bluuebunny/crossref_metadata_2025_split huggingface dataset:
0808 Worsening central sleep apnea: A sole diagnostic marker of a brain tumor in a child
Authors: Mechineni Ashesha , Pattisapu Anil , Mann Harkirat , Adavadkar Pranshu 
Published: May 2022

Abstract

Introduction
Central sleep apnea (CSA) in children is a relatively uncommon and under-studied sleep disorder. A small subset of patients may have intracranial anomalies, but clinical presentation varies. We present a case of malignant intracranial tumor diagnosed primarily due to the unusual presentation and progression of CSA.
Report of Cases: The presented patient is a 12-year-old developmentally appropriate female with a history of obstructive sleep apnea (OSA) status post adenotonsillectomy at two years of age who presented with snoring without witnessed apnea, sleep interruptions, and unrefreshing sleep. Other sleep-related history was unremarkable. No daytime sleepiness or behavioral or learning concerns were noted. Physical examination was unremarkable with normal growth parameters. Initial diagnostic PSG demonstrated severe OSA with an obstructive apnea-hypopnea index (OAHI) of 16/h and mild CSA (CAI:6.7/h); therefore, PAP therapy was pursued after ruling out adenoid regrowth. However, during the first PAP titration study(incomplete study due to mask intolerance), treatment-emergent central apneas were noted (OAHI: 9.8/h; CAI:25.8/h), which were noted even during the second titration study (OAHI:2.7/h; CAI:59.2/h). Even though ordered earlier, the brain MRI was not performed until after the repeat PSG one year later showed persistence of severe CSA (OAHI of 4.5/h and CAHI of 39.5/h) after much persuasion. Interestingly, snoring had reportedly improved with no daytime symptoms or neurologic complaints. The brain MRI demonstrated compressing brainstem lesion highly suspicious for glioma. The patient was emergently sent to neurosurgical care and had chosen hospice care after a few weeks.

Conclusion
CSA can be an early or the only finding in patients with brainstem tumors, even before neurologic signs and symptoms. The PSG findings changed from mild CSA to treatment-emergent CSA to severe CSA, possibly with the progression of underlying disease. Close follow-up and ensuring patient compliance are essential in CSA patients. CSA severity should prompt MRI brain even with an intact neurological examination. More research is needed to fully understand the link between cerebral disease and polysomnographic data. This could aid in early diagnosis and treatment.

Support (If Any)
no conflicting or financial interests to disclose
0814 Three Sleepy Siblings
Authors: Guzman Maria Paula , Trotti Lynn Marie 
Published: May 2022

Abstract

Introduction
Narcolepsy type 1 is caused by destruction of hypocretin-producing neurons, likely via a T-cell mediated autoimmune process, and clinically identified either by CSF hypocretin deficiency or the presence of cataplexy. Individuals with narcolepsy type 1 have an underlying genetic predisposition attributed to the HLA DQB1*0602 gene. This genetic variant has been linked to increased propensity for sleepiness even in healthy adults. Relatives of patients with narcolepsy type 1 appear to be at increased risk for other disorders of hypersomnolence such as idiopathic hypersomnia. Here we describe three siblings, all positive for HLA DQB1*0602, who presented with distinct clinical features diagnostic for narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia.
Report of Cases: A 15-year-old female was diagnosed with narcolepsy type 1 based on typical cataplexy, excessive daytime sleepiness, and mean sleep latency of 2 min with 2 SOREMPs on MSLT. Lumbar puncture (LP) performed 5 years after symptom onset showed low CSF hypocretin (9.3 pg/mL). Her older brother presented at age 21 with excessive sleepiness, somewhat atypical cataplexy, hypnagogic hallucinations, and sleep paralysis. MSLT showed mean sleep latency of 6 min with 5 SOREMPs. Despite the presence of cataplexy, LP performed 2 years after symptom onset showed normal CSF hypocretin (296.5 pg/mL) and he was diagnosed with narcolepsy type 2. Their younger sister presented at age 19 with progressive daytime sleepiness. PSG/MSLT showed mild OSA (RDI 9.2) and mean sleep latency of 6.5 min without SOREMPs. She does not have cataplexy, hypnagogic hallucinations, or sleep paralysis. The current findings are most consistent with idiopathic hypersomnia, although an LP to evaluate for hypocretin deficiency is an important next step. Similarly, a repeat LP in the brother might demonstrate change in hypocretin over time.

Conclusion
These cases may support a familial link between narcolepsy type 1, type 2, and idiopathic hypersomnia. The discordant hypocretin and cataplexy statuses of these siblings implies a mechanism for excessive sleepiness beyond hypocretin deficiency, possibly mediated by HLA DQB1*0602. Identifying the mechanisms of familial aggregation of sleepiness in the central disorders of hypersomnolence may shed light on the pathophysiology of these distinct disorders.

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0825 A Case of Familial Restless Legs Syndrome and Raynaud's Phenomenon
Authors: Maniar Ninad , Walters Arthur S , Karroum Elias G 
Published: May 2022

Abstract

Introduction
Restless legs syndrome (RLS) is a common sensory-motor disorder that frequently leads to sleep disturbances and reduced quality of life. Raynaud's phenomenon (RP) is characterized by episodes of reduced blood flow mainly to the fingers due to vasospasms, with subsequent pain and discoloration, usually triggered by cold exposure or by stress. We present an interesting case report of co-occurrence and familial transmission of RLS and RP which has not been reported previously.
Report of Cases: A 64-year-old woman presented for evaluation of long-standing RLS. She had a history of RP, osteoarthritis (OA), and recurrent late pregnancy losses. The patient, and one brother and a sister had RLS and RP. She had another sister and two maternal first cousins with RLS. Her mother suffered from neither and her father and his brother both had RP. She has a daughter who also has RLS. The patient's mother was treated with Diethylstilbestrol (DES) and had five pregnancy losses. The patient also had 3 miscarriages and the patient's daughter miscarried her first pregnancy as well. The patient first experienced RLS symptoms at the age of 12 and has been treated with several medications since then, most recently clonazepam. Since she was taken off clonazepam, she experienced a worsening of RLS and was subsequently started on Pregabalin up to 300 mg at bedtime but without significant relief. She was then started on pramipexole, titrated up to 0.375 mg which resulted in significant improvement of RLS symptoms. Her RP symptoms were infrequent, occurring every few months and not bothersome. She did not report rheumatological complaints other than chronic OA from lifelong sports.

Conclusion
This case report suggests a possible shared genetic abnormality in the transmission of both RLS and RP in this family. This genetic association may be related to a vascular dysfunction common to both disorders. The co-occurrence of frequent miscarriages (although could be related to DES), in association with the presence of RLS and RP, may also suggest an underlying auto-immune disorder. Further genetic research is needed to confirm above findings with the potential uncovering of new therapeutic targets for RLS.

Support (If Any)
None.
0853 The role of sleep-disordered breathing in the optimization of pediatric epilepsy management
Authors: Youssef Nada , Gupta Gita , Romanowski Erin Fedak , Lewis Toby , Hassan Fauziya 
Published: May 2022

Abstract

Introduction
There is a known bidirectional relationship between epilepsy severity and disordered sleep; however, both the potential scoring limitations of polysomnograms (PSGs) of children with epilepsy and the effect of treatment of sleep disordered breathing (SDB) on epilepsy severity in these children remain poorly understood.
Report of Cases: We describe a 7-year-old male with a history of prematurity (ex-34 weeks), bronchopulmonary dysplasia, recurrent aspiration pneumonia, and refractory nocturnal epilepsy who experienced acute hypoxemic respiratory failure in the setting of co-infection with rhinoenterovirus and parainfluenza 4 virus. The patient’s epilepsy history is notable for multiple nocturnal seizures most days of the week for a period of several years. His mother endorsed that the nocturnal seizures began shortly after his SDB symptoms, and that the severity of his nocturnal seizures seemed to be associated with the quality of his sleep. Two years prior to admission, he underwent adenotonsillectomy for mild obstructive sleep apnea (AHI 2.5, REM AHI 8.9, minimum SpO2 86%). He continued to have persistent SDB symptoms (e.g. witnessed apneas, nocturnal arousals 5-10 times/night, daytime sleepiness) despite adenotonsillectomy. Notably, the background EEG (in the context of epilepsy) demonstrated obscured sleep architecture and led to unreliable staging of sleep states and cortical arousals. Given the disorganized background EEG, arousal-based hypopneas could have been underestimated.
In the setting of acute respiratory failure, our patient was hospitalized and treated with noninvasive ventilation for 6 days. Collateral benefits included improvements in SDB (evidenced by decreased nocturnal awakenings, lack of obstructive features) and reduction in seizure frequency. His mother noted that this hospitalization was the first time in years that her son did not experience nocturnal seizures.

Conclusion
Sleep apnea can be an important modifiable factor in the treatment of pediatric epilepsy. Some PSGs of children with epilepsy may be falsely reassuring given the potential difficulty with scoring cortical arousal-based hypopneas. Therefore, careful clinical correlation should be made between nocturnal seizures and sleep symptoms, even in the context of reassuring PSG parameters.

Support (If Any)
Cystic Fibrosis Foundation Training Grant, AIRE grant, NIH 2T32HL110952-06
0859 AVAPS to the rescue: A case of severe obstructive sleep apnea with treatment resistant to UPPP and CPAP in a pediatric patient with Prader-Willi syndrome
Authors: Hwig Nauras , Peng Victor , Diaz-Abad Montserrat , Lasso-Pirot Anayansi 
Published: May 2022

Abstract

Introduction
Prader-Willi syndrome (PWS) has a prevalence of 1/10,000 to 1/30000 and is the most common syndromic form of obesity. Prader-Willi syndrome is defined by a multitude of features that develop from early childhood to adolescents, but one of the primary developments is obesity in the setting of hyperphagia during early childhood. Due to the development of obesity, there is a high prevalence of obstructive sleep apnea (OSA) among PWS patients.
Report of Cases: A 6-year-old boy with PWS with a 2-year history of loud snoring underwent polysomnography (PSG) which showed severe OSA with Apnea-Hypopnea Index (AHI, events/h) 133.7. The patient underwent surgical intervention with a combined uvulopalatopharyngoplasty and adenotonsillectomy and a follow up PSG showed a residual AHI of 37. On CPAP titration the AHI improved to 1.2 with CPAP 14 cm H2O and the patient was discharged on home nasal CPAP. Over the next several years, the patient had suboptimal CPAP compliance. At 11 years of age, the patient was admitted to the intensive care unit (ICU) with volume overload –with a normal cardiac workup- and respiratory failure requiring high flow nasal cannula oxygen. Venous blood gas (VBG) showed pH 7.34 and severe hypercapnia with pCO2 73 mmHg c/w obesity hypoventilation syndrome (OHS). The patient was started on CPAP then changed to bilevel PAP ST with supplemental oxygen. Due to persistent hypercapnia in the high 60s noninvasive ventilation (NIV) was switched to Average Volume-assured Pressure Support with auto titrating EPAP (AVAPS-AE) with significant improvement in hypercapnia and overall tolerance. Discharge VBG showed pH 7.35 and PCO2 56 mm Hg. The patient was discharged home, is doing well and has avoided readmission for at least 6 months.

Conclusion
This case highlights the potential for newer modes of noninvasive ventilation with autotitrating EPAP to treat severe OSA with OHS and hypercapnic respiratory failure in patients with PWS and other conditions. With the growing obesity epidemic, rates of treatment failures with CPAP and traditional bilevel PAP therapy may increase and consideration of alternative modes of NIV therapy should be considered.

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Valerian and postoperative sleep: a retrospective cohort analysis of gynecological, urologic, and general surgical patients
Authors: Winter Anne-Sophie , Haverkamp Christian , Gratzke Christian , Huber Roman , Lederer Ann-Kathrin 
Published: May 2022

Abstract

Study Objectives
Postoperative sleep disturbances appear to be a common complication after surgery being treated with sleep-promoting medication such as valerian, but robust data and evidence of medicinal approaches are lacking.

Methods
We performed a retrospective cohort analysis of all 21 168 urological, gynecological, and general surgical patients of the University Medical Center Freiburg, Germany, who underwent surgery between 2015 and 2020. Target parameters were the usage of sleep-promoting medication to estimate the occurrence of postoperative sleep disturbances as well as the kind of sleep medication with a special focus on herbal medication such as valerian.

Results
Drug-treated sleep disturbances occurred in 15% (n = 3083) of the patients. Valerian was the second most applied drug (n = 814, 26.4%) after classic benzodiazepines (n = 1 138, 36.9%). The majority of patients got valerian as monotherapy. Age, length of stay, and comorbidities were associated with demand for sleep medication in general (p &lt; .001). Valerian monotherapy was more common in women (OR 1.53, 95% CI: 1.33–1.77, p &lt; .001), elderly patients (OR 1.50, 95% CI: 1.29–1.75, p &lt; .001), and patients with prolonged hospital stay (OR 2.23, 95% CI: 1.91–2.61, p &lt; .001).

Conclusions
Valerian plays an important role in the treatment of postoperative sleep disturbances clinically, and it appears to be a promising therapeutic approach especially in women, older and sicker patients, and those with prolonged hospital stay. Further research has to clarify the efficacy of valerian postoperatively.

Clinical trial registration
DRKS00027903, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027903
Trajectories of insomnia symptoms and insufficient sleep duration in early adolescents: associations with school stress
Authors: Bauducco Serena V , Özdemir Metin , Gradisar Michael , Boersma Katja , Bayram-Özdemir Sevgi 
Published: May 2022

AbstractStudy ObjectivesWe examined how adolescents’ sleep patterns (i.e. insomnia symptoms and sleep duration) change from early- to mid-adolescence and whether adolescents follow different trajectories. Furthermore, we also examined the characteristics of adolescents within different trajectories, with a specific focus on the role of school-related stress.MethodsWe used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1294; Mage = 13.2 [range: 12–15 years], SD = .42; 46.8% girls). Using established measures, the students reported on their sleep duration, insomnia symptoms, and perceived school-stress (including stress of school performance, peer and teacher relations, attendance, and school-leisure conflict). We used latent class growth analysis (LCGA) to identify adolescents’ sleep trajectories, and the BCH method to describe the characteristics of the adolescents in each trajectory.ResultsWe found four trajectories for adolescents’ insomnia symptoms; (1) low insomnia (69%), (2) low-increasing (17%, ‘emerging risk-group’), (3) high-decreasing (9%), (4) high-increasing (5%; ‘risk-group’). For sleep duration, we found two trajectories; (1) ~8 h sufficient-decreasing (85%), (2) ~7 h insufficient- decreasing (15%; ‘risk-group’). Adolescents in risk-trajectories were more likely to be girls and consistently reported higher levels of school stress, particularly regarding school performance and attending school.ConclusionsSchool stress was prominent among adolescents suffering from persistent sleep problems, especially insomnia, and deserves further attention.
Effect of a direct-fed microbial (10-G Armor) on feedlot performance, carcass characteristics, and prevalence of Salmonella in fed-beef heifers
Authors: Mayer Lauren M , Martens Kevin , Word Alyssa B , Holland Ben P , Lucherk Loni L , Lawrence Ty E , Tennant Travis C 
Published: May 2022

Abstract
Crossbred beef heifers (N = 1,394; initial shrunk body weight [BW] 291 ± 9.9 kg) were used to investigate the efficacy of 10-G Armor (Life Products, Inc., Norfolk, NE; 10-G) upon feedlot performance, carcass characteristics, and fecal and subiliac lymph nodes Salmonella prevalence. Heifers were blocked by day of arrival and allocated to 1 of 20 pens (N = 70 heifers/pen) and assigned one of two treatments (10 pens/treatment): no direct-fed microbial (CON) or 2 g/heifer/d of Lactobacillus acidophilus, Enterococcus faecium, Pediococcus pentosaceus, Lactobacillus brevis and Lactobacillus plantarum, respectively (Life Products, Inc., Norfolk, NE; 10-G). Twenty-four animals were randomly selected from each pen for Salmonella sampling. Recto-anal mucosal swab samples (RAMS) were obtained at initial processing and harvest; subiliac lymph nodes were collected at harvest. In addition, pen surface fecal pats were collected and composited by pen (10 pats per composite, 5 composites per pen) on days 0, 52, 120, and 192. Data were analyzed as a generalized complete block design, and pen served as the experimental unit. No differences were observed in live growth performance metrics (P ≥ 0.55). Yield grade distributions did not differ between treatments (P ≥ 0.62); however, cattle fed 10-G tended (P = 0.06; 14.6% vs. 18.9%) to have fewer USDA Select carcasses and more (P = 0.09; 73.6% vs. 78.0%) USDA Choice carcasses. Cattle fed 10-G tended (P = 0.10; 9.2% vs. 12.3%) to have fewer liver abscesses and had fewer (P = 0.04; 5.3% vs. 8.5%) severe liver abscesses. Salmonella prevalence of RAMS did not differ between treatments at initial processing (P = 0.97; CON = 11.6%, 10-G = 11.5%) or at harvest (P = 0.91; CON = 99.0%, 10-G = 98.6%); however, RAMS differed (P &lt; 0.01) in Salmonella prevalence between the two collection times. Cattle fed 10-G had a lower frequency of Salmonella positive lymph nodes (P = 0.01; CON = 15.8%, 10-G = 7.4%) than CON. However, Salmonella log (mpn/g) of lymph nodes did not differ between treatments at harvest (P = 0.34; CON = 0.73, 10-G = 0.34). These data indicate that cattle fed 10-G have decreased rates of severe liver abscesses without altering live animal performance or carcass characteristics. Supplementation of 10-G significantly reduced the prevalence rate of Salmonella recovered from the subiliac lymph nodes. The factors responsible for the observed difference in the effects of 10-G on Salmonella warrant further investigation
Mitochondrial phosphatidylethanolamine synthesis affects mitochondrial energy metabolism and quiescence entry through attenuation of Snf1/AMPK signaling in yeast
Authors: Miyata Non , Ito Takanori , Nakashima Miyu , Fujii Satoru , Kuge Osamu 
Published: May 2022

AbstractThe Ups2‐Mdm35 complex mediates intramitochondrial phosphatidylserine (PS) transport to facilitate mitochondrial phosphatidylethanolamine (PE) synthesis. In the present study, we found that ups2∆ yeast showed increased mitochondrial ATP production and enhanced quiescence (G0) entry in the post‐diauxic shift phase. Transcriptomic and biochemical analyses revealed that the depletion of Ups2 leads to overactivation of the yeast AMPK homolog Snf1. Inactivation of Snf1 by depletion of an Snf1‐activating kinase, Sak1 canceled the changes in mitochondrial ATP production and quiescence entry observed in ups2∆ cells. Furthermore, among the factors regulated by Snf1, upregulation of pyruvate carboxylase, Pyc1 and downregulation of acetyl‐CoA carboxylase, Acc1, respectively, were sufficient to increase mitochondrial ATP production and quiescence entry. These results suggested that a normal PE synthesis mediated by Ups2‐Mdm35 complex attenuates Snf1/AMPK activity, and that Snf1‐mediated regulation of carbon metabolisms has great impacts on mitochondrial energy metabolism and quiescence entry. We also found that depletion of Ups2 together with the cell‐cycle regulators Whi5 and Whi7, functional orthologs of the Rb1 tumor suppressor, caused a synthetic growth defect in yeast. Similarly, knockdown of PRELID3b, the human homolog of Ups2, decreased the viability of Rb1‐deficient breast cancer cells, suggesting that PRELID3b is a potential target for cancer therapy.
Law Enforcement Perceptions About Naloxone Training and Its Effects Post-Overdose Reversal
Authors: Dahlem Chin Hwa (Gina) , Granner Josephine , Boyd Carol J. 
Published: May 2022

Abstract

Background
Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience.

Methods
A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis.

Results
LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training.

Conclusion
Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.