bluuebunny/crossref_metadata_2025_split huggingface dataset:
0408 A Narcolepsy Detection Paradigm: Automated Nocturnal Detection and Notification of Sleep Onset Rapid Eye Movement Periods
Authors: Cairns Alyssa , Bogan Richard , Zheng Alex , Bujanover Shay , Lillaney Prasheel , Friedberg Andrew , Black Jed 
Published: May 2022

Abstract

Introduction
Rapid eye movement (REM) sleep detected by polysomnography (PSG) occurring within 15 minutes of nocturnal sleep (sleep onset REM period; SOREMP) is a known biomarker for hypocretin-deficient narcolepsy. However, the SOREMP is often underappreciated when observed in patients undergoing routine diagnostic sleep testing, evidenced by the paucity of further evaluation for hypersomnia in these individuals. To enhance identification of SOREMP episodes, we developed an automated process to detect and advise sleep clinicians of sleep onset REMs. This study aimed to evaluate the impact of automated SOREMP notification on clinician recommendations for narcolepsy diagnostic evaluation and multiple sleep latency test (MSLT) outcomes.

Methods
The automated SOREMP notification program was offered to all sleep clinicians within a large multicenter sleep clinic network. De-identified sleep studies were uploaded to a secure data cloud for real-time automated SOREMP detection. Algorithmic-determined SOREMPs underwent human adjudication by a team of expert registered sleep scorers. Clinicians were advised of the presence of SOREMPs within the interpretation platform via a visual banner. Clinician recommendations and future testing (including MSLTs) were naturalistically tracked.

Results
Of 17,447 sleep studies processed over 3 years, 145 exhibited a SOREMP (0.8%). Five studies were excluded from primary analyses because of a prescheduled MSLT (n=2 narcolepsy; n=2 idiopathic hypersomnia; n=1 “normal”). Of the remaining 140 patients, 19 (14%) were recommended for further narcolepsy evaluation/MSLT; to date, 4 patients have had an MSLT (n=3 narcolepsy; n=1 “normal”). Excluding the PSG SOREMP, MSLT outcomes were #1: 2 SOREMPs and MSL=4.7 min; #2: 3 SOREMPs and MSL=3.0 min; #3: 5 SOREMPs and MSL=4.6 min; #4: 0 SOREMPs and MSL=11.7 min.

Conclusion
This study implemented enhanced identification and subsequent clinician notification of nocturnal SOREMPs using a novel sensitive SOREMP detection paradigm. This methodology resulted in recommendation of 19 patients, who otherwise may have gone undetected, for further narcolepsy evaluation. When conducted, MSLTs most often supported a narcolepsy diagnosis. This is a call to action for medical providers to critically evaluate patients who exhibit a PSG SOREMP, as it may provide a unique opportunity to identify and treat narcolepsy. Further research is needed to better understand the low referral rate.

Support (If Any)
Jazz Pharmaceuticals.
0414 Estimated Prevalence of Idiopathic Hypersomnia in the Wisconsin Sleep Cohort
Authors: Peppard Paul , Plante David , Hagen Erika , Barnet Jodi , Mignot Emmanuel 
Published: May 2022

Abstract

Introduction
Idiopathic hypersomnia (IH) is a neurologic condition characterized by chronic excessive daytime sleepiness despite normal sleep duration in which sleepiness is unexplained by other sleep disorders, behaviors, or other identifiable causes. Population-based prevalence estimates of IH are unavailable, though a recent analysis of a US insured population found ~1/10,000 persons were diagnosed with IH. Here we estimate IH prevalence in the Wisconsin Sleep Cohort (WSC).

Methods
The WSC is an epidemiology cohort recruited from a working population. To characterize IH we used measures of subjective (Epworth Sleepiness Scale, ESS) and objective sleepiness (Multiple Sleep Latency Tests, MSLT), polysomnography, sleep diaries, and extensive questionnaires. IH was defined as the union of: ESS&gt;10; MSLT&lt;8 minutes; &lt;2 sleep-onset REM periods; apnea-hypopnea index (AHI)&lt;15 (we also estimated prevalence using an AHI&lt;5 cutpoint); &gt;=6 hours habitual daily sleep; and non-shift worker. Other explanations for sleepiness were also investigated.

Results
Among 792 WSC participants (48% female, mean age=59 years [range=40-78 years]), we estimate an IH prevalence=3.8%, 95% CI=2.6-5.4%). We arrived at this estimate thusly: of n=792 participants, n=275 (35%) had ESS&gt;10; of these, n=89 had MSLT&lt;8 minutes; of these, n=71 had &lt;2 sleep onset REM periods; of these, n=35 had an AHI&lt;15; of these, n=33 slept &gt;=6 hours/night; and, of these, n=30 were non-shift workers. Comparing the 30 so-defined “IH participants” to non-IH participants, respectively: 57% (IH) vs. 48% (non-IH) (NS) were female, mean age was 57 vs. 59 years (NS), mean AHI was 4.6 vs. 13.3 (by definition of IH, mean AHI was lower for IH participants), mean sleep duration was 7.6 vs. 7.7 hours (NS), and sedative use prevalence was 3% vs. 10% (NS). No IH participants reported a history of heart failure, heart attack or stroke. Prevalence of IH using an AHI cutpoint of 5 (i.e., IH only classified in participants with AHI&lt;5), we find an IH prevalence of 2.4% (95% CI=1.5-3.7%).

Conclusion
Idiopathic hypersomnia may be more prevalent than previously assumed: approximately 2 to 4% of Wisconsin Sleep Cohort participants had evidence of hypersomnia that could not be explained by other sleep disorders, insufficient sleep, shift work or other examined factors.

Support (If Any)
This work was supported by the National Heart, Lung, and Blood Institute (NHLBI, R01HL62252), National Institute on Aging (NIA, R01AG058680) and the National Center for Research Resources (NCRR, 1UL1RR025011) at the US National Institutes of Health, as well as a grant from Jazz Pharmaceuticals.
0428 A National Survey of 1000 Patients’ and 450 Physicians’ Views and Attitudes on Insomnia Care
Authors: Benca Ruth , Bertisch Suzanne , Ahuja Ajay , Mandelbaum Robin , Krystal Andy 
Published: May 2022

Abstract

Introduction
While the importance of restful sleep is espoused by patients and physicians alike, sleep health may not be receiving appropriate consideration during patient visits with HCPs. This study is the first to survey both patients with sleep difficulties as well as physicians who treat insomnia, in order to understand the perspectives of each group.

Methods
Patient and HCP online surveys were conducted by The Harris Poll from September to October 2021 in the USA. Patient participants were adults ≥18 years with a diagnosis of insomnia by an HCP or with self-reported difficulties sleeping for ≥3 nights/week over ≥3 months. The patient survey consisted of 51 questions pertaining to sleep difficulties, interactions with HCPs, and treatment options. The 34-question HCP survey pertaining to approaches and beliefs regarding insomnia diagnosis and management was completed by primary care physicians (PCPs) and psychiatrists.

Results
The respondents included 1001 patients (54% female; mean age 44.6 years) and 452 physicians (300 PCPs, 152 psychiatrists) who had opted-in for surveys, sourced from 100+ panels. Notable findings included that a majority of patients with sleep difficulties reported feeling frustrated (54%), irritated (52%), stressed (51%) and/or reported that their mood is negatively impacted (59%). While nearly all PCPs (98%) and psychiatrists (97%) affirmed that sleep is critical to good health, only 12% of PCPs and 24% of psychiatrists routinely conducted a full sleep history.Regarding treatment, 66% of patients did not think that current treatment options adequately improve their trouble sleeping; while 50% of PCPs felt their patients are satisfied with their current treatment. Moreover, 55% of people with trouble sleeping believed that there is a stigma associated with taking prescription sleep medications.

Conclusion
This first-ever survey of patients with insomnia and doctors treating this condition provides evidence that both groups agree on the importance of sleep and that treatment is often perceived as ineffective. Also of note, relatively few physicians conduct a sleep history and patients report that there is stigma associated with taking medications for insomnia. Most notably, this survey identifies the need to address our limited understanding and the insomnia conversation gap regarding key issues about insomnia treatment.

Support (If Any)
Idorsia Pharmaceuticals, Ltd.
0439 A Polysomnographic Marker of Sleep Quality using Odds Ratio Product are Associated with Insomnia Symptoms in a Dose-Response Relationship
Authors: Bender Amy , Lambing Kari , Gerardy Bethany , Chalmers Eric 
Published: May 2022

Abstract

Introduction
Insomnia is primarily diagnosed with subjective complaints because objective biomarkers are limited. In the current study, we assessed whether a polysomnographic marker of sleep quality (odds ratio product; ORP) was associated with different types of insomnia symptoms.

Methods
416 participants (age 46.2±12.5; 176 females) recorded their sleep with an in-home Type 2 PSG test using the Cerebra Sleep System and filled out sleep questionnaires. Sleep quality was measured using odds ratio product (ORP) derived from frontal EEG channels across the duration of the recording (ORPTRT). On the questionnaires, participants reported whether they experienced any of the following insomnia symptoms at least three times a week: trouble falling asleep, trouble staying asleep, and waking up earlier than desired. Participants were then classified based on the total number of insomnia symptoms reported. An ANOVA, controlling for age, was performed to compare the effect of the number of insomnia symptoms on ORP.

Results
199 participants reported no insomnia symptoms, while the remaining 217 reported at least one symptom three nights a week (1 symptom: n = 62, 2 symptoms: n = 83, 3 symptoms: n = 70). There was a significant effect of number of insomnia symptoms on ORPTRT F(3,414)=3.45, p =.017. There were significant differences between ORPTRT in participants who reported 0 symptoms (.991±.267), and participants who reported 2 symptoms (1.11±.259) (t(282) = -3.57, p &lt;.001), and between 0 and 3 symptoms (1.13±.31 (t(269) = -3.46, p &lt;.001). Even within individuals reporting insomnia symptoms, there were significant differences in ORPTRT between participants who reported 1 and 2 symptoms (p=.024), and 1 and 3 symptoms (p=.029).

Conclusion
The more insomnia symptoms that were reported, the greater the impairment in sleep quality using ORP were found. Further research could explore if treatment interventions aimed at reducing ORPTRT might be useful to help treat insomnia.

Support (If Any)
0458 The Sleep Diary Questionnaire: An Analysis of Meaningful Change in Subjective Total Sleep Time Using Phase 2 and Phase 3 Clinical Trial Data
Authors: Phillips-Beyer Andrea , Kawata Ariane , Kleinman Leah , Flamion Bruno 
Published: May 2022

Abstract

Introduction
The Sleep Diary Questionnaire (SDQ) is a new content-valid 17-item sleep diary adapted from the Consensus Sleep Diary. It assesses key sleep parameters including total time asleep the previous night or “subjective total sleep time” (sTST). People with insomnia value increasing sTST as a key treatment outcome. We estimated meaningful withinpatient change for sTST from two clinical trials in adults with insomnia.

Methods
Data from a 2-week, phase 2 open-label trial of zolpidem (NCT03056053) and blinded data from a 3-month, phase 3 randomized placebo-controlled trial of daridorexant (NCT03545191) were used. In both trials, subjects completed the SDQ daily before and during treatment. Changes in weekly average sTST were calculated using anchor-based analyses that included patient and clinicianreported outcome measures whose correlations with change in weekly average sTST were at least moderate (Spearman correlation coefficient ≥|0.3|). The outcome measures were Insomnia Severity Index, Patient Global Assessment of Disease Severity, Patient Global Impression of Severity, Patient Global Impression of Change, Clinician Global Impression of Severity, and Clinician Global Impression of Change. Distribution-based analyses calculated standard error of measurement (SEM) as supportive evidence. Change estimates from the anchor and distributionbased analyses were “triangulated” to identify a value where they converged.

Results
In the phase 2 trial (N=114), mean increases in sTST from baseline in subjects with meaningful improvements on the anchors were 60.1–83.2 min at day 8 and 55.5–93.5 min at day 15. SEM was 51.1 min at day 8 and 55.5 min at day 15. In the phase 3 trial (N=930, pooled across treatment arms), mean increases in sTST were 36.5–76.2 min at month 1 and 47.3–87.7 min at month 3. SEM was 43.2 min at month 1 and 53.3 min at month 3. Triangulation of these results supported a meaningful change threshold of 55 min.

Conclusion
Our findings support the importance of using sTST to assess insomnia from the patient’s perspective and provide useful information that an increase in sleep time of almost 1 hour is meaningful to patients.

Support (If Any)
This work was funded by Idorsia Pharmaceuticals Ltd.
0467 Preference for Digital CBTI: Changes due to the COVID-19 Pandemic in a Randomized Controlled Trial of CBTI for Middle Aged and Older Adults
Authors: Gumport Nicole , Tutek Joshua , Simpson Norah , Tully Isabelle , Dietch Jessica , Zulman Donna , Rosas Lisa , Palaniappan Latha , Manber Rachel 
Published: May 2022

Abstract

Introduction
Digital CBTI programs are effective at treating symptoms of insomnia. They also have the potential to increase treatment reach, convenience, and affordability for patients, and to reduce long wait times for behavioral sleep medicine providers. The COVID-19 pandemic has instigated an increased reliance on the use of technology for many. Thus, this study evaluates middle aged and older adults before and during the COVID-19 pandemic to assess: (1) differences in treatment modality preference (digital vs. therapist-led CBTI) and (2) sleep-related predictors of treatment modality preference.

Methods
Participants were older adults (N=229, 74% female, mean age=63.14) who were enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. At baseline, participants rated if they would prefer to access CBTI digitally or with a CBTI therapist, either in person or via telemedicine. After March 2020, in person was no longer listed as an option. Participants completed the Insomnia Severity Index (ISI) and a two-week sleep diary that allowed for an assessment of total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). Analyses compared responses to these items from participants completing assessments before March 2020 (Pre-Covid; n=74, 65% female, mean age=62.52) and after March 2020 (During-Covid; n=155, 78% female, mean age=63.44).

Results
Pre-Covid, 26% of participants preferred digital treatment, 47% of participants preferred a therapist-led intervention, and 27% did not express a preference. During-Covid, 35% of participants preferred digital treatment, 32% of participants preferred a therapist-led intervention, and 32% did not express a preference. This difference was statistically significant (c2=4.24, p=0.04). Responses were not significantly different between the first six months and the most recent six months of the pandemic (p=0.60). None of the sleep measures (ISI, TST, SOL, WASO) were associated with treatment modality preference in the full sample, Pre-Covid, or During-Covid.

Conclusion
The COVID-19 pandemic was associated with increased preference for digital CBTI among patients who are 50 and older, regardless of insomnia severity. Findings suggest that digital CBTI may be an acceptable treatment to many individuals with insomnia, thus increasing its dissemination potential.

Support (If Any)
R01AG057500 and T32MH019938
0483 Clinical Model of Community-Based Sleep Education Intervention for Children with IDD
Authors: Fitzpatrick Kasey , Loring Whitney , Malow Beth 
Published: May 2022

Abstract

Introduction
Sleep difficulties are common for children with intellectual and developmental disabilities (IDD). We previously found that implementing the principles of community-based sleep education intervention with children with IDD through a consultative caregiver training model improved key components of sleep and was a feasible model for both providers and caregivers (MacDonald, 2021).

Methods
Record reviews were conducted from a behavioral sleep clinic for children with IDD to evaluate for the reported effectiveness of the recommendations provided on improving sleep and to gather information regarding reported caregiver implementation of recommendations. A clinical psychologist trained in community-based sleep education and IDD met with 43 children, ages 1 to 18 years old with clinical diagnosis of an IDD, and at least one caregiver, to give individualized recommendations for their caregiver-reported sleep issues. These patients were referred to the psychologist by a developmental medical provider or a sleep medical provider after medical evaluation of these concerns. Concerns consisted of sleep onset latency, nighttime wakings, and/or co-sleeping. Patients and caregivers typically met 1 to 3 months after the initial visit to report their success at implementing recommendations and to share if there were any improvements at first follow-up or questions/concerns regarding the recommendations or sleep behavior. In some cases, additional follow-up visits were typically scheduled 1 to 6 months after and these were also reviewed. The notes from these visits were evaluated using qualitative measures and tools modified from Pediatric Sleep and Autism Clinical Global Impressions Scale (Pediatric CGI; Malow, 2016) to determine effectiveness and feasibility.

Results
Qualitative and quantitative measures adapted from Pediatric CGI were used by the record reviewer to evaluate notes. It was observed that 86% of caregivers reported complying with recommendations by the first follow-up and of those who complied, 81% reported improvements in their child’s sleep and/or daytime behavior. Of those who did not comply by first follow-up, only 28% saw improvement. Of those who had second follow-up, 89% of caregivers reported improvement in their child’s sleep and/or daytime behavior.

Conclusion
Time-limited models of community-based sleep educational interventions within a clinical setting are reported by caregivers and clinicians to be an effective method at delivering sleep education to families and improving sleep for children with IDD. Compliance with recommendations was associated with a higher proportion of improvement in sleep and/or daytime behavior.

Support (If Any)
This work was supported by the Vanderbilt Kennedy Center for Excellence in Developmental Disabilities
0491 Sleep among Adolescents in Juvenile Detention
Authors: Levenson Jessica , London Sarah , Ekas Deana , Woods Mary , Vojtash Misty , Mulvey Edward , Miller Elizabeth 
Published: May 2022

Abstract

Introduction
Adolescents involved in the juvenile justice system demonstrate high rates of psychiatric disorders, suicidality, and trauma, all of which is associated with poor sleep. Poor sleep is common among adolescents and is associated with numerous adverse outcomes like inattention, school absenteeism, emotion dysregulation, and substance use, outcomes that are related to juvenile justice system involvement. Yet very little is known about the sleep of adolescents involved in the juvenile justice system. We conducted a medical chart review and survey of detained adolescents to describe the sleep patterns and problems among these youth.

Methods
We reviewed a random sample (26%) of the medical charts of youth detained in a juvenile detention center (n=31) over four days in Summer 2021. We reviewed all medical encounters in the month prior to the date of chart review. Additionally, 13 youth completed the Patient Reported Outcome Measurement Information System Pediatric Sleep Disturbance Short Form (PROMIS-SD). Twelve of them reported their sleep patterns while in detention.

Results
Sleep was mentioned in 23% of all medical encounters, 62% of which indicated poor sleep. Sleep treatment was documented in 24% of notes, all consisting of pharmacotherapy. A sleep diagnosis was documented on 37% of billing sheets of all youth seen by a medical provider in the detention center in July 2021. On average, participants reported lights out around 9pm (SD=35min), sleep onset latency of 74mins (SD=75mins), wake time after sleep onset of ~20 minutes (SD=16mins), and wake-up time of 7:50am (SD=67min). Youth reported average sleep duration of more than 9 hours while detained (SD=103mins). Average PROMIS-SD score was 66.2 (range 51.5-79.1)

Conclusion
Though most youth obtain the recommended amount of sleep while detained, sleep disturbance is highly common among this population and average sleep disturbance is more than one standard deviation above the average. These data may inform the type of sleep interventions that are most relevant to detained youth. Future work should focus on further examining the sleep of adolescents in the juvenile justice system and identifying feasible, acceptable, and useful strategies for implementing evidence-based sleep interventions in this setting.

Support (If Any)
Dr. Levenson’s effort was supported by K23HD087433
0518 Clinical Correlates, Diagnosis, and Management of Sleep-disordered Breathing in Young Children with Down Syndrome
Authors: Seither Katelyn , Suhrie Kristen , Helm Benjamin 
Published: May 2022

Abstract

Introduction
Individuals with Down syndrome (DS) have high rates of sleep-disordered breathing and demonstrate more severe manifestations of obstructive sleep apnea (OSA) compared with non-syndromic patients. The consequences of untreated OSA in childhood include pulmonary hypertension, cognitive dysfunction, and abnormal growth. The American Academy of Pediatrics recommends that children with DS have a sleep study by age four years. It is unclear if these guidelines are sufficient to address the burden of disease in very young patients. There is also a paucity of data regarding clinical characteristics associated with OSA and outcomes following medical or surgical intervention in this population.

Methods
A retrospective cohort study was performed at Cincinnati Children’s Hospital Medical Center for all children with DS born between 2013-2019. Electronic medical record data were extracted including demographics, use of PSG, incidence of OSA, age at diagnosis, OSA severity, and interventions utilized. Statistical analysis used Fishers exact tests and analysis of variance with a significance threshold of p &lt; 0.05.

Results
A total of 397 patients met inclusion criteria and 235 (59%) had a sleep study. Most patients (n = 221, 94%) had an abnormal PSG and 60% had moderate or severe disease. There was an inverse relationship between age at first sleep study and OSA severity (p &lt;0.0001). Most patients (82%) had a sleep study due to the presence of symptoms; among asymptomatic patients, 91% met polysomnographic criteria for OSA. OSA severity was associated with increased rates of failure to thrive (p &lt; 0.01), aspiration (p = 0.005), G-tube feeding (p = 0.025), and pulmonary hypertension (p = 0.005). Most patients (n=178, 79%) required multiple interventions to manage their OSA.

Conclusion
In this cohort of infants and young children with DS who underwent PSG, a majority had moderate to severe OSA. The pervasiveness of severe disease in young infants suggests that current surveillance guidelines are inadequate. Infants should be evaluated with PSG in the first month of life regardless of clinical symptoms. Further study is needed to prospectively evaluate the impact of early diagnosis and intervention on long term outcomes.

Support (If Any)