bluuebunny/crossref_metadata_2025_split huggingface dataset:
0555 Isolated REM Sleep Without Atonia Following COVID-19 Infection: A Case-Control Study
Authors: Steele Tyler , Bauer David , Cesarone Olivia , Lovold Kevin , Paule Gwen , Bibi Noor , Strainis Emma , Williams Jacob , Jagielski Jack , Feemster John , Vissoneau Laurene LeClair , Boeve Bradley , Silber Michael , McCarter Stuart , Louis Erik St 
Published: May 2022

Abstract

Introduction
REM sleep without atonia (RSWA) is the neurophysiological substrate of REM sleep behavior disorder (RBD), a form of prodromal parkinsonism in most older adults. Isolated RSWA (without clinical RBD) elevation was demonstrated recently in older adults following SARS-CoV2 (COVID-19) infection, but comparison to controls was not reported. We aimed to comparatively analyze RSWA between patients with previous COVID-19 infection and COVID-19 negative controls.

Methods
25 patients with previous COVID-19 infection were compared to 25 age-sex matched controls who tested negative for COVID-19 prior to polysomnography. Patients receiving medications known to increase RSWA were excluded. We reviewed medical records to determine clinical features and quantitatively analyzed RSWA in the submentalis (SM) and anterior tibialis (AT) muscles for phasic, tonic, and “any” muscle activity, phasic burst duration, and the automated REM atonia index. Non-parametric analyses compared clinical and polysomnographic features between groups, with combined SM and AT RSWA as the defined primary outcome. The comparative frequency of COVID-19 positive cases and COVID-19 negative controls who met or exceeded proposed isolated RSWA thresholds was also determined.

Results
COVID-19 patients had significantly greater RSWA than COVID-19 negative controls in the combined SM and AT muscles (p = 0.00076). Most other RSWA metrics were also higher in COVID-19 patients than controls (p&lt;0.03), except tonic muscle activity, phasic burst durations, and RAI. Isolated RSWA occurred more frequently in COVID-19 (9 patients, 36%) than controls (3, 12%; p&gt;0.05). No patients had a clinical history or polysomnographic evidence for parasomnia behavior or a primary neurological condition.

Conclusion
Quantitative RSWA amounts were comparatively greater in COVID-19 patients than in COVID-19 tested-negative controls, suggesting association of previous COVID-19 infection with central nervous system brainstem dysfunction in the region of the dorsal pons and/or ventromedial medulla. Further prospective studies are needed to determine whether RSWA is a predisposing influence to, or consequence of, COVID-19 infection in these patients, and whether COVID-19 survivors might harbor neurodegenerative risk or disease markers.

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0556 Prevalence and Incidence of Hypnagogic Hallucinations In A Longitudinal Study Of The American General Population
Authors: Ohayon Maurice , Pakpour Amir , Cote Marie Lise 
Published: May 2022

Abstract

Introduction
Hypnagogic hallucinations are vivid hallucinations that occur at sleep onset, during the transition between wakefulness and REM sleep. The hallucinations can be visual, auditory, tactile or kinetic and can be terrifying for the individual who experience them. Hypnagogic hallucinations are a common symptom of narcolepsy, a disorder characterized by excessive sleepiness, cataplexy and disturbed sleep. The evolution of hypnagogic hallucinations remains seldomly investigated. There is no data regarding its incidence and its chronicity. This study examines the predictive factors for chronic hypnagogic hallucinations in the general population.

Methods
This longitudinal study had two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the general population based on US Census. Analyses included subjects participating to both waves (N=10,931). Logistic regression models were used to determine the predictive variables for persistent hypnagogic hallucinations.

Results
At W1, 11.7% (95% CI:11.1%-12.3%) reported having experienced hypnagogic hallucinations in the previous year. At W2, 9.3% (95% CI: 8.8%-9.8%) reported hypnagogic hallucinations. A total of 22.8% of subjects with hypnagogic hallucinations at W1 still reported these hallucinations at W2 (2.1% of the sample). The 3-year incidence was 5.7% (95% CI: 5.3%-6.1%). After adjusting for age, sex, alcohol intake and medical conditions, persistence of hypnagogic hallucinations (i.e., present at both interviews) was predicted by the following factors: persistent pain (RR: 3.2 [95% CI:1.9-35.3] p&lt;0.0001), persistent hypersomnolence (RR: 5.8 [95% CI:3.8-8.8] p&lt;0.0001); persistent sleep paralysis (RR: 2.4 [95% CI:1.3-4.2] p=0.003); and persistent cataplexy-like symptoms (RR: 11.6 [95% CI:6.5-20.6] p&lt;0.0001).

Conclusion
Hypnagogic hallucinations are frequent in the general population. Its chronicity is predicted mostly by factors associated with narcolepsy such as hypersomnolence, cataplexy and sleep paralysis.

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0557 Diagnostic Visual and Automated Polysomnagraphic REM Sleep Without Atonia Thresholds in Isolated REM Sleep Behavior Disorder 2.0
Authors: LaClair-Visonneau Laurene , Feemster John , Bibi Noor , Gossard Thomas , Jagielski Jack , Strainis Emma , Steele Tyler , Carvalho Diego , Timm Paul , Boeve Bradley , Silber Michael , McCarter Stuart , Louis Erik St 
Published: May 2022

Abstract

Introduction
Accurate, early diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial given its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds in a current cohort of iRBD patients using submentalis (SM) and individual four limb electromyography (EMG) recordings, including bilateral flexor digitorum superificialis (FDS) and anterior tibialis (AT) during polysomnography.

Methods
We analyzed RSWA in 20 iRBD patients and 20 age-sex-AHI matched controls who underwent polysomnography between 2017-2021 for phasic burst durations, phasic, tonic, and "any" muscle activity, and automated REM atonia index (RAI). Group RSWA metrics were analyzed with non-parametric comparisons, logistic regression, and receiver operating characteristic (ROC) curves to determine optimal diagnostic cutoff thresholds for iRBD. Correlation explored associative relationships between RSWA metrics, and principal components analysis (PCA) defined determinants of RSWA metric variance.

Results
All mean RSWA metrics were higher in iRBD patients than controls (p&lt;0.05), except for left and bilateral AT phasic density and duration. RSWA(phasic%, AUC; "any"%, AUC) cutoffs were: SM (6.5%, AUC=90.2; 6.5%, AUC=92.5); L FDS (7.3%, AUC=95.8; 7.3%, AUC=95.8%); R FDS (5.4%, AUC=93.5; 5.8%, AUC=93.2%); Bilateral FDS (10.7%, AUC=96; 15.3%, AUC=95.8); L AT (6.7%, AUC=74.5; 6.7%, AUC=74.8%); R AT (4.7%, AUC=76.8; 4.7%, AUC=76.8%); Bilateral AT (7.5%, AUC=77.5; 7.5%, AUC=77.5%), combined SM/FDS (15.0%, AUC=95.5; 15.1%; AUC=95.8), combined SM/AT (16.5%, AUC=85.8; 21.0%; AUC=88.8),tonic (0.5%; AUC=85.9), and RAI (0.90; AUC=91.4). Phasic burst duration cutoffs were: SM=0.7s (AUC=90.2), L FDS=0.5 s (AUC=83.2), R FDS=0.6 (AUC=85.2), L AT=0.3 s (AUC=65.0) and R AT=0.4 s (AUC=77.0). PCA demonstrated that FDS and combined SM/FDS and SM/AT RSWA metrics best explained RSWA variance and differentiated controls from RBD, while SM and AT alone were less explanatory.

Conclusion
This study provides evidence for quantitative RSWA diagnostic thresholds applicable in current iRBD populations, and confirms the key importance of FDS to assure accurate iRBD diagnosis. Interestingly, these RSWA diagnostic thresholds are lower than previously determined thresholds, suggesting secular trends toward earlier iRBD detection and heterogeneous disease duration relative to polysomnography acquisition, underscoring the necessity of future large scale prospective, multicenter polysomnographic analyses to determine definitive iRBD diagnostic RSWA thresholds.

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0558 Emergence of Restless Legs Syndrome During Opioid Withdrawal
Authors: McCarter Stuart , Labott Joshua , Mazumder Mridul , Gebhard Judy , Cunningham Julie , Loukianova Larissa , Gilliam Wesley , Lipford Melissa 
Published: May 2022

Abstract

Introduction
Discontinuation of opioid medications may be associated with emergence of restless legs syndrome (RLS), which may complicate opioid withdrawal. However, this has not been systematically studied. We aimed to prospectively determine the frequency of the occurrence and severity of RLS symptoms in patients undergoing physician supervised opioid tapering during a 3-week interdisciplinary pain rehabilitation program.

Methods
Adult patients undergoing prescription opioid taper were prospectively recruited during their participation in the Mayo Pain Rehabilitation Center from 2016 to 2021. Subjects completed the Cambridge-Hopkins RLS Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Scale (IRLS) at baseline, midpoint, and dismissal from the program as well as 2 weeks, 1 and 3 months after dismissal from the program.

Results
101 patients participated with 61% being female taking a mean morphine equivalent dose of 46.6 ± 49.0 mg. Baseline prevalence of RLS symptoms was 29% (29/101), increasing to 32% (32/101) at midpoint of treatment and further to 35% (34/97) at dismissal from the program. Frequency of RLS symptoms peaked 2 weeks after dismissal at 38% (30/78) and steadily declined to 35% (28/80) and 31% (21/68) at 1 month and 3 months after dismissal, respectively. Thirty-five percent of patients without baseline RLS symptoms reported de novo RLS symptoms at some point during their opioid taper. RLS severity score followed a similar trend as the presence of symptoms with a baseline of 16.6 ± 10.0. RLS severity score was maximum at 19.1 ± 7.3 one month following dismissal and decreased but remained elevated above baseline at 3 months following dismissal.

Conclusion
Symptoms of RLS occurred in over a third of patients on chronic opioids and increased during opioid withdrawal, appearing to peak in frequency and severity 2-4 weeks after discontinuation and gradually improved 3 months after discontinuation. Over one-third of patients in our cohort developed de novo symptoms of RLS at some point during their opioid withdrawal. Physicians supervising individuals undergoing opioid withdrawal should be aware of the potential development of RLS symptoms which may hinder successful opioid withdrawal.

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0561 Sleep Disturbance Among COVID-19 Post-hospitalized Patients
Authors: Satashia Parthkumar , Castellanos Paula , Aleger Chary , Yin Mingyuan , Cheung Joseph 
Published: May 2022

Abstract

Introduction
COVID-19 primarily affects the respiratory system, however, a number of clinical sequela have emerged in patients recovered from COVID-19. Besides the most commonly reported symptoms of fatigue and dyspnea, early studies have found that sleep disturbance is also a common complaint. The aim of this study is to survey for sleep disturbance, degree of fatigue and daytime sleepiness in a group of post-hospitalized COVID-19 patients.

Methods
Patients who were discharged from Mayo Clinic hospitals after COVID-19 hospitalization were recruited in this study. Patients who have an existing diagnosis of sleep apnea or other sleep disorders were excluded from this study. Mayo Clinic patients who never had COVID-19 infection, nor a history of sleep disorders or other sleep disorders were also recruited as controls. Patients completed Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) questionnaires via REDCap. Wilcoxon rank sum test was used to evaluate the difference between cases and controls in continuous variables and Fisher’s exact test was used to compare categorical variables. Multivariable linear regression model was used to evaluate the difference in sleep and fatigue scores between cases and controls with baseline characters adjusted. All tests were two-sided with p value &lt;0.05 considered statistically significant.

Results
A total of 62 patients who completed the questionnaires were included in the analysis. Among them, 33 had COVID-19. Cases were significantly older with higher BMI compared to controls. Global PSQI score (median=10 vs 6, p=0.015), ESS total score (median=8 vs 5, p=0.018) and FSS total score (median=30 vs 22, p=0.009) were all significantly higher for cases compared to control patients. After adjusting for age and BMI, the difference stayed statistically significant. The mean difference between cases vs controls was found to be 2.7 (95%CI:0.2-5.2, p=0.038), 2.93 (95% CI: 0.66-5.2, p=0.014), and 12.62 (95% CI:5.22-20.03, p=0.001) for PSQI, ESS, and FSS scores, respectively.

Conclusion
Preliminary results showed that sleep disturbance (PSQI) and daytime symptoms (measured by ESS and FSS) are found to be significantly higher among post COVID-19 hospitalized patients compared to controls.

Support (If Any)
This work is supported by the Mayo Clinic in Florida Department of Medicine Catalyst for Advancing in Academics award and the Mayo Clinic in Florida Research Accelerator for Clinicians Engaged in Research Program.
0573 Daytime and Nighttime Sleep and Symptoms of Depression and Anxiety in Adults with Inflammatory Bowel Disease
Authors: Conley Samantha , Proctor Deborah , Jeon Sangchoon , Redeker Nancy 
Published: May 2022

Abstract

Introduction
Inadequate sleep duration and daytime napping are associated with symptoms of depression and anxiety in the general population. People with autoimmune diseases frequently experience poor sleep and depressive and anxious symptoms; however, little is known about how sleep might contribute to depressive and anxious symptoms in this population. The purpose of this study was to explore the associations between nighttime sleep and naps and depressive and anxious symptoms in adults with inflammatory bowel disease (IBD).

Methods
We conducted a cross-sectional feasibility study of adults with IBD (Crohn’s disease and ulcerative colitis) ages 18 to 60 years recruited from a single academic IBD center. We measured depressive and anxious symptoms using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures. We elicited nighttime sleep [sleep duration, efficiency, and wake after sleep onset (WASO)] using wrist-worn actigraphs (Philips Spectrum Plus) and elicited naps and perceived sleep quality (analog scale 0-100) with sleep diaries over 10 days.

Results
We included 35 adults [age M = 37.8 (14.0); female N = 21 (60.0%); Crohn’s disease N = 18 (51.4%); clinical remission N= 22 (63.9%)]. Mean depression (51.4 SD= 9.1) and anxiety (52.6 SD = 9.9) were over the population-based cut-offs. Additionally, nightly sleep duration was short (M = 391.9 minutes SD = 52.5). Sleep efficiency (M = 83.0% SD = 5.5) was low, and WASO (M = 41.8 minutes SD = 19.9) was high. Twenty-one (60%) participants reported taking at least one nap (median = 2, range 1-7) over the 10 days. Depressive and anxious symptoms were higher in people who napped than those who did not nap with a moderate effect size (Cohen’s d = -.309, -.466 respectively). Sleep quality was correlated with symptoms of depression (r = .622, p &lt; .001) and anxiety (r = .638, p &lt; .001). No other sleep characteristics were associated with depressive and anxious symptoms (r &lt; .1, p &gt; .59).

Conclusion
Health care providers should assess for the presence of depression and anxiety in people with IBD who regularly nap and report poor sleep quality. Future research regarding the treatment of sleep, depression, and anxiety is needed in this population.

Support (If Any)
American Nurses Foundation
0578 Clinical Patterns of Obstructive Sleep Apnea patients in COVID 19
Authors: Mechineni Ashesha , Gardner Jessica , Gordon Howard , Prasad Bharati 
Published: May 2022

Abstract

Introduction
Recent studies indicate Obstructive Sleep Apnea (OSA) patients have higher severity of respiratory compromise after COVID19 infection due to their sleep related hypoxemic burden. The pro-inflammatory state associated with OSA, sympathetic excitation, and recurrent hypoxemia may predispose to poorer post-COVID19 outcomes. We compared COVID19 infection outcomes in a cohort of hospitalized Veterans with and without OSA.

Methods
We used Jesse Brown Veteran Affairs Medical Center (JBVAMC) Registry for Research on Risk Factors and Outcomes of Veterans Evaluated for COVID19. The registry includes all patients who received a test for COVID19 at JBVAMC through November 8th,2021. Data are from the VA COVID19 Shared Data Resource and chart review, and include demographic data, pharmacological and non-pharmacological interventions, clinical outcomes, and pre-existing conditions. The study was approved by the Institutional review board (IRB). STATA v16 was used for data analysis.

Results
Of the 13,385 patients included in the registry, 1890 patients were found to have a positive COVID19 test, of which 625 were hospitalized and included in our study. The sample was older (mean age of 66.8 years), predominantly men (583, 93.3%) and African Americans (461, 73.8%). 18.7% (117, 18.7%) were European American, and (47, 7.5%) were of other race categories. The group with OSA was 37.8% (n=236) and without OSA was 62.2% (n=389) of the total sample. Elixhauser comorbidity index was higher in OSA group compared to those without OSA (p:0.00001, mean (SD): 16.73(14.6) vs. 12.03 (13.1)). Univariate analysis demonstrated a higher rate of readmission at 60 days (p=0.02, Odds ratio (95% CI): 1.69 (1.1-2.6)) and use of mechanical ventilation (p=0.05, Odds ratio (95% CI): 1.65 (0.99-2.75) in OSA vs. without OSA. These associations were attenuated in multivariate logistic regression models including age, gender, race, Elixhauser index and body mass index. OSA did not affect the length of stay or inpatient mortality.

Conclusion
In hospitalized COVID19 patients, OSA increases the probability of readmission and risk of mechanical ventilation, but this effect is likely due to higher comorbidity and obesity rates in OSA. In the future, we plan to examine larger samples of Veterans hospitalized with COVID19 and assess the effect of positive airway pressure treatment to understand the impact of OSA on COVID19 outcomes.

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no conflicting or financial interests to disclose
0580 Sleep Attitudes as a Predictor of Risk for Metabolic Syndrome in College Freshman
Authors: Hirsch Sophie , Ruggiero Aria , Zendels Philip , Peach Hannah , Gaultney Jane 
Published: May 2022

Abstract

Introduction
Transitions into adulthood and starting higher education can be a challenge in habit formation of first-year students. Unhealthy habits related to eating, exercise, substance consumption and sleep can lead to rapid weight gain and conditions such as metabolic syndrome. Research has suggested that regardless of sleep knowledge, favorable sleep attitudes predict better sleep. Thus, our aim was to investigate whether sleep attitudes directly predicted risk for metabolic syndrome or indirectly via subjective and objective sleep measures.

Methods
First year college students (N=165) completed self-report measures and were brought into the lab for height, weight, body fat, blood sugar and fats, and blood pressure analyses. Participants wore FitBit Flex wristwatches to collect sleep data for seven consecutive days. Preliminary correlational analyses were conducted on sleep and obesity measures. Two separate path analyses were conducted to investigate whether there was a direct effect of sleep attitude on risk for metabolic syndrome or indirect via subjective sleep (sleep quality, duration and apnea) and objective sleep (sleep efficiency, duration and apnea). Two moderated mediations were conducted to investigate the effects of gender and age.

Results
The average age was 18.66 (SD=3.33) with the majority of the sample being female (63%) and White (55.9%). In our subjective sleep analysis, we found that sleep attitudes predicted quality and duration, but not apnea, and that the overall model yielded significance. In our objective model, only apnea was a significant predictor, as well as the overall model. The indirect relationships were not moderated by gender or age.

Conclusion
Poor sleep attitudes are related to risk for metabolic syndrome in college aged individuals. Future studies should further examine sleep attitudes as a modifiable risk factor to prevent disease.

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NA
0581 Sleep Patterns and “OFF”-Time in Patients with Parkinson’s Disease and Motor Fluctuations
Authors: Hauser Robert , Videnovic Aleksandar , Soares-da-Silva Patrício , Liang Grace , Olson Kurt , Jen Eric , Rocha José-Francisco , Klepitskaya Olga 
Published: May 2022

Abstract

Introduction
Sleep disruptions in patients with Parkinson’s disease (PD) include difficulty falling/staying asleep, which can contribute to daytime sleepiness and overall worsening of health, mood, and quality of life. Although sleep disturbances in PD are multifactorial, nighttime motor symptoms can negatively affect sleep. To better understand how “OFF”-episodes affect sleep, post-hoc analyses were conducted using baseline data from two phase 3 studies of opicapone, an approved once-daily adjunctive treatment to levodopa/carbidopa (LD/CD) in patients with PD experiencing motor fluctuations.

Methods
In BIPARK-1 and BIPARK-2, participants recorded sleep/awake periods, “OFF”-time, and “ON”-time in 24-hour PD diaries. Sleep metrics included sleep duration, awakenings after sleep onset, and percent of sleep time spent awake. “OFF”-times included “OFF” before sleep (OBS), nighttime “OFF” (NTO), and early morning “OFF” (EMO). Data at baseline were pooled across treatment groups and analyzed descriptively. Mean values are presented with standard deviations (±SD).

Results
Baseline data from 1010 participants were pooled for analysis. Among 964 participants with available sleep metrics, mean total sleep duration was 7.6 (±1.5) hours and longest duration of uninterrupted sleep was 7.2 (±1.9) hours. 332/964 (34.4%) participants experienced an “OFF”-episode before going to sleep and the mean duration of this OBS was 1.8±1.2 hours. 158/964 (16.4%) participants awoke after sleep onset; of these, 128/158 (81.0%) awoke in an “OFF”-state and the mean duration of this NTO was 1.0 (±0.5) hours. Among these 128 participants, the mean number of awakenings was 1.3 (±0.7) and percent of sleep time spent awake was 15.4% (±9.6%). 898/1005 (89.4%) participants experienced an “OFF”-episode upon waking up in the morning and the mean duration of this EMO was 1.5 (±0.9) hours.

Conclusion
Results from this pooled analysis indicate that 34.4% of participants experienced an “OFF”-episode before going to sleep. Moreover, 81.0% of participants who woke up during the night were in an “OFF”-state upon awakening. Reducing “OFF”-episodes before and during the nighttime may help improve sleep in patients with PD, in turn potentially improving quality of life and daytime motor performance.

Support (If Any)
Neurocrine Biosciences, Inc.