bluuebunny/crossref_metadata_2025_split huggingface dataset:
0528 Development of Pediatric OSA Health Communication Messaging for and with Parents
Authors: Honaker Sarah , McQuillan Maureen , Binion Kelsey , Brann Maria 
Published: May 2022

Abstract

Introduction
Pediatric obstructive sleep apnea (OSA) is often undetected, due in part to gaps in parental awareness of OSA symptoms. To activate parents to talk to their child’s provider about OSA symptoms, there is a need for effective OSA health communication messaging.

Methods
We developed a health communication message in the form of an infographic, designed to help parents recognize the link between nighttime and daytime OSA symptoms. The message encouraged parents who saw these symptoms in their child to speak with their child’s provider. The infographic was iteratively reviewed, rated, and refined through a series of twelve virtual focus groups with three types of stakeholder: parents of children with OSA symptoms (n=24), primary care providers (n=9), and sleep medicine specialists (n=4). During groups, we elicited reactions and asked participants to rate various aspects of the message.

Results
Stakeholder feedback (semi-structured sessions and anonymous ratings) was elicited for the initial draft and two subsequent iterations of the message that incorporated prior feedback. Anonymous stakeholder ratings were measured on a scale from 1-5, with 5 denoting stronger endorsement of the construct. Parents rated the message positively for content (M=4.77; SD=0.44), literacy demand (M=4.92, SD=0.28), graphics/design (M=4.69, SD=0.63), and activation (M=4.77, SD=0.44). Sleep medicine providers perceived the message as accurate (M=5.0, SD=0) and primary care providers rated it as acceptable (M=4.67, SD=0.58) and feasible (M=4.33, SD=0.58) for display and dissemination in primary care settings.

Conclusion
We developed a pediatric OSA health communication message that was rated highly by parents, primary care providers, and sleep medicine specialists. Next steps are to disseminate and evaluate the impact of the message on pediatric OSA detection.

Support (If Any)
Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL150299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0540 First Year PAP Trajectories among Treatment-Naive Youth with Sleep Disordered Breathing
Authors: Krietsch Kendra , Duraccio Kara , Peugh James , Carmody Julia , Simmons Danielle , Byars Kelly 
Published: May 2022

Abstract

Introduction
Little is known about the time course for youth adjusting to and achieving optimal PAP adherence.

Methods
This retrospective study identified 12-month PAP trajectories and treatment persistence following treatment initiation in youth. Participants were first-time PAP initiators receiving care at Cincinnati Children’s Hospital from 07/2017-12/2019. Electronic downloads provided monthly PAP use. Adherence indicators were frequency (percentage of nights PAP used each month) and duration of use (average usage hours on nights used each month). Persistence of group-level adherence (frequency and duration) was measured via descriptive statistics in SPSS. Adherence sub-groups were identified using longitudinal mixed models in MPlus.

Results
The sample was 169 youth ages 2-22yrs started on PAP. Within the first month, 55% of participants were using PAP &gt;50% of nights and 43% were using for &gt;4 hours/night. Adherence (frequency and duration, respectively) decreased by month as follows: month 3 - 48% and 42%; month 6 - 41% and 41%; month 12 - 36% and 32%. Longitudinal mixed models identified 5 trajectories for frequency of use (based on the model of best fit using BIC index): “starts high, stays high” (34% of sample); “starts high, slowly decreasing” (7%); “starts high, rapidly decreasing” (12%); “starts low, slowly increasing” (8%); “starts low, stays low” (39%). Two trajectories were identified for duration (average hours worn on nights used, also based on model of best fit) and included: “starts high, slowly increasing” (40%) and “starts low, stays low” (60%).

Conclusion
At the group level, PAP adherence was sub-optimal in the first month of use (around half of participants using PAP &gt;50% of nights or for &gt;4 hours) and declined over the subsequent 11 months. However, mixed models identified distinct adherence subgroups, with about 40% of the sample falling into subgroups with relatively high adherence by month 12. This suggests acclimation to PAP takes time in a pediatric population. Findings may help clinicians/policy makers set realistic expectations around time to achieve optimal PAP adherence among youth, and highlights the need for further PAP adherence promotion interventions.

Support (If Any)
First, and fourth authors’ time supported by NIH post-doctoral training grants (T32 DK063929 and T32HD068223, respectively).
0542 Pediatric Obstructive Sleep Apnea and Poor Appetite
Authors: Tah Sumeer , Modi Meet , Brennan Christine , Rangan Pooja , Castro Walter , Lee-Iannotti Joyce , Rihawi Anas , Knobbe Kirstin 
Published: May 2022

Abstract

Introduction
Obstructive Sleep Apnea (OSA) has many impacts on homeostasis. In pediatrics, there have been links observed between health problems and OSA including failure to thrive, obesity, and behavioral disorders. Existing literature evaluates the links between excess weight, obesity, and OSA. However, there is a lack of research exploring the association between OSA and reduced appetite as a contributor to failure to thrive in the pediatric population. In this study, we hypothesized there is a positive correlation between OSA severity and the presence of poor appetite.

Methods
We analyzed data retrospectively through medical records of 155 pediatric patients (age &lt; 18 years old) who were diagnosed with OSA by pediatric criteria via polysomnography from April through November 2021. Data was collected from a pre-completed questionnaire done by the guardian or child during the sleep study intake. Poor appetite symptoms were ranked on a Likert scale of occurring “never”, “rarely”, “occasionally”, “frequently”, “regularly”, or “don’t know.” The presence of poor appetite symptoms was compared to the severity of pediatric OSA diagnosed during the sleep study. Pearson chi-squared test and Spearman’s correlation coefficient were calculated on the data sets.

Results
Of 155 patients, 33 (21.3%) were diagnosed with mild OSA, 70 (45.2%) with moderate OSA, and 52 (33.5%) with severe OSA based on pediatric criteria. A total of 53 patients reported poor appetite occasionally, frequently, or regularly. 29.4% of patients with mild OSA reported poor appetite, along with 45.7% of patients with moderate OSA, and 21.2% of patients with severe OSA. Of all patients who reported poor appetite, 60.3% had moderate OSA. However, there was a non-statistically significant correlation between apnea hypopnea index (AHI) and the presence of poor appetite symptoms, Spearman's correlation coefficient of -0.1044 (p-value 0.1960).

Conclusion
Overall our data did not show a significant correlation between OSA severity and poor appetite symptoms. There was an association between poor appetite and moderate OSA, however this data is limited by selection bias as 45.2% of patients were categorized as moderate OSA. Further studies are needed, including analyses with similar size populations of each OSA severity category.

Support (If Any)
0546 An Informatics Approach to Assessing Quality of Care Metrics for Restless Legs Syndrome/Willis-Ekbom Disease
Authors: Bongers Quinn , Kunisaki Ken , Irfan Muna 
Published: May 2022

Abstract

Introduction
Management of restless legs syndrome (RLS, aka Willis-Ekbom Disease) with dopaminergic agents is often complicated by development of augmentation. Clinical practice guidelines and stepwise algorithms suggest that prior to prescribing dopaminergic agents, clinicians should assess iron stores and consider alpha-2-delta agents (e.g. gabapentin). We developed an informatics approach to assess quality of care metrics for RLS management.

Methods
We used Veterans Affairs (VA) electronic health record data to identify a cohort of patients at a single tertiary care academic VA facility prescribed dopaminergic agents between 01 Jan 2018 to 31 Dec 2019. Patients with any prior codes for Parkinson’s disease were excluded. A random sample of charts were manually reviewed to determine if dopaminergic drugs were being prescribed for RLS or other indications. We then assessed for evidence of prior iron store assessments, iron repletion if appropriate, and alpha-2-delta agents (gabapentin, pregabalin).

Results
We identified 1160 patients treated with dopaminergic agents and no prior Parkinson’s codes. Chart reviews indicated 95% accuracy of this methodology to identify dopaminergic use for RLS. Evidence of pre-treatment iron storage assessment was missing in 30.2% for ferritin and 33.5% for transferrin saturation. Among those with iron studies present, lack of iron replacement was noted in 34% of those with ferritin &lt;75 mcg/L and 33% of those with transferrin saturation &lt;20%. Prior or concomitant prescriptions of alpha-2-delta agents was present in 59.7% of the cohort.

Conclusion
Our informatics approach provides an accurate and efficient means to quantify RLS care metrics. Results were most notable for a high proportion of dopaminergic-treated RLS patients without iron assessments and without iron repletion when stores were low. This methodology will inform future quality improvement initiatives to improve the delivery of guideline concordant RLS care.

Support (If Any)
This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Health Care System, Minneapolis/USA.
0563 Association between actigraphic sleep measures and lymphocyte subsets in people with chronic HIV infection
Authors: Sharma Malvika , Borker Priya , Macatangay Bernard , Punjabi Naresh , Rinaldo Charles , Wolinsky Steven , Cho Joshua Hyong-Jin , McKay Heather , Patel Sanjay 
Published: May 2022

Abstract

Introduction
While inadequate sleep is known to increase inflammation in immunocompetent individuals, it is unknown if poor sleep worsens inflammation in people living with HIV. The ratio of CD4+/CD8+ T cells is a readily derived measure of chronic inflammation in people living with HIV. We sought to investigate the association between lymphocyte subsets and actigraphy-derived sleep measures in a cohort of HIV seropositive men.

Methods
HIV seropositive men on antiretroviral therapy for &gt; 1 year and with undetectable (&lt; 20 copies/mL) plasma HIV-1 RNA participating in the Multicenter AIDS Cohort Study underwent a sleep evaluation with 1 week of wrist actigraphy. Data from 287 participants with ≥ 5 days of actigraphy were analyzed. We evaluated three dimensions of sleep: mean nocturnal sleep duration, sleep onset latency, and sleep maintenance efficiency. Linear regression was used to assess the association between each sleep dimension with CD4+ and CD8+ T-cell counts. Because of a U-shaped association, nocturnal sleep duration was also modelled dichotomously as a normal (6-8 hrs) vs. abnormal duration (&lt;6 or &gt;8 hrs).

Results
Participants had a mean (±SD) age of 55 ± 12 years, mean CD4+ count of 723 ± 293 cells/ml, and 7.0 ± 1.7 days of actigraphy data. None of the sleep measures were associated with CD4+ counts. However, participants with abnormal sleep duration had 129 ± 31 cells/mL higher CD8+ counts compared to those with normal sleep duration (p=0.01). There were also nonsignificant trends whereby every 30-minute increase in sleep latency was associated with a 138 cells/ml increase in CD8+ count (p=0.07) while every 10% reduction in sleep efficiency was associated with a 56 cells/ml increase in CD8+ count (p=0.12). These findings were unchanged after adjusting for age and body mass index.

Conclusion
Among men with treated HIV infection, abnormal sleep duration (both short and long) is associated with increased circulating CD8+ T cell count, suggesting increased chronic inflammation.

Support (If Any)
NIH AI0355041, HL082610 and American Thoracic Society ASPIRE Fellowship
0570 Does CBT-I Dose effect Sleep Duration and Fatigue in Breast and Prostate Cancer Patients?
Authors: Muench Alexandria , Posner Donn , Seewald Mark , Upton Caitlyn , Boyle Julia , Reddy Varudhini , Thompson Michelle , Vargas Ivan , Perlis Michael 
Published: May 2022

Abstract

Introduction
Cancer-related fatigue (CRF) is highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing some level of CRF. While CRF commonly co-occurs with sleep disturbance during and/or after cancer treatment, CRF is defined as occurring independent of sleep considerations. The present analysis is based on an ongoing pilot study where CBT-I dose (4 & 8 [Low] vs 10 & 12 [High] sessions) is being assessed for whether improved sleep continuity and/or increased TST can improve CRF in subjects diagnosed with breast and prostate cancer.

Methods
This interim analyses includes seven adult subjects (6 females, mean age=57.1 yrs.; n=3 [Low dose], n=4 [High dose]). 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.

Results
Subjects in the low dose group exhibited a 9% improvement and subjects in the high dose group had a 21% improvement on the FACIT. This corresponded to a 28% improvement on the ISI (low group) and a 68% improvement on the ISI (high group). With respect to TWT, subjects in the low dose group decreased their wake time by 36% and those in the high dose group decreased their wake time by 43%. Finally, TST decreased by 7% in the low dose group but increased by 12% in the high dose group.

Conclusion
Preliminary results indicate that a higher CBT-I dose may significantly decrease fatigue, stabilize sleep schedules, and improve sleep continuity in patients with CRF, where the high dose group showed more than double the improvement on the FACIT and ISI (as compared to the low dose group). Not surprisingly, TWT was roughly comparable between the groups while TST was more substantially impacted by high dose CBT-I. This study is ongoing.

Support (If Any)
Support: 5T32HL00795320;K24AG055602
0575 Characterization of the Prevalence of Sleep Disturbances in Cardiovascular and Neurological Patients from the Rush Heart Center for Women
Authors: Johnson Andrew , Goel Namni , Casale Courtney , Volgman Annabelle , Aggarwal Neelum 
Published: May 2022

Abstract

Introduction
Anecdotally, patients with cardiovascular and neurological medical conditions present with sleep disturbances in duration, efficiency, and timing, or with sleep disorders such as obstructive sleep apnea. The frequency of such disturbances remains unknown as does whether they result from cardiovascular and neurological conditions or contribute to the development of these conditions. Thus, characterizing the prevalence of sleep disturbances in this unique clinical population is a first step to establishing the important role of sufficient, healthy sleep for patient care and treatment.

Methods
We conducted a retrospective electronic chart review of patients from the Rush Heart Center for Women (RHCW) based on the following: age, sex, race, body mass index (BMI), blood pressure (BP), sleep studies, cardiac testing, and neurologic testing. Patients were also characterized based on prevalent disease (cardiac, neurologic, or both) including the following: cardiac—coronary artery disease, ischemic vs. non-ischemic heart disease, atrial fibrillation, heart failure, etc; neurologic—vascular etiology, mild cognitive impairment, dementia, Alzheimer’s Disease, etc. We then performed a database search to identify patients who also met the criteria for sleep apnea or for whom a sleep study was ordered due to sleep disturbances.

Results
103 patients (mean age±SD, 68.71±12.55 years; 78 females; mean BMI±SD, 28.65±5.28; 79 White, 14 African American, 4 Asian, 1 Native Hawaiian, 5 Other; mean BP±SD, 128/72±20/9; mean±SD Mini-Mental State Examination (MMSE), 27.47±3.24) had cardiovascular and/or neurological conditions. Of these, 53 patients (mean age±SD, 68.31±9.35 years; 40 females; mean BMI±SD, 29.91±5.73; 39 White, 7 African American, 2 Asian, 1 Native Hawaiian, 4 Other; mean BP±SD, 129/73±21/9; mean MMSE±SD, 27.67±2.99) also presented with sleep apnea symptoms or sleep disturbances.

Conclusion
A strikingly high percentage (51.5%) of patients at the RHWC who had cardiovascular and/or neurological conditions also presented with sleep apnea or sleep disturbance symptoms. The prevalence of this trifecta of disease (cardiovascular, neurological, and sleep apnea/disturbance) demonstrates the criticality of considering the interplay between these various domains when administering clinical care to patients. Future research capitalizing on the physiological and neurobehavioral benefits of adequate, healthy sleep in this population is warranted.

Support (If Any)
RMC Dean’s Award Summer Research Fellowship; NASA NNX14AN49G and 80NSSC20K0243; NIH R01DK117488
0593 Maxillomandibular Advancement Referrals and Follow-up After Drug Induced Sleep Endoscopy
Authors: Rodin Julianna , Fiorella Michele , Taub Daniel , Champion Allen , Boon Maurits , Huntley Colin 
Published: May 2022

Abstract

Introduction
Several surgical options exist for treating obstructive sleep apnea (OSA), but few correct airway obstruction at multiple levels like maxillomandibular advancement (MMA). MMA has been shown to significantly improve OSA, decrease sleepiness, and also improve quality of life. Despite the accepted success of MMA surgery, it is unclear if patients referred for MMA undergo MMA or are lost to follow-up in real world clinical care. This quality improvement study aims to determine if patients referred for MMA by ENT sleep surgeons then undergo MMA surgery by oral maxillofacial surgeons (OMFS).

Methods
At our academic urban hospital, all drug induced sleep endoscopy (DISE) cases performed on OSA patients by two otolaryngology sleep surgeons were reviewed over a one year period. Patients who were not recommended for MMA based on DISE findings were excluded. Retrospective chart review included VOTE classification, DISE findings, and referrals for MMA to the OMFS clinic. Other data included age, BMI, past medical history, sleep study data including AHI and oxygen nadir, and if MMA or other OSA treatments were done.

Results
Out of 408 DISE performed, 58 patients (14.2%) were referred to our OMFS for MMA. Patients’ demographics were: male (48; 82.8%); average age: 51; average BMI: 32.5; 39 (67.2%) with comorbidities. Sleep studies included: 32 HSATs, 22 PSGs, 4 missing. 41 patients (75.9%) had severe OSA. Average O2 nadir was 75%. On DISE, most patients had some level of obstruction at all anatomic subsites (94.8%). All patients had complete obstruction at the level of the palate or velum. 41 (70.7%) also had additional anatomic abnormalities noted including maxillary constriction, midface hypoplasia, retrognathia or micrognathia. From 58 patients recommended for MMA, 35 (60.3%) followed up in OMFS clinic and 11 (31.4%) underwent MMA surgery. Five patients (14.3%) received OATs. 11 patients (19%) had CPAP re-evaluation. 27 patients (46.6%) were lost to follow-up.

Conclusion
Of patients referred by ENT to OMFS following DISE, only 60% were seen at OMFS clinic and only half of these patients underwent MMA. While some received other treatments, nearly half were lost to follow-up altogether. We propose a revised workflow to improve patient education, acceptance, and coordination of OSA care and follow-up.

Support (If Any)
0596 Sleep Disturbances in Cystic Fibrosis and Primary Ciliary Dyskinesia Over Time, Before and After Modulator Therapy
Authors: Cohen-Cymberknoh Malena , Lehavi Maya , Atia Ohad , Gileles-Hillel Alex , Reiter Joel 
Published: May 2022

Abstract

Introduction
Prior studies have shown that cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are associated with sleep disturbances affecting quality of life (QOL).Our aim was to analyze changes in sleep complaints over time in patients with CF and pancreatic insufficiency (CF-PI), pancreatic sufficiency (CF-PS) and PCD, and explore the effect of CFTR modulators.

Methods
Patients completed age-appropriate sleep quality questionnaires (SDSC, PSQI), quality of life questionnaires (PedQL, QOL-BE) and the Epworth sleepiness scale (ESS). They repeated the same questionnaires 3 years later. In addition, medical records were reviewed for clinical data.

Results
Of a total of 50 patients, 27 were children and 23 were adults: 33 CF-PI, 8 CF-PS and 9 PCD. On the 3-year follow up questionnaires the PSQI revealed reduced sleep quality in 11 adult patients (47%), and the SDSC score was pathological, in 5 children (18.5%), suggestive of high rates of disturbed sleep. In children the mean SDSC score had not changed from baseline (41.1±11.5) to follow up (42.5±12.35; p=0.778). In adults the PSQI increased from 3.7±2.5 to 4.5±2.8 (p=0.075), most pronounced in adults that were not on modulators (3.9±2.7 to 4.8±3.4; p=0.027). This effect was driven primarily by changes in sleep initiation and maintenance domains. There were no other differences in the sleep complaints between CF-PI, CF-PS and PCD patients, or between patients on and off modulator therapy during the study period.

Conclusion
Over time, quality of sleep worsened in patients with CF and PCD, particularly the ability to initiate and maintain sleep. Our results may suggest that modulator treatment attenuates the worsening of sleep complaints, however, larger studies are needed to clarify this.

Support (If Any)
None