bluuebunny/crossref_metadata_2025_split huggingface dataset:
0802 Quantifying Screening Efficacy and Referral Patterns in Well Child Visits
Authors: Balog Matthew , Loghmanee Darius , Donskoy Innessa 
Published: May 2023

Abstract

Introduction
Sleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits.

Methods
We queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers.

Results
Before the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022.

Conclusion
The introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options.

Support (if any)
None
0806 Treatment of sleep disordered breathing improves quality of life in children with Down syndrome
Authors: Horne Rosemary , Shetty Marisha , Davey Margot , Walter Lisa , Nixon Gillian 
Published: May 2023

Abstract

Introduction
Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. We examined the effects of treatment of SDB on sleep and daytime functioning in children with DS.

Methods
Children with DS and SDB (n=34) completed a baseline and follow-up study which included 7 days of actigraphy in conjunction with a parental sleep diary. Parents also completed a number of questionnaires assessing sleep, behaviour, daytime functioning and quality of life (QOL). All children had overnight polysomnography (PSG) at baseline and 24 had PSG at follow-up.

Results
15 children (44%) were treated. At baseline the treated group had more severe SDB at baseline compared to the untreated group: obstructive apnoea hypopnoea index (OAHI) 29.3 ± 38.2 events/h vs 3.3 ± 5.2 events/h (p&lt; 0.01). Actigraphy showed no significant differences in total sleep time or sleep efficiency from baseline to follow up in either the treated or untreated group. Wake after sleep onset increased at follow-up in the untreated group (p&lt; 0.01). The sleep disturbance (p&lt; 0.01) and total problems (p&lt; 0.05) scales on the OSA-18 and the SDB subscale on the Pediatric Sleep Problem Survey Instrument (p&lt; 0.01) improved in the treated children. No changes were seen in any of the measures in the untreated children.

Conclusion
Treatment of SDB improves QOL, despite treatment having no demonstrable impacts on actigraphic sleep measures. In contrast despite having less severe SDB children who were untreated had no improvements in QOL and increased sleep disruption.

Support (if any)
Jerome Lejeune Foundation
0808 Comparison of Maxillary Transverse Dimension with Pediatric Obstructive Sleep Apnea Presence and Severity
Authors: Wright Lauren , Rasmussen Chad , Jewell Abby , Giri Subha , Christopher Viozzi , Baughn Julie , Sorensen Channing , Mara Kristin , Lloyd Robin 
Published: May 2023

Abstract

Introduction
Obstructive Sleep Apnea (OSA) in children and adolescents is commonly discussed amongst dental specialists. Physical attributes such as a high and narrow palate, dolichofacial appearance, and retrognathic mandible are reported to increase pediatric risk for OSA. Previous research states rapid maxillary expansion decreases AHI in children with OSA and may be an effective treatment option. Current literature does not report a consistent method of measuring a maxillary transverse deficiency nor does it report a numerical maxillary threshold deficiency that requires expansion in pediatric patients with OSA. Our aims are to compare two different orthodontic diagnostic methods for measuring the maxillary transverse dimension and to assess whether patients diagnosed with mild, moderate, or severe OSA have a numerical threshold for maxillary deficiency.

Methods
Participants were ages 7-17 years old (average 11.7 years) with no history of orthodontic treatment, craniofacial syndromes, craniosynostosis forms, or nasal abnormalities. Those with and without adenoids and tonsils were included. Participants presented to the Mayo Clinic Sleep Center for their polysomnogram. Their dentition was scanned, and a digital model was rendered. The maxillary transverse dimension was measured via two different methods: McNamara’s Analysis and Andrew’s Six Elements of Orofacial Harmony.

Results
There were 65 participants: 31 diagnosed with OSA (13 Mild, 4 Moderate, 5 Severe, and 9 Other) and 34 without (controls). Patients in the Other category were diagnosed based on clinical findings. No statistical difference was found between the maxillary transverse measurements of patients with versus without OSA or between the OSA categories. Patients with OSA were more likely to have permanent teeth (61.3% vs 32.4%, p=0.019), tonsils removed (54.8% vs 26.5%, p=0.020), and to have snored during the PSG (83.9% vs 55.9%, p=0.048).

Conclusion
Conclusions based on this pilot study should be interpreted carefully due to limited sample sizes. No statistically significant differences of the maxillary transverse dimension were found between those with and without OSA using either diagnostic method. No numerical maxillary deficiency threshold was found. Maxillary expansion should not be recommended based on OSA diagnosis alone. Referral to a dental specialist is recommended based on dental needs.

Support (if any)
Support was provided by Mayo Clinic CTSA grant UL1TR002377.
0814 Obstructive sleep apnea in asthmatic children: highly prevalent though no identifiable risk factors
Authors: Togeiro Sonia , Santos Cristiane , Tufik Sergio , Smith Anna , Moreira Gustavo 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) and Asthma often coexist. There is some evidence that adults with asthma are more prone to developing OSA than the general population, as well as OSA may impact asthma control. Different than adults, OSA prevalence is equal in boys and girls, while puberty has strong influence in asthma, especially in pubescent girls. The objectives of this study were to analyze the prevalence of OSA in boys and girls and the impact of asthma severity in OSA prevalence.

Methods
Asthmatic children attending a tertiary pediatric pulmonology clinic performed clinical evaluation, Pulmonary Function Test, and Home Sleep Apnea Test. OSA was defined as habitual snoring and one or more obstructive respiratory events (OREI) per hour of recording. Control and severity of Asthma were evaluated according to Global Initiative for Asthma and puberal stage using Tanner figures for boys and girls

Results
We studied 80 consecutive patients, 7 to 18 years-old, mean age 11.6 years (SD: 2.7), 51.3% female. According to BMI z-score, nutritional status was: 2 (2.5%) underweight, 63 eutrophic (79%), and 15 obese (18.5%). Puberty was present in 17 volunteers. Pulmonary Function Tests were obtained from 71 volunteers, 45% presented obstruction pattern. Home Sleep Apnea Tests were available from 76 volunteers, with mean OREI of 1.8 events/h. OSA occurred in 69 volunteers (91%), while 66% were mild, 21% moderate, and 4% severe. We did not find associations of obstructive sleep apnea with sex or asthma severity.

Conclusion
OSA was highly prevalent among these asthmatic children, but most were mild. Sex and asthma severity were not associated to OSA. Considering the interrelationship of both diseases, it is worth to keep in mind the possibility of OSA among children and teenagers with asthma.

Support (if any)
AFIP (Associação Fundo de Incentivo à Pesquisa) and CNPq (Conselho Nacional de Pesquisas)
0819 Does Sleep Health Modify the Relationship Between Hypertensive Disorders of Pregnancy and Incident Cardiovascular Disease?
Authors: Jackson Chandra , Gaston Symielle , Louis Judette , Sandler Dale 
Published: May 2023

Abstract

Introduction
With pregnancy considered a cardiovascular “stress test”, adverse pregnancy outcomes (APOs), such as gestational hypertension, have been associated with higher risk of poor cardiometabolic health later in life. Sleep has been identified as a contributor to cardiometabolic health; however, few studies have considered how sleep may affect APO-associated cardiovascular disease risk.

Methods
To investigate sleep health during middle-to-older adulthood as a potential modifier of longitudinal associations between hypertensive disorders of pregnancy (HDP) and CVD incidence, we used data collected from 32,313 parous women (mean±SD age 55±8.9 years) without prior CVD in the Sister Study (enrollment: 2003-2009; n=1,407 Hispanic/Latina, n=2,411 non-Hispanic (NH)-Black, n=27,683 NH-White, and n=812 another race/ethnicity). Report of physician-diagnosed CVD or death from CVD (i.e., heart failure, myocardial infarction, stroke) was collected over follow-up until October 2020. At enrollment, participants reported a history of HDP (i.e., gestational hypertension, preeclampsia, eclampsia) and current sleep health characteristics (i.e., short (&lt; 7 hours) habitual sleep duration, frequent napping, insomnia symptoms; all yes vs. no). Adjusting for sociodemographic, health behavior, and clinical characteristics, Cox proportional hazards regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD among participants with vs. without history of HDP. Wald tests assessed HDP*sleep characteristics interactions.

Results
Overall, 11% of women reported a history of HDP, and prevalence varied by racial/ethnic group (14% among NH-Black and Latina, 12% another race/ethnicity, 11% NH-White). Poor sleep characteristics were prevalent and more frequent among participants with a history of HDP (e.g., insomnia symptoms: 46% vs. 43% [no HDP]). Over a mean±SD 12±3.0 years of follow-up, there were 1,658 new cases of CVD. After adjustment, the association between HDP and higher risk of CVD (HR=1.40 [95% CI:1.22-1.60]) did not differ between participants with poor vs. non-poor sleep (all p-interactions &gt; 0.05; e.g., short sleep: HRyes=1.41 [1.11-1.79] and HRno=1.34 [1.13-1.59]).

Conclusion
Using subjective measures, poor sleep during middle-to-older age did not appear to exacerbate risk of CVD associated with HDP. Future studies that include multiple dimensions of objective sleep measured over the life course are warranted to better elucidate how sleep health among parous women may impact CVD risk.

Support (if any)
NIEHS (Z1AES103325[CLJ] and Z01ES044005 [DPS])
0820 Integrated Polysomnographic and Sleep Symptom-Based Cluster Subtypes Associated with Incident Atrial Fibrillation
Authors: Heinzinger Catherine , Lapin Brittany , Thompson Nicolas , Milinovich Alex , Foldvary-Schaefer Nancy , Van Wagoner David , Chung Mina , Mehra Reena 
Published: May 2023

Abstract

Introduction
While sleep disorders are implicated in atrial fibrillation (AF), the interplay and overlap of these disorders in AF risk remains unclear and a risk stratification challenge. Sleep-based clusters associated with AF can account for this complexity and translate to actionable approaches to identify at-risk patients. We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.

Methods
Cleveland Clinic patients (age&gt;18) who underwent PSG 11/27/2004-12/30/2015 were retrospectively examined. Clusters were identified using latent class analysis of 23 symptoms (e.g. related to sleep disordered breathing (SDB), sleepiness, REM intrusion, NREM parasomnias), Epworth Sleepiness Scale (ESS) score, and 24 measures of SDB and sleep architecture from PSG reports. Outcome was 5-year incident AF. Cox-proportional hazards models were adjusted for age, sex, race, body mass index, cardiovascular disease and risk factors, tobacco use, chronic obstructive pulmonary disease, anti-arrhythmic medication use, and positive airway pressure use.

Results
The sample included 43,433 patients: age 51.8±14.5, 51.9% (n=22,548) male, 74.4% (n=32,313) White, 7.3% (n=3,151) with baseline AF, and 4.3% (n=1,875) developed 5-year incident AF. Five clusters were identified and ranked by strength of AF association: 1) Hypoxemic (n=3,245): highest %time SaO2&lt; 90% (T90), 2) Apneas+Arousals (n=4,592): most witnessed apneas, highest apnea hypopnea index (AHI), highest arousal index, least hypopneas, 3) Short sleep+NREM (n=6,126): shortest sleep time, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep+REM (n=26,809): longest sleep time, shortest REM latency, highest %REM. Compared to ‘Long sleep+REM’, ‘Hypoxemic’ had 47% higher AF risk (HR=1.47,95%CI=1.27-1.69), and ‘Hypopneas’ did not differ (HR=1.05,95%CI=0.86-1.28).

Conclusion
Of five clusters identified, the ‘Hypoxemic’ subtype conferred the strongest AF risk with the highest degree of hypoxemia (highest T90, lowest minimum and mean SaO2), maximum end-tidal CO2, heart rate, and ESS score. Consistent with prior evidence of hypoxemia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation should focus on external validation of these findings.

Support (if any)
Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation Pilot Grant, Transformative Research Resource Development Award
0825 Association of Sleep Disturbance and Physical Functioning following Acute Hospitalization in Older Adults
Authors: Arentson-Lantz Emily , Deer Rachel , Kokonda Manasa , Meers Jessica , Carreon Samantha , Shetty Sharonya , Boyle Julia , Taffet George , Vahidy Farhaan , Agarwal Kathryn , Volpi Elena , Nowakowski Sara 
Published: May 2023

Abstract

Introduction
Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Identifying factors, such as sleep quality, that may be related to recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between sleep quality and functional recovery after an acute hospitalization in community dwelling older adults.

Methods
Participants (n=52; age 71.3 ± 6.8y, 75% female, 94.2% white), were recruited during an acute hospitalization. Participants completed sleep questionnaires including PROMIS Sleep-Related Impairment and Sleep Disturbance, as well as physical function testing and questionnaires, Short Physical Performance Battery (SPPB) and PROMIS Physical Function prior to hospital discharge (baseline) and at 4-weeks post-discharge (follow-up). Separate multivariate regression models were conducted to determine whether baseline sleep predicted physical functioning at follow-up as well as if pre-post hospital changes in sleep predicted pre-post changes in physical functioning.

Results
The PROMIS Sleep-Related Impairment score at baseline was inversely associated with SPPB Gait (0.02±0.009, p=0.04), SPPB Balance (0.02±0.008, p=0.02), SPPB Chair Stand (0.05±0.02, p=0.006) and Total SPPB (0.19±0.04, p&lt;.0001) at follow-up. Similarly, baseline PROMIS Sleep Disturbance score was inversely associated with PROMIS Physical Function at follow-up (0.19±0.07, p=0.008). The change in PROMIS Sleep-Related Impairment was inversely associated with the change in Total SPPB (0.05±0.03, p=0.03), SPPB Balance (0.05±0.02, p=0.01) and PROMIS Physical Function (0.15±0.06, p=0.012) from baseline to follow-up. The change in PROMIS Sleep Disturbance was inversely correlated with the change in PROMIS Physical Function (0.11±0.05, p=0.04) from baseline to follow-up.

Conclusion
Together, these results demonstrated that self-reported sleep disturbance and daytime sleep-related impairments during and following hospitalization predicted physical functioning at 4-weeks post-discharge. Improving sleep during hospitalization may reduce hospital deconditioning and improve functional recovery.

Support (if any)
This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi) Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0828 Greater sleep variability is associated with higher systemic inflammation in type 2 diabetes
Authors: Reutrakul Sirimon , McAnany J Jason , Park Jason , Pannain Silvana , Prasad Bharati , Chau Felix , Danielson Kirstie , Van Cauter Eve , Hanlon Erin 
Published: May 2023

Abstract

Introduction
Circadian misalignment increased systemic inflammation in sleep experiments and in those performing shift work. Milder degree of circadian misalignment such as day-to-day shift in sleep timing, i.e. sleep variability, was related to inflammation in population studies. Further, other sleep disturbances and glycemic control can contribute to inflammation. This pilot study explored if sleep variability was associated with inflammation in type 2 diabetes (T2D).

Methods
Subjects included 35 non-shift working T2D patients with and without diabetic retinopathy (DR) who were participating in a clinical study (NCT04547439). Sleep pattern was assessed by 14-day actigraphy, yielding sleep duration and efficiency. Standard deviation of sleep duration across the night was used to represent sleep variability. Sleep apnea severity was assessed by an overnight home monitor. Neuropathy pain, statin use, serum creatinine, low-density lipoprotein (LDL), HbA1C and by high-sensitivity c-reactive protein (hs-CRP) were collected. Spearman’s correlation analyses and multiple regression analysis (using natural-log transformed values) were performed to establish an independent association between sleep variability and hs-CRP.

Results
Mean (SD) age was 54.3 (6.4) years, 54.3% were female and 62.9% had DR. Median (interquartile range) of sleep variability was 69 (56,84) minutes. Median A1C was 7.5 (6.6, 8.7)% and hs-CRP was 2.4 (1.4, 4.6) mg/L. Higher hs-CRP was significantly associated with higher sleep variability (r=0.342, p=0.04), HbA1c (r=0.431, p=0.01) and LDL (r=0.379, p=0.03), but not with sleep duration, sleep efficiency, sleep apnea severity, DR status or other variables. Multiple regression analysis showed that higher sleep variability (B = 0.91, p=0.034) and higher HbA1c (B = 1.51, p=0.035), but not LDL, contributed to higher hs-CRP.

Conclusion
Higher sleep variability in non-shift working T2D patients was shown to be independently associated with higher systemic inflammation, conferring higher cardiovascular risk. This data supports the role of even a mild degree of circadian misalignment on systemic inflammation. Further investigations are needed to determine whether sleep intervention to increase sleep regularity can reduce systemic inflammation and improve cardiometabolic health.

Support (if any)
NEI R01EY029782 The University of Illinois Chicago Center for Clinical and Translational Science, which is supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002003.”
0829 Insomnia with Objective Short Sleep Duration is Associated with Hypertension
Authors: Li Yun , Dai Yanyuan , Chen Baixin , Chen Le , Fernandez-Mendoza Julio , Karataraki Maria , Tang Xiangdong , Vgontzas Alexandros 
Published: May 2023

Abstract

Introduction
Insomnia with objective short sleep duration (ISSD) has been proposed as the most biologically severe phenotype of the disorder associated with cardiometabolic morbidity in population-based samples.

Methods
In this study, we investigated the association between ISSD and hypertension in a large clinical sample. We studied 348 patients diagnosed with chronic insomnia disorder (CID) based on International Classification of Sleep Disorders (ICSD-3) criteria and 150 normal sleepers. Objective short sleep duration was defined by the median total sleep time (TST) of the sample (&lt; 7 hours) measured with 1-night polysomnography. Hypertension was defined based on blood pressure (BP) levels, antihypertensive medication use and/or a physician diagnosis.

Results
After adjusting for potential confounders, patients with CID who slept &lt; 7 hours were associated with 2.8-fold increased odds of hypertension compared to normal sleepers who slept ≥7 hours (odds ratio [OR]=2.81, 95% confidence interval [95%CI]=1.068–7.411) or &lt; 7 hours (OR=2.75, 95%CI=1.005-7.542), whereas patients with CID who slept ≥ 7 hours (OR=1.52, 95%CI=0.537-4.285) or normal sleepers who slept &lt; 7 hours (OR=1.07, 95%CI=0.294-3.904) were not significantly associated with increased odds of hypertension compared to normal sleepers who slept ≥ 7 hours. Linear regression analyses showed that, for every hour decrease in TST, systolic and diastolic blood pressure increased by 1.014 mmHg (p=0.045) and 0.923 mmHg (p=0.015), respectively, in patients with CID but not in normal sleepers.

Conclusion
Our findings further support that ISSD is a risk factor for hypertension and objective short sleep duration may be a useful marker of the biological severity of CID in clinical practice.

Support (if any)
This study was supported by the National Natural Science Foundation of China (81970087), Guangdong Province Science and Technology Special Fund Project (200115165870512), and the 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (2020LKSFG05B). The authors report no conflict of interest.