bluuebunny/crossref_metadata_2025_split huggingface dataset:
0392 Patient Perspective on Idiopathic Hypersomnia: Impact on Quality of Life and Satisfaction With the Diagnostic Process and Management
Authors: Whalen Marisa , Roy Bailey , Steininger Teresa , Dronamraju Nalina , Enson Daniel 
Published: May 2022

Abstract

Introduction
Idiopathic hypersomnia is a debilitating central disorder of hypersomnolence characterized by excessive daytime sleepiness (EDS), severe sleep inertia, and prolonged nighttime sleep. The impact of idiopathic hypersomnia on quality of life (QoL) and patient satisfaction with the diagnostic process and management have not been well established.

Methods
US patients with idiopathic hypersomnia completed an online survey (June 10 to July 2, 2021) assessing symptoms, impact, diagnosis, and management.

Results
Respondents (N=290) were mostly female (88%), White (88%), and 25–44 years of age (mean, 38 years), had postsecondary education (88%), and were employed at least part time (63%). Self-reported years to idiopathic hypersomnia diagnosis were 0–1 (31%), 1–2 (16%), 2–5 (21%), 5–10 (13%), and 10+ (19%). Overall, 67% reported unreasonable delays to diagnosis (strongly/somewhat agree); 61% reported being misdiagnosed prior to their idiopathic hypersomnia diagnosis. Diagnoses of depression/anxiety, sleep apnea, or narcolepsy type 2 were reported by 72%, 25%, and 10% of respondents, respectively; these diagnoses were later removed and changed to idiopathic hypersomnia in 26%, 30%, and 57%, respectively. Symptoms of IH endorsed (strongly/somewhat agree) by ≥95% of patients were EDS (99%), reduced mental energy level and motivation to carry out daily activities (99%), and feeling as if they could never get enough sleep (98%). The following statements were endorsed by ≥90% of patients: idiopathic hypersomnia has had a significant negative effect on my QoL (79% strongly agree, 19% somewhat agree), has prevented me from being who I want to be (66% strongly agree, 26% somewhat agree), and is often unrecognized and under-diagnosed (67% strongly agree, 24% somewhat agree), and the idiopathic hypersomnia community is underserved (67% strongly agree, 24% somewhat agree). Specific QoL impacts (strongly agree) included constantly struggled with maintaining relationships (65%), had suicidal thoughts (34%), and chose not to have children (25%). Nearly half (49%) of patients reported dissatisfaction with the management of their idiopathic hypersomnia (not very/not at all satisfied).

Conclusion
The survey findings indicate that patients with idiopathic hypersomnia experience a profound negative impact on QoL and dissatisfaction with their diagnostic journey and management.

Support (If Any)
Jazz Pharmaceuticals, with participation of the Hypersomnia Foundation.
0417 Odds Ratio Product reveals distinct sleep phenotypes in idiopathic hypersomnia
Authors: Thomas Robert , Gerardy Bethany , Blattner Margaret , Younes Magdy 
Published: May 2022

Abstract

Introduction
The pathophysiology of idiopathic hypersomnia with long sleep times (IH) remains an enigma. Alternate methods to characterize sleep such as the Odds Ratio Product (ORP), a continuous measure of sleep depth, has the potential to improve understanding of IH.

Methods
The Odds ratio product is a continuous measure of sleep depth and propensity ranging 0 (very deep sleep) to 2.5 (Least sleep propensity). The difference between 2.5 and ORP in any epoch indicates extent of wake suppression (sleep depth) for that epoch. The cumulative sleep index (CSI) is the integral of sleep suppression across recording time thereby reflecting both the duration and depth of sleep over specified intervals (higher value is deeper and longer sleep). 36 patients with long sleep (600 minutes or longer) recorded through unconstrained polysomnography were analyzed using ORP across the full study (12.7±1.7 hours). Participants were divided into quartiles, 9 patients each(Q1-Q4) based on accumulated sleep across the entire study.

Results
The mean age for the cohort was 35.8 ± 16.2, of which 29/36 were females. Total sleep time by visual scoring was 679.4 ± 96.4 minutes (range: 601.5 - 1145) minutes). The whole night CSI mean was 989.39 ± 271.64 units (range: 345 to 1427). The quartile values were 618.33 ± 178.83, 919.33 ± 67.27, 1142.89 ± 39.01, and 1277 ± 69.39 units, and not related to total recording or sleep time. The NREM sleep ORP was 1.43± 0.32, 1.06 ± 0.22, 0.73± 0.13 and 0.67 ± 0.19, respectively. This distribution was true for REM sleep ORP also: 1.52 ± 0.30, 1.26 ± 0.19, 1.05 ± 0.25, and 0.84 ± 0.21, respectively. The trait-like ORP-9 (9 seconds post-arousal), and a reflection of sleep fragmentation propensity, was also similarly distributed: 1.60 ± 0.30, 1.29 ± 0.27, 0.92 ± 0.15, and 0.80 ± 0.18, respectively. All comparisons were statistically significant by Tukey multiple comparisons.

Conclusion
Patients with IH are not homogenous, showing a range of sleep depth in both NREM and REM sleep regardless of total sleep time. These phenotypes of IH could reflect unique endotypic mechanisms, requiring different therapies or have differential treatment responses.

Support (If Any)
0436 Effect of sleep on the relationship between pain related disability and neural correlates of pain processing in adults with fibromyalgia and insomnia
Authors: Nair Neetu , Curtis Ashley , Craggs Jason , McCrae Christina 
Published: May 2022

Abstract

Introduction
Up to 80% of adults with fibromyalgia experience insomnia. While sleep and pain are known to be associated, sleep's role in the association between pain related disability and neural correlates of pain processing is unknown. We evaluated whether sleep moderates the association between brain activity in response to painful stimuli and pain related disability in adults with fibromyalgia and insomnia (FMI).

Methods
Twenty-nine adults with FMI (Mage=57.2, SD=13.1) wore Actiwatch 2s over 14 days, completed the Pain Disability Index (PDI), and underwent fMRI using a quantitative sensory testing (QST) protocol involving thermal stimuli. Twelve brain regions with significant activation changes to QST (identified previously, PMID34310276) were included as dependent variables, PDI score as independent variable and actigraphic sleep variables (Sleep Onset Latency (SOL), Total Sleep Time (TST), Sleep Efficiency (%SE)) as moderators in the analysis. For moderation at significance levels of p&lt;0.05 (and trends at p&lt;0.1), significance of simple slopes at high (1 SD above), average and low (1 SD below) sleep levels were examined.

Results
%SE moderated the relationship between right cingulate gyrus (rCG) activity and PDI score (B=0.0009, SE=0.0003, p=.016, R^2=0.22). At lower values of %SE (but not at average or higher levels), there was a negative association between rCG activity and PDI score (B=-0.0166, SE=0.0064, p=0.016). Moderating impact of SOL (B=-0.0002, SE=0.0001, p=.05, R^2=0.14) and TST (B=0.0002, SE=0.0001, p=.06, R^2=0.15) trended towards significance. [MCS1] PDI and rCG activity showed negative associations at highest levels of SOL, while PDI and right inferior frontal gyrus activity showed positive associations at highest levels of TST.

Conclusion
Since the rCG is involved in gating, integration and classification of pain signals, decreased activation in rCG could reflect reduced modulation of pain processing in the region. Preliminary results indicate that at lower levels of sleep efficiency, this decrease in modulation of pain processing is associated with greater perceptions of disability related to pain. Further studies in larger samples are warranted to understand the causal effects, if any, of sleep on pain related disability and the neural correlates of pain processing.

Support (If Any)
NIAMS-R01AR055160/S1; PI-McCrae
0446 Trends and Patterns in Prescriptions of Hypnotics for The Treatment of Insomnia in Japan: Analysis of A Nationwide Japanese Claims Database
Authors: Okuda Shoki , Qureshi Zaina , Yanagida Yukiko , Ito Chie , Honma Yuji , Tokita Shigeru 
Published: May 2022

Abstract

Introduction
Optimal treatment of insomnia is uncommon, given the lack of awareness regarding insomnia management. While the treatment landscape for insomnia has evolved following the introduction of orexin receptor antagonists (ORA), few studies have examined prescribing patterns of hypnotics. We analyzed data from a claims database to examine real-world use of hypnotics in Japan.

Methods
Patients (aged ≥20 to &lt;75 years old) with insomnia diagnosis, prescribed ≥1 hypnotic and continuous enrollment for ≥12 months before the index date were extracted from the JMDC claims database between April 1st, 2009 and March 31st, 2020. Patients were classified as new users of hypnotics or long-term users (prescribed the same mechanism of action [MOA] for ≥180 days). Trends (2010–2019) and patterns (2018–2019) in hypnotics prescriptions were analyzed.

Results
The analysis comprised of 130,177 new users and 91,215 long-term users (2010–2019). Nearly all new users (97.1%–97.9%) were prescribed a single MOA in each year. In 2010, almost all new users (94.0%) of hypnotics were prescribed GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs). The proportions of patients prescribed BZD declined over time (from 54.8% in 2010 to 30.5% in 2019), whereas those prescribed z-drugs remained stable (~40%). The proportion of patients prescribed a melatonin receptor agonist increased slightly (3.2% to 6.3%), while those prescribed ORA increased substantially (0% to 20.2%). Among long-term users, the proportion of patients prescribed BZD steadily declined over time, but more than half were prescribed BZD. Unlike new users, a lower proportion of long-term users were prescribed ORA (0% in 2010, 4.3% in 2019). Analyses using 2018–2019 data showed that a combination of multiple (≥2) MOAs was prescribed to a higher proportion (18.2%) of long-term users than new users (2.8%). The prescription patterns of hypnotics were comparable among patients stratified by age, sex, medical specialty, and psychiatric comorbidities.

Conclusion
The present study showed distinct characteristics in the patterns and trends of the prescriptions of hypnotics among new users and long-term users in Japan. The high proportion of long-term BZD users suggests the need for educating clinicians about the optimal care pathway for insomnia.

Support (If Any)
MSD K.K., Tokyo, Japan
0517 Association of THC Usage on Diet, Exercise, and Sleep in Hispanic/LatinX Teenagers
Authors: Malhotra Niamh , Marganski Jordan , Merz William , Advani Ira , Crotty-Alexander Laura 
Published: May 2022

Abstract

Introduction
Diet, exercise, and sleep are recognized as the three pillars of health, with the assertion that failure to address one will compromise the other two. We have previously observed an association between inhalant use on sleep in adolescents (JCSM 2021). Our previous data raised concern for disruption induced by nicotine among teenagers. Given the recent increase in THC consumption, we sought to test the hypothesis that THC use among teenagers and young adults would be associated with deleterious lifestyle factors including poor diet and minimal exercise. We further sought to test whether Hispanic/LatinX status was predictive of poor health practices.

Methods
We conducted a social media survey using Twitter and Instagram to gather data on willing participants. We obtained IRB approval and used validated instruments to gather data on variables of interest. We assessed past and current THC use including in what form (inhalant, edible etc) and concurrently obtained data on diet and exercise patterns using standardized questionnaires. People self reported race, ethnicity, gender, and other factors.

Results
Of the 471 responders who provided data, we removed suspicious data based on identical responses at a given time suggestive of ‘bots’. We isolated the n=58 (37.3% Hispanic LatinX) who were in our target age range (13-25yrs) with complete data. For THC use, 27/58 participants (46.6%) responded “yes” to current usage, whereas 0 reported previous usage and 31 reported “no” (53.4%). Among people who self-identified as Hispanic/Latinx, 81.8% reported using THC currently whereas among people self-identifying as non-Hispanic, only 24.3% reported current THC use. Among the people reporting regular THC use, diet and exercise tended to be non-favorable compared to non-THC users. Of the 58 participants, only 19 reported never vaping (32.8%) while 15 (25.9%) reported vaping daily or weekly. For cigarettes only 20 people (34.5%) reported never using cigarettes whereas 14 (24.1%) reported using daily or weekly.

Conclusion
Based on our social media survey, we observed a high prevalence of vaping, cigarette smoking and THC use among adolescents and young adults. People who self-identified as Hispanic/LatinX reported high rates of THC use compared to non-Hispanic people. The implications of these findings for the sleep health of teenagers and young adults are unclear, but may provide a therapeutic target for future research.

Support (If Any)
Dr. Crotty-Alexander is funded by VA Merit award and by NIH.
0535 Prevalence of various forms of sleep disordered breathing in infants with Down syndrome
Authors: Cho Yeilim , Kwon Younghoon , Ruth Chris , Cheng Samuel , DelRosso Lourdes 
Published: May 2022

Abstract

Introduction
Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). Undiagnosed SDB in younger children may confer further risks of cardiovascular and neurocognitive complications associated with DS. However, there is paucity of studies examining SDB in infants with DS. The purpose of the study was to examine the prevalence of obstructive sleep apnea (OSA), sleep hypoventilation (SH) and hypoxemia in infants with DS.

Methods
Infants (≤12 months old) with DS who underwent first polysomnography (PSG) at Seattle Children’s hospital over a 6-year period were included. Data collected included obstructive apnea hypopnea index (oAHI), central apnea hypopnea index (CAHI), time spent with CO2 levels &gt; 50 mmHg, time (minutes) spent with saturations &lt;88% (T88), and saturation nadir (minO2sat). Exclusion criteria: follow up studies, and studies post procedures. Data presented by descriptive statistics and comparison by unpaired t-test.

Results
A total of 526 children with DS underwent PSG during the collection time. Forty two fit criteria (Mean age 6.6 months, male 66%). Diagnostic (n=13), split to oxygen (n=29, 69%). Split studies were more severe when compared with full diagnostic AHI (Mean 44.7 vs. 14.8, p=0.0007), T88 (Mean 12.5 vs. 0.2 p=0.03) and minO2sat (77.6 vs. 85.8%, p=0.01). Overall mean oAHI was 33.7 (S.D. 30) CAI was 3.4 (S.D. 3.1). 5/31 with reliable capnography had SH (16.1%) with no difference in age vs. the non-SH group (6.0 [3.2] vs. 6.6 [3.1], p&gt;0.05). Overall, oAHI was more severe in infants with hypoventilation (58.9 [23.6] vs. 29.3 [63],p&gt;0.05). Ten infants spent &gt;5 min with saturations &lt;88% (21.4%). All infants with hypoxemia had OSA (oAHI Mean 66.5 SD 40). Infants with OSA and hypoxemia had worse oAHI than those without hypoxemia (p&lt;0.05).

Conclusion
Our data shows that a large percent of infants with DS (69%) required a split study due to severe OSA (mean oAHI 66.5) or hypoxemia (21.4%). The overall mean AHI for this age group was 33.7. Hypoventilation was present in 16.1%. This study highlights the high prevalence of SDB in infants with DS and supports early PSG assessment in this patient population.

Support (If Any)
0543 The association of sleep-disordered breathing and daytime asthma burden among former premature school age children with bronchopulmonary dysplasia
Authors: Gunnlaugsson Sigfus , Mukharesh Lana , Greco Kimberly , Petty Carter , Gaffin Jonathan 
Published: May 2022

Abstract

Introduction
Sleep-disordered breathing (SDB) and asthma have a bidirectional relationship. Almost half of former premature school age children with bronchopulmonary dysplasia (BPD) have asthma or asthma-like symptoms. Prematurity is a known risk factor for sleep-disordered breathing. However, little is known about the association of SDB and asthma symptoms in former premature school age children with BPD.

Methods
Study sample comprised of participants in an ongoing cohort study, the AERO-BPD study. Participants were 6-12 years old, were born &lt; 32 weeks gestational age and had been diagnosed with BPD. We administered the Pediatric Sleep Questionnaire (PSQ) and asthma symptom questionnaires. The prevalence of SDB was determined based on a PSQ &gt; 0.33. The relationship between SDB and daytime asthma symptoms was assessed by multivariate logistic regression, adjusting for sex, race, BMI, rhinitis, asthma controller medication and days on respiratory support in the NICU.

Results
There were 33 subjects with a mean age of 8.8 years, roughly half were male and one third were overweight/obese. About half (48.5%) had daytime asthma symptoms and 39.4% had SDB. About half were on controller medication (inhaled corticosteroid or leukotriene receptor antagonist) and 39.4% had rhinitis. Among the 13 subjects with SDB, 11 reported daytime asthma symptoms and 5 of the 20 subjects without SDB reported daytime asthma symptoms. Subjects with SDB had over 17 times the odds of daytime asthma symptoms (OR 17.61, 95% CI [1.23, 251.76], p=0.035) compared to subjects without SDB, while adjusting for sex, race, BMI, rhinitis, controller medications and days on respiratory support in the NICU.

Conclusion
Our findings suggest that SDB is highly prevalent among former premature school age children with BPD. The findings suggest a relationship between SDB and daytime respiratory symptom burden among these patients rather than mere co-existence.

Support (If Any)
0571 Associations Between Sleep Problems and Cardiovascular Disease and All-Cause Mortality in Asthma-COPD Overlap
Authors: Luyster Faith , Scott Paul , Chasens Eileen , Imes Christopher , Jeon Bomin , Shi Xiaojun , Strollo Patrick , Baniak Lynn 
Published: May 2022

Abstract

Introduction
Sleep problems (i.e., short and long sleep duration and sleep disorders) are common in persons with either asthma or chronic obstructive pulmonary disease (COPD) and have been linked to increased cardiovascular risk and mortality. This study determined whether sleep problems are associated with increased cardiovascular disease (CVD) prevalence and all-cause mortality in adults with asthma-COPD overlap (ACO).

Methods
Cross-sectional analysis of the 2007-2012 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index. Participants (n=7616) were stratified into four groups, using self-report and spirometry data: asthma (n=483), COPD (n=1006), ACO (n=398), and those without asthma or COPD (controls; n=5729). Sleep duration hours were categorized as short (≤5), normal (6-8), and long (≥9). Self-report of physician diagnosis of a sleep disorder (Yes/No) and cardiovascular disease (angina, congestive heart failure, coronary heart disease, hypertension or myocardial infarction) were collected. Logistic and Cox regression models adjusted for covariates were employed.

Results
Prevalence of sleep disorders in ACO (24.7%) was roughly two times higher than rates in the asthma (10.7%) and COPD (13.5%) groups and 5 times higher than controls (4.6%). The ACO group had a higher proportion of short sleepers (27.6%) compared to COPD (19.2%) and controls (11.7%) and higher proportion of long sleepers (6.9%) compared to COPD (5.5%). Short sleepers had higher odds for CVD (OR=1.70, 95% CI, 1.34–2.15) compared to normal sleepers. Relative to ACO with normal sleep, long sleepers in the other groups had lower odds for CVD (all P-values &lt;0.05). Both short and long sleepers in the control (HR=0.19, 95% CI 0.07–0.47, and HR=0.07, 95% CI 0.02–0.35, respectively) or COPD (HR=0.38, 95% C, 0.19–0.77, and HR=0.24, 95% CI 0.12–0.51, respectively) groups had lower hazards of all-cause mortality compared to ACO with normal sleep. The influence of presence of sleep disorders on CVD and mortality did not vary between groups.

Conclusion
Associations between sleep duration and increased risk of CVD and all-cause mortality were stronger in ACO as compared to COPD and controls. Persons with ACO may represent a high-risk group that should be targeted for assessment and treatment of sleep problems.

Support (If Any)
0594 Functional Limitations and Well-Being Throughout the Adult Lifespan: The Moderating Role of Sleep
Authors: Williams Claire , Dautovich Natalie , Dzierzewski Joseph 
Published: May 2022

Abstract

Introduction
Functional limitations represent individuals’ difficulty with completing essential activities of daily living, such as sitting, stooping, and walking. Though functional limitations have been linked to lower well-being outcomes, less is known about potential protective factors for well-being in the lived experience of functional limitations. This study aimed to examine the potential moderating effect of sleep quality on the association between functional limitations and life satisfaction, a common indicator of well-being, across the adult lifespan.

Methods
The present study used archival data from the Midlife in the United States Refresher study. Participants included 696 individuals (50.6% female, Mage=51.58 years, SD=13.61 years) who completed measures of functional limitations (Functional Status Questionnaire), global sleep quality (Pittsburg Sleep Quality Index), and life satisfaction (single-item measure). A moderated moderation analysis was conducted to examine the moderating role of sleep quality on the association between functional limitations and life satisfaction. Age was included as a secondary moderator in the analysis to determine differences between age groups (younger, middle-aged, elders). Demographic variables of gender and racial identity were used as covariates in study analyses.

Results
Participants’ global sleep score was a significant moderator of the association between functional limitation status and life satisfaction (B = 0.16, p &lt; .001). Overall better global sleep quality buffered the association between higher functional limitations and worse life satisfaction. A significant three-way interaction between age, global sleep, and functional limitations was detected (β = -0.003, ΔR2 = .02, F(1, 686) = 12.25, p &lt; .001). The effect of global sleep on the association between life satisfaction and functional limitation status was significant for younger adults (B = 0.07, p &lt; .001) and middle-aged adults (B = 0.02, p = .0224), but not for elders (B = -0.02, p = .2223). Better global sleep quality buffered the negative association between functional limitations and life satisfaction specifically for younger and middle-aged adults.

Conclusion
The current study provided evidence for the importance of sleep quality in the lived experience of functional limitations, particularly for younger and middle-aged adults. This study contributes to a rapidly growing body of literature that seeks to identify protective factors for individuals experiencing lower functioning. In the future, clinicians should integrate sleep quality screeners in medical and mental health care settings in order to identify at-risk individuals who are experiencing functional limitations, and potentially consider establishing preventative, education-based interventions concerning sleep in the experience of functional limitations.

Support (If Any)