bluuebunny/crossref_metadata_2025_split huggingface dataset:
0953 A Novel Active Humidifier for Non-Invasive Ventilated Patients
Authors: Moylan Melanie , Cunningham Helen , Grau-Bartual Sandra 
Published: May 2023

Abstract

Introduction
The RespirAq® humidifier is a novel, active heated humidifier that humidifies without the need for additional water. Within milliseconds, the humidifier switches between a super-hydrophilic state to capture moisture during expiration, and a super-hydrophobic state, returning moisture during inspiration. The device delivers gases at 37°C/100% relative humidity to individuals requiring humidification, including those with tracheostomies. We demonstrated the device meets EN ISO 80601 2 74:2020 during bench testing. This study aimed to compare the performance of the novel humidifier with a heated humidifier - HH (MR850™ Fisher & Paykel Healthcare) and a heat and moisture exchanger - HME (DAR™ Covidien) in healthy volunteers during non-invasive ventilation (NIV) using a non-vented full face mask.

Methods
Ten healthy volunteers were recruited. NIV was performed at different settings (inspiratory positive airway pressure (IPAP) range 5-20cmH20, expiratory positive airway pressure (EPAP) = 5cmH20) over a one-hour period. Humidity and temperature were collected continuously during the study.

Results
Sixty per cent of participants were female. Mean age of 35.6 ± 5.89 years (M±SD, n=10). Absolute humidity inside the face mask increased from 22.55 ± 2.41 mg/L without humidification to 30.18 ± 2.07 mg/L with an HME, and 39.09 ± 1.05 mg/L and 38.23 ± 1.78 mg/L when using a water-based heated humidifier and the novel humidifier, respectively. When comparing the performance of the humidification devices head-to-head, the two heated humidifiers significantly outperformed the HME (HME vs Novel = P &lt; 0.0001, HME vs HH = p &lt; 0.0001) and there was no significant difference seen between the two active humidifiers (p =0.2047).

Conclusion
Results show that the device meets the 12 mg/L absolute humidity established by the EN ISO 80601-2-74:2020 standards and that there is no significant difference in performance compared to traditional heated humidification. This suggests that the novel device can deliver the performance of a heater humidifier at the size, reliability and ease of use of a heat and moisture exchanger. Due to the mechanism of action, droplet/aerosol transmission of COVID-19 may also be mitigated. Further studies are warranted to confirm these findings.

Support (if any)
This research was supported by Tier 2 KiwiNet funding.
0955 Evaluating state-of-the-art algorithms for sleep-wake classification using wrist-worn wearable devices
Authors: Patterson Matthew , Nunes Adonay , Gerstel Dawid , Pilkar Rakesh , Neishabouri Ali , Guo Christine 
Published: May 2023

Abstract

Introduction
Over the last 40 years, a variety of algorithms have been proposed to classify sleep-wake from wrist acceleration data. Input features into these algorithms have been activity counts or raw acceleration. The algorithms proposed range from a single heuristic rule to logistic regression to machine learning and deep learning. The purpose of this work is to evaluate and compare the accuracy of these algorithms against polysomnography (PSG) annotations on a common dataset from a sleep laboratory.

Methods
The Newcastle PSG dataset was used to compare the various sleep-wake prediction algorithms to concurrent PSG annotations in thirty second epochs. This dataset contains 28 patients, 27 of which had wrist acceleration data for both the right and left wrist and one which had data for the left wrist only. Twenty of the participants had at least one sleep disorder. Sleep disorders included idiopathic hypersomnia, restless leg syndrome, sleep apnea, narcolepsy, sleep paralysis, nocturia, obstructive sleep apnea, RBD, parasomnia and insomnia.

Results
The domain adversarial convolutional neural network (DACNN) model showed the best overall results (sens=83.9, spec=57.6, f1=81.7, WASO-RMSE=80.9). The next best performing model according to WASO-RMSE was Cole-Kripke (sens=81.4, spec=50.3, f1=78.0, WASO-RMSE=90.4). This was followed by the van Hees heuristic model (sens=83.6, spec=47.5, f1=79.1, WASO-RMSE=91.1). The fourth best performing model was the Random Forest model (spec=77.5, sens=55.5, f1=76.4, WASO-RMSE=93.0). The fifth best performing model was Sadeh (sens=82.6, spec=49.7, f1=78.5, WASO-RMSE=93.6). The sixth best performing model was the LSTM model (sens=78.6, spec=58.9, f1=77.8, WASO-RMSE=93.9). The worst performing model was the CNN model (sens=79.8, spec=54.2, f1=77.8, WASO-RMSE=99.8). * sens=sensitivity, spec=specificity, WASO=wake after sleep onset, RMSE=root mean squared error

Conclusion
The DACNN algorithm outperformed all other algorithms on sleep-wake classification from wrist acceleration data. Despite being vastly different in input features’ types and algorithm complexity, all other algorithms performed similarly on the dataset, with f1 scores ranging from 76.4 to 79.1 and WASO-RMSE ranging from 90.4 to 99.8.

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0959 Use of a Memory Foam Mattress Improves Sleep Quality and Consistency
Authors: Danoff-Burg Sharon , Rus Holly , Burke Colin , Weaver Morgan , Carmon Kiara , Ledesma Duvia Lara , Rodriguez Rodolfo 
Published: May 2023

Abstract

Introduction
Previous research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, the structure and firmness of a mattress may play a role in sleep quality. More empirical research is needed to establish the impact of particular mattresses on both objective and self-reported measures of sleep. This study compared sleep on a memory foam mattress to participants’ prior sleep on their original mattress.

Methods
Healthy adults (65% female, ages 24-59) participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, they used a Sleepy’s Memory Foam mattress at home. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
There were over 1,000 nights of tracked sleep across 25 participants. Objective sleep measurements showed many nightly improvements during the intervention compared to baseline: less WASO, both in duration (-7 minutes, p&lt;.001) and proportion of the night (p&lt;.001); fewer awakenings (p=.002); and better sleep efficiency (p&lt;.001) and sleep maintenance (p&lt;.001). Improvement also was observed in SleepScore, a measure of sleep quality (p=.008). Self-report measures revealed greater comfort when using the memory foam mattress, as well as improvement in a variety of perceived sleep outcomes, including time to fall asleep, waking less often, spending less time awake after initially falling asleep, longer sleep duration, better sleep quality, and feeling more rested in the morning (ps&lt;.05).

Conclusion
Objectively-measured sleep and self-reported sleep improved in quality and consistency when using the memory mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable.

Support (if any)
Mattress Firm INC
0962 Depression And Sleep Health In A Nationwide Survey: Implications For Depression Therapy During the COVID-19 Pandemic
Authors: Chery Maurice , Baral Amrit , Rolle LaShae , Bernard Maritza , Alfonso Ana Gabriela Sanchez , Duthely Lunthita M , Jean-Louis Girardin , Seixas Azizi , Blanc Judite 
Published: May 2023

Abstract

Introduction
Sleep disturbances are linked to detrimental health outcomes, including mental health and cardiovascular health. A bidirectional relationship between depression and sleep health is well documented in the literature. However, little is known regarding which sleep health dimensions is associated with depression. The purpose of this study is to investigate the relationship between depression and multiple sleep health dimensions; more specifically sleep duration and insomnia symptoms among US adults from January to December 2020.

Methods
We analyzed data from the 2020 National Health Interview Survey (NHIS) conducted among a representative sample of 31, 568 adults. First, we used binary logistic regression models to examine the association between self-reported diagnosis of depression and insomnia variables. Then, a multinomial regression assessed the association between depression symptoms and sleep duration. Our models statistically adjusted for sociodemographic factors (age, sex, marital status), health risk behaviors (smoking and alcohol use status), race/ethnicity, general health condition.

Results
The mean age was 53.50 [±18.04] years. Women represented 54% of the sample and twice as likely to report depression symptoms (67.51 vs 32.49, p&lt; 0.001) relative to men. Binary logistic regression indicated that participants with symptoms of depression had higher odds of having difficulty staying asleep (OR:1.58; 95%CI: 1.43-1.74, p&lt;.0001), difficulty falling asleep (OR:1.46; 95%CI: 1.30-1.62, p&lt;.0001), and feeling unrested (OR:1.70; 95%CI: 1.50-1.93, p&lt;.0001) respectively. Multinomial logistic regression showed that participants with symptoms of depression reported higher odds of having both short sleep (≤ 6 hours) (OR: 1.10; 95% CI: 1.0-1.21, p=0.0424) and long sleep (&gt; 9 hours) (OR: 1.72; 95% CI: 1.50- 2.0, p&lt;.0001).

Conclusion
Our research is among the first to confirm strong associations between depression and several dimensions of sleep in the US general population during US COVID-19 pandemic. Our findings underline the importance of sleep health in treating depression as the nation battles the current mental health crisis.

Support (if any)
Funding sources: R01HL152453-01 R01HL142066, R01HL095799, RO1MD004113
0966 Correlation of Sleep-related Habits and COVID-19 to Pediatric Residents ITE Scores
Authors: Rico Jorge Valencia , Sendon Carlos , Strunc Michael , Pallera Haree , Vazifedan Turaj 
Published: May 2023

Abstract

Introduction
Inadequate sleep negatively affects decision-making. The extent to which it may affect medical residents' performance on the In-Training Examination (ITE) is unclear. Research from Weeks et al., 2021 showed that each hour of sleep a medical resident received prior to the ITE, increased their odds of scoring over 70% on the exam by 25%. A typical resident sleeps six hours a night, which is less than the recommended seven to nine hours a night. Associations between COVID-19 and sleep disorders are more prevalent among healthcare workers. We aim to correlate pediatric ­residents' habits and COVID-19 status with their 2022 ITE scores.

Methods
A cross-sectional, 10-question, electronic, and anonymous survey was sent to the pediatric residents (N=74) in our program. Fisher’s exact test was used to assess the correlation between ITE score less than 70% and rotation at the time of the exam, COVID-19 status, caffeinated beverages, and exercise. Linear regression model was used to analyze the impact of these variables on ITE scores. All statistical tests were two-sided, and p&lt; 0.05 was considered statistically significant. Our methods were limited by a small sample size and recall bias.

Results
A total of 37(50%) residents completed the survey and were included in the analysis. Of those residents, 27(73%) sleep 6-7 hours/night, 9(24.3%) use melatonin regularly, and 23(62.2%) drink caffeine daily. Residents diagnosed with COVID-19 before the 2022 ITE scored significantly lower on the ITE. (-12.1, 95% CI[-23.9, -0.27], p=0.045. There was not any significant association between ITE score less than 70% and rotation (p=0.79), caffeinated beverages (p=0.41), and exercise (p=0.99).

Conclusion
ITE scores of pediatric residents in our program were not significantly influenced by exercise, caffeine consumption, or rotation at the time of the exam. Interestingly, residents who tested positive for COVID-19 before the 2022 ITE displayed significantly lower scores. This finding is in line with a limited number of prior studies pointing to possible long-term cognitive consequences associated with this infection. To better understand this association, we suggest a larger study incorporating sleep hours the night before the exam and COVID status.

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0973 HGNS Sensing Lead Damage After 3D Mammogram Requiring HGNS IPG and Lead Re-Implantation
Authors: Srikrishnan Anand , Tran Katie 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, nocturnal hypoxemia, and daytime fatigue. Standard therapy is with positive airway pressure (PAP) therapy. If this is unsuccessful or poorly tolerated, a hypoglossal nerve stimulator (HGNS) can be surgically implanted for treatment. The goal of HGNS treatment is to advance the tongue with each respiration during sleep to relieve oropharyngeal obstruction causing OSA. This therapy has been shown to be efficacious and well tolerated for moderate to severe sleep apnea with a low complication rate.

Report of case(s)
A 61 year-old female with history of obesity and severe OSA presented to the sleep clinic with complaint of excessive daytime sleepiness and persistently elevated apnea-hypopnea index (AHI) of 42 events/hour despite adequate usage of CPAP therapy. She underwent an HGNS placement for treatment. Following HGNS activation she used it nightly and three months after implantation underwent an HGNS titration study which was successful (AHI 5.7) and the patient was started on optimal treatment settings with resulting resolution of OSA symptoms. After a period of successful device usage, she presented for follow up and reported complaints of excessive fatigue and sleepiness that was sudden. She attributed these changes to a 3D mammography study she underwent for breast cancer surveillance. Repeat home sleep apnea testing showed sudden worsening of her AHI to 50.6. During a thorough investigation of her device, HGNS sensing waveforms indicated possible sensing lead fracture. The patient was taken to the operating room for implanted pulse generator removal and replacement with new sensing and stimulation leads. Intra-operatively, it was noted that the distal sensing lead had several tears of the polyurethane insulation near the hub of the sensor. Following successful re-implantation sensing returned to normal and she has continued HGNS treatment.

Conclusion
We present a case of an unusual complication of HGNS sensing lead damage following a 3D mammography study. This led to surgical exploration with removal of a torn sensing lead and re-implantation of the HGNS generator and leads. Attention should be brought to patients and providers in the future regarding this rare, but potentially serious complication.

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0974 Limitations of Hypoglossal Nerve Stimulation in Patients with Down Syndrome
Authors: Dabboussi Tarek , Manchanda Shalini , Parker Noah , Shah Sachin , Stahl Stephanie 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common sleep disorder affecting up to 80% of people with Down Syndrome (DS). Tonsillectomy and adenoidectomy (T&A) are commonly utilized as the first line of treatment of OSA in patients with DS. However, even after T&A, OSA can persist in up to 60% of patients. Positive airway pressure (PAP) compliance is low in patients with DS, limiting treatment efficacy. Hypoglossal nerve stimulation (HNS) is FDA-approved for the treatment of select adult patients with OSA. Limited research is available on HNS in people with DS; however, the limited data suggests that HNS may be a safe and effective treatment in this patient population. We describe two cases of patients with DS and HNS with unique challenges with treatment.

Report of case(s)
Case 1: A 36-year-old male with a history of DS presented for follow-up after activation of the HNS. The patient had been living part-time in a group home. While the patient’s mother thought he was using HNS every night, the download from the remote showed 41% usage over a three-week time frame. With further investigation, it was determined that the device was turned on the nights when the patient was at home with his parents, but not when he was at the group home despite detailed caregiver education. Case 2: A 19-year-old male with OSA and DS returned for a follow-up of his HNS. Upon exam, the patient’s HNS was already “on” in clinic, which the mother was unaware of. Download from the remote showed a usage time of 13+ hours, and the HNS was commonly “on” into the afternoon well after the patient had left for school in the morning, indicating that the HNS was commonly left on while the patient was awake. Despite significant education, the caregiver was not correctly turning the HNS off.

Conclusion
HNS offers a therapeutic alternative in patients with DS, who are refractory to T&A and PAP. The success of the treatment is dependent on multiple factors, including therapy mechanics, patient tolerance, and caregiver education/compliance. Additional caregiver instruction may be necessary to ensure optimal use.

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0975 Severe Central Sleep Apnea After Bilateral Lung Transplantation
Authors: Akhverdyan Nazar , Camacho Jessica 
Published: May 2023

Abstract

Introduction
Central sleep apnea (CSA) is characterized by repetitive disruptions in airflow during sleep due to impaired central respiratory drive. Multiple studies have described an increased incidence of sleep disordered breathing after lung transplantation. However, these studies implicate obstructive sleep apnea as the primary sleep disturbance related to post-transplant weight gain, increased neck circumference, and fluid retention from immunosuppressive therapy. We report an uncommon presentation of new onset severe central predominant sleep apnea in a bilateral lung transplant recipient.

Report of case(s)
A 61-year-old female with a history of end stage COPD with chronic hypoxic respiratory failure status post bilateral lung transplantation in 2020 presented to sleep medicine clinic with several months of witnessed apneic episodes, excessive daytime sleepiness, morning headaches, and insomnia. Physical exam was notable for an increased body mass index (BMI) of 35 kg/m² from pre-transplant BMI of 29 kg/m². Epworth Sleepiness Scale was 15, compared to 4 prior to transplant. Polysomnogram showed an apnea hypopnea index (AHI) of 94.5 events/hour with central AHI of 54.6, consistent with severe central predominant sleep apnea. Titration on CPAP at 5 cmH2O and 7 cmH2O improved the AHI to 13.3 and 20.3, respectively, with residual central hypopneas. On follow-up, downloaded therapy data revealed a residual AHI of 23.3 on CPAP at 5 cmH2O and 1.5 L/min O2, suggesting the need for a BiPAP/ASV titration study if control remains suboptimal.

Conclusion
Common etiologies of CSA include heart failure with Cheyne-Stokes respirations, neurologic disease, high altitude, and the use of centrally acting medications. This patient did not have clearly identifiable risk factors. Pre- and post-transplant echocardiograms showed preserved left ventricular function with no regional wall motion abnormalities. She lacks history of neurologic disease or narcotic use, and her current immunosuppressive regimen has not been linked to worsened sleep apnea. Proposed pathogenesis of CSA in lung transplant recipients include abnormalities in respiratory mechanics due to pulmonary denervation and altered chemoreceptor sensitivity. Prompt diagnosis and treatment of sleep disordered breathing is crucial in organ transplant recipients to prevent adverse cardiovascular outcomes. Thus, further investigation is warranted to better characterize the changes in respiratory parameters that occur after lung transplantation.

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0978 I Cannot Stay Still - A Case of Sleep-Related Rhythmic Movement Disorder
Authors: Alla Rupini , Carter Gregory , Mukkavilli Venkata 
Published: May 2023

Abstract

Introduction
Sleep-related rhythmic movement disorder (SRRMD) is characterized by repetitive rhythmic motor behaviors involving large muscle groups that occur predominantly during stage N1 sleep. SSRMs are common in infants and children but they usually spontaneously resolve before adolescence. This case presents a rare adult case of SRRMD.

Report of case(s)
A 60-year-old man initially presents to clinic for evaluation of repetitive movements needed to initiate sleep. Patient reports the problem starting in his childhood, where he needs to rock and roll intentionally in bed to fall asleep. He had been prescribed clonazepam 2mg and had been taking this along with doxylamine and melatonin nightly, but still reports frequent nocturnal awakenings due to body rolling. He specifically denies any hypnic kicking/jerking, or discomfort in legs while falling asleep. Patient has no excessive alcohol consumption, marijuana, or illicit drug use. Differentials for the patient’s condition include hyperarousal, chronic anxiety, iron deficiency, sleep-related breathing disorder, and rhythmic movement disorder. Patient consequently underwent an in-lab diagnostic polysomnography study which showed no evidence of sleep-related breathing disorders with AHI of 1.6 (AASM 3%). Sleep efficiency was low at 60.8% and sleep architecture showed decreased REM sleep and decreased N3 sleep. Rhythmic movements were noted during sleep and it was manifested by excessive transient muscle activity in both limb & chin EMG leads and also whole body rocking in the video recording. Moderate periodic limb movements were noted with PLM index to 17. Patient was seen in clinic 6 months later with persistent symptoms and his dose of clonazepam was increased slowly to 2.5 mg and then 3 mg. On the 3 mg of clonazepam, patient had resolution of symptoms.

Conclusion
Our case describes a patient who had SRRMs that commenced in childhood persisting well into adulthood. Reported adult cases of SRRMD are few, and have been associated with sleep apnea, REM sleep behavior disorder, and RLS, while many remain idiopathic such as the case with this patient. While benzodiazepines are still first line for SRRMD, further work up and investigation into possible comorbid conditions could yield insight into the etiology and offer alternative treatment options to patients.

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