bluuebunny/crossref_metadata_2025_split huggingface dataset:
0861 Does Cognitive Behavioral Therapy for Insomnia Reduce Productivity Loss in Cancer Survivors with Cognitive Impairment?
Authors: Tulk Joshua , Browne Sondria , Ajith Harsha , Garland Sheila 
Published: May 2023

Abstract

Introduction
Insomnia and perceived cognitive impairments (PCI) affect 1 in 4 cancer survivors and negatively affects work productivity. This study explores the impact of cognitive behavioral therapy for insomnia (CBT-I) on work presenteeism and absenteeism in cancer survivors with comorbid insomnia and PCI.

Methods
A sub-sample of 42 Atlantic Canadian survivors with insomnia disorder and PCI who were currently working for pay were analyzed as part of a larger randomized clinical trial. Participants completed 7 virtual sessions of CBT-I. The Work Productivity and Activity Impairment Index Specific Health Problem Questionnaire (WPAI: SHP) was administered pre-and post-treatment. Absenteeism was defined as the percentage of time absent from work, while presenteeism was defined as the extent to which health problems affected productivity at work in the past 7 days. Costs were calculated by the human capital method. Significant changes in productivity loss were defined at ≥15% or 20% change in absenteeism and presenteeism, respectively. Descriptive statistics and paired samples t-tests were used to measure changes in productivity following treatment. Average net benefit was calculated by subtracting the average treatment cost from average treatment benefits after 1 year to reflect cost savings after CBT-I. The cost of treatment was estimated in terms of average cost per session and lost time at work.

Results
Participants (76% Female) were, on average, 50.4 years old with 16.6 years of education. Breast cancer was the most reported cancer type (43%). Overall rates of presenteeism were significantly lower at post-treatment (p=&lt;.001, d=0.55), with 52.4% reporting significant reductions. Absenteeism rates from pre- to post-treatment were not significant (p=.11, d=0.20). Reduced productivity loss post-treatment was associated with an average savings of CAD$10,979/person/year. Average net benefits for the first-year post-treatment equaled CAD$9348/person.

Conclusion
CBT-I can improve work productivity in cancer survivors. Investments to increase and provide access to evidence-based treatment may lead to significant savings for individuals and businesses.

Support (if any)
Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.
0862 Effect of meditation and relaxation on physiological markers of stress and sleep
Authors: Pal Amrita , Agrawal Anurag , Ghahremani Dara , Macey Paul 
Published: May 2023

Abstract

Introduction
Both breathing based meditation (interoceptive) and relaxation by improving blood circulation using heat and massage (exteroceptive) are known to reduce physiological stress. In this study, we determined the effect of stress-reduction on sleep. Our main population of interest was peri- and post- menopausal women who may develop sleep disorders correlated with early-life physical abuse.

Methods
20 adults (15 peri- and post-menopausal females), 13 with high risk of sleep apnea (determined by Berlin questionnaire, age mean±SEM, 54±3 years, waist-by-neck 2.6±0.07, BMI 26±1 kg/m2, Insomnia Severity Index (ISI) Scale 5.71±1.23, Generalized Anxiety (GAD-7) Score 5.33±1.22, Early Trauma Inventory Self-Report Short Form (ETISR-SF)physical 3±0.17. Dreem3 headband was used to get breathing rate (BR), sleep efficiency, sleep staging. Plethysmography was used to obtain mean and nadir oxygen saturation %, heart rate (HR), oxygen desaturation (4%) event index (ODI). BMI, age, waist/neck were recorded. Baseline sleep measures were compared against sleep after administration of 10 minutes rest, 10 minutes relaxation and 10 minutes of Ujjayi pranayama with repeats of 4 in-, 4 hold-, 6 out- breaths. ETISR-physical was correlated with all measures. Paired t-tests were conducted on sleep measures at baseline and after meditation/relaxation. One-sample t-tests were conducted on average % changes during meditation/relaxation compared to rest.

Results
Early-life physical trauma correlated positively with BR during REM sleep (Pearson R= 0.68). Deep sleep significantly (p=0.04) increased by 5% on the sleep after meditation/relaxation. Both meditation and relaxation techniques significantly (p&lt; 0.01) lowered HR by 1.5% and 4.5%, and BR by 20% and 15% respectively during Ujjayi pranayama and relaxation. We observed significant increase (p&lt; 0.05) in oxygen saturation with the Ujjayi pranayama by 0.3%.

Conclusion
Early-life physical abuse was correlated with faster breathing during REM sleep validating existing literature. Both HR and BR were reduced during meditation and relaxation techniques, thus validating their stress-reduction effects. % of deep sleep improved on the night when meditation/relaxation session was administered. Mind-body practices could improve deep sleep if practiced regularly even in peri- and post-menopausal women having early-life physical abuse trauma.

Support (if any)
Sleep Research Society (SRS) Small Research Grant 2022.
0863 Evaluation of sleep apnea among consecutive patients with all patterns of atrial fibrillation
Authors: Mills Eric , Cassidy Michael , Sofer Tamar , Tadros Thomas , Zei Paul , Sauer William , Romero Jorge , Martin David , Antman Elliott , Javaheri Sogol 
Published: May 2023

Abstract

Introduction
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and financial burden. Obstructive sleep apnea is more common in individuals with AF and may impair AF treatment efficacy including with catheter ablation. However, the prevalence of undiagnosed OSA in all-comers with AF is unknown.

Methods
This pragmatic, phase IV prospective cohort study will test 250-300 consecutive ambulatory AF patients with all patterns of atrial fibrillation (paroxysmal, persistent, and long-term persistent) and no prior sleep testing for OSA using the WatchPAT system, a home sleep test.

Results
We report the design, methodology, and results from the initial pilot enrollment of approximately 25% (N=52) of the planned sample size. The primary outcome is the prevalence of undiagnosed OSA in all-comers with AF. Additional outcomes of interest include the sensitivity and specificity of clinical screening instruments for OSA in the AF population and AF-related quality of life measurements among those with and without OSA. Results of the pilot dataset demonstrate a 77.5% prevalence of at least mild (AHI≥5) OSA or greater in all-comers with AF.

Conclusion
Based on our preliminary dataset representing one quarter of the planned total enrollment size of 250-300, there is a high prevalence of OSA in all-comers with AF.

Support (if any)
Zoll Medical
0868 Low-Fidelity Usability Testing of a Smartphone App to Treat Insomnia in Cancer Survivors
Authors: Cotter Riley , Kutana Samlau , Garland Sheila 
Published: May 2023

Abstract

Introduction
Cancer patients and survivors experience insomnia at a higher rate than the general population. Mobile health (mHealth) applications have considerable promise for the treatment of insomnia, but have been criticized for not following evidence-based treatment guidelines. To make insomnia treatment more accessible for survivors, iCANSleep has been developed using user-centered design principles to administer Cognitive-Behavioral Therapy for Insomnia via a smartphone app. The current research presents insights from the low-fidelity usability testing phase of development

Methods
Usability testing is an iterative process of testing an intervention’s user-interface and then applying the results to redesign the prototype to meet users’ needs. Eight cancer survivors from across Canada viewed a video demonstration of the app and completed semi-structured interviews about the app’s design and content. All interviews took place through video conferencing software and were recorded. Researchers transcribed interview responses and analyzed them for common themes.

Results
Participants (71% Female; Mage: 53) were generally very impressed with the design and layout of the app. Most (75%) participants were very interested in trying the app and reported that they would complete the app’s treatment program. Participants appreciated the integration of cancer-specific stories and material, the app’s simple, user-friendly design, the use of incentives and reinforcements, and the depth and breadth of its content. Those interviewed commented on the comprehensive sleep diary within the app and its apparent simplicity. Suggestions were made to streamline the onboarding and replace animations with real people.

Conclusion
User-centered development of the app is promising. The app’s patient-centeredness, accessibility, simplicity, and thoroughness were highlighted as strengths. The development team will integrate these results into the continued app development while working to make onboarding material more engaging. It is important to continue to engage patients throughout to ensure user engagement and effective care.

Support (if any)
Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).
0869 Non-Alcoholic Fatty Liver Disease is Associated with Worse Outcomes in Atrial Fibrillation patients with Obstructive Sleep Apnea
Authors: Aboelnasr Amr , Khokhlov Leonid , Vargas Guillermo Asmar , Thapa Usha , Eshaghabadi Mohammad Amin , Abdelhaleem Ahmed , El Labban Mohamad 
Published: May 2023

Abstract

Introduction
Managing atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA) is challenging and often associated with worse outcomes. Non-alcoholic fatty liver disease (NAFLD) is shown to be associated with increased cardiovascular morbidity and mortality. The effect of NAFLD on AF in patients with OSA is not well studied. This study aims to investigate this association in hospitalized patients.

Methods
We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. Outcomes were adjusted for age, gender, race, heart failure, diabetes, CKD, chronic respiratory failure, stroke and history of MI. P-value &lt; 0.05 was statistically significant.

Results
We identified 1,843,865 hospitalizations for AF with history of OSA: NAFLD in 61,235 (3.4%). AF with OSA and NAFLD vs. no NAFLD had mean age 68.4 vs. 70.6, males 65.2% vs. 64.1%, white 78.2% vs. 80.2%, black 9.3% vs. 10.2%, obesity 45.7% vs. 46.5%, heart failure 69.2% vs. 59.6%, diabetes 59.2% vs. 51.1%, anemia 23.5% vs. 17.2%, CKD 52.4% vs. 40% and COPD 38.2% vs. 39.1%. In-hospital mortality was 11.4% in the NAFLD group vs. 2.5% in the non-NAFLD group (aOR 5.2, P&lt; 0.001). NAFLD vs. non-NAFLD groups had GIB 9.4% vs. 4.5% (aOR 2.1, P&lt; 0.001), cardiac arrest 3.4% vs. 0.9% (aOR 3.4, P&lt; 0.001), cardiogenic shock 7% vs. 1.2% (aOR 4.9, P&lt; 0.001), IMV 10.9% vs. 3.4% (aOR 3.3, P&lt; 0.001) and LOS 7.7 vs. 5.6 (aIRR 1.27, P&lt; 0.001).

Conclusion
Our study shows that NAFLD has worsened the outcomes of patients admitted with AF and has history of OSA. The fivefold increase in in-hospital mortality is likely related to the increase in in-hospital hemorrhagic events and cardiac arrest. Clinicians should be aware of this association. Further research is needed to mitigate the detrimental effect of liver disease on OSA and AF patients.

Support (if any)
0870 Non-pharmacological Sleep Interventions for Patients after Cardiac Surgery: A Systematic Review and Meta-analysis
Authors: Lee Sueyeon , Chen Pei , Zhu Bingqian , Park Chang , Balserak Bilgay 
Published: May 2023

Abstract

Introduction
Patients who have undergone cardiac surgery experience decreased sleep quality, which is associated with patients’ quality of life and mortality. Various interventions were conducted to improve sleep after cardiac surgery; however, findings have been inconsistent. This systematic review was conducted to examine the effects of non-pharmacological sleep interventions in patients after cardiac surgery.

Methods
The review was performed following PRISMA guidelines. CINAHL, PubMed, PsycINFO, Embase, Scopus, and Web of Science were searched. Studies were included if they were a randomized controlled trial that applied non-pharmacological sleep intervention in patients who underwent cardiac surgery and reported sleep as an outcome. Excluded studies conducted on non-open-heart surgery (e.g., percutaneous coronary intervention) or were theses, dissertations, reviews, or study protocols. Quality appraisal of included studies was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted, and mean effect size was separately calculated for studies with reverse-scored scales, which means higher scores indicate poorer sleep quality.

Results
Twenty studies (n=1,460 participants) were included. The most common cardiac surgery was coronary artery bypass graft, and sleep was mostly measured using subjective questionnaires in the studies; only 1 study applied both subjective and objective measures (Actigraphy). Sleep interventions were conducted in a hospital intensive care unit, ward, or outpatient clinic between 1 month before and 2 months after the surgery. The interventions were categorized into educational strategies, complementary medicine relaxation methods, complementary medicine sensory therapies, and the use of a device (e.g., earplugs or eye masks). The meta-analysis results showed that non-pharmacological interventions resulted in better sleep quality as compared to control group. The mean effect size was 0.66 for studies with regular scoring scales (95% confidence interval [CI], 0.38 to 0.94) and -0.83 with reverse scoring scales (95% CI, -1.23 to -0.42), which indicated that the sleep interventions were overall effective for improving sleep quality with medium-to-large effect sizes.

Conclusion
Non-pharmacological sleep interventions improved sleep quality in patients after cardiac surgery. More studies should be conducted to identify the most effective type of sleep intervention and examine the long-term effects of these interventions using objective measures of sleep.

Support (if any)
0871 Outcomes in Overlap Syndrome of COPD and OSA: A Secondary Data Analysis of STAGES
Authors: Clark Lindsey , Keenan Brendan , Hart Joanna , Pack Allan , Sawyer Amy 
Published: May 2023

Abstract

Introduction
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are highly prevalent, and termed Overlap Syndrome (OVS) when coexistent. Patient-reported outcomes (PROs) are impaired in both COPD and OSA alone, but their combined impact is unclear. We examined differences in the impact of COPD on PROs in adults with and without OSA.

Methods
Analyses included adults aged≥8 years with polysomnographic (PSG) data from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. We created sets of individuals with and without COPD, matched up to 1:5 on age±5 years, BMI±2.5 kg/m2, AHI±5 events/hour, and sex. Among all matched sets, we estimated the impact of COPD on fatigue (Fatigue Severity Scale), sleepiness (Epworth Sleepiness Scale), anxiety (Generalized Anxiety Disorder Questionnaire), depression (Personal Health Questionnaire-9), insomnia (Insomnia Severity Index), and function (Functional Outcomes of Sleep Questionnaire) using linear mixed effects models. We also examined whether the effect of COPD differed between those with (AHI≥10 events/hour) and without (AHI&lt; 10 events/hour) OSA.

Results
Overall, 56 patients with COPD were matched to a total of 199 non-COPD controls (51.0% males). The sample was middle aged (55.8±11.8 years), overweight/obese (BMI 29.8±6.9 kg/m2), and had mild/moderate OSA (AHI 11.0±11.5 events/hour) on average; 26 (46.4%) of COPD cases had an AHI≥10. Among all patients, COPD was associated with worse PROs on average (p&lt; 0.05 for all but ESS [p=0.070]). Among those with AHI&lt; 10, there were no differences for any PRO between groups with and without COPD. However, COPD was associated with worse values of all PROs among those with OSA, including fatigue (mean [95% CI] difference = 9.8 [2.9, 16.7], p=0.006), sleepiness (2.8 [0.01, 5.7], p=0.050), anxiety (3.6 [1.1, 6.0], p=0.005), depression (4.4 [1.8, 7.0], p=0.001), insomnia (4.8 [2.0, 7.6], p=0.001) and function (-3.3 [-5.2, -1.5], p=0.001).

Conclusion
The effect of COPD on PROs is modified by OSA, with worse outcomes among those with OVS compared to OSA alone, but no impact of COPD among those without OSA. Identification of adults with OVS through early screening is crucial to prompt treatment of disease and reduce symptom burden.

Support (if any)
T32HL07713 P01 HL094307
0873 Physical Activity, Sleep, and Depressive Symptoms Among Cognitively Impaired Older Adults
Authors: Chung Debbie , Franco J , Cobb R , Pointek J , Seixas Azizi 
Published: May 2023

Abstract

Introduction
Cases of depressive symptoms are highly prevalent among older adults. Moreover, depression among older adults is strongly associated with cognitive impairment, with a prevalence of approximately 8% to 16% of aging adults (Blazer, 2003). Therefore, this study sought to investigate and examine the interplay between physical activity, insomnia, and depressive symptoms among cognitively impaired older adults without dementia using data from the Health and Retirement Study.

Methods
Depressive symptoms and insomnia levels are based on self-reports. We used a negative binomial to assess these relationships and present the incident rate ratios (IRRs) and 95% confidence intervals from our analysis of depressive symptoms associated with insomnia and moderate physical activity.

Results
We observed that insomnia (IRR: 1.18, 95% CI: 1.13-1.24) and moderate physical activity (IRR: 1.13, 95% CI: 1.07 – 1.19) are positively associated with an increase in depressive symptom levels among older adults. Model Two included an interaction term for insomnia and physical activity; results indicate that the interaction term is negative (IRR: .97 95% CI: .94 - .99). Model three tested gender to moderate the relationship between physical activity and depressive symptoms.

Conclusion
The results from the non-significant interaction term suggest that this relationship is non-significant. Similarly, the interaction term (gender x physical activity) results show that the link between physical activity and depressive symptoms did not vary by gender.

Support (if any)
0874 REM Sleep deterioration may modulate tinnitus
Authors: Guillard Robin , Léger Damien , Congedo Marco , Londero Alain 
Published: May 2023

Abstract

Introduction
Sleep quality deterioration often acts as aggravating comorbidity in a variety of chronic conditions. Tinnitus is an auditory symptom that often negatively combines with poor sleep quality, and it has been associated with sleep fragmentation and sleep apnea. Tinnitus is known to be heterogeneous and yet the relationship between tinnitus psychoacoustic characteristics and how precisely sleep is impacted has initiated limited explorative studies, notably for a particular subgroup of patients, which describes that their tinnitus perceived loudness is highly modulated by sleep.

Methods
For this observational prospective study, a sample of 29 tinnitus subjects were recruited. The study group was composed of 15 “on-off tinnitus” subjects who were reporting significant modulations of tinnitus loudness related to night sleep and naps, and a control group composed of 14 subjects that described a constant and permanent tinnitus that was not impacted by sleep. The control group was matched in age, gender and tinnitus impact on quality of life with the study group. All patients underwent a polysomnography (PSG) assessment for one complete night and were asked to fill a screening questionnaire and report tinnitus intensity before and after the PSG.

Results
The “On-off tinnitus” group subjects had less Stage 3 sleep (p&lt; 0.01), less Rapid-Eye Movement (REM) Sleep (p&lt; 0.05) and more Stage 2 sleep (p&lt; 0.05) in proportion and duration compared to the control group subjects. In addition, in the “On-off tinnitus” sample, a correlation was found between REM sleep duration and tinnitus overnight modulation (p&lt; 0.05) as well as tinnitus impact on quality of life (p&lt; 0.05). These correlations were not present in the control group.

Conclusion
This study demonstrates that among the tinnitus population, patients presenting a tinnitus whose intensity is highly modulated by sleep have a deteriorated sleep quality, in which REM sleep may play a role in the overnight tinnitus modulation. Potential physiological explanations accounting for this observation are hypothesized and discussed.

Support (if any)
This study was supported by Felicia and Jean-Jacques Lopez-Loreta Foundation, Robin Guillard EIRL and APHP Hôtel Dieu sleep department.
0876 Sleep and Body Mass Index: The Enduring Effects of Sleep Duration and Wake After Sleep Onset in College Students
Authors: Lico Matthew , Kozak Andrea , Goldstick Jason , Pickett Scott 
Published: May 2023

Abstract

Introduction
College students are an at-risk population for poor sleep health and higher body mass index (BMI), which are both linked to negative health outcomes later in life. Most studies examining the relationship between sleep and BMI are cross-sectional or have collected self-reported sleep data. Therefore, the current study aimed to examine the longitudinal relationship between an objective measure of sleep assessed with a Phillips Respironics Actiwatch 2 device and BMI in college students. It was hypothesized that poorer sleep health would be related to higher BMI.

Methods
At three time points across the first two years of college (i.e., 8 months apart), participants (N=116) wore an Actiwatch 2 device for one week and had their height and weight measured. The sample demographics were 71% female, 72% White or Caucasian, and an average BMI of 24.07. Sleep health was defined by sleep duration, wake after sleep onset (WASO), sleep fragmentation, and midpoint of sleep. Each variable was scored as weekday (Sunday to Thursday) or weekend (Friday and Saturday).

Results
A linear mixed effects model using R was conducted after a person-mean variable (between person) and a person-mean centered variable (within person) were created for each participant. Weekday person-mean sleep duration was negatively related to BMI (t = -2.81), indicating shorter sleep duration was related to higher BMI across time. After controlling for between person effects, there were enduring relationships between both person-mean centered sleep duration (t = -3.12) and WASO (t = 2.06) and BMI, indicating that shorter sleep duration and greater WASO was related to higher BMI within participants across time. No significant relationships were found between weekend sleep variables and BMI.

Conclusion
The current findings add to a growing literature indicating that poor sleep health is related to increased BMI. In particular, the findings indicate that shorter sleep duration and greater WASO may increase risk for weight gain across time but are specific to weekday sleep behaviors. Although alterations in biological and behavioral processes likely serve as the mechanisms by which these variables influence BMI, additional research is needed to understand how this occurs and why weekday sleep behaviors are particularly important.

Support (if any)