bluuebunny/crossref_metadata_2025_split huggingface dataset:
0532 Global prevalence of mild Obstructive Sleep Apnea in females
Authors: Wimms Alison , Benjafield Adam , Valentine Kate , Malhotra Atul 
Published: May 2023

Abstract

Introduction
CPAP has been shown to be beneficial in symptomatic mild OSA. While many healthcare systems have appropriate pathways for treatment of moderate-severe OSA, there remain questions on how to manage treatment optimally for the mild OSA population. Females with OSA tend to be milder than their male counterparts, with lower AHIs, less oxygen desaturations, and different symptoms such as fatigue and insomnia. Females with mild OSA are at risk of being underdiagnosed and under treated. We explored global prevalence data to understand better the scope of this issue.

Methods
A recent publication contained estimations of the global prevalence and burden of OSA. This prevalence was calculated using sex and aged matched data from published prevalence studies, along with estimates for countries without prevalence data, a process which was done by matching the country to a similar country with prevalence data based on BMI, race, and geographical proximity. Finally, a newly developed conversion algorithm was used to standardize different scoring methodologies and to provide equivalent AHI. Raw data from this global prevalence exploration have been divided by sex, and then categorized based on the World Bank 2022 country income rankings, in order to estimate the prevalence of mild OSA in women.

Results
Data from adults aged 30-70 from 164 countries were included in this analysis. Data from 29 low-income countries were excluded due to insufficient information. Based on AASM 2012 scoring, it is estimated that globally at least 202,157,057 of 1,513,628,587 (13.4%) females have mild OSA. The prevalence of mild OSA was 14.6, 15.3, and 10.6% in females; compared to 23.5, 18.3, and 16.3% in males; in high income, upper-middle income, and lower-middle income countries, respectively. The prevalence of moderate-severe OSA was 9.9, 8.5, and 9.4% in females; compared to 22.2, 18.8, and 13.6% in males; in high income, upper-middle income, and lower-middle income countries, respectively.

Conclusion
Globally, mild OSA affects at least 202 million females (13.4%). The highest global OSA prevalence of 15.3% was seen in upper-middle income countries. Continuing awareness, education and appropriate treatment pathways are crucial to ensure this important group are not overlooked.

Support (if any)
This analysis was funded by ResMed.
0557 Sleep apnea detection using photoplethysmography using wearable electronic devices : A systematic review and meta-analysis
Authors: Sharma Rohit , Nguyen-Luu Tristan , Singh Prashant Kumar , Sardar Sundus , Saraza Mohammad , Abbas Sayeda Z , Mirza Wasique 
Published: May 2023

Abstract

Introduction
Sleep apnea, a hyper common disorder is estimated to affect almost 1 billion people with the prevalence of more than 50% in some countries. It is almost impossible to do gold standard polysomnography for all the population for screening. Multiple studies have reported the use of cost effective wearable devices using photoplethysmography (PPG) for the screening. To our knowledge, we presented the first meta-analysis of all studies looking at PPG and screening of sleep apnea.

Methods
We conducted a systematic review and meta-analysis under the PRISMA guidelines. Study Eligibility criteria included patients aged &gt; 18 without a prior diagnosis of sleep disorder. The intervention included screening using a wearable device using PPG with comparison using standard of care sleep study (e.g polysomnography). The databases used were Cochrane, PubMed, Embase and Google scholar. Search strategy with Boolean logic included Sleep apnea, wearable device, smart, photoplethysmography, PPG, smart and smartwatch. Outcomes were pooled diagnostic odds ratio, meta-analyzed area under the curve (AUC),, and forest plots of sensitivity & specificity. Statistical analysis was done using the programming language R with R package mada. Fixed and random effects models were used to derive diagnostic odds ratio (DOR) and paired forest plots for sensitivity & specificity. Summary Receiver operation curve was made using proportional hazard model and Reitsma et al model with a bivariate approach.

Results
The search strategy revealed following number of studies: PubMed (270), Cochrane (0), Embase (41), and Google Scholar(728). Total of 12 studies were included. We found high DOR with the fixed effect model which was 28.979. Mean DOR with the random effects model was 27.6. Bivariate diagnostic random-effects meta-analyzed AUC was 0.902. Studies used various electronic devices some of which are commercially available such as E4 Wristband, Galaxy watch 4, Smartwatch GT2, Belun ring etc. 4 studies used PPG solely while others used multimodal data. 7 studies used conventional machine learning algorithm for analysis.

Conclusion
Screening of sleep apnea could be done in a cost-effective manner from commercially available devices using photoplethysmography owing to possible high sensitivity, AUC and DOR. More studies for data replicability and further standardization is needed.

Support (if any)
0569 Upper Airway Stimulation for OSA: A case series of patients developing intolerance to a previously well tolerated setting
Authors: Brahmandam Sravya , Chan Lawrence , Khan Meena , Chase Margaret 
Published: May 2023

Abstract

Introduction
Hypoglossal nerve stimulation (HNS) is an effective treatment for moderate to severe OSA in patients unable to tolerate PAP therapy. Longitudinal stability of HNS stimulation threshold has been reported. We report a series of 3 patients who developed intolerance over time to previously tolerated and efficacious HNS settings necessitating adjustment to therapy.

Methods
Retrospective chart review.

Results
Patient 1 is a 49 y/o male with moderate OSA implanted with HNS in June 2019. Titration study February 2020 found 2.1V was optimal amplitude. He reported tolerance and benefit of this setting until July 2022. Tongue protrusion was assessed and found to be good at 1.3V. He subsequently tolerated 1.3V well, self-escalating to 1.6V at follow up in Oct 2022. HST is pending. Patient 2 is a 62 y/o female with severe OSA implanted with HNS in Nov 2019. At titration March 2020 3V was optimal amplitude. She reported tolerance and benefit of this setting until December 2021. Tongue protrusion was assessed and found to be good at 2.3V. At follow up April 2022 she reported good tolerance and benefit of 2.3V and HST in July 2022 showed an REI of 8.7. Patient 3 is a 61 y/o female with moderate OSA implanted with HNS in April 2021. At titration August 2021 1.5V was optimal amplitude. She reported tolerance and benefit of this setting until February 2022. Tongue protrusion was assessed and found to be good at 1.0V. HST April 2022 demonstrated an REI of 6.6 at 1V. The patient reported tolerance and benefit to therapy at this level.

Conclusion
Most patients demonstrate stability in HNS stimulation threshold over time, but we describe 3 patients who developed intolerance of a previously tolerated therapeutic setting. No patients reported changes in medical issues, medications, or weight loss as an explanation for developing intolerance. Possible etiologies include delayed nerve healing or change in nerve conduction over time. This may represent a source of potential non-adherence to therapy. Consideration for reduction in amplitude based on objective tongue protrusion may be an appropriate intervention for these patients. Adjustments to therapy should be followed by objective measures of efficacy.

Support (if any)
0640 Depression Symptom Outcomes After a Self-Guided Mobile Application CBT-I Intervention Among College Students
Authors: Hire Veronica , Egeler Mara , Walker Jamie , Dickens Harrison , Vargas Ivan 
Published: May 2023

Abstract

Introduction
Previous research has shown that approximately 78% of college students who suffer from insomnia also endorsed depressive symptoms. Students with depression were 9.5 times more likely to have insomnia than students who did not have depression. There has also been evidence that Cognitive Behavioral Therapy for Insomnia (CBT-I) can reduce depression symptoms. However, the effectiveness of a self-guided mobile version of CBT-I (iCBT-I) in reducing depression among college students has yet to be evaluated. This study aims to assess depression symptoms among students who engaged in a self-guided iCBT-I intervention.

Methods
The study uses a between- and within-subjects design to assess biweekly changes in depression symptom severity before and after completing a four-week mobile intervention for insomnia (i.e., CBT-I Coach). Participants included 39 University of Arkansas college students with a baseline insomnia severity index score ≥ 15. Participants were randomized into the intervention group or a wait-list control group. Participants in both groups are asked to use the CBT-I Coach app for 4 weeks (control group began intervention after a four-week delay). Every four weeks, the Center for Epidemiological Studies Depression Scale was administered to assess depressive symptomology.

Results
Preliminary analyses showed a reduction in CES-D mean scores between baseline (M = 28.3) and week four (M = 25.4) of the intervention group. The intervention group also experienced a depression score rebound at week eight (M = 28.9). The wait-list control group experienced little change in mean CES-D scores from pre-to-post intervention, baseline (M = 23.4), week four (M = 24.2), week eight (M = 23.7).

Conclusion
These results may lend evidence for the short-term effectiveness of iCBT-I in reducing depression symptoms. This could allow for wider dissemination of this treatment modality across a population who suffer from comorbid insomnia and depression.

Support (if any)
K23 HL141581
0641 Difficulty Maintaining Sleep and Sleep Quality mediate the Relationship between Sleep Disturbances and Depression
Authors: Kim Kelly , Huskey Alisa , Taylor Daniel 
Published: May 2023

Abstract

Introduction
Prior epidemiological research has established the relationship between sleep disturbances and depression. Sleep disturbances are also common prodromal features of and comorbid with depression. However, limitations exist across past studies, including the frequent focus on “sleep disturbances” over well-defined facets of sleep, inattention to mediators, and a lack of focus on special populations. As such, there is a need to delineate the relationship between sleep disturbances and depression across specific facets of sleep, particularly in special populations. The current study examined multiple sleep facets as mediators of the relationship between general sleep disturbances and depression severity in college student athletes.

Methods
Student athletes (N = 993) from the Pacific Athlete Conference-12 completed the Athlete Sleep Screening Questionnaire-Sleep Difficulty Subscale (ASSQ-SDS) and Patient Health Questionnaire-9 (PHQ-9). Parallel multiple mediator models were conducted to examine whether the relationship between sleep disturbances and depression severity was mediated by sleep duration, sleep quality, sleep onset latency, and difficulty maintaining sleep.

Results
Using bootstrapping with 5,000 resamples, the indirect effect of sleep disturbances on depression severity was significantly different from zero through sleep quality (indirect effect = .17, SE = .07, 95% CI [.04, .31]) and difficulty maintaining sleep (indirect effect = .12, SE = .03, 95% CI [.06, .19]). Sleep disturbances were associated with sleep quality (b = .29, SE = .01, p &lt; .001) and difficulty maintaining sleep (b = .16, SE = .01, p &lt; .001). Sleep quality (b = .59, SE = .16, p &lt; .001) and difficulty maintaining sleep (b = .78, SE = .17, p &lt; .001) were associated with depression severity. No other mediators reached statistical significance.

Conclusion
Results demonstrate that perceived sleep quality and difficulty maintaining sleep mediate the relationship between general sleep disturbances and depression severity in college student athletes. Findings suggest that sleep quality and difficulty maintaining sleep may be more impactful on depression than other facets of sleep and may be clinically useful targets of intervention for depression.

Support (if any)
0661 Natural History of Nightmares from Childhood to Young Adulthood: A Longitudinal, Population-based Study
Authors: Atha Raegan , Paquet Caitlin , Calhoun Susan , He Fan , Vgontzas Alexandros , Liao Jason , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio 
Published: May 2023

Abstract

Introduction
Nightmares are common in childhood and typically become less prevalent in adulthood. However, little is known about the natural course of nightmares as children grow into adulthood. The purpose of this study was to examine the longitudinal trajectory of nightmares from childhood to adulthood to determine population-based remission, incidence, and persistence rates.

Methods
The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline) who returned for follow-up visits during adolescence and young adulthood. For the current study, 258 young adults (25.1±2.7 years old, 53.9% female, 24.8% minority population) completed their follow-up visit (15.9±2.0 years later). Nightmares were defined by parent-report in childhood and self-report in adulthood, based on severity. Rates of persistence, remission, and incidence for nightmares were computed.

Results
The persistence rate was 28% for mild childhood nightmares and 23% for moderate-to-severe childhood nightmares. About 13% of children with mild nightmares experienced a worsening into moderate-to-severe adult nightmares. The full remission rates was 58% and 32% for mild and moderate-to-severe severe childhood nightmares, respectively. About 45% of children with moderate-to-severe severe nightmares experienced partial remission into mild adult nightmares. Among children without nightmares, 32% and 8% developed mild and moderate-to-severe nightmares, respectively, in adulthood.

Conclusion
Moderate-to-severe nightmares only fully remit in about a third of children in by young adulthood. In addition, about one out of ten children with mild nightmares will worsen in severity by young adulthood. Furthermore, a significant number of children will newly-develop significant nightmares in young adulthood. Given the association of nightmares with adverse mental health outcomes, nightmares should become a focus of independent research and prevention practices.

Support (if any)
National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0679 Do Individuals with ADHD and Sleep Disorders Symptoms Exhibit Worse Executive Function?
Authors: Seewald Mark , Rosenfield Brad , Ramsay J Russell , Alio Courtney , DiTomasso Robert , Muench Alexandria , Boyle Julia , Thompson Michelle , Perlis Michael 
Published: May 2023

Abstract

Introduction
Sleep disorders in individuals with Attention Deficit Hyperactivity Disorder (ADHD) are more prevalent than in people without ADHD. Given that sleep disorders (e.g., insomnia and OSA) impact daytime function (e.g., mood, memory, motivation, attention, executive function [EF], etc.), it is reasonable to wonder if these domains interact. Thus, the aim of the present analysis was to evaluate subjects diagnosed with ADHD who were also symptomatic for insomnia or OSA on a self-report measure of executive function. The hypothesis for the analysis being: subjects with insomnia would show more severe executive function deficits as compared to subjects without symptoms of insomnia and/or subjects with OSA.

Methods
This analysis includes data from 149 subjects diagnosed with ADHD (38% female, Mage 32.8±13.2yrs). Sleep disorder and EF data was provided by the Penn ADHD Treatment and Research Program. Database assessments were gathered from intakes, which included the SDS-CL-25 (a comprehensive screener for sleep disorders) and the BDEFS-LF (a self-report measure of EF deficit). In order to type individuals as “symptom positive” for insomnia or OSA, subjects were required to score &gt;3 for any item within each category. These groups were then compared for their scores on the BDEFS-LF (total score and for three factor scores: self-restraint score [BDEFS-SR], self-regulation of emotions score [BDEFS-SRM], and self-motivation score [BDEFS-SM]).

Results
Subjects with-and-without insomnia symptoms were not found to significantly differ on the BDEFS-T, or any of the three sub-scales. In contrast, subjects with-and-without OSA symptoms significantly differed on the BDEFS-T (p=0.0328), and on two of the three sub-scales (BDEFS-SR [p=0.0183] & BDEFS-SRM [p=0.0032]).

Conclusion
Contrary to our hypothesis, it was the symptom positive OSA group that showed the most deficits on executive function (as measured by the BDEFS-T). This suggests that, in people with ADHD, sleep fragmentation and/or hypoxia may be more associated with EF deficits than problems with sleep initiation or maintenance. This said, it is also possible that other measures of insomnia that better represent sleep insufficiency and/or total nocturnal wakefulness may be more associated with executive functioning deficits, alone or in combination with the sleep sequela of OSA.

Support (if any)
0702 Suicidality in Patients Using Opioid Medications to Treat Severe, Refractory Restless Legs Syndrome: Prevalence and Associations
Authors: Zackon Jordana , Winkelman John 
Published: May 2023

Abstract

Introduction
Prior investigations demonstrate a high prevalence of suicidal ideation and behavior in Restless Legs Syndrome (RLS) patients, particularly those with depression and severe RLS symptoms. The present study examines the prevalence of, and associations with, active suicidal ideation (ASI) and passive suicidal ideation (PSI) in patients using prescribed opioids for severe refractory RLS.

Methods
The National RLS Opioid Registry is an observational longitudinal study consisting of individuals taking a prescribed opioid for diagnosed RLS, nearly all with previously augmented symptoms. Information on opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric symptoms, and opioid abuse risk factors were collected at baseline and every 6 months thereafter by REDCap surveys. Two years following enrollment, the C-SSRS was utilized to assess both PSI and ASI in the previous year, whereas the last question on the PHQ-9 assessed PSI in the past two weeks.

Results
At baseline, participants reported a reduction in previous suicidality following initiation of opioids: ASI from 22.0% to 7.0%, and PSI from 36.7% to 13.4%. At the 2-year PHQ-9 survey, 10.1% of registry participants reported PSI within the two previous weeks. At that same 2-year assessment, on the C-SSRS, 7.8% of participants reported both PSI and ASI in the past year. Overall, suicidality was associated with depression, anxiety, female sex, and perceived opioid stigma. PSI was less likely to be present in those taking methadone. Serial mediation analysis found that both RLS severity and depression severity moderated the relationship between methadone use and PSI. Specifically, methadone use was associated with decreased RLS severity, which was associated with decreased depression severity, and then further, less PSI.

Conclusion
Maximal treatment of RLS symptoms and approaches which mitigate the other clinical features associated with ASI and PSI in this population (anxiety, depression, stigma) are worthy of independent therapeutic attention. Similarly, this data may be useful for prescribers when assessing the appropriateness of opioid treatment for individual patients.

Support (if any)
The National RLS Opioid Registry has received support from the RLS Foundation, the Baszucki Brain Research Fund, Florence Petrlik Family Foundation, Diane and Richard Brainerd, and the Blakeley Foundation.
0747 Association of a novel EEG biomarker of sleep depth with cardiac autonomic modulation in adolescents
Authors: Isely Alexis , He Fan , Fang Jidong , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Ricci Anna , Fernandez-Mendoza Julio 
Published: May 2023

Abstract

Introduction
The odds ratio product (ORP), a continuous spectral EEG measure of sleep depth, increases in the transition to adolescence and with psychiatric/behavioral disorders; however, its association with cardiac physiology has been largely unexplored. Heart rate variability (HRV), a continuous spectral EKG measure of cardiac autonomic balance, includes HR oscillations at low frequencies (LF), the standard deviation between normal heart beats or R-R intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD), reflecting sympathetic vs. parasympathetic tone. We aimed to examine the longitudinal association of non-rapid eye movement (NREM) sleep ORP with 24-hour HRV in adolescents.

Methods
We studied 606 children (Md=9y), of whom 418 were followed-up as adolescents (Md=16y) from the Penn State Child Cohort. We extracted ORP in NREM sleep and in the 9s following cortical arousals (ORP-9) from 9-hour, in-lab polysomnography (PSG), and frequency and time-domain HRV indices from 24-h Holter EKG monitoring immediately following PSG. We stratified 24-h HRV data into daytime and nighttime periods. Linear regression analyses examined the associations between change in ORP and ORP-9 with adolescent 24-h HRV indices, adjusting for age, race, sex, BMI, metabolic syndrome score, AHI, insomnia symptoms, actigraphy-TST, and childhood nighttime HRV indices.

Results
While there were no significant associations between ORP and HRV indices in childhood, there were significant longitudinal and cross-sectional associations in adolescence. Longitudinally, a greater increase in ORP since childhood was associated with lower nighttime Log-LF and SDNN in adolescence (both P&lt; 0.05). Similar longitudinal associations were found for ORP-9, with the addition of higher daytime HR and lower daytime SDNN and RMSSD (all P&lt; 0.05). Cross-sectionally, higher ORP and ORP-9 were associated with higher 24-h HR, yet lower Log-LF, SDNN or RMSSD, for both daytime and nighttime periods in adolescence (all P&lt; 0.05).

Conclusion
Greater developmental declines in sleep depth and increases in arousability during NREM sleep are associated with impaired cardiac autonomic balance in adolescence, independent of sleep apnea, insomnia or insufficient sleep. These data also suggest a coupling between fine-grain spectral measures of the sleeping brain and those of sympathetic/parasympathetic cardiac modulation, which may inform cardiovascular risk early in life.

Support (if any)
NIH (R01HL136587, R01MH118308, UL1TR000127)