bluuebunny/crossref_metadata_2025_split huggingface dataset:
0568 Multidimensional Sleep Health and Mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Chung Joon , Goodman Matthew , Lutsey Pamela , Huang Tianyi , Bertisch Suzanne , Redline Susan 
Published: May 2022

Abstract

Introduction
Prior research on the association of sleep with mortality has tended to focus on single sleep dimensions such as insufficiency. However, sleep health is conceptualized to consist of multiple inter-related dimensions: prior work suggests that simultaneous consideration of multiple sleep dimensions may better predict health outcomes than individual sleep measures considered in isolation. We tested the hypothesis that better multidimensional sleep health is associated with lower mortality in the Multi-Ethnic Study of Atherosclerosis, an ethnically-diverse prospective cohort study.

Methods
At baseline (2010-2013), sleep was measured objectively by at-home polysomnography and 7-day wrist actigraphy, additionally by validated questionnaires. A composite sleep score was constructed in a prior project by summary index whose interpretation is the sum/count of 13 sleep attributes, selected a priori, which met clinical criteria for favorability. We used proportional hazards models to estimate the association between sleep health scores and all-cause mortality, adjusting for socio-demographics, and lifestyle/behavioral factors such as smoking status, alcohol consumption, and Body Mass Index.

Results
1,757 participants were followed for a median of 5.9 years (Q1-Q3, 5.4–6.4 years) until death or last contact (128 deaths). After adjustment, each unit increase in composite sleep health scores (indicating healthier sleep) were associated with a 12% lower mortality risk (HRsummary_index: 0.88; 95% CI: 0.80, 0.96). This result was further supported by a similar association with mortality of a sleep score constructed by Principal Components Analysis. In post-hoc analyses, achievement of favorable actigraphic-estimated sleep regularity (midpoint sd &lt;30 minutes; duration sd &lt;90 minutes), sleep duration (6-8 hours), and Apnea-Hypopnea Index (≤15 events/hour) were significantly associated with lower mortality. Associations with mortality were in the expected direction for % N3, % R, and sleep fragmentation.

Conclusion
More favorable multidimensional sleep is associated with reduced mortality risk. Of specific sleep dimensions, sleep regularity, duration, and obstructive sleep apnea are suggested to be public health targets to potentially reduce risk of premature mortality.

Support (If Any)
This work was supported by the following National Institute of Health (NIH) grants: 5T32HL007901-19, 5K01HL138211-05, K01HL143034, R01HL098433. SR was partly funded by the NIH National Heart, Lung, and Blood Institute (NHLBI) R35HL135818.
0591 Use of FOSQ to characterize sleep disturbances in hospitalized patients with COPD exacerbation
Authors: Aiyer Ishan , Gill Yash , Taweesedt Pahnwat , Chohan Asad , Ratnani Iqbal , Surani Salim 
Published: May 2022

Abstract

Introduction
Sleep disturbances are common in COPD. Hospitalization due to COPD exacerbations likely have a negative impact on sleep in these patients and may contribute to their recovery. The aim of this study was to measure the prevalence of sleep disturbances in hospitalized patients with COPD and characterize their impact by use of the Functional outcomes of Sleep questionnaire (FOSQ).

Methods
The study was done at a community hospital. We included all patients who were admitted with a diagnosis of acute COPD exacerbation. Patients were administered the FOSQ on the day of discharge. Standard statistical methods were used to analyze the data

Results
A total of 54 patients - 28 males and 26 females filled out the questionnaire completely and were included in the analysis. The mean age was 66 +/- 14 years. The average FOSQ was 15 +/- 7. 60% of the patients had a FOSQ of &lt;17.9 showing a high prevalence of sleep morbidity. Individual domains of the FOSQ -( mean +/- SD) showed the following values : General productivity of 3 +/- 2, vigilance 2.5 +/- 2.2, activity 7.2 +/- 2.2, and social outcomes 0.6 +/- 0.9 respectively. Vigilance scores and social outcomes domains were seen to be lower than those previously reported in patients with severe sleep apnea while activity domains were seen to be higher.

Conclusion
There is significant sleep-related morbidity in hospitalized patients with COPD exacerbation, with particularly high prevalence of overall sleep disturbances even after recovery and at the time of discharge. Domains related to social outcomes were the most affected, and vigilance domain scores were critically low. These data point to an urgent need for clinicians to include assessment of sleep quality while discharging patients with COPD exacerbations and providing them appropriate counseling. Future studies should focus on the best interventions to improve sleep in the patients and measure its impact on their lung function.

Support (If Any)
None
0661 Lightbox Therapy for Seasonal Affective Disorder in College Students
Authors: Zhang Meina , Guist Caitlin , Rossmann Patrick , Moon Chooza 
Published: May 2022

Abstract

Introduction
Seasonal affective disorder (SAD) is a mental health issue that can be defined as depressive mood disturbances that align with a seasonal pattern. Research shows that college students are at a higher risk of having SAD leading to poor academic performance and other severe mental disorders. Light therapy can help alleviate the symptoms of SAD. However, few detailed investigations have been conducted on the impacts of light therapy for SAD symptoms and adherence barrier for the therapy. The purpose of this project was to review a light therapy program for college students. Specifically, we aimed to assess the changes in depressive symptoms before and after using a light box and assessed feedback.

Methods
207 college students (mean age of 22.5 years (SD=5.3); female (80.7%)) participated in the light therapy program. Participants were given user instructions and asked to utilize the lightbox daily. Participants completed the patient health questionnaire (PHQ-9) at baseline and when they returned the lightbox along with their feedback of this therapy. Students also completed the open-ended questions. We used paired sample t-test to assess changes in the total PHQ-9 score.

Results
Participants spent 45 days, on average, using the device. Results showed that there was a significant decrease in PHQ-9 score from pre- to post-therapy [M(post-pre) = -2.78; p &lt; .0001]. Most students said the therapy was effective (96.5%) and helped ease SAD symptoms and improve their mood. Some students planned to purchase a light box after the therapy. The major adherence barriers were finding enough time to use it and excessive brightness issue.

Conclusion
The findings suggest that light therapy has positive outcomes in easing college students’ SAD symptoms. Future randomized control trials are needed to assess the effectiveness of the intervention. However, to the time and brightness issues need to be assessed when designing the therapy instructions for college students.

Support (If Any)
This work was supported by the Alzheimer’s Association Research Grant (AARG-19-618403), University of Iowa Institute for Clinical and Translational Science (NIH/NCATS, UL1 TR002537), and the University of Iowa Center for Advancing Multimorbidity Science (NIH/ NINR P20 NR018081).
0701 STOP-BANG Score, Age, and Body Mass Index Predict Severity of Sleep Disordered Breathing in Women Veterans
Authors: Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Fung Constance , Josephson Karen , Song Yeonsu , Agrawal Alpna , Zhu Ruoyan , Mitchell Michael , Badr M Safwan , Washington Donna , Yano Elizabeth , Zeidler Michelle , Alessi Cathy , Martin Jennifer 
Published: May 2022

Abstract

Introduction
Despite increasing evidence that sleep disordered breathing (SDB) is common in women veterans, little is known of how to screen for SDB in this population. Some evidence suggests there are sex-related differences in SDB presentation, where women may be more likely to present with fatigue or depression, compared to men who may present with daytime sleepiness. The goal of this study was to evaluate whether commonly used measures predict SDB in women veterans.

Methods
Women veterans (N=179) without treated SDB, but with 1 or more SDB risk factors (identified from electronic medical records) completed baseline assessment as part of an ongoing controlled trial of treatment for SDB. Measures included: age, body mass index (BMI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FSS), Insomnia Severity Index (ISI), Patient-Health Questionnaire 9-item (PHQ-9), STOP-BANG score, and apnea-hypopnea index (AHI via WatchPAT home sleep apnea testing). Descriptive statistics and bivariate correlations testing the relationship between AHI and other measures were performed.

Results
Mean age was 49.8 [±13.8] years and BMI 29.6 [±6.0] kg/m2. Mean ESS was 8.1, FFS 13.9, ISI 14.0, PHQ-9 7.1, and STOP-BANG score 2.7. Mean AHI was 15.4 [±13.2], where higher AHI correlated with higher BMI (r=0.3, p&lt;0.001), higher STOP-BANG score (r=0.4, p&lt;0.001) and older age (r=0.4, p&lt;0.001).

Conclusion
These findings support the use of the STOP-BANG score to predict SDB severity in women veterans with risk factors for SDB. Age and BMI may be particularly important predictors of SDB in this population. Sleepiness, depression, insomnia, and fatigue questionnaires were not related to SDB severity. Further work is needed to understand the role of patient-reported symptoms in those at-risk for SDB and to inform guidelines for the recognition of SDB in this important and understudied population.

Support (If Any)
VA HSR&D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&D COIN; VAGLAHS GRECC.
0707 Effects of obstructive sleep apnea on Anti-SARS-COV-2 igg levels in older adults vaccinated against covid-19
Authors: Pires Gabriel , Andersen Monica , Rosa Daniela , Tufik Sergio , Tufik Sergio 
Published: May 2022

Abstract

Introduction
Sleep disorders and sleep deprivation induces decreased antibody response following vaccination for different viral diseases (including H1N1, influenza and hepatitis A). The same has been speculated for COVID-19. This study aimed to assess whether obstructive sleep apnea (OSA) reduces antibody levels after COVID-19 vaccination among older adults.

Methods
This was a convenience-sample study composed of older adults (≥60 years old). Those who underwent polysomnography at the Sleep Institute (São Paulo, Brazil) and received complete COVID-19 vaccination schedule were considered eligible. Individuals with previous diagnosis of COVID-19, less than 15 days between vaccination and IgG testing, or CPAP use in the last 3 months were excluded. Anti-SARS-CoV-2 IgG levels were measured using a chemiluminescence assay. The participants were distributed in the following groups, according to their apnea-hypopnea index (AHI): no/mild OSA (AHI&lt;15), moderate OSA (AHI≥15 and &lt;30) and severe OSA (AHI≥30). The effects of OSA on IgG levels (ANOVA), the correlation between IgG levels and AHI (Spearman’s correlation test) and the association between serostatus (positive vs. negative) and OSA severity levels (X2 test) were analysed. Results were considered as statistically significant when p&lt;0.05.

Results
The sample included 122 older adults (median age 72.0 - IQR: 5.7), of whom 35 (28.6%) had AHI no/mild OSA; 31 (25.4%) had moderate OSA, and 56 (45.9%) had severe OSA. Oxford/AstraZeneca was the most referred vaccine (n=111, 91.0%), followed by CoronaVac (n=9, 9.0%). Seropositive status (IgG count ≥50.0 AU/mL) was observed in 90.2% of the participants and the median IgG levels in the complete sample was 273.0 AU/ML (IQR: 744.0). No/mild, moderate and severe OSA groups presented IgG levels of 482.0 (IQR: 677.0), 285 (IQR: 884.0) and 181.0 (IQR: 598.0), respectively, with no statistical difference them (p=0.606). There was no statistically significant correlation between AHI index and IgG levels (Spearman’s rho=-0.169, p=0.063) and no significant association between serostatus and OSA severity groups (X2=0.912; p=0.634).

Conclusion
Anti-SARS-CoV-2 IgG levels after vaccination are not significantly affected by OSA among older adults. Thus, despite being at higher risk for severe cases, OSA does not decrease the antibody response following vaccination against COVID-19.

Support (If Any)
AFIP, CNPq, CAPES
0774 Positive Airway Pressure Utilization, Major Adverse Cardiovascular Events Incidence Risk and Mortality in Medicare Beneficiaries with Obstructive Sleep Apnea
Authors: Mazzotti Diego , Waitman Lemuel Russell , Gozal David , Song Xing 
Published: May 2022

Abstract

Introduction
Positive airway pressure (PAP) is the first line treatment for moderate-severe or symptomatic obstructive sleep apnea (OSA). Randomized controlled trials have established that PAP therapy has beneficial impact on cardiovascular and metabolic functions. However, evidence on the benefits of PAP for preventing major adverse cardiovascular events (MACE) is limited. We aimed to determine the association between PAP utilization and incidence of MACE and all-cause mortality in a large sample of Medicare beneficiaries.

Methods
Medicare beneficiaries (&gt;65 years) with at least 5 years of consecutive enrollment to part A and B and ≥2 distinct OSA claims were collected from multi-state (Kansas, Missouri, Iowa, Wisconsin, Nebraska, Minnesota, Texas, Utah, North Dakota, South Dakota and Indiana), multi-year (2011-2017) Medicare fee-for-service claims data. We further required at least 1-year enrollment before the first OSA claim. Evidence of PAP utilization and index date was defined based on the first Healthcare Common Procedure Coding System PAP initiation codes (E0601, E0470, E0471) after first OSA diagnosis. MACE was defined as the first occurrence of myocardial infarction, coronary revascularization, stroke, or heart failure (identified by diagnostic and procedure code claims) after PAP initiation. Analyses were adjusted by age at initial OSA diagnosis, sex, race and presence of hypertension, type 2 diabetes, obesity, and evidence of MACE prior to the index date.

Results
Our sample included 212,445 eligible Medicare beneficiaries with evidence of OSA diagnosis (mean [SD] age 75 [5.7] years; 45.2% women; median [Q1, Q3] follow-up 4 [2.0, 4.9] years at censoring). Five-year MACE cumulative incidence rate was 59.3% and the mortality rate was 17.8%. In adjusted analyses, OSA patients with evidence of PAP utilization (50.8%) had significantly lower MACE incidence risk (HR=0.812; 95%CI=0.803-0.822; p&lt;0.0001) when compared to those without evidence of using PAP. OSA patients with evidence of PAP utilization also had significantly lower mortality risk (HR=0.575; 95%CI=0.560-0.591; p&lt;0.0001). Pre-existing hypertension, type II diabetes and obesity were also significantly associated with increased mortality and MACE risk.

Conclusion
PAP utilization based on device initiation derived from claims data is associated with lower MACE incidence and mortality in older adults that are Medicare beneficiaries.

Support (If Any)
American Heart Association (20CDA35310360), Patient-Centered Outcomes Research Institute (RI-CRN-2020-003-IC); NIH CTSA NCATS Frontiers: University of Kansas Clinical and Translational Science Institute (UL1TR002366); Tier 2 grant, University of Missouri.
0779 Describing the OSA Patient Journey from Testing to PAP Treatment
Authors: Cole Kathleen , Dexter R Benjamin , Woodford Caleb , Sterling Kimberly 
Published: May 2022

Abstract

Introduction
Patients diagnosed with obstructive sleep apnea (OSA) and prescribed positive airway pressure (PAP) therapy for treatment may have differences in experience based on insurance provider, sex, age, or comorbidity status. This retrospective, real-world analysis investigated the factors that impact the patient’s OSA journey from initial sleep test to starting PAP therapy.

Methods
De-identified US administrative claims data for patients with OSA who had a claim for a sleep test were used for this analysis. Age, sex, and insurance coverage were characterized at the time of the first sleep test. Comorbidity status was evaluated in the year prior to the sleep test by assessing ICD-9/10 codes associated with healthcare encounters. This protocol was submitted to an Institutional Review Board and was determined to be exempt from oversight.

Results
In a population of 1,912,381 patients, 46.6% were female with mean age of 51.0 years. Insurance coverage was 70.6% commercial, 19.9% Medicaid, and 9.5% Medicare Advantage. Four comorbid cohorts were evaluated including those with hypertension (52.2%), type 2 diabetes (21.7%), COPD (9.7%), and atrial fibrillation (5.9%). Time from sleep test to receiving a PAP device was 7 days longer for females than males (median 49 days vs 42 days). Regardless of type of sleep test (polysomnography (PSG), home sleep test (HST)), those with commercial insurance received a device faster (median 41 days, Medicaid 61 days, Medicare Advantage 50 days). In comparison to those without the respective comorbidity, COPD was the only group with a noticeable increase in time from sleep test to device (median 54 days for those with COPD vs. 43 days for those without). No noticeable differences were observed across age categories. For those that had a titration, it occurred a median of 23 days after PSG or 34 days after HST. Consequently, the two fastest pathways were PSG with split night titration and HST without titration.

Conclusion
This retrospective study identified the length of time it takes in a real-world setting for patients to get a PAP device after a sleep test. Depending on demographic factors this time can vary from 1-2 months, delaying the start of OSA treatment.

Support (If Any)
ResMed
0788 The effect of CPAP on quality of life in females with mild OSA: Post hoc analysis from the MERGE Randomised Trial
Authors: Wimms Alison , Kelly Julia , Turnbull Chris , McMillan Alison , Craig Sonia , O’Reilly John , Nickol Annabel , Hedley Emma , Decker Meredith , Willes Leslee , Calverley Peter , Benjafield Adam , Stradling John , Morrell Mary 
Published: May 2022

Abstract

Introduction
The MERGE trial was a multi-centre, randomised, parallel study that showed the beneficial effect of continuous positive airway pressure (CPAP) on quality-of-life in patients with mild obstructive sleep apnea (OSA) (Wimms et al. 2019); findings that have extended the new NICE guidance [Obstructive sleep apnoea/ hypopnoea syndrome and obesity hypoventilation syndrome in over 16s (NG202)].This post-hoc analysis aimed to determine whether differences between the sexes in symptoms and treatment response exist at the mild end of the OSA disease spectrum.

Methods
Patients were recruited (Nov 2016 - Feb 2019) to receive either CPAP plus standard care, or standard care alone. Mild OSA was defined as: apnea-hypopnea index (AHI) &gt;5 to ≤15 events/hr. Symptoms and quality-of-life were measured by a range of generic and disease specific questionnaires at baseline and 3 months post CPAP commencement.

Results
233 participants (30% female) were included in this analysis. Females were on average older (mean ± SD) (51.9±10.4 vs 49.8±12.2 years) with higher BMI (32.2±5.0 vs 29.4±3.7 kg/m2) and had a lower AHI than males (median(IQR)) (9.60(6.50 -12.40) vs 10.30(7.10-13.20) events/hour).Females were sleepier (Epworth Sleepiness Score (ESS) (mean ± SD) (11.0±4.2 vs 9.5±4.4)), more fatigued (Fatigue Severity Score (FSS) (42±12.8 vs. 34.4±13.5)) and reported higher levels of anxiety, depression and insomnia. Reported quality-of-life was lower in the SF- 36 mental (41.8±13 vs. 47.3±10.9) and physical components (43.0±11.2 vs. 49.7±9.1), as well as in all individual domains. Females also reported worse scores in the Euroqol 5 Dimensions (EQ-5D) and Functional Outcomes of Sleep Questionnaire (FOSQ), compared to males.All symptoms improved with CPAP use for both sexes, however female patients had larger improvements in the ESS (mean difference(95%CI)) (-5.2 (-6.7, -3.6) vs (-2.0 (-3.0, -1.0)) p=0.0035, and SF-36 vitality (11.7 (7.9, 15.5) vs 5.6 (3.1, 8.1)) p=0.0092.

Conclusion
In mild OSA, female patients were more symptomatic and reported worse quality-of-life than males, despite having lower AHIs; all were improved with CPAP treatment.

Support (If Any)
Funded by ResMed
0793 Postoperative Monitoring in Children less than 2 years of Age undergoing Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Bhushan Bharat , Lavin Jennifer , Yasuda Mayuri , Billings Kathleen 
Published: May 2022

Abstract

Introduction
To analyze variables associated with postoperative monitoring in children &lt;2 years of age undergoing adenotonsillectomy (T&A) for the management of obstructive sleep apnea (OSA).

Methods
Retrospective case series of children &lt;2 years of age who underwent T&A for the management of OSA between 1/1/08-6/1/18. Postoperative respiratory complications and hospital course were analyzed to determine higher acuity of monitoring in Intensive Care Unit (ICU) versus observation unit was indicated.

Results
A total of 69 children were analyzed. Fifty-two (75.4%) patients were male, and their mean age was 18.8 months. Fifty-six (81.2%) children had severe OSA, 6 (8.7%) had moderate OSA, and 7 (10.1%) children had mild OSA. Thirty-seven (53.6%) children were monitored in the ICU; one (2.7%) child was admitted to the ICU directly from the sleep lab, and3 (8.1%) children were intubated. The average Apnea Hypopnea Index (AHI) for those who were intubated was 64.6 events/hour and low SpO2 average was 66.3%, when compared to an average of 36.2 events/hour and 75.5% respectively for the entire group. Three (8.1%) patients needed &gt;2 liters/minute of O2, and 5 (13.5%) had minor O2 requirements. Only 7/32 (21.9%) patients monitored in the observation unit required supplemental O2.

Conclusion
A greater severity of AHI and low SpO2 nadir were associated with respiratory issues requiring monitoring of children in ICU after T&A for OSA. No specific PSG cut-off values for ICU versus observation unit were noted. Low incidences of respiratory issues were observed, and most children could have been monitored safely outside of the ICU setting.

Support (If Any)
None