bluuebunny/crossref_metadata_2025_split huggingface dataset:
0812 Inconsistent improvements of neurocognitive function after adenotonsillectomy: a pediatric sleep-disordered breathing cohort study
Authors: Huang Yu-Shu , Chin Wei-Chih 
Published: May 2023

Abstract

Introduction
Adenotonsillectomy (AT) is the most common surgical treatment for pediatric obstructive-sleep-apnea (OSA) with fair effectiveness. There are still controversies about the improvement of neurocognitive function after AT. This study investigates the changes of neurocognitive function after AT in preschool and school age children with OSA, including intelligence and attention, and explore the inconsistent improvements by comparing different evaluation tools.

Methods
130 children with pediatric OSA were recruited, including 30 preschool and 100 school-age children. 125 participants underwent clinical evaluation, including polysomnography (PSG), before and 1-year after AT. Preschool children received the Wechsler-Preschool-and-Primary-Scale-of-Intelligence (the revised and IV edition, WPPSI-R and WPPSI-IV) and the Conners’-Kiddie-Continuous-Performance-Test (K-CPT) while school-age children received the Wechsler-Intelligence-Scale-for-Children (the 3rd and 4th edition, WISC-III and WISC-IV), and the Conners’-continuous-performance-test-II (CPT-II), before and 1-year after AT. Questionnaires including the Obstructive-Sleep-Apnea-Questionaire-18 (OSA-18) and Child-Behavior-Checklist (CBCL) were also used. The t-test and chi-square test analysis was used to compare data between preschool and school-age children, including PSG, CPT variables, intelligence variables, OSA-18 and CBCL before and after AT, as well as group differences in changes. Correlation analysis of CPT variables were performed by using the Pearson-Correlation to investigate factors related to treatment response.

Results
No significant group difference was found except age (p=0.000) and less male gender in preschool children (p=0.049). 21.7% of preschool children had language delay, and more than 80% of all children had allergic rhinitis or high narrow palate. After AT, both groups had significant improvement in PSG and OSA-18. No significant change was found by WPPSI-IV in the preschool children and WISC-IV in the school-age children, but significant improvements were found in preschool children and school-age children by WPPSI-R and WISC-III. There were also significant improvements of CPT-II in school-age children, and the Hit-reaction-time-standard-deviation positively correlates with the improvement in PSG.

Conclusion
Besides the improvement of sleep apnea and subjective improvements of emotion and behavior, AT can be beneficial in the neurocognitive function of preschool and school-age children with OSA, including intelligence and attention. Some tools may not be sensitive enough to detect the improvement in neurocognitive function, and selection of proper evaluation tools can be important in study design.

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0872 Periodic limb movements during sleep and hypertension: A systematic review and meta-analysis
Authors: Srivali Narat , Thongprayoon Charat , Tangpanithandee Supawit , Krisanapan Pajaree , Zinchuk Andrey , Koo Brain , Cheungpasitporn Wisit 
Published: May 2023

Abstract

Introduction
Several studies suggest an association between periodic limb movements during sleep (PLMS) and hypertension; however, a systematic evaluation of this relationship is lacking.

Methods
We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio, comparing the risk of hypertension in persons with PLMS (defined by the level of periodic limb movements per hour of sleep depended on individual studies) versus those without PLMS. After assessing heterogeneity and bias, the pooled risk ratio and 95% confidence intervals (CIs) were determined using a random-effect, generic inverse variance method of DerSimonian and Laird.

Results
Out of 572 potentially relevant articles, six eligible cross-sectional studies were included in the data analysis which included 8,949 participants. The statistical heterogeneity of this study was insignificant, with an I2 of 0%. A funnel plot showed no publication bias. The pooled risk ratio of hypertension in patients with PLMS was 1.26 (95% CI, 1.12–1.41).

Conclusion
Our analysis demonstrates an increased hypertension risk among patients with PLMS. Prospective or interventional studies are needed to confirm this association.

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0875 Self-Reported Sleep Indices in Veterans Exposed to Deleted Uranium
Authors: Russo Anthony , Baher Ali , Gucer Patricia , Diaz-Abad Montserrat , Hines Stella , McDiarmid Melissa , Glick Danielle 
Published: May 2023

Abstract

Introduction
During Gulf War I, a group of veterans sustained exposure to deplete uranium (DU) through a series of “friendly fire” incidents. This resulted in both inhalational and traumatic injuries, with a subset having retained fragments and ongoing systemic exposure to DU. These veterans have undergone biennial surveillance assessments to monitor for DU-related health effects. While effects of DU on bones and kidneys have been consistently shown, less is understood about the effect of DU on sleep. In rat models, exposure to DU affected sleep architecture by increasing both sleep fragmentation and quantity of REM sleep. We therefore sought to characterize the effect of DU on self-reported sleep complaints among this unique veteran cohort.

Methods
Of a dynamic cohort of 81 DU-exposed veterans, 37 completed medical history, exposure, and sleep questionnaires and 24-hour urine uranium collections. Responses on the sleep questionnaires -which included subjective assessment of sleep quality and quantity as well as an Epworth Sleepiness Scale (ESS) score – were compared in veterans with elevated (&gt;0.1 mcg U/g creatinine) vs low urine uranium (uU).

Results
The 37 veterans assessed were all male, mostly white, and had a mean age of 54 ± 2.8 years. 10 were identified as having elevated urine DU levels. The mean ESS score for the group overall was in the pathologic range (13 ± 4) and did not differ significantly between the high and low uU groups. The most frequent complaints in the group overall were of difficulty falling asleep, awakening frequently throughout the night, restless sleep, and frequent tossing and turning. Among all self-reported sleep indices, there were no significant differences among the two groups.

Conclusion
In this group of DU-exposed veterans, excessive daytime sleepiness and several other sleep complaints were observed. Although there were no differences in the frequency or severity of self-reported sleep indices among this group of DU-exposed veterans, the group was overall pathologically sleepy. More work is needed to further characterize the possible impact of DU exposure on sleep.

Support (if any)
Funded by the US Department of Veterans Affairs and supported by the University of Maryland General Clinical Research Center.
0878 Sleep Measures Worsen for Individuals who are Obese but Improve for Individuals who are not Obese from 60-90days after Stroke
Authors: Klingman Karen , Duncan Pamela , Billinger Sandra , Bartsch Bria , Moores Sasha , DeBlois Amy , Valastro Daniel , Fulk George 
Published: May 2023

Abstract

Introduction
Goals of post-stroke rehabilitation include recovery of physical function which, in turn, relies on motor learning to relearn functional skills. Given the known association between motor learning and sleep, it is important to understand if sleep is related to characteristics of persons with stroke (PwS) during the subacute timeframe (60–90 days following stroke) to potentially guide interventions. Obesity is a known risk-factor for stroke and therefore prevalent among PwS. The purpose of this study was to determine if there are differences between changes in objectively measured sleep parameters across the 60-90 day post-stroke period that correspond to different levels of body mass index (BMI).

Methods
PwS received standard of care for post-stroke physical rehabilitation, and wore wrist actigraphy for 3-9nights at 60 and 90 days post-stroke, with no additional interventions. Total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep latency (SL), wake after sleep onset (WASO), number of awakenings (NWAK) and average time per awakening (TPA) were obtained from the actigraphy software for each night, and average nightly values determined. Participants were categorized into two groups based on BMI (&lt; 30 and &gt;=30). Changes were calculated as 90-day minus 60-day values. Independent samples t-tests were performed to determine if there were differences in changes in sleep parameters between BMI groups.

Results
The PwS sample (n=31, 52% female, average age 66.7years, range 44–85+) included n=13 with BMI &gt;=30. Independent t-tests found a significant difference in change in SE (6.9%, p=0.016) and change in NWAK (6.3, p=0.003) between the two groups. For those with BMI&gt;=30 SE and NWAK worsened from 60-90-days following stroke (-4.2% and 2counts), whereas for those with BMI&lt; 30 SE and NWAK improved (+2.7% and -4.3counts). No significant differences were found between groups for changes in TST, TIB, SL, WASO or TPA.

Conclusion
Without sleep-related interventions, sleep characteristics worsen for PwS who are obese in the subacute post-stroke recovery phase, but improves for PwS who are not obese. There may be opportunities to explore sleep-related interventions for PwS who are obese.

Support (if any)
This study was supported by NINR Award Number R01 NR018979.
0887 Divergent Slow wave sleep and Alzheimer's disease Plasma Biomarkers’ Associations in Black and White Cognitive Normal Older-Adults
Authors: Azad Dishari , White Payton , Cesar Oliver , Kovbasyuk Zanatta , Gonzalez Moses , Wahab Ariana , Mullins Anna , Kam Korey , Parekh Ankit , Rapoport David , Ayappa Indu , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo , Bubu Omonigho 
Published: May 2023

Abstract

Introduction
We determined whether slow wave sleep is associated with plasma levels of Aβ40, Aβ42, Aβ42/Aβ40, Tau, tau/Aβ42 and NfL and whether this relationship differed between Blacks/African-Americans and non-Hispanic Whites.

Methods
This was a cross-sectional analysis of baseline data from 171 community-dwelling cognitively normal older-adults, participating in ongoing NYU studies on memory, sleep and aging. Non-rapid eye movement sleep (NREM) slow wave sleep (SWS) duration was calculated from 2 nights of in-lab NPSGs. Plasma Aβ40, Aβ42, Tau and NfL were determined using single molecule array (SIMOA). Associations of NREM SWS duration and plasma AD biomarker levels were assessed using adjusted generalized linear models and Pearson correlation analysis after data normalization. Analyses were adjusted for age, sex, BMI, race, and education.

Results
Of the 171 subjects (128 non-Hispanic Whites and 43 Blacks/African-Americans), 112 (65.5%) were females, and mean (SD) age was 68.6 (6.6) years, BMI was 27.6 (6.1) kg/m**2, and education was 16.9 (2.1). There were no racial differences in age, sex, BMI, NREM SWS and AHI4%. Compared to non-Hispanic Whites, Blacks/African-Americans had significantly lower years of education (14.2 vs. 17.2, p &lt;.01), plasma Aβ40 (248.3 vs. 262.5 pg/ml) and NfL levels (11.4 vs. 15.2 pg/ml) p&lt;.05 for both. There were no significant racial differences in levels of plasma Aβ42, Aβ42/Aβ40, Tau, Tau/Aβ40 and Tau/Aβ42 (p&gt;.05 for all). NREM SWS duration was not associated with plasma Aβ42, Aβ40 or tau in the overall sample (p&gt;.05 for all). However, in non-Hispanic Whites, NREM SWS negatively correlated with plasma Aβ42 (r=-0.28, p&lt;=0.05), plasma Aβ40 (r=-0.087, p=0.72), though not significant, and plasma Tau (r=-0.153, p=0.27), though not significant. In Black/African-Americans, NREM SWS positively correlated with plasma Aβ42 (r=0.48, p=0.05), plasma Aβ40 levels (r=0.32, p=0.04), and plasma Tau levels (r=0.52, p=0.04). NREM SWS was not associated with plasma tau/Aβ42, plasma tau/Aβ40 or plasma NfL in the overall sample and across racial subgroups.

Conclusion
Race-specific divergent associations between NREM SWS and plasma Aβ42, Aβ40 & Tau may suggest differences in SDOH factors and mechanisms that could influence sleep and AD-risk in older-adults.

Support (if any)
AASMBTS#231-BS-20, NIAK23AG068534A, AARG-D- 21-848397, BFFA2022033S
0917 A Hybrid Cognitive Behavioral Therapy for Insomnia (CBT-I) Improves Access and Patient Engagement
Authors: Roth Alicia , Kane Alexa , Drerup Michelle 
Published: May 2023

Abstract

Introduction
Despite CBTI being the gold standard for insomnia treatment, numerous barriers need to be overcome in order for the field of sleep medicine to utilize CBTI as the front-line treatment. We investigated if a hybrid intervention combining groups, telehealth, and 1-on-1 visits would provide greater access to CBTI than the traditional model of in-person 1-on-1 sessions.

Methods
Patients receiving CBTI in 2019 (in person, 1-on-1 visits, n=200) were compared to patients receiving CBTI in 2021 (CBTInitiate=hybrid telehealth/in-person, group/1-on-1 visits, n=299). In CBTInitiate, the first 1-on-1 follow-up session was replaced by a 60-minute telehealth group session that introduced sleep psychoeducation and stimulus control followed by 1-on-1 sessions. CBTInitiate (2021) was compared with traditional-CBTI (2019) on wait times (between consultation and initial follow up session; CBTInitiate and 1-on-1 follow-up) utilizing multivariate linear regression with age as a covariate. Treatment completer status (≥ 3 visits) was also compared between groups utilizing chi-square test and two-sample t-test.

Results
Dependent variables were log-transformed to meet normality assumptions. Age significantly differed between groups (Hybrid-CBTI=55.59; traditional-CBTI=51.87; t=2.763, p=.006) and was included as a covariate. CBTI type significantly predicted wait time to first follow-up (overall: R2=.25, F(2, 496)=.83.30, p&lt;.001; β=-.50, p&lt;.001). Back-transformation to estimated means show CBTInitiate patients had a shorter wait time to first follow-up (x̄=11.16 days) than traditional-CBTI (x̄=31.24 days). Age was not a significant predictor (β=-.03, p=.385). CBTI type also significantly predicted wait time from new evaluation to first 1-on-1 follow-up (overall: R2=.04, F(2,452)=8.99, p=&lt;.001; β=.194, p&lt;.001). Age was not a significant predictor (β=-.06, p=.229). However, CBTInitiate had a longer wait time (x̄=38.76 days) than traditional-CBTI (x̄=31.27days) for a 1-on-1 appointment.

Conclusion
The CBTInitiate model addresses systemic, patient, and provider-level barriers to implementing CBTI as the gold-standard treatment for insomnia. The implementation of CBTInitiate significantly decreased wait times to begin CBTI and increased patients completing treatment compared to a traditional care model. Future areas for investigation include CBTInitiate’s impact on healthcare costs and insomnia treatment outcomes.

Support (if any)
None
0976 Central Sleep Apnea (CSA) following treatment with Non-Positive Airway Pressure (PAP) Modalities
Authors: Ramo Kathreen al , Vijayakumar Punitha , Kapish Neeraj 
Published: May 2023

Abstract

Introduction
Emergence or worsening of CSA following non- PAP therapies has not been well studied. We present two cases of CSA following treatment of OSA; one with mandibular advancing device (MAD) and other with hypoglossal nerve stimulation (HGNS).

Report of case(s)
Case 1: A78 y/o male presented with CPAP intolerance and seeking HGNS for OSA treatment. His AHI was 25 with an O2 nadir of 76%. Following a comprehensive evaluation including sleep endoscopy, he was deemed a good candidate for HGNS. Per protocol, his HGNS was activated, PSG done after an interval period during which his stimulation was titrated from 0-2.3V. His AHI remained elevated (50 – 163) at all voltage settings with emergence of CSA at 2.3 & 2.4 V. Due to tongue discomfort, his stimulation parameters were changed and HSAT was done to re-assess his breathing. Home study showed persistent severe sleep apnea- central & obstructive with periodic breathing and desaturations to 70s. Case 2: A 28-y/o male with OSA AHI of 20.2 and O2 nadir of 82%. He was intolerant of CPAP; hence MAD was pursued. PSG done showed MAD was ineffective as his AHI was elevated at 26.8 with elevated CAI (associated with desaturations). A repeat study at home was done following adjustments to the MAD showed a higher index with pAHI of 37.7, predominantly central in nature with periodic breathing. Patient is awaiting a CPAP titration but has returned back to PAP therapy with good tolerance and resolution of his residual symptoms including daytime hypersomnolence.

Conclusion
These two cases highlight that CSA can be associated with non-PAP therapies and symptomatic improvement alone may not be an effective approach. Testing following initiation of treatment would allow for more effective management especially when patient is symptomatic or treatment is suspected to be ineffective.

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0987 Asking the Right Questions: A Case of Restless Legs Syndrome and Spinal Muscular Atrophy
Authors: Brown Peomia , Greer Meredith 
Published: May 2023

Abstract

Introduction
The association between iron deficiency and restless legs syndrome (RLS) is well established. However, there is limited data on the association between motor neuron diseases such as spinal muscular atrophy (SMA) and RLS. A forty-three-year-old with Type 2 SMA presented to clinic for management of chronic respiratory failure. She had recently undergone surgery and chemotherapy for newly diagnosed anal cancer. However, she reported persistent abdominal pain, anorexia, weight loss, and rectal bleeding. She reported “muscle twitching” and bilateral lower extremity pain and tingling that was worse at night. Her husband would awaken every 2 hours to massage her legs. She assumed these symptoms had emerged as a result of an increase in motor function due to risdiplam, a survival motor neuron 2 splicing modifier drug. Further questioning led to the diagnosis of RLS. Bloodwork revealed severe iron deficiency anemia (hemoglobin of 6.0 g/dL, iron 13 mcg/dL, and ferritin 3 ng/ml). She received a blood transfusion and underwent sigmoidoscopy for evaluation of cancer recurrence given the report of bleeding. Fortunately, her cancer remained in remission. Her symptoms of RLS significantly improved after blood transfusions and iron supplementation.

Report of case(s)
n/a

Conclusion
RLS is a complex sensorimotor syndrome. The diagnosis of RLS is clinical, relying on diagnostic criteria that requires lower extremity movement. The case is a reminder of the variable presentation of RLS in individuals with neuromuscular disorders, including SMA. How are symptoms of restless legs disclosed in patients with the inability to move and with potentially altered sensorium? The focus of the patient encounter could have anchored on the common and expected sequalae of SMA, chronic respiratory failure. Unfortunately, anchoring bias would have delayed the diagnosis and treatment of what could have been a potentially fatal disease – metastatic cancer. Ironically, the patient’s longing for motor function repressed her ability to lament. To the patient, symptoms of frequent nighttime awakenings and limb discomfort were perceived as a desired side effect of a medication that would increase movement. This case emphasizes the importance of the patient interview and its value of uncovering subtle complaints that may broaden the differential diagnosis and guide further work-up.

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0994 Neuroblastoma as the Initial Manifestation of Familial PHOX2B NPARM Positive Congenital Central Hypoventilation Syndrome
Authors: Fiala Kaylene , Amos Louella , D'Andrea Lynn 
Published: May 2023

Abstract

Introduction
Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disorder of the autonomic nervous system caused by mutations in the PHOX2B gene. Children with CCHS often present as neonates in hypoxemic, hypercarbic respiratory failure. Most causative mutations are de novo Polyalanine Repeat Mutations (PARMs). Non-Polyalanine Repeat Mutations (NPARMs) have been associated with more severe disease, specifically the need for 24-hour ventilatory support, Hirschsprung disease, and neural crest tumors; however, NPARMs may have variable expressivity and incomplete penetrance, resulting in delayed or atypical presentations. We report a toddler with maxillary sinus neuroblastoma, which led to the diagnosis of familial PHOX2B NPARM positive CCHS.

Report of case(s)
A two-year-old boy presented with right-sided facial swelling. A facial CT uncovered a right maxillary sinus lytic lesion, and biopsy confirmed neuroblastoma. After full recovery from the procedure, he had persistent nocturnal hypoxemia and hypercapnia requiring bilevel positive airway pressure (PAP) during sleep, raising concern for CCHS. Genetic testing revealed a novel PHOX2B NPARM, c.428dup, which likely causes a frameshift and premature protein termination (p.Val144Glyfs*34). His maternal grandfather, mother and brothers tested positive for the same mutation. Family history revealed that his maternal grandfather and maternal great-uncles had frequent childhood apneic spells associated with syncope, his maternal grandfather is currently on nocturnal bilevel PAP, and his mother almost drowned as a younger child while having a breath-holding contest under water. His six-year-old brother underwent polysomnography which showed hypoventilation, now managed with bilevel PAP. His five-year-old brother also underwent polysomnography and does not require nocturnal ventilatory support at this time.

Conclusion
We report a rare case of familial PHOX2B NPARM positive CCHS which initially presented as maxillary sinus neuroblastoma. Additionally, the child and his family display varying disease severity despite having the same NPARM, highlighting the variable expressivity in this novel NPARM.

Support (if any)
None