bluuebunny/crossref_metadata_2025_split huggingface dataset:
0292 Differential Utility of Psychomotor Vigilance Test vs. Sleep Latency Tests in Healthy Humans
Authors: Chaisilprungraung Thitaporn , Thomas Connie , Allotey-Addo Sidney , Stekl Emily , Denby Avery , Garriques Victoria , Chanatry Claire , Balkin Thomas , Hughes John , Doty Tracy 
Published: May 2022

Abstract

Introduction
The Psychomotor Vigilance Test (PVT), the Multiple Sleep Latency Test (MSLT), and the Maintenance of Wakefulness Test (MWT) are widely used in both sleep research and clinical settings. The PVT measures reaction time to a visual stimulus, whereas time to sleep onset is measured in both the MSLT and MWT, which differ primarily with respect to the instructions (i.e., whether to try to fall asleep vs. stay awake). Compared to sleep latency tests, the PVT is relatively inexpensive and easy to administer, so it is advisable to delimit the conditions under which its administration is most appropriate.

Methods
A comprehensive search of sleep studies on healthy adults revealed 30 studies in which both PVTs and sleep latency tests were administered – usually to assess the effects of various interventions on sleepiness and vigilance. Two reviewers compiled findings from each study and graded the levels of outcome agreement based on whether a test intervention produced similar effects on vigilance across tests.

Results
Of the 13 studies that included both PVT and MWT of studies, a high level of agreement (based on the presence and direction significant effect on vigilance) between test outcomes was evident in 8 (61.5%) of the studies. In contrast, a considerably lower percentage of studies in which both the PVT and MSLT were performed (6 of 17 studies; 35.3%) had high agreement between test outcomes. It was also found that the MSLT was more sensitive to interventions (e.g., caffeine, sleep loss, and cognitive workload) than the PVT in the majority of studies in which there was low agreement (5 of 6 studies; 83.3%).

Conclusion
There is generally more agreement between PVT and MWT measures than between PVT and MSLT measures in studies involving sleep loss. This is most likely because the PVT and MWT both require application of effort to resist sleepiness, whereas the MSLT involves the withdrawal of resistance to sleepiness. This suggests that the PVT is potentially more useful in operational environments (where ability to sustain performance is the primary concern) than in clinical settings (where the focus is on determining the severity of sleepiness).

Support (If Any)
Department of Defense Military Operational Medicine Research Program (MOMRP)
0296 Vigilant Attention Performance Advantage Conferred by TNFα G308A Polymorphism is Associated with Diminished Delta and Theta Power in the Non-REM Sleep EEG
Authors: Skeiky Lillian , Finlay Myles , Satterfield Brieann , Schmidt Michelle , Wisor Jonathan , Van Dongen Hans 
Published: May 2022

Abstract

Introduction
Carriers of the A allele of a single nucleotide polymorphism of the TNFα gene (G308A, rs1800629) are relatively resilient to vigilant attention performance impairment from total sleep deprivation (TSD), as compared to G/G homozygotes, and even exhibit a small performance advantage at baseline. The mechanism underlying this effect remains unclear. As TNFα is a sleep regulatory substance, we investigated whether TNFα G308A genotype is associated with systematic differences in markers of sleep homeostasis.

Methods
N=168 healthy young adults (ages 27.4±5.4y; 86 women) participated in one of seven in-laboratory TSD studies. During TSD, performance was assessed every 2–3h using a psychomotor vigilance test (PVT). The TSD period was preceded and followed by nocturnal sleep opportunities (baseline and recovery, respectively), which were recorded polysomnographically and scored according to AASM criteria. The EEG (C3-M2 derivation) of stages N2 and N3 non-REM sleep was investigated using spectral analysis.

Results
The genotype distribution of the sample was 0.6% A/A, 26.8% A/G, 72.6% G/G, in Hardy-Weinberg equilibrium (P=0.14). As documented previously, A allele carriers, compared to G/G homozygotes, had fewer PVT lapses (RTs&gt;500ms) at baseline and during TSD, indicating greater resilience to sleep deprivation. During both baseline and recovery sleep, A allele carriers, compared to G/G homozygotes, displayed reduced power in the delta (0.8–4.0Hz; P=0.017) and theta (4.2–8.0Hz; P=0.004) bands of the non-REM sleep EEG.

Conclusion
The performance advantage of the A allele carriers brings to mind the “banking sleep” phenomenon previously observed in sleep deprivation studies with prior sleep extension, suggesting that the A allele carriers gained this advantage by essentially being able to bank sleep. If this interpretation is correct, then the diminished power in the delta and theta bands of the non-REM sleep EEG in the A allele carriers, which suggests reduced homeostatic sleep pressure during both baseline and recovery sleep, may imply that the A allele carriers operate at a lower homeostatic setpoint due to an underlying advantage in the recuperative efficiency of sleep.

Support (If Any)
NIH R01HL070154, R21CA167691, R01HL105768; ONR N00014-13-C-0063, N00014-13-1-0302, FAA DTFAAC-11-A-00003, CDMRP W81XWH-16-1-0319, USAMRDC W81XWH-05-1-0099, and an SRS Elliot D. Weitzman, M.D. Research Grant.
0301 Does Orexin Influence Sleep Fragmented Brain Inflammation? A Pilot Study
Authors: Nick Henry , Fenik Polina , Zhu Yan , Veasey Sigrid 
Published: May 2022

Abstract

Introduction
Fragmented sleep occurs when there are repetitive, short interruptions of sleep, resulting in less than six hours of sleep per day. Overall, however, in the United States, sleep fragmentation is reported by 30% of employed adults. Sleep fragmentation may be a risk factor for Alzheimer's disease, and orexin reduction appears effective in reducing amyloid plaque formation in mice with transgenic Alzheimer's disease. Orexin is a neuropeptide that regulates arousal, wakefulness, and appetite. Thus we hypothesized that loss of orexin might also be protective against sleep disruption injury in non-Alzheimer's mice. This study aims to combine sleep fragmentation with orexin loss to see if brain health is severely reduced.

Methods
The 24 mice in this study were split into four groups: B6 rested, B6 sleep fragmented, orexin knockout rested, orexin knockout sleep fragmented. The sleep fragmented mice were placed on a shaker table for 10½ weeks to initiate chronic sleep loss. The mice were all perfused within five to eight months of birth, and then the brains were cryopreserved and sliced. These sections were immunolabeled with different protein antibodies using immunohistochemistry techniques. The stained brains were either analyzed through microscope stereology counts or computer image analysis.

Results
Two-way ANOVA analysis for tyrosine hydroxylase, ionized calcium binding adaptor, and vesicular acetylcholine transporter had p&lt;0.05 for the sleep fragmentation variable, showing differences in these antibodies for rested and sleep loss mice. ANOVA for cluster of differentiation 68, cofilin, postsynaptic density protein, and RanBP had p&lt;0.05 for the genotype variable, showing differences in these antibodies for knockout and normal orexin mice. ANOVA for glial fibrillary acidic protein and amyloid-beta had p&lt;0.05 for both variables, showing differences for sleep and orexin levels. There was no ANOVA significance for synapsin.

Conclusion
Our results show that knocking out orexinergic neurons causes hippocampal tissue damage, dampens the functioning of synapses, and diminishes the ability of the brain to adapt through plasticity and memory. Sleep fragmentation, however, increases phagocytic activity, and harms the acetylcholine and norepinepherine neurotransmitter pathways. When combined, cell communication worsens and the blood brain barrier loses function, resemblant of neurodegenerative diseases.

Support (If Any)
NIH AG054104; AG064231
0327 Age-Related Associations Between Chronotype and Sleep-Wake Cycles: A Big Data Analysis
Authors: Gottlieb Elie , Gahan Luke , Danoff-Burg Sharon , Rus Holly , Watson Nathaniel , Raymann Roy 
Published: May 2022

Abstract

Introduction
Circadian rhythms progressively delay throughout adolescence until older adulthood when they advance to become early as children. Chronotype represents a subjective assessment of when one feels their performance is optimal. Evidence suggests evening chronotype is associated with adverse health effects. Presently, it is unclear whether sleep-wake cycles and chronotype diverge across ages. Here, we examined whether self-reported chronotype was associated with the daily start of the sleep-wake cycle (indicated through objectively measured bedtime) across the lifespan using a large, ecologically-valid dataset.

Methods
Data from 11,026 users (mean age: 45.3, 54.3% female) across 1,167,489 nights were included in the analysis from the PSG-validated SleepScore Mobile Application, which uses a non-contact, sonar-based method to objectively capture sleep-related metrics, and questionnaires to assess self-reported lifestyle factors. Chronotype was subjectively assessed with a 5-item question ranging from definitely morning-type to definitely evening-type. Bedtime, a proxy for the daily start of the sleep-wake cycle, was captured as the time at which users started a sleep recording in the Application. Linear regressions were used for the analysis.

Results
Overall, chronotypes showed a near-normal distribution with a skew toward definite evening types (n=2147) compared to definite morning (n=1560) types (21.70% versus 15.70%). As expected, average bedtime was earliest for definite morning types (mean=23:02 ± 86.4 mins) and latest for definite evening types (mean=01:10 ± 102 mins). Across all chronotypes, linear regressions revealed a significant negative association between overall age and bedtime (p&lt;0.0001). Among definitive evening types, younger ages had later bedtimes and older ages had earlier bedtimes (ß=-0.014, SE=0.002, p&lt;0.00001). Further, the degree of change in bedtimes across age was largest for definite morning types, whereby average bedtime decreased from 23:38 (SD=86.3 mins) at age 20 to 22:29 (SD=88.2mins) at age 80 (ß=-0.019, SE = 0.002, p&lt;0.00001).

Conclusion
The present analysis showed that, across chronotypes, younger ages had later bedtimes and older ages had earlier bedtimes, presumably driven by age-related changes in circadian rhythmicity. This association was also exemplified by morning-types showing the greatest change in bedtimes across the lifespan. Future prospective studies are warranted to examine the relationship between longitudinal changes to chronotype and endogenous circadian rhythmicity across the lifespan.

Support (If Any)
0341 Digital Health Technology to Support Autonomous Sleep Monitoring and Management in Multi-Domain Operational (MDO) Environments
Authors: Wolfson Megan , Pulantara Wayan , Mesias George , Nugent Katie , Clarke-Walper Kristina , Wilk Joshua , Germain Anne 
Published: May 2022

Abstract

Introduction
Sleep and fatigue management strategies can substantially impact the Armed Forces’ readiness and fitness. These strategies can be implemented with behavioral health personnel and Wi-Fi connectivity to support real-time assessment, monitoring, and intervention. However, these resources are not readily available in multi-domain operational (MDO) environments. An autonomous Wi-Fi-independent digital sleep and fatigue management tool (DSFMT) could offer a critical advantage in detecting, monitoring, and providing just-in-time sleep and fatigue recommendations for Soldiers and support unit performance. We describe how we adapted a validated sleep-focused clinical decision support platform into a DSFMT for use in MDO environments.

Methods
Semi-structured interviews were conducted with 6 Army Key Opinion Leaders (KOLs) to assess perceived utility of a DSFMT and identify key requirements. We also conducted a literature review to identify evidence-based sleep optimization and fatigue mitigation strategies in real or simulated military environments, or occupations with high sleep disruption. Directives for sleep and fatigue management from all branches of the U.S. Armed Forces were reviewed.

Results
KOLs were enthusiastic about the proposed DSFMT and emphasized three requirements: (1) brief and actionable content; (2) tap into Soldiers’ competitive nature; (3) provide unit level metrics to the medic. Five sleep education topics (e.g., consequences of insufficient sleep) and eight evidence-based sleep self-optimization strategies (e.g., sleep banking) were identified and included in the digital content. The resulting DSFMT consists of a smartphone-based Soldier App that captures self-reported sleep and fatigue data and offers individualized feedback and self-management strategies, and a Medic App that displays aggregate unit-level sleep and fatigue status. The apps operate when connected to Wi-Fi and have capabilities for offline data collection and transfer via Bluetooth.

Conclusion
We created an initial prototype of an autonomous Wi-Fi-independent DSFMT that can be used in MDO environments and meets KOL requirements. 246 Soldiers have field tested this prototype. Findings from ongoing acceptability and feasibility analyses will inform the next iteration.

Support (If Any)
This project is partially funded by MTEC-19-02-TeleSleep-001-2019-406. The opinions and assertions contained herein are those of the authors and do not necessarily reflect the views of the U.S. Army or the U.S. Department of Defense.
0343 In-person Expert Pillow Fitting Process Improves Sleep Quality and Duration
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Rodriguez Rodolfo , Gavrilova Larisa , Burke Colin , Carmon Kiara , Ledesma Duvia Lara , Gottlieb Elie 
Published: May 2022

Abstract

Introduction
The myriad of anecdotal claims about the benefits of different pillow types may complicate consumers’ ability to find a pillow that can support better sleep. Services that provide consumers with personalized recommendations may address this problem. This study examined the sleep of research participants using pillows selected during an in-store pillow fitting process compared to using their original pillows.

Methods
Healthy adults (71% female, ages 21-59) who reported interest in a new pillow participated in a 9-week field study using a pre-post intervention design. The intervention consisted of being guided through the Mattress Firm in-store pillow fitting process to be paired with a pillow that provided the best fit and support based on body type and sleeping position preferences. During the 4-week baseline period, participants used their regular pillow. Once they were fit for their new pillow, participants slept with that pillow for 5 weeks, including a 1-week adjustment period. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests and were used to test for statistical significance.

Results
There were 722 nights of tracked sleep across participants (n=17). Objective sleep measurements showed nightly improvement in SleepScore, a measure of objective sleep quality (p=.003), longer time in bed (+13 minutes, p=.034),longer sleep duration (+16 minutes, p=.010), a lower proportion of the night awake after falling asleep (p=.009), and better sleep maintenance (p=.009). In addition, participants got more deep sleep (+5.6 minutes, p=.017) and showed improved BodyScore, a measure of deep sleep (p=.031). Self-reported measures showed improvements in pillow comfort and overall comfort in bed; perceived ability to sleep through the night; perceived reduction in number of awakenings and amount of time awake at night; better overall sleep quality; and feeling more well-rested in the morning when using the fitted pillows compared to baseline (all ps &lt;.05).

Conclusion
Objective and self-reported sleep improved among healthy adults using a pillow selected by an expert, in-person pillow fitting process. The results suggest that a pillow fitting process can improve sleep by helping individuals find a pillow that provides a personalized fit and optimal comfort.

Support (If Any)
Mattress Firm INC
0344 Use of an Adjustable Bed Base Improves Sleep Quality and Duration
Authors: Danoff-Burg Sharon , Rus Holly , Burke Colin , Weaver Morgan , Rodriguez Rodolfo , Carmon Kiara , Ledesma Duvia Lara , Gottlieb Elie 
Published: May 2022

Abstract

Introduction
The positional adjustment of a bed can potentially contribute to better sleep and alleviation of discomfort associated with a variety of medical conditions. As most studies in this area have focused on inclined sleeping for therapeutic purposes, understanding the impact of postural change on improving sleep among healthy individuals requires further research. This study compared sleep in an inclined position on an adjustable bed base to participants’ prior sleep on their original bed bases.

Methods
Healthy adults (61% female, ages 23-60) willing to sleep at an incline participated in an 8-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular bed base at home. During the 4-week intervention period, they used the Mattress Firm 600 Adjustable Base at home with head and/or feet raised (not flat). Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
There were over 1,100 nights of tracked sleep across 26 participants. Objective sleep measurements showed many nightly improvements during the intervention compared to baseline: increased time in bed (+21 minutes, p=.003), total sleep time (+21 minutes, p=.001), and REM (+5 minutes, p=.009); less WASO, both in duration (-3 minutes, p=.046) and proportion of the night (p=.015); fewer awakenings (p=.034); and better sleep maintenance (p=.014). Improvements also were observed in 3 objective sleep quality measures: SleepScore, BodyScore, and MindScore (ps&lt;.05).Self-report measures revealed greater comfort and enjoyment when using the adjustable base, as well as perceived improvement in a variety of outcomes, including time to fall asleep and falling asleep within a preferred amount of time, ability to sleep through the night, sleep duration, sleep quality and satisfaction, and feeling more rested in the morning (ps&lt;.05).

Conclusion
Objectively-measured sleep and self-reported sleep improved in duration and quality when using the adjustable base compared to healthy adults’ original bed bases. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as a comfortable and enjoyable experience.

Support (If Any)
Mattress Firm INC
0368 Leveraging the Electronic Health Record to Facilitate Shared-Medical Decision Making in a Large Health System: Response to the PAP Recall
Authors: Lance Colleen , Wang Lu , Foldvary-Schaefer Nancy , Wyllie Robert , Baugh Kristin , Kazaglis Louis , Carroll Don , Colwell Dawn , Hall Greg , Mehra Reena 
Published: May 2022

Abstract

Introduction
The positive airway pressure (PAP) device manufacturer recall afflicting ~4 million users has posed a major challenge for the care of patients with sleep disordered breathing. We report on the Cleveland Clinic enterprise-wide response efforts and relevant predictors of medical decision-making surrounding this recall.

Methods
A taskforce developed a strategic response to the recall with the goal of distributing enterprise-wide communications; providing key guidance to providers and patients. For patients, a multi-pronged, tiered approach of MyChart messaging, phone and mailings instructing device registration and continuing use of PAP until discussed with the provider was implemented. For providers, an Epic smartphrase, embedded with a tracker, was developed as a resource including details of a decision-making algorithm while awaiting remediation. A team of mid-level providers was trained in the use of the algorithm; and the smartphrase was utilized for targeted virtual visits and communications. Presented is a retrospective cohort analysis of demographics and comorbid predictors between the group of patients advised to continue therapy, versus those advised to discontinue. Wilcoxon rank sum test or t-test was used for comparisons.

Results
15,759 patients were contacted; message confirmed read/heard for 99.3%. Analysis of smartphrase use yielded 1135 instances (median,IQR): age:61.0 [51,70];48.5% female, 13.6% African American, body mass index(BMI) 33.5[29,38.9] kg/m2, apnea hypopnea index(AHI)=22.8[11.7,46.1] of whom n=770(67.8%) were advised to continued therapy. Predictors of provider guidance to continue versus temporarily hold PAP therapy respectively include: age:63[53,71] vs. 58[47,67] p&lt;0.001, female:44% vs. 57%,p&lt;0.001, BMI:33.9[29.5, 39.7] vs. 32.0[28.0,37.5],p&lt;0.001, AHI:31.9[15.5, 58.0] vs.15.7[9.1,21.2],p&lt;0.001 and the following comorbidities: hypertension:61.0% vs. 46.3%,p&lt;0.001, coronary artery disease,11.3% vs. 3.6%,p&lt;0.001,heart failure:2.6% vs. 0.6%,p&lt;0.001, atrial fibrillation:9.5% vs. 2.5%,p&lt;0.001 and chronic obstructive pulmonary disease:5.8% vs. 1.6%,p&lt;0.001,but not diabetes.

Conclusion
We conclude that EHR tools can be used to coordinate device recall response efforts and guide both providers and patients. The use of a system smartphrase facilitated provider-patient shared medical decision-making to continue versus temporarily discontinue use of PAP therapy efficiently. Those advised to continue PAP therapy had higher burden of sleep apnea and cardiopulmonary comorbidity.

Support (If Any)
0375 Effectiveness of an intelligent sleep management system in the US military: Preliminary results
Authors: Mounts Charles 
Published: May 2022

Abstract

Introduction
There are well-recognized barriers limiting access to evidence-based sleep interventions in the military. Given the large number of patients seeking treatment and the shortage of trained specialist providers, demand greatly exceeds available supply. As part of a larger implementation effort, the purpose of this study was to evaluate health provider ratings of the effectiveness and usability of a novel sleep telehealth assessment at a busy military treatment facility.

Methods
Health providers were recruited from the Internal Medicine and Sleep Medicine clinics at Walter Reed National Military Medical Center. Effectiveness was defined a priori based on the established Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework. Providers from participating clinics completed a questionnaire that measured specific aspects of effectiveness: perceived satisfaction, usability, improvement, credibility, risks, benefits, acceptability and overall satisfaction with a sleep assessment report.

Results
Providers (n=16) were surveyed regarding perceived satisfaction, usability, improvement, credibility, risks, benefits, and acceptability of the sleep assessment report were rated favorably, with each domain being rated with a positive or very positive response by more than 75% of providers. All providers viewed the usability of the report favorably and all but one provider had a positive view on the report improving their documentation of sleep problems.

Conclusion
Health care providers at our hospital rated a novel sleep telehealth assessment as highly effective across established key domains of implementation science. Providers were highly satisfied with the content, usability, and credibility of the report, and felt this intervention would improve their documentation. Research is ongoing to further evaluate the implementation of the system.

Support (If Any)
This research was supported by an investigator-initiated research award from the Department of Defense (via the Medical Technology Enterprise Consortium) to the University of Maryland, Baltimore (PI: EMW).