bluuebunny/crossref_metadata_2025_split huggingface dataset:
0547 RLS Patient Odyssey Survey II
Authors: Cinatl Christopher , Ondo William , Koo Brian , Dzienkowski Karla , Durmer Jeffrey , Phelps Charles , Winkelman John 
Published: May 2022

Abstract

Introduction
RLS affects 5%-10% of European and North American adults, with 2%-3% experiencing moderate to severe symptoms. RLS patients, often undiagnosed or improperly treated, experience significant depression in addition to loss of sleep.

Methods
ODYSSEY II, an online and in-print self-administered questionnaire (respondents primarily from the United States) included validated questions on RLS diagnosis and severity, associated medical conditions, RLS treatment responses, access to RLS care, and standardized PHQ-9 depression measures. RLS status was confirmed using the Cambridge-Hopkins Questionnaire. Analysis included linkage of PHQ-9 depression scores to EQ-5D Health-Related Quality-of-Life (HRQoL) scores using externally validated methods.

Results
Of 3,003 online or mail-in participants, 2,745 were RLS confirmed, 55% having severe symptoms (IRLS ≥ 21), 86% using medications and 73% reporting histories of dopaminergic augmentation (medication related worsening of symptoms).Of RLS-confirmed respondents, average PHQ-9 depression scores were 8.98 for women (US average 3.72) and 7.22 for men (US average 2.67). Among RLS patients, 29% of males and 40% of females (comparable US averages 11% and 6.5%) had PHQ-9 depression scores ≥ 10 (moderate, moderately severe or severe) a fourfold risk of important (≥ 10 score) depression. Suicidal ideation was reported by 15% of respondents (US average 4.0%). Associated EQ-5D scores show that 37% of all respondents had HRQoL scores below 50% of “full health.”Of six drug classes used to treat RLS, three drug classes had patient-reported efficacy above 60%, but all had patient-reported drawbacks, ranging from weaker efficacy for some patients (alpha-2-delta ligands) to augmentation (dopaminergics, almost three-quarters of patients) and difficulties in obtaining prescriptions (opioids) for others.Respondents reported decade-plus delays from time of symptom onset to diagnosis, and still may remain improperly diagnosed or inadequately treated. Respondents managed by RLSF certified providers reported better outcomes.

Conclusion
ODYSSEY II documents that depression, suicidal thinking and HRQoL losses are very significant among many RLS patients. Respondents report troubling delays from symptom onset to correct diagnosis. Survey results demonstrate that RLS related symptoms are best improved when patients use RLSF certified providers. Improved education to both primary care providers and patients may also lead to better patient outcomes.

Support (If Any)
Arbor Pharmaceuticals
0565 Examining obstructive sleep apnea knowledge and attitudes of providers in southern West Virginia
Authors: Aryal Shubekchha , Salyer Rachel , Stansbury Robert 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) syndrome is a common but underdiagnosed clinical problem with multiple health implications. The rising prevalence of OSA has been linked to increasing obesity. Because the obesity rate of West Virginia (WV) is almost 40%, successful identification and treatment of OSA is essential to improving the health of WV communities. Our previous work demonstrated that OSA is ineffectively managed in our rural communities. This study aimed to evaluate OSA knowledge and attitudes of primary care providers (PCPs) practicing at Federally Qualified Health Centers (FQHC) serving rural communities with significant health disparity in southern WV.

Methods
We assessed OSA knowledge and attitudes of 14 PCPs in southern WV (n=6 physicians and 8 mid-level providers; 53.2 + 12.2 years of age; 78% female) practicing at FQHC. The OSA Knowledge and Attitudes (OSAKA) questionnaire assesses providers’ knowledge via 18 true-false statements and importance and attitude via five Likert. OSA attitudes are assessed via two items for importance of OSA and three items for confidence in identifying and treating OSA.

Results
No respondents answered the 18-knowledge portion with 100% accuracy (mean = 14.3). Mann Whitney U tests were then used to compare Physicians’ and mid-level providers’ years in practice and OSAKA responses. Knowledge scores in physicians (Mdn = 16) significantly differed from mid-level providers scores (Mdn = 13.5) in our sample (U = 5.5, p &lt; 0.05, r = -0.66). OSAKA Importance and Confidence questions revealed that PCPs felt OSA identification was important, but were not confident in their ability to manage OSA.

Conclusion
Our results demonstrate that rural PCPs have fairly good knowledge of OSA in general but lack knowledge in specific domains. Interestingly, providers feel OSA is an important disease and were fairly knowledgeable with the disease, but lacked confidence to manage OSA. Further explanatory studies are warranted to more robustly examine these findings. Our prior work demonstrates sleep apnea is ineffectively managed in the region. Thus, targeted training and further engagement with rural providers may well address disparity in OSA management for Appalachian communities.

Support (If Any)
(NIH/NIGMS 5U54GM104942-03).
0577 Sleep Quality and Its Association with Inflammation Over Time in Patients Undergoing Radiation Therapy for Head and Neck Cancer
Authors: Ye Lichuan , Miller Andrew , Bruner Deborah , Paul Sudeshna , Felger Jennifer , Wommack Evanthia , Higgins Kristin , Shin Dong , Saba Nabil , Xiao Canhua 
Published: May 2022

Abstract

Introduction
Sleep disturbance is a prominent concern in patients with cancer with detrimental effect on health outcomes. Although inflammation has been proposed as a potential mechanism of sleep disturbance, there is a dearth of longitudinal data supporting the relationship between cancer-related sleep disturbance and inflammatory markers. The goal of this prospective longitudinal study was to examine the change in sleep quality and its association with inflammatory markers in patients undergoing radiation therapy for head and neck cancer.

Methods
A total of 176 patients who had head and neck cancer without distant metastases were assessed before, immediately after, and at 3 and 12 months after radiotherapy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Peripheral blood inflammatory markers were measured using standard techniques at the same four assessment times. Generalized estimating equations with exchangeable within-subject correlation matrix were used to analyze repeated measures.

Results
The participants were mostly middle-aged White (79.5%) men (74.0%) who were married or living with significant others (70.0%) and received concurrent chemoradiotherapy (80.1%). Using the PSQI of 5 as the cut-off, 66.3% of the participants were poor sleepers at baseline, and this rate increased to 82.8% immediately after, then dropped to 56.8% at 3 months and 46.2% 12 months after therapy. Being single (p=0.007), taking antidepressants (p=0.020), and with feeding tube (p=0.01) were identified to be significantly associated with poor sleep quality over time. Controlling for relevant demographic and clinical factors, changes in sleep quality were associated with changes of circulating levels of two inflammatory markers, C-reactive protein (CRP) and interlukin-1 receptor antagonist (IL-1ra). Increased CRP and IL-1ra levels were associated with higher PSQI global scores (beta=0.826, p=0.007 for CRP; beta=1.412, p=0.050 for IL-1ra), indicating worse sleep quality.

Conclusion
Patients with head and neck cancer experienced poor sleep quality, especially immediately after treatment completion and in those who were single, depressed, or with feeding tube. Inflammation is associated with cancer-related sleep disturbance and both sleep and inflammation may be potential targets to promote health outcomes in patients with cancer.

Support (If Any)
The study was supported by NIH/NINR K99/R00NR014587, NIH/NINR R01NR015783, NIH/NCI P30CA138292.
0582 Effects of non-melanoma skin cancer on sleep and quality of life among renal transplant recipients
Authors: Xerfan Ellen , Leandro Gabriela , Pires Gabriel , Andersen Monica , Tufik Sergio , Facina Anamaria , Tomimori Jane 
Published: May 2022

Abstract

Introduction
Non-melanoma skin cancer (NMSC) is highly prevalent in renal transplant recipients (RTR), due to the immunosuppressive effects of anti-rejection therapy after transplantation. Sleep disturbances can impair the immune system and enhance the repercussions of oxidative stress, which may play an important role in the carcinogenesis pathways. This survey aimed to compare data on quality of life and sleep in RTR with and without NMSC in a dermatology service.

Methods
The study comprised 126 individuals, distributed in the following groups: RTR with NMSC (n=42), RTR without NMSC (n=43) and healthy controls (n=41). Participants answered a set of questionnaires, including the WHOQOL-bref, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Berlin Respiratory Disorder questionnaire (BRD).

Results
The proportion of men were significantly higher among RTR (p=0.034). No statistically significant differences were observed regarding age, body mass index (BMI) and socioeconomic class. Transplantation living donors were statistically more frequent among RTR with NMSC (67% against 37% in the RTR without NMSC group; p=0.005). Among patients of the RTR with NMSC group, 9% had only basal cell carcinoma, 42% had only squamous cell carcinoma and 49% had both types of NMSC. There were no statistically significant differences on the final scores of the sleep questionnaires, except in 3 domains of the PSQI: sleep quality (p&lt;0.001), sleep latency (p=0.01) and daytime dysfunction (p=0.02). Worse sleep quality was seen in the RTR with NMSC and controls, while worse sleep latency and more daytime consequences were found in both RTR clusters. All groups were predominantly composed of subjects with morning-type chronotype, low sleep quality and increased daytime sleepiness. In the WHOQOL, the physical domain was significantly impaired in the RTR groups (p&lt;0.001).

Conclusion
Although all groups were mainly composed of individuals with excessive daytime sleepiness and low sleep quality, there were no differences regarding quality of life and sleep between RTR and controls. Further long-term examination of kidney transplant recipients and their sleep pattern are warranted, as poor sleep may have a link with immunosuppression and organism imbalance, as well as on quality of life of these individuals.

Support (If Any)
AFIP, CAPES, CNPq, and FAPESP.
0583 Tolerance and feasibility of daytime bright light in medical intensive care unit patients
Authors: Intihar Taylor , Samojedny Veronica , Korwin Amy , Knauert Melissa 
Published: May 2022

Abstract

Introduction
Sleep and circadian disruption in critical illness are associated with poor outcomes. Normal circadian entrainment requires bright light exposure during the day and dim or no light during the night. Disruption of this diurnal light pattern can cause circadian abnormalities. To leverage this highly influential circadian entrainment cue, our study investigates the tolerance and feasibility of a daytime bright light (DBL) intervention in the medical ICU (MICU). We hypothesize that DBL is tolerable and has high fidelity and sustainability (i.e., feasibility).

Methods
Here we present the findings of a pilot randomized control trial of DBL in MICU patients. Patients were randomized to receive light for either 4 hours, 8 hours, or no light (usual care). For DBL groups, the light was turned on at 09:00 daily for 4 consecutive days. Metrics of tolerability (percentage of days patient agreed to light), fidelity (percentage of intended hours light was delivered), and sustainability (percentage of days light delivered out of days patients allowed light) were collected.

Results
Sixteen patients were enrolled; 5 were assigned to 8 hours of DBL, 9 were assigned to 4 hours of DBL, and 2 were assigned to usual care. Mean (standard deviation) patient age was 73 (10) and mean severity of illness, as determined by Acute Physiology and Chronic Health Evaluation II score, was 21(5). Patients who received 4 hours of DBL averaged 69% tolerability, 55% fidelity, and 94% sustainability. Patients who received 8 hours of DBL averaged 70% tolerability, 57% fidelity, and 90% sustainability. Further analysis of light delivery data showed that the 8-hour group was subject to a higher number of requests to delay light start or end light early and more care related breaks versus the 4-hour group.

Conclusion
Our study demonstrates the feasibility of a DBL intervention for MICU patients. While fidelity was lower than expected, the findings support that DBL is tolerable and sustainable in critically-ill patients. These findings have influenced the design of our ongoing randomized control trial further evaluating the impact of daytime bright light on circadian phase in critical illness.

Support (If Any)
This work was supported by the NHLBI (K23 HL138229), the Academy of Sleep Medicine Foundation, and the Fund to Retain Clinical Scientists at Yale sponsored by the Doris Duke Charitable Foundation award #2015216 and the Yale Center for Clinical Investigation.
0588 Relationship Between Congestive Heart Failure and Poor Sleep Quality in the US Population
Authors: Blethen Caroline , Mason Brooke , Wills Chloe , Killgore William , Grandner Michael 
Published: May 2022

Abstract

Introduction
Few recent, population-level datasets have explored the relationship between congestive heart failure (CHF) and sleep difficulties.

Methods
The 2017 - March 2020 data from the National Health and Nutrition Examination Survey (NHANES) were used. Sleep difficulties were self-reported as difficulties “falling asleep, staying asleep, or sleeping too much” within the previous two weeks, categorized as “never,” “less than half the days,” “more than half the days,” and “nearly every day.” Sleep duration was self-reported and categorized as normal (6.5-8.5h), short (&lt;6.5h), and long (&gt;8.5h). A modified STOP-BANG score was created based on NHANES measures of snoring, daytime tiredness, snorting/gasping during sleep, hypertension, body mass index, age, and gender (no measure of neck circumference). Covariates included sex, age, race/ethnicity, education, and relationship status. Analyses were unweighted, with weighted results forthcoming.

Results
Those who reported sleep difficulties more than half the days (OR: 1.78, [1.20,2.65], p=0.004) and nearly every day (OR: 2.76, [2.01,3.78], p&lt;0.001) were more likely to also report a history of CHF, relative to those without sleep difficulties. After adjusting for covariates these relationships were maintained for those who reported sleep difficulties more than half the days (OR: 1.71, [1.14,2.58], p=0.010) and nearly every day (OR: 2.45, [1.76,3.41] p&lt;0.001). When adding sleep duration category as a covariate (normal, short, or long sleep), those diagnosed with CHF were more likely to have sleep problems nearly every day (OR: 2.21, [1.38,3.25], p&lt;0.001). Those diagnosed with CHF are also likely to have a high risk for OSA (OR: 1.67, [1.39,1.95], p&lt;0.001).

Conclusion
Poor sleep quality is associated with history of CHF, independent of sleep duration. CHF is also associated with population-level sleep apnea risk. Screening for sleep disorders (insomnia and/or sleep apnea) in CHF patients may improve outcomes.

Support (If Any)
0595 Inflammatory Plasma Biomarker Cluster Associations with Sleep in People with and without HIV
Authors: Bakewell Nicholas , Mallon Patrick , Sabin Caroline , Winston Alan , Post Frank , Sachikonye Memory , Doyle Nicki , Redline Susan , Kunisaki Ken 
Published: May 2022

Abstract

Introduction
Sleep problems are commonly reported in people with HIV (PWH) and may be exacerbated by HIV-induced inflammation. We determined associations between systemic inflammation and objective/subjective sleep measures in PWH and demographically/lifestyle similar HIV-negative controls.

Methods
Objective sleep measures from 7-day actigraphy (e.g. mean/standard deviation (SD) of wake after sleep onset [WASO], sleep duration/efficiency), overnight oximetry (oxygen desaturation index [ODI]), and patient-reported measures (Insomnia Severity Index [ISI] and Patient-Reported Outcomes Measurement Information System [PROMIS] sleep questionnaires) were assessed in participants in the multicenter POPPY-Sleep Study in the UK and Ireland. Principal Component Analysis using 31 plasma inflammatory biomarkers followed by cluster analysis previously identified 3 distinct inflammatory clusters: 1 (low inflammation), 2 (immune activation) and 3 (systemic inflammation). Baseline characteristics and between-cluster differences in sleep outcomes were assessed using Kruskal-Wallis or logistic regression/Chi-squared tests.

Results
The 465 participants (74% PWH, median [interquartile range] age 54 [50-60] years) were mainly male (80%), men having sex with men (71%) and white (88%). Among PWH, most (98%) were on antiretroviral therapy, 92% had viral load ≤50 cps/mL and CD4 cell count was 610 [470-785] cells/mm3. Overall, 18% met ISI criteria for insomnia (ISI≥ 15), and other sleep measures suggested generally good sleep (e.g., ODI 3.1/hr [1.5-6.4]). Clusters 1 (n=209), 2 (n=47) and 3 (n=209) differed significantly for HIV status (73%, 60%, 78%, p=0.03); BMI (24.8, 25.9, 26.2 kg/m2, p=0.002); systolic blood pressure (126, 135, 126 mmHg, p=0.002); cardiovascular disease (39%, 28%, 53%, p=0.001) and arthritis (8%, 9%,16%, p=0.02) – all factors associated with sleep problems. There were no clinically relevant between-biomarker-cluster differences in the proportions with insomnia (17%, 18%, 20%) either before (p=0.76) or after (p=0.75) adjustment for potential confounders. Few associations were observed among other actigraphy, oximetry and PROMIS measures.

Conclusion
Despite observed differences in clinical factors associated with sleep problems, we found no consistent or strong associations between inflammatory biomarker clusters and a range of sleep outcomes. Although associations could exist with other sleep outcomes (e.g. sleep architecture) or biomarker types (e.g. cerebrospinal fluid) not assessed, our findings do not support a strong association between sleep and plasma inflammatory biomarkers in this population.

Support (If Any)
NIH R01HL131049
0599 Sleep duration across the lifespan in type 1 diabetes and association with cardiometabolic risk
Authors: Simon Stacey , Snell-Bergeon Janet , Schauer Irene , Nadeau Kristen 
Published: May 2022

Abstract

Introduction
Individuals with type 1 diabetes (T1D) are at high risk for morbidity and mortality from cardiovascular disease which begins as early as adolescence. Some studies have reported a high prevalence of insufficient sleep in this population which may be due to behavioral and physiological aspects of T1D and its management. Emerging evidence suggests a link between short sleep duration and increased cardiometabolic risk, but this has not been specifically examined across the lifespan in individuals with T1D.

Methods
Inclusion criteria were T1D duration &gt; 9 months, HbA1c 6.5-10% for adults and ≤ 12% for adolescents, and ages 12-60 years. Participants completed home monitoring for one week with continuous glucose monitoring (CGM) and wrist actigraphy prior to a study visit with anthropometric measurements, fasting autonomic/orthostatic and laboratory testing. Peripheral arterial stiffness was measured by Dynapulse brachial artery distensibility (BAD), and insulin sensitivity was estimated by the validated CACTI equation utilizing waist circumference, fasting triglycerides, adiponectin, and diastolic blood pressure. Sleep variables, glycemic markers and health parameters were examined by age group (adolescent vs. adult) using students t-test for univariate comparisons, and linear regression models for age, sex and diabetes duration-adjusted comparisons by age group.

Results
Forty-two adolescents (mean age 16 ± 3 years, diabetes duration 7.4 ± 5 years, HbA1c 8.4 ± 1.1%) and 42 adults (mean age 41 ± 10 years, diabetes duration 21 ± 13 years, HbA1c 7.4 ± 0.9%) completed the study. Sixty-two percent of adolescents and 74% of adults obtained insufficient sleep (&lt; 7 hours of sleep per night). When examined in linear regression adjusted for age group, sex, diabetes duration and age, insufficient sleep was associated with higher BMI (adults), BMI percentile (adolescents), waist circumference, systolic blood pressure, and lower estimated insulin sensitivity and BAD (all p &lt; 0.05).

Conclusion
Most adolescents and adults with T1D obtained insufficient sleep. Objectively-estimated insufficient sleep was associated with worse markers of cardiometabolic risk. Further study examining the impact of sleep health interventions in this population is warranted as sleep may be an important and novel target for improving cardiometabolic health in individuals with T1D.

Support (If Any)
JDRF grant 3-SRA-2015-125-M-R
0602 Rapid Eye Movement (REM) Sleep Duration Is Inversely Related To Daytime Pruritus Severity: Preliminary Findings in Posttraumatic Stress Disorder (PTSD) Patients
Authors: Gupta Madhulika , Gupta Aditya 
Published: May 2022

Abstract

Introduction
Pruritus (itching) is one of the most distressing symptoms of dermatologic disease. There can be a bidirectional relationship between pruritus severity and sleep. Pruritus during sleep is most frequently encountered during stages N1 and N2 and sleep fragmentation can exacerbate pruritus. Often there are limited effective treatments available for pruritus. In this study we examined REM sleep data obtained from PTSD patients who reported somatic complaints including daytime pruritus. To our knowledge there are no studies of REM sleep and pruritus during wakefulness.

Methods
Seventy-five consenting patients with mild-to-moderate PTSD (all female; mean ±SD age 48.89 ±13.50 years) completed a battery of psychiatric and sleep ratings and underwent ≥ 1 home sleep apnea test (Watch PAT200; Itamar) which provided measures of %REM and REM duration. Exclusion criteria were use of benzodiazepines or narcotics. Pruritus was measured using Item 2 of the Pennebaker Inventory of Limbic Languidness (PILL), which assesses the frequency of common physical symptoms. For PILL Item 2 patients self-rated the frequency with which they experienced “Itchy eyes or skin” with a rating of “1” = “”never or almost never”, “2”=”less than 3 or 4 times per year”, “3”=”every month or so”, “4”=”every week or so’, and”5”=”more than once every week”.

Results
The mean±SD % REM was 21.78 ±7.64 (range 1.76% to 40.69%); and overall duration of REM sleep (mean ±SD) was 91.37±38.20 minutes (range 5.01 to 194.47 minutes). The frequency of pruritus ratings were as follows:: 39.5% endorsed a rating of “5” . The remainder self-endorsed the following frequencies: “4” (15.8%), “3” (21.1%), “2” (15.8%), and “1” (7.9%).. Pearson product moment correlation between the pruritus rating (item 2 of PILL) and REM sleep parameters were as follows: % REM (Pearson r= -0.172; p=0.144) and REM duration (Pearson r= -0.247; p=0.035).

Conclusion
Daytime pruritus was inversely related to the duration of REM sleep in a sample of PTSD patients. Pruritus can be a difficult condition to manage. Optimization of REM sleep may have a role in the management of pruritus.

Support (If Any)
None