bluuebunny/crossref_metadata_2025_split huggingface dataset:
0472 Dynamic Features of the Treatment Process Predict Different Outcomes for Patients Undergoing Cognitive Behavioral Therapy for Insomnia
Authors: Hu Yueqin , Xu Yishan , Barwick Fiona 
Published: May 2022

Abstract

Introduction
Individuals who undergo Cognitive Behavioral Therapy for Insomnia (CBT-I) show different trajectories during treatment and different outcomes after treatment. However, the factors contributing to this interindividual variability have not been adequately identified. Daily sleep logs might help us understand some of these factors.

Methods
Patients with insomnia (N=34), as confirmed by clinical evaluation and Insomnia Severity Index score &gt;10, completed 4 weeks of group CBT-I conducted in Mandarin via telehealth. Participants completed daily sleep logs and self-reported sleep quality, sleep effort and anxiety before and after treatment. Predictor variables included daily sleep efficiency and daily sleep anxiety. Response variables included pre-post changes in sleep quality, sleep effort and anxiety. Multilevel structural equation modeling was performed to examine the relationship between trajectories of change in predictors and response variables.

Results
Dynamic features of sleep log data significantly predicted individual differences in response variables. The growth rate of daily sleep efficiency during treatment significantly predicted reduced sleep effort (p=.012), decreased anxiety (p=.046), and improved sleep quality (p&lt;.01) after treatment. Conversely, the growth rate of daily sleep anxiety during treatment significantly predicted increases in sleep effort (p&lt;.01). In addition, daily sleep anxiety had a significant negative effect on daily sleep efficiency (p&lt;.001), and the weaker this negative effect, the greater the reduction in sleep effort (p&lt;.001) and anxiety (p&lt;.01) after treatment.

Conclusion
Individuals exhibit different trajectories during treatment, which are related to different outcomes after treatment. Those who experience less wakefulness at night across treatment become less anxious about sleep and exert less effort to manage sleep, leading to better sleep quality. However, those who experience increasing anxiety across treatment exert more effort to control sleep. Finally, individuals whose anxiety is not as closely associated with sleep efficiency show greater reductions in anxiety and sleep effort post-treatment. Thus, different trajectories and treatment outcomes appear to distinguish between those individuals who are less anxious about sleep during CBT-I, and thus more willing to implement recommendations, which leads to better outcomes, and those individuals who are more anxious about sleep during treatment, and thus less willing to implement recommendations, which leads to worse outcomes.

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0498 Intravenous Iron Therapy in the Pediatric Sleep Clinic: A Single Institution Experience
Authors: Ingram David , AL-Shawwa Bahauddin , Sharma Mukta 
Published: May 2022

Abstract

Introduction
Initial reports of intravenous (IV) iron administration have been promising for children with restless legs syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep. The aim of the current study was to further evaluate the clinical response to IV iron supplementation in children seen in a pediatric sleep clinic.

Methods
We performed a retrospective chart review of children cared for in a single pediatric sleep clinic who also underwent IV iron infusion. Data regarding their sleep symptoms and ferritin levels were abstracted.

Results
Overall, 63 pediatric sleep patients underwent IV iron infusion, mostly with ferric carboxymaltose (n=60). Of the 59 patients with clinical follow-up, 39 (73%) noted improvement in at least one symptom, and 14 (26%) did not notice improvement or noticed worsening symptoms. Of the 59 patients with pre- and post-infusion labs, the average ferritin level increased from 21.7+/-13.3 to 147.9+/-120.9, p&lt;0.001. Comparing patients who experienced clinical improvement versus those who did not, there were no statistically significant differences in change in ferritin levels (176.6+/-127.7 vs 120.5+/-118.1, p=0.278), sex (68% in females vs 77% in males, p=0.452), or age (8.8+/-5.9 vs 7.0+/-5.1, p=0.391). In terms of immediate adverse reactions to the IV infusion, 7 (11%) experienced at least 1 side effect, with the most common being behavior change (n=6) or gastrointestinal discomfort (n=4); no episodes of anaphylaxis or extravasation were noted.

Conclusion
These data provide additional support for the efficacy and safety of IV iron for pediatric RLS, PLMD, and restless sleep recalcitrant to oral iron.

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0511 Sleep Profiles in Children with 22q Deletion Syndrome: A Study of 100 Consecutive Children seen in a Multidisciplinary Clinic
Authors: Ingram David , Raje Nikita , Arganbright Jill 
Published: May 2022

Abstract

Introduction
While previous studies have suggested a high prevalence of sleep disorders in children with 22q deletion syndrome (22qDS), they were limited by potential selection bias. In the current investigation, we assessed sleep characteristics in 100 consecutive children presenting to a multidisciplinary clinic.

Methods
Chart review of consecutive children presenting to 22qDS multidisciplinary clinic was performed. Children aged 2 to 17 years of age were included, and data were abstracted including sleep characteristics (sleep history, Childhood Sleep Habits Questionnaire [CSHQ], and free response questions), comorbid medical conditions, and demographics.

Results
Overall, 100 children were included in analysis, 85% of whom had scores on the CSHQ consistent with clinically meaningful sleep disorder. Sleep problems were common in all domains of the CSHQ, including daytime sleepiness (66%), sleep onset delay (54%), parasomnias (52%), night wakings (52%), sleep disordered breathing (49%), sleep duration (45%), bedtime resistance (38%), and sleep anxiety (33%). Overall CSHQ score was significantly associated with daytime behavioral problems and speech delay (F(2,97) = 10.4, p &lt;0.001, adjusted R2 = 0.16). The most common interventions reported to be helpful for sleep by parents were behavioral (routine, bedtime story), environmental (light avoidance at night, calming music), and pharmacologic (melatonin, clonidine).

Conclusion
These data confirm a high prevalence of sleep disorders in a large, unselected sample of children with 22qDS, and suggest an important relationship between sleep dysfunction and daytime behavioral challenges. Our findings highlight the potential role for multimodal treatment approaches including behavioral, environmental, and pharmacologic interventions.

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0515 A Middle School and High School Sleep Trends Identified by a School Based Sleep Screening Program
Authors: Morse Anne , Blessing Kristina , Snyder Mallory , Liscum Denise , Vanenkenvort Erin , Winter Maive 
Published: May 2022

Abstract

Introduction
WUAL is a population based preventative sleep screening and education program for 7th to 12th graders through an asynchronous virtual platform. A descriptive summary of the program has been presented previously. First year results of a partnership with a middle school and high school with established delayed school start times are available and reveal unique trends across the academic year and specific patterns that differ between 7th-9th grade and 10th-12th grade.

Methods
The WUAL team consists of a board-certified pediatric sleep specialist, school guidance counselor and 2 project managers. The Protection of Pupil Rights Amendment (PPRA) was considered. A letter describing the program with an opt-out option was provided to parents prior to survey distribution. Survey data was captured using REDcap and included the Epworth sleepiness scale -CHAD (ESS) and the childhood sleep habits questionnaire (CHSQ). The surveys were completed at two-time points: December 2020 and April 2021. WUAL website was developed to serve as an educational resource and to access the surveys.

Results
A total of 346 students participated. Average weekday sleep reported by 7th- 9th graders was 8.6 hours (mean 8.9, 9 and 8 hours respectively). Average weekday sleep reported by 10th-12th graders was 7.1 hours (mean 7.1, 7 and 7.3 hours). Pairwise comparisons showed that students’ raw scores on both the ESS and the CSHQ decreased from December to April (ps ≤ .002). To examine the clinical significance of these changes, students’ trajectories were examined. There were 4 specific patterns of responses identified over the 2 time points: normal to normal, normal to pathologic, pathologic to normal and pathologic to pathologic. Despite the significant changes in raw scores, between 1/3 and ½ of the students with pathologic responses remained pathologic.

Conclusion
This method of screening has demonstrated a high degree of successful completion. Sleep patterns evolve over the course of the school year and for at least half of students appear to improve. There are additional differences observed between younger and older teenagers as observed by weekday sleep hours reported in 7th to 9th grade students compared to 10th to 12th grade students.

Support (If Any)
Grant Funding Support from Jazz Pharmaceuticals and Janet Weis Children's Hospital (Geisinger)
0523 Prevalence And Severity Of Sleep Disordered Breathing In Asthmatic Children
Authors: Singla Aarushi , Bagla Jyoti , Gothi Dipti , Kumari Sweta , Sasidharan Jaseetha , Mishra Ruchi , Dubey Anand , Vaidya Sameer , Patro Mahismita 
Published: May 2022

Abstract

Introduction
Children with severe and poorly controlled asthma have a higher predisposition for sleep disordered breathing (SDB). It can lead to cardiovascular, neurocognitive, and behavioral problems. Variable data exists currently whether demographic factors like age, sex, obesity, adeno-tonsillar hypertrophy tend to increase the risk of SDB in asthmatics. Our objective was to evaluate the risk factors and prevalence of SDB in asthmatics as compared to non - asthmatics and describe the polysomnographic parameters in asthmatics with SDB.

Methods
Asthmatic and non - asthmatic children aged 5 – 15 years, were recruited in this case – control study. Parameters like age, gender, body mass index, adeno-tonsillar hypertrophy, and the history of snoring were compared. All participants completed the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ) and prevalence of risk of SDB (defined as SDBS - PSQ ≥ 0.33) was calculated. A subset of asthmatics with risk of SDB underwent polysomnography, and subjects were classified into no, mild, moderate, and severe SDB [based on apnea-hypopnea index (AHI) ≤1, 1-5, 5-10, and ≥10, respectively].

Results
120 children, with 60 asthmatics were included. Amongst asthmatic group, 61.7% were male and mean age was 9.51 ± 2.50 years. Risk of SDB was significantly higher in asthmatics compared to non - asthmatics (18.33% vs 1.67%, p = 0.001; with mean SDBS-PSQ score 0.14 ± 0.17 vs 0.05 ± 0.08, p = 0.001). History of snoring was reported in 25% of asthmatic children versus 11.7% in non – asthmatics (p&gt; 0.05). Other parameters were similar in both the groups (p&gt; 0.05). Of the 11 asthmatics with risk of SDB, 10 underwent polysomnography. 9 patients (15% of asthmatics) were diagnosed with SDB, with a mean AHI of 4.21 ± 3.28, mean total sleep time of 279.23 ± 57.69 minutes and mean arousal index of 10.23 ± 8.67. In this subset, 60% had mild SDB.

Conclusion
Prevalence of SDB is higher in asthmatics, compared to general population. SDBS-PSQ is a useful screening tool for diagnosing SDB and should be incorporated in the daily practice, the gold standard being polysomnography. Further studies would help in a better understanding of SDB spectrum in children.

Support (If Any)
Nil
0539 Obstructive sleep apnea symptoms and their improvement with PAP in the pediatric population: A Retrospective Study in a Pediatric Sleep Disorders Center
Authors: White Jay , Scribner April , Spray Beverly , Viscioni-Wilson Lance , Jambhekar Supriya 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is estimated to occur in 1% to 5% of the pediatric population1. The Agency for Healthcare Research and Quality (2021) recently released a draft report titled, “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea.”2 The conclusions of this report determined that the published evidence reviewed by the agency did not support that positive airway pressure (PAP) affects long term, clinically important outcomes. No pediatric studies were included in this report. Pediatric patients who require PAP are held to the same standards as adults regarding adherence and insurance requirements3. However, clinical symptoms to determine improvement of OSA symptoms in adults are not the same in children. Symptoms in the pediatric population such as decreased concentration, hyperactivity, memory impairment, learning disorders, nocturnal enuresis and growth impairment have improved with PAP and are important indicators in this population of improved clinical outcomes4.

Methods
Retrospective chart review was used to examine symptoms reported by pediatric patients initiated on PAP for OSA. Symptom information was extracted before and after initiation of PAP. A chi-Square test was used to determine if there was an association between PAP treatment and improved clinical symptoms.

Results
235 patient records were reviewed. The distribution of sex was 150 (63.9%) males and 76 (32.3%) females. The mean age at PAP initiation was 12.0 (SD = 4.5), age range from 9 months to 19 years. Most frequent symptoms pre PAP initiation included excessive daytime sleepiness (51%), at least one of the daytime behaviors above (45%), and nocturnal enuresis (14%). Excluding patients with missing data, first and fourth visit post PAP initiation, 78% (221 patients; 66 missing) and 90% (90 patients; 12 missing), respectively, reported improvement in symptoms.

Conclusion
Results indicate that PAP is a beneficial treatment of OSA with improvement in symptoms specific to the pediatric population. Due to the clinically significant outcomes to growth and development that PAP provides to pediatric patients with OSA, we suggest that they should not be held to the same insurance requirements as adults and further studies should be conducted to validate these findings.

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0553 At-home Detection of REM Sleep Behavior Disorder using a Machine Learning Approach and Wrist Actigraphy
Authors: Brink-Kjaer Andreas , Gupta Niraj , Marin Eric , Zitser Jenny , Sum-Ping Oliver , Hekmat Anahid , Bueno Flavia , Cahuas Ana , Jennum Poul , Sorensen Helge , Mignot Emmanuel , During Emmanuel 
Published: May 2022

Abstract

Introduction
Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) affects over 1% of middle-aged and older adults and is in most cases a prodromal stage of alpha-synucleinopathy. However, a small fraction of them is currently diagnosed due to poor access to the gold-standard diagnostic procedure polysomnography (PSG). We aimed to test an ambulatory diagnostic procedure for iRBD based on wrist actigraphy alone and combined with a short questionnaire on nonmotor symptoms.

Methods
A total of 35 PSG-confirmed iRBD and 28 age-matched clinic and community control participants with and without a sleep disorder (1:1 ratio) wore high-frequency (25 Hz) wrist actigraphy for at least 7 nights and completed sleep diaries. Raw accelerometer data recorded during sleep was analyzed by deriving an activity count and extracting movement-related features for each night. Additionally, participants completed the Innsbruck RBD inventory (RBD-I) and a 3-item questionnaire on hyposmia, constipation, and orthostasis. We fitted machine learning models, specifically, boosted decision trees, in a leave-one-out cross-validation framework to classify iRBD patients from controls based on either actigraphy or questionnaire data. For each participant, model predictions from actigraphy were averaged across all available nights.

Results
The boosted decision trees classified iRBD with an area under the receiver-operator-characteristics (ROC) curve (AUC) of 0.972, a sensitivity of 97.1%, and a specificity of 89.3%. Analyses revealed that performance plateaued after one week of actigraphy. Best single feature “short immobile bursts” achieved an AUC of 0.958, a sensitivity of 94.3%, and a specificity of 78.6%. In this population, RBD-I item 3 best discriminated between groups with an AUC of 0.892, a sensitivity of 91.4%, and a specificity of 85.7%. The combination of a positive RBD-I item 3 and a positive actigraphy-based classification achieved a sensitivity of 88.6% and a specificity of 96.4%.

Conclusion
High-frequency actigraphy using machine learning detects iRBD with high accuracy. Addition of a single RBD question to this procedure increased specificity. These results need to be validated in a larger sample and lay the groundwork for an ambulatory screening paradigm in the general population.

Support (If Any)
The Klarman Family Foundation and the Feldman Foundation Ca.
0554 Proteomic Approach for Understanding the Mechanisms of Periodic Limb Movements and Restless Legs Syndrome
Authors: Cederberg Katie , Hanif Umaer , Leary Eileen , Schneider Logan , Morse Anne Marie , Blackman Adam , Schweitzer Paula , Kotagal Suresh , Bogan Richard , Kushida Clete , Mignot Emmanuel 
Published: May 2022

Abstract

Introduction
Periodic limb movements (PLMs) are episodes of involuntary, repetitive muscle movements that are highly associated with restless legs syndrome (RLS). Although PLMs and RLS are reportedly two separate phenomena, both are tightly correlated and may result from a similar pathology. The present study profiled plasma protein biomarkers of PLMs and RLS to contribute to the identification of mechanisms associated with each disorder/trait.

Methods
The SomaScan highly multiplexed aptamer assay was used to profile 5,000 proteins in 24–48-hour old EDTA plasma samples from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. PLMs per hour (PLMI) were derived from overnight polysomnography and RLS was classified based on affirmative responses to questions of the Alliance Sleep Questionnaire. Three linear regression models were conducted to examine significant protein markers of 1) PLMI in the sample as a whole; 2) PLMI controlling for the presence of RLS; and 3) RLS without PLMs (i.e.,PLMI&lt;5). All models included log2-normalized relative protein expression as the dependent variable and important covariates such as age, gender, BMI, sample storage time, and blood draw period. False discovery rate (FDR) to control for multiple testing was applied with an a-priori p-value of 0.05 for identifying significant associations.

Results
PLMI was significantly associated with 253 proteins (219 positive,34 negative). The inclusion of RLS in the model mitigated the significance of most proteins, and only 8 proteins remained significant. Negatively associated proteins (LEAP-1, Ferritin, SELH, Caspase-8) included functions related to iron storage, absorption, and delivery and negative regulation of inflammatory/immune responses. Positively associated proteins (SFRP4, RANTES, CathepsinA, DKK1) included proteins with functions related to immune response, inflammatory response, bone formation, and protein stability. RLS without PLMs was associated with 7 upregulated proteins (megalin, RUFY1, TADBP, ANGL7, LRTM2, SNAPN, STOM) with functions related to vitamin D metabolism, calcium and zinc binding, circadian rhythm regulation, and calcium-dependent neurotransmitter secretion.

Conclusion
These large proteomic analyses identified independent differential protein expressions for PLMs and RLS that suggest different pathophysiological contributions.

Support (If Any)
This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952] and the Klarman Family Foundation.
0560 Rest-Activity Rhythms are Associated with Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults
Authors: Makarem Nour , German Charles , Zhang Zhanhao , Diaz Keith , Palta Priya , Duncan Dustin , Castro-Diehl Cecilia , Shechter Ari 
Published: May 2022

Abstract

Introduction
Prior studies have linked rest-activity rhythms (RAR), a measure of circadian rhythmicity in the free-living setting, to morbidity and mortality. However, evidence is limited on the associations of RAR with adiposity, hypertension, and cardiovascular disease (CVD) in a nationally representative sample of US adults.

Methods
Participants were 4,822 adults (age:≥20y) from the 2013-2014 National Health and Nutrition Examination Survey, who participated in the physical activity monitoring examination. Data from a wrist-worn ActiGraph GT3X+ accelerometer were used to estimate non-parametric 24-h RAR variables. Logistic models adjusted for age, sex, race/ethnicity, education, marital status, smoking, and alcohol use were used to evaluate associations of RARs with prevalent CVD (self-reported), hypertension (blood pressure≥130/80mmHg or medication use), obesity (BMI≥30kg/m2), and central adiposity (waist circumference&gt;102cm for men and &gt;88cm for women).

Results
Participants (mean age: 48y, 53% female, 33% racial/ethnic minority) in the highest vs. lowest tertile of relative amplitude, indicative of more robust RAR, had lower odds of prevalent CVD (OR(95%CI):0.47(0.25-0.87)), hypertension (OR(95%CI):0.63(0.40-0.99)), obesity (OR(95%CI):0.50(0.36-0.69)), and central adiposity (OR(95%CI):0.50(0.36-0.69)). Those in the highest vs. lowest tertile of M10 counts, indicating a more active wake period, had 66%, 54%, and 39% lower odds of CVD, obesity, and central adiposity, respectively. In contrast, participants in the highest vs. lowest tertile of intradaily variability, indicative of more fragmented RARs, had &gt;2-fold (OR(95%CI):2.40(1.23-4.70)) and 40% (OR(95%CI):1.40(95%CI:1.04-1.88)) higher CVD and obesity odds, respectively. Further, those in the highest vs. lowest tertile of L5 midpoint, indicative of a later sleep period, had 68% and 41% higher odds for CVD and hypertension, while those with higher L5 counts, indicative of less efficient sleep, had 72%, 57%, and 79% higher hypertension, obesity, and central adiposity odds, respectively. A statistically significant linear trend was observed across RAR tertiles for all associations (p-trend&lt;0.05).

Conclusion
Robust RAR, an active wake period, and an earlier and more efficient sleep period are associated with lower odds for CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The timing, regularity, and periodicity of sleep-wake and rest-activity patterns may represent an important target for reducing cardiovascular risk in adults.

Support (If Any)
NHLBI R00-HL148511; AHA grant #855050