bluuebunny/crossref_metadata_2025_split huggingface dataset:
0410 Lavender essential oil and sleep hygiene as therapeutic options for insomniac postmenopausal women: a randomized clinical trial
Authors: Hachul Helena , Lucena Leandro , Santos-Junior Jair , Tufik Sergio 
Published: May 2023

Abstract

Introduction
Menopausal transition and postmenopause often bring sleep complaints and insomnia, a common sleep disorder. In addition, women at this stage also experience vasomotor symptoms, which can compromise sleep maintenance and quality of life. This study aimed to observe the effect of an intervention with aromatherapy and sleep hygiene in the quality of life, self-related sleep pattern and hot flashes record in postmenopausal women with insomnia diagnosis.

Methods
This pilot study is a double-blind randomized clinical trial. Of the 135 women interested in participating in the study, 34 postmenopausal women met the inclusion criteria and completed the protocol. Volunteers were clinically diagnosed with insomnia and distributed in two groups: Aroma Group (Lavandula angustifolia essential oil) (n=17) and Placebo Group (sunflower oil) (n=17), both inhaled before bedtime for 29 days. The groups received sleep hygiene guidelines and were monitored weekly. To assess the effect of the intervention, the Menopause-Specific Quality-of-Life Questionnaire, intervention version (MENQOL-I), and Epworth Sleepiness Scale (ESS) were used. With data from the sleep diary, we evaluated sleep onset latency (SLO), total sleep time (TST) and sleep efficiency (SE) daily. Additionally, participants who complained of vasomotor symptoms were invited to fill out a hot flashes form, reporting the presence or absence of these symptoms, daily amount, and its intensity.

Results
The therapeutic approaches in this study benefited participants in both groups in almost all domains of quality of life and self-rated sleep patterns such as TST and SE. Particularly, the lavender essential oil intervention provided significant improvement in the overall quality of life score over time. No differences were observed considering the hot flashes record and sleepiness.

Conclusion
The aromatherapy intervention was effective in improving overall quality of life in the Aroma group. Furthermore, strategies such as sleep hygiene and a sleep diary helped participants to self-assess their sleep routine and improve it.

Support (if any)
This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, and Conselho Nacional de Pesquisa (CNPq). Laszlo (essential oils, books, foods, and aromatherapy products) donated the necessary oils for this project.
0416 Preliminary Study of the Effects of Continuous Theta Burst Stimulation of the Default Mode Network on Subjective Sleepiness
Authors: Franca Gabriela , Hildebrand Lindsey , Jankowski Samantha , Henderson-Arredondo Kymberly , Trapani Christopher , Reich-Fuhrer Melissa , Patel Salma , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie , Killgore William 
Published: May 2023

Abstract

Introduction
Repetitive transcranial Magnetic Stimulation (rTMS) is a noninvasive intervention commonly used to treat clinical depression by modulating brain activity in specific regions. We investigated rTMS of the default mode network (DMN) as a potential treatment for insomnia. The DMN is associated with internally focused cognition and rumination. Therefore, we expected that modulation of this network would improve sleep. As reported elsewhere, this trial showed that active cTBS to the DMN improved polysomnographically (PSG) measured sleep. Here, we hypothesized that participants who were treated with active continuous theta burst stimulation (cTBS) rTMS over the DMN versus sham cTBS would report reduced subjective sleepiness following post-treatment sleep.

Methods
Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants completed two overnight visits; one where they received active cTBS treatment and one where they received sham TMS treatment. We analyzed the Karolinska Sleepiness Scale (KSS), which was administered six times throughout each visit. KSS 1-3 were administered prior to treatment and KSS 4-6 were post TMS treatment. We used a repeated measures ANOVA to analyze effects of TMS on reported daytime sleepiness.

Results
There was no main effect of condition on sleepiness score F(1,18 )=1.165, p=0.295, ηp 2=0.061. There was a significant interaction effect of condition and pre/post intervention on reported subjective sleepiness F(1,18)=3.079, p=0.013, ηp 2 = 0.146, although follow-up analyses did not reveal significant differences. Nonetheless, there was a continuous negative trend toward reduced sleepiness for post TMS administration after overnight sleep in active cTBS (M = 4.8, SD = 1.96) compared to the sham cTBS session (M = 5.2, SD = 1.91) (p = 0.366).

Conclusion
As reported elsewhere, this trial of a single administration of cTBS showed improved PSG sleep. Here we saw that there was no significant change in subjective sleepiness following a night of sleep with or without the trial of cTBS, but there was a nonsignificant trend toward declining sleepiness for the active cTBS group relative to the sham condition. This preliminary study is encouraging and suggests that further research into this approach is warranted.

Support (if any)
W81XWH2010173
0417 Pre-sleep wakefulness in patients with insomnia: heart rate variability during sleep onset
Authors: Ma Yan , Wayne Peter , Yeh Gloria 
Published: May 2023

Abstract

Introduction
Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. However, physiological alterations during the sleep onset period are not well-understood. We aimed to characterize heart rate variability (HRV) in patients with insomnia during sleep onset.

Methods
Using data from the Sleep Heart Health Study at National Sleep Research Resource, we conducted a secondary analysis exploring HRV during the sleep onset period (defined as the time between lights-off and sleep onset) in patients with insomnia (IS group; n = 68) and comorbid obstructive sleep apnea (IS + OSA group; n = 135), compared with normal sleep controls (NSC group; n = 122). Overall group differences were tested using ANOVA. Post-hoc pairwise comparisons were conducted using the least significant difference (LSD) tests.

Results
During sleep onset, mean heart rates of the IS group (74.4±15.0 beats/min) and IS+OSA group (72.6±11.5 beats/min) were both significantly higher than the NSC group (69.7±9.4 beats/min, p=0.007 and p=0.044 respectively). Both the IS and IS+OSA groups showed lower heart rate variability compared to the NSC group, with significant differences in both time and frequency domains of HRV analysis including SDNN (p=0.002), RMSSD (p=0.035), pNN20 (p&lt; 0.001), pNN50 (p=0.008), LnLF (p&lt; 0.001), LnHF (p&lt; 0.001). For all these measures, IS+OSA group had lower HRV compared to the IS group, although differences were not significant. When controlling for age, gender and BMI, and compared to the NSC group, IS group had significantly higher heart rates (β=4.8, p=0.008), and the IS+OSA group had significantly lower pNN20 (β=-0.039, p=0.002), pNN50 (β=-0.031, p=0.017) and LnHF (β=0.007, p=0.007).

Conclusion
Patients with insomnia had lower vagal activity during the sleep onset period, reflected in higher heart rates and lower heart rate variability. Such altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress.

Support (if any)
This research project was made possible by a grant from the American Academy of Sleep Medicine Foundation (PI: Yan Ma). We acknowledge the National Sleep Research Resource as the resource through which the Data/Datasets were obtained.
0418 Racial disparities in patient engagement and treatment outcomes in digital cognitive behavioral therapy for insomnia
Authors: Ruprich Melissa , Bayoneto Alec , Kalmbach David , Cheng Philip , Reffi Anthony , Fellman-Couture Cynthia , Iqal Justin , Sagong Chaewon , Peterson Edward , Roth Thomas , Drake Christopher 
Published: May 2023

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBTI) is gold standard for insomnia care. However, recent data suggest Black CBTI patients may complete fewer sessions and experience poorer outcomes relative to white CBTI patients. The present study examined whether racial disparities in CBTI engagement mediated group differences in treatment outcomes on insomnia symptoms.

Methods
We conducted a secondary analysis of pretreatment and posttreatment data from 569 Black and white patients with clinical insomnia symptoms (Insomnia Severity Index [ISI] ≥ 15) who were randomized to digital CBTI in a large-scale RCT. Study outcomes included number of sessions completed (≥4 sessions considered an adequate dose) and insomnia symptoms (ISI).

Results
Black CBTI patients completed fewer CBTI session than white patients (M±SD: 2.81±2.36 vs 3.79±2.45; t(561)=4.06, p&lt;.001). Consequently, Black patients were 1.53 times more likely than white patients to prematurely discontinue CBTI before receiving an adequate dose (premature discontinuation rates: 62.5% vs 40.7%, Χ2=19.28, p&lt;.001). A multivariate linear regression showed that Black patients reported higher ISI scores than white patients after CBTI (b=1.28, p=.009) while controlling for pretreatment ISI (p=&lt;.001). However, race became non-significant in the multivariate model (b=.55, p=.248) when sessions completed was entered as a predictor (b=-.60, p&lt;.001). The PRODLIN method estimated the indirect to be αβ=2.27 with a 95% Confident Interval of 1.59 to 2.96, thereby supporting a significant mediation. We estimated that 55.5% of racial disparities in posttreatment ISI outcomes were mediated through group differences in number of sessions completed. Notably, posttreatment insomnia remission (ISI≤9) rates did not differ between Black and white patients (36.9% vs 39.6% remission, p=.613), whereas insomnia remission rates were nearly twice as high among CBTI patients who received an adequate dose relative to those who discontinued prematurely (46.7% vs 24.9% remission, Χ2=23.46, p&lt;.001).

Conclusion
Black patients reported greater insomnia symptoms after CBTI relative to white patients, but these racial disparities in insomnia outcomes were largely attributable to lower rates of CBTI engagement among them. No racial disparities in CBTI outcomes were observed among those who completed ≥4 sessions. Enhancing treatment engagement among Black patients may improve dCBTI efficacy in this group.

Support (if any)
This RCT (NCT03322774) was supported by NIMH R01-MH122636.
0419 Sensitivity of ORP to classify individuals with insomnia based on subjective complaints
Authors: Bender Amy , Guadagni Veronica 
Published: May 2023

Abstract

Introduction
The diagnosis of insomnia is currently based on subjective complaints. Previous research has demonstrated limited benefits of polysomnography in improving diagnostic accuracy with no evident differences in sleep macro-architecture and traditional indices of sleep quality. In this study, we aimed to assess the ability of a novel index of sleep quality, the Odds Ratio Product (ORP), to correctly identify individuals with insomnia, based on subjective complaints.

Methods
We analyzed responses to a custom sleep survey from 510 participants (age 46.2±12.4; 229 females). We entered 13 outcomes to a principal component analysis (PCA). These included age, body mass index (BMI), Epworth Sleepiness Scale (ESS) scores, sex, questions about snoring, subjective hours of sleep, satisfaction with own sleep, movement symptoms, problems falling asleep, staying asleep and waking up early. Based on the correlations between the original outcomes, the PCA extracted 3 factors that were interpreted as 3 different phenotypes: 1) insomnia (e.g., sleep initiation and maintenance complaints, satisfaction with sleep, lower subjective sleep duration); 2) OSA (e.g., bed partner snoring complaints, snoring self-awareness, sleepiness, respiratory complaints); 3) movement disorder (e.g., movements, female, lower age, higher BMI). We then computed the pre-test probability of insomnia (factor 1 scores &gt;80%) and conducted a series of ROC analyses to assess specificity of PSG indices traditionally used to evaluate the presence of insomnia, and of ORP metrics.

Results
The AUC values assessing the ability of ORP metrics to predict 80% pre-test probability of insomnia were: ORPwake (0.592, 95% CI 0.499-0.685), ORPNREM (0.465, 95% CI 0.362-0.558), ORPREM (0.542, 95% CI 0.447-0.636), and ORPTRT (0.567, 95% CI 0.475-0.659). When looking at traditional indices like total sleep time (TST), wake after sleep onset (WASO), and number of awakenings, the AUC values were 0.471 (95% CI 0.385-0.556), 0.612 (95% CI 0.528-0.697) and 0.509 (95% CI 0.421-0.597), respectively.

Conclusion
WASO, ORPwake and ORPTRT have the highest sensitivity to detect insomnia in participants with &gt;80% pretest probability measured by subjective complaints. These analyses indicate the value of EEG metrics of sleep quality to correctly identify individuals with insomnia and the need to investigate both sleep and wake states.

Support (if any)
0422 The relationship between EEG spectral analysis and pre-sleep cognitive arousal in insomnia disorder
Authors: Dressle Raphael , Riemann Dieter , Spiegelhalder Kai , Frase Lukas , Perlis Michael , Feige Bernd 
Published: May 2023

Abstract

Introduction
The hyperarousal model suggests that insomnia is characterized by increased cortical, cognitive, and physiological arousal. However, the relationship between these domains of arousal remains insufficiently studied. The aim of the current observational study was to investigate pre-sleep cognitive arousal, cortical arousal during the night, and the relationship between these domains.

Methods
109 patients with insomnia disorder (ID) and 109 age-and gender matched healthy controls (GSC) were investigated on two sleep laboratory nights. As a measure of cortical arousal, EEG spectral power was analyzed during NREM and REM sleep. In addition, participants completed the Pre-Sleep Arousal Scale (PSAS), which consists of a subscale for cognitive arousal (PSAS-CA) and another subscale for self-reported somatic arousal (PSAS-SA). The relationship between the subscale scores and EEG spectral power was calculated by multivariate and univariate analyses of variance.

Results
The total sample consisted of 218 participants. ID patients had a mean age of 44.7 years (± 10.6 years) and GSC had a mean age of 44.4 years (± 12.6 years). Both groups consisted of 78 women and 31 men.During NREM and REM sleep, patients with ID showed significantly increased spectral power in the EEG gamma band (NREM: p &lt; .001; REM: p = .002). In addition, patients with ID showed significantly increased scores on the PSAS-SA (ID: M = 12.4, SD = 4.4; GSC: M = 10.7, SD = 3.3; t(216) = 3.34, p = .001, d = 0.45) and the PSAS-CA (ID: M = 18.3, SD = 7.2; GSC: M = 10.6, SD = 2.9; t(216) = 10.33, p &lt; .001, d = 1.40). The PSAS-CA score was significantly associated with increased NREM (p = .001) and REM gamma power (p = .004), whereas PSAS-SA was associated with significant decreases in NREM (p &lt; .001) and REM gamma power (p = .001).

Conclusion
In line with our hypothesis, patients with ID showed increased cortical and cognitive arousal. Moreover, there was a relationship between pre-sleep cognitive arousal and high-frequency EEG activity during the night. This might suggest that the latter is caused (at least in part) by pre-sleep worry and rumination.

Support (if any)
0426 A real-world exploration of non-CPAP therapies for mild obstructive sleep apnea in the veteran population
Authors: Pillai Shanta , Jacobs Roberta , Starks Helene , He Ken , Mccall Catherine , Palen Brian , Sharma Rahul , Parsons Elizabeth 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common sleep disorder that is characterized by repetitive episodes of upper airway obstruction during sleep. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for OSA, but it is not always well-tolerated by patients. As a result, alternative treatment options for mild OSA have been investigated. This study aims to explore the usage of non-CPAP alternatives in the veteran population.

Methods
Informed consent was obtained from the participants. The desired target cohort included veterans newly diagnosed with mild obstructive sleep apnea (OSA) on home sleep study (HSAT) or primary snoring on polysomnography (PSG). Specifically, mild OSA was considered pAHI &lt; 15, pRDI &lt; 15, and ODI &lt; 15 and primary snoring was diagnosed if snoring is a primary symptom on e-consult, technically adequate study and pAHI &lt; 5 and pRDI &lt; 5. During a one-week period, sleep medicine providers assigned to sleep study interpretations determined eligible veterans that met inclusion criteria. Veterans who had nocturnal hypoxemia (5% sleep time with saturation 88%), active home oxygen order, commercial driver, significant heart disease (e.g., heart failure, atrial fibrillation) or other sleep concern (parasomnia) were excluded from this study. Upon meeting selection criteria, eligible subjects were cosigned to nursing staff to discuss and choose non-CPAP treatment altervatives. A second point of contact was made 90 days later (T=90) to evaluate progress of the initial intervention. A standardized script was use for both communications.

Results
There were 62 subjects that were ultimately included in the study, of which 3 chose weight loss/lifestyle therapy, 5 chose positional therapy, 17 chose oral appliance, 19 chose nasal EPAP and 12 chose oral stimulator. Analysis of the treatment pathways is pending.

Conclusion
Data analysis is pending with conclusions to follow.

Support (if any)
0427 Airway Pressures Define Collapsibility of Specific Pharyngeal Sites of Obstruction during Drug-induced Sleep Endoscopy
Authors: Tangutur Akshay , Seay Everett , Thuler Eric , Parekh Manan , Dedhia Raj , Schwartz Alan 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal obstruction at one or more collapse sites. Multilevel collapse is a negative predictive factor for PAP-alternative surgical treatments. Pharyngeal manometry during drug-induced sleep endoscopy (DISE) permits an objective evaluation of anatomical obstruction sites and mechanisms, and may play a role in patient selection for PAP alternative therapies. We hypothesized that patients with multilevel collapse would have primary velopharyngeal collapse and secondary, downstream sites.

Methods
This prospective cohort of twenty consecutive patients with diagnosed OSA underwent DISE with nasal airflow monitoring and pharyngeal manometry. Two pressure catheters were placed at the (1) distal margin of the soft palate (Pus) and (2) retroepiglottic space (Pds). We sought to delineate site(s) of collapse by evaluating dissociations in airflow and air pressure during inspiratory flow limitation and/or complete obstruction. The primary site of collapse was defined by the initial segment at which inspiratory airflow and pressure dissociated (the critical pressure, Pcrit). Secondary site(s) were defined as the pressure at which the Pus and/or Pds signals subsequently dissociated (beyond the initial point of maximal flow).

Results
Twenty-one patients were evaluated of which signal quality and catheter placement in twenty were sufficient for analysis. Participants were elderly (58.3±14.3yrs, mean±SD), overweight (BMI 28.7±2. kg/m2), and had moderate-severe OSA (AHI 28.2±14.2 events/hour). Six patients had a single site of collapse, of which one was naso-palatal (Pcrit -2.6cmH2O) and five were infra-palatal (mean Pcrit -1.3cmH2O). In the patients with multilevel collapse (N=14), all had primary naso-palatal collapse (mean Pcrit 0.17±2.0cmH2O) and secondary infra-palatal sites of collapse (mean Pcrit -11.7±5.8cmH2O). Pcrit differed between the primary and secondary site by 11.9±6.5cmH2O (p&lt; 0.01).

Conclusion
These findings suggest that single-site pharyngeal collapse is usually infra-palatal. In contrast, multilevel collapse is primarily due to velopharyngeal collapse with varying degrees of instability in downstream pharyngeal segments. When secondary infra-palatal sites readily collapse with minimal additional respiratory effort, laxity of the tongue and/or lateral walls may be strongly implicated in the pathogenesis of pharyngeal obstruction. Future studies can utilize pharyngomanometry to further target specific pharyngeal structures for OSA therapy.

Support (if any)
National Institutes of Health 1R01HL144859 (PIs: Schwartz, Dedhia)
0429 ASSOCIATION BETWEEN HEALTHCARE COSTS AND CONTINUOUS POSITIVE AIRWAY PRESSURE ADHERENCE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA
Authors: Kim Joseph , Hwang Dennis , Shi Jiaxiao M , Arguelles Jessica , Klimper Matthew T , Becker Kendra , Sekhon Anupamjeet , Zhang Jing , Sawyer Amy , An Jaejin 
Published: May 2023

Abstract

Introduction
The impact of positive airway pressure (PAP) therapy on healthcare cost among patients with obstructive sleep apnea (OSA) requires further exploration. This study evaluated the associations between PAP adherence and cost in a large integrated healthcare system.

Methods
The study included adult patients with OSA (apnea-hypopnea index (AHI) ≥5) with available PAP therapy data between 1/1/2015 to 8/31/2019 from Kaiser Permanente Southern California. We followed the identified patients from the date of highest AHI before PAP use (index) up to 2 years. Each patient had PAP usage and cost organized into 6-month intervals, and mean hours/night and cost was calculated for each interval. Patients were stratified into the following adherence groups: (a) high adherence (≥4 hours/night consistently across all intervals); (b) moderate adherence (2–3.9 hours/night or ≥4 hours/night in some but not all intervals); (c) low adherence (&lt; 2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs associated with PAP adherence were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Stratified analyses based on age (&lt; 65, ≥65 years) and AHI (&lt; 15, ≥15) were conducted.

Results
A total of 25,700 patients (63.3% male; 41.6% with AHI ≥30) were included in the study. Among those, 53.2% (n=13,684) categorized as having low PAP adherence, 24.2% (n=6221) as moderate adherence, and 22.5% (n=5795) as high adherence. High adherence was associated with the lowest average multivariable adjusted 6-month healthcare cost ($3,586, 95% CI: $3,428, $3,745) compared with moderate ($4,035, 95% CI: $3,859, $4,211) and low ($4,232, 95% CI $4,110, $4,355) adherence. The cost differences between “high vs low” and “moderate vs low” adherence were $646 (p&lt; 0.001) and $197 (p=0.050), respectively. The cost differences between “high vs low” adherence were $999 (p&lt; 0.001) for those with ≥65 years and $657 (p&lt; 0.001) for those with AHI ≥15.

Conclusion
Better PAP adherence was associated with significantly lower healthcare costs in patients with OSA although further understanding of the relationship is needed.

Support (if any)
KPSC Regional Research Committee Grant: KP-RRC-20210506.