bluuebunny/crossref_metadata_2025_split huggingface dataset:
0686 Cognitive Behavioral Therapy for Insomnia to Reduce Cannabis Use: Results from a Pilot Randomized Controlled Trial
Authors: Arnedt J Todd , Conroy Deirdre , Stewart Haylie , Bohnert Kipling , Ilgen Mark 
Published: May 2022

Abstract

Introduction
Cannabis use, including use for insomnia, has increased significantly in the United States over the past decade. Cannabis use disorders and/or heavy cannabis use have been linked to numerous negative outcomes, including poor work performance, other substance use, increased risk of psychosis, and neurocognitive deficits. In a pilot randomized controlled trial, we compared telemedicine-delivered CBT for insomnia tailored to individuals regularly using cannabis for sleep (CBT-CB-TM) to sleep hygiene education (SHE-TM) for improving sleep and daytime functioning and for reducing cannabis use.

Methods
Adults with chronic insomnia who reported using cannabis for sleep at least three times weekly were recruited through advertisements and at local cannabis dispensaries and screened for disqualifying sleep, medical, and mental health disorders. Fifty-seven eligible participants (43 women, mean age 37.6 ± 12.8 years) were randomized to 6 sessions of CBT-CB-TM (n=30) or SHE-TM (n=27). Participants completed self-reported measures of insomnia (Insomnia Severity Index, primary outcome), daytime functioning (sleep beliefs, depression, and overall functioning) and cannabis use before and after treatment and at 8-week follow-up.

Results
Mixed models showed that scores improved more on the Insomnia Severity Index (β=-2.83, se=0.62, p&lt;.001) and Dysfunctional Beliefs and Attitudes about Sleep scale (β=-0.73, se=0.25, 9&lt;.006) in the CBT-CB-TM compared to SHE-TM condition. Small pre- to post-treatment reductions in the daily frequency of cannabis use were evident for CBT-CB-TM compared to SHE-TM participants (pre-post change: 0.60 ± 0.94 vs. -0.04 ± 0.35, p&lt;.007). Depression symptoms (PHQ-8: CBT-CB-TM 8.5 ± 0.7 to 6.8 ± 1.0 vs. SHE-TM 9.1 ± 0.7 to 7.0 ± 0.9, p&lt;.004), and overall functioning (SF-12 MCS: CBT-CB-TM 43.3 ± 1.9 to 50.8 ± 2.9 vs. SHE-TM 39.8 ± 2.0 to 51.6 ± 2.5, p&lt;.0005) improved in both conditions from pre-treatment through follow-up.

Conclusion
Telemedicine-delivered CBT for insomnia improved sleep and reduced cannabis use more than a matched behavioral placebo control in this pilot trial of adults using cannabis regularly for insomnia. These preliminary findings support the need for adequately-powered randomized controlled trials with longer follow-up periods to evaluate the efficacy of targeting insomnia to reduce problematic cannabis use.

Support (If Any)
R34 DA047466 (MPI: MA Ilgen, JT Arnedt)
0687 The circadian misalignment is associated with reduced slow-wave sleep in individuals with autism spectrum disorder
Authors: Ishii Toru , Chen Jenny , Parker-Fong Kai , Kawai Makoto , O'hara Ruth 
Published: May 2022

Abstract

Introduction
Sleep disturbances are one of the key features among individuals with autism spectrum disorder (ASD). Many studies have uncovered critical developmental links between cognition, behavior, and sleep. It is suggested that the circadian system desynchronization plays a vital role in the development of ASD. While research on sleep disruption and circadian disturbance has accumulated, only a few studies have investigated a relationship between sleep architecture and circadian rhythm of individuals with ASD to date. We aim to elucidate the relation using the methods of dim light melatonin onset (DLMO) and ambulatory PSG.

Methods
Eleven individuals with autism (3 females, age: 13.07 ± 4.76 years; age range: 8-23 years) were recruited. After a week of systematic desensitization, an ambulatory overnight PSG was conducted in the participant’s home. Participants collected saliva samples independently at home on two consecutive days. The first evening sample took place 3 hours before the average sleep onset time and continued each 30-minute interval afterward for a total of 5 evening samples. The DLMO was calculated for each day by plotting melatonin levels against the time of saliva sampling. Linear regression was used to determine the best-fit line equation for each plot to calculate when melatonin levels first reached 4 pg/mL and continued to rise.

Results
The percentage of Stage N3 sleep across the night was significantly negatively associated with phase angle (time between DLMO and sleep onset), revealing that Stage N3 percentage decreases as the phase angle increases. The Phase angle showed a significant positive association with REM percentage across the night. Additionally, a significant difference was found between the mean phase angle for the ASD subjects in this study and the mean phase angle expected from a group of age-matched, typically developing (TD) individuals.

Conclusion
Our data revealed that circadian misalignment in individuals with ASD is associated with sleep architecture characterized by reduced slow-wave sleep and increased REM sleep. Given the importance of slow-wave sleep for memory and cognitive functions, this finding may contribute to understanding the relationship between sleep alterations and brain development in ASD.

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0690 Greater variability of sleep disturbance is associated with executive functioning among people with schizophrenia
Authors: Patapoff Molly , Lee Ellen 
Published: May 2022

Abstract

Introduction
Sleep disturbance is common among people with schizophrenia (PwS) and has been found to be related to poorer cognition in both PwS and non-psychiatric comparison participants (NCs). However, previous findings have been inconsistent on which aspects of executive functioning are most impacted by sleep. Additionally, the relationship of sleep variability to cognition in PwS has yet to be explored. This study aims to further understand the link between cognitive dysfunction and disturbed sleep in PwS and inform future sleep interventions to improve functioning and disability in PwS.

Methods
The current sample includes 36 participants (18 PwS, 18 NCs) from the San Diego area who completed executive functioning assessments (Delis-Kaplan Executive Function System, D-KEFS). Participants wore a wrist-worn Fitbit activity tracker for a 7-day period to monitor their sleep and activity. Independent samples t-tests were used to examine differences in mean and variability of sleep measures (total sleep time or TST, wake after sleep onset or WASO, and efficiency) and cognitive function between patients and controls. Spearman correlations were run to identify preliminary relationships between cognitive performance and sleep in both groups.

Results
The PwS and NCs were comparable on sex (50% female, age (mean 53 ± 10 years) and race (majority Caucasian). PwS and NCs were similar in mean sleep and variability of sleep measures. PwS had significantly poorer performance in all cognitive domains (p &lt; 0.05). In the PwS, more variable WASO and sleep efficiency were significantly correlated with worse performance on visual-motor sequencing and motor speed tasks (rs = -0.56 to -0.66). Additionally, trending relationships were found between better executive function composite scores with both longer mean TST (rs = 0.43) and higher mean sleep efficiency (rs = 0.30) over the monitoring period. Data collection is ongoing, and updated results will be presented at the conference.

Conclusion
Poor sleep is a prominent problem in PwS and has been associated with deficits in various cognitive domains. The present study examines the relationships of mean and variability of sleep with executive functioning. Preliminary results found strong associations between worse and more variable sleep and cognitive performance that may strengthen as sample size increases.

Support (If Any)
National Institutes of Health [NIMH K23MH119375-01 (PI: Ellen E. Lee), NIMH R01MH094151-01 (PI: Dilip Jeste)]
0696 The Application of a QTc Risk Score in Patients with Obstructive Sleep Apnea
Authors: Patel Salma , Zareba Wojciech , Parthasarathy Sairam , Perez Karolina , Wendel Chris , Xia Xiaojuan , Patel Imran , Quan Stuart , Grandner Michael , Youngstedt Shawn , Miller Jerod , Woosley Raymond 
Published: May 2022

Abstract

Introduction
Evidence suggests that patients with obstructive sleep apnea (OSA) are at risk for QTc prolongation which, is a known risk factor for arrhythmias, sudden cardiac death and all cause mortality. QTc risk scores have been implemented widely to help physicians identify patients at risk for mortality however, these risk scores have not been routinely implemented in patients undergoing sleep studies or those diagnosed with OSA. The goal of this study was to evaluate the distribution of pro-QTc risk scores for patients with and without OSA diagnosed at our facility and its relationship to mortality.

Methods
Medical records of all patients undergoing a sleep study at our sleep center from 2/2012 through 8/2020 were analyzed. Patients were identified with or without OSA based on polysomnography or Type III home sleep study. The pro-QTc risk score was calculated with 1 point assigned for: female sex, QT-prolonging diagnoses and conditions, QT-prolonging electrolyte abnormalities, and QT-prolonging medications defined as medications with known and possible risk of torsades de Pointes based on the CredibleMeds website. Mortality was determined if a death date was noted in the electronic medical record.

Results
A total of 2,834 patient records (54% male, age 58 ± 16 years, n=106 dead) were evaluated. A total of 2,265 patients (age 58 ±15, 54% male, 89 dead) were identified as having OSA and 428 patients (age 54 ± 18, 41% male, 17 dead) did not have OSA. The remaining patients (n=141) had either central sleep apnea or a combination of both obstructive and central sleep apnea. A higher pro-QTc score was associated with greater mortality regardless of presence of OSA (HR 1.3, p&lt;0.0001, 95% CI 1.12 -1.46) after adjusting for age. The association of pro-QTc with mortality was not increased in the moderate or severe OSA groups compared to those without OSA or mild OSA (p=0.36).

Conclusion
Increased pro-QTc scores were associated with greater mortality in all patients undergoing sleep studies. OSA status did not affect this association.

Support (If Any)
American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140, 2L30HL154400-023), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)
0700 Prospective and Cross-sectional Associations Between Sleep Apnea and Disease in a Phenome-wide Analysis of a Clinical Biobank
Authors: Cade Brian , Hassan Syed , Dashti Hassan , Kiernan Melissa , Pavlova Milena , Redline Susan , Karlson Elizabeth 
Published: May 2022

Abstract

Introduction
The potential contributions of sleep apnea (SA) to the risk of developing many diseases remain unidentified due to survey limits in cohort studies. We aimed to identify novel associations between common comorbidities in participants with SA compared to matched controls in a clinical biobank by leveraging electronic health record (EHR) information informed by natural language processing (NLP)-based phenotyping. We also investigated the relationship between polysomnography (PSG) statistics and these diseases.

Methods
The sample from the Mass General Brigham Biobank was comprised of 4,876 NLP-defined SA adult cases and 12,314 controls matched on age, biological sex, BMI, race/ethnicity, and healthcare utilization with a “data floor” of minimal EHR information. Prospective (&gt;1 year post SA diagnosis) and cross-sectional analyses considered 527 merged PheCode groups of NLP-defined diseases with ≥1% prevalence. Sex-stratified analyses were also performed. Associations with case/control status were further analyzed using rank-normalized Apnea-hypopnea Index (AHI3p) and the percentage of sleep with hypoxemia &lt;88% (Per88) in 4,544 participants, adjusting for age, biological sex, BMI, and race/ethnicity in a smaller single-night clinic sample (57% with AHI3p ≥15).

Results
In prospective analyses, 170 diseases had significant odds ratios (OR) when comparing participants with SA versus controls following Bonferroni adjustment (p &lt; 3.3 × 10-5), 8 of which were confirmed using PSG. Lead associations included a broad range of pathophysiology (e.g. chronic pulmonary heart disease, tension headache, and chronic fatigue syndrome). Diseases with higher ORs in women compared to men included chronic pulmonary heart disease, chronic renal failure, congestive heart failure not otherwise specified (NOS), and gout (p for sex interaction ≤3.2 × 10-3). Significant associations with PSG traits included hypertensive heart disease, fluid overload, and heart failure NOS (p ≤7.8 × 10-5). 281 diseases significantly differed in cross-sectional analyses, 41 of which were confirmed using PSG. 37 of these 41 associated diseases had lower p-values for Per88 compared to the AHI3p.

Conclusion
Sleep apnea may contribute to disease risk across a broad range of pathophysiology, with increased sex-specific risks for multiple common comorbidities. Future work should investigate the specific role of hypoxemia in these associations.

Support (If Any)
NIH (K01-HL135405, R35-HL135818, U01-HG008685 and P30-AR070253).
0705 Association of high risk obstructive sleep apnea with atherosclerotic plaque, coronary stenosis and coronary artery calcium score in asymptomatic young and middle-aged adults in The Miami Heart (MiHeart) Study at Baptist Health South Florida
Authors: Walia Harneet , Saxena Anshul , Ali Shozab , Feldman Theodore , Fialkow Jonathan , Elizondo Javier Valero , Achirica Miguel Cainzos , Nasir Khurram 
Published: May 2022

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is associated with clinical cardiovascular disease (CVD). There are limited data evaluating association with subclinical CVD measured by cardiac computed tomography (CT). We hypothesized there would be significant association between high OSA risk and atherosclerotic plaque, coronary stenosis, and coronary artery calcium (CAC) score in Miami Heart Study cohort free of CVD.

Methods
Data from CVD free 2359 participants, age 40-65 years (May 2015-Sept 2018) from greater Miami were analyzed. Cardiac CT measured CAC, coronary plaque burden and stenosis. High OSA risk was defined as either OSA diagnosis and/or a high risk from Berlin questionnaire. Logistic regression examined association between high OSA risk (reference low OSA risk) and any plaque, coronary stenosis &gt;50%, and CAC (&gt; 0 and &gt; 100 vs 0) in unadjusted models, and after accounting for age, sex, race/ethnicity (model 2), and BMI, diabetes, high cholesterol, and smoking (model 3).

Results
800 (34%) participants had high OSA risk; were more likely to be male, Hispanic, with higher CVD risk factor burden compared to low OSA risk. High OSA risk had higher prevalence of any plaque (60% vs 44%), coronary stenosis ≥ 50% (8.3% vs 4.8%), CAC scores &gt;0-99 (34% vs 26%), and CAC score ≥ 100 (16% vs 12%), compared to low OSA risk (all p &lt; 0.05). High OSA risk was associated with higher odds of any plaque, coronary stenosis ≥ 50%, high-risk plaque features, CAC &gt; 0 and CAC ≥ 100 in univariable models. When adjusting for age, sex and race/ethnicity, these patterns persisted, with 1.58 higher odds of any plaque (95% CI 1.31, 1.91), 1.54 higher odds of coronary stenosis ≥ 50% (95% CI 1.08, 2.20), 1.37 higher odds of having CAC &gt; 0 (95% CI 1.13, 1.66). Associations became non-statistically significant when adjusting for CVD risk factors, except any plaque, which was independently associated after fully adjusted (OR 1.31 (1.05, 1.63).

Conclusion
Individuals with high risk for OSA, significantly prone for CVD risk factor, have higher likelihood for presence of any plaque, significant stenosis and CAC scores &gt; 0, with these associations mostly mediated by CVD risk factors.

Support (If Any)
Baptist Health South Florida
0709 The Efficacy of Home Sleep Apnea Tests Alone in Determining Optimal Treatment Modality for Sleep Disordered Breathing During the Height of the COVID-19 Pandemic
Authors: Tomkinson James , Cutrufello Nicholas , Grigg-Damberger Madeleine 
Published: May 2022

Abstract

Introduction
Home sleep studies have shown strong accuracy and reliability in diagnosing obstructive sleep apnea compared to PSG. Recent studies have suggested they can accurately detect central sleep apnea as well. The combination of better technology, stricter insurance requirements for in lab polysomnograms, and a rise in telemedicine has seen their utilization rapidly increase. Specifically, at the height of the COVID pandemic many sleep practices had to shut down their labs and rely on HSATs alone to evaluate patients with potential sleep disordered breathing.

Methods
The Albuquerque VA Sleep Center was one of these, which provided an opportunity to reflect on the effectiveness of this diagnostic modality over that timeframe. A total of 780 patients with suspected sleep disordered breathing were studied using ResMed ApneaLink II Machines from 3/16/21 to 7/1/21 while in lab PSGs were unable to be completed due to health and safety guidelines.

Results
Of these 780 patients, only 34 were determined to need further evaluation with an in lab titration study once the lab reopened. Given how few of these patients ended up with titration studies, no additional criteria were used to categorize them other than a provider deciding they needed the study. The charts of these patients were reviewed in detail to identify any common characteristics that could have contributed to them needing a more detailed evaluation with an in lab polysomnogram. This provided further information about the accuracy and reliability of HSATs, as well as traits of patients who would have been ideally studied with an in lab PSG instead.

Conclusion
Overall such a small percentage of patients, only 4%, needing further titration speaks to both the reliability of HSATs as diagnostic studies, and the effectiveness of remote titration through cloud based monitoring systems like AirView.

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0716 Risk for Heart Failure with preserved Ejection Fraction in patients with or without Obstructive Sleep Apnea
Authors: Schütz Sonja , Nguyen-Phan Andy , Konerman Matthew , Chervin Ronald , Hummel Scott 
Published: May 2022

Abstract

Introduction
Approximately two out of three patients with Heart Failure with preserved Ejection Fraction (HFpEF) have co-morbid sleep apnea, but the risk of HFpEF in patients who test positive for obstructive sleep apnea (OSA) is unknown.

Methods
Referred subjects (n=228) over the age of 18 underwent a diagnostic in-lab polysomnogram at the University of Michigan Sleep Laboratories between 1/8/2019-3/11/2020 and an echocardiogram within 12 months of their sleep study. Individuals with a known history of HFpEF were excluded (n=44). OSA was defined as an apnea-hypopnea-index (AHI) ≥ 5/hour. Clinical and echocardiogram variables were abstracted from the electronic medical record and used to determine H2FPEF scores (ordinal scale, range 0-9). The H2FPEF score is a validated predictor of HFpEF risk in patients with dyspnea. In the presence of dyspnea, a H2FPEF score ≥ 3 indicates a &gt;50% risk of HFpEF, though dyspnea was not assessed in this study. HFpEF probability (continuous variable) was determined using the corresponding online calculator. Linear regression was used to predict HFpEF probability based on AHI.

Results
The 184 subjects without a known diagnosis of HFpEF had a median age of 65 years (interquartile range (IQR) 51, 71). Seventy subjects (38%) were male, 150 (82%) had OSA, and the median AHI was 15 (7, 35). The median H2FPEF score was 3 (2, 5). Among 34 participants without OSA, 10 (29%) had an H2FPEF score ≥ 3, whereas among 150 participants with OSA, 59 (39%) had an H2FPEF score ≥ 3. Linear regression indicated that higher AHI is associated with a higher probability of HFpEF (β = 0.39, p=0.0001).

Conclusion
Many patients referred for polysomnography may be at high risk for HFpEF. Sleep-study-referred subjects without clinically-indicated echocardiograms were not assessed, but patients at sleep disorders centers who test positive for OSA may have a particularly high rate of undiagnosed HFpEF. Sleep physicians should consider a cardiology referral in appropriately screened patients.

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0717 Obstructive Sleep Apnea Symptom Subtype Transitions over Five Years are Associated with Increased Cardiovascular Disease Incidence Risk
Authors: Mazzotti Diego , Scott Paul , Morris Jonna 
Published: May 2022

Abstract

Introduction
Efforts to characterize clinical heterogeneity of obstructive sleep apnea (OSA) resulted in the identification and replication of symptom-based subtypes. Individuals with moderate-severe OSA that are excessively sleepy are at increased risk of cardiovascular disease (CVD). There is limited evidence about whether OSA patients that worsen their symptom presentation over time are at increased cardiovascular burden. This study aimed to assess the association between five-year transitions among OSA symptom subtypes and incidence of CVD in a community-based cohort.

Methods
Participants of the Sleep Heart Health Study with complete baseline and 5-year follow-up data on symptom presentation, polysomnographic data and CVD outcomes were included (N=2,643). We used latent transition analysis on 14 symptom items to determine symptom subtype transitions in participants diagnosed with OSA (apnea-hypopnea index [AHI]≥5) across both visits. The primary outcome was incidence of CVD, defined as first occurrence of a composite of coronary heart disease, heart failure or stroke after the follow-up visit (median CV follow-up: 6.7 years). Cox proportional hazards models were used to assess the association between symptom subtype transitions and CVD incidence, adjusted by relevant demographic and cardiovascular risk factors.

Results
Four OSA symptom subtypes were identified at baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy. When compared to participants without OSA at baseline and follow-up visits, those with OSA that transitioned from moderately sleepy to excessively sleepy had increased CVD incidence risk (HR=2.09; 95%CI=1.27-3.45; p=0.004), independent of other CV risk factors. Increased CVD incidence risk was also observed in participants who transitioned from moderately sleepy to excessively sleepy when compared to those that remained moderately sleepy (HR=2.02; 95%CI=1.20-3.40; p=0.008) and in participants who transitioned from disturbed sleep to excessively sleepy when compared to those that remained with disturbed sleep (HR=3.25; 95%CI=1.03-10.23; p=0.044).

Conclusion
Five-year transitions across OSA symptom subtypes are associated with increased CVD incidence risk when adjusted by other relevant cardiovascular risk factors. Participants that transitioned from moderately sleepy or from disturbed sleep to excessively sleepy were at higher CVD risk. Results of this study might inform the role of symptom progression on CVD risk in OSA.

Support (If Any)
American Heart Association (20CDA35310360), National Institutes of Health (U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL53938, U01HL53940, U01HL53941, U01HL64360 R24 HL114473, 75N92019R002).