bluuebunny/crossref_metadata_2025_split huggingface dataset:
0879 The Association Between Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review
Authors: Chehade Nabile El Hage , Fu Yuhan , Lor Dorothy , Shah Sagar , Ghoneim Sara , Issak Abdulfatah , Baroud Serge , Krishnan Sharan , Fass Ronnie 
Published: May 2023

Abstract

Introduction
The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) remains an area of controversy with varying hypotheses. Both disorders negatively impact health-related quality of life and lead to detrimental clinical outcomes. The aim of our study was to determine the association between OSA and GERD.

Methods
We performed a review of the literature across major databases including PubMed/MEDLINE, Embase, and Google Scholar in November 2021. Studies including patients with GERD and OSA were eligible for inclusion. The endpoints were to assess the association between OSA and GERD, the prevalence of OSA in patients with GERD or without GERD, and the prevalence of GERD in patients with or without OSA. Subgroup analyses were performed to determine whether body mass index (BMI), sex, smoking, or alcohol intake affect the degree of association. The total sleep time, sleep efficiency, and apnea hypopnea index (AHI) were compared between OSA patients with or without GERD. Results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I2 statistics

Results
6 studies involving 2950 patients with either GERD or OSA were included in the pooled analysis. Our findings suggest that there was a statistically significant association between GERD and OSA (OR=1.67, 95% CI [1.18, 2.37], P=0.004). The prevalence of GERD was higher in patients with OSA compared to those without OSA (OR=1.63, P=0.001). Conversely, there was no difference in the prevalence of OSA in patients with or without GERD (OR=1.94, P=0.11). Subgroup analysis shows that BMI, sex, smoking, and alcohol intake did not alter the association between GERD and OSA. In patients with OSA, there were no statistically significant differences in the total sleep time, sleep efficiency, and AHI between those with or without GERD. The mean differences were -5.89 minutes (P=0.19), -0.81% (P=0.67), and 0.80 (P=0.83), respectively.

Conclusion
Our results showed an increased prevalence of GERD is observed in patients with OSA but not vice-versa. However, the presence of GERD does not alter the total sleep time, sleep efficiency, and AHI in patients with OSA. BMI, sex, smoking, and alcohol intake do not seem to affect the strength of this association.

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0880 The Burden of Non-Alcoholic Fatty Liver Disease on Acute Heart Failure Admissions in Patients with Obstructive Sleep Apnea
Authors: Aboelnasr Amr , Khokhlov Leonid , Vargas Guillermo Asmar , Thapa Usha , Abdelhaleem Ahmed , Mejia Carlos , El Labban Mohamad 
Published: May 2023

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is prevalent in heart failure and is associated with cardiovascular and all-cause mortality. The evidence is growing that Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with increased cardiovascular morbidity and mortality. There is limited scientific evidence of clinical outcomes in patients with Acute Heart Failure (AHF), OSA and NAFLD. Therefore, we sought to investigate this population.

Methods
We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AHF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital 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. P-value &lt; 0.05 was statistically significant.

Results
We identified 1,029,785 hospitalizations for AHF with history of OSA: NAFLD in 138,415 (3.7%). AHF with OSA and NAFLD vs. no NAFLD had mean age 65.8 vs. 67.9, males 62.2% vs. 59.2%, Caucasian race 71.6% vs. 68.7%, obesity 50.8%, 55.6%, atrial fibrillation 53.6% vs. 50.5%, diabetes 61.3% vs. 60.4%, anemia 24.8% vs. 20.3%, CKD 56.9% vs. 51.7 and COPD 42.7% vs. 48%. In-hospital mortality was 11.9% in the NAFLD group vs. 2.6% in the non-NAFLD group (aOR 5.2, P&lt; 0.001). AHF and OSA with NAFLD vs. non-NAFLD groups had GIB 6.4% vs. 2.8% (aOR 2.4, P&lt; 0.001), cardiac arrest 4% vs. 1.1% (aOR 3.7, P&lt; 0.001), cardiogenic shock 13.1% vs. 2.6% (aOR 5.2, P&lt; 0.001), IMV 13.2% vs. 5% (aOR 2.9, P&lt; 0.001) and LOS 9.1 vs. 6.6 days (aIRR 1.3, P&lt; 0.001).

Conclusion
In patients with OSA admitted for AHF, NAFLD is independently associated with five times higher odds of in-hospital mortality. It's also associated with a significantly higher incidence of cardiac arrest, cardiogenic shock, IMV and increased hospital LOS. The NAFLD group patients were younger, less obese, with more anemia and CKD. The chronic inflammatory process and humoral dysregulation associated with OSA and NAFLD would induce worsening outcomes of AHF hospitalization. Further research is needed on the impact of OSA optimization in patients with heart failure and NAFLD.

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0881 The Clinical and Policy Impact of Increasing Awareness about Sleep and CVD Health through Public health Programs for Women
Authors: Taylor Kayla , Campos Catherine , Estevez Daniella , Goodman Mackenzie , Kimble Rachel , Sur Nicole , Jean-Louis Girardin , Seixas Azizi 
Published: May 2023

Abstract

Introduction
Sleep is important for cardiometabolic health (CVH) and cardiovascular disease (CVD) prevention, especially for women. Relative to men, women have less awareness of CVD risk factors. Particularly, minority women have disproportionately higher prevalence of short sleep and CVD risk awareness. The primary objective of this review is to investigate the clinical, public health, and policy implications of three major public health programs: the Go Red for Women campaign, the Heart Centers for Women initiative, and the HEART for Women Act, on increasing CVD and sleep health awareness among women in the United States. The secondary objective is to create public health action plan to increase awareness of sleep health and CVD risk. The third objective is to describe barriers and facilitators of implementing the public health action plan for minority women.

Methods
To assess the impact of these interventions, a systematic review was conducted. Studies that directly examined the impact of the 3 CVD awareness programs on the prevalence of CVD in the U.S. Next, studies that evaluated the level of awareness of CVD risk factors and sleep were identified. The current literature was synthesized and described qualitatively to elucidate individual, provider, community and policy knowledge gaps in CVD and sleep health programs for women.

Results
Prevalence of CVD deaths among women decreased from 459,000/ year in 2004 to 339,500/year in 2015. Majority of these interventions include diet, exercise, and smoking cessation and exclude sleep and. Of the three programs, the Go Red for Women campaign proved to have the greatest public health and policy impact. From the results of systematic review, we created a public health action plan to increase awareness of sleep health and CVD risk. Third, we found patient, provider, and policy barriers and facilitators of implementing the public health action plan for minority women.

Conclusion
Public health action plans that focus on sleep health should be culturally sensitive to all women and accessible to those that live in both rural and urban areas addressing the importance of sufficient sleep and its benefits to CVH.

Support (if any)
K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
0882 The Longitudinal Relationship between Objective Sleep and Cardiovascular Parameters During Pregnancy
Authors: Guo Yuqing , Xu Qi , Kehoe Priscilla , Qu Annie 
Published: May 2023

Abstract

Introduction
Growing evidence shows the important role of sleep on cardiovascular health in pregnant women with nearly 50% self-reporting poor sleep quality and 30% insufficient sleep. These sleep disturbances have been associated with adverse perinatal outcomes (e.g., hypertension, preterm births). Many studies have only used self-reported questionnaires during pregnancy. However, a few studies have utilized sleep labs and found that subjective and objective assessments of sleep varied from poor to low associations. The aim of this study was to examine the longitudinal relationship between objective sleep and cardiovascular parameters in pregnant women.

Methods
Seventeen healthy pregnant women with 88% self-identifying as Hispanic were consented to participate in the longitudinal observation study. Their average age was 27.8 years (SD=4.48). A validated Oura ring was used to daily monitor objective sleep and cardiovascular parameters across the pregnancy, including resting heart rate (HR), heart rate variability (HRV) indicated by RMSSD (root mean square of successive differences) of interbeat intervals, deep, light, and Rapid EYE Movement (REM) sleep, awake time and sleep onset latency. Mixed effects models were conducted to analyze daily changing patterns of these parameters using R-4.2.0 for Mac.

Results
Over the pregnancy, when deep and light sleep increased by 1 hour, heart rate decreased by 5.55 bpm (p&lt; 0.001) and 1.32 bpm (p = 0.01), respectively; when REM sleep increased by 1 hour, heart rate increased by 2.15 bpm (p =0.049). Conversely, when deep and light sleep increased by 1 hour, RMSSD increased by 10.32 ms (p&lt; 0.001) and 2.93 ms (p&lt; 0.02), respectively; when REM sleep increased by 1 hour, RMSSD decreased by 7.27 ms (p=0.001). There were no significant associations between HR/RMSSD and awake time/sleep onset latency.

Conclusion
This study appears to be the first to investigate the longitudinal relationship between sleep and cardiovascular parameters among primarily Hispanic pregnant women in the U.S. in a non-lab setting. Our study provides preliminary evidence that longer deep/light sleep and shorter REM sleep may improve cardiovascular health among pregnant women.

Support (if any)
National Science Foundation grants including the Smart and Connected Communities (CNS: 1831918) and Collaborative Research: Integrative Heterogeneous Learning for Intensive Complex Longitudinal Data (DMS: 2210640).
0889 Isolated Rapid Eye Movement Sleep Behavior Disorder: Differences Between Sexes at Presentation
Authors: Alexandres Christina , McCarter Stuart , Tabatabai Grace , LeClair-Visonneau Laurene , Feemster John , Gossard Thomas , Jagielski Jack , Strainis Emma , St. Louis Erik 
Published: May 2023

Abstract

Introduction
Most older adults with isolated REM sleep behavior disorder (iRBD) are men, yet in younger adults there is greater parity between the sexes. Whether the clinical characteristics between women and men with iRBD may differ remains unclear. We aimed to analyze presenting clinical and demographic characteristics of iRBD in men and women.

Methods
We identified 130 women and 130 men with PSG confirmed iRBD who were matched for time of polysomnographic diagnosis, abstracted their clinical histories, and comparatively analyzed clinical characteristics between the sexes.

Results
RBD symptom onset average age (50.4 ± 20.0 vs. 55.4 ±16.9 years, p=0.03) and age at diagnosis (56.4 ±16.7 vs. 62.5 ± 13.3 years, p&lt; 0.01) were younger in women than in men. Injury frequency was similar between groups. Antidepressant use prior to diagnosis (80.8% vs 53.0%, p&lt; 0.01), psychiatric comorbidity (79.8% vs. 50.8%, p&lt; 0.01) and chronic pain syndrome (39.2% vs. 17.4%, p&lt; 0.01) diagnoses were more frequent in women than men. Insomnia (31.5% vs. 18.2%, p= 0.01), hypersomnoence (50.8% vs 37.9%, p=0.04) and overlap parasomnia disorder (13.8% vs 9.8%, p=0.06) were more frequent in women than men, while sleep apnea (43.1% vs. 70.5%, p &lt; 0.01.) and vascular co-morbidity (62.3% vs 83.3%, p&lt; 0.01) occurred more frequently in men than women. Autoimmunity was similar between sexes.

Conclusion
Women were younger when diagnosed, and had more frequent psychiatric diagnoses and antidepressant use, with different comorbid sleep disturbances and comorbidities than men with iRBD. Key sex differences in iRBD could imply different etiologies and aid accurate and timely diagnosis.

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0890 Multiple Sleep Measures and Cognition by Race/Ethnicity and Age
Authors: Alhasan Dana , Gaston Symielle , Whitehurst Lauren , Spira Adam , Sandler Dale , Jackson Chandra 
Published: May 2023

Abstract

Introduction
Disturbed sleep may affect cognition directly (e.g., through sleep fragmentation) and indirectly through effects on related health outcomes (e.g., cardiovascular health). However, investigations of sleep and cognition among diverse racial/ethnic samples and women are sparse.

Methods
We analyzed longitudinal associations among 50,000 Sister Study participants (enrollment: 2003-2009) who reported on short (&lt; 7 hours) and long sleep duration (&gt;9 hours), sleep debt (≥2-hour difference between longest and shortest sleep duration during the week), frequent napping (≥3 times/week), and insomnia symptoms. Participants completed an eight-item Dementia Screening Interview during two follow-up periods (2012-2014; 2017-2019). Poor cognition was quantified as a change in cognitive function indicative of impairment in ≥2 items. Adjusting for sociodemographic and health behavior characteristics, we used log-binomial regression to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between sleep dimensions and cognition, by race/ethnicity and age.

Results
Mean age was 55±8.9 years, 83% self-identified as Non-Hispanic [NH]-White, 9% NH-Black, and 5% Hispanic/Latina. Compared to NH-White women, NH-Black and Hispanic/Latina women reported higher prevalence of all poor sleep dimensions but lower prevalence of poor cognition. Participants with short and long sleep duration, sleep dept, napping, and insomnia symptoms had a higher prevalence of poor cognition (RR=1.09 [95% CI: 1.03-1.16]; RR=1.19 [1.06-1.35]; RR=1.18 [1.11-1.25]; RR=1.27 [1.18-1.39]; RR=1.33 [1.26-1.41], respectively). Estimates for short sleep with poor cognition were higher among minoritized racial/ethnic groups (RRNH-Black=1.15 [0.91-1.45]; RRHispanic/Latina=1.48 [1.09-2.03]; RRNH-White=1.08 [1.01-1.15]), although interactions terms were not statistically significant (p-value= 0.37 and 0.07, respectively). Patterns were similar for insomnia. Sleep debt and insomnia symptoms estimates with poor cognition were higher among younger than older groups (sleep debt: RRAge 26-55 years=1.20 [1.11-1.31]; RRAge 56-76 years =1.14 [1.05-1.25]; insomnia: RRAge 26-55 years=1.39 [1.27-1.51]; RRAge 56-76 years =1.27 [1.18-1.38]). Interaction terms were non-significant (p-value= 0.96 and 0.26, respectively).

Conclusion
Poor sleep health was associated with poorer cognition, and associations may be stronger among minoritized and younger women. Future studies using a life course perspective among large, more diverse populations can elucidate how early-life and later-life factors (e.g., psychosocial experiences; environmental conditions) accumulate to impact sleep health and contribute to differential cognitive risk in adulthood.

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0891 Sex-Specific Differences in Polysomnographic Biomarkers of Sleep Disruption and Sleep Disordered Breathing in Migraine
Authors: Carter Isabelle , Wang Lu , Saab Carl , Gruenthal Eric , Mehra Reena 
Published: May 2023

Abstract

Introduction
The importance of sex as a biological variable on the relationship of migraine and sleep disturbance has not been well-characterized. Given evidence of 1)bidirectional relationships of poor sleep and migraine severity and 2)greater activation of brain regions involved in emotional processing in women compared to men with migraine, we hypothesized that sleep architectural disruption may contribute to sex-specific differences in quality of life measures, particularly those attributed to emotional processing.

Methods
This was a retrospective cohort study of migraine patients aged &gt;18 years seen in the Cleveland Clinic headache program with polysomnogram data. Migraine burden was measured by the 20-item migraine-specific quality of life(MSQOL) encompassing three domains: emotional function(EF), role function-preventative, and role function-restrictive. Linear regression models were used to assess the association of each MSQOL domain with sleep architectural measures and the statistical interaction with sex was examined. Coefficients and 95% confidence intervals were estimated and compared with adjustment of age, race, body mass index(BMI) and comorbidities.

Results
Of 245 patients with migraine,37(15.1%) were male. Males had higher AHI (10.0 [5.3, 18.5] vs. 5.7[1.8, 11.4], p=0.006). The difference in MSQOL-EF scores was not statistically significant (males:73.3[53.3,86.7] vs. females:60.0 [33.3,80.0], p= 0.066). There was no statistical difference in percent N2 or REM between sexes, though males had greater %N1, and lower %N3 (10.9[5.9,19.2] vs. 6.6[4.1,11.9],p=0.039). The association of MSQOL-EF with percent of N2 and REM sleep differed by sex. For each 5% increase in N2, there was a 5% reduction of MSQOL-EF 2.08 (-2.08, 95%CI [-6.86,2.70],p=0.39) in females compared to a 6.84 reduction in males (-6.84, 95%CI [-15.9,2.22],p=0.14), p-value for interaction=0.044. For each 5% increase in REM, MSQOL-EF increased 1.26 (1.26, 95%CI [-3.68,6.21],p=0.61) in females, and increased by 6.27 in males (6.27, 95%CI [-3.11,15.6], p=0.19),p-value for interaction=0.044.

Conclusion
Although males had greater sleep disruption compared to females, there was no significant difference in MSQOL-EF scores. However, sex-specific differences of extent of sleep stage composition and MSQOL-EF were observed suggesting influence of sleep architectural alterations on greater responsivity of migraine emotional processing in men versus women. Future investigation should better characterize longitudinal relationships and underlying neurobiological mechanisms underlying these findings.

Support (if any)
Association of Migraine Disorders
0892 Insomnia and poor sleep efficiency predict cognitive decline among non-demented elderly: findings from the Cretan Aging Cohort
Authors: Basta Maria , Skourti Eleni , Alexopoulou Christina , Ganiaris Andronikos , Aligizaki Marina , Zampetakis Alexandros , Zaganas Ioannis , Simos Panagiotis , Vgontzas Alexandros 
Published: May 2023

Abstract

Introduction
Previous cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the longitudinal associations between sleep quality/quantity with cognitive progression in non-demented community-dwelling elderly.

Methods
A sub-sample of 105 participants (77.5% females) from a large population-based cohort in Crete, Greece of 3,140 older adults (&gt;60 years; baseline) were followed up 8 years later (follow-up). All participants underwent neuropsychiatric/neuropsychological evaluation on both phases. At baseline, subjective sleep complaints and objective sleep variables based on 3-day 24 hour actigraphy were assessed. The impact of baseline objective sleep characteristics and/or insomnia (as defined by at least two subjective sleep complaints) on cognitive progression was assessed with univariate and multivariate models controlling for confounders.

Results
At baseline 50 participants were diagnosed as CNI and 55 as MCI; at follow-up 60 participants (57.1%) displayed clinically significant cognitive deterioration while the remaining showed relatively stable cognitive status. The frequency of persons reporting insomnia symptoms at baseline was higher among those who displayed cognitive deterioration (31.7%) than those in the cognitively stable group (13.3%, p=0.037). Logistic regression analysis showed that participants with insomnia symptoms at baseline, were significantly more likely to deteriorate cognitively at follow-up (p=0.05, OR=2.90). Also, among objective sleep variables added to the model, it was poor sleep efficiency that was associated with cognitive deterioration (p=0.035, OR=3.48).

Conclusion
More than half of the participants displayed significant cognitive deterioration over 8 years and this decline was predicted by insomnia symptoms and objective poor sleep efficiency at baseline. Improving both quality and quantity of sleep may significantly delay the deterioration of cognitive function in non-demented community-dwelling elderly.

Support (if any)
National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397
0894 Impulsivity across early stages of synucleinopathy: from high-risk relatives, REM sleep behavior disorder to Parkinson’s disease
Authors: Zhou Li , Liu Yaping , Chau Steven Wai Ho , Huang Bei , Wang Jing , Chan Joey , Zhang Jihui , Yu Mandy W M , Tsang Jessie C C , Li Shirley Xin , Mok Vincent C T , Wing Yun Kwok 
Published: May 2023

Abstract

Introduction
Increased impulsivity is a common neuropsychiatric feature in patients with Parkinson’s disease (PD), especially attributed to the use of dopaminergic medications. Interestingly, emerging evidence suggested that impulsivity had changed in drug-naïve PD patients. However, it remains unclear whether impulsivity has been altered in prodromal stage of PD, namely isolated rapid eye movement sleep behavior disorder (iRBD) and their high-risk relatives.

Methods
This was a cross-sectional study with four groups of subjects, including early drug-naive PD patients, patients with iRBD and their first-degree relatives (iRBD-FDRs, a high-risk group with potential prodromal RBD features), and controls. A panel of neuropsychological computerized tasks, including go/no-go task, four-choice serial reaction time task (4CSRTT), beads task, balloon analogue risk task (BART) and delay/effort discounting task, would measure various dimensions of motor and decisional impulsivity.

Results
A total of 331 subjects were recruited, including 27 early drug-naïve PD patients (mean age ± SD: 70.1 ± 5.8 years, 77.8% man), 152 iRBD patients (67.2 ± 6.6 years, 77.6% man), 68 iRBD-FDRs (63.2 ± 6.4 years, 51.5% man), and 84 controls (67.4 ± 8.1years, 61.9% man). Early drug-naïve PD and iRBD patients had fewer numbers of extracted beads in beads task 1 (P&lt; 0.001) and task 2 (P&lt; 0.001) in making decisions and fewer numbers of pumps of unexploded blue balloons in BART (P&lt; 0.001) than controls and iRBD-FDRs, suggesting a higher level of reflection impulsivity and a lower level of risk taking, respectively. In addition, early drug-naïve PD and iRBD patients had more no-go errors in go/no-go task (P=0.023), suggesting a marginally lower level of response inhibition in PD and iRBD groups. Early drug-naïve PD and iRBD patients had more premature responses in 4CSRTT than iRBD-FDRs (P=0.008). The delay and effort discounting indexes were comparable among four groups.

Conclusion
While risk taking and response inhibition decreased, reflection impulsivity actually increased in iRBD and drug-naïve PD patients. These novel findings indicated that a complex construct of altered impulsivity has already occurred at the earlier stage (at iRBD) of α-synucleinopathy, which will have implications for pathophysiology and clinical management.

Support (if any)
This study has been supported by the General Research Fund (14116119).