bluuebunny/crossref_metadata_2025_split huggingface dataset:
0377 Success Rates of Self-Applied Type 2 Studies in 191 Participants
Authors: Tomson Heather , Lambing Kari , Bender Amy , Decock Darren 
Published: May 2022

Abstract

Introduction
Wait times for the gold standard Type 1 polysomnograms are lengthy, and the pandemic has only increased the backlog. The need for having home sleep testing has grown yet Type 3 home sleep apnea tests (HSAT) can be inaccurate despite their popularity. In this study, we assessed the reliability of a self-applied in-home Type 2 sleep test using the Cerebra Sleep System.

Methods
213 sleep files were collected from 191 participants that had their Type 2 device shipped to their home with no prior training. Participants watched videos and read written instructions to self-apply the full Type 2 system. The lab-quality in-home PSG included a recording of EEG (Fp1,Fp2), EOG (E1, E2), EMG (chin), EMG (legs), respiratory channels (one effort or two RIP belts), nasal flow, and pulse oximetry. The study was considered successful if the head unit (EEG/EOG/EMG), leg EMG, nasal flow, and oximetry were present for recordings of 3 and 4 hours in duration.

Results
Based on a 4-hour success criterion, 82.6% of studies were considered successful. This percentage increased with 3 hours (85.4%). When studies did fail at the 4-hour criterion, 10.8% had failures of all signals, 5.4% had failures of 4/5 signals, 10.8% had failures of 3/5 signals, 16.2% had failures of 2/5 signals, and 56.8% had failures of 1/5 signals. The head unit failed on 15 records (7%), the right leg on 9 records (4.2%), the left leg on 6 records (2.8%), the cannula on 12 records (5.6%), and the oximeter on 7 records (3.3%). For 13 participants who had a failed study, the issues were resolved in 6 cases (46%) with a second night of recording.

Conclusion
We found that the Cerebra Sleep System Type 2 in-home test showed reliable performance with a high success rate. When studies did fail, in most cases, a single signal was the source of the problem. For patients suspected of having sleep disordered breathing or other sleep disorders, Type 2 testing is a reliable, convenient, and safe alternative to in-lab polysomnography and performs similar success rates to Type 3 HSATs.

Support (If Any)
0378 Daytime PAP Accommodation: A Breath of Fresh Air
Authors: Newitt Jennifer , Holmes William , Strollo Patrick 
Published: May 2022

Abstract

Introduction
Rising healthcare costs and resource utilization represents a growing problem in the United States, especially for individuals with progressive neuromuscular disorders. Diagnosis and treatment of obstructive sleep apnea has been demonstrated to decrease healthcare resources in the general population; however, there is no well-defined approach to diagnosis and management of sleep-disordered breathing (SDB) in patients with neuromuscular disease (NMD). Many providers believe it best to diagnose and introduce positive airway pressure (PAP) support during a single overnight in-laboratory sleep study. Patients with NMD require a team with understanding of sleep physiology, complex pulmonary pathophysiology, disease process and progression, and advanced PAP therapy modes and indications. Optimal treatment requires patient and caregiver education, frequent monitoring of PAP data, ongoing evaluation of oxygenation and ventilation parameters, as well as assistance with device issues. We hypothesized a focused, personalized approach to managing patients with NMD will improve patient adherence to PAP therapy, nocturnal oxygenation, and ventilation, as well as limit hospital admissions.

Methods
10 patients diagnosed with NMD (including muscular dystrophy, diaphragm paralysis, and scoliosis) presented to UPMC Montefiore sleep lab for daytime accommodation study with a pulmonary-sleep physician and dual-trained respiratory therapist-sleep technician. The visit included mask fitting, patient education, and initiation of PAP therapy with titration of bilevel pressure settings. Data collected included: pre- and 3-month-post nocturnal oxygen saturation and serum bicarbonate level; data download at 3 months including device usage, leak, average PAP pressures; and number of hospital admissions.

Results
All 10 patients demonstrated initiation of PAP therapy with usage on 100% of days for minimum of 6 hours per night. There was improvement in average nocturnal oxygen saturation and serum bicarbonate level after visit compared to prior. 3 patients were hospitalized in 6-12 months following, none for respiratory related reasons.

Conclusion
In this pilot study, an innovative daytime PAP accommodation study for patients with sleep-disordered breathing due to NMD results in excellent initiation and adherence to PAP therapy, as well as improvement in oxygenation and ventilation and minimal hospitalizations. Future studies are necessary including a larger randomized trial to demonstrate the safety and efficacy of home based NIV initiation.

Support (If Any)
NIH T32 HL082610-15, American Thoracic Society ASPIRE fellowship
0399 Patient Preference and Nocturnal Experience With Sodium Oxybate Treatment for Narcolepsy: Interim Data From RESTORE
Authors: Roy Asim , Harsh John , Ajayi Akinyemi , Stern Thomas , Seiden David , Dubow Jordan 
Published: May 2022

Abstract

Introduction
Available, immediate-release oxybate products for narcolepsy require patients to awaken for a second dose 2.5-4 h after the first to cover a full night of sleep. The investigational, extended-release once-nightly sodium oxybate (ON-SXB; FT218) eliminates this middle-of-the-night dosing. This interim analysis from the ongoing RESTORE study (NCT04451668) assessed patient preferences for ON-SXB versus twice-nightly sodium oxybate (SXB) and experiences with the second nightly SXB dose in patients who switched from twice-nightly SXB to ON-SXB.

Methods
Participants enrolled in the open-label extension/switch study (RESTORE) were aged ≥16 y with a confirmed diagnosis of narcolepsy type 1 or 2 from the phase 3 REST-ON trial or receiving stable doses of twice-nightly SXB for ≥1 month. Initial ON-SXB doses for switch patients were equivalent/closest to their previous total nightly SXB dose. Patient preference questionnaires were completed by switch patients 3 months after switching and nocturnal adverse event (AE) questionnaires at baseline.

Results
At an interim data cutoff date of November 22, 2021, 46 participants completed patient preference questionnaires; 93.5% (43/46) preferred ON-SXB to twice-nightly SXB. Nocturnal AE questionnaires were completed by 76 switch participants. In the 3 months before switching to ON-SXB, 62% (47/76) had unintentionally missed their second twice-nightly SXB dose, with 86% experiencing worse narcolepsy symptoms the next day. Forty percent (30/76) reported taking their second twice-nightly SXB dose &gt;4 h after the first dose, with 47% reporting being somewhat, quite a bit, or extremely groggy/unsteady the next morning. For 76% (58/76), taking a second nighttime dose was somewhat, quite a bit, or extremely inconvenient. Additionally, 91% (69/76) reported that they had arisen from bed after the second dose; of these, 5 reported associated falls, and 3 had injuries. Anxiety (25%) and the need for someone else to wake them (21%) were also reported. One participant reported that the medication was missing when they awoke for the second dose.

Conclusion
These interim data indicate that individuals with narcolepsy and prior experience taking SXB prefer ON-SXB to twice-nightly SXB. Treatment burden from the second nightly SXB dose may be alleviated with ON-SXB.

Support (If Any)
Avadel Pharmaceuticals
0413 Are High Intellectual Abilities a Protective Factor for Psycho-social Repercussions in Children with Narcolepsy?
Authors: Thieux Marine , Zhang Min , Marcastel Agathe , Poitrinal Alice , Vassias Fanny , Guyon Aurore , Herbillon Vania , Guignard-Perret Anne , Franco Patricia 
Published: May 2022

Abstract

Introduction
Narcolepsy can have deleterious impact on cognitive and psychosocial functioning. Adequate intellectual abilities are generally a protective factor for bio-psycho-social adjustments in chronic disorders. The main objective of this study was to describe sleep, cognitive abilities and psychosocial repercussions between children with narcolepsy and controls according to the intellectual abilities’ classification.

Methods
Children with narcolepsy and controls underwent one-night polysomnography, completed an intellectual abilities assessment (WISC) and filled in the Epworth Sleepiness Scale for children, the Insomnia Severity Index, the Children Depression Inventory and the Conners. Comparisons between children with narcolepsy and controls were made in two subgroups with High intellectual Potentialities (HP; with an IQ or a verbal or reasoning index higher or equal to 130 evaluated by the WISC) or without HP.

Results
The group with HP consisted of 25 children with narcolepsy (40% boys, median 11,5 years) and 25 controls (68% boys, median 11,7 years). Compared to the controls, the children with narcolepsy did not present the same intellectual profile at the WISC (lower perceptual reasoning index and less discrepancy between verbal and perceptual indexes). They had fewer conduct disorders and a tendency to have fewer school difficulties, learning disabilities, and impulsivity than controls. The group without HP consisted of 22 children with narcolepsy (55% boys, median 12,1 years) and 21 controls (68% boys, median 10 years). The children with narcolepsy presented the same intellectual profile at the WISC as their peers without narcolepsy, but they reported more school difficulties and higher insomnia scores. Compared to controls, both groups of children with narcolepsy had higher sleepiness scores and showed a classic pattern of narcolepsy characteristics on the PSG. There was no difference for the socio-economic level of parents between groups.

Conclusion
In children with narcolepsy, high intellectual abilities act as protective factor against the impact of the disease on cognitive and adaptive functioning, whereas normal-to-low intellectual abilities predict a greater impact of the pathology on daily-life functioning, highlighting the need for multifactorial management.

Support (If Any)
This work was supported by a French Grant from the SFRMS to Marine Thieux.
0415 Does HLA DQB1*0602 testing at our center improve the management of the patient with suspect narcolepsy? A quality improvement project
Authors: Miller Evan , Masood Muaaz , Healy William , Gunsolus Brandy , Bravo-Egana Valia 
Published: May 2022

Abstract

Introduction
The gene DRB1*06:02, a subtype of the DQ6 antigen, has been identified as the DQ6 subtype with the strongest association with narcolepsy type 1 (NT1). As many as 98% of patients diagnosed with narcolepsy-cataplexy are positive for DQB1*06:02. However, DQB1*06:02 has a prevalence of 12-38% in the general population and is commonly found in individuals without NT1. Testing for DQB1*06:02 may still be helpful in the diagnosis of patients with symptoms characteristic of narcolepsy owing to its high negative predictive value of 99%. When ordered appropriately, HLA-testing may reduce unnecessary sleep studies on patients.

Methods
All patients who underwent genetic testing for HLA DQB1*06:02 at our institution between 2015 and 2021 were included (n=8). A retrospective chart review was conducted to gather data on age, gender, total sleep time, apnea-hypopnea index, sleep efficiency, sleep latency, rapid eye movement (REM) latency, mean sleep latency, sleep-onset REM episodes, HLA DQB1*06:02 result, ordering specialty, whether genetic testing was performed before or after multiple sleep latency test (MSLT) and the final diagnosis. These parameters were evaluated in all patients to determine the utility of genetic testing in narcolepsy.

Results
The patients’ age ranged from 15 to 83 years old and 6 of 8 patients (75%) were male. 38% of tested patients were positive for HLADQB1*06:02. One patient with narcolepsy type 1 by MSLT was negative for HLA DQB1*06:02. 1 of 3 patients (33%) with a positive HLA DQB1*06:02 proceeded to have an MSLT performed at our institution. The ordering specialty was neurology in 7of 8 (87.5%) patients.

Conclusion
HLA DQB1*06:02 testing should not be ordered on patients with an MSLT consistent with narcolepsy. If a high index of suspicion for narcolepsy is present and HLA DQB1*06:02 testing is ordered, a positive result should be followed by an MSLT as it was uncertain an MSLT was ever obtained anywhere in these patients. Genetic testing with HLA DQB1*06:02 did not change management in any of the patients where it was performed. Consultation with a sleep specialist prior to performing HLA DQb1*06:02 testing to determine its medical necessity may be a cost-effective strategy.

Support (If Any)
none
0427 Having Insomnia vs. Identifying as an “Insomniac”: What is the role of insomnia severity?
Authors: Boyle Julia , Muench Alexandria , Thompson Michelle , Seewald Mark , Vargas Ivan , Perlis Michael 
Published: May 2022

Abstract

Introduction
The present study sought to evaluate whether insomnia severity (i.e., sleep continuity disturbance) is worse in those who endorse insomnia identity (i.e., identify as an “insomniac”) vs. those who endorse “having insomnia.”

Methods
This study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area. This dataset (n=3,483) was comprised of adults between 18 and 90 years of age (X̅age=53.6±11.0; female [76.4%]; White [91.4%]). All subjects in this analysis endorsed sleep problems. Subjects answered questions regarding demographics, sleep continuity (in minutes), and insomnia identity (“Do you think of yourself as someone that has insomnia” and “do you think of yourself as an ‘insomniac’"?). For both questions, individuals were categorized by their answers: strongly agree, agree, undecided, disagree, strongly disagree. MANOVAs and two-way ANOVAs were conducted to assess group differences (α=.01).

Results
Most individuals endorsed “having insomnia” (n=2,301 [66.1%; strongly agree and agree]) but did NOT endorse being an ‘insomniac’ (n=1,981 [56.9%; undecided, disagree, and strongly disagree]). For all measures, except TST, the two groups did not differ with respect to insomnia severity (i.e., SL[55.4±48.5;60.5±52.1], WASO[45.1±51.7;47.6±55.3], EMA[71.8±51.6;72.9±52.4], and TST [328±75.5;319.6±76.4, p=.009]). The magnitude of the differences between these groups ranged from 1-10 minutes.

Conclusion
It was found that individuals are more likely to endorse ‘having insomnia’ than they are to endorse being an ‘insomniac.’ Despite the implicit differences in “having” something vs. “being” something, the groups did not differ appreciably with respect to sleep continuity. Thus, the tendency to have insomnia identity may not be related to insomnia severity considerations. It is possible, if not likely, that such differences may be related to frequency or chronicity of insomnia. Barring, or in addition to these things, insomnia identity may be related to the mismatch between sleep ability and need and/or related to other non-specific factors. Future directions include refining the group definitions to include forms of insomnia identity that occur with relatively normal sleep continuity (i.e., normal severity and/or frequency and/or chronicity). It will also be important to evaluate whether the various forms of insomnia identity vary with age, sex, or disease comorbidity.

Support (If Any)
K24AG055602
0432 Insomnia is Associated with Endothelial Dysfunction in Young Adulthood: the Penn State Child Cohort
Authors: Fernandez-Mendoza Julio , Gao Zhaohui , Calhoun Susan , Brandt Kristen , He Fan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward 
Published: May 2022

Abstract

Introduction
Clinical and population-based studies in middle-aged and older adults have shown that insomnia is associated with prevalent and incident cardiovascular diseases. However, there is a lack of studies demonstrating an association between insomnia and subclinical cardiovascular measures such as endothelial function in young adults from the general population.

Methods
We studied 200 subjects from the Penn State Child Cohort (20-30 years old, 47% male, 22% racial/ethnic minority), who underwent a thorough clinical history and physical examination to ascertain the presence of sleep disorders and body mass index (BMI), in-lab polysomnography to ascertain the apnea/hypopnea index (AHI), and Doppler ultrasound to assess flow-mediated dilation (FMD). We identified the presence of moderate-to-severe difficulties initiating and/or maintaining sleep (i.e., poor sleep) and of insomnia, the latter including a physician diagnosis of the disorder. The study outcome was FMD as a continuous measure and the square root of FMD (sqrt-FMD) to test the robustness of the analysis. General linear models adjusted for sex, age, race/ethnicity, BMI, AHI, alcohol intake, and sleep medication use.

Results
Compared to normal sleepers (0.111±0.003), subjects with poor sleep (0.104±0.006) and insomnia (0.092±0.008) showed a significant association with lower FMD levels (p-linear&lt;0.05), with subjects with insomnia having significantly lower FMD levels (p=0.029). Results remained significant and in the same direction based on sqrt-FMD (p-linear=0.015).

Conclusion
These data indicate that insomnia is associated with increased risk for cardiovascular disease as early as young adulthood, and independent of major contributors such as obesity, sleep apnea or alcohol use. These data further reinforce the need to include insomnia as a target in the preventative efforts for cardiovascular disease.

Support (If Any)
National Institutes of Health (R01HL136587, UL1TR000127)
0433 Does Social Media Use Before Bed Lead to Sleep Continuity Disturbance?
Authors: Snyder Hope , Walker Jamie , Bell Jessica , Egeler Mara , Hire Veronica , Vargas Ivan 
Published: May 2022

Abstract

Introduction
Research shows that the use of electronics before bed can negatively impact the circadian rhythm and sleep. Less is known, however, about social media use in relation to sleep continuity disturbance (i.e., insomnia). In the early months of the COVID-19 pandemic, social media use increased and updates about the pandemic were easily accessible online. It is possible that social media use before bed could introduce additional psychological stressors due to availability of negative content online and known correlations to depression and anxiety. Thus, the aim of this research was to examine how social media use before bed influenced different subtypes of insomnia during the initial months of the pandemic.

Methods
4,138 adults (mean age = 45.8 years; 79% women) completed a national online survey during April – June 2020. Social media use before bed was measured using the first item on the Social Media Engagement questionnaire (i.e., “How often do you use social media in the 15 minutes before you go to sleep?”). Participants responded to this item based on how many days per week (range = 1-7). Sleep disturbance was assessed using a retrospective sleep diary and the Insomnia Severity Index (ISI). The sleep diary asked about sleep continuity (e.g., sleep latency, wake after sleep onset, total sleep time) during the past month.

Results
Results from separate regression analyses supported that social media use before bed was positively related to greater ISI scores, b = 0.25, t = 8.0, p &lt; 0.001. For example, those who use social media before bed every day reported greater mean ISI scores and sleep latency times (mean ISI = 9.5; SL = 37.5 minutes) compared to those who reported never using social media before bed (mean ISI = 7.7; SL = 27.9 minutes). In contrast, social media use before bed was not related to other sleep continuity variables.

Conclusion
The present data supports that social media use before bed is related to insomnia symptoms, specifically difficulty with sleep initiation. These findings are significant as they may help us understand which aspects of insomnia are most vulnerable to the negative impact of online social interactions, especially during a highly stressful period, such as the COVID-19 pandemic.

Support (If Any)
K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)
0445 Non-pharmacological Insomnia Therapy is Robust to Co-occurring Pain in Older Adults
Authors: Krause Adam , Ahmadi Maryam , O'Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Saletin Jared , Goldstein-Piekarski Andrea 
Published: May 2022

Abstract

Introduction
Pain worsens insomnia symptoms and increases hyperarousal during sleep. The effectiveness of treatments for improving insomnia symptoms may therefore be affected by co-occurring pain, though this currently remains unknown.

Methods
We tested the hypotheses that (1) higher levels of pain will lead to smaller improvements in subjective and objective markers of insomnia following a non-pharmacological insomnia treatment and (2) insomnia treatment will moderate the relationship between pain and markers of insomnia. 114 adults &gt;60 years (age=69.7, SD=6.3, 66% female) with insomnia (Insomnia Severity Index [ISI] score &gt;10, Mean=16.1, SD=4.5) underwent polysomnographic (PSG) recordings before and after completing a 6-session non-pharmacological insomnia treatment regimen. Pain severity (Brief Pain Inventory), insomnia symptoms (ISI), and hyperarousal derived from the PSG (relative α-band power [7.5-12.0Hz] across all sleep stages) were acquired at each time-point. Two-tailed paired t-tests were used to determine the main effects of treatment on insomnia and alpha power. Ranked-correlation tests were used to assess the impact of baseline pain on treatment outcomes, and mixed-effects models were employed to assess whether the relationship between pain and markers of insomnia differed pre- and post-treatment.

Results
Non-pharmacological insomnia treatment reduced insomnia symptom severity (t=19.4, p&lt;0.001) but not α-power (t=0.97, p=0.33). Baseline pain severity was not associated with insomnia symptom improvement (ρ=-0.09, p=0.49) nor with changes in α-power (ρ=-0.19, p=0.23). There was no significant pain-by-time interaction in determining insomnia symptom improvement (β=-0.05, t=-0.18, p=0.86), and a trending pain-by-time interaction in determining changes in α-power (β=-0.007, t=-1.8, p = 0.07).

Conclusion
These findings suggest that pain is not likely to alter the effectiveness of non-pharmacological treatment for subjective insomnia symptoms, but pain may reduce change in the markers of hyperarousal in older adults with co-occurring pain and insomnia.

Support (If Any)
National Institute of Mental Health grant 1R01MH101468-01