bluuebunny/crossref_metadata_2025_split huggingface dataset:
0817 Associations between Sleep Health and Injuries among Adults in the US: Findings from the National Health Interview Survey
Authors: Locklear Clarence , Narcisse Marie-Rachelle , Seixas Azizi , Martin Chloe M , Moise Rhoda , Turner Arlener D , Blanc Judite , Rogers April , Jean-Louis Girardin 
Published: May 2023

Abstract

Introduction
In 2020, 55.4 million Americans sought medical attention due to nonfatal, preventable injuries. Injury-related death rate was 15.7% higher than in 2019. Poor sleep health is associated with increased risk of injuries (e.g., falls, sports, and motor vehicle-related injuries). This study examined the associations between sleep health and injuries among adults (≥18 years).

Methods
This study utilized the 2020 National Health Interview Survey (n=31,568). The primary outcome encompassed sustained bodily injuries in the past 3 months. Secondary outcomes were fall-related, sports-related, and motor vehicle (MV)-related injuries. Sleep health in the past month was measured via 1) sleep quantity: very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours); 2) sleep quality: trouble falling asleep and trouble staying asleep; 3) feeling well-rested upon waking-up; and 4) sleep medications. Response categories included never, some days, most days, or every day. Adjusted multivariable logistic regression was used to examine associations between injuries and these four domains of sleep health.

Results
Overall, 9.1% of respondents sustained an injury. Among injured adults, 47.4% had fall-related injuries, 29.1% had sport-related injuries, and 6% had a MV-related injury. Adults with very short, short, and long sleep were 37%, 15%, and 22% more likely to be injured than adults with healthy sleep (p&lt; 0.05). Adults with trouble staying asleep were 36% more likely to be injured than adults who never had trouble staying asleep (p&lt; 0.01). Adults who woke up never rested or rested on some days were 49% and 36% more likely to be injured (p&lt; 0.01) Adults who took medications for sleep on some days or every day were 24% and 36% more likely to be injured (p&lt; 0.05; p&lt; 0.001). Adults who had trouble staying asleep some days were 22% more likely to have a fall-related injury (p&lt; 0.05). Respondents with long sleep were 43% less likely to have sports-related injuries (p&lt; 0.05). Those who had trouble staying asleep were 3.5 times more likely to have experienced a MV-related injury (p&lt; 0.01).

Conclusion
Sleep health is strongly associated with injuries among adults. Further studies are needed to determine causality in the observed associations.

Support (if any)
0818 Comorbid obstructive sleep apnea and insomnia in type 2 diabetes: Association with diabetes-related distress and glycemic control
Authors: Jeon Bomin , Chasens Eileen , Luyster Faith 
Published: May 2023

Abstract

Introduction
It is unclear how comorbid insomnia and sleep duration may influence diabetes-related distress and glycemic control in adults with obstructive sleep apnea (OSA) and type 2 diabetes (T2D). This analysis examined whether diabetes-related distress mediates the associations of OSA and insomnia severity with glycemic control in adults with T2D and OSA based on sleep duration.

Methods
This study was a secondary analysis of merged baseline assessment data from two clinical trials of adults (N=240) with self-reported T2D and OSA. OSA (apnea-hypopnea index ≥ 5) was determined by a home sleep study. Participants completed questionnaires to elicit insomnia severity, diabetes-related distress, sleep duration, daytime sleepiness, and global sleep quality. Sleep duration was classified as normal (&gt;6 h) or short (≤ 6h). Glycemic control was measured by HbA1c (%). Mediation analyses with bootstrapped samples were employed after controlling for sociodemographic covariates in participants with normal and short sleep durations.

Results
More participants (mean age 57.8 years; 49.6% female; 65% White; 56.3% post high school education, mean HbA1c 7.93%) had short sleep duration (n=128; 53.5%) than normal sleep duration (n=111, 46.5%). Participants with short sleep duration had significantly worse sleep quality, daytime sleepiness, insomnia, and HbA1c levels compared to those with normal sleep duration (all p&lt;.05). In participants with normal sleep duration, insomnia severity was associated with diabetes-related distress (b=0.942, p=0.008); diabetes-related distress did not mediate the association between insomnia severity and HbA1c (indirect effect [IE]=0.013, 95% CI: -0.003, 0.036). In participants with short sleep duration, insomnia severity was significantly associated with diabetes-related distress (b=1.470, p&lt; 0.001), and diabetes-related distress mediated the association between insomnia severity and HbA1c (IE=0.023, 95% CI: 0.001, 0.053). Regardless of sleep duration, OSA severity was not associated with diabetes-related distress or HbA1c.

Conclusion
Only among participants with short sleep duration, comorbid insomnia significantly contributes to greater diabetes-related distress, which leads to higher HbA1c levels. Short sleep duration in persons with insomnia could be a potential mechanism involved in the association between diabetes-related distress and glycemic control in adults with T2D and OSA.

Support (if any)
The NIH (R01- DK0960281; K24-NR016685) and the CTSI grants (UL1-RR024153; UL1-TR000005) funded the parent studies
0821 Nighttime Average and Dipping Blood Pressure Can Differ Based on the Temporal Distribution of Ambulatory Measurements at Nighttime
Authors: Brito Leandro , Bowles Nicole , McHill Andrew , Rice Sean , Butler Matthew , Rueda Jose , Emens Jonathan , Shea Steven , Thosar Saurabh 
Published: May 2023

Abstract

Introduction
Ambulatory blood pressure (BP) monitoring is recommended in preference to office BP as it enables BP assessments across the night and quantification of the degree of nocturnal BP dipping (dipping” = nighttime/daytime BP of &lt; 0.9; non-dipping = ≥0.9). Both nighttime BP and dipping% are independent predictors of adverse cardiovascular events. Standard guidelines recommend at least ≥20/7 daytime/nighttime measurements for reliable ambulatory BP monitoring, but newer reports suggest ≥8/4 daytime/nighttime measurements are sufficient. Considering BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. To test whether this new recommendation holds for extreme examples of temporal distribution, we compared average nighttime BP and dipping% when using BP measurements only in the first (1st-half) vs. only in the second half (2nd-half) of the night.

Methods
Seventeen females and twenty-six males (50±10 years [mean±SD]) without cardiovascular disease or severe sleep disorders wore an ambulatory BP monitor for 24 hours, programmed to measure BP every 20 minutes when awake and every 30 minutes during a self-selected 8-hour time-in-bed for nighttime. We compared the nighttime BP averages and the calculated dipping% when using the first four measurements from the 1st-half of the nighttime, from the 2nd-half of the nighttime, and all measurements during the nighttime (All nighttime, AN). Repeated measures ANOVA was conducted with significance set as p&lt; 0.05.

Results
Systolic BP was higher using 1st-half than 2nd-half but similar to AN (111±9 vs.107±11 vs. 109±9 mmHg, p&lt; 0.01), while systolic BP dipping% using 1st-half was lower than 2nd-half and AN (9.7±7.4 vs.13.0±7.6 vs. 11.4±6.7 %, p&lt; 0.01, respectively). Diastolic BP and diastolic dipping% were similar among the 1st-half, 2nd-half, and AN segment (63±6 vs. 63±7 vs. 62±7 mmHg, p=0.19) and (17.2±7.6 vs. 17.2±8.8 vs. 18.4±8.8 %, p=0.16), respectively.

Conclusion
In adults without cardiovascular disease or severe sleep disorders, nighttime BP and dipping% may depend upon when BP measurements are taken. The minimum threshold of 4 measurements for a reliable nighttime BP readout should be used cautiously.

Support (if any)
NIH F32-HL131308, R01HL163232, R01HL125893, R35HL155681, Medical Research Foundation, and OHSU OFDIR fellowship.
0824 The Effect of CBT-I Dose on Sleep Outcomes in Cancer Survivors at 3-month Follow-up
Authors: Muench Alexandria , Lampe Elizabeth , Posner Donn , Seewald Mark , Boyle Julia , Vargas Ivan , Thompson Michelle , Grandner Michael , Perlis Michael 
Published: May 2023

Abstract

Introduction
Cancer-related fatigue (CRF) is highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing such symptomatology. While CRF commonly co-occurs with sleep disturbance during and/or after cancer treatment, CRF is (nevertheless) defined as occurring independent of sleep considerations. Last year it was reported (based on preliminary findings from a pilot study), that CBT-I affects both sleep continuity and fatigue, with high dose CBT-I producing up to a 72% reduction in pre-to-post measures of Fatigue. The present analysis is based on a completed pilot study where we evaluate the durability of the anti-fatigue and sleep continuity effects of CBT-I in patients diagnosed with breast and prostate cancer.

Methods
This descriptive analysis (percent change from post-treatment to three month follow-up) includes 11 adult subjects (91% female; Mage=57.8±7.7yrs). CBT-I was provided by a master CBT-I therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries, and weekly measures of fatigue (FACIT), and insomnia severity (ISI) questionnaires. In order to evaluate durability, post-treatment scores were compared to three-month follow-up scores, where all subjects were typed for whether or not they retained &gt; 90% of their clinical gains as assessed with the ISI and the FACIT.

Results
82% of the subjects in our pilot study maintained their clinical gains with respect to fatigue and 64% maintained their gains with respect to insomnia.

Conclusion
This preliminary analyses suggest that clinical gains via CBT-I are remarkably robust for fatigue outcomes. The findings with respect to the ISI, while less robust, are within the range that is typical for insomnia RCTs (~70% of subjects maintain treatment responses at follow-ups). If these results are replicated, this may suggest that the anti-fatigue effects of CBT-I are more durable than the “insomnialytic” effects.

Support (if any)
5T32HL00795320;K24AG055602
0826 Chronotype, unhealthy lifestyle, and diabetes risk in middle-aged US women: A prospective cohort study in Nurses’ Health Study II
Authors: Kianersi Sina , Liu Yue , Guasch-Ferre Marta , Redline Susan , Schernhammer Eva , Sun Qi , Huang Tianyi 
Published: May 2023

Abstract

Introduction
Chronotype refers to one’s inclination to earlier or later sleeping times. Late chronotype has been linked to increased diabetes risk, which may be mediated through adherence to unhealthy lifestyle. This study aimed to evaluate the interplay among chronotype, lifestyle factors, and diabetes risk.

Methods
In 2009, 63,594 diabetes-free women (mean age=54 yrs) from the Nurses’ Health Study II self-reported their chronotype using a validated question from the Morningness-Eveningness Questionnaire and were prospectively followed for incident type 2 diabetes (T2DM) until June 2017. Unhealthy lifestyle was defined by having &lt; 4 of the following 6 healthy lifestyle factors: high diet quality (AHEI≥49), physical activity (≥3.5 MET-hours/week), moderate alcohol intake (≥5 and &lt; 15 g/day), normal body mass index (≥18.5 and &lt; 25 kg/m2), non-current smoking, and 7-9 hours of sleep. T2DM was self-reported and confirmed using a validated supplementary questionnaire. We used modified Poisson regression models to estimate the cross-sectional associations between chronotype and unhealthy lifestyle. Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHR) for incident diabetes risk according to chronotype and assess the proportion of the association explained by lifestyle factors (mediation analyses).

Results
Participants reporting a “definitely-evening” type were 55% (95% CI: 1.51-1.60) more likely to have an unhealthy lifestyle compared with participants reporting a “definitely-morning” type. We documented 1,921 T2DM cases over 468,555 person-years of follow-up. With increasing eveningness, the risk of T2DM became significantly higher (Ptrend&lt; 0.0001). Compared with the “definitely-morning” type, the aHR (95% CI) for T2DM was 1.10 (0.97-1.24) for “more-morning”, 1.01 (0.81-1.27) for “intermediate”, 1.26 (1.11-1.42) for “more-evening”, and 1.65 (1.44-1.90) for “definitely-evening” chronotypes, after adjusting for sociodemographic factors, shift-work, depression and family history of diabetes. Additional adjustment of unhealthy lifestyle explained 56.8% (95% CI: 39.4%-72.6%) of the association [aHR (95% CI) for “definitely-evening” versus “definitely-morning”: 1.27 (1.10-1.46)].

Conclusion
Women with a late chronotype are more likely to engage in unhealthy lifestyle behaviors. Late chronotype is prospectively associated with increased diabetes risk, which is partly explained by unhealthy lifestyle behaviors. Our results suggest that lifestyle interventions may potentially reduce the adverse impact of late chronotype on diabetes risk.

Support (if any)
R01HL155395, K01HL143034, U01CA176726
0827 Effect of virtual cognitive behavioral therapy for insomnia on perceived cognitive functioning among cancer survivors
Authors: Garland Sheila , Tulk Joshua , Rash Joshua , Seal Melanie , Browne Sondria , Thoms John , Laing Kara , Urquhart Robin , Savard Josée 
Published: May 2023

Abstract

Introduction
Comorbid insomnia and perceived cognitive impairments (PCI) affect up to 26% of individuals diagnosed with cancer. Given the association between sleep and cognition, and the lack of interventions to improve PCI, the present study examined the impact of cognitive behavioral therapy for insomnia (CBT-I) on PCI among cancer survivors with insomnia disorder and cognitive complaints (clinicaltrials.gov:NCT04026048).

Methods
Cancer survivors (N=122) with insomnia and PCI were randomized to 7 weekly virtual CBT-I treatment sessions (n=56) or waitlist control (WLC: n=66). Participants completed the Insomnia Severity Index and the Functional Assessment of Cancer Therapy – Cognitive Function upon entering the study (baseline; T0), and then again at 4 (T1), and 8 (T2) weeks. A series of 2 (treatment group: CBT-I and WLC) by 3 (time: T0, T1, T2) mixed ANOVAs were performed to assess changes in insomnia symptoms, PCI, perceived cognitive abilities (PCA), and impact of cognitive function on quality of life (QOL).

Results
Participants were, on average, aged 60 years, had 16 years of education, and 79% were female. Breast cancer was the most reported cancer type (46%). No significant differences were observed between groups at T0 for demographic or clinical variables (p&gt;.05). There was a significant group by time interaction for insomnia [p=&lt;.001, partial eta squared (pes)=.36]. Individuals randomized to CBT-I reported significant decreases in insomnia symptoms post treatment compared to WLC (CBT-I: -11.5; WLC: -2.7). Significant interactions were also observed for PCI (p=&lt;.001, pes=.11), PCA (p=&lt;.001, pes=.16), and impact on QOL (p=&lt;.001, pes=.15). Participants randomized to CBT-I reported significantly less PCI (CBT-I: 14.7; WLC: 4.1), better PCA (CBT-I: 5.8; WLC: 1.1), and less impact on QOL (CBT-I: 4.9; WLC: 1.1) than participants in the WLC.

Conclusion
In addition to improving insomnia, CBT-I significantly improve perceived cognitive functioning and quality of life among cancer survivors. Further research is needed to understand the mechanisms underlying improvements in cognition following CBT-I.

Support (if any)
Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.
0840 Exploring the relationship between sleep disturbances and Alzheimer’s disease using machine learning
Authors: Bonfa Antonia , Zhang Weiping , Keller Yvo , Barbisch Florin , Schürmann Patrick , Moguel Leticia Fernández , Seixas Azizi , Ramos Alberto , Rogers April , Jean-Louis Girardin , Çöltekin Arzu 
Published: May 2023

Abstract

Introduction
Alzheimer’s Disease (AD) is one of the most common neurological diseases, affecting about 50 million people worldwide. Despite its prevalence and many promising recent developments, the factors that contribute to AD are still poorly understood. In this study, we examined the influence of sleep disturbances (sleep apnea, insomnia, and poor sleep quality) on the chances of developing AD and conversion from normal cognitive functioning (NL), to mild cognitive impairment (MCI) to AD, using the ADNI dataset and state-of-the-art machine learning models.

Methods
We conducted a series of Random Tree classifiers to determine whether sleep disturbances predicted changes in cognitive status (NL, MCI, or AD). Using three sleep target variables OSA, insomnia, and Neuropsychiatric Inventory’s sleep related questions (NPIK) markers, participants that were surveyed for sleep patterns (n=1848) self-declared if they have insomnia (n=49), obstructive sleep apnea (OSA) (n=65), or poor sleep quality via NPIK (n=114). NPIK contains 11 variables, including OSA and NPIK, we explored a total of 7089 observations. Following that, a logistic regression and k-nearest neighbor (KNN) model using only the NPIK questionnaire as NPIK provides a rich and coherent inventory of sleep parameters.

Results
Based on Random Tree classifiers, the best model predicted a change from MCI to AD with an accuracy of 70%. Logistic regression and KNN models predict that caregiver distress, frequency of sleep disturbances and excessive daytime sleepiness play important roles in worsening the cognitive functioning status from MCI to AD. For the MCI patients, a random forest model with 60% accuracy predicted re-conversion from MCI to NL. Caregiver distress, frequency of sleep disturbances, and OSA predicted re-conversion from MCI-NL, and was most pronounced among males.

Conclusion
Our research broadly suggests that sleep disturbances increases Alzheimer's disease risk. However, the data on sleep in the ADNI dataset has limitations. All markers for sleep were subjectively reported by the patients or their caregivers and were not verified with objective observations. Further research under clinical conditions would be of value to find conclusive evidence of sleep disturbance as a risk factor for Alzheimer's Disease.

Support (if any)
0841 Feasibility of Actigraphy during a Daytime Bright Pilot Study in the Medical ICU
Authors: Lukas Molly , Doyle Margaret , Intihar Taylor , Wright Kenneth , Redeker Nancy , Pisani Margaret , Yaggi H , Knauert Melissa 
Published: May 2023

Abstract

Introduction
Medical intensive care unit (MICU) light patterns are inadequate for proper circadian alignment. Sleep disruption and circadian misalignment are observed in MICU patients and adversely impact patient outcomes. We sought to establish the feasibility of using longitudinal actigraphy to measure diurnal rest-activity patterns, as a in the context of a pilot study evaluating daytime bright light (DBL). In an exploratory manner, we analyzed diurnal rest-activity characteristics.

Methods
Patients &gt;50 years admitted to the MICU without pre-existing circadian disruption were enrolled. An actigraph was placed (wrist) on study day 1 (D1) and remained for up to 5 days. DBL exposure (&gt;1200 lux, 5000K) began at 09:00 on D2 and continued until D5 (varied lengths of exposure among patients). Actigraphy feasibility was assessed via (1) total recording duration and (2) proportion of total recording with activity data (e.g., proportion of epochs on wrist with data capture). In an exploratory analysis, we evaluated rest-activity characteristics from D1 and D2 for fit with gamma distribution cosinor analysis. Characteristics included ratio of day/total activity, mesor (midline estimation statistic of circadian rhythm), and circadian quotient (normalized amplitude/mesor).

Results
Thirteen of fourteen enrolled patients completed actigraphy. Mean (SD) age was 74 (11) years. Mean APACHE II illness severity score was 21 (4). Patients had a mean 3.7 (1.3) days of actigraphy recording and a mean activity data proportion of 92% (16%). There were only two reports of temporary actigraph removal related to patient care. All actigraphy patients had fit using cosinor analysis. D1 median (IQR) day/total ratio was 0.76 (0.68,0.82), mesor was 10.31 (6.36,13.00), and circadian quotient was 0.82 (0.48,0.99). D2 (after DBL start) median (IQR) day/total ratio was 0.76 (0.64,0.78), mesor was 11.90 (8.97,15.83), and circadian quotient was 0.89 (0.65,0.95).

Conclusion
Here we demonstrate the feasibility of actigraphy as a measure of diurnal rest-activity patterns in MICU patients based on successful collection and analysis of data in all patients. While cohort size remains a limitation of this study, Actigraphic rest-activity patterns are being explored in an ongoing RCT evaluating the impact of DBL versus usual light exposure on circadian rhythms in critical illness.

Support (if any)
K23HL138229, AASM Foundation
0844 Impact of Obstructive Sleep Apnea on patients admitted with Influenza Viral Pneumonia, A Nationwide Study
Authors: El Labban Mohamad , Chaaban Toufic , Khan Syed 
Published: May 2023

Abstract

Introduction
There is evidence of increased risk of admission with influenza in patients with untreated obstructive sleep apnea (OSA). There is however limited evidence of the impact of OSA on patients admitted with influenza pneumonia. We aim to study this association on a nationwide scale.

Methods
Using the National Inpatient Sample (NIS) Database from 2017 to 2020, a retrospective study of adult patients with principal diagnosis of influenza viral pneumonia with secondary diagnosis with or without obstructive sleep apnea (OSA) according to ICD-10 codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p value less than 0.05 considered statically significant.

Results
The study included 174,339 patients admitted with an influenza pneumonia, 13,094 of which had OSA. The Mean age for patients with and without OSA was 67 and 70 years, respectively. In the OSA group, 48% were females compared to 55% in the non-OSA group. Around 73% in both groups were Caucasian white. Statistically significant comorbidities noticed in the OSA group included chronic kidney disease (29% vs. 22%), Diabetes Mellitus (48% vs. 31%), COPD (47% vs. 31%) . In-hospital mortality rate was not higher in the OSA group with statistical significance (2.1% vs. 2.3%, p =0.48). The adjusted Odds ratio was 0.51 without statistical significance. In-hospital mechanical ventilation and tracheotomy rates were higher in the OSA group with statistical significance (5.3 % vs. 3.7%, p &lt; 0.01) (0.31 % vs. 0.12%, p 0.013 ) however the adjusted odds ratio was not statistically significant in either (aOR 1.27, p value 0.14). (aOR 0.9, p value 0.98). The length of stay was higher in the OSA group (5.5 vs. 4.9 days, adjusted means +0.4 days, p value 0.04) Patients in the OSA group had a higher total charge (59,949$ vs. 44,091$, adjusted means +1,997$ p value 0.45)

Conclusion
Patients admitted with influenza viral pneumonia with associated OSA were not found to have worse clinical outcomes and a higher economic burden.

Support (if any)