bluuebunny/crossref_metadata_2025_split huggingface dataset:
0358 Defining Existing Practices to Support the Sleep of Hospitalized Patients: A Mixed-Methods Study of Top-Ranked Hospitals
Authors: Affini Murtala , Arora Vineet , Gulati Jasmine , Mason Noah , Klein Aviva , Clarke Karen , Cho Hyung , Lee Vivian , McDaniel Lauren , Orlov Nicola 
Published: May 2022

Abstract

Introduction
While sleep is critical for health, the hospital is not conducive to patient sleep and few efforts have been made to improve. The current practices to promote hospitalized inpatient sleep at highly-ranked hospitals are unknown.

Methods
A mixed-methods study of Hospital Medicine Section Chiefs at the 2020 US News and World Report Honor Roll pediatric and adult hospitals was conducted to understand the current practices and attitudes towards inpatient sleep between June and August 2021. An anonymous, quantitative survey was disseminated to quantify current practices and satisfaction with sleep-friendly institutional efforts. Survey participants were invited to share their institutions’ progress and potential ways to further improve inpatient sleep during structured, qualitative interviews.

Results
Pediatric (n=10) and adult (n=20) section chiefs were queried. Survey response rate was 77% (n=23/30; pediatric n=8/10; adult n=15/20). While 96% (n=22) of hospitalist leaders rated sleep as important, only 43% (n=10) were satisfied with their institution’s efforts to improve patient sleep. Although 91% (n=21) of hospitalist leaders rated sleep equity as important, one institution (4%) had practices in place to address the issue. Less than half (n=11) of institutions reported having sleep-friendly practices. Among these institutions, the most common practices included: reducing overnight vital sign monitoring (91%, n=10), decreasing ambient light in the wards (91%, n=10), adjusting lab and medication schedules (73%, n=8), and implementing quiet hours (64%, n=7). Twenty-seven percent of hospitalist leaders (n=8/30; pediatric interviews=3/10; adult interviews=5/20) participated in interviews. Themes included: the importance of having a sleep-friendly culture, environmental changes, modified hospital practices, and external incentives to improve patient sleep.

Conclusion
Hospitalists recognize the importance of improving patient sleep, but few institutions have sleep-friendly practices in place. Most institutions have no sleep health equity practices in place in their hospital. Building sleep-friendly hospital cultures and establishing best practices should be a priority for clinicians.

Support (If Any)
The authors thank the Society of Hospital Medicine and the Pritzker School of Medicine for funding support.
0367 Novel 3D-Printed Custom Oral Appliance Therapy: A Pilot Study
Authors: Glick Aaron , Abbassi Elham , Farach-Carson Mary 
Published: May 2022

Abstract

Introduction
Oral appliance (OA) therapy protrudes the jaw in a more anterior position during sleep to treat obstructive sleep apnea. OA therapy can be used in combination or as an alternative to positive airway pressure (PAP) therapy. Most custom oral devices are fabricated with expensive manufacturing equipment or individually hand-made increasing treatment costs that prevent access to care for patients. Previous studies report concerns of cost-effectiveness of OA therapy and surveys of sleep physicians with cost concerns leading to barriers in prescribing OA therapy. More recent technological advancements in additive technology have allowed low-cost, custom fabrication of digitally designed OA. To date there have been no clinical studies that the authors are aware of that have investigated the feasibility of offering 3D printed custom OA therapy.

Methods
A novel OA was designed specifically for 3D-printing with additional features to improve clinician efficiency, patient comfort, and patient safety. A review of 3D-printed materials was completed to ensure biocompatibility requirements prior to clinical testing. Approval from the Committee for Protection of Human Subjects of University of Texas Health Science Center at Houston was obtained. Five participants had novel OA digitally designed based on scans of upper and lower teeth in addition to a bite registration recorded using a George Gauge. Participants were surveyed based on comfort of device and safety monitoring.

Results
Participants found the novel OA generally comfortable. Comfort questions were presented on a scale of 1 – 10, where ten is the highest level of comfort. On average participants found that the novel OA had comfort levels of 9.0 ± 0.77 on gums, 8.2 ± 0.92 on teeth, and 9.8 ± 0.20 of the jaw joints. No major adverse events were reported and the most common minor adverse event reported was increased salivation.

Conclusion
This pilot study illustrates the clinical feasibility of a novel 3D printed OA. Future studies will further investigate patient outcomes and clinician efficiency during clinical implementation of this novel OA. Though the use of 3D-printing technologies OA therapy has the potential to be offered at lower cost and delivered to the patient in one visit representing a paradigm shift.

Support (If Any)
0372 Patient Perspectives of Sleep Disturbances on a Neurology Inpatient Unit
Authors: Poulakis Alexander , Ibarra Michael , Lin Jennifer , Wielgus Oskar , Eisner Lauren , McGauley David , Kadura Sullafa 
Published: May 2022

Abstract

Introduction
Sleep is a process critical to our daily physical revitalization, but sleep in the hospital is often very disruptive and is associated with poorer health outcomes during recovery. We aimed to assess patient and staff perceptions on sleep disturbances on a neurology inpatient unit in order to minimize sleep disturbances during hospitalization.

Methods
From April 2021 to November 2021, patients on a neurology inpatient unit completed Karolinska Sleep logs, Berlin questionnaires, and the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Surveys were administered three times a week to patients oriented, available to participate, and slept on the unit for at least one whole night. Responses were dichotomized and compared to previously-surveyed dichotomized disturbance perceptions by the unit staff. We used chi-square tests to analyze disturbances across both groups for statistical significance.

Results
One hundred twenty-nine patient surveys were collected, and of the disturbances listed, bed comfort, general noise, vital signs, and toileting were the most significant disruptors to sleep. Staff agreed that noise was a top disruptor but ranked testing, pain, and medications higher than patients.High-risk patients for sleep apnea were more likely to be disturbed by medication administration than low-risk patients (19% vs. 7%, p=0.0288), with trends also nearing significance in neuro checks (17% vs. 7%, p=0.059) and light (17% vs. 7%, p=0.059).Overall, there were significant differences across almost all sleep disturbances when comparing the groups, with staff ranking noise, medications, testing, vital sign checks, neuro checks, anxiety, pain, light, and bed comfort significantly higher than patients (p&lt;0.0001). Temperature was not statistically significant. While survey collecting, we found that patients reported specific interventions disrupted their sleep but later ranked them lower than we expected on PHSDNQ. Upon further questioning, patients thought those interventions were required by inpatient teams.

Conclusion
There is undoubtedly room to minimize the top-ranked disruptors and identify discrepancies between high and low-risk sleep apnea patients. We found that patients typically expect certain sleep disturbances during hospitalization, and are generally unaware that we can modify them. Future studies should involve empowering patients to minimize sleep disruptions.

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0373 Developing an Online Sleep Education Training- Lessons Learned & Future Directions
Authors: Groton Danielle , Spadola Christine , Alford Nicole 
Published: May 2022

Abstract

Introduction
Systems of higher education are increasingly offering online education, with the most recent expansion of e-learning surrounding the COVID-19 pandemic. As the e-learning industry grows, it provides the opporunity to expand a burgeoning body of research focusing on the development of online training to promote health across disciplines. This presentation describes the development of an interdisciplinary online training to educate social work students on sleep health and shares feedback recieved from the student experience. We describe the steps taken to develop the instructional method, content management, and the delivery of the training.

Methods
This training involved 25 collaborators across seven universities. The Center for Online and Continuing Education (COCE) at the ‘home’ institution partnered with faculty to recommend best practices in online learning and provide technical assistance. Based on formative research conducted with the target population, the training included 5 ‘modules’: introduction to sleep health, sleep hygiene, fatigue and fatigue countermeasures, sleep disorders, and sleep health among special populations. The content included mixed media, humor, and props to bolster student engagement. The COCE team created a digital ‘Sleep Health Badge’ and certificate of completion that students would earn after completing the training. The training was offered to social work students at a public university in the southeastern United States.

Results
90 students participated in the training. Students increased their sleep health knowledge, and reported being very satisfied with the structure and curriculum of the training(96.7%). Of note, while the training was only 2 hours long and asynchronous, the the most frequent recommended change given by participants was to shorten the length of the videos (20.8% of responses).

Conclusion
Overall, the training was well-received and is in the process of being adapted for professional social workers. For future development of online trainings, we will share reflections and recommendations as they relate to each of the major components of e-learning: content development, instructional method, content management, and content delivery/presentation. We center these reflections around both student feedback on the online training, and our own experiences in developing this training.

Support (If Any)
American Academy of Sleep Medicine Foundation
0376 Evaluation of healthcare delivery disparities among the Native American population: Knowledge and Attitudes of obstructive sleep apnea among the Indian Health Services primary care physicians
Authors: Rihawi Anas , Tah Sumeer , Rangan Pooja , Knobbe Kirstin , Lee-Iannotti Joyce 
Published: May 2022

Abstract

Introduction
The burden of racial disparities in diagnosis and treatment of Obstructive sleep apnea (OSA) remains underrecognized among the Native American population. This study intends to assess the knowledge and attitudes towards diagnosis and management of obstructive sleep apnea among the primary care physicians caring for the Native American population.

Methods
A cross-sectional survey was conducted at an Indian Health Services (IHS) primary care clinic. A validated OSA Knowledge (18 questions) and Attitudes (5 questions) (OSAKA) questionnaire was used, in addition to one question to address referrals to a sleep specialist.

Results
A total of 20 primary care providers were invited to participate in the survey with a response rate of 45% (9 participants, 2 males and 7 females). The median (IQR) knowledge score was 14 (13-16). The mean (±SD) percentage of correct response (proportion of correctly answered questions) was 79% (±9.5), which was similar to previously reported scores among primary care physicians in other studies. There was no significant knowledge difference between males and females and no difference based on age. All participants felt it was very or extremely important to identify patients with OSA and that OSA is important as a clinical disorder. There was a significant positive correlation between knowledge and recognizing the importance of OSA as clinical disorder, and between knowledge and confidence in identification of OSA. There was a negative correlation between confidence in OSA identification and referral to a sleep specialist but was not statistically significant. Only one participant (11%) felt comfortable managing patients on CPAP therapy, but there was no significant correlation with referrals to a sleep specialist.

Conclusion
Obstructive sleep apnea knowledge in IHS primary care providers is comparable to their peers. However, the lack of comfort in managing patients with OSA on CPAP did not increase referrals to a sleep specialist. This highlights a possible disparity and resource gap in treating Native Americans within the IHS health system with sleep apnea and further studies are needed.

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0394 Efficacy and Safety in People With Narcolepsy Transitioning From Sodium Oxybate to Lower-Sodium Oxybate: Data From the Real-World TENOR Study
Authors: Leary Eileen , Zee Phyllis , Fuller Douglas , Macfadden Wayne , Steininger Teresa , Bae Charles , Husain Aatif 
Published: May 2022

Abstract

Introduction
Lower-sodium oxybate (LXB) contains 92% less sodium than sodium oxybate (SXB) and is approved for treating cataplexy or excessive daytime sleepiness in patients with narcolepsy (aged ≥7 years) and idiopathic hypersomnia in adults. The Transition Experience of persons with Narcolepsy taking Oxybate in the Real-world (TENOR) study collects data from patients transitioning from SXB to LXB in a real-world setting.

Methods
TENOR is a patient-centric, prospective, observational, noninterventional, virtual-format study (NCT04803786). Eligible participants include US adults with confirmed narcolepsy (type 1 or 2) transitioning from SXB to LXB within the previous/upcoming 7 days. Longitudinal data are collected for 21 weeks post-transition. Efficacy measures (Epworth Sleepiness Scale [ESS]; Functional Outcomes of Sleep Questionnaire, Short Version [FOSQ-10]; and British Columbia Cognitive Complaint Inventory [BC-CCI]) are collected at baseline (taking SXB) and weekly beginning at week 1 (taking LXB). Participants were prospectively queried about changes in tolerability. These analyses include data collected during the first week of LXB from all qualifying participants.

Results
The analyses include 85 participants (type 1, n=45; type 2, n=40) at baseline and 79 participants at week 1. At baseline, mean (SD) age was 40.3 (13.0) years; most participants were female (73%) and White (87%), and 79% took ≥1 concomitant medication for narcolepsy at baseline in addition to SXB. Patient-reported comorbidities included depression (54%), anxiety (46%), obstructive sleep apnea (27%), and hypertension (24%). At baseline (taking SXB) and week 1 (taking LXB), mean (SD) ESS scores were 9.9 (5.2) and 9.7 (5.2), respectively (mean [SD] change: −0.3 [2.7]); mean (SD) FOSQ-10 scores were 28.7 (7.1) and 28.8 (7.5), respectively (mean [SD] change: 0.2 [3.9]); and mean (SD) BC-CCI scores were 6.1 (4.4) and 6.1 (4.7), respectively (mean [SD] change: 0.0 [2.3]). Tolerability associated with LXB treatment was consistent with the known safety profile of SXB.

Conclusion
In this real-world study in people with narcolepsy who are transitioning from SXB to LXB, efficacy of oxybate treatment on measures of excessive daytime sleepiness, quality of life, and cognition as well as safety were maintained after 1 week. Longer-term maintenance of efficacy and safety will be reported at study completion.

Support (If Any)
Jazz Pharmaceuticals.
0397 Autonomic Reflex Testing Confirms Autonomic Disturbances in a Cohort of Patients with Idiopathic Hypersomnia
Authors: Aviv Rachel , Zitser Jennifer , Miglis Mitchell , Chiaro Giacomo , Guaraldi Pietro 
Published: May 2022

Abstract

Introduction
Symptoms suggestive of autonomic nervous system (ANS) dysfunction have been previously described in patients with idiopathic hypersomnia (IH), however, objective ANS reflex testing data has not been reported. We aimed to better quantify symptoms of ANS dysfunction in a cohort of patients with IH through the use of standardized ANS reflex testing.

Methods
Patients diagnosed with IH based on ICSD-3 criteria using overnight video polysomnography and multiple sleep latency testing (MSLT) were consecutively enrolled in our study, regardless of ANS symptoms. All patients underwent ANS reflex testing, including measures of parasympathetic (heart rate variability with deep breathing and Valsalva ratio) and sympathetic adrenergic function (Valsalva blood pressure response and 10-minute head-up tilt at an angle of 70 degrees) with continuous blood pressure and heart rate monitoring. Eleven patients also underwent measures of sympathetic cholinergic function (quantitative sudomotor axon reflex testing). All medications that affect ANS function were held prior to ANS testing, including wake-promoting medications and sodium oxybate.

Results
Twenty patients with IH were enrolled. Fifty percent (10/20) were long sleepers (&gt;11hrs). Mean sleep onset latency and number of sleep onset REM periods (SOREMs) on MSLT were 6.9 (± 3.1) mins and 0.2 (± 0.4), respectively. Mean duration of IH symptoms prior to the date of ANS testing was 6.3 (± 8.1) yrs. Eighty-five percent (17/20) of patients had abnormal ANS testing. Of these, 75% (15/20) had sympathetic adrenergic impairment, 64% (7/11) had sympathetic cholinergic impairment, and 5% (1/20) had parasympathetic impairment. Fifty-five percent (11/20) of patients were diagnosed with postural tachycardia syndrome (POTS), 45% (5/11) with small fiber neuropathy, 5% (1/20) with inappropriate sinus tachycardia and 15% (3/20) with neurally-mediated syncope. Seventy percent (14/20) of patients reported orthostatic intolerance regardless of autonomic diagnosis.

Conclusion
ANS dysfunction was common and severe in our cohort of IH patients, affecting all domains of ANS reflex testing, with more prominent impairment in sympathetic domains. POTS was the most common comorbid diagnosis, and most patients reported orthostatic intolerance. There was no association with IH disease duration, though our sample size was limited. Future studies will focus on ANS testing in larger cohorts of IH patients, specifically on shared pathophysiological mechanisms of hypersomnia and ANS dysfunction.

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0403 Efficacy of Once-nightly Sodium Oxybate (ON-SXB; FT218) for Excessive Daytime Sleepiness and Cataplexy: Post-hoc Number Needed to Treat and Effect Size Analyses From REST-ON
Authors: Thorpy Michael , Roth Thomas , Kushida Clete , Seiden David , Dubow Jordan , Gudeman Jennifer 
Published: May 2022

Abstract

Introduction
FT218 is an investigational, extended-release, once-nightly formulation of sodium oxybate (ON-SXB) for adults with narcolepsy. ON-SXB treatment achieved significant improvement vs placebo (6 g, 7.5 g, and 9 g, all P&lt;0.001) for the coprimary endpoints of mean sleep latency on the Maintenance of Wakefulness test (MWT), Clinical Global Impression of Improvement rating, and number of weekly cataplexy episodes (NCA), and the secondary endpoint Epworth sleepiness scale (ESS) score, in the phase 3 REST-ON trial (NCT02720744). Post-hoc analyses of numbers needed to treat (NNT) and effect sizes were performed to further contextualize the effectiveness of ON-SXB.

Methods
Participants in REST-ON (aged ≥16 years with narcolepsy type 1 or 2) were randomized 1:1 to receive ON-SXB (1 week, 4.5 g; 2 weeks, 6 g; 5 weeks, 7.5 g; 5 weeks, 9 g) or placebo. MWT response was defined as ≥5-min increase from baseline in mean sleep latency, ESS response as a score ≤10, and cataplexy response as ≥50% reduction from baseline in mean NCA. Effect sizes were calculated using Cohen’s d; NNTs were the inverse of the absolute risk reduction.

Results
The modified intent-to-treat population included 190 participants (ON-SXB, n=97 [NT1, n=73]; placebo, n=93 [NT1, n= 72]). For MWT response, all ON-SXB doses (6 g at week 3, 7.5 g at week 8, and 9 g at week 13) had NNTs of 3 and effect sizes of 0.7–0.9. A dose-response effect was seen for ESS response with NNTs ranging from 3 to 6. Effect sizes were between –0.5 to –0.7 for the 3 doses (decreases signifying response). The NNT for cataplexy response was 6 for ON-SXB 6 g and 3 for ON-SXB 7.5 and 9 g; effect sizes were between –0.7 to –0.8.

Conclusion
NNT calculations show that 3–6 patients need to be treated with ON-SXB to achieve ≥5 minutes increased sleep latency on the MWT, ESS score ≤10, or a ≥50% reduction in cataplexy. Considering these post-hoc analyses may be useful to clinicians in discussing treatment expectations and provide support for the efficacy of ON-SXB for excessive daytime sleepiness and cataplexy in adults with narcolepsy.NNT calculations show that 3–6 patients need to be treated with ON-SXB to achieve ≥5 minutes increased sleep latency on the MWT, ESS score ≤10, or a ≥50% reduction in cataplexy. Considering these post-hoc analyses may be useful to clinicians in discussing treatment expectations and provide support for the efficacy of ON-SXB for excessive daytime sleepiness and cataplexy in adults with narcolepsy.

Support (If Any)
Avadel Pharmaceuticals
0404 Patient and Provider Preferences for Oxybate Treatment for Narcolepsy: A Discrete Choice Experiment
Authors: Morse Anne Marie , Krahn Lois , Kushida Clete , Thorpy Michael , Flygare Julie , Seiden David , Athavale Amod , Gudeman Jennifer 
Published: May 2022

Abstract

Introduction
Currently available immediate-release sodium oxybate (SXB) and mixed-salt oxybates are dosed twice nightly (second 2.5–4 hours after first). Extended-release, once-nightly SXB (ON-SXB; FT218) is in development. To characterize drivers of oxybate treatment attribute preferences, discrete choice experiments (DCEs) were conducted for both patients and healthcare providers (HCPs).

Methods
Thirty-minute web-based surveys were fielded to 1) adults with self-reported physician-diagnosed narcolepsy with/without prior/current use of oxybate, and 2) board-certified/board-eligible HCPs treating ≥5 narcolepsy patients in the last month. Choice sets of 2 hypothetical treatment profiles were generated combining attributes of twice-nightly SXB, mixed-salts oxybate, and ON-SXB. While viewing 12 choice sets, each participant indicated (1) their preferred product overall, (2) the product that would improve quality of life (QoL), and (3) the product that would result in less patient stress/anxiety. Results were analyzed using a mixed logit model.

Results
For patients (n=120) and HCPs (n=100), the most important attribute driving overall product choice was dosing frequency (relative attribute importance, 26.0 and 46.1, respectively), with once-nightly preferred over twice-nightly dosing (relative preference weight, ±25.6 and ±43.6); QoL (relative attribute importance, 28.7 and 41.7), with once-nightly preferred over twice-nightly dosing (relative preference weight, ±25.7 and ±38.5); and reducing patient anxiety/stress (relative attribute importance, 26.7 and 44.0), with once-nightly preferred over twice-nightly dosing (relative preference weight, ±23.9 and ±41.6). Other drivers of overall product choice were as follows: patients, clinical efficacy and sodium content (relative attribute importance, 23.5 and 20.8); HCPs, adverse reactions and sodium content (relative attribute importance, 19.7 and 18.6). Drivers of QoL preference were as follows: patients, clinical efficacy and sodium content (relative attribute importance, 28.3 and 20.9); HCPs, adverse reactions and clinical efficacy (relative attribute importance, 21.5 and 18.6). Drivers of reducing patient anxiety/stress were as follows: patients, clinical efficacy and sodium content (relative attribute importance, 17.4 and 17.3); HCPs, adverse reactions and sodium content (relative attribute importance, 18.2 and 14.2).

Conclusion
Dosing frequency was identified as the most important attribute driving preference for overall product choice, QoL, and reducing patient anxiety/stress for both patients and HCPs with once-nightly preferred over twice-nightly dosing.

Support (If Any)
Avadel Pharmaceuticals