bluuebunny/crossref_metadata_2025_split huggingface dataset:
0603 Changes in Healthcare Visits and Exercise habits Associated with Poor Sleep in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Kokonda Manasa , Debian Ahmad , Arentson-Lantz Emily , Shaib Fidaa , Nowakowski Sara 
Published: May 2022

Abstract

Introduction
Patients may be experiencing increased stress and sleep disturbance due to healthcare and changes in daily habit during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and daily habits on sleep.

Methods
Sleep medicine clinic patients completed an online survey during the pandemic and again 6 months later (December 2020 - May 2021), where they answered questions about COVID-19 (COVID-19 vaccination and test results, changes in health care visits and habits during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). General linear regression model was performed using SAS to determine if changes in healthcare and daily habits predicted poorer sleep.

Results
Among 81 patients who completed baseline survey, 54 (aged 55.2±18.4 y, 61% female, 70% Caucasian) completed the 6-month follow-up survey. Among them, 6% tested positive for COVID-19 and 83% were vaccinated. 30% changed their healthcare office appointments to telephone visits, 50% changed to video visits; whereas 22% cancelled and 30% rescheduled their healthcare appointments. At baseline, changes in health care visits had significant increase on ISI (3.98 ± 1.66, p=0.02). Upon follow-up, changes in health care visits had significant increase on ISI (4.77 ± 2.12, p=0.03) and Sleep Impairments (7.97 ± 3.83, p=0.04). A decrease in exercise predicted lower Sleep Disturbance (6.81 ± 3.31, p=0.04).

Conclusion
Sleep medicine patients who reported changes in health care visits at baseline and 6-month follow up reported higher insomnia severity, and sleep-related impairments. Changes in healthcare had deleterious effects on sleep and should be considered when managing patients’ healthcare. Unexpectedly, patients who reported a reduced level of exercise reported improved sleep. Pandemic public policies (e.g., gym closures) may have made it more difficult to exercise but allowed for greater opportunity to 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).
0606 A Paradigm for Testing the Accuracy of Digital Sleep Staging Systems
Authors: Gerardy Bethany , Tomson Heather , Kuna Samuel , Pack Allan , Walsh James , Kushida Clete , Younes Magdy 
Published: May 2022

Abstract

Introduction
Despite evidence showing that agreement between human and some automatic staging systems is generally comparable to agreement between human scorers, automated scoring is rarely used in clinical practice, even though it offers time savings and consistency. We propose a paradigm for testing digital systems that reveals their true accuracy vs. highly experienced academic scorers. As an example of a digital method to be tested, we used Michele Sleep Scoring (abbreviated:Digital).

Methods
70 PSGs were scored by 6 experienced technologists from 3 academic centers. Staging results were compared to digital staging results using an epoch-by-epoch approach. For each PSG we carried out 6 cycles of comparisons. Each cycle consisted of two steps, one comparing one scorer (tested scorer) with the scoring of the five remaining scorers (judges), and one comparing Digital as the tested scorer with the same 5 judges. Error 1 was assessed when all judges disagreed with the tested scorer but there was disagreement between the judges. Error 2 was assigned when all judges disagreed with the tested scorer but agreed unanimously on the stage. For each PSG the number of epochs with types 1 and 2 errors was counted for each scorer (n=6 scorers) and for Digital. Results of all 70 PSGs were pooled, and percent of types 1 and 2 errors is reported for all scorers and Digital.

Results
70 PSGs (females aged 51.1 ± 4.2 years) were evaluated. Average times in different sleep stages (manual scoring) were 43±18, 244±47, 30±21, and 81±25 minutes for stages N1, N2, N3 and REM, respectively. TST was 398±52 minutes, and sleep efficiency was 84±8%. There was a total of 65,053 epochs scored by each scorer and Digital. The average percent of type 1 errors made by scorers for all epochs was 6.4% (0-33.2) vs. 7.8% (1.68-26.6) made by Digital. The average percent of type 2 errors made by scorers for all epochs was 3.9% (0-28.6) vs. 4.3% (0-17.3) made by Digital.

Conclusion
This study provides an objective way of testing the accuracy of automated scoring systems and supports evidence that the accuracy of Michele Sleep Scoring is comparable to manual scoring.

Support (If Any)
None
0620 Is SVI a Risk Factor for Sleep and Cardiometabolic Health Among Blacks?
Authors: Locklear Clarence , Jin Peng , Seixas Azizi , Briggs Anthony , Rogers April , Turner Arlener , Blanc Judite , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
The Social Vulnerability Index (SVI) is a novel metric that incorporates a multitude of population factors to predict the susceptibility of communities to deleterious effects of disaster, natural hazards, and environmental insult. Studies show socioeconomic status (SES), an important component of SVI, is a risk factor for cardiometabolic disease and sleep quality. Objectives: This study examined the effect of SVI on cardiometabolic and sleep health among Blacks.

Methods
We utilized harmonized data extracted from two NIH-funded studies enrolling Blacks (i.e., MetSO and PEERS-ED registries). Participants (N=1,497) included New York residents; 65% were male, with a mean(SD) age of 55(±16.2). Data were collected via self-reports (e.g., ARES questionnaire) for sleep quality/duration and cardiometabolic factors (e.g., weight and diet). SVI components included SES, household composition, minority status, and housing type. Mixed-effect logistic regression models were applied, which assessed the effect of SVI and its many subcomponents on each health-related variable of interest. The model was adjusted for age, sex, and education to account for the effects of these factors overlapping in the SVI subcomponents.

Results
Approximately 81% of the sample population was obese, 37.9% were diabetic, 62.3% had a history of hypertension, and 18.4% with a heart disease. Regarding sleep health, 7.7% suffered from sleep apnea, 66.6% were short sleepers, 6.64% were long sleepers, and 14.2% reported insomnia. They had a mean(SD) sleep time of 5.92(±2.05) hours. “Overall SVI” was associated with hypertension (OR=3.98) and “housing type & transport” was correlated with heart disease (OR=4.44) prior to adjusting the model. Applying the adjusted model, “minority status & language” predicts obesity (OR=5.32). Also, “overall SVI” and “SES” were associated with diabetes (OR=3.26; OR=2.71) and hypertension (OR=4.00; OR=3.95). “Household composition” approaches significance as a predictor for sleep apnea (unadjusted - OR=0.26; adjusted - OR=0.26) despite the relatively low case proportion.

Conclusion
SVI seems to be a good indicator of cardiometabolic health among Blacks. However, it is likely a poor marker for sleep health in that population, although trends were observed suggesting that it might play an important role. Further studies are necessary to elucidate the role of SVI on sleep health among Blacks.

Support (If Any)
R01HL142066, R01HL095799, RO1MD004113, R01HL152453
0630 A 4-Week Sleep Intervention that Advances and Stabilizes Sleep Timing Leads To Meaningful Improvements in Pain and Physical Function in People With Fibromyalgia
Authors: Burgess Helen , Bahl Sonal , Wilensky Katelyn , Spence Emily , Jouppi Riley , Rizvydeen Muneer , Goldstein Cathy , Williams David , Kim Myra , Burns John 
Published: May 2022

Abstract

Introduction
Fibromyalgia is characterized by chronic widespread pain, mood and sleep disturbance, and affects over 20 million Americans. Pharmacological treatments (antidepressants, antiepileptics, opioids) often have small treatment effects and adverse side-effects. Exercise therapy requires significant patient motivation, and psychotherapy requires specialized personnel. Here we report on a randomized clinical trial in which we tested a 4-week sleep-wake scheduling intervention with either a dim or bright daily 1 hour morning light treatment.

Methods
Fifty-four adults (52 females, 18-78 years) meeting ACR 2011 diagnostic criteria for fibromyalgia completed a 5-week protocol. In the first week each participant slept at home, ad lib, on their usual sleep schedule. Thereafter, they followed a fixed sleep schedule and a daily 1-hour morning light treatment (randomized to dim or bright light). The sleep schedule advanced each participant’s individual sleep-wake timing by no more than 1 hour, and focused on stabilizing sleep timing. Participants were monitored with wrist actigraphy throughout the study. Outcomes were assessed at baseline, 2 weeks and 4 weeks after the intervention.

Results
The 4-week intervention resulted in an average 36-minute advance in participants’ sleep timing in both groups (ps&lt;0.001). Night-to-night variability in sleep timing also significantly decreased in both groups (ps&lt;0.01). Pain and physical function improved equally in both groups (Fibromyalgia Impact Questionnaire-Revised, PROMIS Pain intensity, PROMIS Physical Function, ps&lt;0.01). Across both groups, a greater shift in morningness (Owl-Lark score) was associated with a greater reduction in depressive symptoms (PHQ-9; r=-0.45, p&lt;0.001). No significant side effects were reported in either group. Treatment expectations were not significantly correlated with symptom improvement (all rs nonsignificant).

Conclusion
Results suggest that 4 weeks of an advanced and stabilized sleep schedule can lead to meaningful improvements in pain and physical function in people with fibromyalgia. The addition of a bright vs. dim morning light treatment did not further increase symptom improvement. A reduction in depressive symptoms during the intervention may have contributed to the improvements in pain and physical function. Sleep-wake scheduling should be further explored as a potentially feasible, acceptable and effective adjunctive non-pharmacological treatment for fibromyalgia.

Support (If Any)
Grant awarded from NINR R21 NR016930.
0632 Early sleep-disordered breathing in moderate-to-severe traumatic brain injury (TBI) is linked with chronic pain status at long-term follow-up: A TBI Model Systems study
Authors: Martin Aaron , Tang Xinyu , Pinto Shanti , Hoffman Jeanne , Schwartz Daniel , Wittine Lara , Walker William , Kane Georgia , Takagishi S , Nakase-Richardson Risa 
Published: May 2022

Abstract

Introduction
Sleep disorders and chronic pain (pain of &gt;3 months duration) are common after traumatic brain injury (TBI). A recently completed multi-center trial found that two-thirds of adults with moderate-to-severe TBI had sleep apnea diagnosed during polysomnography (PSG) completed during inpatient rehabilitation. Although a bidirectional relationship between sleep and pain exists, attention to sleep apnea as a specific diagnosis and its possible role in chronic pain following TBI has not been explored. We hypothesized that PSG-derived respiratory indices shortly following TBI would be worse among those reporting chronic pain at 1- to 2-year follow-up compared to those without chronic pain.

Methods
Sample (N=66) derived from overlapping cohorts across two separate multicenter studies. Participants with moderate to severe TBI underwent PSG during inpatient rehabilitation and completed a telephone follow-up interview to assess chronic pain status using standardized measures at 1-2 years post-TBI (610-day average). Pairwise comparisons across participants with and without chronic pain were made to determine the magnitude of clinically significant differences on respiratory indices including oxygen desaturation, central and obstructive apneas, and total apnea-hypopnea index (AHI).

Results
Presence of chronic pain at follow-up was associated with elevated central apnea events (2.6) and oxygen desaturation (19.6) relative to those without chronic pain (0.8 and 7.9, respectively). Important differences were also seen between obstructive and total apnea hypopnea index (AHI) using Centers for Medicaid and Medicare Services scoring criteria, with those in the chronic pain cohort being 6.5 and 8.7 points higher than their non-pain counterparts, respectively. Group differences on obstructive and total AHI were considered minor when using the American Academy of Sleep Medicine scoring criteria, although those with current pain experienced categorically worse sleep apnea (total AHI = 19 versus 12.4).

Conclusion
This is the first study to find an association between PSG-derived respiratory indices and long-term chronic pain status following moderate-to-severe TBI. Sleep apnea represents an important modifiable factor following injury that may contribute to long-term pain-related outcomes. Given the prominence of chronic pain several years post injury, future studies should investigate the role of sleep apnea and early intervention among those following moderate-to-severe TBI to determine impact on long-term rehabilitation and pain outcomes.

Support (If Any)
PCORI; CER-1511-33005); VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901.
0634 Symptoms of insomnia and depression among individuals with Multiple Sclerosis before and during the COVID-19 – results from a prospective longitudinal study
Authors: Sadeghi-Bahmani Dena , Mohammadian Youkhabeh , Piri Nahid , Bahmani Laleh Sadeghi , Brand Serge , Goldstein-Piekarski Andrea , Khazaie Habibollah , Gross James 
Published: May 2022

Abstract

Introduction
There is some -- but inconsistent -- evidence that sleep and psychological health have deteriorated in the general population as a result of the COVID-19-pandemic and its related social restrictions. In the present study, we investigated whether and to what extent symptoms of insomnia, depression, fatigue, and paresthesia changed from before to during the COVID-19-pandemic among women diagnosed with multiple sclerosis (MS).

Methods
A total of 90 women with MS (mean age; 37.62 (SD = 8.61) years; EDSS score: median: 2.5 (range: 0-6.50)) completed a series of self-rating scales at two time-points: Nine months before the COVID-19-outbreak in May 2019 (baseline) and during the COVID-19-pandemic (study end; 12 months after baseline: May 2020). Self-rating questionnaires covered sociodemographic and disease-related information, symptoms of insomnia, depression, fatigue, and paresthesia.

Results
Symptoms of depression increased over time (medium effect size: Cohen’s d = 0.53), while symptoms of insomnia (small effect size: Cohen’s d = 0.43), fatigue (trivial effect size: Cohen’s d = 0.19), and paresthesia (trivial effect size: Cohen’s d = 0.08) did not. The only predictor for insomnia during the COVID-19-pandemic was insomnia before the COVID-19-pandemic (β = 0.36; p = 0.001); the only predictor for depression during the COVID-19-pandemic was insomnia before the COVID-19-pandemic (β = 0.66; p = 0.001).

Conclusion
Overall, among a sample of female individuals with MS the COVID-19-pandemic and its related social restrictions may have had a modest influence on participants’ core concerns of insomnia, depression, fatigue, and paresthesia.

Support (If Any)
0638 Circadian rhythms among youth with craniopharyngioma
Authors: Kamara Dana , Crabtree Valerie McLaughlin , Crowley Stephanie , Hancock Donna , Semko Joshua , Merchant Thomas , Mandrell Belinda 
Published: May 2022

Abstract

Introduction
Craniopharyngioma is an intracranial tumor located in the hypothalamic and pituitary region. Despite high survival rates for youth with craniopharyngioma, quality of life is substantially affected. Morbidity includes high rates of sleep disruption, particularly disorders of hypersomnolence. Circadian rhythms may also be affected due to the proximity of the tumor and subsequent treatment to the hypothalamic-pituitary-adrenal axis, though the role of circadian rhythms has been less studied in this patient population. To evaluate circadian rhythms among youth with craniopharyngioma, dim light melatonin onset (DLMO), an established marker of the circadian system, was estimated.

Methods
Fifty-five patients between the ages of 7 and 20 years participated in this study. Data were collected prior to completion of proton therapy (if indicated). Participants provided hourly saliva samples, in their homes, starting 3 hours prior to habitual bedtime until 1 hour following in dim light conditions (&lt;30 lux). DLMO was calculated based on a threshold of 4 pg/ml. Participants also wore actigraphs to measure sleep patterns. We derived bedtime and waketime from actigraphy and calculated phase angles to bedtime and waketime. DLMO timing and phase angles were compared to published norms for healthy youth ages 9 to 17 years.

Results
DLMO could not be estimated for almost half of the sample (n=25), most often due to a melatonin value above the threshold at the first collection time point. Higher grade of hypothalamic involvement and the presence of diabetes insipidus predicted inability to capture DLMO. Subsample analyses of participants with DLMO (n=30) showed later DLMO timing and shorter phase interval to bedtime than the healthy reference sample.

Conclusion
With standard practice for DLMO estimation, we only obtained estimates for slightly more than half our sample. This may reflect circadian rhythm disturbances or advanced circadian phase. Relative to published norms, those with captured DLMO had later DLMO timing and shorter phase angles to bedtime, indicating sleep at an earlier circadian phase. These findings suggest possible circadian rhythm disruption in pediatric craniopharyngioma. Methodological differences among samples may also contribute to findings. Further examination of circadian rhythm disruption and relations with other sleep disturbances is needed.

Support (If Any)
This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.
0666 Sleep Quality and Depression Among High-Risk Perinatal Women: Impact of the COVID-19 Pandemic
Authors: Okun Michele , Kohl Vanessa , Wisner Katherine 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has negatively impacted sleep and mood on a global scale. To date, a handful of studies have reported on sleep and mood in perinatal women during the pandemic. They suggest that many pregnant women have poor sleep quality and depression. However, since these studies are cross-sectional with no comparison group, it is difficult to determine whether they are suffering more now.

Methods
The current study compared sleep quality and the presence of likely clinical depression in perinatal women from two studies (one prior to the pandemic (~1998)) and one during the pandemic (Aug 2020 – April 2021). All women had a history of MDD/PPD. Sleep quality and depression were ascertained at ~36 weeks and 4 weeks postpartum for both groups. Sleep quality was characterized by the Pittsburgh Sleep Quality Index (PSQI). Depression was ascertained by the Hamilton Depression Rating Scale (HRDS) for the non-pandemic group and the Edinburgh Postnatal Depression Scale (EPDS) for the pandemic group. PSQI scores were analyzed continuously and categorically, while the depression scales were categorized according to published cutoffs.

Results
The Mage = 31.1 (4.2) and did not differ between groups; 84% were White. Sleep quality in late pregnancy did not differ between groups (7.62 (3.5) vs 7.16 (3.8), (ns), pre-pandemic vs pandemic), but they did differ at 1 month PP (7.10 (3.1) vs 8.7 (2.6), P &lt; .001). The number of women who met criteria for depression in late pregnancy differed (28(41.1%) vs 7 (7.5%) X2 = 26.1, P &lt; .001), but not at 1 month PP (9 (13.2%) vs 18(19.3%), X2 = 1.05, P = .31). Sleep quality in late pregnancy was correlated with whether a woman met criteria for depression during pregnancy (r = .22, P = .005), but not at 1-month postpartum (ns).

Conclusion
Our findings suggest that the pandemic negatively impacted sleep quality in the first month postpartum, but not the rate of depression. We interpret these findings with caution due to varying methodologies. The pre-pandemic group was a RCT of 4 drug treatment groups in postpartum, and the pandemic group women used the SNOO®, a robotic, responsive bassinet.

Support (If Any)
Happiest Baby, Inc
0679 CBT-I for Psychosis Leads to Reduced Insomnia Severity and Improved Sleep-Related Functioning in Veterans with Psychosis and Insomnia: Results from a Preliminary RCT
Authors: Klingaman Elizabeth , Fischer Melanie , Howell Mary Katherine , Brown Clayton , Li Lan 
Published: May 2022

Abstract

Introduction
People with psychosis often suffer from insomnia. Even when psychotic symptoms are well-controlled, sleep disturbances persist, which puts these individuals at a higher risk of psychiatric relapse. We have developed guidelines and materials for conducting CBT-I with people living with psychotic disorders so it can be conducted according to their needs and experiences.

Methods
We conducted a preliminary efficacy study comparing CBT-I using novel psychosis-specific guidelines against an active treatment control (Health and Wellness [HW] intervention). Veterans with insomnia and psychosis (N=47) completed the Insomnia Severity Index (ISI), Functional Outcomes of Sleep Questionnaire (FOSQ), and Veterans RAND-36 (VR-36) at baseline, post-treatment, and 3-month follow-up.

Results
Participants (mean age=52 years) were primarily Black (55.3%), male (76.6%), and not married (76.6%). Using a repeated measures model (SAS proc mixed), mean change from baseline was compared between CBT-I for psychosis and HW at post and follow-up. There was a significant group difference on ISI at post (t=-2.07, df=46, p=.044, Cohen’s d=-.70), but not follow-up (t=-0.22, df=46, p=.827, Cohen’s d=-.10). Similarly, there was a significant group difference on the FOSQ at post (t=2.21, df=46, p=.032, Cohen’s d=.46), but not follow-up (t=1.05, df=46, p=.298, Cohen’s d=.33). The VR-36 Physical Component Scale showed no group difference at post (t=-1.43, df=46, p=.159, Cohen’s d=-.35), but a difference at follow-up (t=-3.11, df=46, p=.003, Cohen’s d=-.67) favoring the HW group, although about 50% were lost to follow-up on this item. For the VR-36 Mental Component Scale, there was no significant group difference at either timepoint (t=.20, df=46, p=.841, Cohen’s d=.05; t=.77, df=46, p=.444, Cohen’s d=.26).

Conclusion
At both post and follow-up, the CBT-I group surpassed estimated thresholds for clinically important improvements in both insomnia severity and sleep-related functioning, whereas HW did not. CBT-I for psychosis should be investigated with a larger, fully-powered randomized controlled trial, using sleep-specific functioning outcome measures.

Support (If Any)
This material is the result of work supported by: resources and facilities at the VA Maryland Health Care System, Baltimore, Maryland; the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2RX001836 (NCT02535923), PI: Elizabeth A. Klingaman. Contents do not represent the views of the U.S. Government or Department of Veterans Affairs.