bluuebunny/crossref_metadata_2025_split huggingface dataset:
0323 Gender-Specific Differences in Self-Reported Factors Attributed to Sleep Disruption
Authors: Ruder Michael , Gahan Luke , Raymann Roy , Watson Nathaniel , Gottlieb Elie 
Published: May 2022

Abstract

Introduction
Women are more likely to report sleep difficulties. There are many ways for sleep to be disrupted (social influences, external sensory stimuli, somatic cues) but limited data exists on the relative burden of these disruptors. The purpose of the present analysis was to compare the occurrence of disruptors between males and females of equal ages.

Methods
We used self-reported data from the PSG-validated SleepScore mobile app to analyze the relative occurrence of a variety of sleep disruptors in an age- and gender-balanced sample of users (39,560 male and 39,560 female, median age=41, SD=15). Fisher's exact test was used to examine whether gender was a significant factor in the likelihood of reporting each disruptor. Disruptors were categorized as follows: somatic cues included hot flashes/thermal discomfort, chronic pain, bathroom visits, and heartburn; external sensory stimuli included temperature, light, and noise; social influences included: bed partner, pet, and children. All p &lt; 0.00001 results are reported.

Results
Women were significantly more likely than males to report at least one sleep disruptor (Odds ratio (OR): 2.29, prevalence: 90% vs 80%) and were more likely to report sleep disruption attributed to external stimuli (OR: 1.61, prevalence: 54% vs 42%), somatic cues (OR: 1.66, prevalence: 68% vs 56%), and social influences (OR: 1.95, prevalence: 50% vs 34%). Among somatic cues, women were more likely than males to report hot flashes/thermal discomfort (OR: 3.42), chronic pain (OR: 2.32), bathroom visits (OR: 1.24), and heartburn (OR: 1.14). Among external sensory stimuli, women were more likely than males to report sleep disruption attributed to sound (OR: 1.58), light (OR: 1.54), and temperature (OR: 1.54). Among social influences related disruptive factors, women were more likely than males to report sleep disruption attributed to pets (OR: 2.31), bed partners (OR: 1.65), and children (OR: 1.62).

Conclusion
The present analysis found that women reported higher rates of regular disruption for every cause. These findings highlight the role of gender in sleep-health reporting behavior and mirror other findings showing lower symptom reporting and healthcare utilization among males.

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0328 Social Jetlag Decreases Across the Lifespan: A Longitudinal Big Data Analysis of Objective Sleep
Authors: Gottlieb Elie , Gahan Luke , Danoff-Burg Sharon , Rus Holly , Watson Nathaniel , Raymann Roy 
Published: May 2022

Abstract

Introduction
Changes in social zeitgebers across the lifespan likely impact the interplay between biological and social clocks that fosters the circadian misalignment seen in social jetlag. Extant literature is limited to self-reported methods and cross-sectional designs and suggests older adulthood may be associated with a reduction in social jetlag given declining social obligations occurring after retirement. Using longitudinal ecologically-valid data, we examined the association between age as a continuous measure and social jetlag. We also examined whether work cessation is associated with a reduction in social jetlag.

Methods
Data from 2,446 users (mean age: 52.2 +/- 15.8, 51.8% female) across 473,113 nights were included in the analysis from the PSG-validated SleepScore Mobile Application, which uses a non-contact sonar-based method to objectively capture sleep-related metrics and self-reported lifestyle. Social jetlag (expressed in minutes) was defined as the difference between midsleep times on week and weekend days from a user’s total recording period. Linear regressions were used for the analysis. Age was examined as a both continuous variable, and as a dummy variable in a subsequent analyses in a subgroup of older adults, serving as a proxy for pre– (n = 604, age: 54-64, mean age: 60.5 +/- 2.8) and post-retirement (n = 428, age: 65-75, mean age: 69.9 +/- 2.8).

Results
Linear regressions revealed a significant negative association between overall age and social jetlag, whereby older age was associated with a reduction in social jetlag (ß=-0.64, SE=0.082, p&lt;0.0001). In agreement with this finding, post-retirement age was associated with a significant reduction in social jetlag (ß=-15.31, SE=3.78, p&lt;0.0001) as compared to pre-retirement.

Conclusion
The present analysis showed that social jetlag decreases across the lifespan, and its reduction appears to be amplified following retirement. Our findings are in-line with prior work demonstrating the reduction, but not extinction, of social jetlag in older adulthood.

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0329 Social Jetlag and Increased BMI: A Population-Based Study Using a Contactless Sleep Measurement Application
Authors: Watson Nathaniel , Gahan Luke , Raymann Roy , Gottlieb Elie 
Published: May 2022

Abstract

Introduction
Social jetlag involves delayed bed and wake times on weekends relative to weekdays. Resulting circadian rhythm disruption, sleep disturbance, and shortened sleep have untoward consequences for human health and performance. Elevated BMI is associated with habitual short sleep and circadian disruption, as seen in shift workers. Studies assessing the relationship between social jetlag and BMI often rely on self-reported sleep patterns, or measure sleep objectively with a worn device for short periods of time. We assessed the relationship between social jetlag and BMI in a novel manner using longitudinal, ecologically valid assessments (measured in subjects typical home environment) using the PSG-validated contactless, sonar-based SleepScore mobile application.

Methods
A total of 357 individuals across 130,120 nights monitored their sleep with the contactless SleepScore mobile application (ages 18-87, mean age, 46.7% females). Social jetlag was determined in a well-established manner by subtracting the mean objective sleep midpoint on weekdays from the mean objective sleep midpoint on weekends. Body mass index (BMI) was self-reported and defined as kg/m2. Chronotype was subjectively assessed with a 5-item question ranging from definitely morning-type to definitely evening-type. Chronotype, age and gender were included in the analysis as confounds.

Results
Mean social jetlag was 26.6 min (95% CI 22.2 – 31.0). Linear regression revealed a significant association between social jetlag and BMI (ß=0.025, SE=0.012, p&lt;0.05) after adjustment for age, gender and chronotype. Thus, for every one-minute increase in social jetlag, there was a 0.025 kg/m2 increase in BMI. For expository purposes, a social jetlag of 60 minutes would increase BMI by 1.5 kg/m2.

Conclusion
In our population-based sample of individuals using a sonar-based contactless consumer sleep technology to objectively measure sleep we found a positive association between a well-validated measure of social jetlag and BMI, such that increased social jetlag portended increased BMI. This is consistent with previous reports demonstrating the untoward effect of social jetlag on human health and metabolism. The longitudinal and ecologically valid nature of our sleep measurement adds to the veracity of our growing understanding of the problem with social jetlag.

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SleepScore Labs
0333 Gender and Menopausal Status Correlate with Sleep Surgery Outcome
Authors: Taheri Nazlie , Hong Yeon , Abdelwahab Mohammad , Huang Allen , Fleury Thomaz , Liu Stanley 
Published: May 2022

Abstract

Introduction
With recognized anatomic and physiological differences between males and females, it is critical to describe outcomes of sleep surgery with respect to gender. The objective of this study is to compare the subjective and objective outcomes of phase I sleep surgery with respect to gender and age.

Methods
This was a retrospective review of adult subjects who presented to a single center for surgical evaluation of OSA from January 2019 to June 2021. Only subjects undergoing phase I surgery (turbinate reduction, septoplasty, nasal valve surgery, DOME, tonsillectomy, preservation palatopharyngoplasty, tongue base reduction, genioglossus advancement, and upper airway stimulation), who also had complete pre and post-operative PSG data were included. Objective measures were post operative apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturations (LOS). Subjective outcomes include Epworth Sleepiness Scale (ESS), and Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires. The groups were matched for age and pre-operative BMI.

Results
Twenty-six subjects met inclusion criteria, of which 12 were female and 13 were males. Of the females 5 were post-menopausal. The average male pre-operative AHI, ODI, lowest SpO2, and ESS were 34.4± 28.7, 30.2±28.3, 80.7±6.6, and 10.3±5.6 respectively. Pre-operative values for females were, 31.9±19.2, 18.47±20.4, 82.8±8.4, and 12.5±4.8 respectively. The average AHI reduction in males was 25.5± 29.1, and for females it was 8.3±21.0 (p=0.042). Specific to post-menopausal females, Average AHI reduction was 8.3± 21.0 and 20.2±16.6 for pre-menopausal females (p=0.01). The average ESS reduction in males was 3.1±3.2 (p=0.22) and for females 5.5±5.4 (p=0.001).

Conclusion
In this cohort, pre-menopausal women have higher objective surgical success rate (Sher’s criteria) after phase I surgery as compared to post-menopausal women. Men respond more favorably than women to phase I surgery based on AHI reduction, but not with ESS. Gender and menopause status are important factors in evaluating efficacy of sleep surgery.

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0334 The Role of Race-Gender Intersectionality in Associations between Insomnia Patterns and Late-Life Memory Trajectories
Authors: Zaheed Afsara , Chervin Ronald , Zahodne Laura 
Published: May 2022

Abstract

Introduction
Difficulty initiating sleep (DIS) may be a stronger predictor of neurodegenerative risk than other insomnia symptoms. This study examined whether longitudinal patterns of DIS are associated with subsequent memory trajectories, and whether associations differ across non-Hispanic Black and White men and women.

Methods
12,565 participants in the Health and Retirement Study (Mage=67.8±9.1, 59.1% women) who self-identified as non-Hispanic Black (14.5%) or non-Hispanic White were included. DIS (“How often do you have trouble falling asleep?”) at three biennial waves (2002-2006) was dichotomized (“never/rarely/sometimes”=0, “often”=1). Participants were categorized into three mutually exclusive groups: low (reference group), persistent, and variable DIS. Episodic memory was assessed using a 10-item word list recall test at five biennial waves (2008-2016). Latent growth curves modeled associations between DIS patterns and subsequent memory level and change, adjusting for sociodemographics (model 1), health conditions (model 2), and depressive symptoms (model 3) in 2002. Stratified models compared associations across White men, Black men, White women, and Black women.

Results
Compared to low DIS, persistent (β=-0.03, p&lt;.001) or variable (β=-0.07, p&lt;.001) DIS was associated with worse subsequent memory in models 1 and 2. The effect of variable (β=-0.05, p&lt;.001), but not persistent (β=-0.01, p=.271), DIS remained in model 3. Persistent DIS was most prevalent among White women (5.4% vs. 2.4-4%), and variable DIS was most prevalent among Black women (24.1% vs. 14-22.2%). Persistent DIS was only significantly associated with memory among White women (β=-0.04, p=.003 vs. β=-0.04, p=.324 for Black Men; β=-0.03, p=.087 for White men; and β=0.01, p=.859 for Black women). Variable DIS was most strongly associated with memory among Black men (β=-0.141, p=.003), followed by White men (β=-0.09, p&lt;.001), White women (β=-0.06, p&lt;.001) and Black women (β=-0.06, p=.064). There were no associations between DIS patterns and memory change.

Conclusion
While links between persistent DIS and subsequent memory may reflect negative cognitive effects of depression, variable DIS may presage worse memory above and beyond depression. Race/gender differences in the prevalence and predictive value of DIS patterns for subsequent cognitive function highlight the value of an intersectional lens. Gender disparities in DIS may be more prominent than racial disparities.

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NIA F31AG067717 (PI: Zaheed)
0340 Non-Surgical Maxillary Expansion Using A Novel Oral Appliance System
Authors: Heckman Seth , Katz Daniel , Kushida Clete 
Published: May 2022

Abstract

Introduction
Complete Airway Repositioning and Expansion (CARE; Vivos Therapeutics, USA) consists of a series of dental devices that cause gradual expansion of the airway over an 18-month course used to treat mild-to-moderate obstructive sleep apnea. In this retrospective database review we sought to determine whether airway and obstructive sleep apnea (OSA) parameters changed via treatment as measured without the appliance in their mouths.

Methods
After IRB exemption by the Mount Sinai Health System IRB (STUDY-21-01561) we conducted a retrospective review of the Vivos database. Demographics, pre-, mid-, or post-treatment maxillary dimensions, and pre-, mid-, or post- treatment sleep study parameters were reviewed. CBCT parameters for trans-palatal width (TPW) and total three dimensional (3D) airway volume were analyzed along with available AHI data.

Results
There were 786 patients with complete radiographic datasets. The median (interquartile range) age was 49 (36-59) years, and half were female. Both the median TPW of 33.5 (31.0-35.3) mm and median 3D volume of 19,752 (15965-25042) mm3 increased, to 35.0(33.0-37.5) mm and 21919 (17484-27711) mm3, respectively. These increases were significantly different (p&lt;0.001 in both measures by related-samples Wilcoxon signed rank test). A subset of patients had complete sleep study data (N=139). For those patients with pre- and post-treatment studies who had also completed at least 18 months of therapy (N=37), the TPW increased by a median of 2.50 (1.00-3.50) mm and the 3D volume by a median of 3092 (1006-6480) mm3. Overall, the number of patients with no OSA went from 4 to 13 and the number of patients with severe OSA went from 10 to 3. Twenty-five patients (65%) had improved AHI, and 15 (41%) had their AHI improve by 50% or more (all of these were decreased to an AHI &lt;20).

Conclusion
This retrospective database review showed that OSA patients treated with BOAT improved their OSA with concomitant increases in maxillary dimensions. Further analyses of these data, and future prospective clinical trials are warranted to better understand this novel OSA treatment.

Support (If Any)
Support from Vivos Therapeutics in the form of granting access to their database and compensated clinical advisors.
0342 Use of a Diffused Fragrance Before Bed May Contribute to Improved Objective and Perceived Sleep
Authors: Rus Holly , Danoff-Burg Sharon , Weaver Morgan , Rodriguez Rodolfo , Gavrilova Larisa , Gottleib Elie , Lillford Stephen , Raymann Roy 
Published: May 2022

Abstract

Introduction
This study examined if a diffused fragrance used at home before bedtime would contribute to sleep improvement in a sample of healthy females. Existing evidence regarding the sleep-promoting properties of fragrances often has been anecdotal or based on clinical research, thereby limiting the generalizability and ecological validity of results.

Methods
26 women with self-reported interest in air care to support healthy sleep participated in a 9-week field study. A within-subjects, counterbalanced intervention design was implemented, comparing 3 weeks of nightly product use to 3 weeks without using the product after a baseline period. Intervention consisted of the use of a fragrance diffuser and fragrance by Reckitt’s Scientific Platform Fragrance Research for at least an hour at the participants’ preferred settings in the room where they spent the most time before going to bed. Sleep was measured objectively with SleepScore Max every night. Self-report data were collected at bedtime, in the morning, and after each measurement period. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
Across all participants there were 835 nights of tracked sleep. Participants (100% female, age 21 to 55, average 36 years old) showed improvement in both objective and perceived sleep during the intervention. Participants got more deep sleep, spent a greater proportion of the night in deep sleep, and had an improved BodyScore, a measure of deep sleep (ps&lt;.05). Additional objective improvements were related to sleep consistency: fewer awakenings during the night, less time awake during the night, and better sleep maintenance (ps&lt;.05). Self-report results complemented the objective findings. Participants felt sleepier at bedtime, felt they woke up less often and spent less time awake after initially falling asleep, reported better sleep quality, and experienced better mood both at bedtime and in the morning (ps&lt;.05). No significant negative impacts were seen on sleep in the objective and self-report measures.

Conclusion
Using the fragrance diffuser before bed may contribute to improvement of many aspects of sleep within this study population of females without underlying sleep conditions. Objectively improved sleep outcomes were supported by self-report, showing multifaceted benefits of the diffused fragrance on sleep.

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Reckitt
0348 Sleep Staging Using End-to-End Deep Learning Model Based on Nocturnal Sound for Smartphones
Authors: Hong Joonki , Tran Hai , Jeong Jinhwan , Jang Hyeryung , Yoon In-Young , Hong Jung Kyung , Kim Jeong-Whun 
Published: May 2022

Abstract

Introduction
Convenient sleep tracking with mobile devices such as smartphones is desirable for people who want to easily objectify their sleep. The objective of this study was to introduce a deep learning model for sound-based sleep staging using audio data recorded with smartphones during sleep.

Methods
Two different audio datasets were used. One (N = 1,154) was extracted from polysomnography (PSG) data and the other (N = 327) was recorded using a smartphone during PSG from independent subjects. The performance of sound-based sleep staging would always depend on the quality of the audio. In practical conditions (non-contact and smartphone microphones), breathing and body movement sounds during night are so weak that the energy of such signals is sometimes smaller than that of ambient noise. The audio was converted into Mel spectrogram to detect latent temporal frequency patterns of breathing and body movement sound from ambient noise. The proposed neural network model consisted of two sub-models. The first sub-model extracted features from each 30-second epoch Mel spectrogram and the second one classified sleep stages through inter-epoch analysis of extracted features.

Results
Our model achieved 70 % epoch-by-epoch agreement for 4-class (wake, light, deep, rapid eye movement) stage classification and robust performance across various signal-to-noise conditions. More precisely, the model was correct in 77% of wake, 73% of light, 46% of deep, and 66% of REM. The model performance was not considerably affected by existence of sleep apnea but degradation observed with severe periodic limb movement. External validation with smartphone dataset also showed 68 % epoch-by-epoch agreement. Compared with some commercially available sleep trackers such as Fitbit Alta HR (0.6325 in mean per-class sensitivity) and SleepScore Max (0.565 in mean per-class sensitivity), our model showed superior performance in both PSG audio (0.655 in mean per-class sensitivity) and smartphone audio (0.6525 in mean per-class sensitivity).

Conclusion
To the best of our knowledge, this is the first end (Mel spectrogram-based feature extraction)-to-end (sleep staging) deep learning model that can work with audio data in practical conditions. Our proposed deep learning model of sound-based sleep staging has potential to be integrated in smartphone application for reliable at-home sleep tracking.

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0350 At-home Sample Collection for Measurement of Diurnal Rhythms of Urinary Cortisol and Melatonin
Authors: Daumeyer Natalie , Kreitzberg Daniel , Gavin Kathleen , Seixas Azizi , Bauer Timothy 
Published: May 2022

Abstract

Introduction
Sleep- and stress-related hormones (e.g., melatonin, cortisol) can be measured from dried urine samples collected at-home and sent for laboratory testing. These measures may be used to identify patterns of circadian alignment, peak nocturnal melatonin levels as well as a cortisol awakening response. The purpose of this analysis was to describe diurnal patterns and reference ranges from a 4-timepoint serial assessment of urinary cortisol and melatonin in a large cohort of at-home self collected samples.

Methods
This retrospective analysis evaluated data from 3,966 individuals who used an at-home Sleep and Stress Test (Everlywell, Inc.) between September 28, 2017 and July 14, 2021. Individuals provided four urine samples according to habitual sleep patterns: upon waking (T1), two hours after waking (T2), prior to the evening meal (T3), and at bedtime (T4). Melatonin and cortisol distributions were normalized to creatinine and log transformed to approximate normal distributions to define respective reference ranges (two standard deviations above and below the log transformed mean) and reverted to original units for reporting.

Results
71% (n=2,832) of users were female and mean age was 42.8 (sd=12.0) years. Mean (sd) urinary values were as follows: Cortisol: T1, 29.3 (37.9) ug/g Cr; T2, 47.2 (49.8); T3, 14.9 (36.3); T4. 8.38 (26.9). Melatonin: T1, 745 (3208) ug/g Cr; T2, 169 (1189); T3, 45 (620); T4, 155 (1701). For cortisol, only 4-5% of samples fell outside the defined reference ranges across time points. Melatonin was more variable with 23% and 15% falling outside the reference range at time points T3 and T4, respectively. A majority of individuals’ peak cortisol occurred at T2 (67.4%), and melatonin at T1 (85.2%).

Conclusion
This analysis demonstrates measurable physiological diurnal patterns for cortisol and melatonin using at-home self-collection for dried urine tests. This provides evidence that at-home sample collection kits using dried urine spots are a viable tool for assessing diurnal patterns of sleep and stress. Future controlled studies are needed to evaluate the utility in identifying abnormal patterns associated with shift-work or sleep disorders.

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