bluuebunny/crossref_metadata_2025_split huggingface dataset:
0676 Sleep medication prescribing among patients receiving opioid use disorder treatment with comorbid insomnia
Authors: Martin Caitlin , Patel Hetal , Dzierzewski Joseph , Moeller Frederick , Bierut Laura , Grucza Richard , Xu Kevin 
Published: May 2023

Abstract

Introduction
People initiating treatment for opioid use disorder (OUD) report insomnia to be a high priority, and insomnia is associated with compromised OUD treatment outcomes. However, insomnia treatments have yet to be investigated in the OUD clinical setting. Knowledge of prescribing patterns for sleep medications among OUD treatment patients is an essential first step to advance therapeutic development at the insomnia-OUD comorbidity. This retrospective cohort study used administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases (2006-2016) to investigate the prevalence of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. In doing so, we assess sex differences in prescription receipt within this unique patient population, given the known sex-based disparities in insomnia among other adult populations.

Methods
We included people aged 12-64 years with diagnoses of insomnia and OUD initiating buprenorphine during the study timeframe. The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g., hydroxyzine, trazodone, and mirtazapine). Descriptive analyses present prescription prevalence for the total sample as well as separately for males and females. Lastly, associations between sex and insomnia medication prescription receipt were estimated using Poisson regression models.

Results
Our sample included 9,510 individuals (female n=4,637; male n=4,873) initiating buprenorphine for OUD who also had insomnia, of whom 6,569 (69.1%) received benzodiazepines, 3,891 (40.9%) Z-drugs, and 8,441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR=1.17 [1.11-1.23]), Z-drugs (RR=1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR=1.07, [1.02-1.12]).

Conclusion
Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment, especially females. These findings juxtapose the known increased overdose risk with benzodiazepine use and lack of efficacy data for these pharmacologic insomnia treatments in this growing patient population in the opioid crisis.

Support (if any)
National institute of Drug Abuse: K23 DA053507 (CEM), UG1DA050207 (FGM). National Institutes of Health: R25 MH112473-01 (HP), T32 DA015035 (KYX), R21 DA044744 (RAG and LJB). National Center for Advancing Translational Sciences: UL1 TR002345 (Washington University), UL1TR002649 (Virginia Commonwealth University)
0678 Consequences of following the herd: Perceptions drive a vicious cycle of poor student sleep habits at an elite university
Authors: Marquardt Matthew , Pontis Sheila 
Published: May 2023

Abstract

Introduction
Poor sleep health is widespread among undergraduate university students. This study sought to understand the contributors to poor sleep quality at an elite undergraduate university in the United States. In particular, we were interested in uncovering the social influences on sleep regularity, which is increasingly regarded as a critical determinant of overall sleep quality.

Methods
An exploratory, mixed-methods study was designed combining a week-long diary study (n=5) and in-depth contextual interviews (n=5) to better understand undergraduate students’ college experience and sleep behaviors, followed by a student survey (n=181) to uncover primary macro trends and factors related to those sleep behaviors.

Results
A significant irregular sleep schedule emerged as highly common among students. Sleep irregularity was strongly influenced by students’ perceptions about their peers’ sleep and working habits. These perceptions combined with a personal desire to keep pace with their peers and the prioritization of academic work implicitly stated by the university culture influenced when and how students went about their lives, even if those behaviors meant acting against their knowledge and judgment. The convergence of perceptions and behaviors generates a vicious cycle of sleep deprivation and low productivity. The cycle stems from students’ desire to match their peers, which leads to late nights and sleep deprivation. The resulting impaired executive functioning contributes to subsequent inefficient scheduling and lack of concentration. As concentration drops, students multi-tasked more often and incomplete tasks piled up, necessitating further sleep deprivation to get it all done.

Conclusion
Poor sleep regularity in college is influenced by a set of interconnected factors derived at both the level of the individual student and at the student-body level. Interventions should consider a dual approach to break the vicious cycle, targeting the harmful beliefs among students about the sleep and working habits of their peers, and the prioritization of academic work.

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0684 Effects of Transcranial Magnetic Stimulation (TMS) on Treatment of Intrusive Thinking in Insomniac Populations
Authors: Reich-Fuhrer Melissa , Hildebrand Lindsey , Jankowski Samantha , Henderson-Arredondo Kymberly , Trapani Christopher , Franca Gabriela , Desai Shivani , Patel Salma , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie , Killgore William 
Published: May 2023

Abstract

Introduction
Patients with clinical insomnia commonly report intrusive thinking (IT) as a common contributor to delayed sleep onset. Evidence suggests that the default mode network (DMN) may contribute to this intrusive thinking. Therefore, we employed continuous theta burst (cTBS) repetitive transcranial magnetic stimulation (rTMS) to modulate DMN activation, and thus reduce IT before sleep.

Methods
In a counterbalanced cross-over design, active or sham cTBS was administered to 20 participants with clinical insomnia, 8 males (Mage=31.63, SD=6.74) and 12 females (Mage=23.75, SD=4.29), with sessions separated by at least 5 days. To assess intrusive thoughts prior to sleep, participants took the Glasgow Content of Thoughts Inventory (GCTI). We utilized the subscale of the GCTI measuring sleep and wakefulness. Higher scores indicate more persistent intrusive thoughts. We conducted a mixed ANOVA to examine effects of sham and active cTBS conditions on intrusive thoughts.

Results
There was a medium effect size (ηp2 =.087) but no significant variance (p&gt;.05) in average IT scores between participants sham cTBS (M=19.100, SD=5.349) and active cTBS (M=18.200, SD=4.502) Post-TMS sessions. There was a significant interaction between sex, TMS, and administration (F(1,18)= 4.697; ηp2=.207; p=.044). We then conducted a simple effects analysis between males and females. There was no significant effect of cTBS condition on reported intrusive thinking post-TMS administration (F(1,7)= .628; ηp2=.082; p=.454). However, there was a significant interaction of cTBS condition on intrusive thoughts post-TMS administration for females (F(1,11)= 5.894; ηp2=.349; p=.034). Post-hoc pairwise comparison revealed that females reported significantly greater intrusive thinking post-TMS administration (M=20.167, SD=5.68) compared to pre-TMS administration (M=17.5, SD=5.73) during their sham cTBS session (p=.042). This was not present post-TMS administration during active cTBS (p&gt;.05).

Conclusion
There was a decrease in intrusive thoughts relating to sleep and wakefulness in females, but not males, following active TMS. Interestingly, we also observed an increase in intrusive thoughts for the sham condition, suggesting that participants may have developed expectations of improvement and been sensitized to these cognitions when sleep was not improved. These findings are encouraging suggesting that cTBS may improve IT, although preliminary data suggest this may differ between males and females.

Support (if any)
W81XWH2010173
0693 Rest-activity rhythm in Methadone and Buprenorphine-maintained patients
Authors: Zhang Rui , Manza Peter , Tomasi Dardo , Shokri-Kojori Ehsan , Demiral Sukru , Wang Gene-Jack , Volkow Nora 
Published: May 2023

Abstract

Introduction
Opioid use disorder (OUD) is a chronic relapsing disorder with a high overdose death rate. In OUD, sleep and circadian disruptions are highly prevalent, interfere with retention in opioid maintenance treatment (OMT) and increase relapse. Growing evidence suggests a link between sleep/circadian disruptions and dopaminergic (DA) signaling which accounts for addictive properties of drugs of abuse. The current study investigated rest-activity rhythm in Methadone and Buprenorphine-maintained patients and how it relates to DA changes in patients.

Methods
To access rest-activity rhythm, twenty-five OUD patients (9 Females; age 44.34±11.97; 60% White, 32% Black; 18 Methadone; 7 Buprenorphine) and thirty-four age, sex, race and BMI-matched healthy controls wore wrist accelerometers for one-week and completed questionnaires for sleep and chronotype. Among OUD patients, sixteen of them completed [11C]NNC112 and [11C]raclopride PET scans for the assessments of D1R and D2R availability, respectively. Negative mood was accessed as secondary outcomes.

Results
Our preliminary data showed that compared to healthy participants, OUD patients undergoing OMT reported greater sleep problems and showed greater sleep irregularity measured by actigraphy, but no differences in other parameters such as sleep duration, rhythm timing or physical activity. Among patients, greater eveningness and irregularity were associated with higher level of negative mood including depression and anxiety. There is a tendency of a positive correlation between later phase and greater D1 receptor availability and a negative association between sleep irregularity and D2 receptor availability.

Conclusion
Our finding suggests that a link between altered rest-activity rhythm and DA signaling in OUD patients. Circadian/sleep interventions that regulate rest-activity rhythm might benefit mood improvement and promote OUD recovery by normalizing DA transmission.

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0697 The Relationship Between Anger Expression and Sleep
Authors: David Michelle , Sedano Brandon Fernandez , Shurovi Sumayya , Yurgel Tyla , Cornelius Talea , Schwartz Joseph , Abdalla Marwah 
Published: May 2023

Abstract

Introduction
Increased anger expression (AE) is linked to worse health outcomes. Short sleep duration and poor sleep quality are linked with increased anger. However, few data have examined whether increased AE may lead to disturbed sleep. We examined if AE is associated with objectively and subjectively-assessed sleep measures in two cohort studies.

Methods
The Masked Hypertension Study (MHTN, n=888) is a multi-site study of the prevalence and predictors of masked hypertension. Participants completed the Spielberger Anger Expression Scale (SAES) and the Pittsburgh Sleep Quality Index. Sleep duration and percent of time awake after sleep onset (%waso) during a 24-h period were derived from wrist-worn actigraphy (ActiWatch; Phillips Respironics), supplemented by diary reports. The Worksite Blood Pressure study (WSBPS, n=472) is a multi-site study of psychological factors and ambulatory blood pressure. Participants completed the SAES and a sleep quality questionnaire. In MHTN, linear regression models were estimated for each sleep outcome with age, sex, race/ethnicity, and anxiety as covariates. In the WSBPS, the analysis was conducted for sleep quality only, controlling for age, race/ethnicity, anxiety, sleep apnea , and study site.

Results
Participants in MHTN (n=782) were 59.5% female, 11.5% Hispanic/Latinx. Mean age was 45.5 years (SD = 10.4). Mean AE was 34.7 (SD = 6.6 ). Mean sleep duration was 6.3 hours (SD = 1.1), mean %waso was 7.1% (SD = 4.0), and mean sleep quality was 5.6 (SD = 3.2). AE was not significantly associated with sleep duration, B = 0.01, 95% CI -0.01, 0.02, p = .30, waso, B = 0.02, 95% CI -0.03, 0.07, p = .43, or sleep quality, B = 0.01, 95% CI -0.03, 0.05, p = .71. Participants in WSBPS (n=278) were 23.7% female, 6.1% Hispanic/Latinx and mean age was 53.1 years (SD = 8.5 ). Mean AE was 46.8 (SD = 5.0). Mean sleep quality was 8.4 (SD = 4.4). AE was not significantly associated with sleep quality, B = -0.014, 95% CI 0.14, 0.07, p = 0.50.

Conclusion
AE was not associated with objective or subjectively-assessed sleep measures. Our findings may suggest that clinicians should focus on other factors rather than AE to improve sleep.

Support (if any)
P01HL47540
0698 Contrasting Painful and Painless Restless Legs Phenotypes: An Adult Twin Family Study
Authors: Champion David , Bui Minh , Aouad Phillip , Ng Georgia , Joyce Emily , Teng Arthur , Karroum Elias , Walters Arthur , Jaaniste Tiina , Hopper John 
Published: May 2023

Abstract

Introduction
Several studies characterized painful and painless restless legs syndrome (RLS) phenotypes based on clinical, topographical, polysomnographic, and genetic background. One pediatric twin family study demonstrated a clear contrast between these two forms of RLS. The painful pediatric RLS being familial, probably genetically influenced, and associated with primary pain disorders (non-migraines headaches; recurrent abdominal pain), the painless pediatric RLS being familial but probably not genetically determined, and associated with iron deficiency, female gender, and persistent/chronic pain disorders. The current study investigated these contrasting painful and painless RLS phenotypes in the adult population.

Methods
The Twins Research Australia database was used to recruit adult twins and their families. The subjects were surveyed and responded to questions related to their demographics, the Cambridge-Hopkins diagnostic questionnaire for RLS diagnosis and categorization into painful and painless RLS subgroups, the history of physician-confirmed iron deficiency, the presence of selected chronic and primary pain disorders, and also other medical, non-pain conditions associated with RLS. Association analyses, using logistic regression with application of generalized estimating equations to control for twin influences, and adjusting for gender and age, were conducted.

Results
A total of 1449 adult subjects responded to the RLS diagnostic questionnaire and to pain related and other medical conditions questions (64.4% females). A total of 1327 adult subjects responded to the iron deficiency pertinent questions (65.7% females). Numbers of dizygous twins and painful RLS subjects were insufficient for heritability testing and for association analyses with medical conditions. Painless RLS was associated with iron deficiency (OR= 1.59; p=0.003), while painful RLS was not (OR=1.26; p=0.444). Painful RLS was associated with migraine (OR=2.35; p=0.004), recurrent abdominal pain (OR=1.96; p=0.026), growing pains (OR=2.13; p=0.050), diverse chronic pain (OR=2.88; p=0.017), chronic spinal pain (OR=3.65; p=0.001) and dysmenorrhea (OR=2.46; p=0.009). Painless RLS was not associated with any pain disorder.

Conclusion
This study further confirmed contrasting associations in adults with painless and painful phenotypes of RLS (association with iron deficiency and multiple pain disorders, respectively).

Support (if any)
This work was supported by the School of Women's and Children's Health, Medicine, University of New South Wales, Kensington 2052, NSW, Australia; Private donors.
0701 Perceptions of People with Restless Legs Syndrome on the Effect of Exercise on Symptoms: Results of a Nationwide Survey
Authors: Cederberg Katie , Sikes E Morghen , Mignot Emmanuel 
Published: May 2023

Abstract

Introduction
Restless legs syndrome (RLS) is a prevalent, sensorimotor sleep disorder that significantly disrupts sleep and is associated with increased risk of cardiovascular disease, hypertension, stroke, depression and anxiety, and causes overall poorer health. As two key diagnostic features of RLS include the worsening of symptoms at rest and relief by movement, there is increasing interest in utilizing physical activity and exercise to manage symptoms. The present study describes personal perceptions of the effects of exercise on symptoms of RLS.

Methods
Participants (N=528) completed a mixed-methods, nationwide survey including items assessing personal experiences with exercise and RLS (both positive and negative) as well as RLS diagnosis, RLS severity, and demographic and clinical characteristics.

Results
Most respondents (72%) perceived that exercise improves RLS symptoms with only a small proportion (13%) perceiving exercise only makes symptoms worse. Participants described any abrupt change in exercise would almost always elicit RLS symptoms (e.g., hiking for a long time, stopping an exercise routine) and that a consistent pattern of exercise seemed to be associated with improvements in RLS symptoms and an overall beneficial effect on frequency of symptomatic bouts. Most (55%) perceived exercise in the morning (4AM to noon) improved their symptoms and 56% perceived exercise in the afternoon/evening (4PM to 11 PM) made symptoms worse. Participants described several questions that they wanted answered regarding the evidence for exercise in RLS and specific exercise prescription recommendations.

Conclusion
Our results suggest that there is individual variation in the response to exercise, whereby some people experience improvements in symptoms with exercise, while others experience worsening of symptoms with exercise. Such individual differences and specific attributes should be considered in exercise-based management to further optimize personalized treatment plans to prevent and manage symptoms in people with RLS.

Support (if any)
This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952].
0704 A PSG Study of the Effect of Clonazepam and Melatonin on REM Sleep without Atonia in Isolated REM Sleep Behavior Disorder
Authors: Mogavero Maria , Ferri Raffaele , Marelli Sara , Castelnuovo Alessandra , Lanza Giuseppe , DelRosso Lourdes , Schenck Carlos , Ferini-Strambi Luigi 
Published: May 2023

Abstract

Introduction
Although very few prospective clinical trials are available assessing the benefits of drugs in isolated REM sleep behavior disorder (iRBD), clonazepam and melatonin are considered as the first-line treatment options. However, while evidence supporting the efficacy of these two compounds on the clinical behavioral outcomes seems to be clear, it is not clear if they are able to significantly modify the main polysomnographic (PSG) feature of iRBD, i.e. REM sleep without atonia (RSWA). For this reason, we carried-out an observational cross-sectional retrospective PSG study of the effects of clonazepam and melatonin on RSWA.

Methods
A total of 83 iRBD patients (70 males and 13 females, age range 50.9-83.2 years) were enrolled in this study: 43 drug-free, 21 patients taking at bedtime chronically (&gt;6 months) clonazepam (0.5-2 mg), seven patients taking melatonin extended-release alone (2-3 mg), and 12 taking a combination of clonazepam and melatonin extended-release (same doses as above). PSG studies were assessed for all subjects, including the measurement of the automatic REM sleep atonia index (RAI) and periodic leg movements during sleep, as well as a series of demographic and clinical variables, such as age, age at onset, disease duration, clinical global impression scale (severity and improvement), mini-mental state evaluation, and RBD severity scale.

Results
None of the outcomes considered in this study showed significant differences between the groups considered. All showed low average values of RAI, as expected, and there were no differences between patients taking clonazepam, melatonin, or a combination of them (drug-free 0.778±0.184, clonazepam 0.797±0.183, clonazepam+melatonin 0.692±0.224, melatonin 0.673±0.228; ANOVA F = 1.329, p = 0.271), despite the clinical global impression scale-improvement was reported to be “much improved” or “minimally improved” in all treated patients.

Conclusion
This study confirms our previous findings in smaller patient series taking only clonazepam and suggest that both clonazepam and melatonin might be beneficial on some clinical manifestations of iRBD but are unable to modify its underlying neurophysiology. This might also indicate that these agents do not seem to interfere with the core mechanisms of this disease and other disease modifying drugs need to be discovered for iRBD.

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0706 Sleep Related Bruxism, Headaches and Cardiovascular Diseases
Authors: Luco Ken 
Published: May 2023

Abstract

Introduction
Sleep-related bruxism is a movement-type sleep disorder affecting 10-12% of the population. It affects men and women equally and has been shown to be a risk factor for cardiovascular disease, tension, and migraine-type headaches (without auras). This disorder is very destructive to the dentition, reduces deep sleep, and can result in significant pain and dysfunction.

Methods
Review of the literature as well as clinical findings.

Results
Sleep-related bruxism affects the trigeminal cardiac reflex resulting in a significant sympathetic stimulation of the cardiovascular system.

Conclusion
Sleep-related bruxism is a risk factor for cardiovascular disease as well as tension and migraine-type headaches (without auras).

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0707 Spinal Cord Stimulation for Restless Legs Syndrome: Case Report and Scoping Review
Authors: Carvalho Diego , Pagani-Estévez Gabriel , Kissoon Narayan , Silber Michael , Tippmann-Peikert Maja 
Published: May 2023

Abstract

Introduction
Restless legs syndrome (RLS) can dramatically impair sleep quality and quality of life. Some patients have insufficient treatment response or intolerance to available pharmacological options. Exploration of novel therapeutic approaches is needed.

Methods
We report a case of spinal cord stimulation (SCS) providing benefit in RLS. We also performed a scoping review of SCS in RLS with comprehensive literature search of MEDLINE, EMBASE, Cochrane, and Scopus.

Results
A 77-year-old woman with DM2, OSA (on ASV), depression, familial RLS and iron deficiency with typical RLS symptoms for all of her adult life presented for management in 2000. In 2011 she developed intractable painful peripheral neuropathy and chronic back pain. Levodopa, pramipexole, oral/intravenous iron, gabapentin, pregabalin, tramadol, oxycodone, and methadone were ineffective or poorly tolerated. A 7-day percutaneous SCS trial resulted in RLS symptoms improvement initially by 50%. A Medtronic stimulator with lead placement at T8-T9 was implanted. 6 months later, the patient toggled between a tonic program (2.1-4.6 mA, 200 us, 50 Hz) and a sub-perception, differential target multiplexed program duty-cycled to 1:2 on:off (3.7 mA, 170 us, 300 Hz). She reported 75% improvement in RLS symptoms. Pain improved by 50%. Total daily dose of Oral Morphine Equivalents was reduced from 48.75mg/day to 37.5mg/day, with a stable once daily dose of 400 mg gabapentin at night. Uninterrupted sleep went from 2-5 hours to 6 hours. RLS worsened when the device was off. Our case corroborates the current evidence of benefit of SCS for RLS from the literature. We identified other 16 unique patients from case reports and series who had undergone SCS for RLS. Leads were most often implanted in mid or low thoracic levels. Stimulation waveforms were high frequency in 4 patients, tonic in 3 patients, burst stimulation in 1 patient, and undescribed in the others. All patients had RLS symptom reduction. Comorbid pain was reported in 14 patients, which also improved with SCS. Complication with lead erosion was reported in one case.

Conclusion
SCS remains a promising therapeutic approach for refractory RLS that deserves further investigation. SCS may reduce hyperexcitability seen in RLS by modulating dysfunctional spinal, subcortical, and cortical networks.

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