bluuebunny/crossref_metadata_2025_split huggingface dataset:
0353 Estimated Sleep-Wake Patterns Obtained from a Large U.S. Sample by Home-Based Under-Mattress Monitoring Devices
Authors: Zitser Jennifer , Cotton-Clay Andrew , Baron Susan , Easwar Venkat , Kinsolving Arthur , Kahn Philippe , Kushida Clete 
Published: May 2022

Abstract

Introduction
Sharing the bed with a partner is common among adults and is likely to impact sleep in multiple ways. However, polysomnograms are performed without a bed partner and objective data on co-sleeping couples are extremely rare. This study aimed to investigate the effects of a bed partner's presence on objective sleep parameters.

Methods
Sleep data from 5190 users (43% female, 14% unspecified gender, mean age 47) and their bed partners were collected through a commercially-available home sleep monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies, California, USA). The device passively monitors sleep using piezo-electric sensors that register the forces exerted through the mattress. Subjects with at least 10 weekday sleep recordings with a bed partner present for at least an hour, and at least 10 weekday sleep recordings without a bed partner present at all during the period from 08/2021 to 11/2021 were included. Estimated total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE), and light, deep, and REM sleep were analyzed comparing between the nights with and without a bed partner.

Results
The mean (standard deviation) across subject averages of estimated TST (min), WASO (min), SE (%), and light, deep and REM sleep (min) with a bed partner were: TST 417.2(44.5), WASO 47.2(24.9), SE 89.5(6.4), light sleep 255.4(34.2), deep sleep 56.7(11.9) and REM sleep 105.2(17.5) and without a bed partner were: TST 414.7(49.2)-*, WASO 40.7(20.5)-*, SE 90.7(5.8)+*, light sleep 243.6(38.0)-*, deep sleep 62.9(12.9)+* and REM sleep 108.2(19.0)+*; a (+) indicates an increase and (-) a decrease in the sleep parameter between nights with and without a bed partner, and (*) signifies p &lt; 0.05 by paired t-test.

Conclusion
When the bed partner is absent, an individual’s sleep architecture shows on average a higher sleep efficiency, with less awake time but also less total sleep; more minutes spent in deep and REM sleep, and less in light sleep. This suggests a less interrupted night, perhaps due to fewer disruptions from the partner, where the individual has enough continuity in his/her sleep to transition to deeper stages. Further work will add the effect of a bedpartner in AHI and snoring.

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0354 The Feasibility of Research Using In-Home Polysomnography for 20 Nights Across 25 Days
Authors: Ariyibi Bisola , Lambing Kari , Bender Amy , Gerardy Bethany 
Published: May 2022

Abstract

Introduction
Several studies have studied sleep with polysomnography (PSG) in the laboratory across multiple days but there is a paucity of research using lab-quality PSG in the home where the sleep environment is much different. In this study, we assessed the feasibility of conducting research while recording PSG in the home across multiple nights under real-world conditions.

Methods
Twenty-one participants volunteered to participate in the study and wore in-home PSG using the Cerebra Sleep System which used gel electrodes to record EEG, EOG, EMG, ECG, and a chest effort belt for 20 nights across 25 days. Participants completed baseline questionnaires (pre – and post-study), daily activities, sleep disturbances, and any skin sensitivities via online morning and evening questionnaires.

Results
Eighteen participants (age 40.2±10.5; 9 females) completed at least 18 nights of recordings and were included in the final analysis. PSG was recorded for 375 nights with an average of 20.1 nights (±3.5) recorded per participant across 24.3 days (± 2.9). Three participants withdrew from the study due to a change in work schedule (3 nights), skin sensitivity issues (5 nights), and lack of motivation (10 nights). There were 100% completion rates for questionnaires at baseline, 98% completion rates for morning questionnaires, and 93% completion rates for evening questionnaires. Participants reported skin sensitivities on 36.4% of the nights but were typically not reported again at the evening session. When there was a complaint, most of the irritations were minor with 27.1% having residual stickiness from the electrodes, 26.1% redness, and 17.5% imprints. For more of the major complaints, they were less common with 5% reporting soreness or irritation and 3.3% swelling.

Conclusion
We found that data collection from electronic questionnaires was good. Skin irritations were reported about a third of the time but typically went away across the day. These results highlight the feasibility of doing research using in-home PSG for multiple nights and the utility of collecting electronic questionnaire data for in-home research.

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0357 Interdisciplinary Training in Pediatric Sleep
Authors: Moore Melisa , Afolabi-Brown Olufunke , Tapia Ignacio , Beck Suzanne , Xanthopoulos Melissa , Mindell Jodi 
Published: May 2022

Abstract

Introduction
Sleep is a critical domain of child functioning. However, clinical psychology programs lack formal sleep education while behavioral sleep instruction is deficient in sleep and pulmonary fellowships. Cross-disciplinary training in pediatric sleep is ideal. This study examined medical and psychology trainee satisfaction with two interdisciplinary experiences: a 1-2 semester clinical rotation for medical fellows and psychology doctoral students and a concentrated annual elective for medical students. The rotation includes 1-2 half-day clinics per week wherein medical sleep fellows and behavioral sleep medicine trainees conduct a sleep interview together and ask specific questions within their discipline. With an attending psychologist and physician, they discuss case conceptualization, differential diagnoses, and possible interventions. The team reviews pertinent findings and collaboratively provides recommendations to the patient. Trainees also participate in weekly didactics presented by psychologists and physicians.The second interdisciplinary training experience, Frontiers, is designed to impact physician learners earlier in their careers. Sleep physicians and psychologists teach an annual week-long sleep elective for medical students.

Methods
Evaluations from fellows, psychology trainees, and medical students from the most recent 3 years were analyzed to determine trainee satisfaction with the interdisciplinary rotation and the medical student course.

Results
Results of sleep fellow evaluations rated the program as having effective teachers`X=4.67 (0.62) and high educational value `X=4.6 (0.83) on a 5-point Likert scale with 5 being the highest. Similarly, psychology trainees rated the overall rotation experience over the past 3 years on a 4-point Likert scale with 4 being the highest as`X=3.74 (0.43).Medical students who took the Frontiers course also rated the training highly on a 4-point Likert scale with 4 being the highest:`X=3.79 (0.43) in 2021,`X=3.76 (0.75) in 2019, and,`X= 3.73 (0.47) in 2018. The course was not offered in 2020 due to the pandemic.

Conclusion
Comprehensive pediatric sleep education and training (both clinical and didactic) is feasible within a single interdisciplinary rotation provided simultaneously to both psychology and medical trainees with high trainee satisfaction. Sleep-related in vivo training and didactics are relevant to physician and psychology training programs and prepare trainees for future work in interdisciplinary care.

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0362 The Cost of In-Person versus Telehealth PAP Initiation for Patients with Sleep Apnea
Authors: Jambulingam Nikita , Sarmiento Kathleen , Gomez Alexander , Smith Connor , Mitchell Michael , Lee Diane , Sanders Elizabeth , Ryden Armand , Martin Jennifer , Zeidler Michelle 
Published: May 2022

Abstract

Introduction
Telehealth has been widely integrated into healthcare systems during the COVID-19 pandemic and is likely to remain a part of routine clinical care. At the VA Greater Los Angeles Healthcare System (VAGLAHS), positive airway pressure (PAP) set-up visits transitioned from in person to telehealth for newly diagnosed sleep apnea patients during the pandemic. The telehealth pathway included mailing of PAP machines to patients with follow-up video/phone education by respiratory therapists (RTs). As part of a larger study examining the clinical outcomes resulting from telehealth versus in-person PAP initiation, we performed a cost analysis of these two treatment pathways within VAGLAHS.

Methods
We examined the total variable direct cost of telehealth versus in-person PAP initiation for patients newly diagnosed with sleep apnea at VAGLAHS between March and October 2021 (n = 2,662 PAP set-ups) using a bottom-up analysis. There was an average of 16 PAP set-ups per day with 11 set-ups (68.7%) via telehealth and 5 set-ups (31.3%) in person.

Results
The total variable direct cost of telehealth PAP initiation was $98.87 per patient. The total variable direct cost of in-person PAP initiation was $50.58 per patient. For telehealth, there was an additional cost of mailing the PAP machine and 31.2% more RT time spent on educating patients compared to the in-person pathway. After the initial PAP set-up visit, a larger subset of patients required additional troubleshooting help from RTs about proper PAP use after telehealth compared to in-person set-ups (5% versus 1%).

Conclusion
The telehealth PAP initiation pathway was nearly two times the cost of in-person PAP initiation. This resulted from the additional cost of mailing the PAP machine, more RT time spent on education, and a greater need for troubleshooting after the visit. Telehealth visits may need to be supplemented by written educational materials or web-based resources to reduce the need for additional support after the initial visit.

Support (If Any)
OCC study funding, VAGLAHS GRECC
0366 Investigating the use of STOP-BANG questionnaire in inpatient and outpatient settings in a rural healthcare system
Authors: Mojarrab Javad Najjar , Nwaedozie Somto , Stoflet Matthew , Yeung Paul , Kumar Sanjay , Biswas Amit 
Published: May 2022

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is one of the strongest modifiable risk factors for Atrial Fibrillation (AF). Although, STOP-BANG questionnaire is a well-validated screening tool for OSA, its adoption and utility to screen newly diagnosed AF has not been reported in a large rural healthcare system. Our aim was to identify the characteristics in patients with AF, which led to screening and referral for a sleep study by providers. In addition, we identified the provider specialty types that had the highest rate of screening for OSA and sleep study referral.

Methods
We conducted a retrospective multicenter study that identified newly diagnosed patients with AF from January 2018- January 2020. STOP-BANG questionnaire, patient demographics, electrocardiogram, and sleep study data were collected. A logistic regression model was used to identify patient characteristics that were associated with increased screening. Using a chi-squared test, we compared differences in provider specialty that screened for OSA and referred patients for a sleep study.

Results
Among the study cohort (N=845), 136 (16.1 %) were female and 709 (83.9 %) were male. Only 82 patients (9.7%) had confirmed OSA screening by STOP-BANG questionnaire. Among higher risk patients for OSA (at least 3 of the following: age&gt;50, male, hypertension, BMI&gt;35), the screened patients were 5.8 years younger (95% CI: 3.7-7.9, p&lt;0.001) compared to patients that were not screened. Patients who were screened for OSA had significantly higher BMI (p&lt;0.001), hypertension (p&lt;0.001), and diabetes mellitus (p&lt;0.001). Our findings revealed that OSA screening providers, were most commonly Primary Care Providers (PCP) (47.5%) followed by cardiologists (31.7). Furthermore, PCPs (48.5 %) and cardiologists (14.1%) were most likely to provide referrals for a sleep study. All of the patients, who were screened using STOP-BANG questionnaire and referred for a sleep study, were diagnosed with OSA.

Conclusion
Our findings revealed underutilization of STOP-BANG to screen for OSA in newly diagnosed AF patients. Screening pattern may be tilted towards patients with obvious and severe forms of OSA therefore missing on milder cases. This study could prompt systemic adoption of STOP-BANG questionnaire, education, and periodic evaluation of healthcare providers in a large rural healthcare system to improve outcomes in AF patients.

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0370 Polysomnography following an indeterminate HSAT: Low Compliance with AASM Guidelines
Authors: Nygate Yoav , Rusk Sam , Turkington Fred , Fernandez Chris , Glattard Nick , Sprague Matt , Winzurk Zac , Watson Nathaniel 
Published: May 2022

Abstract

Introduction
Home sleep apnea test (HSAT) provides a low risk, cost-effective, and convenient diagnostic test for obstructive sleep apnea (OSA) in adult patients. However, in situations where HSAT are inconclusive, technically inadequate, or produce a negative result, the American Academy of Sleep Medicine (AASM) strongly recommends that a polysomnography (PSG) be performed. In this study, we evaluate whether patients are likely to comply with receiving a follow-up PSG following an indeterminate HSAT to rule out any presence of OSA and assess the demographic characteristics of individuals who are more likely to follow the AASM guidelines.

Methods
In order to assess routine compliance with the AASM follow-up guidelines, we have conducted an observational study with N=3,049 patients that received a HSAT in 2019 from 6 independent AASM accredited sleep centers across the U.S. The patient sample included 39.8% female and 60.2% male. 30.34% from the 19-44 age group, 47.2% from the 45-64 age group, and 21.2% from the 65-84 age group. Furthermore, 33% of the patients received a negative HSAT and were advised for a follow-up PSG.

Results
14.8% of patients who received a negative HSAT in 2019 underwent a follow-up PSG by the end of 2021. Male patients and patients who are younger in age were more likely to follow the AASM guidelines. 16.4% of male patients and 9% of female patients who received a negative HSAT underwent a follow-up PSG. 17.7% of patients aged 19-44 who received a negative HSAT received a follow-up PSG, while only 11.1% of patients aged 45-64, and 7.6% of patients aged 65-84 conformed with the AASM guidelines and followed-up with a PSG.

Conclusion
The overall percentage of patients who comply with the AASM guidelines is relatively low at 14.8%. Emphasis should be put on patient outreach and education to improve this statistic. Such endeavors may try to target female and older patients who appear to be slightly less compliant with AASM guidelines. Simultaneously, more attempts should be made to improve HSAT to increase OSA specificity and decrease the necessity for a follow-up PSG, as this AASM guideline is often overlooked by patients.

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0371 Sleep Medicine Care Through the COVID-19 Pandemic
Authors: Junna Mithri , Glasgow Amy , Sangaralingham Lindsey , Morgenthaler Timothy 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic accelerated use of telehealth, an expansion of services that required the appropriate technological infrastructure for health care facilities and in patient homes. Telehealth on the one hand has held promise for addressing health disparities perpetuated by inadequate rural access, but delivery requires extensive broadband and technologic access. That creates the possibility for new kinds of healthcare disparities. In addition, COVID-19 forced marked reduction in in-lab polysomnography (PSG), and concurrent expansion of home sleep apnea testing (HSAT). We hypothesized that the pandemic led to an increase in the overall frequency of telehealth and HSAT utilization, particularly in those who were younger, White, more educated, and from a non-local area.

Methods
We completed a retrospective chart review of all adult patients seen by all provider types across the Sleep Medicine practices in Mayo Clinic Rochester, Arizona, Florida, and the Mayo Clinic Health System between 1) 6/1/18—3/8/20 (Pre-COVID-19), 2) 3/9/20—4/19/20 (Early COVID-19), and 3) 4/20/20—present (Late COVID-19). We recorded the total number of PSGs and HSATs and total number of face-to-face and telehealth visits, along with the age, gender, race, educational level, and locality by zip code for patients served. These data were compared across the 3 timeframes.

Results
Average monthly visits changed from Pre-COVID-19, Early COVID-19, to Late COVID-19 [2194.7/m, 1416.5/m, 2690.6/m (P&lt;0.001)]. Average monthly sleep test volumes also changed [1004.1/m, 530.5/m, 1123.4/m (P&lt;0.001)], with a proportionate increase in HSATs across the 3 periods [34.71%, 65.37%, 53.59% (P&lt;0.005)]. The increase in Late COVID-19 in telehealth visits occurred proportionately more in those who were younger, female, non-White, college and post-graduate educated, and from a non-local area. The increase in use of HSATs occurred proportionately more in patients who were younger, female, non-White, college and post-graduate educated, and from a local area.

Conclusion
The COVID-19 pandemic increased the use of telehealth visits and HSATs in Sleep Medicine practices across our enterprise, particularly in those who are younger and more educated, which may be due to ease of use with and access to technology. The reasons for the presence of additional disparities based upon gender, race, and locality needs further exploration.

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0384 Clinical Utilization of a CSF Orexin Test: First Two Years of Data from Mayo Clinic
Authors: Ruoff Chad , Louis Erick St , Cheung Joseph , Carvalho Diego , Larson Bethany , Silber Michael , Kotagal Suresh , Krahn Lois , Bornhorst Joshua 
Published: May 2022

Abstract

Introduction
Orexin deficiency in cerebrospinal fluid (CSF) was first reported in human narcolepsy in 2001, included in diagnostic criteria for narcolepsy in 2014, and made clinically available at the Mayo Clinic in 2019. The purpose of this publication is to report orexin test utilization and results, and other clinically relevant findings from patients evaluated at Mayo Clinic.

Methods
We retrospectively reviewed CSF orexin samples and clinical records from patients evaluated at Mayo Clinic from 2019 to 2021.

Results
A total of 98 internal samples (Rochester, n=56; Arizona, n=25, and Florida, n=17) from 95 patients (mean age 32.4 +/- 16.6 years with 20 %, 52 %, and 28 % of patients &lt; 18, 18 – 40, and &gt; 40 years, respectively, at time of CSF collection; 62 % female) have been submitted for CSF orexin measurement (mean CSF orexin 335.17 +/- 158.3 pg/ml; deficient &lt; 110 pg/ml, n=11, 64 % &lt;=40 years with mean age 32.9 +/- 17.0 years; intermediate 110 – 200 pg/ml, n=8, 100 % &lt;= 40 years with mean age 21.1 +/- 12.8 years; normal &gt; 200 pg/ml, n=79, 57 % &lt;=40 years with mean age 33.5 +/- 16.7). No significant correlation was found between orexin levels, and time of collection (i.e., diurnal variation), gender, or age. Repeat testing was performed on three individuals (ages 10, 14, and 19 years) with a change in category of orexin level found in one patient from an intermediate to a normal level.

Conclusion
Orexin deficiency was found in 12 % of the patients (64 % of the deficient samples were found at ages &lt;= 40 years). This result may reflect the fact that this test is frequently pursued in clinical patients presenting with inconclusive findings and/or comorbidities. Intermediate orexin levels found in 8 % of the samples (100 % &lt;= 40 years). Although most of the patients tested were female (62.2%) and most were 40 years or younger (72%), no significant correlation was found between orexin levels, and time of collection (i.e., diurnal variation), gender, or age.

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none
0389 Efficacy of Lower-Sodium Oxybate in the Treatment of Idiopathic Hypersomnia: Evaluation of Response Based on the Epworth Sleepiness Scale Score
Authors: Rosenberg Russell , Chen Abby , Steininger Teresa , Macfadden Wayne , Dauvilliers Yves 
Published: May 2022

Abstract

Introduction
Idiopathic hypersomnia is a debilitating neurologic sleep disorder characterized by excessive daytime sleepiness (EDS), with sleep inertia and prolonged nighttime sleep as key symptoms in many patients. The Epworth Sleepiness Scale (ESS) is an 8-item self-report questionnaire (0–24 score range; higher scores indicate greater EDS). An ESS total score ≤10 is considered normal. The minimum clinically important difference (MCID) for narcolepsy is considered to be a decrease of ≥2 points; the MCID in idiopathic hypersomnia has not been established. This post hoc analysis evaluated response to lower-sodium oxybate (LXB; Xywav®) treatment on ESS scores in a phase 3 clinical trial (NCT03533114).

Methods
Eligible participants with idiopathic hypersomnia began LXB treatment with an open-label titration and optimization period (OLT; 10–14 weeks), followed by a 2-week, open-label, stable-dose period (SDP). The ESS was completed at baseline, during OLT (week [W]1, W4, W8, and end of OLT), and end of SDP. Response was defined as ESS total score ≤10 or decrease in total ESS score of ≥4 points after open-label LXB treatment.

Results
Participants were treatment naive (n=47) or taking alerting agents other than sodium oxybate at study entry (stable doses ≥2 months; n=62). At W1, W4, W8, end of OLT, and end of SDP, the percentage of participants achieving a response of total ESS score ≤10 was 13.0%, 55.3%, 70.2%, 85.1%, and 87.2% (treatment-naive participants), respectively, and 21.0%, 56.5%, 65.6%, 74.2%, and 83.9% (participants taking alerting agents), respectively. At W1, W4, W8, end of OLT, and end of SDP, the percentage of participants achieving a response of total ESS score decrease of ≥4 points was 26.1%, 68.1%, 76.6%, 87.2%, and 87.2% (treatment-naive participants), respectively, and 33.9%, 64.5%, 78.7%, 88.7%, and 95.2% (participants taking alerting agents), respectively. Treatment-emergent adverse events (≥10%) included nausea, headache, dizziness, anxiety, and vomiting.

Conclusion
Over 80% of participants achieved a clinically meaningful response based upon ESS total score ≤10, and up to 95% demonstrated a decrease in total ESS score of ≥4 points at end of SDP. The response rate increased over the study period. The safety profile of LXB was consistent with that observed in narcolepsy.

Support (If Any)
Jazz Pharmaceuticals.