bluuebunny/crossref_metadata_2025_split huggingface dataset:
0182 ADHD traits and psychomotor vigilance after 5 nights of experimental sleep restriction in early adolescents: preliminary results
Authors: Christiansen Taylor , Dionisos Victoria , Mason Gina , Barker David , Dickstein Daniel , Carskadon Mary , Saletin Jared 
Published: May 2023

Abstract

Introduction
Chronic insufficient sleep is prevalent in early adolescence with potential neurobehavioral consequences. However, individual differences examining such outcomes are understudied. Using psychomotor vigilance task (PVT) performance, we examine ADHD traits as a potential factor contributing to the vulnerability of performance following insufficient sleep in youth.

Methods
A preliminary sample of 22 children (11F; 12.25±0.91yrs) were characterized as either high [n=10] or low [n=12] on Conners-3-Parent ADHD-Probability Index [&gt;=/&lt; 50%tile]. In our crossover at-home protocol, 5 stabilization nights (10h time-in-bed[TIB] set to habitual risetime) were followed by 5 nights of sleep optimization (SO; 10h TIB) or restriction (SR, 7.5h TIB; delaying bedtime and advancing risetime equally), then restabilization for 2-4 nights, and the reverse SO or SR condition. Sleep was monitored via wrist-worn actigraphy (Micro MotionLogger). Following SO or SR, participants completed a 10-minute PVT as part of a larger battery administered in the lab in late afternoon. Primary variables included: mean reciprocal reaction time (RRT), mean of the 10% fastest (FRRT), and 10% slowest (SRRT) RRTs.

Results
Mixed-effects ANOVA evaluating condition (SO vs. SR) and group (low- vs. high-ADHD) showed a significant main effect of condition (F(1, 20)=10.91, p=.004, ηp2=.35) with slowed RRTs after sleep restriction (m±sd(1/s): SO=3.31±¬0.46; SR=3.07±0.58), no main effect of group or group-by-condition interaction (ps&gt;.42). No significant effects emerged for FRRT (ps&gt;.13); however, a significant group-by-condition interaction on SRRT(F(1, 20)=4.78, p=.04, ηp2=.19) indicated that only the low-ADHD group demonstrated slower SRRT with SR (SO=1.84±0.45, SR=1.61±0.54), an effect not evident in the high-ADHD group (SO=1.64±0.50, SR=1.69±0.61).

Conclusion
These preliminary data indicate that sleep restriction on a simulated school-night schedule impairs vigilance in young adolescents as in adults. While overall SR reaction times were slower for all participants, SR impacted the slowest 10% of RTs specifically in the low-ADHD group. In ongoing analyses, we are evaluating two empirically testable explanations for this effect: (1) potential floor or ceiling effects in the high-ADHD group (2) a paradoxical hyperactivity following sleep loss in the high-ADHD group.

Support (if any)
R01HD103655; P20GM139743
0199 Effects of acute sleep deprivation on cognitive performance in depressed individuals
Authors: Larson Olivia , Basner Mathias , Rao Hengyi , Dinges David , Barilla Holly , Goldschmied Jennifer , Boland Elaine , Sheline Yvette , Detre John , Thase Michael , Gehrman Philip 
Published: May 2023

Abstract

Introduction
Acute sleep deprivation (SD) is an effective, rapid antidepressant treatment. However, SD has adverse effects on cognitive performance. The effects of SD on cognitive performance in depression remain underexplored. This study investigated relationships between depression and performance on Cognition – a neurocognitive battery of 10 tests that cover a range of cognitive domains – during acute SD.

Methods
Thirty-six individuals with current depression (69.4% female; 33±9.5 yrs) and 10 euthymic controls (40% female; 35±9.5 yrs) underwent a baseline night of sleep followed by 36 hours SD in the laboratory. Participants completed the Cognition battery twice after each protocol night. Each of the 10 Cognition tests has two separate metrics of performance: speed and accuracy. Multivariable linear regressions were used to assess effects of depression status, age, and gender on each performance metric at baseline. Mixed effects models were used to assess effects of depression status, sleep deprivation, and their interaction on performance metrics. All models included a random effect over participants and were adjusted for age, gender, and time of day.

Results
At baseline, depressed individuals were significantly faster than controls on three tests of working memory (β=-72.6; p=0.03), spatial orientation (β=-2944.7; p=0.01), and emotion recognition (β=-537.5; p=0.005) respectively, although these effects did not survive correction for multiple comparisons. Mixed effects model results revealed a significant effect of depression status on the speed metric from the spatial orientation test, whereby depressed individuals were faster across the protocol (β=-2579.6; p=0.04) and a significant interaction effect between depression status and study day on the speed metric from a risk-taking behavior test, whereby depressed individuals were slower after SD (β=480.9, p=0.01); neither effect survived correction for multiple comparisons. However, sleep deprivation was significantly associated with reductions in performance in models for 10 out of 20 metrics (all adjusted ps &lt; 0.05).

Conclusion
These results suggest that currently depressed individuals exhibit the same decrements in cognitive performance after acute SD as non-depressed individuals. Future analyses will examine whether baseline depression severity predicts cognitive performance and whether differences in performance exist between SD responders versus non-responders.

Support (if any)
This work was supported by the National Institute of Mental Health (R01MH107571).
0291 Attending Physician Perceptions of Nightshift Work in the ICU: Results from a Large Tertiary Medical Center
Authors: Johnson Kimberly , Braksick Sherri , St. Louis Erik , Somers Virend , Olson Eric , Caples Sean 
Published: May 2023

Abstract

Introduction
Nightshifts represent a substantial proportion of time dedicated to working in the inpatient setting, particularly among ICU staff. Our institution implemented a 24/7 in-person ICU attending model more than a decade ago. With practice growth and more than 200 ICU beds across disciplines, there are now at least 8 ICU attendings in-hospital all night. Yet, little is known about attending staff perceptions and desires about night work, so we began an exploratory analysis.

Methods
An online survey of 13 multiple-choice, slider scale, and open-ended questions were sent via email to critical care staff physicians of different disciplines within our institution.

Results
69 out of 150 physicians completed the survey (46% response rate). Half were between 35 and 45 years old; 29% were age 45 to 55 years old. About half self-identified as a morningness chronotype. Most (84%) work 3- or 4-night shifts consecutively. Most viewed night shift work as having a negative influence on their quality of life (48% “somewhat negative” and 22% “very negative”) and on their health (51% “somewhat negative” and 24% “very negative”). Most would choose to work less nightshifts (37%) or none (29%). During nightshift assignments, about half (53%) self-report an average of 5 hours of sleep per 24-hour period; 18% self-report ≤ 4hours. Only 6% reported 7 or 8 hours of sleep. Mitigating strategies utilized during series of night shifts include use of caffeine (78%), naps (66%) and use of sleeping aids (21%). Outside of the nightshift series, more than half (56%) reported no sleep difficulties while 21% reported onset or maintenance insomnia.

Conclusion
At our large tertiary hospital employing an in-house nightshift model across multiple ICUs, most staff ICU physicians have a negative perception of night shift work on their quality of life and health. The majority of respondents would choose to work less or no night shifts. How self-reports of limited sleep (average 5 hours) per 24-hour period compare to objectively measured sleep duration in this population remains to be determined in the next phase of this study.

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0303 Insomnia and Morning Drinking During the COVID-19 Pandemic: A Mediating Role of Depression
Authors: Watson Tyler , Killgore William 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic constructed a world of unpredictable cultural and commercial stressors to growing connectivity and proliferating society. A potential relationship between the aspects of heavy drinking and insomnia during the pandemic has not been analyzed. We hypothesized that there would be a significant correlation between morning drinking and insomnia. However, we also hypothesized that this relationship would be mediated by depression.

Methods
13,313 individuals across the United States were surveyed (M=37.19 years old; SD ± 12.375). Neurocognitive battery assessments including self-report measures of depression, insomnia symptoms, and alcohol use. The variable description for this analysis was (How often during the last year have you needed a first drink in the morning to get yourself going after heavy drinking?) The scoring was based on a five-point scale ((0) never (1) less than monthly (2) monthly (3) weekly (4) daily or almost daily.) Insomnia Severity Index reported symptoms qualify for (0-7 score = no clinical insomnia, 8-14 = subthreshold insomnia, 15-21 = moderate clinical insomnia, and 22-28 = severe clinical insomnia). Participants also completed the PHQ-9 Depression Scale.

Results
Morning drinking scores correlated with insomnia (r=.254, p&lt;.001) and depression (r=.344, p&lt;.001). A mediation model revealed a total effect of insomnia on morning drinking when the depression was not accounted for (E=.0303, p&lt;.0001). After including PHQ-9 Depression as a mediator, the direct effect was still significant (E=.0032, p=.0406), suggesting partial mediation. On the other hand, when insomnia was the mediator variable, the total effect and direct effect had no significant change (“total effect” E=.0414 p&lt;.0001) (“direct effect” E=.0391 p&lt;.0001), suggesting no mediating influence.

Conclusion
These results suggest that the association between morning drinking and insomnia was significantly partially mediated by depression during the pandemic. When depression was the independent variable and insomnia as the mediated variable, there was no longer efficiency in the mediation model. These results suggest that observed associations between insomnia and morning drinking during the pandemic were partially mediated by depression.

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0430 Central Sleep Apnea and Incident Atrial Fibrillation in a Sleep Disorders Clinic
Authors: Tompkins Amanda , Patel Sanjay , Genuardi Michael , McKane Scott , Fudim Marat , Lund Lars , Mehra Reena , Song Nan , Germany Robin , DeSensi Rebecca 
Published: May 2023

Abstract

Introduction
Given conflicting evidence in the literature, we sought to evaluate the relative importance of central sleep apnea (CSA) and obstructive sleep apnea (OSA) on incident atrial fibrillation (AF) risk in a cohort of patients referred for sleep evaluation.

Methods
We reviewed the medical records of patients without AF at baseline who underwent in-lab diagnostic polysomnography (PSG) at six sleep laboratories within the University of Pittsburgh Medical Center (UPMC) between 2004 and 2018. Baseline characteristics including apnea hypopnea index (AHI), central apnea index (CAI), and obstructive apnea index (OAI) were extracted from the electronic health record. Among those with AHI≥15, patients were categorized as CSA if CAI≥5 and CAI&gt;OAI or OSA if OAI≥5 and OAI&gt;CAI. Patients with AHI&lt; 15 were included as the reference group. Incident AF was identified based on AF as a primary or secondary diagnosis on either inpatient or outpatient UPMC visits.

Results
We identified 24,199 patients (425 CSA, 7559 OSA, 16,215 no sleep-disordered breathing [reference]) for analysis who had a mean age of 49, mean body mass index (BMI) 34, and 48% male. The incidence rates for AF ranged from 1.07 per 100 person-years in the reference group to 1.91 and 2.60 in the OSA and CSA groups (p&lt; 0.01). Using Cox proportional hazards models, the hazard ratio for incident AF in the OSA group compared to reference was 1.78 (95% CI [1.63-1.94], p&lt; 0.01) and in the CSA group was 2.48 (95% CI [1.92-3.21], p&lt; 0.01). After adjusting for age, sex, race, BMI, and baseline diagnoses of diabetes, heart failure, prior heart attack, and prior stroke, OSA was no longer associated with incident AF risk (HR=1.01, 95% CI [0.92-1.12], p=0.76). However, a potentially important association between CSA and incident AF persisted (HR=1.28, 95% CI [0.99-1.67], p=0.06).

Conclusion
We found that CSA was associated with a 28% increased rate of incident AF independent of traditional risk factors, which was nearly statistically significant. This suggests CSA may be a risk factor for AF. In contrast, OSA was a risk marker but not independent risk factor for AF.

Support (if any)
ZOLL Respicardia, Inc.
0487 The effect of negative pressure ventilation on airflow in obstructive sleep apnea subjects undergoing drug induced sleep endoscopy
Authors: Yu Jason , Plageman Jack , Schwartz Alan 
Published: May 2023

Abstract

Introduction
Drug induced sleep endoscopy (DISE) is used to visually characterize pharyngeal airway collapse in obstructive sleep apnea (OSA) to help determine appropriate patients for OSA surgery. The procedure has grown in complexity with the addition of airflow recording and continuous positive airway pressure (CPAP) titration to obtain additional measures of airway collapsibility. Lung volume can also influence airway collapse in OSA but is not evaluated as part of routine DISE. The purpose of this study is to characterize the relationship between changes in lung volume and upper airway collapse during DISE to gain further insight into factors contributing to airway collapse and their potential roles in influencing surgical decision making.

Methods
This study is an ongoing IRB approved prospective clinical trial assessing the effects of negative pressure ventilation on airway collapse during DISE. Enrolled patients first undergo DISE evaluation per clinical routine including a CPAP titration. CPAP is then held at a level where patients exhibit stable flow limitation. A negative pressure ventilator shell is placed over the torso of the body and negative pressures of up to -25cmH2O are applied to expand the chest and increase lung volume. Changes to nasal airflow and tidal volume are evaluated. The negative pressure ventilator is then released and changes to airflow back to baseline are recorded.

Results
Between 6/30/2022 and 11/30/2022, 5 patients completed the study. There were 4 men and 1 woman with an average age of 60 years, BMI of 26.67kg/m2, and apnea-hypopnea index (AHI) of 44.44 events/hr. Average peak inspiratory flow increased from 8.38L/min to 13.78L/min and average tidal volumes increased from 155mL to 269mL on negative pressure ventilation.

Conclusion
Increases in lung volume from negative pressure ventilation during DISE can improve airflow and tidal volume suggesting that changes in lung volume can influence the severity of upper airway collapse. Further study to better characterize this relationship can help add additional diagnostic information regarding airway collapse characteristics to provide better informed surgical decisions and develop new interventions.

Support (if any)
Supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Numbers UL1TR002378 and KL2TR002381
0500 Impact of positive airway pressure on drug-induced sleep endoscopy to deliver precision medicine
Authors: Singh Supriya , Dang Lequan 
Published: May 2023

Abstract

Introduction
Sleep endoscopy during natural sleep will be ideal, to evaluate the upper airway during episodes of obstructive sleep apnea, but quite difficult to achieve. Drug-induced sleep endoscopy is an alternative standard of care to document the level and severity of the collapse of the upper airway. It is especially of benefit for patients who are intolerant to positive airway pressure and is used as a part of a work-up for alternative therapy for treating sleep apnea. Using propofol infusion and a Bi-spectral index of 50-70, to monitor the depth of sedation, the upper airway collapse can be determined with sleep endoscopy, conducted initially without CPAP and then with a CPAP ranging from 10 cmH2O to 20 cm H2O in patients who failed PAP therapy.

Methods
Drug-induced sleep endoscopy (DISE) was carried out in the bronchoscopy suite by the same Pulmonologist with an anesthesiologist to manage sedation using Propofol. Adequate depth of sedation was confirmed by the presence of snoring, and a BIS. The patient underwent the entire procedure while supine. The severity of obstructions followed the velum/oropharynx/tongue base/epiglottis and was recorded as patent/partial/complete. The obstruction pattern was classified into circumferential, anteroposterior, or lateral. Tongue base obstruction was identified when the tongue base pushed the epiglottis causing lumen obstruction. The DISE was conducted initially without CPAP followed by DISE with CPAP.

Results
Out of a total of 80 patients, upon application of the CPAP, 3 patients (4%) had patent velum and the base of the tongue. 3 (4%) with partial collapse of the velum and complete collapse of the base of the tongue. One (1%) had persistent anterior-posterior and lateral wall collapse of the velum, but the base of the tongue was patent. 68 (85%) had improved lateral wall collapse and obstruction of the velum improved from complete to partial anteroposterior collapse. Five patients (6%) continued to have persistent circumferential collapse of the velum.

Conclusion
Drug-induced sleep endoscopy performed in combination with various pressures of CPAP allows real-time visualization of the impact of these pressures on the upper airway. It allows us to provide alternative treatment options sooner than later.

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0529 Efficacy of a Novel Acceptance-Based Approach in Improving PAP Adherence in Women Veterans
Authors: Gogineni Swetha , Carlson Gwendolyn , Mitchell Michael , Swistun Dominika , Lee Diane , Song Yeonsu , Fung Constance , Kelly Monica , Erickson Alexander , Washington Donna , Yano Elizabeth , Alessi Cathy , Martin Jennifer , Zeidler Michelle 
Published: May 2023

Abstract

Introduction
Sleep disordered breathing (SDB) is associated with a myriad of health conditions yet is often underrecognized in women. Positive airway pressure (PAP) therapy is first line therapy for SDB; however, adherence rates are low, with women in the U.S. having lower PAP adherence than men. In studies of veterans, published research has not evaluated interventions specifically for women with SDB. Acceptance and Commitment Therapy (ACT) is a technique that utilizes individuals’ values, commitment to change, and mindfulness techniques to promote behavioral change and may be an effective technique in improving PAP adherence among women veterans.

Methods
We analyzed data from women veterans newly diagnosed with SDB who agreed to try PAP therapy (mean age=53.2 years [range 26-80], 30% African American, 28% Hispanic; n=90) who participated in a randomized controlled trial comparing an ACT-based intervention (Acceptance and Behavioral Changes to treat Sleep Apnea - ABC-SA; n=44) to a PAP educational control (n=46). Remote monitoring was used to determine days of PAP usage, days PAP used &gt; 4 hours (main outcome), and hours of PAP used per month for the first 3 months of use. We used mixed models to compare changes in PAP adherence measures between groups over the first 3 months of use.

Results
In the ABC-SA group, mean nights of use were 20.9, 14.9, and 11.5 for months 1, 2, and 3 respectively, versus 16.9, 11.0, and 8.7 in the control group, with a non-significant trend towards more nights of use in the ABC-SA group in month 1 (p=0.056). There were no significant differences between ABC-SA and control in other PAP use outcomes in months 1, 2 or 3.

Conclusion
An ACT-based approach did not improve PAP adherence in women veterans over the first three months compared to education alone. Future studies are needed to evaluate whether subgroups may benefit from more intensive interventions such as ABC-SA and to evaluate interventions for improving PAP use long-term.

Support (if any)
This research was supported by the VA HSR&D IIR 16-244. Dr. Martin was supported by VA HSR&D RCS 20-191 and NIH/NHLBI K24 HL143055.
0540 OBESITY IS LINKED WITH HIGHER RISK OF OSA WITHOUT SUBJECTIVE HYPERSOMNIA IN MENOPAUSAL WOMEN
Authors: Marichalar José Garza , Torrecillas-Gordillo Meliza J , Chávez Luévanos Beatriz E , Martinez Carlos , de la Garza Luis , Moreno Ricardo 
Published: May 2023

Abstract

Introduction
Obesity is one of the biggest public health problems in the world, with the incidence of obesity estimated to be around 30% in some countries. There is a well-established link between Obstructive Sleep Apnea and obesity. This is due to many factors including a narrower airway because of fat deposits in this region, as well as decreased muscle activity. Subjective sleepiness measured with the Epworth Sleepiness Scale (ESS) is also associated with an increased risk of OSA. There are some studies that suggest that the ESS has a better predictive value in men than in women to detect Sleep Disordered Breathing, but to our knowledge, there are no studies in menopausal women

Methods
A retrospective study was performed using the data from the menopause clinic at the University Hospital in Monterrey, Mexico. All patients in the menopause clinic are evaluated using a screening protocol to detect sleep disorders, using the following tools: Pittsburgh Sleep Quality Index (PSQI), STOP-BANG questionnaire, and the Epworth Sleepiness Scale (ESS).

Results
Data were collected from 89 menopausal patients, identifying a total of 36 patients (40.44%) that had a BMI equal to or higher than 30 kg/m2. Of these 36 patients, 28 (77.7%) had a STOP-BANG questionnaire with 3 or more positive answers. Nevertheless, only 6 patients (16.6%) had an ESS of 10 or more with most having no subjective hypersomnia that was detected through this screening tool.

Conclusion
Subjective hypersomnia, which can be measured with the ESS, has been long considered an essential feature of OSA and is routinely used to screen different patient populations and decide whether a polysomnography or other sleep study is necessary for the diagnosis of OSA. Nevertheless, in menopausal women with obesity (BMI of 30 or higher), it seems that even though there may be an increased risk for OSA there is not an increase in subjective hypersomnia, which could lead to some patients with OSA not being studied properly. Better studies should be performed to get a better clinical picture of what OSA looks like in menopausal women.

Support (if any)