bluuebunny/crossref_metadata_2025_split huggingface dataset:
0572 Sleep Quality Prior to Admission May Be Linked to Length of Stay in Older Intensive Care Unit Survivors
Authors: Elias Maya 
Published: May 2022

Abstract

Introduction
Older adults who are admitted to an intensive care unit (ICU) often experience daytime sleepiness and inactivity during hospitalization, yet it remains unclear how pre-hospital sleep may influence hospital outcomes. The aim of this study was to explore trends between pre-hospital self-reported nighttime sleep duration, post-ICU daytime sleep duration, and hospital length of stay (LOS) among older ICU survivors.

Methods
Thirty older ICU survivors who were functionally independent prior to hospitalization and were mechanically ventilated while in ICU were enrolled in the present pilot study. Actigraphy was used to estimate post-ICU daytime total sleep time (TST) for a daytime period (06:00-22:00) within 24-48 hours post-ICU discharge. The Pittsburgh Sleep Quality Index was used to estimate self-reported nighttime sleep duration prior to hospital admission, and participants were grouped into three categories: short sleep (5.5-7.5 hours), moderate sleep (7.5-9 hours), and long sleep (9-10.5 hours). Total hospital LOS in days was obtained via chart review. Descriptive statistics were used to explore trends between pre-hospital sleep duration, post-ICU daytime sleep duration, and hospital LOS.

Results
Of the 30 enrolled participants, 29 completed the post-ICU actigraphy observation period; one participant was transferred back to ICU for surgical complications. The mean post-ICU daytime TST among participants who reported short pre-hospital sleep was 6.54 hours, while the means for those who reported moderate and long pre-hospital sleep durations were 7.83 and 8.39 hours, respectively. Participants who reported short pre-hospital sleep had a mean hospital LOS of 14.1 days, while participants who reported moderate and long pre-hospital sleep durations had a mean LOS of 29.1 days and 29.2 days, respectively.

Conclusion
Older ICU survivors who reported shorter sleep at home prior to hospital admission tended to also sleep less during the daytime hours immediately following transition out of ICU, compared to those who reported longer sleep at home. In addition, older ICU survivors who reported shorter sleep at home tended to have shorter LOS, compared to those who reported longer sleep at home. Potential interventions may focus on increasing daytime activity in older ICU survivors who endorse frequent daytime sleepiness and long nighttime sleep at home.

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0574 Sleep Duration and Sleep Quality in Association with Risk of Prostate Cancer in the UK Biobank
Authors: Freeman Joshua , Saint-Maurice Pedro , Watts Eleanor , Patel Shreya , Moore Steven , Matthews Charles 
Published: May 2022

Abstract

Introduction
Studies of shift work suggest extreme sleep disruption may increase prostate cancer risk. However, studies evaluating sleep duration and quality are inconsistent due to low ascertainment of cases and whether subdomains of sleep quality were queried. Our objective was to evaluate sleep duration, multiple sleep quality domains, and prostate cancer incidence among a large, prospective cohort.

Methods
We conducted a secondary analysis among 219399 men aged 40-69 years without prevalent cancer enrolled in the UK Biobank (2006-2010). At baseline participants self-reported their usual sleep duration, difficulties falling or staying asleep, snoring, and falling asleep during the day. We used Cox-proportional hazards models to calculate hazards ratios and 95% confidence intervals for associations with prostate cancer risk. Models were adjusted for confounders. Given potential concerns of reverse causality due to nocturia from undiagnosed prostate cancers increasing sleep disturbances, we restricted the cohort to men with ≥4 years of follow-up in a sensitivity analysis.

Results
Over 6.7 years of follow-up, there were 5829 prostate cancer cases. Sleep duration (vs. 7-8 hours; &lt;5 hours HR: 1.08, 95% CI: 0.95, 1.22; 5-6 hours HR: 0.92, 95% CI: 0.85, 1.00; 6-7 hours HR: 0.97, 95% CI: 0.91, 1.03; 8-9 hours HR: 0.93, 95% CI: 0.84, 1.04; ≥9 hours HR: 1.09, 95% CI: 0.91, 1.31) was not associated with prostate cancer. Participants who reported “sometimes” (HR: 1.09, 95% CI: 1.02, 1.16) or “usual” (HR: 1.17, 95% CI: 1.09, 1.26) difficulties falling or staying asleep had greater prostate cancer risk compared to those who reported “never/rarely.” Snoring and falling asleep during the day were not associated with prostate cancer. Results were unchanged when restricting to men who had ≥4 years of follow-up.

Conclusion
In this large, prospective study, sleep duration, snoring, and falling asleep during the day were not associated with prostate cancer. However, men who had greater difficulties falling or staying asleep had greater prostate cancer risk. These results suggest that poor sleep quality rather than sleep duration may be an important consideration for prostate cancer.

Support (If Any)
This work was supported by the NIH Intramural Research Program Cancer Research Training Award, NCI.
0576 Impact of Obstructive Sleep Apnea on In-Hospital Mortality Due to Acute Myocardial Infarction - A Large Retrospective National Study of Veterans
Authors: Valenzuela Andrew , Razjouyan Javad Javad , Sharafkhaneh Amir , Agrawal Ritwick 
Published: May 2022

Abstract

Introduction
Ischemic preconditioning (IPC) is a phenomenon that refers to multiple, brief periods of myocardial ischemia followed by reperfusion. This counterintuitive preconditioning is thought to provide cardioprotection from subsequent prolonged ischemic events. Obstructive sleep apnea (OSA) may lead to IPC by frequent, recurrent short episodes of hypoxia and sympathetic stimulation. We hypothesized in patients who were admitted with acute myocardial infarction (MI), the presence of OSA was associated with improved survival during the hospitalization, likely due to IPC.

Methods
This is a retrospective cohort study utilizing national Veterans Health Administration (VHA) records. The cohort includes patients from 1999-2020 with a hospitalization for MI as the principal diagnosis. We confirm the OSA diagnosis using ICD9/10 codes. The primary outcome was in-hospital mortality during the index admission for acute MI. We reported the odds ratio (OR) of in-hospital mortality between with-OSA and without-OSA using logistic regression. We adjusted the OR (aOR) by age, gender, race, ethnicity, BMI, and Charlson Comorbidity index.

Results
Out of 4,237,444 veterans with any sleep diagnosis, 76,359 patients were hospitalized with a diagnosis of MI. We observed 30,116 with OSA (age, 64±10; BMI, 33±7) and 43,480 without OSA (age, 68±12; BMI, 29±6). The aOR of in-patient mortality was lower in with-OSA (n = 333[1.1%]; aOR, 1.86; 95% CI, 1.63 to 2.12) compared to without-OSA (n = 1,102[2.5%]; aOR, 2.02; 95% CI, 1.78 to 2.30). After stratifying the patients based on previous history of MI, the results remained the same.

Conclusion
We found that in patients admitted with acute MI, the OSA cohort was associated with lower mortality when compared to non-OSA cohort. We speculate that these differences may be attributed to IPC likely due to repetitive, chronic episodes of hypoxia in obstructive sleep apnea. Further research is warranted to elicit the clinical implications of ischemic preconditioning and OSA.

Support (If Any)
Culebras, A. Exploring the trail between cerebral ischemic aggravation and ischemic preconditioning. Obstructive sleep apnea leads the way. Sleep Medicine, Volume 67 ,2020, p 276-277Salman LA, Shulman R, Cohen JB. Obstructive sleep apnea, hypertension, and cardiovascular risk: epidemiology, pathophysiology, and management. Curr Cardiol Rep 2020;22(2):6
0579 The impact of intracranial EEG on sleep is independent of whether a craniotomy was performed
Authors: Tyner Kevin , Alsammani Abdallah , Hegeman Garnett , Stacey William , Gliske Stephen 
Published: May 2022

Abstract

Introduction
Patients with refractory epilepsy are often evaluated with intracranial electrodes prior to resection. While depth electrodes can be placed through small burr-holes, grids and strips generally require large craniotomies. We have observed many differences in patient experience between these two populations. As sleep is crucial for many aspects of health and healing, our objective was to quantify whether subjects with craniotomies had different sleep patterns.

Methods
We analyzed data from N=47 patients with refractory epilepsy who underwent intracranial EEG monitoring at the University of Michigan (N = 23 with craniotomies). Sleep stages were scored by a certified sleep technician using simultaneously recorded scalp EEG. To quantify sleep patterns, we computed the fraction and average bout-length of each state of vigilance.

Results
No statistical difference was found between subjects with or without craniotomies for any measure (p&gt;0.4, Wilcoxon Rank Sum). The median fraction of time awake for all subjects was 0.70 (0.65-0.74, 95% confidence interval). However, sleep architecture appeared altered, with median fraction of sleep time in NREM 1 being 0.07(0.06-0.09), NREM 2 being 0.16 (0.13-0.17), NREM 3 being only 0.01 (0.0-0.2) and REM being 0.05 (0.04-0.06). The median bout lengths for all stages of sleep was less than 5 minutes.

Conclusion
Intracranial monitoring appears to alter sleep similarly for both subjects who received craniotomies and those who had smaller burr-holes. The impact on sleep is not a significant factor when deciding between grid or depth electrodes.

Support (If Any)
National Institutes of Health (K01-ES026839 and R01-NS094399), and the Doris Duke Foundation (grant number 2015096).
0585 Use of a Hybrid Closed Loop Insulin Delivery System Improves Sleep and Glycemic Control in Adults with Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness
Authors: Malone Susan , Matus Austin , Peleckis Amy , Flatt Anneliese , Grunin Laura , Yu Gary , Jang Sooyong , Weimer James , Lee Insup , Rickels Michael , Goel Namni 
Published: May 2022

Abstract

Introduction
Insulin delivery and continuous glucose monitoring systems (CGMs) have been reported to disrupt sleep in individuals with type 1 diabetes (T1D), potentially thwarting the adoption and continued use of diabetes therapeutic technologies. This study assessed changes in actigraphic sleep and glycemic outcomes in individuals at high risk for life threatening nocturnal hypoglycemia after initiating a hybrid closed loop (HCL) insulin delivery system with integrated CGM.

Methods
10 adults (median age=51y) with long-standing T1D (median duration=34y) and hypoglycemia unawareness participated in an 18-month ongoing clinical trial assessing the effectiveness of a HCL system. Wrist actigraphs and CGMs measured sleep and glycemic control, respectively, at baseline (1 week) and at months 3, 6, 9, 12, 15, and 18 (3 weeks) following HCL initiation. Body mass index and hemoglobin A1c (HbA1c) were also collected at these timepoints. Hypoglycemia awareness was assessed using the Clarke hypoglycemia questionnaire, HYPO score, and glycemic lability index. Paired sample t-tests and Cohen’s d effect sizes modeled changes in sleep, glycemic control, and hypoglycemic awareness and the magnitude of these changes from baseline to 18 months.

Results
Sleep improved from baseline to 18 months [shorter sleep latency (p&lt;0.01), later sleep offset (p&lt;0.05), and less wake after sleep onset (WASO) (&lt;0.01)]. Medium effect sizes were found for later sleep onset (d=0.74) and later sleep midpoints (d=0.77). HCL also improved hypoglycemia awareness from baseline to 18 months [Clarke score (p&lt;0.01), HYPO score (p&lt;0.01), lability index (p&lt;0.05)]. Medium to large effect sizes were found for reduced nocturnal hypoglycemia (percent time glucose was &lt;54mg/dL,&lt;60mg/dL,&lt;70mg/dL; d=0.66 – 0.81), daytime and nocturnal hypoglycemia (percent time glucose was&lt;54mg/dL,&lt;60mg/dL,&lt;70mg/dL; d=0.61 – 0.69), and glucose variability (coefficient of variability; d=0.62).

Conclusion
HCL insulin delivery with CGM improved sleep over time as indicated by shorter sleep onset latency, later sleep offset, and less WASO. HCL insulin delivery also improved hypoglycemia awareness and led to clinically significant reductions in hypoglycemia and glucose variability.

Support (If Any)
NIH (R01DK117488 (NG), R01DK091331 (MRR), K99NR017416 (SKM), and UL1TR001878 (University of Pennsylvania Center for Human Phenomic Science)). National Aeronautics and Space Administration (NASA) (NNX14AN49G and 80NSSC20K0243 (NG)) and from the Pennsylvania Department of Health (SAP 4100079750 (IL)).
0586 Extending Sleep in Short Sleeping Middle-aged Adults at Risk for the Metabolic Syndrome
Authors: Malone Susan , Patterson Freda , Hoopes Elissa , Wong Agnes , Grunin Laura , Yu Gary , Dickson Victoria , Melkus Gail 
Published: May 2022

Abstract

Introduction
Short sleep predicts the metabolic syndrome (MetS). Extending sleep improves certain MetS factors, specifically insulin sensitivity and blood pressure in adults without MetS. The absence of sleep intervention studies in community-dwelling adults with MetS limits progress in advancing sleep extension interventions to this subgroup. This study evaluated the feasibility, acceptability, and impact on End-of-Treatment (EOT) sleep outcomes of a 12-week sleep intervention.

Methods
Middle aged adults who were short sleepers and at risk for METs participated in a single-arm 12-week, 12-session sleep intervention based on cognitive behavioral therapy for insomnia delivered via videoconferencing platform. Feasibility and acceptability were assessed using retention and attendance rates as well as mean sleep diary completions (≥4 diaries/week). Anticipated (baseline) and experienced (EOT) acceptability were assessed using a 16-item survey that estimated self-reported acceptability, feasibility, perceived benefit, satisfaction, and overall satisfaction. Sleep was estimated from baseline and EOT 2-week wrist actigraphy data. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in acceptability, feasibility, perceived benefit, satisfaction, overall satisfaction, sleep and daytime sleepiness from baseline to EOT.

Results
The intent-to-treat sample included 44 adults (mean age 52y, 59% female, 41% Black, 48% White, 11% Other, 82% non-Hispanic). Three participants withdrew leaving N=41 (retention rate=93%). Eighty-six percent attended &gt;80% of sessions and mean sleep diary completion was 6.7 diaries/week. There were statistically significant changes in self-reported anticipated (baseline) and experienced (EOT) acceptability surveys indicating greater EOT acceptability (p&lt;0.001), perceived benefit (p&lt;0.001), satisfaction (p&lt;0.001), and overall evaluation (p&lt;0.001). Statistically significant improvements in sleep from baseline to EOT included increased time-in-bed (Mbaseline=6.00h SD= 0.68h – MEOT=7.48, SD= 1.21; p&lt;0.001), increased total sleep times (Mbaseline=5.16, SD= 0.63 – MEOT=6.26, SD= 1.23 p&lt;0.001), earlier sleep onsets (Mbaseline=12.26am, SD= 0.05 – MEOT=11.53pm, SD= 0.06 p&lt;0.05), more regular sleep onsets (Mbaseline=0.06, SD= 0.04 – MEOT=0.04, SD= 0.02 p&lt;0.01), a higher sleep regularity index (Mbaseline=44.02, SD= 17.25 – MEOT=55.88, SD= 12.82 p&lt;0.01), and reduced daytime sleepiness (Mbaseline=7.26, SD= 4.30 – MEOT=3.15, SD= 2.46, p&lt;0.001).

Conclusion
Extending sleep, as well as improving sleep timing and regularity in racially/ethnically diverse middle-aged short sleepers using a videoconferencing platform is acceptable and feasible.

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0589 REM Sleep Behavior Disorder is Associated with Poor Outcomes in Pulmonary Embolism Hospitlizations
Authors: Al Khateeb Mohannad , Laswi Hisham , Al Jabiri Yazan , Aldiabat Mohammad , Yusuf Mubarak , Horoub Ali 
Published: May 2022

Abstract

Introduction
REM Sleep Behavior Disorder (RBD), is a rare sleep behavior disorder, characterized by loss of skeletal muscle atonia during REM sleep, resulting in prominent motor activity with exhibited behavior mirroring the image of the dreams during sleep. Other sleep disorders were studied before in patients with Pulmonary Embolism (PE). Although, REM sleep behavior disorder association with pulmonary embolism has never been described. In this study we aim to study the prevalence of RBD in patients admitted with PE, and to assess the association between RBD and PE.

Methods
Adults with principal diagnosis of Pulmonary Embolism (PE) on discharge were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis. We queried the 2019 National Inpatient Sample for secondary diagnosis of RBD, Obstructive Sleep Apnea (OSA) and other secondary diagnoses (hyperlipidemia,history of old myocardial infarction, atrial fibrillation, Chronic obstructive pulmonary disease, hypertension, heart failure, smoking, chronic kidney disease , electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses.

Results
In a total of 188,355 hospitalizations with PE primary diagnosis on discharge were included from the 2019 national inpatient sample, 25 hospitalizations had concomitant secondary diagnosis with RBD. The overall in-hospital mortality for PE was 3.2%. On weighted analysis, Patients with RBD had statistically significant higher odds for mortality compared to patients without [adjusted odds ratio (OR): 17.15; 95% confidence interval (CI): 2.75-106.8, p= 0.002], 20% mortality rate in patients with RBD compared to 0.03% in patients without RBD (p= 0.03). OSA did not show significant result for mortality when compared to without OSA [adjusted odds ratio (OR): 0.83; 95% confidence interval (CI): 0.67-1.04, p= 0.114].

Conclusion
Our analysis showed a low number of patients with secondary diagnosis of RBD in hospitalizations with primary diagnosis of PE on discharge. However significant association between RBD and mortality in patients with PE primary diagnosis on discharge. The identification of patients with RBD in patients admitted with PE may help decrease mortality rate. Furthermore, our analysis showed that OSA is an independant variable for mortality in PE hospitalization.

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0604 Depression, Anxiety and Coping-avoidance Behaviors Associated with Long-Term Insomnia Symptoms During the COVID-19 Pandemic
Authors: Arentson-Lantz Emily , Kokonda Manasa , Debian Ahmad , Shaib Fidaa , Nowakowski Sara 
Published: May 2022

Abstract

Introduction
Stressful events, such as the COVID-19 pandemic, can have long-lasting, detrimental effect on sleep. It is important for practitioners to understand how their patients may be stil experiencing residual negative effects of the pandemic to optimize their care. In this study we evaluated how measures of self-reported measures of anxiety and depression during the COVID-19 pandemic predicted measures of sleep disturbnce 6 months later among sleep medicine clinic patients.

Methods
Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were recontacted 6 months later to complete the same surveys. 54 patients (55.2±18.4 y, 39% male, 70% Caucasian) completed the follow-up survey and were included in this present analysis. We conducted multivariate regression analyses to determine how the change in self-reported PROMIS measures from baseline during the pandemic were predictive of post-pandemc 6 month follow-up PROMIS measures and ISI.

Results
PROMIS depression score at baseline was predictive of both sleep disturbance (0.63 ± 0.15; p&lt;.0001) and sleep impairment (0.49 ± 0.18; p=0.01) 6 months later. Baseline brief coping avoidance also predicted 6 month sleep disturbance (0.85 ± 0.33; p&lt;0.009) and sleep impairment (0.85 ± 0.33; p=0.014) as well as ISI (0.52 ± 0.18 units; p=0.006). Baseline anxiety predicted ISI at 6 months (0.25 ± 0.09 units, p=0.009).

Conclusion
Higher levels of self-reported depression, anxiety and coping-avoidance behaviors during the COVID-19 pandemic lead to long-lasting increase in sleep disturbance and impairment as well as insomnia. Addressing depression, anxiety and coping behaviors that occur as result as a stressful event is advised to avoid long-term detrimental effects on sleep.

Support (If Any)
This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0605 Longitudinal assessment of CPAP use in Sleep Medicine Clinic Patients during the COVID-19 Pandemic
Authors: Nowakowaki Sara , Teague Taylor , Kokonda Manasa , Debian Ahmad , Arentson-Lanz Emily , Malhotra Sonal , Shaib Fidaa 
Published: May 2022

Abstract

Introduction
Due to the COVID-19 pandemic, there may be changes in continuous positive airway pressure (CPAP) adherence. This study aimed to examine the longitudinal effect of using CPAP as advised and self-reported sleep quality improvements in sleep medicine clinic patients using CPAP early in the pandemic and six months later.

Methods
Between June-November 2020, 81 sleep medicine clinic patients completed an online survey that included questions about CPAP use, using CPAP as advised, and changes in sleep quality associated with CPAP use. Patients were recontacted 6 months later to complete the same survey. Among survey respondents completing both surveys, 27 (50%; aged 58±18.2 y, 48% female, 67% Caucasian) reported using CPAP and were included in the present analysis. We conducted multivariate regression analyses Chi-square Association tests to determine whether self-reported CPAP use, CPAP use as advised, and sleep quality changed from baseline to 6-month follow up during the pandemic.

Results
Among CPAP users, 89% reported no change, 7% reported they use CPAP more, and 4% reported they use CPAP less at 6-month follow up. There was a significant increase in using CPAP as advised at 6-month follow up compared to the baseline survey, p=0.003. Additionally, there was a significant improvement self-reported sleep quality while using CPAP at 6-month follow up compared to the baseline survey, p=0.012.

Conclusion
Patients reported an increase in using CPAP advised and improvements in sleep quality as a result of CPAP use at 6-month follow up compared to a baseline survey administered early in the pandemic. Understanding why patients are more adherent to using CPAP as advised during the pandemic may help in developing interventions to increase CPAP adherence.

Support (If Any)
This work is supported by National Institutes of Health Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).