bluuebunny/crossref_metadata_2025_split huggingface dataset:
0584 Impact of Obstructive Sleep Apnea on Chronic obstructive pulmonary disease Hospitalizations
Authors: Al Khateeb Mohannad , Yusuf Mubarak , Horoub Ali , aldiabat Mohammad , Jabiri Yazan Al 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is a sleep disorder that has been linked to increase the risk for hypertension, ischemic heart failure, arrhythmia and heart failure. There are multiple similarities between OSA and Chronic Obstructive Pulmonary Disease (COPD); both are associated with hypoxia and hypercapnia, with different mechanisms of hypoxia; in COPD its chronic and slow progression, whereas it is suddenly intermittent hypoxia in OSA. Intermittent hypoxia was hypothesized to enhance the protective effect on subsequent hypoxia resulting in cardioprotective effect [1]. There is little data on rates of in-hospital mortality on patients with OSA and COPD using a nationwide study. In this study, we aim to analyze the impact on mortality and length of hospital stay of obstructive sleep apnea in patients with COPD.

Methods
Adults with principal diagnosis of COPD were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis on discharge. We queried the 2019 National Inpatient Sample for OSA, and other secondary diagnoses (hyperlipidemia, hypertension, heart failure, smoking, CKD, electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses.

Results
In a total of 520,624 adult hospitalizations with COPD primary diagnosis on discharge were included from the 2019 national inpatient sample. 73,705 patients had concomitant secondary diagnosis with OSA. On weighted analysis, hospitalizations with primary diagnosis of COPD and secondary diagnosis of OSA had lower in-hospital mortality rates compared to hospitalizations with COPD alone (0.6% vs 1.08%, p= 0.000), .COPD hospitalizations with OSA had statistically significant lower odds for mortality compared to COPD patients without OSA (adjusted OR 0.73, 95% CI 0.57-0.93; p= 0.009).However, COPD hospitalizations with OSA showed increased in the mean length of stay by 0.21 days (95% CI 0.12-0.30, p=0.000) compared to patients without OSA.

Conclusion
Our analysis showed better mortality outcomes for COPD patients with OSA , supporting the protective effect hypothesis of intermittent hypoxia. COPD patients with concomitant secondary OSA diagnosis have increased in-hospital length of stay.

Support (If Any)
1- Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136
0592 Hybrid Closed Loop Insulin Delivery Systems Reduce Perceived Hypoglycemia During Sleep in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness
Authors: Matus Austin , Malone Susan Kohl , Flatt Anneliese , Peleckis Amy , Dalton-Bakes Cornelia , Rickels Michael , Goel Namni 
Published: May 2022

Abstract

Introduction
Sleep-associated hypoglycemia is a major concern for individuals with type 1 diabetes (T1D). Hybrid closed loop insulin delivery systems with continuous glucose monitoring (HCL-CGM) may reduce the perceived frequency, severity, and impact of sleep-associated hypoglycemia. This analysis assessed changes in perceived sleep-associated hypoglycemia in individuals with T1D at high risk for hypoglycemia after initiating HCL-CGM.

Methods
Seven adults (median age=53y) with long-standing T1D (median duration=41y) and hypoglycemia unawareness participated in an ongoing 18-month clinical trial assessing effectiveness of HCL-CGM. At baseline and every 6 months thereafter, participants completed the validated Hypoglycemia Awareness Questionnaire (HypoA-Q), a 33-item tool consisting of three subscales (impaired awareness, symptom level, and symptom frequency), and 16 conceptually distinct items, including six items that relate to the frequency, severity, and impact of sleep-associated hypoglycemia, each which is scored and assessed individually. Friedman Tests assessed changes in items over the 18-month interval and Kendall’s W determined effect sizes.

Results
HCL-CGM significantly reduced the reported frequency of the following questions: (a) “How often you have had a hypo during your sleep?” (χ2(3)=8.4, p&lt;0.05; moderate effect size, W=0.40) and (b) “…and were unable treat yourself when you woke up?” (χ2(3)=12.1, p&lt;0.05; large effect size, W=0.57). HCL-CGM also reduced the reported frequency to: (c) “…and someone else gave you sugar by mouth?” (χ2(3)=7.2, p&lt;0.07; moderate effect size, W=0.34). By contrast, HCL-CGM did not affect reported frequency to the questions: (d) “…which led to a major problem?” (p&gt;0.05; moderate effect size, W=0.26)”; (e) “…and someone else gave you a glucagon injection?” (p&gt;0.05; small effect size, W=0.14); and (f) “…where you stayed asleep and only later realized that you had been hypo?” (p&gt;0.05; small effect size, W=0.19).

Conclusion
HCL-CGM improved various critical aspects of perceived sleep-associated hypoglycemic events in individuals most at-risk for hypoglycemia. Our results have important implications for self-care and patient treatment in this population.

Support (If Any)
NIH R01DK117488 (NG), R01DK091331 (MRR), K99NR017416 (SKM), and UL1TR001878 (University of Pennsylvania Center for Human Phenomic Science); NASA NNX14AN49G and 80NSSC20K0243 (NG); Pennsylvania Department of Health SAP 4100079750 (IL).
0597 The Relationship Between Sleep Quality and Functional Outcomes Following Acute Stroke and Inpatient Rehabilitation
Authors: Chen Pin-Wei , O’Brien Megan , Nguyen Amy , Prokup Sara , Knutson Kristen , Yang Hyun Sik , Hucker Alejandro , Byron Max , Goyal Swati , Adcock Emma , Morris Linda , Mokhlesi Babak , Zee Phyllis , Arora Vineet , Jyaraman Arun 
Published: May 2022

Abstract

Introduction
There is mounting evidence that sleep plays an important role in the rehabilitation and recovery process following acute stroke. Following acute care, many patients with stroke are admitted to inpatient rehabilitation facilities (IRFs), where they undergo intensive, interdisciplinary therapy to recover or relearn functional skills to minimize long-term disability. The role and impact of sleep in this early stage of stroke rehabilitation, however, is poorly understood. The purpose of this study is to investigate the relationship between sleep quality and clinical outcomes in the IRF setting following acute stroke.

Methods
Patients wore a collection of wearable sensors to measure sleep and wake throughout their IRF stay. Linear mixed-effect models (LMEMs) were built to determine the relationship between functional outcomes and sleep quality. Independent variables were total sleep time (TST) and sleep efficiency (SE) derived from wearable sensors, calculated between two clinical measures. Dependent variables included scores from repeated measures of the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), Berg Balance Scale (BBS), and Action Research Arm Test (ARAT). Covariates included demographics such as age and stroke type.

Results
Fifty-three individuals with stroke (age: 58.26±15.57 years; BMI: 28.27±6.16 kg/m2) consented to participate during their IRF program within 7 days of admission. All individuals were recruited from a single-site IRF between July 2020 and August 2021. The average length of stay was 17.85±6.99 days. There were no significant differences in TST between the first three nights and the last three nights (5.1±1.9 hours vs. 5.2±2.0 hours) or SE (67.8±17.7% vs. 69.0±17.8%). The greater standard deviation of TST was associated with lower 6MWT scores (R2=0.77, beta=−0.48, p=0.06), while the greater standard deviation of SE was associated with lower 10MWT scores (R2=0.80, beta=−0.20, p=0.18).

Conclusion
Our preliminary findings indicate that greater variability in TST and SE are associated with walking endurance and mobility recovery. Future analyses will investigate additional measures of sleep and activity in IRF settings and their relationship with patient outcomes. This work can inform novel sleep interventions to optimize post-stroke recovery.

Support (If Any)
This work is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NIH R01HD097786-01A1).
0609 Sleep Stabilization in Prehypertensive/Hypertensive Patients
Authors: Stokes Alicia , Yang Huan , Buraks Olivia , Vazquez Michael , Pandeya Sarbesh , Haack Monika , Mullington Janet 
Published: May 2022

Abstract

Introduction
Variable sleep/wake patterns have been linked to increased cardiometabolic risk. The current project investigates the effects of using sleep hygiene interventions to stabilize sleep timing in prehypertensive/hypertensive patients. Growing evidence supports the importance of regularizing sleep timing in improving cardiovascular health, and we believe that using sleep hygiene techniques to stabilize sleep may reduce these risks.

Methods
As part of a larger study, fifty-three participants (55.5 ± 1.4 years; 51% male) completed sleep diaries during 3 study periods. The first period (S1) was a baseline control, the second period (S2) was a 4-week wait-list control condition, and the third period (S3) was an 8-week randomly assigned intervention that used sleep hygiene approaches and scheduling to stabilize sleep timing or stabilize and lengthen sleep. Currently, we are still blind to condition; however, because both conditions involve sleep stabilization, an analysis using linear mixed models was used to assess change in the variability of total sleep time (SDTST), wake up time (SDWUT), and fall asleep time (SDFAT) across the 3 study periods.

Results
There was a significant decrease in SDTST variability (standard deviation) at post-intervention (S3) compared to S2 (p&lt;0.01) and S1 (p&lt;0.01). There was also a significant decrease in SDWUT variability at post-intervention (S3) compared to S2 (p&lt;0.01) and S1 (p&lt;0.01). There was a trend towards a significantly decreased SDFAT at S3 compared to S2 (p=0.057), but there was a significant decrease in SDFAT variability during S3 compared to S1 (p&lt;0.01).

Conclusion
These data suggest that we were able to utilize sleep hygiene interventions to decrease the variability in total sleep time, wake-up time and fall asleep time. When we unblind we will report on if we were able to increase and lengthen the sleep period for those in the sleep extension condition.

Support (If Any)
NIH (R01HL125379 to Dr. Janet Mullington), Harvard Catalyst, Harvard Clinical and Translational Science Center (UL1TR001102)
0611 Intraindividual Variability in Subjective Sleep and Average Fatigue in Parents of Children on the Autism Spectrum
Authors: Hayse Braden , Stearns Melanie , Mazurek Micah , Curtis Ashley , Nair Neetu , Beversdorf David , Golzy Mojgan , Sohl Kristin , Ner Zarah , Davis Beth , Takahashi Nicole , McCrae Christina 
Published: May 2022

Abstract

Introduction
Fatigue is related to various adverse health outcomes. Mean levels of some common sleep variables, such as total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO), have been associated with fatigue. However, intraindividual variability (IIV) of sleep parameters might play an independent role in sleep’s relationship with fatigue. Understanding fatigue is particularly important for parents of children with autism spectrum disorder (ASD) given fatigue's negative associations with positive parenting and implementation of child interventions. This preliminary study examined linear associations between subjective sleep IIV and mean fatigue levels in parents of children on the autism spectrum.

Methods
The sample included 66 parents who expressed interest in a behavioral treatment sleep study for their school-aged children diagnosed with ASD (6-12 years old; NCT04545606). All parents (Mage=37.03, SD=6.53; 91% female) completed daily electronic diaries over a two-week baseline period. Daily fatigue rating was collected using a visual analog scale (0-100) and averaged within individuals. Within-individual standard deviations of subjective TST, SOL, and WASO were calculated to estimate IIV. Data were analyzed in R (v4.1.2) using multiple linear regression models controlling for participant age, gender, and individual sleep parameter means.

Results
Bivariate correlations between sleep variable IIV and average fatigue indicated a positive association between TST variability and average fatigue, r(64)=0.33, p&lt;0.01. Multiple regression analyses showed that greater IIV of TST was associated with higher average fatigue (β=0.14, 95%CI [0.01, 0.27], sr2=0.06, p=0.041). No significant associations were found between average fatigue level and IIV of WASO or SOL.

Conclusion
Results suggest that greater TST variability may be one factor independently contributing to higher fatigue levels in parents of children on the autism spectrum, which warrants further examination of sleep variability in this population. Future research could explore IIV of additional sleep parameters, fatigue IIV as an outcome, alternative methods of sleep measurement, and study designs that address causation. Increased insight into these connections might inform the importance of considering sleep interventions for both children and parents, and potential subsequent treatment benefits.

Support (If Any)
MU Research Board Grant (McCrae, PI); Department of Defense Autism Research Program (McCrae, PI; W81XWH2010399).
0612 Does Coping Strategy Protect Sleep Quality During COVID-19? An Examination of Racial, Ethnic, Cultural Differences
Authors: Blanc Judite , Seixas Azizi , Small Sean , Locklear Clarence , Dorcent Rodginie , Auguste Evan , Buysse Daniel , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
Little has been done to examine within/between group predictors and mediators of race/ethnic differences in sleep health outcomes, due to COVID-19 exposure. We evaluated the effect of COVID-19 exposure on sleep quality in a multiracial/ethnic sample of New York residents.

Methods
We conducted a cross-sectional study among adults exposed to COVID-19 across New York State from September to November of 2020. Comparisons of participant characteristics e.g., mean scores by race/ethnicity status were made using one-way ANOVA for continuous variables, and chi-square tests for categorical variables. Associations between social determinants of health (employment, location), Trauma Coping Self-Efficacy (CES-T), and sleep quality (Pittsburgh Sleep Quality Index-PSQI) were examined using multilinear regression analysis stratified by race/ethnicity.

Results
Of the 541 participants, 373 (68.9%) were female; mean age was 40.9 years (SD=15), 198 (36.6%) identified as Whites, 111 (20.5%) as Black, 97 (17.9%) as Hispanics, and 135(25%) identified as either Asians, Native-Americans, Pacific-Islanders. Sex was the strongest predictor [β = 1.335; p &lt; .05] of sleep quality, but only among Whites. Trauma Coping Self-Efficacy was negatively associated with sleep quality among Asian, Native-American, or Pacific-Islander participants [β = -.114; p &lt; .05 ]; Black [β = -.099; p &lt; .05] and White participants [β = -0.79; p &lt; .05] but not among Latinos/as [β = -.058; p = 0.71].

Conclusion
Coping Self-Efficacy moderated the effect of COVID-19 on sleep quality among some, but not all, racial/ethnic groups. While CSE-T scores during the first wave of COVID-19 acted as a protective factor for sleep quality among Asians, Native-Americans, and Pacific-Islanders, White and Black participants, this was not the case for Latinos/as/Hispanics residing in New York. Clinical interventions that are tailored for racial/ethnic, community and cultural needs may help to mitigate sleep problems associated with COVID-19 exposure.

Support (If Any)
T32HL129953; 7R01HL142066-04; 1R01HL152453-01
0613 COVID-19 Is Associated with Shorter Sleep Duration among American Adults
Authors: Narcisse Marie-Rachelle , Bernard Mark , Briggs Anthony , Locklear Clarence , Rogers April , Sexias Azizi , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has deteriorated sleep health in the United States (U.S.) and worldwide. Most studies that have examined the association between COVID-19 and sleep outcomes have used a non-probability sampling with potential sampling bias and limited generalizability. We examined the association between diagnosed COVID-19 and sleep health in a large representative sample of civilian adults aged ≥18 years in the U.S.

Methods
This study was based on data from the 2020 National Health Interview Survey (NHIS) of adults (n=17,636). Sleep health was captured by self-reported sleep quantity [(very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours)] and sleep complaints (trouble falling and staying asleep; with responses ranging from never to every day) in the past 30 days. To account for correlated residuals among the endogenous sleep outcomes, generalized structural equation modeling (GSEM) was conducted with COVID-19 diagnosis as the predictor of interest. Other covariates (age, sex, race/ethnicity, education, employment, poverty level, marital status, birthplace, health insurance, region of residence, metropolitan areas, number of children and adults in the household, obesity, and sleep medication) were included in the models. NHIS complex probability sampling design was accounted for in descriptive and GSEM analyses.

Results
About 4.2% of adults had a positive COVID-19 diagnosis. Among them, 3.1% had very short sleep, 24.2% had short sleep, 59.9% had healthy sleep, and 12.8% had long sleep; 37.0% had trouble falling some days, 10.9% most days, and 6.5% every day; and 33.7% had trouble staying asleep some days, 13.9% most days, and 6.6% every day. Findings from GSEM revealed that a history of COVID-19 almost doubled the odds of having short sleep (OR: 1.9; 95% CI: 1.1-3.4; p=0.032). No significant associations were found between COVID-19 and the other sleep outcomes.

Conclusion
Individuals with a COVID-19 diagnosis were more likely to report very short sleep, although they did not exhibit a greater likelihood of reporting more sleep complaints. Further research using longitudinal national data and examining environmental factors are needed to determine causality.

Support (If Any)
NIH R01HL142066, R01HL095799, RO1MD004113, R01HL152453, R25HL105444
0614 Polysomnographic Measures of Sleep Architectural Disruption and Incident Atrial Fibrillation and Stroke in a Large Clinical Cohort
Authors: Heinzinger Catherine , Thompson Nicolas , Milinovich Alex , Foldvary-Schaefer Nancy , Van Wagoner David , Chung Mina , Mehra Reena 
Published: May 2022

Abstract

Introduction
Although epidemiologic studies have identified associations of architectural disruptions in sleep and atrial fibrillation (AF), inconsistencies in results limit understanding of longitudinal AF and stroke development in clinic-based cohorts. We hypothesize lower arousal index as a biomarker of prolonged respiratory events and objective measures of sleep disruption increase incident AF and stroke.

Methods
Cleveland Clinic patients (age&gt;18) who underwent polysomnogram (PSG) or split studies 11/27/2004-12/30/2015 were examined. Arousal index, total sleep time (TST,hours), sleep efficiency (SE,%), and wake after sleep onset (WASO,hours) were assessed as predictors of incident AF. Cox proportional hazard models were fit with time from sleep study to AF diagnosis. Secondary analyses were conducted in the subset of patients with baseline AF, with time from sleep study to stroke. Covariates included age, sex, race, body mass index (BMI,kg/m2), cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia), heart failure, coronary artery disease, myocardial infarction, coronary artery bypass grafting, chronic obstructive pulmonary disease, tobacco use, and use of anti-arrhythmic drugs. Data were censored at date of last follow up or the 5-year mark.

Results
The sample comprised 43,634 patients: age 51.7±14.5, 51.9% male, 74.5% White, and 7.1%(n=3,090) with AF. Of those without baseline AF, 1,176(2.9%) developed 5-year incident AF. Incident AF increased by 9% (HR=1.09, 95%CI=1.04-1.13) for each hour of lost TST. For every 10 percentage point decreased SE, incident AF increased by 7% (HR=1.07, 95%CI=1.04-1.11). For every hour increased WASO, incident AF increased by 14% (HR=1.14, 95%CI=1.07-1.21). Arousal index conferred no statistically detectable change of incident AF. In secondary analyses, any association of arousal index and incident stroke was attenuated after accounting for confounding comorbidities (omnibus p=0.055).

Conclusion
Objective measures of disrupted sleep architecture predicted incident AF in this clinical cohort. However, arousal index was not associated with AF development, nor stroke development in secondary analyses. Further investigation is needed to elucidate the role of arousal in SDB, perhaps with hierarchal models to clarify the degree to which confounders attenuate or accentuate any relationship.

Support (If Any)
Cleveland Clinic Neurological Institute Center for Outcomes Research & Education Pilot Grant
0615 Association between Ambient Light Exposure and Sleep Duration among American Adults from Varying Race/Ethnicities: Findings from the National Health and Nutrition Examination Survey
Authors: Narcisse Marie-Rachelle , Bernard Mark , Briggs Anthony , Moore Jesse , Seixas Azizi , Jean-Louis Girardin 
Published: May 2022

Abstract

Introduction
One in three American adults are sleep deprived in the United States (US). Racial/ethnic minorities are more likely to experience shorter sleep duration than are whites. Light exposure is associated with sleep duration. However, whether this association is independent of individuals’ race/ethnicity has not been studied in a nationally representative sample of the US adult population. We examined associations between ambient light exposure and sleep duration and between race/ethnicity and sleep duration. We also assessed whether associations between light exposure and sleep duration are independent of participants’ race/ethnicity.

Methods
We used data from the National Health and Nutrition Examination Survey (n=4,277 adults; 2013-2014). Participants (≥ 18 years old) wore an actigraph that collected 24-hour sleep/wake and light data for 7 consecutive days. Objective measurements in our analyses included sleep duration (valid minutes) and light exposure (lux). To determine the associations between light exposure and sleep duration, a weighted mixed-effects linear model was estimated controlling for age, sex, family income to poverty ratio, education, employment, marital status, homeownership status, birthplace, household size, vitamin D, smoking, physical activity, sedentary lifestyle, health status, body mass index, depression, chronic conditions, and time in days. A product term between lux and race/ethnicity was included in a second regression model.

Results
Participants had a mean sleep duration of 468.2 minutes. On average, White adults had the longest sleep duration (mean=478.8), followed by other/multiple races (mean=458.6), Asians (mean=449.1); Blacks (mean=445.0), and Hispanics (mean=444.7). Overall, light exposure was negatively associated with sleep duration (= -0.08 lux; p&lt;0.001). Black slept significantly less than did Whites (= -37.1 p&lt;0.001) followed by Asians ( = -26.5; p&lt;0.01) and Hispanics (= -24.6; p&lt;0.01). The association between light exposure and sleep duration did not significantly differ across all race/ethnic groupings, except for Blacks (= -0.05; p&lt;0.01).

Conclusion
To our knowledge, this is the first study that used national data to assess racial/ethnic disparities in objectively measured light exposure. Future research is needed to shed more light on racial/ethnic disparities in the light-exposure-sleep-duration link.

Support (If Any)
R01HL142066, R01HL095799, RO1MD004113, R01HL152453, R25HL105444