bluuebunny/crossref_metadata_2025_split huggingface dataset:
0951 Inter-Scorer Reliability between Somno-Art Software and 5 Sleep Centers
Authors: Viola Antoine , Thiesse Laurie , Staner Luc , Fuchs Gil , Roth Thomas , Schaffhauser Jean Yves , Saoud Jay , Luthringer Remy 
Published: May 2023

Abstract

Introduction
A number of studies have evaluated epoch-by-epoch agreement between 2 technologists in scoring individual sleep stage. Scoring for the specific sleep stages average agreement ranged from 20% to 90% in different studies. The goal of this study is to evaluate the validity of the Somno-Art analyses against a pool of scorers including validated automated system for scoring polysomnograms.

Methods
Sixty polysomnography recording nights, representative of clinical practice (participants who are healthy or suffering from obstructive sleep apnea [OSA], or insomnia or major depressive disorder [MDD]), were scored by 5 different sleep scoring centers and by the Somno-Art Software (total of 6 scorers). Intra-class correlation coefficient (ICC) and Wilcoxon Signed-Rank Test were calculated between each scorer and the average value of the 6 scorers. In addition, epoch-by-epoch agreements between scorers were analyzed.

Results
Somno-Art Software estimation of sleep efficiency, wake, N1+N2, N3 and REM sleep belonged to the interscorer range for the full dataset and the participant groups, except N3 sleep in OSA patients. Somno-Art Software tended to overestimate sleep latency with a significant difference to the average scoring for insomniacs (4.7±1.6 min). On the full dataset, Somno-Art Software had good or excellent ICC scores for all sleep parameters except N3 sleep (moderate score). 4-stages epoch-by-epoch agreement ranged between 78.5-88.7% for the visual scorers and 69.9-71.2% for Somno-Art Software. For the healthy participants, visual scorers agreed between 68.9 and 86.9%, while Somno-Art Software overlapped this range with an interscorer agreement between 62.0 and 71.4%.

Conclusion
Somno-Art solution provides results that are comparable to manual and automatic scoring for commonly used metrics in sleep medicine. It shows a robust interscorer reliability in the range of the 5 polysomnography scorers

Support (if any)
0954 CORRELATION OF PULSE RATE VARIABILITY (PRV) AND HEART RATE VARIABILITY (HRV) METRICS DURING SLEEP IN SUBJECTS SUSPECTED OF OSA
Authors: Tsai Chih-Wei , Gu Wenbo , Yeh Eric , Chen Pai-Lien , Leung Lydia , Cheung Cynthia , Wu I-Chen , Wu Jia-Rong , Strohl Kingman , Chiang Ambrose 
Published: May 2023

Abstract

Introduction
Whether photoplethysmography (PPG)-derived pulse rate variability (PRV) metrics can be surrogates for ECG-derived heart rate variability (HRV) is a decade-long debate. Very few studies have assessed the performance of PRV metrics in wearables. We aimed to evaluate the performance of time- and frequency-domain PRV metrics derived from the Belun Ring (BR) in subjects suspected of sleep apnea.

Methods
Using Pearson’s correlation coefficient (PCC), we retrospectively analyzed the relationship between concurrent BR-PRV and PSG ECG-HRV metrics (standard deviation of NN intervals [SDNN], root mean square of successive RR interval differences [RMSSD], percentage of successive RR intervals that differ by more than 50 ms [PNN50], HF [high frequency] power, LF [low frequency] power, VLF [very low frequency] power, and LF/HF ratio) in 73 subjects suspected of OSA. Subgroup analyses were performed based on demographic information, OSA, co-morbidities, and HR-affecting medication status.

Results
Age (SD) 50.1 (13.4); female 68%; black 52%; BMI (SD) 36.1 (9.7); 56% OSA; mean AHI (SD) 14.7 (17.3). Nine (12%) subjects had significant arrhythmias (defined as having any arrhythmias in ≥25% of all 12-second segments.) Key findings: There was a unitary linear relationship between BR PPG-pulse rate and ECG-heart rate in the overall group. In those without significant arrhythmias (N=64), PRV-SDNN, PNN50, HF, LF, and VLF had excellent correlations (PCC ≥0.90) with corresponding HRV metrics in all subgroups. PRV-RMSSD and PRV-LF/HF also had a strong correlation (PCC ≥0.80) with ECG HRV-RMSSD and HRV-LF/HF in all subgroups except for LF/HF in the diabetes group. In those with significant arrhythmias (N=9), PRV performed less well, with most metrics having PCC &lt; 0.90 or wide CI, except for PNN50. All PRV metrics had PCCs ≥0.90 in subjects on HR-affecting medications except for LF/HF.

Conclusion
BR-PRV metrics can serve as surrogates for ECG-HRV in patients suspected of OSA who do not have significant arrhythmias. PRV-RMSSD and LF/HF may be less robust than the rest of the PRV metrics but still showed strong correlations in most subgroups. BR-PRV can be a useful clinical and research tool in assessing autonomic nervous system function.

Support (if any)
This study is supported by a Grant from Belun Technology Company
0956 Evaluation of a novel automated oxygen desaturation analysis
Authors: Zin Gaia , Swaenpoel Pauline , Verbraecken Johan , Wittevrongel Benjamin 
Published: May 2023

Abstract

Introduction
The oxygen desaturation index (ODI) quantifies the number of desaturations per hour of sleep and is a valuable parameter in diagnosing sleep-related breathing disorders. While oximetry alone is insufficient for an accurate diagnosis, it provides meaningful insights for Obstructive Sleep Apnea (OSA) and the ODI has been shown to correlate with the Apnea-Hypopnea Index (AHI). The close relationship between the ODI and other parameters is especially interesting for home-based sleep studies and/or screening, which typically use a limited set of sensors (but almost always include oximetry) and are becoming increasingly more prevalent. An accurate and automated tool for oximetry analysis will thus be paramount for the sleep clinician.

Methods
The current study aims to evaluate a novel automated solution for oxygen desaturation scoring, provided by Somnilog. We selected 20 overnight recordings, a mix of hospital- and home-based recordings from a dataset from the Antwerp University hospital and an internal database collected from several French sleep centers. The analyzed population (10 females, age 53.0±16.7 years old, BMI of 28.8±4.8 kg/m²) had a variety of diagnoses, including non-apneic snoring and central and obstructive sleep apnea. Each recording was also scored for oxygen desaturations by a sleep expert, using the AASM guidelines and a 3% drop criterion.

Results
The automated solution accurately detected desaturation events with a precision and recall of 0.97 and 0.96, respectively. The reported ODI had an intraclass correlation (ICC) of 0.99 with the index found by the expert. The difference in the number of events reported by the automated solution and the expert was not significant between the lab- and home-recorded patients (p=0.23). We furthermore validated the novel solution with another well-used commercial package and obtained similar performance metrics: precision and recall of 0.96 and ICC of 0.99.

Conclusion
The current study demonstrates the validity of the novel commercial package for oxygen desaturation scoring. The automated tool achieved near-perfect agreement with the sleep experts, and a similar performance to another existing solution in the market. The tool is robust for home-based recordings which are typically more artifact-prone, thereby supporting the increasing demand for out-of-centre overnight studies.

Support (if any)
n/a
0957 Sleeping for one week on a temperature-controlled mattress cover improves slow wave sleep, heart rate, and heart rate variability
Authors: Moyen Nicole , Ediger Tatiana , Hancock Erin , Holden Lucas , Kotzen Kevin , Irick Charles , He David 
Published: May 2023

Abstract

Introduction
Body temperature should be tightly regulated for optimal sleep. A decline in core temperature during sleep onset can increase slow wave sleep (SWS) and decrease heart rate (HR). Passive solutions such as high-heat capacity mattresses are difficult to maintain temperature control during sleep. Thus, we examined how sleeping on an active temperature-controlled mattress cover (TCMC; i.e., the Eight Sleep Pod) for one week affected sleep and cardiovascular health.

Methods
49 participants [24 men, 25 women; mean±SD (range): age = 34.4±11.5 (21.8-64.6) years] slept for 16 nights each (784 total nights) with TCMC temperature-control off (OFF) for the first week as baseline, TCMC temperatures on (ON) at their desired temperatures for the second week, and TCMC OFF for two nights. Participants wore a home sleep test device (HST) for eight nights total: four nights during each OFF and ON for ground truth sleep-staging. Participants wore a Fitbit device throughout the study to collect nightly HR and heart rate variability (HRV). Paired t-tests compared each participant’s sleep and HR/HRV for TCMC ON vs. OFF, separating for biological sex and TCMC temperature. A multiple linear regression was used to evaluate the percent change in SWS from OFF to ON.

Results
Four factors explained 64% of the variance in the percent change in SWS from OFF to ON (r2=0.64; P&lt; 0.001): participants’ baseline SWS during OFF, age, average mattress-cover temperature, and sex. Men sleeping at cooler temperatures (&lt; 26°C) increased SWS by 17 min (P=0.0001; cohen’s-d=0.65), decreased HR by 1.5 beats/minute (P=0.007, cohen’s-d=0.20), and increased HRV by 13% (P=0.045; cohen’s-d=0.23). Women’s sleep was unaffected by TCMC ON (all P&gt;0.05); however, sleeping at warmer mattress-cover temperatures (&gt;27°C) decreased HR by 1.5 beats/minute (P=0.021; cohen’s-d=0.18).

Conclusion
Sleeping on an active temperature-controlled mattress cover at cooler temperatures significantly improved SWS in males, especially those with below-average SWS at baseline and increasing age. One week of sleeping on the TCMC improved HR in both sexes similar to exercise-training.

Support (if any)
Eight Sleep, Inc.
0958 Use of a Hybrid Mattress Improves Objective and Perceived Sleep Outcomes
Authors: Danoff-Burg Sharon , Rus Holly , Burke Colin , Weaver Morgan , Carmon Kiara , Upadhyaya Devanshi , Ledesma Duvia Lara 
Published: May 2023

Abstract

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

Methods
Healthy adults (81% female, ages 25-67) who reported sleeping hot participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, they used a Serta iSeries mattress at home. This hybrid mattress includes materials designed to help the user feel cool. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
There were over 1,400 nights of tracked sleep across 39 participants. Objective sleep measurements showed increased time in bed (+10 minutes, p=.001) and total sleep time (+14 minutes, p=.002), as well as increased REM, both in duration (+6 minutes, p=.004) and proportion of the night (p=.023). Improvements also were observed in two objective sleep quality measures: SleepScore (p=.002) and MindScore (p=002). Self-report measures revealed that the hybrid mattress felt cooler (p&lt;.001) and more comfortable (p&lt;.001). Improvements also were found for a variety of perceived sleep outcomes, including time to fall asleep, waking less often, spending less time awake, longer sleep duration, better sleep quality, and feeling more rested in the morning (ps&lt;.05).

Conclusion
Objectively-measured sleep and self-reported sleep improved when using the hybrid mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable and felt cool. These perceptions likely are what led to more time in bed, which in turn led to the key sleep improvements.

Support (if any)
Mattress Firm INC
0964 Anxiety and Poor Sleep Quality are associated with Cortisol in University Students during the COVID-19 pandemic
Authors: Okun Michele , Sollenberger Alaric , Raval Foram , Dominguez Ahria , Dupy Cameron , Feliciano Leilani 
Published: May 2023

Abstract

Introduction
Students experience a disproportionate amount of stress. The COVID-19 pandemic exacerbated and introduced stressors rarely encountered by students, including quarantining, and switching to remote learning. Psychological stress, mood, and sleep issues are known to have a negative effect on a variety of physiological biomarkers of stress, especially cortisol and a less studied marker, dehydration, (e.g., urine specific gravity levels (USG)).

Methods
This cross-sectional study examined associations between psychological and physiological markers of stress in university students during the latter part of the COVID-19 pandemic. Students completed online questionnaires on stress, depression, anxiety (DASS-21), and sleep quality (PSQI), followed by home collection of saliva (8 samples for 2 days) and urine (first catch). Three cortisol indices were evaluated: CAR, diurnal slope, and AUCg. Urine specific gravity was assessed as a marker of dehydration. Bivariate correlations assessed associations and independent t-tests were used to compare the 25th and 75th percentiles on cortisol indices and dehydration levels.

Results
A total of 43 female students (22.7 ± 6.9 years old) completed the study. Levels of depression (70.7%), anxiety (75.8%), stress (90.2%) fell in the normal range. Sleep quality was poor (9.4 ± 2.8), but TST = 7.74 ± 1.2 hours and SE = 88.1 ± 1.0%. About 20% had symptoms of insomnia. There was a significant difference in AUCg between the 25th and 75th percentile of anxiety (t = -1.90, p = .037; 154.26 ± 17.0 vs 228.12 ± 35.0, ug/dL) indicating those with highest levels of anxiety had higher overall diurnal cortisol than those with lowest levels. Sleep quality was also significantly associated with AUCg. Those with poor sleep (PSQI &gt; 5) had higher cortisol levels than those with good sleep (t = -2.17, p = .019; 236.4 ± 21.2 vs 120.1 ± 10.6 ug/dL). There were no significant associations between the psychological measures and USG levels.

Conclusion
Findings suggest that while stress, depression, and anxiety levels may have leveled off 1 ½ years into the pandemic, those with residual high anxiety and poor sleep quality may continue to be at risk for poor health due to high levels of cortisol.

Support (if any)
0965 Changes in sleep status and the effects of obesity indexed by sex before and after COVID-19: a 2-year follow-up cohort study
Authors: Baek Younghwa , Jung Kyoungsik , Kim Jimi , Lee Siwoo 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic has changed people’s lifestyles. This study aimed to examine the changes in sleep status before and after COVID-19 according to sex in middle-aged Koreans, and investigate the effect of sleep status on obesity indicators.

Methods
This prospective cohort study was the Korean Medicine Daejeon Citizen Cohort study and included participants aged 30-59. A baseline survey was conducted from 2017 to 2019 before COVID-19, and a follow-up survey from 2020 to 2021 after the outbreak of COVID-19. This study analyzed the data of 1436 people, with 422 males and 1014 females completing follow-up. Using the Pittsburgh Sleep Quality Index (PSQI) questionnaire with validity, we evaluated sleep, sleep duration, sleep quality score, and group (categorized into good sleep and poor sleep, based on a PSQI score of 5). Body mass index (BMI), waist circumference (WC), body fat mass (BFM), and percent body fat (PBF) were measured to determine obesity indices. For changes in sleep status before and after COVID-19, Fisher's exact test and Paired t-test were conducted. ANCOVA was performed to determine changes in the obesity index according to sleep quality groups in the baseline survey, which was age-adjusted. All analyses were stratified by sex.

Results
Sleep duration decreased significantly by 13.88 minutes for males and 11.23 minutes for females to 6.54 hours (SD=1.2) and 6.48 hours (SD=1.2), respectively. Sleep quality scores increased by 1.03 points and 0.7 points for males and females, respectively, to 5.2 points and 5.7 points, respectively. The distribution of poor sleep increased from 25.6% before COVID-19 to 38.6% after COVID-19 for males (p &lt; 0.001), and from 36.5% before COVID-19 to 43.1% after COVID-19 for females (p&lt; 0.001). Significant changes in the obesity index were observed according to the sleep quality group only in males. In the male poor PSQI group, WC (Δ3.4 cm), BFM (Δ1.3 kg), and PBF (Δ1.2%) increased significantly more than those in the good PSQI group indices changes.

Conclusion
COVID-19 has negatively impacted sleep, and such sleep changes have contributed to an increase in the obesity index for males.

Support (if any)
This was funded by the Korea Institution of Oriental Medicine, KSN2023120.
0967 Do Pre-existing Sleep Disorders Worsen Long COVID Fatigue and Brain Fog?
Authors: Carter Isabelle , Strohl Kingman , Rosenberg David , Patil Susheel , Torer Juliane , Griggs Stephanie , Decker Michael , May Anna 
Published: May 2023

Abstract

Introduction
Long COVID is common after COVID-19 infection and leads to functional limitations with most reporting substantial symptom burden from fatigue. Symptoms in sleep disorders are attributed to inflammatory dysregulation and may predispose to fatigue expression. We hypothesize prior diagnoses of sleep disorders are associated with severity of long COVID fatigue.

Methods
A retrospective EMR review was performed of 210 consecutive adult patients (9/2021 to 2/2022) referred at least 3 months after COVID-19 infection seen in a new community-based long COVID clinic. The intake process collected demographics, past medical history, functional questionnaires, and symptom checklists. Primary outcome was Fatigue Severity Scale (FSS) score. Sleep disorders were evaluated as a composite of self-reported insomnia, sleep disordered breathing, and restless legs syndrome as well as subset analyses of each disorder. Secondary outcome was physical functioning measured by ECOG performance scale. Linear analyses were used for FSS and ECOG analyses. Adjustors included age, sex, body mass index (BMI), and whether patient had COVID-19 hospitalization.

Results
Cohort was female (66.2%), aged 51.6±SD14.4 yrs, BMI 29.8 [IQR 26.2, 37.7]). Prior chronic insomnia was present in 9%, sleep disordered breathing in 23%, and RLS in 4%; the pooled history of sleep disorders was 30%. Fatigue was reported in 76% with mean FSS score of 5.44 [interquartile range, IQR: 4.11,6.44]; 48% reported brain fog. The interval between acute COVID infection and clinic evaluation was 10.4±5.34 months and had no association to FSS severity (r = 0.07, p = 0.30). Sleep disorders in aggregate, insomnia, and restless legs syndrome had no associations with fatigue or functional status. Sleep disordered breathing had an association to fatigue in unadjusted (β = 0.68, 95% confidence interval, [CI]:0.13,1.24), but not adjusted models (β = 0.53, 95%CI: -0.06,1.13). Sleep disorders both in aggregate and evaluated individually had no associations to brain fog.

Conclusion
A prior history of sleep disorders contributed little to post-COVID fatigue reported in those presenting to a community-based Long COVID clinic.

Support (if any)
TEAMS institutional award, Department of Medicine, University Hospitals of Cleveland, VA CSRD IK2CX001882
0968 Relationship between Breakthrough COVID-19 Infections in Vaccinated Patients and Sleep Disturbances
Authors: Punj Mantavya , Desai Aakash , Hashash Jana , Farraye Francis , Castillo Pablo 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic caused by SARS-CoV-2 continues to result in significant morbidity and mortality on a global scale. Prior studies have examined the effectiveness of non-COVID vaccines in setting of sleep disturbances. This study evaluated data from a large national database to examine the relationship between the risk of breakthrough COVID-19 infections in patients with certain sleep related disturbances.

Methods
Real-time search and analysis using the TriNetX platform to evaluate risk of COVID-19 breakthrough infections (BTI) for patients having ICD-10 diagnoses relating to insomnia, circadian rhythm disorders, and inadequate sleep. The sleep disorder and control cohorts underwent propensity matching including factors for age, gender, race, ethnicity, and multiple co-morbid conditions.

Results
Of 24,720 patients identified as having a sleep disturbance relating to insomnia, circadian rhythm disorder, or inadequate sleep, 815 (3.2%) were found to have a developed a BTI. There was a significant increased risk of BTI noted between the sleep disorder and control cohorts (adjusted odds ratio (aOR) of 1.40, 95% confidence interval (CI) of 1.23-1.58). Subgroup analysis showed an elevated risk for BTI receiving two doses (aOR 1.53, 95% CI 1.24 – 1.89) versus three doses (aOR 1.45, 95% CI 1.24 – 1.69). Patients with the sleep disturbance were not found to be at an increased risk of hospitalization, intubation, death, or composite outcome of death and intubation.

Conclusion
The presence of having a diagnosis of insomnia, circadian rhythm disorder, or inadequate sleep was associated with increased risk of COVID-19 breakthrough infection.

Support (if any)
0970 The impact of the COVID-19 pandemic on healthcare academicians’ sleep quantity and quality
Authors: Macheledt Kait , Berge Jerica , Spencer Sade , Pusalavidyasagar Snigdhasmrithi 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic globally disrupted workplaces, including at academic institutions. Many clinical and research activities were paused and, when clinics and laboratories reopened, operations and workflows had changed. These changes were often stressful. We examined the changes in the quality and quantity of sleep for University of Minnesota health sciences faculty to understand the impact of these disruptions.

Methods
A cross-sectional survey of 291 University of Minnesota health sciences faculty was conducted over the months of April-June 2021 aimed at gaining insight into their lived experiences during the COVID-19 pandemic. The survey included validated measures and general questions developed using survey best practices. Information on personal demographics (gender, race, caregiver status etc.), academic demographics (rank, track, school, etc.), reflective sleep quantity (e.g. hours) and reflective sleep quality were collected through self-report. Associations between gender (e.g. men/women), sleep quantity and quality pre-COVID-19 and during COVID-19 were examined using summary statistics as well as the chi-square test and T-test with statistical significance set to &lt; 0.05.

Results
In general, the study population reported fewer hours of sleep since the COVID-19 pandemic began (µ=6.96) in comparison to before the COVID-19 pandemic (µ=7.23), t(285) = -5.04, p&lt;.001, 95% CI [-0.37.-0.16]. Survey respondents also reported that their quality of sleep was “moderately” restful (N=160) prior to the pandemic but only “somewhat” restful (N=120) during the pandemic, X2(9)=123.59, p&lt;.0001. Demographics (gender and race), caregiver status, and academic attributes (rank, track, school) will be reported.

Conclusion
The COVID-19 pandemic impacted academicians’ sleep quality and quantity. Understanding these changes is important for promoting wellbeing and resilience in academic healthcare.

Support (if any)
N/A