality
Authors: Price Garrett , Shi Elliott , Kim Debora , Garrison Michelle 
Published: April 2024

Abstract

Introduction
Previous studies indicate that stress and trauma within family systems can affect the sleep quality of all family members. While most research on parent-child conflict and sleep has focused on child outcomes, this study aims to investigate the potential role of familial stress caused by arguments between families on the quality of parent’s sleep through the lens of Bowen’s Family Systems Theory.

Methods
Cross-sectional data from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) 2011 cohort’s 5th grade parent surveys in 2016 were utilized to understand the feelings of parents and other guardians on how often they argue with their children, how often they felt restless during their sleep, and how often they feel depressed. To assess the effects of parent-child conflict on parent report of restless sleep, two survey-weighted logistic regression models were created, both adjusting for parent and child age and one also adjusting for parental depression, and average marginal effects were calculated.

Results
The analysis included 8,375 parents and guardians, with a mean age of 39.9 years (SE = 0.17), of whom 14.0% reported mostly or always arguing with their child, 15.0% usually experiencing restless sleep, and 3.9% that they feel depressed most or all of the time. The first regression model found that parents report of frequent parent-child conflict was associated with an 13.2% increase (95%CI 10.4 to 16.1) in the predicted probability of parent restless sleep, an effect which decreased in size but remained significant after adjusting for parental depression (to a 9.1% increase, 95%CI 6.5 to 11.6), which may be a partial mediator of this effect.

Conclusion
These results emphasize the significant impact of familial arguments on parental restlessness, emphasizing the critical role of family cohesion in shaping parent’s sleep quality. One important limitation is the temporality and causality of the relationship between familial arguments, depression, and restless sleep, which cannot be evaluated with these models and requires further research.

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0125 The Association Between Maternal Closeness and Sleep Health During Adolescence
Authors: Ngam Christa-Maria , Master Lindsay , Reichenberger David , Hale Lauren , Chang Anne-Marie 
Published: April 2024

Abstract

Introduction
Quality of the parent-child relationship is an important factor for children's psychological health and adequate sleep. Few studies, however, have focused specifically on maternal closeness and adolescent sleep. We hypothesized that there would be an association between maternal closeness and improved dimensions of sleep health including timing, duration, and quality in adolescents.

Methods
Data were from the age 15 wave of the Future of Families and Child Wellbeing Study, a longitudinal birth cohort. Adolescents self-reported maternal closeness on a continuous scale with four levels (“not very close,” “fairly close,” “quite close,” and “extremely close”) and bedtime, sleep duration, and nights with difficulty falling or staying asleep (N=3,241). A subset of adolescents wore an actigraph to assess sleep onset, duration, wake after sleep onset, and sleep maintenance efficiency (N=775). Separate multiple linear regression models tested maternal closeness and sleep outcomes, adjusting for age, sex, race/ethnicity, household income, family structure, and caregiver education level.

Results
Results showed that 84.4% of adolescents reported feeling “quite close” or “extremely close” to their mother. For each unit closer to their mother, adolescents’ self-reported sleep duration was 12.2 minutes longer (p&lt; 0.001), bedtime was 11.3 minutes earlier (p&lt; 0.001), and they reported 1.7 fewer nights with difficulty falling asleep (p&lt; 0.001) and 1.3 fewer nights with difficulty staying asleep (p&lt; 0.001). With the smaller actigraphy sample, maternal closeness was not associated with actigraphic sleep outcomes.

Conclusion
Cross-sectional findings suggest that maternal closeness is associated with improved self-reported sleep health as measured by longer sleep duration, earlier bedtime, and fewer nights of insomnia symptoms. However, it is not clear whether closeness directly affects sleep or whether sleeping well improves the parent-child relationship. Future research should leverage micro-longitudinal studies to assess the daily fluctuations in maternal closeness and sleep.

Support (if any)
R25-HL147668, R01HD073352, R01HD36916, R01HD39135, and R01HD40421