bluuebunny/crossref_metadata_2025_split huggingface dataset:
0640 North American Prodromal Synucleinopathy Consortium: Baseline characteristics in 251 patients with REM Sleep Behavior Disorder
Authors: Elliott Jonathan , Lim Miranda , Keil Allison , Avidan Alon , Bliwise Don , Gagnon Jean-François , Howell Michael , Huddleston Daniel , McLeland Jennifer , Postuma Ronald , Louis Erik St , Videnovic Aleksandar , Boeve Bradley , Ju Yo-El 
Published: May 2022

Abstract

Introduction
Introduction: Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is characterized by a lack of muscle atonia during REM sleep with dream enactment. RBD is regarded as a prodromal synucleinopathy as a high proportion of patients eventually phenoconvert to Parkinson’s Disease and related synucleinopathies, suggesting RBD may be an early non-motor symptom of disease. Accordingly, patients with RBD are ideally situated to test potential therapeutic interventions to prevent phenoconversion to synucleinopathy. However, RBD itself, and associated patient registries, are rare. The North American Prodromal Synucleinopathy Consortium (NAPS) establishes a multisite registry of RBD patients with standardized neurological, neuropsychiatric, and neuropsychological assessments and biomarker collection. The present work reports baseline characteristics of this RBD patient database at its current state.

Methods
Methods: Participants &gt;18 years of age with overnight polysomnogram-confirmed RBD by ICSD-3 criteria who did not meet criteria for the diagnosis of PD, dementia, MSA, or narcolepsy were enrolled from 10 sites across North America (8/2018 to 4/2021). Data collection included family and personal history of RBD and related symptoms, as well as standardized assessments related to cognitive, motor, sensory and autonomic function. Additionally, all subjects have contributed blood, and a subset of subjects have contributed cerebrospinal fluid samples to the National Centralized Repository for Alzheimer's Disease and Related Dementias for future analysis.

Results
Results: A total of n=251 participants were enrolled. Outcomes are reported based on sex (n=202 male, n=49 female). Data were further examined based on participants’ history of antidepressant use (n=142 with, n=103 without) and based on participants’ extent of synucleinopathy burden (n=70 defined as isolated RBD, n=181 defined as RBD+ [i.e., exhibiting ≥1 abnormality]). Any observed sex differences among the data did not persist after correction for antidepressant use.

Conclusion
Conclusions: This prospective, cross-sectional data on history, demographic, cognitive, motor, sensory, and autonomic function in n=251 participants with RBD highlight the lack of sex differences and the high preponderance of concomitant neurological abnormalities with RBD, and provide a valuable registry for future longitudinal studies and neuroprotective clinical trials.

Support (If Any)
NIH NIA R34 AG056639 (YJ, BB)
0645 Associations of Objective Sleep Parameters and Gray Matter Microstructure in community dwelling cognitive normal older adults
Authors: Bubu Omonigho , Zanetta Kovbasyuk , Mbah Alfred , Korey Kam , Anna Mullins , Parekh Ankit , Umasabor-Bubu Ogie , Rapoport David , Ayappa Indu , Jean-Louis Girardin , Varga Andrew , Osorio Ricardo 
Published: May 2022

Abstract

Introduction
Disturbed sleep measures differentially alter white-matter microstructure. We examined whether obstructive sleep apnea (OSA)-severity, sleep fragmentation and duration measures were associated with gray-matter diffusion tensor-imaging metrics (DTI) (i.e., fractional anisotropy [FA], mean diffusivities [MD] and kurtoses [MK]) in community-dwelling cognitive-normal older-adults.

Methods
Gray-matter DTI metrics from MRI including mean FA, MD and MK measures of the hippocampus, thalamus, medial prefrontal-cortex (mPC) and Alzheimer’s Disease (AD) vulnerable regions (temporal [inferior, middle, and superior], parietal [inferior and superior], entorhinal cortex, and precuneus) were determined from 85 subjects. OSA-severity measures included AHI3a and AHI4%. Other sleep measures included sleep efficiency (SE), non-rapid eye movement (NREM) slow wave sleep (SWS) duration, percent time spent in SWS (%SWS), slow wave activity (SWA), total sleep time (TST), and wake after sleep onset (WASO). To analyze the data, first, we utilized factor analysis using varimax rotation to account for the DTI metrics as multivariate outcomes. Using factor loadings, we anticipated a two or three-factor model was sufficient to explain the variance of the DTI metrics. Second, we investigated predictive associations between the sleep parameters and the loaded DTI factors, and explored age, sex, BMI, education and APOE4 as covariates underlying any differences.

Results
Of the 85 participants, 60 (70.6%) were women, 67 (78.8%) were non-Hispanic Whites. Mean (SD) age, BMI and education was 66.7 (5.3) years, 27.9 (6.1) kg/m2 and 16.8 (2.4) years respectively. We selected the two primary loadings’ factor model based on AIC criteria. FA metrics of the investigated brain regions except thalamus, loaded on one factor, conceptualized as manifest indicators for FA. MD and MK metrics of all the investigated brain regions loaded on the second factor, conceptualized as manifest indicators for MD/MK. SWS, %SWS, TST were predictors of FA (P ≤0.01 for all). AHI3a, AHI4%, and SWA were predictors of MD/MK (P ≤0.05 for all). Additionally, sex, age, APOE4 and education were predictors of FA (P ≤0.01 for all).

Conclusion
In this limited sample of cognitively-normal older-adults, sleep duration measures predicted gray-matter FA, OSA-severity measures predicted gray matter MD and MK. Demographic, genetic and SES factors explained the differences in these relationships.

Support (If Any)
AASM 231-BS-20, AARGD-21-8488397, NIH/NIA/NHLBI (K23AG068534, L30-AG064670, CIRAD P30AG059303 Pilot, NYU ADRC P30AG066512 Developmental Grant, R25HL105444, SRG, R01AG12101, R01AG022374, R01AG13616, RF1AG057570, R01HL118624, R01AG056031)
0656 Demographic and Clinical Features of Nocturnal Suicide
Authors: Arevalo Sabrina , Tubbs Andrew , Fernandez Fabian-Xosé , Karp Jordan , Klerman Elizabeth , Chakravorty Subhajit , Perlis Michael , Grandner Michael 
Published: May 2022

Abstract

Introduction
The risk for suicide is greatest at night after adjusting for population wakefulness, possibly due to sleep- and circadian-dependent changes in neurophysiology to promote sleep. Those who die by suicide at night, however, may differ by demographic and/or clinical characteristics from those who die by suicide during the day.

Methods
An archival analysis of the National Violent Death Reporting System for 2003-2017 identified 77,784 suicide deaths with time of fatal injury. Cases were divided into daytime (5AM to 10:59PM) or nighttime (11PM to 4:59AM) and characterized by age, sex, race, ethnicity, marital status, military service, education, prior diagnosis of an anxiety disorder, bipolar disorder, depression, history of suicidal ideation, PTSD, and schizophrenia, as well as the presence of an opiate or cannabis, and blood alcohol level (BAL) on autopsy. Bidirectional stepwise regression and robust Poisson models characterized significant predictors of nocturnal suicide using incident risk ratios (IRR).

Results
Nocturnal and daytime suicides differed on all sociodemographic variables. Nocturnal suicides were more prevalent among those with bipolar disorder, PTSD, an elevated BAL, and those who tested positive for cannabis. Stepwise models identified a significant age by BAL interaction. Using adults 35-64 with BAL=0mg/dl as the reference, adults 35-64 with a BAL&lt;80mg/dl had a 46% greater risk of suicide at night, and those with a BAL≥80mg/dl had a 78% greater risk. Individuals 15-34 had a nighttime suicide that was 26% greater with BAL=0mg/dl, 84% greater with BAL&lt;80mg/dl, and 298% greater with BAL≥80mg/dl. Conversely, individuals 65 and older were 27% less likely to die at night with BAL=0mg/dl, while those with a BAL&gt;0mg/dl did not differ from those aged 35-64 with BAL=0mg/dl. The risk of nocturnal suicide was also 17% greater among those with a prior history of suicidal ideation, and 13% less likely among those with documented depression.

Conclusion
Nocturnal suicide is more prevalent among intoxicated younger adults and those with previous suicidal ideation. However, suicide victims with depression were less likely to die at night. Further research is needed to target suicide prevention efforts at appropriately times for those with mood, substance, and alcohol use disorders.

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0664 Temporal Patterns of Suicidal Ideation in the Emergency Department
Authors: Tubbs Andrew , Ghani Sadia , Karp Jordan , Fernandez Fabian-Xosé , Klerman Elizabeth , Perlis Michael , Grandner Michael 
Published: May 2022

Abstract

Introduction
Nocturnal wakefulness may be dangerous for vulnerable populations: the incident risk for suicide is highest at night after adjusting for population wakefulness, and nocturnal wakefulness is associated with suicidal ideation. These observations support the hypothesis that sleep- and circadian-dependent changes in mood, reward processing, and executive function increase the risk for disinhibited behavior at night (during periods of nocturnal wakefulness). The present study evaluated this hypothesis by using the timing of emergency department encounters for suicidal ideation.

Methods
An archival analysis of data from two emergency departments (EDs) in Tucson, Arizona from 2018 and 2019 yielded 51,370 encounters for any reason across 29,359 individuals with usable data, and the time of initial contact was extracted for each case. Of these, 571 individuals (1.94%) sought care for 763 (1.49%) instances of suicidal ideation (determined by ICD-10 code R45.861). Encounters were characterized by date/time, age, sex, race/ethnicity, blood alcohol level (if tested), homelessness, and prior diagnosis of a psychotic disorder, bipolar disorder, or depressive disorder. Suicidal ideation encounters were analyzed as raw counts and as a proportion of all encounters by clock hour and time-of-day categories (night: 12AM-5:59AM; morning: 6AM-11:59AM; afternoon:12PM-5:59PM; evening: 6PM-11:59PM) using robust Poisson models.

Results
Although most ED encounters occurred between 6PM and midnight (mean: 9:42PM), the greatest number of suicidal ideation encounters occurred between 12AM and 3AM (mean: 12:18AM). After adjusting for the per-hour proportion of ED visits, the incident risk for a suicidal ideation encounter increased between 8AM and 11AM, peaked at 10AM (IRR: 1.95 [1.10-3.44]) and was lowest at 4PM (IRR: 0.54 [0.32-0.91]). Compared to the evening, the incident risk of suicidal ideation was 64% greater in the morning (IRR: 1.64 [1.31-2.06]), 25% greater at night (IRR: 1.25 [1.00-1.56]), but not different for afternoon encounters.

Conclusion
After adjusting for overall encounter rates, ED encounters for suicidal ideation are more likely to occur in the morning. Although the morning peak in incident risk is later than the reported nocturnal risk for incident suicide, this may reflect a delay between when an individual develops suicidal ideation and when they seek or receive treatment.

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0668 The Effect of Antidepressant Medications on Sleep Architecture in a Primarily Middle-aged Sample of Women with Multi-morbidities: Chronic Insomnia, Chronic Pain, and Depression
Authors: Sparrow Emilie , Stearns Melanie , Nair Neetu , McCrae Christina 
Published: May 2022

Abstract

Introduction
Depression commonly impacts sleep architecture by increasing REM and decreasing stage 3 sleep. Growing evidence suggests antidepressants may reduce or reverse those effects in depressed individuals but has largely ignored their impact in the context of multi-morbidities. Depression, chronic insomnia, and chronic pain are common in middle-aged women and are thought to share a common neurobiological basis. They often co-occur, and thus, represent a common multi-morbidity triad. Here we examine whether %REM and %stage 3 sleep differ as a function of antidepressant use (yes/no) in a primarily middle-aged sample of women with all three morbidities.

Methods
Female adults (18+ years, n=91, Mage=51, SD=10.16) with comorbid insomnia, chronic pain, and depression (≥17 BDI-II score) completed one night of ambulatory polysomnography and reported antidepressant medication use (yes/no) and type (SSRI/SNRI/SARI/TCA/NDRI) as part of baseline data collection for a RCT (SPIN, NCT02688569). ANCOVA (R v4.1.1) examined group differences (antidepressant use: yes/no) in %REM and %stage3 sleep, controlling for age and sleep medication use.

Results
Only %REM was significantly lower (F=6.213, p=.015) in antidepressant users (n=48, M=14.85, SD=9.38) versus non-users (n=43, M=19.23, SD=6.70). An exploratory follow-up ANCOVA examined whether antidepressant type was important. Two groups were formed based on antidepressant mechanism of action (medications affecting serotonin, i.e., SSRI/SNRI/SARI vs medications affecting other neurotransmitters, i.e., TCA/NDRI), and their means were compared. Only %stage3 sleep was significantly lower (F=7.937, p=.007) in SSRI/SNRI/SARI users (n=37, M=11.18, SD=9.28) versus TCA/NDRI users (n=11, M=19.36, SD=13.04).

Conclusion
Thus, general antidepressant medication use may help decrease REM, but the increase of stage 3 sleep depended on which medications were used (i.e., TCA/NDRI). These findings suggest a neurophysiological functioning difference between types of antidepressants, particularly for this population of women with chronic pain, insomnia, and depression. This difference may be due to SSRI/SNRI/SARIs impacting serotonin, which may have an impact on REM, but not stage 3 sleep. However, the current study only had a small group of people using TCA/NDRIs, limiting generalizability and inferences. Future longitudinal research with a larger sample size is needed to parse out the effects of each antidepressant medication type individually and over time.

Support (If Any)
ClinicalTrials-NCT02688569, PI McCrae.
0674 CPAP Adherence and Response to Cognitive Processing Therapy for PTSD in Veterans with Obstructive Sleep Apnea
Authors: Kunes Kristina , Johnson Cyle , Driscoll David , Walters Ryan , Ramaswamy Sriram 
Published: May 2022

Abstract

Introduction
Cognitive processing therapy (CPT) is a recommended first-line psychotherapy treatment for veterans with PTSD. Veterans with PTSD are at higher risk for sleep disorders including obstructive sleep apnea (OSA), and there is evidence that OSA can exacerbate PTSD and vice versa. Several studies have shown that CPAP use is associated with improvement in PTSD symptoms. CPT is an effective, yet time and resource intensive treatment option, making it critical to identify potential health factors impacting its efficacy. This retrospective chart analysis of veterans diagnosed with OSA and PTSD evaluated the effect of CPAP adherence on response to CPT.

Methods
Medical records of patients seen in a VA Health Care System were reviewed to identify veterans diagnosed with OSA and PTSD that received between 1-12 sessions of CPT with documented weekly PTSD Checklist for DSM-5 (PCL-5) scores, Patient Health Questionnaire-9 (PHQ-9) scores, and were issued a CPAP machine for OSA. Data collected included demographics, CPAP adherence (mean CPAP use, % days with greater than 4 hrs./night of CPAP use, mean residual apnea hypopnea index, mask leak), and PTSD symptoms (PCL-5 and PHQ-9 scores). For each outcome, we estimated a linear mixed-effects model; models for PCL-5 allowed heterogeneous residual variances for each veteran.

Results
This study identified 25 veterans receiving CPT for PTSD with access to a CPAP machine for OSA. The median age of patients was 43 years, median BMI was 35.6, and median residual AHI was 2.4. Patients received CPT for a median duration of 11.0 weeks. There was significant improvement in weekly PCL-5 and PHQ-9 scores over the course of CPT (both p &lt; .001). CPAP adherence of at least 4 hrs./night for ≥70% of days did not significantly impact PCL-5 and PHQ-9 scores during CPT. Residual AHI and mask leak were not associated with PTSD symptoms during CPT.

Conclusion
While CPAP nonadherence appears to be a potential contributing factor to the reduced effectiveness of evidence-based treatments for veterans with PTSD, our study revealed significant improvement in PTSD symptoms during CPT regardless of CPAP adherence. Given the retrospective nature and small sample size of this study, further research is needed to expand on these findings.

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0677 Impact of Cognitive Behavioral Therapy for Post-trauma Nightmares on Sleep-efficiency: Examining Data on Sleep Diary Data
Authors: Paquet Caitlin , Villarreal Dayana , Whitney-Snel Kendall , Beims-Ukens Leyli , Davis Joanne 
Published: May 2022

Abstract

Introduction
Prior research has not examined the impact of cognitive behavioral therapy (CBT) for post-trauma nightmares on aspects of sleep quality as measured by sleep diary data. While self-report measures assessing sleep quality have demonstrated that CBT for post-trauma nightmares is associated with significant improvements in sleep quality pre- to post-treatment, it is important to specifically analyze changes using sleep diary data given that research has demonstrated large discrepancies in self-report measures of sleep behavior and prospective sleep diary data.

Methods
All participants in this study were recruited from the local community as part of ongoing clinical trials studying the efficacy of Exposure, Relaxation, Rescription Therapy (ERRT). Each individual reported a history of a criterion A trauma and at least one nightmare weekly. Sleep diary data was collected at each weekly treatment session and included questions regarding time in bed, sleep-onset latency, time out of bed, wake time after sleep onset so that variables of total sleep time, time in bed, and sleep efficiency could be calculated. Participants were instructed to complete the sleep diary each morning while in treatment. Only participants who completed the full ERRT protocol were included.

Results
Results from 93 individuals were analyzed with a dependent samples t-test. The mean sleep efficacy prior to treatment was .85 (SD = .14) and after treatment was .92 (SD = .07), resulting in a t-value of 3.00 (p &lt; .01; Cohen’s d = .57; 95% CI .16 -.96).

Conclusion
Results show that there is a significant and meaningful change in sleep efficiency from pre- to post-treatment of a form of CBT for post-trauma nightmares. Given that ERRT does not directly target time in bed or utilize sleep restriction, this is notable that it is associated with such improvements in sleep directly related to time spent in bed. As some research has suggested that aspects of CBT for insomnia may need to be combined with treatment for nightmares to successfully treat trauma-related sleep disturbances, these results indicate that CBT for nightmares alone may be sufficient. Limitations and future directions will be discussed.

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0681 Association of poor sleep with stress, anxiety, emotional support, social isolation, and depression during the COVID-19 pandemic
Authors: Teague Taylor , Debian Ahmad , Kokonda Manasa , Malhotra Sonal , Arentson-Lantz Emily , Shaib Fidaa , Nowakowski Sara 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has impacted multiple facets of daily living: personal finances, physical activity, and mental and physical health. These changes can result in additional stress and negatively affect sleep. It is important for sleep medicine providers to understand how their patients are impacted by these changes to optimize their care. In this study, we evaluated the association of poor sleep with stress, anxiety, emotional support, social isolation, and depression among sleep medicine clinic patients during the COVID-19 pandemic.

Methods
Sleep medicine clinic patients were distributed an online survey at baseline followed by a 6-month follow-up survey (December 2020 - May 2021). Participants answered questions regarding Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (sleep disturbance and sleep-related impairments), and COVID-19 testing. Stepwise linear regression was performed using SAS to determine if self-reported poor sleep predicted stress, anxiety, emotional support, social isolation, and depression. This study was approved by Baylor College of Medicine IRB. Informed consent was obtained from all subjects involved in the study.

Results
Eighty-one adults completed baseline survey, and 54 adults (mean age 55.2±18.4 years, 61% female, 70% Caucasian) completed 6-month follow-up survey. At baseline, anxiety had a significant effect on sleep disturbance (0.43±0.11, p=0.0001), sleep-related impairments (0.53±0.12, p=0.0001) and ISI (0.28±0.08, p=0.0004). Upon follow-up, an increase in ISI predicted higher perceived stress (0.18±0.07, p=0.013) and worse anxiety (0.61±0.16, p=0.0003). An increase in sleep disturbance predicted a decrease in emotional support (0.25±0.12, p=0.038). Additionally, an increase in sleep-related impairments predicted an increase in social isolation (0.39±0.11, p=0.0002) and depression (0.57±0.07, p&lt;0.0001). Interestingly, only 3 participants tested positive for COVID-19.

Conclusion
In this study of sleep medicine clinic patients during the COVID-19 pandemic, we observed that poor sleep predicted greater stress, anxiety, social isolation, and depression along with less emotional support. This study illustrates the importance of addressing stress management, mental health (anxiety, depression), and emotional support when treating sleep medicine clinic patients during the COVID-19 pandemic.

Support (If Any)
National Institutes of Health (NIH) Grant #R01NR018342 (PI: Nowakowski); Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development; Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413)