bluuebunny/crossref_metadata_2025_split huggingface dataset:
0374 A sleep health educational module for social work students is associated with improvements in sleep knowledge and sleep quality
Authors: Spadola Christine , Groton Danielle , Freeman Katherine , Burke Shanna , Hilditch Cassie , Pandey Abhishek , Littlewood Kerry , Zhou Eric , Bertisch Suzanne 
Published: May 2022

Abstract

Introduction
Insufficient sleep is highly prevalent, particularly among underserved groups. Social workers often work with underserved populations who are at risk for sleep deprivation and are well-positioned to promote healthy sleep behaviors. However, sleep health training is rarely integrated into social work curriculums. To address this gap, we developed and tested a 2-hour online sleep health educational intervention, designed to improve sleep-related knowledge among social work students.

Methods
We recruited 106 social work students via a departmental listserve to participate in a 1-hour sleep education module. Pre-post module changes in knowledge and beliefs were assessed using the Sleep Beliefs Scale (SBS) and the Sleep Practices and Attitudes Questionnaire (SPAQ). We also assessed changes in self-reported sleep quality using the Pittsburgh Sleep Quality Index (PQSI). Wilcoxon Signed-Rank tests were used to assess pre- to post-module scores. We conducted qualitative research (open-ended questions and focus groups) to assess acceptability and to inform future module refinement.

Results
Of the 106 students participating in the module, mean age was 28.3±8.8 yrs, 92.5% were female, 4.7% male, and 2.8% other. The sample was racially/ethnically diverse with 37.7% identifying as non-Hispanic White, 34.0% African American/Black, 22.6% Hispanic/Latino, 0.9% Asian, and 4.7% other. Ninety (84.9%) participants completed the questionnaires. Demographics did not differ between students who completed the training and those who did not. Students participating in the module reported improvements in the Sleep Beliefs Scale (Median=2.0, range: -4, 10 [positive change=increased knowledge]), the SPAQ (Median=-10, range: -37, 95 [negative change=increased importance of sleep]), and the Global PQSI Score (Median=-1, range: -7, 4 [negative change = improved sleep quality]). Qualitative data supported the module’s acceptability and utility (e.g., “Not only will I adapt these healthy sleep habits, I will always ask my clients how they are sleeping!”). Suggestions for improvement included adding additional topics (e.g., over-the-counter sleep aids) and shortening the training duration.

Conclusion
Participation in an online educational module was associated with not only improvements in sleep knowledge but also self-reported sleep among social work students, suggesting feasible ways to expand providers promoting sleep health.

Support (If Any)
American Academy of Sleep Medicine Foundation
0382 Optimizing Obstructive Sleep Apnea Screening and Education in Underserved Community
Authors: Singh Jasmin , Corso Michael , Jones Willie , Campbell Onae , Moskos Frank 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. There are many conditions associated with OSA, including obesity hypoventilation syndrome, congestive heart failure, atrial fibrillation, pulmonary hypertension and pulmonary diseases. Majority of patients endorse daytime sleepiness, but family often report snoring and apneas. There are multiple screening tools, including the STOP-BANG. Scores 5 or above are high risk for OSA. Untreated OSA worsens comorbidities and increases risk of myocardial infarction and stroke. We provided physicians with this screening tool to help risk stratify, thus providing better patient education and treatment.

Methods
Physicians educated on OSA, STOP-BANG and documentation in didactic sessions. Patients ages 18 and older provided with questionnaire. Physicians measured neck circumference and BMI. Questionnaire reviewed with patient and education given. If high risk, sleep medicine referral recommended. Physicians documented in charts about discussion, risk category and referral status.

Results
Total of 407 patients completed the questionnaire, but 67 patients were excluded for no neck circumference. Remaining 340 patients stratified by STOP-BANG scores: 128 Low, 142 Intermediate, 70 High Risk. From High Risk category, 20 patients referred to Sleep Medicine. Only 18 charts from the 50 not referred explained why, which included patient declining, already on CPAP, referral already in, and because outpatient sleep study was ordered instead. Data stratified for age, gender, BMI and neck circumference. Age range from the 340 total was 19-87-years-old. From High Risk, 39 were male and 31 female. BMI range for total was 17-61, while High Risk was 22-61. Neck circumference range for total was 12-21 inches, while High Risk was 12.5-17.5 inches.

Conclusion
The goal was not only to provide a validated screening tool, but also provide better OSA education for physicians and patients. Results indicate many patients were intermediate or high risk. Majority of patients had multiple comorbidities, including obesity, hypertension and diabetes. This study highlights the prevalence of OSA in an inner-city primary care clinic and challenges involved in screening all at risk patients. Further investigations could include the effect of more education, continued screening and effect of lifestyle changes in this vulnerable population.

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0383 Clinical Impact of Pitolisant on Excessive Daytime Sleepiness and Cataplexy in Adults With High Burden of Narcolepsy Symptoms
Authors: Meskill Gerard , Davis Craig , Zarycranski Donna , Doliba Markiyan , Schwartz Jean-Charles , Dayno Jeffrey 
Published: May 2022

Abstract

Introduction
This post hoc analysis evaluated the clinical impact of pitolisant for the reduction of excessive daytime sleepiness (EDS) and cataplexy in adults with a high burden of narcolepsy symptoms. When evaluating results of randomized, placebo-controlled trials, the clinical impact of a treatment can be assessed using effect size metrics that include Cohen’s d (the standardized mean difference of an effect) and number needed to treat (NNT; number of patients that need to be treated to achieve a specific outcome for one person).

Methods
Data were pooled from 2 randomized, placebo-controlled, 7- and 8-week studies of pitolisant (individually titrated; potential maximum dose, 35.6 mg/day) in adults with narcolepsy. Analyses included 3 independent patient subgroups with high symptom burden: (1) baseline score of ≥16 on the Epworth Sleepiness Scale (ESS), (2) sleep latency of ≤8 minutes on the Maintenance of Wakefulness Test (MWT), and (3) ≥15 cataplexy attacks per week. Efficacy measures included the ESS, MWT, weekly rate of cataplexy (WRC), and Clinical Global Impression of Change (CGI-C). Cohen’s d was derived from the least-squares mean difference between treatment groups (pitolisant vs placebo), and NNTs were calculated from response rates. Missing values were imputed using a last observation carried forward approach.

Results
The high-burden populations included 118 patients for the ESS subgroup (pitolisant, n=60; placebo, n=58), 105 for MWT (pitolisant, n=59; placebo, n=46), and 31 for cataplexy (pitolisant, n=20; placebo, n=11). Cohen’s d effect size values for pitolisant versus placebo were 0.80 for ESS, 0.31 for MWT, and 1.31 for WRC. NNTs for pitolisant were 3 for ESS score reduction (≥3-point decrease from baseline or final score ≤10) in the ESS subgroup and 2 for WRC reduction (≥50% decrease from baseline) in the cataplexy subgroup. For the CGI-C for EDS (“much” or “very much” improved), NNT was 5 in the ESS subgroup and 4 in the MWT subgroup; for the CGI-C for cataplexy, NNT was 3 in the cataplexy subgroup.

Conclusion
The results of this analysis demonstrate the robust efficacy of pitolisant for the reduction of both EDS and cataplexy in patients with severe narcolepsy symptom burden.

Support (If Any)
Bioprojet Pharma and Harmony Biosciences, LLC.
0406 Efficacy of Once-Nightly Sodium Oxybate (ON-SXB; FT218) Across Stimulant Use Subgroups: Post-hoc Analyses From the REST-ON Trial
Authors: Thorpy Michael , Dauvilliers Yves , Roth Thomas , Morse Ann Marie , Roy Asim , Bogan Richard , Seiden David , Dubow Jordan , Gudeman Jennifer 
Published: May 2022

Abstract

Introduction
In the REST-ON trial (NCT02720744), once-nightly sodium oxybate (ON-SXB; FT218) was associated with significant improvement vs placebo for mean sleep latency on the Maintenance of Wakefulness test (MWT) and Clinical Global Impression of Improvement (CGI-I) rating in the overall population (both P&lt;0.001) and in subgroups of participants taking concomitant stimulants (both P&lt;0.05). Post-hoc analyses of ON-SXB efficacy on disturbed nocturnal sleep (DNS) and Epworth Sleepiness Scale (ESS) score were conducted.

Methods
Participants (≥16 years of age) with narcolepsy type 1 or 2 were randomized 1:1 to ON-SXB (1 week, 4.5 g; 2 weeks, 6 g; 5 weeks, 7.5 g; 5 weeks, 9 g) or placebo. Mixed-effects models for repeated measures calculated P values for change from baseline vs placebo at weeks 3 (6 g), 8 (7.5 g), and 13 (9 g) in ESS score, sleep shifts (ie, number of shifts from N1, N2, N3, and rapid eye movement [REM] sleep to Wake and from N2, N3, and REM sleep to N1), nocturnal arousals (NA), and patient-reported outcomes of sleep quality and refreshing nature of sleep on a 100-point visual analog scale.

Results
In the modified intent-to-treat population (n=190), 119 participants took concomitant stimulants (ON-SXB, n=66; placebo, n=53); 71 did not take stimulants (ON-SXB, n=31; placebo, n=40). Improvements with ON-SXB vs placebo were reported: ESS (stimulants: all doses, P≤0.01; no stimulants: 6 g, directional improvement; 7.5 g, P&lt;0.01; 9 g, P&lt;0.001), sleep shifts (stimulants: 6 g, P&lt;0.01; 7.5 and 9 g, P&lt;0.001; no stimulants: all doses P&lt;0.001), NA (stimulants: 6 g, directional improvement; 7.5 g, P&lt;0.01; 9 g, P=0.001; no stimulants: 6 and 7.5 g, P&lt;0.05; 9 g, P=0.01), sleep quality (stimulants: 6 and 7.5 g, P&lt;0.01; 9 g, P&lt;0.05; no stimulants: all doses P&lt;0.001), refreshing nature of sleep (stimulants: 6 and 9 g, P&lt;0.05; 7.5 g, P&lt;0.001; no stimulants: 6 and 7.5 g, P&lt;0.01; 9 g, P=0.001).

Conclusion
Data from these post-hoc analyses were consistent with the previously reported results from REST-ON and support the efficacy of ON-SXB for EDS and DNS, as measured by objective and subjective endpoints whether or not stimulants were concurrently used.

Support (If Any)
Avadel Pharmaceuticals
0412 Post-Traumatic Narcolepsy in 9 Military Veterans with a History of a Head Injury
Authors: Stultz Debra , Osburn Savanna , Burns Tyler , Gills Thomas , Shafer Christina , Walton Robin , Stoner Jamie , Roe Star , Pawlowska-Wajswol Sylvia 
Published: May 2022

Abstract

Introduction
Head injuries can be associated with hypersomnia acutely and chronically and can occur in those with mild/moderate/severe head injuries and with or without loss of consciousness. If hypersomnia persists, additional evaluation is warranted. Head injuries are increasingly reported in the military due to falls, assaults, motor vehicle accidents, and IED explosions, with some reporting, repeated blast injuries; secondary narcolepsy should be considered within the differential. Untreated narcolepsy can lead to safety issues for both the patient and others; therefore, aggressive evaluation is necessary with a PSG/MSLT combination and/or by the patient meeting the diagnostic criteria outlined in the DSM-V.

Methods
At the 2021 SLEEP conference, we presented a poster on our retrospective chart review of 176 patients diagnosed with narcolepsy from 2013 through 2020, with 50 patients having a history of head injury (28.4%). Of those 50 patients, nine were military veterans who reported a history of some degree of traumatic brain injury. While the majority had coexisting psychiatric disorders and/or other sleep disorders, the complaints of excessive daytime sleepiness were persistent despite aggressive treatment of the other associated diseases. The diagnosis of narcolepsy was confirmed by MSLT and/or DSM-V criteria.

Results
This study is a case series of 9 U.S. military veterans diagnosed with narcolepsy and a head injury history. There were eight males and one female, with the average age being 48. Five of the patients were diagnosed with type 1 narcolepsy with cataplexy, the other four without cataplexy were all on long-term treatment with antidepressants. The use of antidepressants while evaluating narcolepsy should be considered as they are REM suppressants, can interfere with MSLT findings, and can inhibit cataplexy symptoms preventing the appropriate diagnosis of Narcolepsy by DSM-V criteria.

Conclusion
Persistent hypersomnia in a patient with a history of a head injury could suggest a disorder of narcolepsy, and appropriate evaluation for this disorder appears indicated. The military having a high risk of head injuries may require assessment of narcolepsy while in active duty or long after discharge as the hypersomnia may be chronic and previously undiagnosed.

Support (If Any)
**No support was given for this research
0431 Examining the indirect effects of acculturation stress on insomnia through alcohol use and brooding among Latinx women and men
Authors: Cosenzo Luciana Giorgio , Alcántara Carmela 
Published: May 2022

Abstract

Introduction
Acculturation stress, a type of sociocultural stress, and insomnia have been consistently, positively associated among Latinx populations; however, the mechanisms of this association remain elusive. Models of insomnia suggest maladaptive coping strategies, such as brooding and alcohol use, may drive the relationship between stress and this disorder. Because acculturation stress has been positively associated with brooding and alcohol use, these coping strategies may explain the relationship between acculturation stress and insomnia among Latinxs. Additionally, gender differences in the use of these coping strategies and insomnia have been well documented. Thus, we examined the indirect effects of acculturation stress on insomnia through brooding and alcohol use among Latinxs and explored gender differences in these effects.

Methods
Separate bias-corrected boot-strap tests of mediation with case resampling (1000 replications) were conducted to examine the indirect effect of acculturation stress measured using the Hispanic Stress Inventory(HSI), on insomnia, measured with the Insomnia Severity Index(ISI), through brooding and alcohol use. These tests were conducted using cross-sectional survey data from healthy Latinx adults participating in the Latino Sleep and Health Study(n=187). Unadjusted models were the primary models. Progressive adjustments were made to account for age and socioeconomic status. Stratified analyses by gender were conducted to explore potential differences in the mediation models between Latinx women and men.

Results
Participants were Mage=37.43(SD=13.67), 64.17% were women, and 30.48% were of low socioeconomic status. Participants reported a mean HSI of 9.28(SD=9.51), brooding score of 9.44(SD=2.88), and ISI of 6.65(SD=5.51). In a typical week, participants consumed M=2.61 alcoholic beverages(SD=4.68). In primary models, the total and direct effects of acculturation stress on insomnia were significant, (b=0.04,95%CI:0.02-0.06; b=0.02,95%CI:0.004-0.04). The indirect effects of acculturation stress through brooding were also significant (b=0.02, 95%BCa CI:0.01-0.03). Among women, these indirect effects had larger coefficients than among men (b=0.02,95%BCa CI:0.01-0.04; b=0.01,95%BCa CI:0.004-0.04). Alcohol use was not a significant mediator in this relationship, (b=-0.001,95%BCa CI:-0.004-0.0002).

Conclusion
These findings suggest that psychological interventions targeting Latinxs should aim to reduce brooding as a coping strategy for acculturation stress to promote healthy sleep. Future studies should replicate these analyses in temporally ordered data to test the causal relationships among these variables.

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0450 Effect of Lemborexant on Early Morning Awakening in Subjects with Severe Problems with Waking Too Early
Authors: Moline Margaret , Zee Phyllis , Kumar Dinesh , Pappadopulos Elizabeth , Malhotra Manoj 
Published: May 2022

Abstract

Introduction
Lemborexant (LEM) is a dual orexin receptor antagonist approved in multiple countries for the treatment of adults with insomnia. In Study E2006-G000-304 (Study 304; NCT02783729), LEM improved sleep onset and sleep maintenance. This analysis evaluated treatment with LEM in subjects reporting “problems waking up too early” on the Insomnia Severity Index (ISI) Item-3 as assessed by wake after sleep onset in the second half of the night (WASO2H).

Methods
Study 304 was a 1-month, randomized, double-blind, placebo(PBO)-controlled and active-comparator (zolpidem extended-release 6.25mg [ZOL]) study of LEM 5mg (LEM5) and LEM 10mg (LEM10). Subjects whose baseline scores were ≥3 (severe/very severe) for ISI Item-3 were included in this analysis. WASO2H was defined as minutes of wake during the interval from 240 minutes after lights off until lights on (based on 8hr time in bed). WASO2H was measured at Days 1/2 and 29/30 using polysomnography and averaged across consecutive nights; change from baseline was analyzed using mixed effect model repeated measurement analysis.

Results
Treatment groups were (number of subjects: treated/had ISI Item-3 scores ≥3) LEM5 (220/140), LEM10 (219/140), ZOL (216/158) and PBO (180/122). Baseline mean (standard deviation) WASO2H (minutes) ranged from 77.8-82.25 (30.3-35.5) across treatment groups. By Day 1/2, WASO2H improved significantly with LEM versus ZOL and PBO. Least-squares mean (LSM; standard error [SE]) WASO2H change from baseline at Day 1/2 was -15.56(2.3) (PBO), -34.19(2.2) (LEM5), -42.54(2.2) (LEM10), and -27.82(2.1) (ZOL); all P&lt;0.0001 versus PBO, P=0.0222 and P&lt;0.0001 for LEM5 and LEM10 versus ZOL, respectively. Improvements in WASO2H were maintained through Day 29/30. LSM (SE) change from baseline in WASO2H at Day 29/30 was -15.07(2.5) (PBO), -30.06(2.4) (LEM5), -34.30(2.4) (LEM10), -25.30(2.3) (ZOL); all P&lt;0.002 versus PBO, P=0.1187 and P=0.0033 for LEM5 and LEM10 versus ZOL, respectively. ISI Item-3 improved from ≥3 at baseline to &lt;3 for most LEM5 (97/137[70.8%]) and LEM10 (92/133[69.2%]) treated subjects.

Conclusion
LEM provided significant benefit in WASO2H versus PBO (LEM5 and LEM10) and versus ZOL (only LEM10 at Day 29/30) among subjects with severe/very severe problems with waking too early. Improvements reported for ISI Item-3 for LEM subjects supports this benefit.

Support (If Any)
Eisai Inc.
0475 Prevalence and Potential Benefits of Cannabis Use in Patients with Insomnia
Authors: Jamil Saad Bin , Kachechian Talar , Fleet Benjamin , Grewal Ritu 
Published: May 2022

Abstract

Introduction
Insomnia is highly prevalent amongst patients presenting to sleep centers and it can be challenging to treat. Current treatment modalities include pharmacological intervention and cognitive behavioral therapy. Cannabis use is widely prevalent and has been approved in most states in the United States for medical use. Insomnia has been approved in some states as a qualifying condition for prescribing medical marijuana. Although the sedative effects of cannabis are well known, there are no established clinical guidelines with regards to its use for the treatment of insomnia.

Methods
We conducted a retrospective chart review to determine the use and potential benefits of cannabis in patients with insomnia over a three-year period at a tertiary care academic center. All patients with cannabis/marijuana and insomnia use listed in their electronic health record were included.

Results
Our cohort included 159 patients (67 males, 91 females; mean age= 48.4 years) who had a diagnosis of insomnia and used cannabis. 62 out of 159 (39%) patients reported improvement in sleep symptoms, whereas 18 (11.3%) patients denied any improvement. The status of remaining 79 patients (49.7%) was undetermined. 40 patients were African American, 103 were white, 4 were Hispanic; the remaining were of other or unknown ethnicities. 80 (50.3%) patients were using medically prescribed marijuana for various disorders; 50 (31.4%) were using non prescribed cannabis and prescription status was undetermined in 29 (18.2%) patients. Average use of cannabis was 4.9 days per week as reported by 47 patients who used cannabis regularly.50 out of the 62 patients with diagnoses of insomnia and cannabis use who reported improvement in symptoms had a history of comorbid anxiety, whereas 37 of 62 (59.6%) patients had comorbid depression. 29 out of 62 (46.7%) patients were using selective serotonin receptor uptake inhibitors (SSRI) and 24 of 62 (38.7%) were using benzodiazepines.

Conclusion
Cannabis use is highly prevalent among patients with a diagnosis of insomnia. Patient with cannabis use may have comorbid mood and anxiety disorders and may be taking SSRIs or benzodiazepines. Sleep physicians need to be aware of cannabis use and its impact on sleep symptoms in patients with insomnia.

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0520 Effect Of Sleep Disordered Breathing On Control And Severity Of Asthma On Pediatric Population
Authors: Singla Aarushi , Bagla Jyoti , Gothi Dipti , Kumari Sweta , Sasidharan Jaseetha , Mishra Ruchi , Dubey Anand , Patro Mahismita , Vaidya Sameer 
Published: May 2022

Abstract

Introduction
Pediatric sleep disordered breathing (SDB) can co-exist with asthma, affecting its control and severity, adding to the overall health care burden. Our aim was to determine the association of SDB with control and severity of asthma, and to evaluate any concomitant risk factors associated with both.

Methods
Based on the Sleep-Related Breathing Disorder scale extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5 – 15 years) with persistent asthma were classified as: with SDB (SDBS-PSQ ≥ 0.33) and without SDB, in a cross – sectional study. Characteristics like age, gender, body mass index and spirometry were compared. Control of asthma was categorized into well-controlled, not-well, and poorly controlled using childhood – asthma control test (c-ACT ≥20, 12-19 and ≤12, respectively). Correlation between SDBS-PSQ and c-ACT was analysed. Correlation of risk factors like adeno-tonsillar hypertrophy, gastroesophageal reflux disease, obesity and allergic rhinitis (AR) with presence of SDB in asthma was also assessed.

Results
Among sixty asthmatics, mild, moderate, and severe persistent asthma was observed in 26.67%, 40% and 33.33%, respectively. 18.33% asthmatics had risk for SDB (mean SDBS-PSQ of 0.45 ± 0.11 vs 0.07 ± 0.07 in those without SDB, p&lt;0.001). Baseline and spirometric characteristics were similar in both groups. Asthmatics with SDB had higher rates of severe persistent (63.6% vs 26.5%, p = 0.018) and uncontrolled asthma (100% vs 30.6%, p&lt;0.001), and a lower mean c–ACT score (14.45 ± 3.20 vs 20.04 ± 4.56, p&lt;0.001) compared to asthmatics without SDB. Amongst asthmatics with SDB, mean SDBS-PSQ score was higher in not-well and poorly controlled asthmatics (0.41 ± 0.07 vs 0.12 ± 0.08, p &lt;0.001 and 0.58 ± 0.08 vs 0.01 ± 0.07, p&lt;0.001; respectively), compared to those without SDB. Negative correlation was confirmed between c-ACT and SDBS-PSQ scores (p&lt;0.001, r2 = 0.36). Only AR was associated with SDB (p = 0.001, correlation coefficient &lt;0.001).

Conclusion
Control and severity of asthma is adversely affected by SDB, independent of other risk factors. AR can increase the risk of SDB in asthmatic children, further affecting the control. Therefore, children with severe and difficult-to-control asthma should be screened for SDB using objective questionnaires like SDBS-PSQ.

Support (If Any)
Nil