bluuebunny/crossref_metadata_2025_split huggingface dataset:
0673 Script-Driven Imagery in PTSD: Comparing Reactivity to Imagery of Trauma Memories to Imagery of Trauma-Nightmare Memories
Authors: Mendelsohn Augustus Kram , Orr Scott , Ivkovic Vladimir , Fortier Elizabeth , Kelly Anne , Cetinkaya Doga , Martinez Uriel , Bazer Oren , Tanev Kaloyan , Lasko Natasha , Pineles Suzanne , Pace-Schott Edward 
Published: May 2022

Abstract

Introduction
Prolonged Exposure (PE) therapy produces therapeutic fear extinction via imaginal exposure to trauma memories. However, traumatic events that occurred in the distant past and the associated memories may become distorted or habituated. Posttraumatic nightmares are more recent, potentially salient, and may better support extinction learning. Physiological responses to imagery of a trauma and nightmare related to this trauma were compared to each other and to neutral imagery.

Methods
Twelve participants (mean age=26.16, 11 female) with PTSD (mean CAPS-5=27.83) and frequent trauma-related nightmares wrote accounts of their trauma. Participants then completed a 14-day sleep-monitoring period with diaries, actigraphy and two nights of ambulatory PSG. Participants narrated a nightmare report into an audio recorder when awoken by a nightmare or when recalled upon awakening. Two pairs of short narratives were created from the written account of the trauma and recording of a nightmare most similar to the trauma. These narratives (scripts) were audio-recorded by an investigator. Participants then underwent two script-driven imagery (SDI) sessions, one hour apart, during which they listened to either their two trauma-memory or their two nightmare-memory scripts (counterbalanced across participants) with 3 interspersed neutral scripts. Each script in an SDI session included baseline, listening, and imagery periods (approximately 30 sec apiece). Skin conductance (SC), heart rate (HR), and corrugator electromyography (EMG) biosignals were continuously recorded throughout each SDI session. For each script, HR, SC, and EMG means during the baseline period were subtracted from their respective imagery-period means. These difference scores were square-root transformed and analyzed by ANOVA with Type (trauma vs. nightmare) and Valence (trauma/nightmare vs. neutral) factors.

Results
Biosignals from scripts of both Types (trauma and nightmare) significantly exceeded those from their respective neutral scripts [HR:F(1,11)=23.42, p=0.0005; SC:F(1,11)=9.53, p=0.01; EMG:F(1,10)=8.0, p=0.018]. However, biosignals from trauma and nightmare scripts did not differ (p’s&gt;0.39) nor did the Type x Valence interactions (p’s&gt;0.10).

Conclusion
Physiological reactivity during imagery of a trauma memory and a trauma-related nightmare both significantly exceeded reactivity to neutral scenarios. Nightmare-memory and trauma-memory imagery produced similar reactivity. Thus, imagery of nightmares have potential utility as alternative PE stimuli.

Support (If Any)
This project was supported by NIMH grant 1R21MH121832-01A1 to E.P.S.
0678 Slow Wave Sleep Recovery Correlates with Brain Functional and Structural Changes in Alcohol Use Disorder
Authors: Zhang Rui , Tomasi Dardo , Shokri-Kojori Ehsan , Manza Peter , Feldman Dana , Kroll Danielle , Biesecker Caterine , McPherson Katherine , Wang Gene-Jack , Wiers Corinde , Volkow Nora 
Published: May 2022

Abstract

Introduction
Sleep disturbances are very common in alcohol use disorder (AUD) and contribute to relapse. Recovery of N3 sleep within the first 30 days of abstinence is limited. Brain mechanisms associated with N3 sleep recovery in AUD are still poorly understood.

Methods
We examined brain functional and structural changes associated with inter-individual differences in N3 recovery in 30 AUD patients (9 Females, mean age: 41 years) undergoing a 3-week inpatient detoxification. We measured patients’ N3 sleep, resting state functional connectivity (RSFC), grey matter volume (GMV) and negative mood on week 1 and week 3.

Results
AUD patients had shorter N3 sleep than healthy controls on week 1 and showed a trend towards N3 sleep recovery after 3-week detoxification. Inter-individual differences in N3 recovery were observed. Larger increases in N3 sleep were associated with greater improvement in negative mood. Inter-individual variations in N3 recovery were associated with increases in midline default mode network (DMN) RSFC and anterior DMN GMV. Exploratory analyses revealed significant sex effects on N3 sleep and N3 recovery such that AUD females had greater N3 impairments on week 1 and greater N3 recovery after detoxification than AUD males.

Conclusion
We show a significant relationship between N3 recovery and structural and functional changes in DMN in AUD patients during detoxification. Combining nighttime and daytime interventions that target N3 sleep and DMN might have a complementary therapeutic effect on AUD recovery including mood improvement. Future investigations on sex differences with a larger sample and with longitudinal data for a longer period of abstinence are needed.

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0691 Examining the Associations between Insomnia and Adult-ADHD Diagnosis in Army Soldiers
Authors: Kautzmann Jeremie , Goldschmied Jennifer , Miller Katherine , Klingaman Elizabeth , Gehrman Philip 
Published: May 2022

Abstract

Introduction
Most research on the association between insomnia and attention deficit hyperactivity disorder (ADHD) has been conducted in children. It has been established that insomnia and ADHD are frequently comorbid, but less is known about whether the association extends to individual ADHD symptoms, or any possible moderators of the association. This study aims to understand whether sex plays a key role in the moderation between insomnia and ADHD in adult military servicemembers, as well as to investigate the relationship between insomnia diagnosis and ADHD symptomology.

Methods
Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21292; age 18-61, 88.24% male). Participants completed a survey that included items assessing insomnia and ADHD status based on DSM-5 criteria. Chi-squares and logistic regression, including interactions with sex, were used to examine the relationship between insomnia diagnosis and ADHD symptomology.

Results
There is a significant association between insomnia and ADHD diagnoses (r = 0.30; &lt;.0001), consistent with prior literature. There was a small but statistically significant moderation by sex of the relationship between insomnia and ADHD diagnosis (Chi square = 9.43; p = .002). There was also a strong association between insomnia diagnosis and certain symptoms of ADHD: keeping attention on repetitive work (Chi square = 3687.75; &lt;.0001), remembering appointments (Chi square = 3186.735; &lt;.0001), and getting things in order (Chi square = 2756.28; &lt;.0001).

Conclusion
Insomnia diagnosis was associated with both ADHD diagnosis and symptomology in a nationwide sample of army servicemembers, with the relationships being stronger in males compared to females. These findings highlight the importance of assessment and treatment of insomnia in patients with ADHD given their interrelationships.

Support (If Any)
This publication is based on data obtained from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1). KEM’s time was supported by the U.S. Department of Veterans Affairs, Clinical Science Research and Development Service - IK2 CX001874. EAK’s time was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2 RX001836.
0692 Physical activity and sleep patterns before and during the COVID-19-pandemic – results from a cross-sectional and retrospective study
Authors: Sadeghi-Bahmani Dena , O’Hora Kathleen , Osorno Raquel , Lopez Mateo , Morehouse Allison , Krause Adam , Goldstein-Piekarski Andrea 
Published: May 2022

Abstract

Introduction
In general, higher physical activity is related to lower symptoms of insomnia, depression, and anxiety. The COVID-19-pandemic and its related restrictions unfavorably impacted both physical activity and sleep patterns. However, it remains unknown how better sleep and physical activity prior to the pandemic confer resilience to psychological and health-related disturbances during the pandemic. We investigated whether people with higher physical activity and lower insomnia scores before the COVID-19-pandemic also reported higher physical activity, lower insomnia scores, and lower symptoms of depression and anxiety during COVID-19-pandemic-related restrictions.

Methods
A total of 826 adults (mean age: 34.58±12.37 years) completed self-rating questionnaires covering physical activity, and symptoms of insomnia, depression, and anxiety during the COVID-19-pandemic. Further, participants retrospectively rated their physical activity and insomnia before the COVID-19-pandemic. Hypotheses were tested using Pearson’s correlations and paired t-tests with significance at p &lt; 0.05.

Results
Retrospectively assessed higher physical activity levels before the COVID-19-pandemic were associated with lower symptoms of depression (r = 0.84, p = 0.041), but neither insomnia (r = 0.02, p = 0.67) nor anxiety scores during the COVID-19-pandemic (r = 0.05, p = 0.20). Retrospectively assessed lower insomnia scores before the COVID-19-pandemic were associated with lower symptoms of insomnia (r = 0.57, p &lt; 0.001), depression (r = 0.30, p &lt; 0.001) and anxiety (r = 0.31, p &lt; 0.001) during the COVID-19-pandemic. Consistent with other studies both insomnia and physical activity worsened; insomnia scores increased (p &lt; 0.001, d = 0.66) and physical activity decreased (p &lt; 0.001, d = 0.19) from before to during the COVID-19 pandemic.

Conclusion
These results suggest that those with lower levels of insomnia prior to the pandemic may be resilient to the psychological and health-related consequences of the COVID-19-pandemic and its related restrictions in everyday life, while those with higher physical activity prior to the pandemic were more resilient specifically to depression during the pandemic).

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0712 Cluster analysis for the association between obstructive sleep apnea phenotypes: a population-based longitudinal study
Authors: Tempaku Priscila , Silva Luciana , Guimarães Thaís , Vidigal Tatiana , D'Almeida Vânia , Andersen Monica , Bittencourt Lia , Tufik Sergio 
Published: May 2022

Abstract

Introduction
The identification of subgroups of obstructive sleep apnea (OSA) is critical to understand disease causality and ultimately develop optimal care strategies customized for each subgroup. In this sense, we aimed to perform a cluster analysis to identify subgroups of individuals with OSA based on clinical parameters. Furthermore, we aimed to analyze whether subgroups remain after 8 years.

Methods
We used data derived from the São Paulo Epidemiologic Sleep Study (EPISONO) cohort, which was followed over 8 years. All individuals underwent polysomnography, answered questionnaires and had their blood collected for biochemical exams. OSA was defined according to AHI≥ 15 events/hour. Cluster analysis was performed using latent class analysis (LCA).

Results
Of the 1,042 individuals in the EPISONO cohort, 68.3% accepted to participate in the follow-up study (n=712). We were able to replicate the OSA 3-cluster solution observed in previous studies: disturbed sleep, minimally symptomatic and excessively sleepy in both baseline (35.5%, 45.4% and 19.1%, respectively) and follow-up studies (41.9%, 43.3% and 14.8%, respectively). 44.8% of the participants migrated clusters between the two evaluations and the factor associated with this was a greater delta-AHI (B=-0.033, df=1, p=0.003). The optimal cluster solution for our sample based on Bayesian information criterion (BIC) was 2 cluster for baseline (disturbed sleep and excessively sleepy) and 3 clusters for follow-up (disturbed sleep, minimally symptomatic and excessively sleepy).

Conclusion
The results found replicate and confirm previously identified clinical clusters in OSA even in a longitudinal analysis.

Support (If Any)
This work was supported by grants from AFIP and FAPESP.
0715 Diagnosis of Sleep Disordered Breathing in Patients with Interstitial Lung Disease: A Retrospective Evaluation of Polysomnogram and Home Sleep Apnea Testing Using Peripheral Arterial Tonometry
Authors: Kelly Bryan , Moua Teng , Escalante Patricio 
Published: May 2022

Abstract

Introduction
Previous studies have shown that sleep disordered breathing (SDB) is common in patients with Interstitial Lung Disease (ILD), and oximetry is often used for screening prior to further diagnostic testing. Current guidelines recommend polysomnography (PSG) for diagnosis of SDB in patients with significant pulmonary disease, however, home sleep apnea tests (HSAT) are increasingly used in clinical practice for a variety of reasons despite lack of evidence regarding accuracy in this population. In this study, we evaluate the correlation between screening oximetry, a commercial brand HSAT (WatchPAT®) and PSG to examine the diagnostic accuracy of this HSAT technology in patients with ILD.

Methods
The institution electronic medical record was screened for patients with a diagnosis code for ILD who underwent screening oximetry followed by PSG or HSAT using peripheral arterial tonometry from July 1, 2012 to present. Clinical review confirmed presence of ILD according to American Thoracic Society guidelines. Among the respective cohorts, Paired Wilcoxon Test was used to compare the oximetry 4% oxygen desaturation index (ODI) to the HSAT ODI and PSG apnea-hypopnea index (AHI) as well as percent time spent below oxyhemoglobin saturation of 89%. Spearman correlation was used to correlate the oximetry ODI and parameters of SDB on HSAT and PSG.

Results
Data was analyzed for 25 patients who had undergone oximetry/HSAT and for 25 patients who had undergone oximetry/PSG. Oximetry ODI showed no significant difference from PSG AHI (p = 0.2635) or between HSAT ODI (p = 0.0755), and no difference was seen in hypoxic time between oximetry and PSG (p = 0.9789). Hypoxic time on HSAT was significantly longer than that on oximetry (p &lt; 0.001). Using HSAT ODI as the standard, HSAT AHI and respiratory disturbance index (RDI) showed rs of 0.9638 and 0.8913 respectively, while oximetry ODI was 0.3893. Compared to PSG AHI, the PSG RDI and oximetry ODI rs were 0.9759 and 0.7407 respectively.

Conclusion
Among patients with ILD, screening oximetry appears to correlate more strongly with indices of SDB and hypoxic time on PSG rather than HSAT. Further studies are warranted to evaluate efficacy of additional HSAT testing modalities in this patient population.

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0725 Five-year Transitions of Symptom Subtypes in Untreated Obstructive Sleep Apnea
Authors: Morris Jonna , Scott Paul , Mazzotti Diego 
Published: May 2022

Abstract

Introduction
Symptom subtypes have been consistently identified in mild and moderate-severe OSA in cross-sectional studies. The objectives of this study were to determine how often participants transition between symptom subtypes over 5 years and whether baseline clinical factors were associated with observed transitions.

Methods
We analyzed demographic, clinical, polysomnographic and symptom data from 2,643 participants of the Sleep Heart Health Study (53.7% women; mean age 62.4 years) with complete baseline and follow-up visits (5.2 years between visits). Latent transition analysis was conducted using 14 daytime and nighttime symptom items in individuals with OSA diagnosis (apnea-hypopnea index [AHI]≥5) to determine symptom subtypes at baseline and follow-up as well as their transition probabilities over time. Individuals without OSA (AHI&lt;5) were incorporated as a known class at each time point. Multinomial logistic regression was conducted to assess the effect of age and sex on class transitions between baseline and follow-up visits.

Results
We identified four OSA symptom subtypes at both baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy. Most participants did not transition subtypes between visits (55.8%). Of participants whose subtype remained the same between visits, 54.1% had minimal symptoms at baseline; 48.5% were in moderately sleepy; 31.5% were excessively sleepy and 34.6% were in disturbed sleep. A transition to moderately sleepy was the most common. Excessively sleepy participants transitioned most often to moderately sleepy (37.9%). One-year increase in baseline age was associated with a 7% increase in odds to transition from excessively sleepy to disturbed sleep (OR=1.07; 95%CI=1.01-1.15) and about 6% increase in odds to transit from excessively sleepy to moderately sleepy (OR=1.06 (95% CI=1.02-1.12). Women had higher odds to transit from moderately sleepy to minimal symptoms (OR=2.35; 95%CI: 1.27-3.27) and to transit from minimal symptoms to no longer having an OSA diagnosis (OR = 2.30; 95%CI=1.40-3.80).

Conclusion
Approximately half of the participants transitioned their symptom subtypes over a period of 5 years, with most transitioning to minimal symptoms. Increasing age and sex may affect the transitions.

Support (If Any)
National Institutes of Health: U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL53938, U01HL53940, U01HL53941, U01HL64360
0727 Age-related association of visceral adiposity with cardiometabolic disorders in mild-to-moderate sleep apnea
Authors: Karagkouni Efthalia , Vgontzas Alexandros , Fernandez-Mendoza Julio , Lenker Kristina , Basta Maria , Krishnamurthy Venkatesh , Bixler Edward 
Published: May 2022

Abstract

Introduction
Visceral adiposity is a key predictor of both metabolic syndrome and obstructive sleep apnea (OSA). Both metabolic syndrome and OSA are associated with cardiometabolic disorders, however, the association of OSA with these disorders weakens in older adults. We compared the relative strength of the association between visceral adiposity vs. OSA with hypertension and diabetes and whether this association is stronger in middle-aged vs. older adults.

Methods
A clinical sample of 148 adults (53.79±12.45y, 36,5% female) with mild-to-moderate OSA (5≤AHI&lt;30) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure and fasting glucose. Hypertension was defined as blood pressure ≥140/90mmHg or use of anti-hypertensive medication. Diabetes was defined as fasting glucose ≥100mg/dL or receiving treatment for diabetes, except insulin. Visceral Adiposity Index (VAI) was calculated within each sex using Amato et al (2010) standardized formulas based on waist, BMI, triglycerides and HDL cholesterol. Logistic regression models examined the association between VAI and AHI with hypertension and diabetes, while simultaneously adjusting for sex and stratifying by age. We also generated under the receiver-operating characteristics (ROC) curves (AUC) having hypertension and diabetes as outcomes and gender, age, BMI, AHI and VAI as independent variables.

Results
VAI was associated with greater odds of having hypertension (OR=1.57, 95%CI=1.20-2.06, P=0.001) and diabetes (OR=1.27, 95%CI=1.02-1.57, p=0.031) compared to AHI (OR=1.05, 95%CI=0.98-1.13, p=0.185; and OR=1.07, 95% CI=1.00-1.14, p=0.690, respectively) in adults aged &lt;60y. There was no association between VAI or AHI with hypertension and diabetes in adults aged ≥60y. Adding VAI to standard clinical factors (age, sex, and BMI) yielded moderately-good risk models for hypertension (AUC=0.73) and diabetes (AUC=0.70) in adults aged &lt;60y, while suboptimal risk models (AUC=0.61 and 0.68, respectively) in adults aged ≥60y.

Conclusion
These data indicate that visceral adiposity, but not AHI, is associated with cardiometabolic disorders in patients with mild-to-moderate OSA, an association that is stronger in middle-aged adults. Visceral obesity should be a priority in preventive/therapeutic interventions in young and middle-aged patients with OSA. These findings also further support that OSA in older adults is a distinctly different phenotype.

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0736 Mandibular Movements Are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome
Authors: Martinot Jean-Benoit , Le Dong Nhat Nam , Cuthbert Valérie , Coumans Nathalie , Tamisier Renaud , Malhotra Atul , Pépin Jean-Louis 
Published: May 2022

Abstract

Introduction
Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA).

Methods
In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed. PSGs were scored manually using AASM 2012 rules. Data blocks (n=8042) were randomly sampled during normal breathing (NB), obstructive or central apnea/hypopnea (OA/OH/CA/CH), respiratory effort-related arousal (RERA), and mixed apnea (MxA). Analyses were: evaluation of the similarity and linear correlation between PES and MM using the longest common subsequence (LCSS) algorithm and Pearson’s coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from NB to a respiratory disturbance for a given change in MM signal using a mixed linear-regression.

Results
Participants (n=38) had mild to severe OSA (median AH index 28.9/h; median arousal index 23.2/h). MM showed a high level of synchronization with concurrent PES signals. Distribution of gyroscope MM signal amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.17–2.43) for CA, 0.83 (0.23–4.71) for CH, 1.93 (0.54–5.57) for MxA, 3.23 (0.72–18.09) for OH, and 6.42 (0.88–26.81) units for OA. Mixed regression indicated that crossing from NB to central events would decrease gyroscope MM signal amplitude by –1.23 (CH) and –2.04 (CA) units, while obstructive events would increase gyroscope MM signal amplitude by +3.27 (OH) and +6.79 (OA) units (all p&lt;10-6).

Conclusion
In OSA patients, MM signals facilitated the measurement of specific levels of RE associated with obstructive, central or mixed apneas and/or hypopneas. A high degree of similarity was observed with the PES gold-standard signal.

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