bluuebunny/crossref_metadata_2025_split huggingface dataset:
0904 Exaggerated hypoxia burden of sleep apnea in patients with hyperacute lateral medullary infarction
Authors: Hong Yooha , Im Hee-Jin 
Published: May 2023

Abstract

Introduction
Acute lateral medullary infarction (LMI) can sometimes appear with respiratory failure in the acute stage. Polysomnographic investigations have shown a specific association between LMI and sleep apnea syndrome. The aim of our study was to investigate this association in hyperacute stage of LMI.

Methods
We investigated 8 patients who underwent polysomnography (PSG) for sleep apnea during hyperacute stage of LMI and compared the data to 8 healthy control subjects matched according to age, sex, body-mass index (BMI), and apnea-hypopnea index (AHI). The PSG was performed within an average of 1.5 days after the onset of neurological symptoms. PSG recordings in the hyperacute phase of LMI were analyzed.

Results
Six patients were males (75%) and two were females (25%). The average age of the patients was 51.9 ± 14.5 years and the average BMI was 27.2 ± 3.5. According to the AHI results of patients with LMI in the hyperacute phase, there were 2 (25%) cases of mild obstructive sleep apnea (OSA), 2 (25%) cased of moderate OSA, and 4 (50%) cases of severe OSA. The central sleep apnea index was higher in the patient group (4.3 ± 5.4/hr) than the control group 0.6 ± 0.4/hr) and was statistically significant (p=0.035). On the other hand, sleep parameters (obstructive sleep apnea index, respiratory arousal index, mean saturation) related to obstructive sleep apnea were poor in the control group.

Conclusion
Our study showed that sleep apnea syndrome, particularly CSA, is common in the hyperacute phase of LMI compared to control group. Early recognition of this problem and appropriate intervention may minimize the adverse effects on the respiratory system and improve the prognosis. Further and follow-up studies are needed to clarify the clinical significance and appropriate treatment options in these patients.

Support (if any)
0914 Perception of Sleep Medicine (SM) Training among Internal Medicine (IM) Trainees in Puerto Rico
Authors: Irizarry Juan , Rivera-Diaz Alba , Padilla-Diaz Miriam , Fernandez-Hawa Patricia , Jimenez-Davila Lissette , Rodriguez-Cintron William 
Published: May 2023

Abstract

Introduction
Awareness of the importance of SM among trainees at our IM Training Program (IMTP) has not been documented, despite the high prevalence of Sleep Disordered Breathing (SDB) within our clinical population. Recently, the Indiana University Sleep Questionnaire (IUSQ) was administered to quantify the perception of SM in IM residents.

Methods
We administered the IUSQ questionnaire through an anonymous computer survey sample of IM residents at our ACGME accredited IMTP.

Results
A total of 52/61 (85%) residents from the Veterans Administration Caribbean Health Care System (VACHS) IMTP participated. There were 18 PGY-1, 16 PGY-2, 15 PGY-3 and 3 PGY-4 residents whom the majority strongly agreed or agreed that the burden of SDB was large in the general population (63% & 35%), that it is important for their training (48% & 46%) and for their general practice (54% & 38%). They were mostly neutral or disagreed about getting adequate training in SDB during residency (38% & 40%). The majority strongly agreed or agreed that sleep specialist is needed for managing SDB (27% & 48%) and 9.6% disagreed with this. Many do not have interest in pursuing a sleep medicine fellowship answering neutral, disagree and strongly disagree (23%, 38% &23%). The majority strongly agree and agree that a sleep fellowship is important in treating sleep disorders (48% & 33%). The residents are mostly neutral or disagree when it comes to their confidence in treating sleep apnea (40% & 48%) and treating other sleep disorders (46% & 38%).

Conclusion
Despite the high prevalence of SDB in the population they manage, residents do not feel they are getting enough training in the management of sleep disorders. They acknowledge the importance of SM education for the latter purpose, but the majority does not want to pursue formal subspecialty training in SM. In addition, they do not feel comfortable managing SDB and other sleep disorders. Interestingly this mismatch between burden of disease and the need for disease management proficiency is similar to one found previously in a different resident population to which the same IUSQ was administered. An educational approach toward residents may furtherly change these perceptions.

Support (if any)
0918 Elevated stress during the first-year of medical school negatively impacts sleep quality
Authors: Fisher Fielding , Marquardt Matthew , Grandner Michael , Khan Meena 
Published: May 2023

Abstract

Introduction
Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Stress contributes to poor sleep quality and is commonplace in medical education. This study sought to understand how stress impacts sleep among first-year medical students.

Methods
A one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Highly prevalent anxiety was defined as feeling nervous/anxious/on edge for more than half of the days during the previous two weeks. Odds ratios (OR) include 95% confidence intervals and were determined using binary logistic regression. Statistical significance was considered a p-value ≤0.05.

Results
138 of the 209 students (66%) in the first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. Short sleep was prevalent with a mean (standard deviation) sleep time of 6.85 (0.86) hours. Additionally, more than three-quarters reported suboptimal sleep: 56% rated quality as average, and 21% rated quality as poor/very poor. 33% of respondents reported difficulty falling asleep at least once per week. A lack of restorative sleep was also common: 38% felt that sleep was rarely or never refreshing. Over half of respondents (51%) attributed poor sleep to either stress or school, and 29% of students reported elevated or highly prevalent anxiety. Elevated anxiety predicted suboptimal sleep quality (OR 14.67, 1.70-126.76, p=0.015) and a lack of restorative sleep (OR 6.00, 1.52-23.71, p=0.011). Similarly, suboptimal sleep quality was associated with highly prevalent anxiety (OR 44.0, 4.62-418.93, p&lt; 0.001) and difficulty falling asleep (OR 4.14, 1.76-9.75, p=0.001).

Conclusion
Poor sleep and stress are both prevalent during the first year of medical school, with students directly linking stress from their academic workload to impaired sleep quality and insufficient sleep duration. Due to the pervasiveness of stress within medical education, future interventions should help students improve their sleep during both low and high stress time periods.

Support (if any)
0921 Insomnia Symptoms and Environmental Disruptors: A preliminary evaluation of Veterans within a VA subacute rehabilitation unit
Authors: Boyle Julia , Boeve Angelica , Moye Jennifer , Masse Soraya , Driver Jane , Ruopp Marcus , O'Malley Kelly 
Published: May 2023

Abstract

Introduction
Insomnia symptoms during rehabilitation admission are associated with slower rehabilitation progression, increased healthcare utilization, worse functional recovery one-month post discharge, and decreased survival rates one-year post discharge. Insomnia symptoms are complex, multifactorial (e.g., insomnia severity, sleep need, daytime sleepiness), and are often unintentionally worsened by rehabilitation admission due to environmental factors (e.g., light, noise) and behavioral factors (e.g., increased time in bed). The aim of this clinical innovation project was to conduct a preliminary evaluation of Veterans’ sleep at admission and discharge in a VA subacute rehabilitation unit for the purposes of informing clinical interventions.

Methods
Veterans admitted to the VA subacute rehabilitation unit between March and August 2022 (N=67) were approached within 7 days of admission to complete a brief evaluation (Insomnia Severity Index [ISI], Sleep Need Questionnaire [SNQ], Epworth Sleepiness Scale [ESS]). Veterans also answered questions regarding environmental sleep disruptors. Following the evaluation, Veterans were offered sleep resources and behavioral treatment options. Veterans repeated the evaluation within 7 days of discharge and were offered outpatient referrals for their sleep difficulties. Pearson correlations were used to determine associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge.

Results
33 of 67 (49.2%) Veterans (Mage=73.3±8.8; 96.9% male; 78.8% white) completed admission and discharge evaluations. Over 80% of Veterans reported at least 1 environmental disruptor at admission and discharge. The number of environmental disruptors at discharge was correlated with ISI (r =.549, p=.001) and SNQ (r =.475, p=.005) scores at discharge. LOS was correlated with ESS scores at discharge (r =.524, p=.002).

Conclusion
This preliminary evaluation demonstrated relationships between higher numbers of environmental disruptors and greater insomnia severity and sleep need at discharge from a VA subacute rehabilitation unit. Additionally, longer durations of admission were associated with higher levels of daytime sleepiness at discharge. Future evaluations should include larger sample sizes to determine causality between these variables in Veteran populations. Given the impact of insomnia symptoms on rehabilitation progression, future evaluations should also consider physical function and sleep variables post-discharge.

Support (if any)
0939 Obstetrician-Gynecologists’ knowledge and practice patterns regarding sleep disorders in pregnant patients
Authors: Raglan Greta , Swanson Leslie , Schulkin Jay 
Published: May 2023

Abstract

Introduction
Prenatal sleep quality is an important factor in pregnancy and delivery outcomes and prenatal sleep disorders have been linked to a variety of negative maternal/fetal outcomes. At the same time, pregnancy itself is a risk factor for the development of several sleep disorders including insomnia, sleep apnea, and restless legs syndrome. Obstetrician-gynecologists (ob-gyns) are well-positioned to provide access to resources or treatment for sleep disorders early in the presentation of symptoms, and thus could contribute to overall sleep health and positive birth outcomes.

Methods
A 104-question survey was developed to assess ob-gyns’ knowledge and treatment patterns as they relate to screening and treating sleep disorders among pregnant patients. It was distributed to randomly selected physicians registered with the Pregnancy-Related Care Research Network (PRCRN; N= 220).

Results
Response rate was 46%. Of those surveyed, 89.2% reported that they never screen for sleep disorders, or do so only when their patients report symptoms. When asked about various risks associated with maternal sleep disorders, providers recognized, on average, 60.9% these associations. Roughly half of providers did not recognize associations between maternal sleep disorders and gestational diabetes (49%), maternal mortality (54.9%), premature delivery (51%), or low infant birth weight (50%). Only 18.6% recognized the association between sleep disorders and cesarean delivery. While 99.0% of respondents endorsed that sleep quality is important to wellness, and 90.2% reported that it is an important issue for their patients, only 14.7% and 11.8% reported confidence in their own ability to diagnose and treat sleep disorders, respectively.

Conclusion
There are significant opportunities for educating ob-gyns about sleep disorders and their impact on perinatal outcomes. Additional resources aimed at increasing screening of pregnant patients during perinatal visits could increase early interventions and improve maternal/fetal outcomes.

Support (if any)
0942 Sleep duration benefits for Spanish-speaking Hispanic/Latine respondents of the 2020 BRFSS
Authors: Valencia Dora , Mendoza Javier , Esquivel Denise Rodriguez , Killgore William D S , Armenta M Denisse , Grandner Michael 
Published: May 2023

Abstract

Introduction
Habitual sleep duration is associated with many aspects of health. Previous studies show that some groups of Hispanic/Latine Americans are somewhat protected from sleep disparities seen in other groups, but also that this may depend on acculturation. This study expanded this finding to nationally-representative data and explored some potential pathways that may link acculturation and sleep in Hispanics/Latinos.

Methods
Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used (N=309,548 provided complete data). Habitual sleep duration was self-reported in hours and converted to minutes for analysis. Race/ethnicity was self-reported as Non-Hispanic White, Black/African American, Hispanic/Latine, Asian/Pacific-Islander, American Indian/Alaskan Native, and Multiracial/Other. The Hispanic/Latine group was further divided into those who chose to complete the survey in English versus Spanish. Covariates included age, sex, education level, household income, employment status, overall health, and mental health. Linear regression examined sleep duration (minutes) as the outcome, with race/ethnicity as the predictor. Race/ethnicity-by-covariate interactions were explored.

Results
Compared to non-Hispanic Whites, Blacks/African Americans reported 7.4 minutes less sleep (p&lt; 0.0005), English-speaking Hispanics/Latine reported 4 fewer minutes (p=0.038), Spanish-speaking Hispanic/Latine reported 16.9 more minutes (p&lt; 0.0005), Asians/Pacific Islanders reported 4.7 fewer minutes (p=0.042), no difference was seen for American Indians/Alaskan Natives, and Multiracial/Others reported 9.5 fewer minutes (p&lt; 0.0005). Significant interactions were seen for age, education, income, employment, health, and mental health (all p&lt; 0.05). Sleep duration benefits of speaking Spanish were evident especially in younger groups (under age 50, peaking age 30), those with more education, those with higher income, those in better health, those with fewer mental health problems, and those who were employed or were students.

Conclusion
Spanish-speaking Hispanics/Latine Americans were the only race/ethnicity group to report more sleep than non-Hispanic White adults and showed markedly different relationships versus when including English-speaking Hispanic/Latine adults. This advantage was differentially experienced, though, and depended on age, socioeconomics, and health status. Also, the BRFSS did not ask about primary household language nor English fluency. Future research is needed to explicitly explore acculturation-related explanations and develop linguistically- and culturally-targeted interventions for sleep health, especially for addressing apparent generational and socioeconomic differences.

Support (if any)
0960 Use of an Innerspring Mattress Improves Deep Sleep and WASO
Authors: Rus Holly , Danoff-Burg Sharon , Burke Colin , Saba Shaddy , Weaver Morgan , Carmon Kiara , Ledesma Duvia Lara , Upadhyaya Devanshi 
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 an innerspring mattress to participants’ prior sleep on their original mattress.

Methods
Healthy adults (68% female, ages 23-69) 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 Sleepy’s by Sealy mattress at home. 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 757 nights of tracked sleep across 18 participants. Objective sleep measurements showed decreased WASO, both in duration (-13 minutes, p=.024) and proportion of the night (p=.025). Also, there was an increase in deep sleep (+12 minutes, p=040). Self-report measures revealed that the innerspring mattress felt 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 innerspring mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable.

Support (if any)
Mattress Firm INC
0961 Applying Fractal Analysis Towards the Understanding of Long-COVID-Induced Insomnia
Authors: Emerling Max , Rouen Alexandre , Taieb Jonathan , Salmon Dominique , Léger Damien 
Published: May 2023

Abstract

Introduction
As part of the recent international COVID Sleep Study-II, long COVID syndrome was found to be associated with chronic insomnia. However, an article submitted for publication out of the Hôpital Hôtel-Dieu found no significant difference between long-COVID-related insomnia and standard insomnia with respect to routine polysomnographic (PSG) parameters. In light of these findings, we seek to better understand the difference between long COVID insomnia and standard chronic insomnia by conducting a fractal analysis of the raw PSG signals of our subjects.

Methods
15 long COVID patients with complaints of chronic insomnia were included as subjects, as well as 34 matched controls without long COVID who had similar complaints of chronic insomnia. All participants underwent one night of polysomnographic recording. We perform our analysis on movements of the abdomen (as an approximation of deep breathing quality) and on EEG waves, considering that shortness of breath and cognitive dysfunction are commonly associated with long COVID. Building upon an existing repertoire of medical research using the fractal dimension (FD) of patients’ signal data to differentiate pathologic and physiologic processes, we make use of Detrended Fluctuation Analysis (DFA) to calculate the FD of the abdomen (FDA) and of an aggregated EEG wave (FDE) for each patient.

Results
We find a decrease in the FDA (p=0.036) and increase in the FDE (p=0.012) of long COVID insomniacs with respect to those of our control group. These results are shown to be significant after applying a Holm-Bonferroni correction for multiple hypotheses.

Conclusion
Despite our small data sample, an in-depth analysis of PSG signals shows significant differences in the fractal nature of long-COVID-related insomnia with respect to standard chronic insomnia. Our results furthermore match our expectations, given that related research outside of the COVID domain indicates a decrease in the FD of muscle movements and an increase in the FD of EEG waves in unhealthy individuals. Further research could employ more participants in order to extend our results to other data channels outside of EEG signals and the abdomen.

Support (if any)
0969 Severe persistent specific sleep disorders in post-acute sequelae of SARS-CoV-2
Authors: Czuma Richard , Thomas Robert , Maley Jason , Gott Danielle 
Published: May 2023

Abstract

Introduction
Viral infections have long been associated with sleep disorders, especially hypersomnia following the acute phase The Covid-19 epidemic has resulted in a post-viral syndrome called post-acute sequelae of SARS-CoV-2 (PASC), or Long-Covid. Sleep has been reported to be severely disturbed during acute Covid-19 infection, and is a major feature of PASC. Much of the subjective data is based on questionnaires, with a paucity of objective sleep evaluations including polysomnography. We share our early experience with diagnosis and management of sleep disorders in PASC.

Methods
PASC patients are seen in a dedicated Long-Covid clinic at the Beth Israel Deaconess Medical Center for a comprehensive evaluation. The patients presented with new onset persistent sleep impairments shortly following acute COVID-19 infection, without pre-existing sleep impairments, in association with a clinical diagnosis of long covid. Sleep symptoms (excessive sleepiness, hypersomnia/long sleep, and insomnia) are identified and those who consider these a key symptom are referred to the Covid Sleep Clinic, for formal sleep evaluation by RJT. Diagnostic evaluations include polysomnography (extended for hypersomnia diagnosis), Multiple Sleep Latency Test for excessive daytime sleepiness, and home sleep apnea test for suspected sleep apnea. Sleep logs and sleep quality using a Ring oximeter-based SleepImage system complements evaluation of sleep-wake instability. Standard management is offered based on the ensuing diagnosis.

Results
Twenty-six patients (age range 22 to 58 years, 16 females) have been evaluated in this sleep pathology enriched pathway. Specific new sleep disorders diagnosis so far have included narcolepsy without cataplexy (3), hypersomnia with long sleep (3), hypersomnia without long sleep (3), rapid eye movement sleep disorder (2), persistent insomnia (3), a sleep-wake instability syndrome we call cyclical insomnia (2), and sleep apnea (7). Treatment has included CPAP, stimulants, modafinil, and sodium oxybate. Clinical responses to treatment have so far been as expected. One patient with cyclical insomnia has had a marked subjective and objective improvement with low dose (250 mg) sodium valproate.

Conclusion
PASC/Long-Covid can induce specific sleep syndromes. These include narcolepsy, hypersomnia, persistent insomnia, sleep-wake instability, and REM-behavior disorder.

Support (if any)