bluuebunny/crossref_metadata_2025_split huggingface dataset:
0610 Development of a Rule-Based Text Mining Algorithm to Identify Sleep Complaints in Primary Care Progress Notes
Authors: Horner Matthew , Abul-el-rub Noor , Mays Mary , Mazzotti Diego 
Published: May 2022

Abstract

Introduction
Sleep complaints are among the most common reasons to seek medical attention, yet sleep disorders are largely underdiagnosed in primary care settings. The ability to process large collections of unstructured clinical notes might offer an opportunity to promote screening of patients suffering from significant sleep disorders. The goal of this study was to develop a simple rule-based algorithm to identify sleep complaints in progress notes from primary care encounters and validate the performance of the algorithm against manual chart review.

Methods
De-identified progress notes of a random sample of patients with primary care encounters at the University of Kansas Health System in 2019 were extracted from the institution’s clinical research data warehouse (Healthcare Enterprise Repository for Ontological Narration). Review of 163 notes from patients enriched for presence (N=95) or absence (N=68) of sleep disorders based on the International Classification of Disease (ICD)-10 code hierarchy G47 guided the development of a vocabulary of sleep complaints and symptoms, including corresponding negation terms. The vocabulary was used to design a rule-based, regular expression matching algorithm, which was evaluated against manual chart review of the same patient cohort (training dataset). An independent set of notes from another sample of patients with primary care encounters (N=77; testing dataset) was also manually reviewed and used to assess the validation performance of the algorithm.

Results
In the training dataset, the algorithm had a sensitivity=75%; specificity=91%, positive predictive value (PPV)=90%, and a negative predictive value (NPV)=87%. The area under the receiver operating characteristics (AUC) curve in the training set was 0.84. When the algorithm was evaluated in the testing dataset, we found a sensitivity=53%, specificity=91%, PPV=78%, and NPV=77%. The AUC in the testing dataset was 0.78.

Conclusion
A simple pattern matching algorithm designed to identify sleep complaints in primary care progress notes showed good performance in the training set and acceptable performance in the testing set. Further refinement of this algorithm with potential incorporation of natural language processing might offer a feasible approach to screen patients for underdiagnosed sleep disorders using primary care clinical notes.

Support (If Any)
NIH CTSA UL1TR002366.
0618 Association between Ambient Light Exposure, Race/Ethnicity, and Vitamin D among Adults in the United States: Analysis of the National Health and Nutrition Examination Survey
Authors: Moore Jesse , Narcisse Rachelle , Briggs Anthony , Rogers April , Grandner Michael , Seixas Azizi , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
The prevalence of vitamin D deficiency (VitD) in the United States is 41 percent, with the highest rate among Blacks 82 percent. Vitamin D deficiency has been linked to chronic diseases. The extent to which the association between light exposure and vitamin D serum levels can vary by individual’s race/ethnicity of which has not been studied at a national level. We aim to explore the associations of ambient light exposure between race/ethnicity and vitamin D.

Methods
The study used data from the National Health and Nutrition Examination Survey (2013-14). For detection of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 nmol/L, ultra-high-performance liquid chromatography-tandem mass spectrometry was performed based on serum samples from adults aged ≥ 18 years. Light levels (lux) data were gathered using 24-hour actigraphic monitoring over /a 7day period. Weighted generalized linear models were fitted examining association between light exposure and VitD adjusting for age, sex, family income/poverty ratio, education, employment, house tenure, marital status, birthplace, number of people in household, smoking, physical activity, and sedentarity. To compare this association across race/ethnicity, a product term between lux and race/ethnicity was included in adjusted models.

Results
Among 4,251 participants, White adults had the highest levels of VitD (mean=76.0; se=1.3), then other/multiple races (mean=65.1; se=2.2), Asians (mean=62.5; se=1.4); Hispanics (mean=57.4 nmol/L; se=1.6), and Blacks (mean=50.1; se=1.4). Regression analysis revealed estimated mean VitD of 64.9 nmol/L and positive association between light exposure and VitD ( 0.020). Blacks had significantly lower VitD levels ( -19.3) followed by Asians (-12.1) and Hispanics (-12.6) (all p-values &lt;0.001). The association between light exposure and VitD depended on participant’s race/ethnicity

Conclusion
To our knowledge, this is the first study showing associations between objectively measured light exposure and VitD serum levels using a large representative sample of the US population. Although the study revealed racial/ethnic disparities in VitD levels, light exposure was associated with VitD even when race/ethnicity was adjusted for in the model. Further research on racial/ethnic differences in VitD is warranted.

Support (If Any)
R01HL142066, R01HL095799, RO1MD004113, R01HL152453, R25HL105444
0619 The Relationship Between Sleep Disturbance and Inflammatory Markers in Individuals with 22q11.2 Copy Number Variations
Authors: O'Hora Kathleen , Chiem Emily , Grigoryan Vardui , Amir Carolyn , Irwin Michael , Chiang Jessica , Bearden Carrie 
Published: May 2022

Abstract

Introduction
The 22q11.2 locus contains genes critical for brain development. Individuals with copy number variations (i.e. a deletion or duplication; CNV) at this locus have greatly increased risk of developmental neuropsychiatric disorders, as well as immune dysfunction and sleep problems. However, it remains unknown if sleep disturbance and immune dysfunction are related to each other in this population, as they are in typically developing individuals.

Methods
We examined the relationship between self-reported sleep disturbance and blood cytokine levels in 22q11.2 deletion (22qDel; n= 40, Mage = 17.5±8.4 years, 45% males) and duplication (22qDup; n=28, Mage =16.8±12.9 years, 45% males) carriers. Blood plasma samples were obtained to measure interlukein-6 (IL-6), interlukein-10 (IL-10), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF) and interferon-gamma (IFN) using a MesoScale Discovery multiplex immunoassay. We also measured levels of C-reactive protein (CRP) using an ELISA. Subjects were classified as either good or poor sleepers based on the sleep disturbance score on the Structured Interview of Psychosis-Risk Symptoms (SIPS). Linear regression models were used to test the effect of sleep disturbance, subject group (22qDel vs. 22qDup), and a group-by-sleep interaction on each cytokine level while controlling age, sex, body mass index, and collection time. We corrected for multiple comparisons using False Discovery Rate (FDR) correction.

Results
Overall, 22qDup carriers had higher levels of IL-8 (q&lt;0.001) and TNF (q&lt;0.001) relative to 22qDel. Across CNV groups, poor sleepers had higher levels of IL-8 (p=0.046) and IFN (p=0.028), but these effects did not survive FDR correction (q&gt;0.18). There was a group-by-sleep interaction for IL-8 (p=0.013), TNF (p=0.048), and IFN (p=0.034) such that sleep disturbance had a greater effect on cytokine levels in the 22qDel group, but only the interaction for IL-8 survived as a trend towards significance after FDR correction (q=0.076).

Conclusion
Our findings suggest that poor sleep may contribute to immune dysfunction in 22q11.2 CNV carriers. Further, there may be differential impacts of sleep on immune function, depending on gene dosage at the 22q11.2 locus. Future research in larger samples is required to determine if immune disruption and sleep problems are related to elevated psychiatric symptoms in 22q11.2 CNV carriers.

Support (If Any)
RO1MH085953; U01MH10171
0622 Influence of Cannabis Use Disorder on Sleep Quality among College Students
Authors: Turner Arlener , Keen Larry , Bernard Mark , Blanc Judite , Seixas Azizi , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
Poor sleep, which has numerous deleterious effects, is one of the most common health complaints among college students. Both race/ethnicity and sex are associated with poor sleep outcomes, with Black college women potentially having higher risk. The college experience is often associated with an increase in stress, as well as drastic shifts in lifestyle and sleep patterns. Research indicates that college students report cannabis use enables them to cope with life stressors and negative emotions and is often used as a sleep aid. The use of cannabis as a to cope may lead to more chronic cannabis use, and the development of Cannabis Use Disorder (CUD), which is most prevalent in individuals aged 18-25. Therefore, this study examined the influence of CUD symptomatology on sleep among Black female college students.

Methods
Participants included 200 Black/African American women (age range: 18-25 years) attending a Historically Black College/University. Each participant completed an Qualtrics online survey including assessment of DSM-5 CUD criteria, and validated measures of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and perceived stress (Perceived Stress Scale [PSS]).

Results
11.5% of the sample met criteria for CUD. There were no significant differences between the CUD and non-CUD groups in perceived stress, however, all participants endorsed moderate stress levels (M=19.51, SD=5.33). Additionally, all participant’s PSQI scores met criteria for impaired sleep (score &gt;5). [MOU1] [TAD2] T-test analyses indicate that the CUD subgroup reported poorer sleep quality (M=9.04, SD=3.69 vs M=7.07, SD=3.28), more sleep disturbances (M=1.52, SD=0.59 vs M=1.15, SD=0.74), and longer sleep latency (M=37.70, SD=25.28 vs M=25.92, SD=23.95), than the non-CUD group (all p&lt;.05).

Conclusion
Black/African American female college students who met criteria for CUD reported more sleep disturbances, longer sleep latencies, and poorer overall sleep quality. Given the lack of difference in perceived stress, these results suggest that the use of cannabis as a coping aid may exacerbate poor sleep. Previous research indicates that Black women are not only more likely to report poor sleep, but that they also report exploring non-traditional strategies to address their sleep problems. These findings suggest a need to examine these non-traditional coping strategies for possible paradoxical and deleterious effects.

Support (If Any)
Funding: R01HL142066, R01HL095799, RO1MD004113, R01HL152453, 1R15 DA052886-01A1
0623 Neural Dynamics During Sleep in Parkinson’s Disease Patients
Authors: Abunimer Luma , Vess Gavin , Kvavilashvili Andrew , Williams Della , Vijayan Sujith 
Published: May 2022

Abstract

Introduction
Parkinson’s Disease (PD) is a neurodegenerative disease marked by tremor, body tone changes, and cognitive decline with deficits in motor task learning. Characteristic neural patterns during non-Rapid Eye Movement (NREM) sleep have been correlated with learning procedural motor memory tasks. We seek to understand how the neural dynamics of NREM sleep (e.g., sleep spindles and slow waves) interact with motor learning ability in a neurodegenerative disease process. This information might be used to identify electrical biomarkers that could be therapeutically targeted.

Methods
PD subjects and healthy age-matched controls were identified by physician interview, flyering, and medical chart review. Eligibility requirements for subjects precluded severe cognitive decline and untreated sleep disorders. Baseline sleep characteristics were ascertained via survey data collected prior to and on the day of the sleep study. Subjects were fitted with EEG electrodes prior to an all night polysomnogram. Subjects were also fitted with EMG and EOG electrodes for sleep scoring purposes. Motor tasks were performed prior to and following overnight sleep.

Results
Surveys indicated worse sleep quality among PD subjects compared to age-matched controls prior to their sleep session. Sleep macro-architecture of PD subjects showed a smaller percentage of sleep time in N2/N3 stages, and at the spectral level, there were indications of reduced power for slow waves and spindling. Furthermore, we observed aberrant patterns of coupling between slow waves and spindling in PD subjects.

Conclusion
Our study has implications for sleep as a component of motor skill learning and as a marker for a neurodegenerative movement disorder. NREM sleep rhythms such as sleep spindles and slow waves, and their relationships to one another, are thought to be important in motor learning and memory. Aberrations in these rhythms and their coupling may inform potential therapies to enhance motor learning and mitigate the progression of PD.

Support (If Any)
NCATS of the NIH, Award Number UL1TR003015.
0626 Nocturnal Pulse Event Frequency in Multiple System Atrophy: An Exploratory Pilot Study
Authors: McCarter Stuart , Coon Elizabeth , Benarroch Eduardo , Louis Erik St 
Published: May 2022

Abstract

Introduction
Risk of sudden death in multiple system atrophy (SuD-MSA) is greatest during sleep. Mechanisms underlying SuD-MSA may involve impaired brainstem arousal and cardiovascular responses to hypercapnia in MSA patients. We hypothesized that nocturnal arousal-related tachycardia events are reduced in MSA patients. We analyzed whether nocturnal pulse event frequency was altered in patients with MSA compared to patients with sleep disordered breathing without MSA utilizing portable overnight oximetry.

Methods
We retrospectively analyzed 46 probable MSA and 46 age-sex matched patients with sleep disordered breathing (SDB) without MSA, excluding patients receiving cardioactive medications. Nocturnal oxyhemoglobin desaturation indices (ODI) and pulse event indices (PEI) were automatically recorded for all patients using portable overnight oximetry. We calculated a PEI/ODI ratio to determine the relationship between probable breathing-related arousals and pulse rate change. Cardiovagal function was assessed by heart rate to deep breathing and Valsalva ratio in patients with MSA and Composite Autonomic Severity Score was assigned. Group comparisons were made with non-parametric tests. Multivariable regression explored relationships between oximetry variables and clinical characteristics.

Results
Average age at overnight oximetry was 62.9 ± 7.7 years. Total respiratory events between MSA patients compared with OSA controls were similar (95.0 ± 118.6 vs 73.5± 54.2, p=0.61). Total pulse events were lower in MSA than OSA controls without MSA (25.5±44.2 vs 111.6±120.2, p&lt;0.001), as were pulse events per hour (3.1 ± 5.3 vs. 12.8 ± 10.8, p &lt;0.001). The ratio of PEI/ODI was lower in MSA than OSA patients without MSA (p&lt;0.001). Twelve (26%) MSA patients had zero pulse rate events, while all OSA patients without MSA had at least 1 pulse rate event (p&lt;0.001). The number of pulse events was not associated with severity of cardiovagal dysfunction on daytime autonomic function testing.

Conclusion
Patients with MSA have fewer pulse rate events when compared with SDB patients without MSA, despite similar overall respiratory event frequency. The number of pulse events was not explained by severity of daytime autonomic dysfunction in those with MSA. Whether nocturnal pulse event response to sleep disordered breathing is a marker of disease severity or plays a role in SuD-MSA deserves further study.

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0629 Metabolic syndrome in narcoleptic children
Authors: Zhang Min , Thieux Marine , Guyon Aurore , Arvis Laura , Villanueva Carine , Lin Jian-Sheng , Franco Patricia 
Published: May 2022

Abstract

Introduction
Narcolepsy is a disabling neurological disorder characterized primarily by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis, rapid eye movement (REM) behavior disorder (RBD) and disturbed nocturnal sleep. Over 50% of children with narcolepsy are obese. Metabolic syndrome (MetS), a constellation of disturbances associated with obesity, is increasingly seen in narcolepsy. A higher prevalence of MetS was revealed both in adults and children with narcolepsy. The objective of the present study was to compare clinical and sleep characteristics in children with narcolepsy with different components of MetS to clarify the mechanisms in MetS in these children.

Methods
This retrospective study included 58 children with narcolepsy. Data on blood pressure, High density lipoprotein (HDL) cholesterol, triglyceride, glucose, insulin and anthropometry (height and weight) were collected. MetS was defined when ≥3 of the following criteria were met: (1) Body mass index (BMI) ≥IOTF-30, (2) Blood pressure ≥90th percentile, (3) HDL-C ≤0.4 g/L, (4) Triglycerides ≥1.3 g/L, (5) homeostasis model assessment of insulin resistance (HOMA-IR) ≥75th percentile. Then, clinical and sleep characteristics were compared in groups with different MetS components.

Results
A total of 17 % of children with narcolepsy had MetS including 79% with high HOMA, 26% with high BMI, 24% with low HDL cholesterol and 12% with high triglycerides, but no patient with high blood pressure. 58% of the patients without obesity had at least 1, 2 or ≥3 MetS risk factors (78%, 15% and 6%, respectively). 55% of them were overweight. In children with narcolepsy with at least two MetS risk factors, there was a higher proportion of night eating, a lower percentage of N3 sleep, a higher arousal index, a shorter mean sleep latency and more sleep onset REM periods (SOREMPs) compared to patients with fewer MetS risk factors.

Conclusion
Altered sleep architecture and eating behavior are closely associated with risk factors of MetS in children with narcolepsy, even without obesity. We recommend to evaluate MetS risk in all children with narcolepsy to prevent complications such as type 2 diabetes and cardiovascular outcomes.

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0637 Associations between Alzheimer’s Disease Pathology and the Psychomotor Vigilance Task in Cognitively Unimpaired Adults with and without Obstructive Sleep Apnea
Authors: Plante David , Tran Kieulinh , Cook Jesse , Hagen Erika , Peppard Paul , Kollmorgen Gwendlyn , Suridjan Ivonne , Blennow Kaj , Zetterberg Henrik , Carlsson Cynthia , Johnson Sterling , Bendlin Barbara 
Published: May 2022

Abstract

Introduction
Daytime sleepiness is a risk factor for Alzheimer’s disease (AD) pathology and is associated with more severe cardiometabolic sequalae in persons with obstructive sleep apnea (OSA). However, limited studies have examined objective measures of decreased alertness in the context of AD. Here, we examined performance on the psychomotor vigilance task (PVT) in relation to AD pathology as indexed by AD biomarkers in cerebrospinal fluid (CSF), among individuals with and without OSA.

Methods
Sixty-one cognitively unimpaired adults (39 women), mean age 66.1±7.5 years, enrolled in the Wisconsin Alzheimer’s Disease Research Center completed a multifaceted sleep assessment. WatchPAT at-home overnight recordings characterized OSA severity, defined by the apnea-hypopnea index (AHI). Actigraphy determined habitual sleep-wake characteristics. 10-minute PVT measured neurobehavioral alertness. CSF biomarkers were measured using the Roche NeuroToolKit assays (Roche Diagnostics International Ltd, Rotkreuz, Switzerland), an exploratory panel of immunoassays for neurodegeneration. Generalized linear models examined associations between AD biomarkers, AHI, and PVT performance. Primary AD biomarkers of interest were phosphorylated-tau (p-tau) and amyloid-beta (Ab) 42/40 ratio, measured in CSF. The primary PVT variable of interest was the mean response time of the 10% slowest responses, which is associated with daytime sleepiness and default mode network activity. Log transformed PVT and AHI+1 were utilized for analysis. Covariates included age, sex, body mass index, total sleep time, sleep efficiency, APOEe4 status, years of education, AD parental history, biomarker-to-sleep assessment time interval, and Ab42/40 (for p-tau).

Results
No significant relationship of AHI or PVT was observed for Ab42/40. In fully adjusted models, a significant AHI*PVT interaction was observed for p-tau (p=0.0003). Specifically, among individuals with OSA (AHI&gt;5/hour; n=24), slower PVT was associated with increased p-tau (b=13.2, p=0.006), an association that was not significant among those without OSA.

Conclusion
PVT performance may be an objective measure of sleepiness relevant to AD pathology, particularly among individuals with OSA. Replication and expansion of these findings in larger and longitudinal datasets are indicated.

Support (If Any)
R03AG063274 and P30-AG062715.
0639 Polysomnographic Biomarkers of Sleep Disruption and Sleep Disordered Breathing in Migraine: a Large Matched Case Control Clinical Registry-Based Study
Authors: Gruenthal Eric , Foldvary-Schaefer Nancy , Wang Lu , Milinovich Alex , Saab Carl , Bucklan Julia , Mehra Reena 
Published: May 2022

Abstract

Introduction
Sleep disruption and sleep architectural changes in relation to migraine are not well characterized. Disruption in sleep may serve as a risk for migraine or result from migraine. We leveraged a large clinical cohort to examine the hypothesis that those with migraine have greater degrees of sleep architectural alterations and sleep disordered breathing (SDB).

Methods
This was a polysomnogram-based retrospective case (migraine) control (non-migraine) study of patients aged &gt;18 matched 1:3 on age, sex, race, body mass index (BMI), and year of polysomnogram. Two domains were considered: 1)Sleep architecture (arousal index:AI, (primary predictor), total sleep time (TST), percentage of sleep stage time) and 2)SDB (apnea hypopnea index (AHI:primary predictor), mean oxygen saturation) were considered. Comparisons were performed by two-sample t-test or Wilcoxon rank sum test for continuous variables, and chi-square test or Fisher’s exact test for categorical variables.

Results
4,783 migraine cases (47.5 ±13.3 years, 76.4% Caucasian, body mass index:BMI 33.7 ±8.6kg/m2) were matched to 14,287 controls. In migraine patients vs those without, TST was lower (359.0[307.0, 421.0] minutes vs 363.0[306.0, 432.5] minutes,p=0.01), percentage of N2 was higher (67.8%[59.6, 75.6] vs 67.0%[58.4, 74.8],p&lt;0.001), percentage of REM was lower (16.7% [10.0, 22.0] vs 17.0% [11.1, 22.2],p=0.012), AHI was lower (7.4 [2.6, 17.0] vs 9.5 [3.7, 22.1],p&lt;0.001), AI was lower (19.6 [12.8, 30.9] vs 22.6 [14.7, 34.9],p&lt;0.001), and mean oxygen saturation was higher (93.7%±2.4 vs 93.3±2.6,p&lt;0.001).

Conclusion
In this largest study of its kind, we identify novel associations of migraine in relation to curtailed sleep and sleep architectural alterations, i.e. increase in N2 and reduced REM sleep and lower AI compared to contemporaneously matched controls. Directionality of these relationships requires further elucidation given the cross-sectional nature of this study. Interestingly, we observed lower degree of sleep apnea and hypoxia burden in patients with migraine. As Calcitonin Gene-Related Peptide (CGRP), a neuropeptide increased during and between migraine attacks in migraine patients, and serotonin are implicated in arousals due to apnea-related increases in CO2, there is biologic plausibility for migraines patients to exhibit potential protection from SDB. Further investigation is needed to confirm these findings.

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