bluuebunny/crossref_metadata_2025_split huggingface dataset:
0531 Characterization of Sleep-Disordered Breathing among Newborn Infants with Myelomeningocele
Authors: Hassan Fauziya , Mason Thornton , McCaffery Harlan , Chervin Ronald , Shellhaas Renee 
Published: May 2022

Abstract

Introduction
Myelomeningocele (MMC) is a neural tube defect associated with hindbrain herniation (Chiari II malformation) and respiratory center dysfunction. Prior cross-sectional polysomnographic studies indicated that older children with MMC have an elevated risk of sleep-disordered breathing (SDB), a risk factor for sudden death. Most infants with MMC (78%) had abnormal pneumograms, reported predominantly as central sleep apnea (CSA) and sleep-related hypoventilation (SRH). Pneumograms, however, have significant limitations compared with full polysomnography (PSG).

Methods
The North-American Fetal Therapy Network (NAFTNet) with nine participating sites has collaborated in a prospective study of SDB among infants with MMC. Bedside PSGs were conducted among infants &gt;35 weeks post-menstrual age without supplemental oxygen or respiratory support. PSGs were scored by a pediatric-experienced RPSGT using the American Academy of Sleep Medicine infant sleep staging and pediatric scoring criteria for respiratory events. PSGs were reviewed independently by two board-certified pediatric sleep faculty who then reached diagnostic consensus.

Results
Twenty-eight PSGs were evaluated as an interim analysis from 4 of 9 participating sites. Many (11/28, 39.3%) infants had predominantly frequent hypopneas, which could not be distinguished confidently as central vs. obstructive by two experienced pediatric physicians. The proportions of neonates with CSA (3/28, 10.7%), OSA (6/28, 21.4%) and SRH (1/28, 3.6%) were small by comparison. Only 10/28 infants (35.7%) did not display significant SDB and 14/28 had PSG abnormalities considered clinically concerning. Across all subjects the median [IQR] hypopnea index was 18 [10, 33], central apnea index was 4 [1,7]) and obstructive apnea index was 1.0 [0, 6]. The median [IQR] apnea-hypopnea index was 28 [15, 46].

Conclusion
This ongoing study already provides the largest available cohort of neonates with MMC and PSG data. Predominant hypopneas were far more common than any other classified expression of SDB and were challenging to distinguish as central or obstructive. These data confirm the high frequency of SDB in MMC (64%), suggest that PSG may be an important consideration in neonates with MMC, but highlight that current scoring criteria may not always allow confident separation of central from obstructive SDB processes.

Support (If Any)
National Institutes of Health 1 R01 HL147261-01A1
0538 “Something is Wrong!” A Qualitative Study of Racial Disparities in Parental Experiences of OSA Detection among Their Children
Authors: Chung Alicia , Farquharson Leone , Gopalkrishnan Akila , Seixas Azizi , Jean-Louis Girardin , Honaker Sarah 
Published: May 2022

Abstract

Introduction
Blacks are 4-6 times more likely to have obstructive sleep apnea (OSA) than white children. Yet disparities in detection, diagnosis and treatment persist. Our study objective was to examine parents’ perceptions and experiences with OSA detection among their children.

Methods
Semi-structured phone interviews were conducted with 30 parents of children (ages 2-12 years) who were referred for overnight polysomnography due to OSA. Parents who identified as Black non-Hispanic (n=19) or White non-Hispanic (n=8) were included in the current analysis. Qualitative thematic analysis was conducted using a grounded theory approach, with themes organized in NVivo 12 software. Twenty-one themes falling into five categories were identified. To examine racial/ethnic disparity in parental experiences, themes were classified as convergent (presented by Black and White parents) or divergent (presented by one racial/ethnic group but not the other).

Results
Participating parents were primarily mothers (92.59%). Children were 51.90% female; aged range from 3 to14 years old (M=7.93 years, SD=3.08). Delayed OSA detection was observed among Black children (M=9.00 years), compared to white children (M=5.78 years). Analysis of themes by race/ethnicity identified both shared experiences and perspectives, as well as those that were specific to or more salient for parents of one race. Convergent themes that overlapped among both groups included “Wanting to Know, Worries, and Child Daytime Symptoms.” Divergent themes experienced by White caregivers included “Low threshold for raising concerns with provider, Institutional delays, and Trust in provider.” “Misplaced blame, Whatever it Takes, Something is wrong, OSA Awareness, and Missing the day-night connection,” were divergent themes named by Black parents/caregivers.

Conclusion
Black and white parents experience different paths to detection and diagnosis for their child’s OSA, which may be affected by individual awareness, education, patient-provider interactions and experience with the healthcare system.

Support (If Any)
Research is supported by K23HL150290
0551 Movement Parasomnias in a Community Sample: Associations with Sleep Health and Mental Health
Authors: Thesz Isadora , Hale Lauren , Branas Charles , Killgore William , Wills Chloe , Grandner Michael 
Published: May 2022

Abstract

Introduction
Movement-related parasomnia symptoms are associated with several sleep disorders and are associated with adverse health, mental health, and social outcomes. Current literature lacks data regarding parasomnia prevalence in the general population. This study examined prevalence of these symptoms and correlates in a community-based sample.

Methods
Data were from the Sleep and Healthy Activity, Diet, Environment and Socialization (SHADES) study, consisting of N=1,007 working-age adults. Parasomnia symptoms were assessed with, “I have been told that I walk, talk, eat or act strange or violent while sleeping.” Responses were categorized as Never (1/year or less), Sometimes (&lt;1/week), or Often (&gt;=1/week). Sleep health variables included sleep duration, categorized as very short (&lt;=4h), short (5-6h), normal (7-8h, reference group) or long (&gt;=9h), Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Brief Index of Sleep Control, frequency of loud snoring, and frequency of sleep medication use. Mental health variables included PHQ9 depression score, GAD7 anxiety score, Perceived Stress Scale, and self-reported survival of severe physical/emotional trauma (None, Possible, Definite). Covariates included age, sex, race/ethnicity, education, income, employment, and body mass index.

Results
Parasomnia symptoms were reported sometimes by 24% and often by 7% of the sample. The following sleep-related variables were associated with more movement-related symptoms sometimes: very short sleep (RRR=2.26), higher ISI (RRR=1.08), ESS (RRR=1.09), and FSS (RRR=1.05), and frequent snoring (RRR=2.84). The following were associated with more symptoms often: very short sleep (RRR-4.40), higher ISI (RRR=1.18), ESS (RRR=1.18), FSS (RRR=1.07), frequent snoring (RRR=7.38) and medication use (RRR=5.99), and less sleep control (RRR=0.43). Regarding mental health, more symptoms sometimes or often was associated with higher depression (RRR=1.11 and 1.16, respectively), anxiety (RRR=1.12 and 1.17, respectively), and stress (RRR=1.06 and 1.10, respectively) scores. Trauma survivors were more likely to report symptoms often (RRR=4.78).

Conclusion
Movement-related parasomnia symptoms are fairly prevalent and may impact nearly one third of community-dwelling working-age adults. Those exhibiting symptoms are more likely to experience shorter sleep duration, poor sleep quality, daytime dysfunction, and worse mental health. Screening efforts for subclinical symptoms should be increased, and further work should explore pathways linking these symptoms to health and functional outcomes.

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0566 Impact of Obstructive Sleep Apnea in Patient Admitted For Diabetic Ketoacidosis. Analysis Of The National Inpatient Sample
Authors: Yusuf Mubarak , Aldiabat Mohammed , Al-khateeb Mohannad , Horoub Ali , Jabiri Yazan Al , Kilani Yassine , Abdulkarim Faridat , Garba Kazeem , Thompson Pytregay 
Published: May 2022

Abstract

Introduction
The prevalence of type 2 diabetes mellitus in patients with obstructive sleep apnea has been estimated to be 15-30%. Studies have shown increased severity of diabetes in patients with underlying OSA independent of other confounders such as age and obesity.We aim to assess the effect of obstructive sleep apnea on patients admitted for diabetic ketoacidosis.

Methods
We queried the National Inpatient Sample (NIS) 2016, 2017, and 2018. We searched the NIS for adult patients hospitalized with DKA as principal diagnosis with exposure of OSA as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality, while secondary outcomes were length of stay (LOS), total hospital charge, cerebral edema, cardiac arrest, acute respiratory failure (ARF), and health cost utilization defined by total hospitalization costs. Multivariable logistic and linear regression analysis was applied to estimate the clinical outcomes. STATA software was used to analyze the data.

Results
There were about 367,555 adult hospitalizations principally for DKA, of which 2.5% had OSA as a secondary diagnosis. Demographic characteristics based on OSA vs non-OSA cohorts with mean age of 52.3 years (CI 51.6-52.9) vs 40.4 years (CI 40.2-40.5), females (43.2% vs 49.7%), Whites (64.7% vs 57.2%), Black (25.6% vs 26.7%), and Hispanic (7.1% vs 11.6%). A total of 1,440 inpatient mortality (0.39%) occurred in hospitalizations for DKA. After adjusting for age, sex, disease severity and race, hospitalizations for DKA with OSA had similar inpatient mortality [0.59% vs 0.39%, AOR 0.81, 95% CI: 0.423 - 1.565, p=0.538], total hospital charge [$38,790 vs $30,516 P=0.185], LOS [4.19 vs 3.27 days, P=0.064], cerebral edema [0.32% vs 0.1% AOR 1.25, 95% CI: 0.437 - 3.616, p=0.671], cardiac arrest [0.54% vs 0.27% AOR 1.01, 95% CI: 0.493 - 2.105, p=0.959] compared to those without DM. However patient with OSA had an increased odds of ARF [0.55% vs 0.22% AOR 1.48, 95% CI: 1.173 - 1.867, p=0.001].

Conclusion
In conclusion, patients admitted primarily for DKA with co-existing OSA had similar inpatient mortality, LOS, total hospital charges, cerebral edema, and cardiac arrest compared to those without OSA. However, the OSA group had more odds of ARF.

Support (If Any)
1. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest. 2017;152(5):1070-1086. doi:10.1016/j.chest.2017.05.0092. Mahmood K, Akhter N, Eldeirawi K, et al. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med. 2009;5(3):215-221.3. Morgenstern M, Wang J, Beatty N, Batemarco T, Sica AAL, Greenberg H. Obstructive sleep apnea: an unexpected cause of insulin resistance and diabetes. Endocrinol Metab Clin North Am 2014;43:187–204
0643 Sleep Quantity, Quality and Sleep Apnea Risk for Inpatients on a Neurology Unit
Authors: Poulakis Alexander , Ibarra Michael , Lin Jennifer , Wielgus Oskar , Eisner Lauren , McGauley David , Kadura Sullafa 
Published: May 2022

Abstract

Introduction
Sleep disorders frequently complicate neurological disorders such as stroke and epilepsy. Despite these known relationships, sleep disorders screening is insufficient in the inpatient neurology setting. We aimed to assess patient sleep quantity and obstructive sleep apnea (OSA) risk on an inpatient neurology unit.

Methods
From April 2021 to November 2021, patients completed the Epworth Sleepiness Scale, Berlin Questionnaire, and Karolinska Sleep log to assess sleep quality and duration from the previous night. Surveys were administered three times a week to patients oriented, available to participate, and slept on the unit for at least one whole night. T-tests and chi-squared were utilized for analysis of statistical significance.

Results
Of the preliminary sample (n=117), 45% were male with mean age of 53 and mean BMI of 30.3. The top primary diagnoses were seizures (35.0%) and acute strokes (27.4%). Seventeen patients had known OSA, and 30% had an Epworth Sleepiness Scale score greater than 10 prior to admission, indicating daytime sleepiness. 37% screened high-risk for OSA without a known diagnosis - 46.9% of these patients presented with an acute stroke, and 32% with seizures. The mean (SD) total sleep time across 129 completed surveys was 7.02 hours (2.43), with an average sleep efficiency of 83.0% (18%), wake after sleep onset of 52.6 minutes (63.12), and 2.69 (2.66) awakenings a night. Patients with known sleep apnea had significantly increased sleep latency (43 minutes vs. 26 minutes, p=0.04) and increased awakenings (2.8 vs. 1.6, p=0.039). There was no statistical significance in sleep logs between high and low-risk Berlin patients, although there was a trend towards increased sleep latency in high-risk patients (32 minutes vs. 23 minutes, p=0.08).Between high and low-risk patients, there was no statistically significant difference in sleep aid ordering (p=0.48). Sleep aids were more likely to be ordered for patients in shared rooms than private (75% vs. 25%, p= 0.0025).

Conclusion
This study demonstrated that underlying sleep apnea significantly affected sleep latency and awakenings; preliminary data shows that Berlin risk may affect sleep latency. We will continue to review these trends as data collection continues. Future studies should compare objective data with patient-reported sleep logs.

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0649 Objective and Subjective Sleep Patterns in Youth with Obsessive-Compulsive Disorder
Authors: Swisher Valerie , Rozenman Michelle , Peris Tara , Tan Patricia , Piacentini John , Ricketts Emily 
Published: May 2022

Abstract

Introduction
Sleep disturbance commonly presents in youth with obsessive-compulsive disorder (OCD). However, studies elucidating the nature of sleep problems in OCD are limited and pose discrepant findings. The present study examines objective and subjective sleep disturbance in youth with OCD relative to healthy controls, and investigates the relationship between sleep disturbance and OCD symptom severity.

Methods
Participants were 61 youth aged 8 to 17 years (M = 12.18, SD = 2.64) with OCD (n = 26), and healthy controls (n = 35). An evaluator assessed psychiatric diagnosis through a diagnostic interview and rated OCD symptom severity (Children’s Yale-Brown Obsessive-Compulsive Scale). Objective sleep patterns, including sleep onset latency, wake after sleep onset, duration and number of awakenings, total sleep time, and sleep efficiency were assessed through 7-day sleep monitoring using the wActiSleep-BT actigraph. Youth rated sleep using the Sleep Self-Report (SSR), and parents rated youth sleep using the Children’s Sleep Habits Questionnaire (CSHQ).

Results
Independent samples t-tests were performed to compare youth with OCD and healthy controls on sleep measures. Findings revealed no significant differences between youth with OCD and healthy controls on the actigraphy measures (i.e., total sleep time, wake after sleep onset, duration and number of awakenings, and sleep onset latency, sleep efficiency). Youth with OCD had significantly greater self-reported, t(24) = 3.29, p &lt; 0.01, and parent-reported sleep disturbance, t(41) = 2.94, p &lt; 0.01, relative to healthy controls. OCD symptom severity was positively correlated with SSR scores, r = .53, p &lt; 0.01, and CSHQ scores, r = .47, p = 0.03. There were no significant correlations between actigraphy measures and OCD symptom severity.

Conclusion
Youth with OCD exhibit sleep disturbance on subjective but not objective sleep measures relative to healthy controls. Findings are discrepant from objective-subjective sleep patterns found in other studies of youth with OCD, but consistent with those found in youth with anxiety disorders. Findings may suggest subjective measures capture forms of sleep disturbance (e.g., bedtime resistance, nighttime anxiety, etc.) not measured by actigraphy.

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0650 Does pain related disability moderate the relationship between subjective insomnia and anxiety in comorbid fibromyalgia and insomnia?
Authors: Guandique Alan , Nair Neetu , McCrae Christina 
Published: May 2022

Abstract

Introduction
Fibromyalgia is a chronic widespread pain condition with up to 90% of patients experiencing comorbid sleep disorders (e.g., insomnia) and up to 64% experiencing comorbid anxiety disorders. Past research has shown: 1) a bidirectional relationship between insomnia and anxiety, 2) associations between pain and insomnia and 3) associations between pain and anxiety. However, research has yet to explore the role of pain, specifically pain related disability, in moderating the association between insomnia and anxiety. The present study evaluated the moderating impact of self-reported pain related disability on the relationship between subjective sleep variables and anxiety scores in adults with fibromyalgia and insomnia (FMI).

Methods
Two-hundred and nineteen adults with FMI (Mage=51.53, SD=1.89, 92.8% female) completed daily sleep diaries over fourteen days, the Pain Disability Index (PDI), and the State-Trait Anxiety Inventory Form Y-1 (STAI-Y1) as part of the baseline for a larger randomized clinical trial (SPIN, NCT#02001077). Moderation analyses included STAI-Y1 as the dependent variable, sleep variables averaged over 14 days (Sleep Onset Latency- SOL, Wake After Sleep Onset-WASO, Total Sleep Time-TST, Sleep Efficiency-%SE) as independent variables, PDI as the moderator, and age and years of education as covariates. For moderation at significance levels of p&lt;0.05, significance of simple slopes at high (1 SD above), average, and low (1 SD below) PDI scores were examined.

Results
PDI moderated the relationship between SOL and STAI-Y1 (B=0.0052, SE=0.0019, p=0.01, R2=0.04). At high PDI scores (but not average), higher SOL was associated with higher STAI-Y1 scores (B=0.0748, SE=0.0310, p=0.02). At low PDI scores, higher SOL was associated with lower STAI-Y1 scores (B=-0.0844, SE=0.0453, p=0.06; trend).

Conclusion
Results indicate that at higher levels of perceived pain related disability, greater difficulty falling asleep is associated with increased levels of anxiety in FMI. At lower levels of pain related disability though, difficulty falling asleep and anxiety levels may have an inverse relationship. This points to a possible complex interplay between sleep difficulties, pain related disabilities and anxiety in the FMI population. Future research is warranted to examine potential causal relationships between pain, sleep, and anxiety.

Support (If Any)
NIAMS-R01AR055160(PI-McCrae)
0652 Associations Between Anhedonia and Maladaptive Beliefs About Sleep in Middle Age and Older Adults with Insomnia Disorder
Authors: Tully Isabelle , Tutek Joshua , Gumport Nicole , Simpson Norah , Dietch Jessee , Palaniappan Latha , Manber Rachel 
Published: May 2022

Abstract

Introduction
Comorbid depression often exacerbates dysfunctional beliefs about sleep in those with insomnia disorder. Anhedonia, a core symptom of depression, may be mechanistic in this association. Previous research suggests that, when appraising potential decisions, individuals with anhedonia regularly overestimate the probability of negatively valenced outcomes and underestimate the likelihood of positive outcomes. This study explores the relationship between anhedonia and sleep-related cognitions in patients with insomnia disorder.

Methods
Adults 50 years and older (N = 241) who met DSM-5 criteria for insomnia disorder were enrolled in a randomized controlled trial assessing the effectiveness of a stepped care approach to delivering Cognitive Behavioral Therapy for Insomnia. At baseline, participants completed the Dysfunctional Beliefs and Attitudes about Sleep Scale, Pre-Sleep Arousal Scale (cognitive subscale), Beliefs about Medications Questionnaire (Subscales assess the belief that hypnotics are necessary and concern regarding consequences of use), and PROMIS sleep-related impairment short form. A t-test was used to compare participants who did and did not endorse anhedonia on the Geriatric Depression Scale (GDS). We also correlated the Patient Health Questionnaire-4 (PHQ-4) anhedonia item with sleep-related cognition measures.

Results
Participants reporting anhedonia (GDS) endorsed greater dysfunctional beliefs about sleep (p &lt; .001, d = 0.44) and sleep-related impairment (p &lt; .01, d = 0.39). Groups did not differ significantly regarding belief in the necessity of sleep medications and concern with hypnotic use, nor in pre-sleep arousal. Higher anhedonia (PHQ-4) was correlated with more severe dysfunctional beliefs about sleep (r = .20, p &lt; .01), belief in the necessity of hypnotics to manage sleep disturbance (r = .22, p &lt; .001), and greater pre-sleep arousal (r = .18, p &lt; .01).

Conclusion
Endorsement of anhedonia was associated with stronger dysfunctional beliefs about sleep in this sample of middle age and older adults with insomnia disorder. Participants reporting anhedonia also reported greater sleep-related impairment. Exploring anhedonia as a transdiagnostic symptom that influences interpretation of sleep-related difficulties may elucidate underlying mechanisms that sustain maladaptive cognitions. Prospective, multi-method studies will be essential to clarify predictive interactions between reward system dysfunction and sleep-related beliefs in those with insomnia disorder.

Support (If Any)
1R01AG057500