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Sleep
Journal Prestige (SJR): 2.37
Citation Impact (citeScore): 5
Number of Followers: 30  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0161-8105 - ISSN (Online) 1550-9109
Published by Sleep Research Society Homepage  [1 journal]
  • 1224 Management of Dopaminergic Augmentation of Restless Legs Syndrome
           with Concurrent High Dose Benzodiazepine Therapy

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      Pages: A521 - A522
      Abstract: AbstractIntroductionRestless Legs Syndrome (RLS) or Willis-Ekbom disease, is sleep related movement disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable and unpleasant sensations. Over the years, dopaminergic agonists (DAs) have served as the primary treatment for RLS. However, the emergence of dose-dependent augmentation has prompted a shift in the management approach. This change is marked by a growing emphasis on prioritizing alpha2-delta calcium channel ligands (A2D) as alternative therapeutic agentsReport of case(s)We report a case of a 70-year-old woman with a 15-year history of RLS, with crawling and unpleasant sensation of her legs preventing from falling asleep, successfully managed initially with pramipexole 0.5mg at night and eventually started on clonazepam. With escalating symptoms, Pramipexole and Clonazepam gradually increased. Despite dose escalation of pramipexole to 0.75mg and clonazepam to 4mg nightly, symptoms persisted and even intensified. Abruptly discontinuing Pramipexole and transitioning to ropinirole at 1mg and continuing Clonazepam 4mg nightly failed to yield improvement. Patient presented for consultation at this time highlighting the severity of RLS augmentation as moderate. Recommendation in this situation is to introduce A2D or possible opiate medication to ameliorate symptoms before tapering DA. The patient's high-dose benzodiazepine regimen increases respiratory depression and fall risk, hindering the standard approach of introducing alternative agents. In response, a tailored strategy was implemented, gradually tapering clonazepam while initiating gabapentin therapy, RLS symptoms began to improve. Subsequent cautious tapering of ropinirole contributed to sustained relief. This case demonstrates the need for individualized approaches in managing dopaminergic augmentation in RLS, especially when high-dose benzodiazepines are involved.ConclusionIn navigating the intricacies of RLS treatment, our case highlights the effectiveness of a nuanced approach when confronted with dopaminergic augmentation alongside concurrent high-dose benzodiazepine therapy. Tapering benzodiazepines and introducing gabapentin proved successful, emphasizing the importance of tailored interventions. This case contributes to the understanding of RLS management in complex scenarios.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01224
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0868 Cardiac Remodeling: Apnea-Hypopnea Index as a Predictor for Changes
           in Left Atrial Volume

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      Pages: A372 - A373
      Abstract: IntroductionLeft atrial (LA) size and volume are of interest in sleep-disordered breathing (SDB) as they are associated with cardiac arrhythmias. However, whether the apnea-hypopnea index (AHI) predicts LA longitudinal changes over time remains unknown.MethodsThis retrospective cohort study includes adults (≥18 years) without congestive heart failure (CHF) who were referred for a diagnostic in-laboratory polysomnogram (PSG) between January 2019 and March 2020; a baseline echocardiogram within one year of the PSG; and a follow-up echocardiogram more than one year after the initial studies. Clinical, PSG and echocardiographic variables, including LA volume and LA size, were abstracted from the medical record. SDB was classified as absent, mild, moderate, or severe (AHI ≤4.9/h, 5.0-14.9/h, 15.0-29.9/h, and ≥30/h, respectively). Regression models were used to assess the baseline cross-sectional relationships between AHI and LA measures, and the association of baseline AHI with LA changes over time.ResultsWe identified 103 patients (58.8% male, median age 66 years (interquartile range, IQR 52-71)) with and without SDB (AHI median 19.9, IQR 7.3 – 35.6). The median time between baseline and follow-up echocardiograms was 3.2 years (IQR 2.3-4.1). AHI was associated with larger LA volume (β=0.64, p=0.0002) and LA size (β=0.08, p=0.04) at baseline. AHI also predicted changes in LA volume over time (β=0.57, p=0.02), but not changes in LA size. A dose-dependent relationship between SDB severity and changes in LA volume was noted: Individuals without OSA demonstrated a slight decrease in LA volume over time (median -7, IQR -36 - -5) whereas those with severe SDB demonstrated an increase in LV volume (median 13, IQR -9 – +18). Individuals with mild/moderate SDB fell between those groups.ConclusionMany patients with SDB are at risk for cardiac arrhythmias. Our results indicate that SDB severity at baseline predicts changes in LA volume over time. These findings may help identify patients at risk for LA enlargement and associated arrhythmias, and suggest a potential opportunity for early intervention to decrease cardiovascular risk.Support (if any)NIH R25NS088248
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0868
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0869 Association Between Accelerometer-Measured Irregular Sleep Duration
           and Incidence of Obesity in Older Adults

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      Pages: A373 - A373
      Abstract: AbstractIntroductionAbnormal sleep duration is an established risk factor for obesity. However, the potential adverse effects of sleep's nightly variability, including fluctuations in duration, remain less explored. Irregular sleep duration may increase circadian disruption and subsequently contribute to metabolic alterations, behavioral and mood changes, and obesity development.MethodsFrom 2013-2015, a subsample of the UK Biobank (UKB) participants wore accelerometers for a week. Our longitudinal study included 8,438 participants (mean age: 64 years) with ≥5 days of accelerometer data and repeated weight measurements who had BMI< 30 kg/m2 at baseline. Irregular sleep duration was assessed by the within-person standard deviation (SD) of 7-night accelerometer-measured sleep duration. Weight was objectively measured at UKB center visits or extracted from UK general practice records at two timepoints. The baseline measurement was taken in a period spanning from two years before to one year after the accelerometer study. The follow-up measurement was obtained on average 3.6 years after the baseline measurement (interquartile range: 1.8-5.0) and at least 6 months after the accelerometer study. Poisson regression with robust error variance was used to estimate relative risk (RR) for incident obesity (BMI≥30 kg/m2) according to sleep duration-SD categories.ResultsA total of 419 participants developed obesity at the follow-up measurement. Compared with participants with a sleep duration-SD < 30 minutes, the RR (95% CI) for incident obesity was 1.22 (0.86, 1.73) for 31-45 minutes, 1.60 (1.14, 2.26) for 46-60 minutes, and 2.01 (1.45, 2.80) for >60 minutes (p-trend=0.0024), after adjusting for age, sex, race, and follow-up period. Additional adjustment for lifestyle (smoking, physical activity, diet, and alcohol use), co-morbidities (dyslipidemia, hypertension, and depression), and other sleep-related factors including average sleep duration resulted in a weaker but statistically significant association (RR comparing >60 versus < 30 min: 1.73; 95% CI: 1.24, 2.41). The association was similar in men and women (P-interaction in the fully-adjusted model=0.84).ConclusionIrregular sleep duration was associated with higher risk of incident obesity in older adults, independent of average sleep duration and other obesogenic behaviors.Support (if any)R01HL155395
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0869
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0870 Association Between Narcolepsy and Cardiovascular Outcomes: A Matched
           Cohort Study Adjusting for Medication Use

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      Pages: A373 - A374
      Abstract: AbstractIntroductionEmerging research suggests that narcolepsy, a chronic disabling condition characterized by excessive daytime sleepiness, directly impacts the cardiovascular system, leading to increased risk of cardiovascular disease (CVD). Existing studies evaluating CVD risk among persons with narcolepsy (PWN) have not considered medications to treat the symptoms of narcolepsy (e.g., stimulants). We aimed to assess the real-world association of narcolepsy with CVD risk while accounting for medications.MethodsWe conducted a retrospective cohort study using 2005-2021 MarketScan® Commercial and Medicare Supplemental databases. Patients with newly diagnosed narcolepsy with ◻2 outpatient claims identified using International Classification of Diseases – Clinical Modification diagnosis codes were included (narcolepsy group). A comparison cohort of patients without narcolepsy and hypersomnia (non-narcolepsy group) was matched at a ratio of 1 up to 3 using propensity score (PS) matching based on baseline demographics, comorbidities, and medication use. After PS matching, we used multivariable Cox regression to compare the risks of CVD (i-e., stroke, atrial fibrillation, heart failure (HF), myocardial infarction (MI), or acute coronary syndrome) and major adverse cardiac events (MACE) (i-e., MI, ischemic stroke, HF, acute coronary syndrome, coronary artery bypass grafting, or percutaneous coronary intervention) between the two groups after controlling for baseline wake promoting agents and stimulants use, and post-index time-varying stimulants use. Follow-up continued until the occurrence of outcomes, end of enrollment, or December 31, 2021.Results134,967 patients (34,562 PWN and 100,405 non-narcolepsy; mean age 40±16.78 years and 62% female) were identified. The crude incidence of CVD was 1.50 and 0.85 per 100 person-years for narcolepsy and non-narcolepsy groups, respectively. After controlling for baseline and time-varying covariates, PWN was associated with a 93% higher CVD risk compared to non-narcolepsy group (adjusted hazard ratio (aHR), 1.93; 95% confidence interval (95% CI), 1.75-2.13). Similarly, PWN was associated with a 97% higher MACE risk compared to non-narcolepsy group (aHR,1.97; 95%CI, 1.72-2.26).ConclusionIn this PS-matched cohort study, PWN experienced increased risk of developing CVD or MACE relative to propensity-matched patients without narcolepsy after controlling for baseline medication use (stimulant and wake promoting agent), and post-index time-varying stimulant use.Support (if any)Sleep Research Society Foundation (23-FRA-001).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0870
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0871 Sleep Disturbance and Disability Severity After Stroke
           Hospitalization

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      Pages: A374 - A374
      Abstract: AbstractIntroductionStroke survivors frequently report sleep disturbance and feelings of not being back to where they were, physically, prior to their event. Post-stroke sleep disturbance may be a factor related to sub-optimal recovery.MethodsData came from the Reactions to Acute Care and Hospitalizations (ReACH) Stroke-Sleep Study, an observational cohort assessing the relationship of sleep with secondary cardiovascular risk in the year following stroke or transient ischemic attack (TIA). Data were collected using self-reported questionnaires at 1 month and chart reviews. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), with a score >5 indicating poor sleep quality. Insomnia symptoms were assessed with a single item from the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): “In the past month, how much were you bothered by trouble falling or staying asleep'” with a rating of “moderately,” “quite a bit,” or “extremely” indicating presence of insomnia symptoms. Degree of disability was assessed using the Simplified Modified Rankin Scale Questionnaire (smRSq), with presence of disability defined as smRSq score >2. Binary logistic regression was used to analyze the relationships between presence of poor sleep and insomnia, separately, with presence of disability at 1-month post-hospitalization. Analyses were adjusted for age, gender, race/ethnicity, and stroke severity (NIH Stroke Scale).ResultsThe sample included n=436 participants (mean [SD] age=60.2 [15.5] y, 52% Hispanic/Latino, 59% female). Fifty-six percent of participants reported poor sleep quality, 27% reported presence of insomnia symptoms, and 23% reported presence of disability at 1 month. Poor global sleep quality (vs. good sleep) was significantly associated with presence of disability (adjusted OR: 2.45, 95% CI: 1.48-4.04, p< 0.001). Insomnia (vs. no or mild symptoms) was also significantly associated with presence of disability (adjusted OR: 2.40, 95% CI: 1.50-3.85, p< 0.001).ConclusionMore than half of participants reported poor sleep quality, and over a quarter reported insomnia symptoms, 1 month after stroke hospitalization. Compared to those without sleep problems, individuals with sleep disturbance had nearly 2.5 times higher odds of disability. While causal relationships cannot be concluded based on this cross-sectional analysis, findings suggest that sleep may play a role in stroke survivors’ outcomes and recovery.Support (if any)R01HL141494
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0871
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0872 Sleep-Disordered Breathing Is Associated with Endothelial Dysfunction
           in Adults

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      Pages: A374 - A375
      Abstract: AbstractIntroductionShort sleep duration and obstructive sleep apnea (OSA) are associated with increased rates of cardiovascular disease. Vascular inflammation and endothelial dysfunction are potential mechanisms for this association but can be burdensome or impractical to measure in clinical settings. Other characteristics of sleep health, such as sleep quality, insomnia symptoms, and daytime sleepiness, are infrequently studied in relation to endothelial function. The current study investigated the association between multiple dimensions of sleep health (apnea hypopnea index (AHI), insomnia symptoms, sleep quality, and daytime sleepiness) and endothelial dysfunction using peripheral arterial tonometry (PAT; EndoPAT, Itamar Medical).MethodsParticipants (N=43) with mild-to-moderate OSA, completed a baseline assessment including demographics, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). OSA severity was measured with AHI from one night of PSG (home or in-lab). Microvascular endothelial function was assessed using EndoPAT. The hyperemic response was measured following upper arm occlusion and the reactive hyperemia index (RHI) was calculated. Cross-sectional associations of sleep (ISI, PSQI, ESS, AHI), demographic characteristics (age, sex) and BMI with the natural log of RHI (used due to non-normality) were examined using linear regression models.ResultsIn the study sample, mean (SD) age = 54.4 (12.6) years, 63% were female and 77% identified as Black race. Higher AHI (b = -.015. SE = .01, p =.03) and older age (b = -.01. SE = .003, p =.005) were significantly associated with lower RHI, indicating worse endothelial function. ISI, PSQI, ESS, sex, and BMI were not significantly associated with RHI (p’s>.05).ConclusionThis study identified an association between OSA severity (higher AHI) and greater endothelial dysfunction, using the novel non-invasive EndoPAT, and null associations with other self-reported sleep characteristics. The study was underpowered to include covariate adjustment or interaction terms, but future studies with larger samples and studies examining potential benefits of OSA treatment on endothelial function are needed.Support (if any)R01HL146059, K24HL143055, K24HL13632. EndoPAT device provided by ZOLL Itimar.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0872
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0873 Impact of Obstructive Sleep Apnea Treatment on Mortality in Atrial
           Fibrillation Patients

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      Pages: A375 - A375
      Abstract: AbstractIntroductionThe intricate relationship between atrial fibrillation (AF) and obstructive sleep apnea (OSA) has garnered attention due to its potential impact on morbidity and mortality. This study explores the characteristics of individuals with both AF and OSA, aiming to shed light on associated outcomes.MethodsUtilizing data from the Geisinger Health System (2007-2023), we focused on cardiology patients with AF. Inclusion criteria comprised age > 18, AF and OSA diagnosis, and polysomnography with an apnea-hypopnea index (AHI) > 5. Data collected included age, gender, body mass index (BMI), mean AHI, oxygen desaturation index (ODI), ablation, cardioversion rates, and electrophysiology (EP) clinic follow-ups.ResultsAmong 29,000 patient encounters, 2,971 unique patients met inclusion criteria. 64% were male, with a mean age of 74.9 for deceased patients versus 68.1 for the alive cohort (p < 0.001). Deceased patients had a higher mean BMI (35.8 vs. 34.3, p = 0.003) and AHI (27 vs. 25, p = 0.0143). Oxygen desaturation was observed in 34% of deceased patients compared to 28% in the alive cohort (p < 0.0001). Ablation and cardioversion did not significantly impact mortality. The all-cause mortality rate was 12.7%.ConclusionAnalysis revealed that prolonged hypoxia increased mortality risk in AF and OSA patients. Although higher AHI was noted in deceased patients, its clinical significance was limited. We also found that ablation and cardioversion did not improve mortality. Effective OSA treatment in AF patients can potentially improve outcomes. Further studies are necessary to determine if reducing oxygen burden reduces mortality in this population.Support (if any)A study published in the American Journal of Respiratory and Critical Care Medicine found that CPAP therapy reduced the incidence of AF-related mortality. The data from over 10,000 patients, demonstrated that those receiving effective sleep apnea interventions, such as CPAP, exhibited a 35% reduction in all-cause mortality compared to untreated counterparts. This research highlights the potential life-saving benefits of addressing sleep-disordered breathing in the management of AF.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0873
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0874 Impact of Physical Activity on Subsequent Night's Sleep in Patients
           After Cardiac Surgery

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      Pages: A375 - A375
      Abstract: AbstractIntroductionAfter cardiac surgery, patients often experience sleep disturbances, including poor sleep quality and increased awakenings. Sleep benefits postoperative physical function and overall recovery and has been related to physical activity. Physical activity and sleep have daily variations, but no study has examined their relationships on a daily basis after cardiac surgery. To address this gap, we investigated the effects of daily physical activity on daily sleep in postsurgical cardiac patients.MethodsEmploying a longitudinal pilot study design, 33 adults aged 18 to 80 who had undergone cardiac surgery were recruited from one hospital in Chicago and using an online recruitment site. Daily physical activity and sleep were measured in participants’ homes using a wrist-worn ActiGraph over 7 days and nights. Sociodemographic and psychosocial factors were assessed through self-reported online questionnaires. Mixed-effects model analyses were applied to examine the effects of daily physical activity on five sleep variables; covariates were selected from bivariate correlational and regression analyses as well as previous research evidence.ResultsParticipants were mostly male (57.6%), non-Hispanic whites (63.6%) and had a mean age of 60.8 ± 10.1 years. Their mean body mass index (BMI) indicated overweight (28.4 ± 5.2 kg/m2), and 54.6% had undergone coronary artery bypass graft surgery 85.7 ± 91.2 months earlier. In mixed-effects model analyses, higher moderate-to-vigorous physical activity was significantly associated with lower next-day sleep latency (b=-1.32, p<.05). Among covariates, lower depression (b=2.72, p<.05), higher companionship (b=0.37, p<.05), and higher instrumental support (b=2.40, p<.05) were associated with lower daily wake after sleep onset, increased daily sleep efficiency, and longer total sleep time, respectively. In addition, older age, higher BMI, and a higher comorbidity index predicted more daily sleep disturbances.ConclusionIn postsurgical cardiac patients, daily physical activity should be assessed and managed as a means to enhance daily sleep. Tailoring sleep interventions to individuals based on their comorbidities and psychosocial factors is also important. Future research should explore interactions between daily physical activity and sleep in a larger sample of postsurgical cardiac patients during varying time periods after surgery and should comprehensively assess sleep status, including sleep disorders, daytime napping, and daytime sleepiness.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0874
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0833 Identifying Clinical Determinants of Obstructive Sleep Apnea in
           Children with Sickle Cell Disease

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      Pages: A357 - A357
      Abstract: AbstractIntroductionChildren with sickle cell disease (SCD) are at increased risk for obstructive sleep apnea (OSA). Guidelines recommend screening for OSA in this population based on clinical assessment. Several aspects of OSA in children with SCD remain poorly understood, such as clinical characteristics and the optimal approach for screening. Although polysomnography (PSG) proves valuable for diagnosing individuals who exhibit signs and symptoms of OSA, its cost-effectiveness as a screening tool for asymptomatic children with SCD remains uncertain. There is a need for an effective clinical screening approach for OSA in this population. The objective is to compare the clinical characteristics of children with SCD who had OSA (AHI >1) against those who did not on PSG.MethodsAll SCD patients aged 2 to 18 between March 2016 to May 2023 attending the Comprehensive Sickle Cell Center who underwent PSG were retrospectively compared with sleep apnea symptoms during clinic visits. Symptoms criteria were retrieved from clinical encounters for snoring, apnea, mouth breathing, gasping, enuresis in children older than ten, morning headache, hyperactivity, daytime sleepiness, and daytime naps.ResultsFrom 180 children with SCD who attended the clinic, 56 patients (31.1%) had a PSG performed, whereby 37.5% (n=21) were diagnosed with OSA, and 62.5% (n=35) did not have OSA. In children with OSA, 80.9% (n=17) reported snoring, 23% (n=5) mouth breathing, and 4.7% (n=1) witnessed apnea. From the group without OSA, 40% (n=14) had no symptoms, 42% (n=14) reported snoring, 20% (n=7) mouth breathing, 17.1% (n=6) reported taking naps, 14.2% (n=5) gasping. Despite being the most frequent symptom to occur in those with and without OSA, habitual snoring was significantly higher in the OSA group (p= 0.02). Conversely, in the absence of symptoms, patients were unlikely to have OSA (p=0.003).ConclusionIn children with SCD, the absence of symptoms suggests OSA is not present; therefore, PSG may not be warranted. However, the presence of habitual snoring may be an indicator for OSA requiring PSG confirmation.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0833
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0834 Bedtime and Naptime Routines: Associations with Newborn and Parental
           Sleep Outcomes

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      Pages: A357 - A358
      Abstract: AbstractIntroductionA consistent bedtime routine is associated with better sleep and well-being in young children. However, little is known about the prevalence of bedtime and naptime routines in newborns, and their association with sleep outcomes in both the newborns and their parents.MethodsParents (67% mothers, 33% fathers) of 135 newborns (1-15wks; M=8.2wks) from the US and UK completed an online questionnaire addressing questions about sleep and routines in newborns, as well as measures of sleep in the parents (PROMIS sleep disturbance scale and sleep-related impairment scale).ResultsOverall, 62% (n=84) reported having a bedtime routine and 20% (n=27) a naptime routine for their newborn. Of these families, 50% started a bedtime routine before 4 weeks of age with 58% starting a naptime routine within the same time frame. Most parents who engaged in a bedtime routine indicated that they liked it (79%), it was easy (70%), it helped their newborn fall asleep (62%) and sleep for longer stretches overnight (54%). For those with naptime routines, approximately half liked them (54%) and reported they were easy (50%), but fewer thought they helped their newborn nap (35%). Most parents thought that sleep routines helped them bond with their newborn (88% bedtime, 69% naptime). Further, newborns with a bedtime routine had longer stretches of sleep (5.1h vs. 4.2h, p=.023), shorter total time awake during the night (128.6m vs. 175.7m, p=.002), and trended toward fewer night wakings (2.1 vs. 1.7, p=.070). Finally, parents who had bedtime routines for their newborn were less likely to experience sleep disturbances themselves, p=.017, but there were no differences in sleep-related impairment.ConclusionOver half of all newborns have a bedtime routine, but only 20% a naptime routine. However, these routines are liked by parents and associated with increased sleep consolidation in newborns and decreased sleep disturbances in parents. A simple recommendation of instituting sleep routines for newborns may result in improved sleep outcomes for newborns and their parents.Support (if any)Kenvue, Skillman, NJ, USA
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0834
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0835 Impact of Daylight Saving Time Change on Parental Anxiety, Stress,
           and Infant Sleep Expectations

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      Pages: A358 - A358
      Abstract: AbstractIntroductionDaylight Saving Time (DST) transitions can disrupt infant sleep routines, and lead to temporary sleep disturbances, potentially contributing to heightened stress levels for parents. This study examines the associations between DST-related stress, parental anxiety, and parental and infant sleep.Methods602 parents of infants aged 0-24 months (11.45±5.5) from the US were recruited,79% mothers. A week prior to the spring DST transition, parents completed the Pittsburgh Sleep Quality Index (PSQI) and the Edinburgh Postnatal Depression Scale-3A (EPDS-3A) to assess perinatal anxiety. Additionally, they reported concerns regarding the impact of the DST change on their child's sleep (How long do you think it will take your child to adjust to the new time' How stressed are you about the impact of daylight saving on your child's sleep'). Objective infant total sleep time (TST) was measured using Nanit autovideosomnography for 7 nights prior to the DST change. Logistic regression analysis was performed with anxiety as the predictor and stress and anticipation about DST as the outcomes. Furthermore, a Wilcoxon test compared the average sleep duration of infants and parents between the anxious and non-anxious groups. An EPDS-3A score ≥5 was considered anxious. Infant age was a covariate in all analyses.ResultsParents experiencing anxiety before DST were 1.98 times more likely (CI 1.15-2.42) to report being stressed about the DST change (p< 0.001), and were 1.66 times more likely (CI 1.15-2.42) to anticipate >3 days adjustment period for their child following DST (p=0.007) than those who did not experience anxiety. There was no significant difference in TST between infants of anxious and non-anxious parents, but non-anxious parents slept for an average of 11 minutes longer than anxious parents (p=0.017).ConclusionThis study demonstrates that parents experiencing anxiety exhibit higher stress levels and more negative expectations regarding their infants’ sleep during the DST transition than non-anxious parents. Moreover, anxious parents reported shorter sleep durations before the DST change compared to non-anxious parents. Notably, there was no significant difference in TST between infants of the non-anxious and anxious parent groups.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0835
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0884 Slow Wave Sleep Is Associated with Glucose Metabolism in Obstructive
           Sleep Apnea: A Registry-based Study

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      Pages: A379 - A380
      Abstract: AbstractIntroductionObstructive sleep apnea (OSA) is a common condition being increasingly recognized and is a known risk factor for cardiovascular and metabolic disease. Impaired sleep architecture and (or) frequent nocturnal hypoxia are characteristic features in patients with OSA. However, little is known about the sleep parameters linking OSA with glucose metabolism. The objective of this study was to evaluate the association between glycated hemoglobin (HbA1c) and sleep traits from polysomnography and subjective sleep diary in a Chinese population with proven OSA (Huashan OSA Registry Study, Hs-OSARS).Methods535 participants were recruited in Huashan OSA Registry Study, from January 2018 to August 2021. Objective sleep characteristics were measured via one-night laboratory PSG and biochemical parameters was tested the next morning. Associations were conducted using Pearson’s correlation with adjustments for age, gender, and body mass index (BMI). Regression was used to investigate predictive power of sleep subscales for glucose levels.ResultsAmong the participants, 133 subjects underwent HbA1c and lipid profile (triglyceride, total cholesterol, LDL- and HDL-cholesterol, etc). Age, BMI, ApoE, TC and non-HDL-C (rage=0.281, p=0.001; rBMI =0.249, p=0.004; rApoE=0.250, p=0.004; rTC=0.264, p=0.005; rnon-HDL-C=0.281, p=0.002) had positive associations with HbA1c. Among sleep traits, only stage 3 sleep had a negative association with HbA1c (r=-0.219, p=0.011). After controlling for gender, age and BMI, these associations remained and were statistically significant. Stepwise regression analysis found that non-HDL-C, stage 3 sleep and age were significant predictors retained in the model. Upon fixing the covariates (including gender, age and BMI), TC and stage 3 sleep were significant for predicting HbA1c outcomes.ConclusionInsufficient slow wave sleep is associated with higher blood glucose levels. Our study shows that other PSG indices, such as total sleep time, sleep efficiency, arousal index, apnea-hypopnea index and hypoxemic burden, are not associated with HbA1c. These findings highlight the importance for clinicians to evaluate and improve the slow wave sleep as part of preventing glucose metabolism impairment in OSA patients.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0884
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0885 Exploring Sleep Health in the Context of COPD and Obesity: Insights
           from a Population-Based Cross-Sectional Study

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      Pages: A380 - A380
      Abstract: AbstractIntroductionMany individuals with obstructive lung disease such as COPD suffer from sleep disturbances. Poor sleep quality is related to disease severity. COPD has been associated with obesity in a bidirectional manner, though few studies have examined the interaction between COPD, obesity, and aspects of sleep health including quality and duration. This study aims to examine if decreased sleep duration and trouble sleeping are associated with increased risk of COPD and obesity.MethodsUsing data from three consecutive rounds of the National Health and Nutrition Examination Survey (2013-14, 2015-16, and 2017-18), a cross-sectional analysis was conducted. Sleep quality was assessed through the survey by inquiring if subjects experienced trouble sleeping. Sleep duration was categorized into normal (7-8 hours of sleep), short (< 7 hours of sleep), and long (>8 hours of sleep). Weight was categorized into normal weight, overweight, obese, and severely obese. Poisson regression and multinomial logistic regression analyses were used. Adjusted incidence rate ratio (aIRR) and adjusted relative Risk Ratios (aRRR) with their 95% CI were reported.ResultsThe total sample size was 16,939, with females comprising the majority (52%), and ages ranging from 20 to 80 years. Those with COPD were more likely to report trouble sleeping (aIRR 1.48, p < 0.001). Obese and severely obese groups were also associated with trouble sleeping (aIRR 1.27 and 1.50 respectively, p < 0.001). An increased likelihood of trouble sleeping (p < 0.001) was observed among individuals with COPD and overweight (aIRR 1.54), obesity (aIRR 1.89), and severe obesity (aIRR 1.97). COPD was also found independently associated with long sleep duration (IRR 1.50, p < 0.004); however, in the same model, severely obese groups were significantly associated with shorter sleep duration (aRRR: 1.39, p: 0.002).ConclusionIn the current study, COPD was associated with long sleep duration and trouble sleeping. Increasing obesity was associated with short sleep duration and trouble sleeping, consistent with previous findings that sleep deprivation likely contributes to obesity.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0885
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0886 Impact of Multidimensional Sleep Health on Glycemic Control and
           Self-Reported Health Outcomes in Type 1 Diabetes

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      Pages: A380 - A381
      Abstract: AbstractIntroductionSleep is important to health in patients with type 1 diabetes (T1D). This study comprehensively explored the impact of individual sleep dimensions, (e.g. satisfaction, alertness, timing, efficiency, duration, and regularity) as well as global multidimensional sleep health (MSH) on glycemic control and other self-reported health outcomes in T1D.MethodsData from 118 adults with T1D participating in an ongoing sleep intervention study (NCT04506151) were analyzed. Satisfaction was assessed by the Pittsburgh Sleep Quality Index and alertness by the Epworth Sleepiness Scale. Timing (sleep midpoint), efficiency, duration, and regularity (standard deviation of sleep midpoint) were derived from 7-day actigraphy. A composite MSH score was the sum of “Good” individual sleep health dimensions. Glycemic control was assessed through blinded 7-day continuous glucose monitoring (time-in-range (TIR, % of glucose levels between 70-180 mg/dL) and %CV), and hemoglobin A1C level (A1C). Self-reported outcomes (diabetes self-care and psychological factors) were collected through validated questionnaires. Multiple regression analyses were performed to determine whether individual sleep dimension and MSH scores independently predicted glycemic control or self-reported outcomes.ResultsMedian (IQR) age was 33.87 (27.4, 43.61) years, 69.49% were female, and mean (SD) A1C was 6.74% (.93). After adjusting for covariates, only less sleep regularity was associated with poorer glycemic control [higher %CV (β=.262, p<.01), less TIR (β=-.280, p<.01) and higher A1C (β=-.175, p<.05)]. Sleep satisfaction was associated with higher diabetes quality of life (β=-.243, p<.01), lower diabetes distress (β=-.189, p<.05), lower fatigue (β=-.249, p<.01), and lower depression (β=-.211, p<.05). Daytime sleepiness was associated with higher fatigue (β=.228, p<.05), while later sleep timing was associated with higher depressive symptoms (β=.211, p<.05). Higher sleep efficiency was associated with lower anxiety and depression (β=-.305, p<.01, β=-.293, p<.01), respectively. Sleep duration was not associated with any outcomes. Higher MSH was significantly associated with higher TIR (β=.191, p<.05), lower A1C level (β=-.266, p<.01), and lower depression (β=-.211, p<.05), Diabetes self-care measures were not predicted by any individual sleep dimensions or MSH score.ConclusionIndividual sleep dimensions and MSH composite score are linked to glycemic and self-reported psychological outcomes, highlighting the importance of comprehensive sleep health evaluation in T1D.Support (if any)NIH/NIDDK R01DK121726
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0886
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0887 Effects of Melatonin on Glucose, Insulin, and C-Peptide Dynamics in
           Carriers of MTNR1B Type 2 Diabetes Risk Variant

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      Pages: A381 - A381
      Abstract: AbstractIntroductionGenome-wide association studies identified the common variant rs10830963 in the MTNR1B gene (encoding melatonin receptor 1B) as a risk factor for type 2 diabetes. This sparked great interest in the role of the circadian hormone melatonin in glycemic control; however, the mechanisms underlying this association remain unclear. We investigated whether exogenous melatonin administration worsens glucose tolerance, insulin sensitivity, and beta-cell function, and whether such effect is stronger in MTNR1B G-allele risk carriers compared to non-carriers.MethodsTwenty-one healthy participants of European ancestry were studied in a double-blind, randomized, cross-over trial, including ten MTNR1B risk carriers (mean age±SD, 29±10y; BMI, 24.4±2.6kg/m2; 5 women) and eleven non-carriers (32±10y; 22.5±3.0kg/m2; 3 women). Each participant underwent a highly-controlled 5-day laboratory protocol, during which they received 5mg oral melatonin or placebo in randomized order on two nonconsecutive days. Elevated circulating melatonin levels after melatonin administration were confirmed by hourly blood draw. Insulin sensitivity (SI), beta-cell function, and disposition index (DI, product of insulin secretion and sensitivity) were derived from insulin-modified frequently-sampled intravenous glucose tolerance test (FSIGT) using minimal models.ResultsThe effect of melatonin versus placebo differed significantly between MTNR1B genotypes for glucose incremental area under the curve (iAUC180min, Pinteraction=0.005), insulin iAUC20min (Pinteraction=0.03), and C-peptide iAUC20min (Pinteraction=0.03) during FSIGT, with 11.7% increase in glucose iAUC180min (95%CI 3.1%─20.2%, P=0.03), 25.2% decrease in insulin iAUC20min (4.4%─41.2%, P=0.06), and 19.2% decrease in C-peptide iAUC20min (4.9%─31.2%, P=0.04) in carriers, without significant changes in non-carriers (n.s.). While we did not find significant effects of melatonin nor its interaction effects with MTNR1B genotype on DI and SI, first-phase insulin secretion was affected differently by melatonin in carriers and non-carriers (Pinteraction=0.001), with a 40.0% reduction in carriers (27.6%─50.3%, P< 0.0001), but no significant changes in non-carriers (n.s.).ConclusionExogenous melatonin administration significantly impaired glucose tolerance and beta-cell function in MTNR1B risk carriers, but not in non-carriers. These data suggest that first-phase insulin secretion plays an important role in mediating the effect of melatonin on glucose control and its interaction with MTNR1B genotype.Support (if any)NIDDK Grant R01-DK102696 to FAJLS and RS, ADA fellowship 1-17-PDF-103 to JQ, and CTSA-UL1RR025758 to Harvard University and Brigham and Women’s Hospital.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0887
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0888 Characterization and Outcomes in Patients with Bronchiectasis and
           Obstructive Sleep Apnea with PAP Therapy

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      Pages: A381 - A381
      Abstract: AbstractIntroductionBronchiectasis (BE) is characterized by recurrent infections and dilated airways and has been associated with recurrent exacerbations and hospitalizations affecting quality of life. Approximately 40-60% of patients with BE have concomitant OSA, with an increased AHI (apnea-hypopnea index) in BE patients with Pseudomonas infections. We hypothesize that patients with BE are less tolerant of PAP therapies, contributing to worsening quality of life related to either condition. We aim to determine differences in PAP adherence and treatment response in patients with BE and OSA compared with a matched OSA-control group.MethodsA retrospective cohort analysis was conducted on adult patients evaluated at Mayo Clinic Center for Sleep Medicine between January 2000 to December 2020. Inclusion criteria were patients greater than 18 years old diagnosed with BE and OSA per current guidelines and were prescribed PAP therapy. Control OSA patients were matched to BE/OSA patients by gender, BMI, and AHI severity. Exclusion criteria included cystic fibrosis, hospice enrollment, active lung transplant evaluation, and lack of sleep clinic follow-up. Follow-up visits determined PAP compliance and change in quality-of-life metrics over 3 years.ResultsWe compared 50 patients with BE/OSA with 74 OSA matched controls. The etiology of BE in these cases included COPD (32%) or other etiologies (34%). Baseline characteristics were not statistically different in gender, BMI, and AHI severity across groups. Median treatment follow-up for the BE/OSA group was 3 years [IQR 2 to 4]. Importantly, there was no statistically significant difference in PAP adherence in patients with BE/OSA compared to OSA controls regardless of etiology of BE, but these patients more often required supplemental oxygen therapy. Interestingly, there was a statistically significant increase in MRC and decrease in FEV1 over time in BE patients compliant to therapy.ConclusionThere was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence, except for need of oxygen supplementation in BE patients with OSA compared with matched non-BE OSA controls. FEV1 values decreased, and dyspnea score increased in BE patients compliant to PAP therapy; however, future larger studies should include longer-term follow-up to further assess the impact of PAP therapy on BE progression and outcomes.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0888
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0889 Association of U.S. Military Burn Pit Smoke Exposure with Objective
           Sleep Parameters Among Smoking Veterans

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      Pages: A382 - A382
      Abstract: AbstractIntroductionBurn pits (BPs) have been widely used by the U.S. military for waste disposal. Due to the obviously toxic nature of the BP emissions exposure (BPe) may contribute to diverse adverse health conditions, including sleep apnea. This study aimed to examine the association between self-estimated amount of BPe and objective sleep problems among smoking veterans.MethodsUsing polysomnography reports in the Veteran Affairs electronic medical records, sleep measures were extracted for 4940 Veterans and active-duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. Objective sleep parameters included Total Sleep Time (TST) and Sleep Efficiency (SE). Cumulative BPe variable was calculated by multiplying the response (in hours) to a question about BPe by number of deployment days, summing across deployments, and categorized into quartiles by ranking. Inverse probability treatment weighing method was used to adjust the imbalances of covariates age, BMI, sex, race, ethnicity, military branch, and duty status between treatment groups. We employed separate weighted logistic regression models to determine the association between cumulative BPe days and sleep outcomes among smoking veterans.ResultsCurrent smokers in prolonged BPe quartile predicted higher odds of shorter TST (OR:1.43, 95%CI: 1.08-1.89, p=0.02, with reference to never smokers), whereas no significance shown in SE (OR:0.97, 95%CI: 0.75-1.27, p=0.89).ConclusionHigher levels of self-estimated BPe was associated with shorter objective TST in current smoking veterans. Smoking may exert synergistic effect to BP emission exposure on sleep problems. Further research is needed to define the effects of BP emission exposure on sleep among deployed and non-deployed Veterans.Support (if any)This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E DeBakey Veteran Affairs Medical Center Bridge Grant, and the VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0889
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0890 Polysomnography Extracted Sleep Health Disparities Among Burn Pit
           Registered U.S. Military Veterans

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      Pages: A382 - A382
      Abstract: AbstractIntroductionDisparities are under-recognized factors for sleep health. Additionally, there are concerns about sleep health among Veterans with exposure to burn pit emissions during deployment. This study aimed to examine the association between age, sex, and race and objective sleep related problems in veterans and active duty personnel.MethodsUsing polysomnography reports between April 2000 and September 2022 in the Veteran Affairs electronic medical records, objective sleep problems were extracted to 4940 Veterans and active duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. We examined the association between sociodemographic variables (age, sex, and race) and objective sleep related problems (Total Sleep Time (TST), Sleep Efficiency (SE), Minimum SAO2, and Apnea-Hypopnea Index (AHI)) in separate logistic regression models.ResultsMiddle age Veterans (41 - 50 y) predicted greater odds of shorter TST, lower SE, (ORs:1.26-1.36, p’s< 0.03), and older age Veterans (>50 y) predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.29-1.71, p’s< 0.01). Male sex predicted greater odds of shorter TST, lower SE, lower Minimum SAO2, and higher AHI (ORs:1.22-1.97, p’s< 0.04). African American race predicted greater odds of shorter TST (OR:1.25, p=0.04).ConclusionWe observed a higher prevalence of objective sleep problems and sleep-disordered breathing problems among middle age compared to young Veterans and males compared to females. We also found a higher prevalence of shorter TST in Black compared to White Veterans and active duty personnel who completed the burn pit registry. This research address the importance of sleep health disparities of objective sleep related problems among Veterans with burn pit emission exposure.Support (if any)This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); Michael E DeBakey VAMC Bridge Grant, and VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0890
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0891 Sleep Quality Among Post-9/11 Veterans with Exposure to Airborne
           Hazards

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      Pages: A382 - A383
      Abstract: AbstractIntroductionDisordered sleep, including insomnia and obstructive sleep apnea, is common among post-9/11 veterans returning from Southwest Asia and Afghanistan. Environmental exposures, such as elevated respirable particulate matter, may contribute to the development of sleep apnea. Additional occupational exposures sustained during military service may contribute to poor sleep, for example hyperarousal and resultant insomnia. We sought to describe sleep quality and prevalence of sleep disorders among a veteran population exposed to airborne hazards with unexplained dyspnea.MethodsVeterans from across five sites of the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN) completed, as part of a more comprehensive evaluation, questionnaires inclusive of demographic information and the Pittsburgh Sleep Quality Index (PSQI). Limited polysomnography data was also available through chart review at the Baltimore site. Descriptive statistical analysis was performed, with means and standard deviations or medians and interquartile ranges reported for all questionnaire and PSG outcomes, as appropriate.ResultsIn total, 168 veterans completed the PSQI and demographic questionnaires. The majority of respondents were aged 45±9 years, male (82%), and white (73%). Approximately half had served in the Army branch of the military. BMI was available for only 127 veterans, with mean 31.9±5.9 kg/m2. The group overall reported prolonged sleep onset latency (56±51 minutes) and reduced total sleep time (5±1 hours). Overall PSQI scores were elevated at 13±5. In Baltimore (N=38), PSQI data was similar. Sleep study data was available for 30/38 veterans, of whom 27 had a diagnosis of obstructive sleep apnea (OSA). Among those with OSA, the median AHI was 13.5 (IQR 14.5) events/hour and the mean BMI was 31.0±5.2 kg/m2.ConclusionAmong a cohort of post-9/11 veterans with exposure to airborne hazards, insufficient and disturbed sleep was common. In a limited subset with sleep study data, the majority had at least mild OSA. Future work will evaluate the presence of comorbid medical and mental health conditions. This early descriptive data is consistent with prior reports among similar veteran populations, and highlights the need for further research to elucidate causes of sleep disturbances and possible relation to exposure to airborne hazards.Support (if any)Supported by the VA’s Airborne Hazards and Burn Pits Center of Excellence
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0891
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0988 Evaluation of Sleep Disorders in College Student Athletes

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      Pages: A424 - A424
      Abstract: AbstractIntroductionCollege student athletes experience unique factors in addition to those of being a traditional college student that may exacerbate sleep difficulties and/or mental health difficulties which may in turn negatively affect sleep (e.g., competition pressures, training, travel demands). Previous research has found that mental health problems are common in this population, however, less attention has been given to the evaluation of sleep disorders. This study provides an evaluation of sleep disorder questionnaires and comparison with a structured clinical sleep disorders interview (SCISD-R).MethodsCollege student athletes (N = 114) from two Universities completed self-report questionnaires and participated in a clinical interview. Average total scores were calculated for the Epworth Sleepiness Scale (ESS), Nightmare Disorders Index (NDI), Reduced Composite Scale of Morningness (rCSM), Sleep Condition Indicator (CSI), Shiftwork Disorder Index (SWDI), STOP-Bang Questionnaire, PROMIS Sleep Disturbance B (SD) and Sleep Related Impairment (SRI), and International RLS Rating Scale (IRLS-RS). Diagnostic criteria were calculated for the SCISD-R, NDI, SCI, and SWDI. Endorsement of Insomnia Identity (“I am an Insomniac”) was obtained.ResultsAverages and standard deviations are as follows: ESS = 6.75±3.16; NDI = 2.83±3.38; rCSM = 20.42±2.92; SCI = 24.87±5.92; SWDI = 3.11±2.03; STOP-Bang = 1.28±1.06; PROMIS SD = 18.05±6.35; PROMIS SRI = 17.37±6.46; IRLS-RS = 2.70±4.62. Diagnostic criteria for assessments and clinical interview with shared symptoms are as follows: Nightmare disorder: 4 participants met criteria on the NDI and 3 met criteria on the SCISD-R. Insomnia disorder: 1 participant met criteria on the SCI and 10 met criteria on the SCISD-R. Circadian disorder - Shiftwork type: 11 participants met criteria for on the SWDI and 1 met criteria on the SCISD-R. Additionally on the SCISD-R, 5 participants met for hypersomnolence, 5 met for possible obstructive sleep apnea, and 1 met for possible narcolepsy. 6 participants endorsed an insomnia identity.ConclusionCollege student athletes endorse symptoms across a variety of sleep disorders. Differences in the number of participants who met criteria based on assessment measures versus the structured clinical interview indicate that alternate cutoff scores may be warranted for this population.Support (if any)Pacific-12 Conference Student-Athlete Health and Well-Being Initiative Grant
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0988
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0989 Examining the Relation Between ADHD Symptoms and Poor Sleep Quality:
           The Role of Household Chaos and Sleep Hygiene

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      Pages: A424 - A424
      Abstract: AbstractIntroductionWhen compared to typically developing youth, adolescents with ADHD exhibit greater sleep disturbances (Becker et al., 2019). While research supports a link between ADHD and sleep disturbances, less is known about potential contextual mechanisms underlying this relation, and this gap hinders development of prevention and intervention efforts. Families of youth with ADHD are at higher risk of exhibiting poor sleep hygiene (Nikles et al., 2020) and of living in chaotic households, characterized by low structure, excessive noise, and instability (Agnew-Blais et al., 2022). Furthermore, sleep hygiene has mediated the relation between household chaos and adolescent sleep quality among those not assessed for ADHD (Billows et al., 2009). Therefore, we hypothesized that household chaos and sleep hygiene would sequentially mediate the relation between ADHD symptoms and sleep quality among adolescents.MethodsA community sample of 259 mother-adolescent dyads (adolescent M age = 15.2 years; SD age = 1.18; 54.9% female) was recruited from across the United States via Facebook ads. Mothers rated adolescent ADHD symptom severity with the ADHD Rating Scale V (DuPaul et al., 1998). Adolescents completed the Pittsburg Sleep Quality Index (Buysse et al., 1989), Confusion, Hubbub and Order Scale (Matheny et al., 1995), and Adolescent Sleep Hygiene Scale (LeBourgeois et al., 2005).ResultsUtilizing structural equation modeling, we tested a model in which household chaos and sleep hygiene mediated the relation between ADHD symptoms and poor sleep quality after controlling for adolescent age and gender. All hypothesized direct pathways were significant and in the expected directions. Results examining indirect pathways indicated that the relation between ADHD symptoms and sleep quality was partially mediated through chaos (β = 0.08; p =.001), sleep hygiene (β = 0.06; p =.036), and sequentially mediated through chaos and sleep hygiene (β = 0.04; p =.003).ConclusionThe results suggest that improving daily structure and stability of the household may not only improve sleep hygiene but may also help improve sleep in adolescents with ADHD symptoms. Furthermore, behavioral sleep interventions with components of sleep hygiene may benefit from targeting the routine and structure of the whole household rather than just the individual.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0989
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0837 Associations Between Sleep Health, Diet Quality and Movement
           Behaviors in a Community Sample of Preschoolers

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      Pages: A359 - A359
      Abstract: AbstractIntroductionLifelong sleep, diet and movement behaviors are formed during the preschool (age 3-5) years. Inadequate sleep health (i.e., short duration, late bedtimes, low quality) and poor diet quality are independently associated with physical inactivity and subsequent risk of obesity development. Not known is how sleep health and diet quality may interact in association with movement behaviors (moderate-to-vigorous physical activity [MVPA] and sedentary behavior [SB]) during this critical period of the life course. This study explored the interaction between diet quality and sleep health on movement behaviors in a community sample of preschoolers.MethodsPreschoolers from families living in Delaware communities wore an Actigraph on their waist for up to one-week (average wear time=6 days) to measure sleep health, SB, and MVPA. Sleep health metrics included sleep duration (minutes), timing of sleep onset and offset (hours), and sleep efficiency (percentage of time in bed spent asleep). Parents completed 3-days of dietary records for their child, and Nutrition Data Systems for Research (NDS-R) software was used to analyze these dietary records. Healthy Eating Index 2015 (HEI-2015) scores were derived (higher scores=better diet quality). Generalized Linear Models utilizing GEEs quantified the associations between sleep health and diet quality on SB and MVPA; and the interaction between diet quality and sleep health was explored. Models adjusted for age, sex, race, parent education, and BMI.ResultsIn a sample of 24 preschoolers (mean age=4.6 years, SD=0.78; 50% male, 63% White, non-Hispanic), there was a significant interaction between diet quality and sleep timing on movement behaviors. Having an HEI-score above the sample median of 61 was associated with less SB (p< 0.001), but having a late bedtime (p< 0.001) and late wake time (p=0.004) tempered this association. Similarly, having an HEI-score above the median was associated with more MVPA (p< 0.001), but having a late bedtime (p< 0.001) and late wake time (p=0.03) tempered this association.ConclusionOur findings underscore the interdependence of health behaviors in preschoolers. Future integrated interventions may consider targeting multiple behaviors, including sleep timing, diet and physical activity, to impede early childhood obesity development.Support (if any)2020 Center for Innovative Health Research Interdisciplinary GOLD Research Grant
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0837
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0838 Sleep Hygiene in Mexican American Toddlers: Bedtime Screen Use and
           the Role of Maternal Beliefs and Self-efficacy

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      Pages: A359 - A359
      Abstract: AbstractIntroductionGood sleep hygiene includes restricting screen use in the hour before bedtime. Despite this, bedtime screen use starts for many in early childhood. To inform the design of interventions aiming to promote quality sleep, a better understanding of parental conceptualizations about their children’s bedtime screen use is needed. We evaluated whether maternal beliefs about bedtime screen use and self-efficacy to limit bedtime screen use are related to toddler screen use before bedtime in Mexican American families.MethodsThis study used data from a larger study enrolling Mexican American families with toddlers (15-26 months old) recruited from a federally qualified health system. Participants were asked how much they agreed that using a screen device before bed helps little children sleep better (belief) and how confident they were about limiting their toddler’s bedtime screen use (self-efficacy). Screen use before bedtime was measured via a 7-day diary completed by mothers, resulting in a count of nights the child used a screen device in the hour before bedtime. We used multiple regression to evaluate whether maternal beliefs and self-efficacy were associated with toddlers’ bedtime screen use, adjusting for child age, and maternal education and employment status.ResultsParticipants (n=286) were on average 31.4 years old (SD=5.9) and 73% reported ≤ high school degree. Mean child age was 21.7 (SD=3.1) months. Over one-third (36%, n=103) of children used a screen device in the hour before bedtime at least 4 nights per week. Mothers’ stronger beliefs that screen use before bed helps with sleep (Incidence rate ratio (IRR)=1.22, 95% CI 1.06-1.41) and mothers’ lower self-efficacy to limit bedtime use (IRR=0.79, 95% CI 0.70-0.89) were associated with greater toddler bedtime screen use.ConclusionMaternal beliefs and self-efficacy regarding limiting screen use at bedtime should be considered in interventions addressing toddler sleep hygiene in this population.Support (if any)Research reported in this publication was supported by NIH/NINR (R01NR017605, PI: Thompson) and NIH/NCATS Colorado CTSA Grant Number UM1 TR004399. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0838
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0839 Parental Perspectives on the Effectiveness of a Sleep Intervention
           for Preschoolers: A Preliminary Assessment

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      Pages: A359 - A360
      Abstract: AbstractIntroductionHealthy sleep is essential to a child's development, particularly during preschool. However, interventions that address sleep difficulties among children in this age group are scarce. This preliminary study explored parental perspectives on the effectiveness and barriers of a short sleep intervention for preschool children.MethodsTwenty-nine families (either one or both parents) and their 3 to 5-year-olds participated in a two-hour sleep intervention and one-hour follow-up meeting to address children's sleep difficulties. Parents were taught about children’s optimal sleep habits. They were given tips on maintaining a consistent bedtime routine, managing their child's anxiety at bedtime and during the night, helping their child fall asleep independently, and reducing the occurrence of nightmares and night terrors. Parents were asked open-ended questions two months later to assess its success and barriers. Responses were analyzed using NVivo 14.23.2 to identify common themes.ResultsNumerous parents reported that their child's sleep improved in at least one aspect after the intervention. The most reported improvements were reduced nighttime awakenings, improved sleep independence, reduced sleep onset latency, a consistent sleep schedule and routine, and reduced conflicts at bedtime. More than half of parents noted that at least one aspect of their own sleep had improved, the most common being reduced sleep fragmentation. Almost all parents denoted other positive outcomes, such as better moods and reduced fatigue in children, increased patience, more personal time, improved mood and heightened energy levels in parents. A few parents indicated having a better relationship with their child. Sleep difficulties persisted in some children, such as trouble falling asleep, autonomous sleep and nighttime awakenings. Among parents who identified obstacles in implementing sleep strategies, conflicts at bedtime, changing sleep schedules, separation anxiety, and screens before bedtime were the most frequent.ConclusionParents found the brief intervention effective and well-suited to their specific needs. Reducing children's sleep difficulties contributed to improving parents' sleep quality and the overall health and well-being of the family. This research highlights the need for tailored interventions that address preschoolers' sleep issues.Support (if any)This study was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0839
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0840 Center-based Childcare Attendance and Sleep in Children Under Six
           Years Old: A Systematic Review

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      Pages: A360 - A360
      Abstract: AbstractIntroductionMany children within and outside of the United States spend a considerable amount of time in childcare settings during early childhood. The early childhood period is also marked with significant transitions in sleep, and many young children rely on a combination of daytime and nighttime sleep to meet their sleep needs. Thus, childcare settings may impact children’s sleep outcomes. The current systematic review aims to summarize findings of past research examining center-based childcare attendance and sleep outcomes.MethodsWe followed the steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Keywords related to sleep and childcare were entered into PubMed and PsycINFO on November 13, 2023, yielding 2,355 articles. Articles were reviewed using the following inclusion criteria: population included children ages 0-6 years old, intervention included formal center-based childcare attendance, control or comparison included between-subject (i.e., center-based childcare vs. no center-based childcare; half-day vs. full-day) and within-subject (i.e., weekdays vs. weekends) designs, outcomes included sleep duration and timing, and study designs included observational and experimental research. Methods were critically assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS).ResultsNine studies were included in the final data extraction process. Studies were conducted in five countries: Japan (n=5), United States (n=1), Malaysia (n=1), France (n=1), and Australia (n=1). Evidence indicated that center-based childcare attendance is associated with decreased sleep duration, though findings were mixed. Four studies found that attendance was associated with shorter nighttime sleep duration whereas one study found null association. Two studies found positive association between attendance and daytime sleep (i.e., weekends/weekdays, half/full day) whereas one study found a negative association when comparing childcare type (i.e., relative/non-relative). Two studies found no association between attendance and total sleep duration. Most studies reported nighttime sleep and did not use an objective measure of sleep. Classifications of childcare type varied, making comparisons across studies challenging.ConclusionMore research is needed to examine how center-based childcare attendance may impact sleep outcomes in young children. Future research should use objective measures of sleep when possible and describe details about childcare consistently to facilitate comparison or generalization.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0840
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0841 TigerCHAT: Sleep and Cellphone Access in Rural Elementary School
           Children

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      Pages: A360 - A361
      Abstract: AbstractIntroductionThere is increasing awareness of the importance of sleep for health and wellness in children, and the impact technology has on sleep. However, many children are not getting the necessary sleep for optimal school functioning. The purpose of this project is to describe cellphone access, placement at night, and bedtime in 8–9-year-olds attending an elementary school in a rural area.MethodsTigerCHAT is a school-based health education outreach program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after IRB approval. In fall of 2022, nursing students led small groups of students in a sleep educational module during their gym period. Before education began, 50 3rd- grade students filled in a questionnaire regarding phone usage (do they have one, location during bedtime, bedtime and wake time).ResultsFrequencies, percentages, and ANOVA were run on the data to describe sleep and phone placement during the nighttime. Children ages 8-9 years (n = 50, 49% female, 51% male, 91.2% White, 8.4% Black, 46.4% classified as economically disadvantaged, 41% receive free or reduced lunch). Over half reported having a cellphone (n=31, 62% yes; n=19, 38% no). Of those with a cellphone, eleven (22%) reported having it under or by pillow, 11 (22%) reported having it on the bedside table, and 9 (18%) reported it not in their room at night. There was no significant difference in bedtime between those with a phone or without (F=.696, p=.402,) or where cellphone was located (in vs outside room) (F=1.55, p=.277). Children self-reported an average bedtime of 9:12pm (range 7:30pm-1am), and an average wake time of 5:15am (range 4:30am-6:30am), with an average total sleep time of 8.3 hours (range 4-10 hours).ConclusionThe majority of students in this sample reported having access to a cellphone, and also reported having the cellphone close to them at night. While there was no significant difference in bedtime based on location or having a phone in this sample, it is still an important aspect of the sleep environment. Future studies should examine the significance of nighttime cellphone placement for school age and adolescent populations.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0841
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0842 Parent Engagement with Digital Sleep Health Interventions for Young
           Children: A Global Scoping Review

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      Pages: A361 - A361
      Abstract: AbstractIntroductionIt is widely recognized that young children may experience sleep problems early in life that affect child development outcomes. Digital technology offers an accessible platform to reach and engage families of young children with sleep health solutions early in life.Our global scoping review aimed to investigate the use of digital technology as a resource to facilitate parental interventions aimed at enhancing sleep health among children in early childhood (3 –8 years old).MethodsWe performed a scoping review of peer-reviewed articles published from inception to 2023 for the following databases: PubMed, Embase, Web of Science including FSTA and Scielo, MEDLINE, Cochrane Library, Engineering Village, CINAHL, APA PsycInfo, Global Health and citation searching. In conjunction with the authors, two librarians conducted an extensive literature search, and the strategies can be found at [osf.io/74hba]. Our methodological approach encompassed a systematic review of key terms related to sleep, communication, parental involvement, and internet-based intervention. Inclusion criteria included intervention studies with parents of children 3-8 years old via digital communications (e.g. social media, telehealth, websites, mobile apps, wearable devices) to address sleep health in their child. Exclusion criteria included platforms unrelated to sleep, studies that digitally recruited participants but did not use a digital platform, studies with children outside the target age, or protocol studies. Review Registration: https://doi.org/10.17605/OSF.IO/TNFY2ResultsFour articles met the final inclusion criteria. A final sample size of 194 parent-child dyads across Australia, Canada, the Netherlands, and the United States were enrolled. Mean child age was 5 years old and mean parent age was 37. Sleep health behavior outcomes in children addressed by digital mobile health solutions included bedtime resistance, night wakings, sleep onset, sleep duration, obstructive sleep apnea, sleep latency and independent sleep in child’s own bed. Sleep health outcomes also included positive improvements in parent sleep health education.ConclusionParent engagement with child sleep health interventions yielded favorable outcomes, enhancing the overall sleep health of children. More research is needed to understand tailored interventions for sustained sleep health improvements in child sleep.Support (if any)K01HL169419-01
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0842
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0883 Sleep and Circadian Health, Insulin Sensitivity, and Glycemic Control
           in Adolescents with Type 1 Diabetes

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      Pages: A379 - A379
      Abstract: AbstractIntroductionInsulin resistance and poor glycemic control are significant risk factors for cardiovascular disease for individuals with type 1 diabetes (T1D). Adolescents with T1D are at heightened risk for poor sleep and circadian health due to behavioral and physiologic aspects of T1D in combination with biological, psychosocial, and environmental factors of adolescence. Emerging evidence suggests an association between sleep and circadian health with insulin sensitivity (SI) and glycemic control among adults with T1D and healthy adolescents, but this has not been explored in adolescents with T1D.MethodsTwenty-three adolescents with T1D underwent a cross-sectional assessment during the academic year with one week of in-home actigraphy and continuous glucose monitoring (CGM) followed by in-laboratory serial salivary melatonin sampling and hyperinsulinemic-euglycemic clamp. BodPod assessed free-fat mass (FFM). SI was expressed as steady-state glucose infusion rate (“M”) in mg/kg/FFM/min. Sleep variability was calculated as the standard deviation of weekday actigraphy-estimated sleep metrics. Duration between dim-light melatonin onset (DLMO) and bedtime was calculated to determine circadian phase angle. Pearson correlations examined associations between sleep and circadian variables with SI and glycemic control.ResultsAdolescents with T1D (age=15.9±1.1 years, 48% female, 91% non-Hispanic White, HbA1c=7.6±1.1%) obtained 6.7±0.8h sleep on weeknights. Greater nightly variability of time in bed (TIB) and sleep midpoint timing across the monitoring period were associated with worse SI (M mg/kg FFM/min; r=-0.43, p=0.045; and r=-0.44, p=0.04, respectively). Greater nightly variability in the duration of wake after sleep onset (WASO) was associated with poorer CGM metrics, including higher mean sensor glucose (r=0.62, p=0.006), less time in range (70-180mg/dL, r=-0.56, p=0.016), and higher standard deviation (r=0.51, p=0.031). A longer duration (wider phase angle) between DLMO and bedtime was associated with a higher CGM coefficient of variation (r=0.91, p=0.002).ConclusionNightly variability in TIB, sleep timing, and WASO, and circadian phase angle may represent contributing mechanisms of poorer SI and glycemic control in adolescents with T1D. Further research is warranted examining the health impact of sleep and circadian health interventions in adolescents with T1D.Support (if any)Ludeman Center for Women’s Health Research; JDRF 2-SRA-2019-848-S-B and 2-SRA-2022-1144-M-B; CCTSI Maternal & Child Health Pilot Award; NIH NCATS UM1TR004399.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0883
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0964 Depression Moderates the Effect of Repetitive Negative Thinking on
           Set-shifting Ability in Youth with Insomnia

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      Pages: A413 - A414
      Abstract: AbstractIntroductionRepetitive negative thinking (RNT), a perpetuating factor of insomnia, is often associated with adverse outcomes (e.g., depression). According to the Attentional scope model of rumination, RNT is associated with a narrowed attentional scope. As such, individuals with more RNT tend to exhibit stable attention toward task-relevant information. Previous research has also shown that RNT is linked to better set-shifting ability in adolescents. However, the evidence was mainly based on the research on mood disorders and remained limited and inconclusive in the context of insomnia. The study aimed to examine the relationship between set-shifting ability and RNT and explore the role of depression in this relationship among adolescents with insomnia.MethodsAdolescents diagnosed with DSM-5 insomnia disorder were recruited. Participants completed self-reported questionnaires, including the Perseverative Thinking Questionnaire (PTQ) for the measure of RNT, the Insomnia Severity Index (ISI) and the Beck’s Depression Inventory-Short Form (BDI-SF) and were administered Wisconsin Card Sorting Test (WCST). A score ≥ 10 on BDI-SF indicated the presence of depression. The number of Perseverative Responses (PR) and Perseverative Error (PE) on WCST were used to reflect set-shifting ability.ResultsOf 115 recruited participants with insomnia (Age: 18.34 ± 1.56, 14-20, female: 65.22%), the prevalence of depression was 51.30%. PTQ scores were significantly associated with PR and PE. The effect of PTQ on PR, but not PE, was moderated by the presence of depression. Among the participants with depression, lower PTQ scores were associated with greater PR, but such association was not observed in those without depression. Insomnia symptoms, presence of depression, age, and gender were not found to be associated with PR and PE, respectively.ConclusionRNT is associated with better performance in set-shifting among adolescents with insomnia. The result may be explained by the attentional scope model, which suggests that RNT enhances the ability to ignore irrelevant information to the tasks, thus exerting greater set-shifting ability. Further exploration with neuroimaging is needed to understand the relationship between RNT and set-shifting ability in the context of insomnia and psychopathology.Support (if any)This work was funded by General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0964
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0965 Investigating Cardiac Autonomic Activity During Sleep in Individuals
           with Major Depression and Bipolar Disorder

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      Pages: A414 - A414
      Abstract: AbstractIntroductionAutonomic nervous system dysfunction and reduced heart rate variability (HRV) have been reported in individuals with mood disorders, a phenomenon likely to be influenced by sleep disturbances. Several studies have previously assessed HRV in individuals with major depression or bipolar disorder across the entire sleep period. This study investigated whether distinct heart rate (HR) and HRV profiles across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep are linked to unipolar versus bipolar mood disorders in individuals with sleep complaints.MethodsPolysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms referred to a specialized sleep clinic for sleep assessment [60 diagnosed with bipolar disorder (70% female, mean age= 43.4±11.6 years) and 60 age-matched cases diagnosed with a unipolar depressive disorder (68.3% female, mean age= 43.2±11.6 years)], and 60 age-matched healthy controls (68.3% female, mean age= 43.4±12.6 years). HR and time-based HRV parameters were computed on 30-second segments and averaged across the night for wake and sleep stages.ResultsSignificant group by sleep stage interactions showed that the unipolar and bipolar groups had lower standard deviation of normal-to-normal intervals (SDNN) and vagal tone root mean square of successive R-R interval differences (RMSSD) compared to controls during NREM sleep ( p≤.001) and REM sleep (p≤.003), but not during wake (p>.050). The unipolar group had significantly higher heart rate than controls regardless of sleep stages (all, p≤ .042), while the bipolar group had higher heart rate than controls only during NREM 2 (p=.012) and NREM 3 (p=.009) sleep. These interactions persisted after excluding individuals taking antipsychotic, lithium, anticonvulsant, and cardiovascular medications.ConclusionWhile additional research is required to account for manic and euthymic states, as well as the impact of psychotropic and cardiac medications, and potential confounders like variations in body mass index, the present findings suggest that the sleep-based autonomic signature of depressive states differs across different types of mood disorders and could potentially inform the development of biomarkers and therapeutic targets.Support (if any)This project was supported by the Ottawa Region for Advanced Cardiovascular Research Excellence (ORACLE) funding program.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0965
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0966 Mood in OSA Patients with Different Chronotypes with and Without
           Chronic Pain

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      Pages: A414 - A414
      Abstract: AbstractIntroductionMood has been related to chronotype, OSA and pain, although no studies have examined these three variables simultaneously. This study analyzes depression symptoms in relationship to self-reported sleep timing, PSG-determined AHI and the presence of chronic pain conditions (CPC) in patients referred for OSA evaluation.MethodsFrom patients tested between 08/2017 and 04/2021, 360 (210 women) were selected based on self-reported sleep time criteria, no shift work, no significant cardiac, pulmonary, neurological, endocrine or psychiatric history except depression/anxiety; 78 had CPC (e.g., fibromyalgia, arthritis, sciatica, musculoskeletal pain and similar). Self-reported sleep times defined typical chronotype (TC, asleep 10pm-12am, wake-up 6-9am), early and late chronotypes (EC, LC, earlier or later than TC); those not clearly meeting these criteria or reporting < 6hr or >10hr of usual sleep were excluded. The Center for Epidemiologic Studies Depression Scale-Revised (CESDR) was an outcome; explanatory variables were AHI, chronotypes (EC, TC, LC), CPC; covariates were age, sex, BMI.ResultsEC (n=115), TC (n=163) and LC (n=82) were unrelated to CPC (chi-square=1.1, p=0.58). Older age (M=48.5±15.7) was predictive of lower CESDR (F=17.5, p< 0.001). AHI (M=14.6±21.0) was unrelated to CESDR (F=1.6, p=0.21) and did not interact with CPC or chronotypes. CPC presence predicted higher CESDR (F=8.1, p=0.004). Chronotypes predicted CESDR (F=7.8, p< 0.001) without significant interaction with CPC. LC/CPC-absent group had higher CESDR (M=20.7±18.9) relative to EC/CPC-absent (M=11.5±11.3, p< 0.001) and TC/CPC-absent (M=10.1±10.6, p< 0.001, Bonferroni post-hoc). Among CPC-present patients, CESDR did not significantly differ between EC (M=17.5±14.5), TC (M=16.3±10.3) and LC (M=22.9±17.3).ConclusionIn this sample, there was no relationship between OSA and depression symptoms. In patients without CPC, late self-reported sleep time was associated with higher depression symptoms, relative to early and typical sleep times. However, in patients with CPC, CESDR scores did not reach significant difference between chronotypes, apparently due to the overall elevation of depression symptoms in these patients.Support (if any)none
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0966
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0828 Investigation of Sleep Disturbances in Pediatric Patients with
           Septo-Optic Dysplasia

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      Pages: A355 - A355
      Abstract: AbstractIntroductionSepto-optic dysplasia (SOD) is a heterogenous neurodevelopmental condition diagnosed based on the presence of two or more of the following findings: optic nerve hypoplasia, absence of the septum pellucidum, dysgenesis of the corpus callosum, and pituitary hormone abnormalities. Sleep disturbances in SOD are common, however, they have not been well characterized. This study aims to investigate and characterize sleep disturbances in SOD.MethodsWe used the Slicer-Dicer tool to identify pediatric patients (< 21 years) from EPIC with a diagnosis of SOD (ICD Q04.4) who had encounters between July 2013 and July 2023 at Norton Children’s Hospital, KY, USA.ResultsWe identified 35 patients (M:F=12:23) with SOD. The mean age was 9.5 years (SD:4.5). Twenty-six patients described a sleep disturbance including snoring (n=5), insomnia (n=8), and frequent arousals (n=5). Of those, ten patients had previous polysomnography (PSG) at a mean age of 4.5 years (SD:3.3). For those who underwent PSG, the mean total sleep time was 381.3 minutes (SD:75.8); the median sleep latency was 14.0 minutes (SD:34.1); four patients had a prolonged sleep latency of > 20 minutes (IQR:5.1-70.9); the mean sleep efficiency was 70.7% (SD: 26.9); the median percentage of N1 sleep was 0.15 % (IQR:0-0.6), N2 42.9% (IQR:35.3-49.9), N3 38.1% (IQR: 25.1-43.4), REM 21.8% (IQR:16.1-28.2). Four patients had an elevated arousal index of > 10. The mean AHI was 8.2 (SD:11.6). No patients had central apnea or elevated periodic limb movements. Of the 35 patients, eight had obstructive sleep apnea and seven used medications, such as melatonin, to assist with sleep.ConclusionPatients with SOD have fragmented sleep and are at increased risk of obstructive sleep apnea. The presence of sleep disturbances in patients with SOD is likely multifactorial. Many patients with SOD have midline brain defects and midline areas that regulate sleep such as the suprachiasmatic nucleus (SCN) of the hypothalamus and the pineal gland may be impacted by their condition.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0828
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0829 Effects of Sex on Sleep EEG in Typical and Atypical Neurodevelopment

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      Pages: A355 - A356
      Abstract: AbstractIntroductionSleep electroencephalography (EEG) patterns exhibit intricate variations influenced by multiple factors, including sex-specific disparities. While sex effects in sleep neurophysiology are relatively well-described in adults, information is more limited in pediatric samples, even less so in specific cohorts such as neurodevelopmental disorders (NDD). In this study we aimed to describe sex differences in a comprehensive set of EEG-derived sleep features in non-NDD individuals and compare those to the NDD cohorts including autism spectrum disorder(ASD), attention deficit hyperactivity disorder(ADHD), and intellectual disabilities(ID).MethodsWe used whole-night polysomnography data from a large National Sleep Research Resource sample, spanning from 2.5 to 17.5 years and Nationwide Children’s Hospital Sleep Databank, a pediatric sleep clinic cohort. Using ICD codes, we have defined the NDD subsets for ASD (N=196), ADHD (N=525), intellectual disabilities (N=167), and no-NDD sample (N=1523). The open-source package Luna was used to derive multiple sleep features including sleep spindles, slow oscillations (SOs) and spectral power across standard frequency bands. Linear regression models controlling for age were used to investigate sex effects with standardized b-coefficients (bstd) and p-values reported.ResultsAlmost half of sleep EEG features expressed nominally significant sex differences in the no-NDD cohort (165 out of 351 tested EEG metrics), although their effect sizes were rather small. The strongest sex differences were observed in fast spindle density across all channels (largest effect at C4, bstd=-0.22,p=7x10-6 at C3, higher in girls), SO duration across all channels (largest effect at F3, bstd=0.24,p=1x10-5, longer in boys), occipital spectral power in alpha and sigma bands during REM sleep (bstd=-0.23,p=7x10-6 at O1, higher in girls). Generally, the NDD groups expressed similar pattern of sex differences evidenced by significant correlation between the standardized beta coefficients of each disorder and no-NDD group across all metrics (Pearson’s r=0.32 in ASD, 0.34 in ADHD and 0.27 in ID) although we also found evidence of disorder-specific sex differences.ConclusionOur findings indicate that multiple sleep EEG metrics express significant sex differences in childhood which are also observed in NDD populations. Such sex differences could potentially relate to disorder-relevant factors such as the differential prevalence of sleep issues in boys and girls or symptom manifestation.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0829
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0830 Polysomnography Differences in Children with and Without Hypertension
           in the Absence of OSA

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      Pages: A356 - A356
      Abstract: AbstractIntroductionThere is growing evidence linking hypertension and sleep disturbances in adults, even in the absence of OSA. Even though hypertension is associated with OSA in children, there is a lack of data on influence of the non-respiratory parameters of sleep on hypertension. The objective of this study is to compare respiratory and non-respiratory sleep parameters in children with and without hypertension, among those without OSA based on PSG.MethodsIRB approved retrospective chart review of patients ages 8-17 years, who underwent PSG at Nemours Children’s Hospital, DE, between January 2020 and May 2023. Data was collected on demographics, anthropometrics, comorbid medical conditions, and PSG findings from EMR. Hypertension was defined as an average systolic (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for gender, age, and height based on AAP Clinical Practice Guidelines. An average of 5 BP measurements from clinic visits within year prior to the date of the PSG were analyzed. Height percentiles were calculated using CDC guidelines. Descriptive and comparative statistics were performed to compare PSG findings between non-hypertensive and hypertensive youth.ResultsWe collected data on 228 children. The cohort (n=228) was split into non-OSA and OSA groups based on PSG results. Among the non-OSA group (n=108), 22 individuals were categorized as hypertensive (20.3%). Mean age was 11.4 years and mean BMI z-score was 2.7 (1.83) among the hypertensive group and 12.6 years and 1.12 (2.04) respectively among the non-hypertensive group, with a significant difference in BMI z-score (p< 0.001). Respiratory and non-respiratory sleep parameters were similar, except average heart rate during sleep was significantly higher in the hypertensive group; 79.3 BPM (±11.34) vs 70.9 BPM (±10.07) for the non-hypertensive group (p = 0.002).ConclusionIn children without OSA, there were no observed differences in respiratory or non-respiratory parameters between the hypertensive and non-hypertensive groups. Children in hypertensive group had a significantly higher BMI Z-score and average heart rate during sleep. This may suggest that obesity and sympathetic activation are important in the pathogenesis of pediatric hypertension even in the absence of detectable sleep disorders. Future studies with larger cohorts are necessary to further explore these relationships.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0830
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0831 Grand Connections: Inter- and Intraindividual Sleep Between
           Grandparents Raising Grandchildren and Grandchildren

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      Pages: A356 - A356
      Abstract: AbstractIntroductionGrandparents raising grandchildren (GRG) report greater global sleep problems and sleep disturbances than non-caregiving grandparents. Moreover, 70% of grandchildren being raised by their grandparents sleep shorter or longer than recommended. However, no studies examined the daily relationship (intraindividual) or average (interindividual) relationship between GRG/grandchild sleep. We examined daily and average GRG and grandchild sleep associations.MethodsCo-residing GRG (N=24, Mage=58.41, 66.7% female; 63% primary grandchild caregiver) completed daily sleep diaries for themselves/their grandchildren (Mage=8.19, 33.4% female). Grandparent/grandchild variables included sleep onset latency-SOL, wake after sleep onset-WASO, and total sleep time-TST. Multi-level models (Rv4.2.2) examined grandchild and grandparent sleep associations, controlling for grandparent and grandchild age.ResultsDaily grandchild sleep was positively associated with daily grandparent sleep for SOL (t(276)=5.75, p<.001), WASO (t(276)=7.71, p<.001), and TST (t(276)=5.68, p<.001). Daily grandparent sleep was positively associated with daily grandchild sleep for SOL (t(276)=5.74, p<.001), WASO (t(276)=7.71, p<.001), and TST (t(276)=5.68, p<.001). Average grandchild sleep was positively associated with average grandparent sleep for SOL (t(23)=2.31, p=.030) and WASO, (t(23)=8.31, p<.001). Average grandparent sleep was positively associated with average grandchild sleep for SOL (t(23)=2.36, p=.027) and WASO (t(23)=8.26, p<.001).ConclusionAnalyses suggest a bidirectional relationship between GRG and grandchild sleep. Because over half of all GRGs coparent children with one or more family members, family-level analyses may help clarify sleep associations. Given that grandparents in this study reported on both their own and the child's sleep, longitudinal/multi-method studies are needed to determine causality. It remains to be determined whether improving grandchild sleep may improve grandparent sleep (and vice versa), or if dyadic intervention is needed.Support (if any)Sleep Research Society Small Research Grant (Stearns, PI)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0831
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0832 Hypertension in Pediatric Patients Without Obstructive Sleep Apnea
           (OSA)

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      Pages: A356 - A357
      Abstract: AbstractIntroductionStudies show that sleep disturbances are associated with adult hypertension. The relationship between OSA and hypertension has been extensively studied, however, is understudied in pediatric patients without OSA. The aim of this study was to identify socioeconomic factors, social determinants, and medical co-morbidities associated with hypertension in pediatric patients without OSA based on polysomnography (PSG).MethodsIRB-approved retrospective chart review of patients who underwent PSG at Nemours Children's Hospital, DE between January 2020 and July 2023. Eligibility criteria included children 8-17 years, completed PSG, and office visit blood pressure (BP) recordings. Anthropometrics, demographics, and socioeconomic, social determinants, and medical history obtained from EMR. Those without OSA based on PSG were divided into hypertensive and non-hypertensive groups. Hypertension was defined as the average (5 BP measurements from clinic visits within a year from PSG) systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) that is ≥95th percentile for gender, age, and height based on AAP Clinical Practice Guidelines. Height percentiles were calculated using CDC guidelines. Descriptive and comparative statistics were performed to compare the two groups. Data is reported as mean ± SD, non-hypertensive vs. hypertensive. Frequency of categorical data is reported in parentheses for the hypertensive group.ResultsOf the 228 patients, 108 did not meet criteria for OSA based on AHI>2 and were excluded from the analysis (47.3%). Of the 108 without OSA, 22 were hypertensive (20.3%). All 22 had SBP ≥95th percentile; two had both SBP and DBP ≥95th percentile. Significant differences between hypertensives and non-hypertensives were in race (p=0.037, higher frequency of blacks), parents in household (p=0.042, lower frequency in those with both parents in the household), diabetes (p= 0.047, higher frequency of type 2 diabetes), and mental illness (p=0.027, higher frequency of autism and mood disorders). Daytime HR (96.2 ±12.4 vs 87.1±12.2, p=0.003), and BMI (2.7± 2.0 vs 1.1±1.8, (p< 0.001) were both significantly higher in the hypertensive group.ConclusionIn pediatric patients without OSA, there are multiple factors and co-morbidities associated with hypertension. Future larger studies are necessary to establish these associations and relationships in non-OSA patients.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0832
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0906 Free-text Documentation of Sleep Disturbance in Acute Myeloid
           Leukemia: A Natural Language Processing Study

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      Pages: A389 - A389
      Abstract: AbstractIntroductionSleep disturbance in acute myeloid leukemia (AML) patients is usually linked to cancer-related fatigue, affecting quality of life. Although addressing sleep disturbance might prevent fatigue, it is often overlooked. Limited knowledge about healthcare clinician’s observations of sleep disturbance in AML patients hampers evidence-based interventions. To address this gap, this study identified sleep disturbance documentation in patients with AML from free-text narrative notes in electronic health record (EHR) using a natural language processing (NLP).MethodsThe sample consisted of 692 patients with AML, who received 2,064 encounters at Midwestern academic hospital. We followed a stepwise process using NLP. 1) Identify a preliminary list of synonyms based on (a) 57 common symptoms from a previous study; (b) relevant literature; and (c) “synonyms” category of the Unified Medical Language System. We developed and validated algorithms using the publicly available NLP system, NimbleMiner, then an NLP algorithm was applied to extract sleep disturbance documentation using 316,038 EHR narrative notes of AML patients. The overall accuracy to identify documentation of sleep disturbance was high, with F score = 0.97.ResultsIn general, this study involves older AML patients (average age, 59 years) and male (57%). When applying the NLP algorithm, 543/692 (78.5%) patients and 1,255/2,064 (60.8%) encounters in this sample were identified as having notes with language describing sleep disturbance. The most common language describing sleep disturbance was sleeping medication (40.5%), such as melatonin, olanzapine, zolpidem. Additionally, around 30% of languages mentioned sleep disorders including insomnia and obstructive sleep apnea (OSA).ConclusionWe have demonstrated the feasibility of identifying sleep disturbance from EHR narrative notes with NLP in AML patients. While using sleeping pills are found as a common treatment option for sleep disturbance, it is important to consider the established first-line treatment for insomnia (cognitive behavioral therapy) and OSA (continuous positive airway pressure). Utilizing NLP-generated symptom indicators can assist in identifying high-risk patients for targeted sleep interventions. The impact of sleep disturbance on health outcome in AML patients should be further evaluated.Support (if any)This study was funded by Center for Advancing Multimorbidity Science: NIH/NINR 1 P20 NR018081-01 (MPI: Gardner & Rakel)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0906
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0907 Sleep Disturbances in Lung Cancer Patients Based on Patient Reported
           Outcomes and Polysomnography

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      Pages: A389 - A390
      Abstract: AbstractIntroductionSleep disturbances are common in lung cancer patients, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) is lacking. Earlier studies described significant insomnia in this cohort. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders.MethodsA retrospective review of lung cancer patients undergoing formal sleep evaluation from 4/1/2009 to 7/31/2014 was performed. Clinical characteristics, PROs using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and PSG data were reviewed.Results128 patients (58% men, median age 63 years, median BMI 29.9 kg/m2) were identified. Lung cancer stage was 40% early, 22% locally advanced and 38% metastatic disease, and most (48%) were undergoing active treatment. Comorbidities included hypertension (60%), COPD (42%), depression (16%) and anxiety (13%), and 59% were ever smokers. The majority (94%) were referred for sleep-related breathing disorder (SRBD). While 50% did not know when sleep disruption started in relation to their cancer, 33% report symptoms prior to cancer diagnosis, and 14% associate sleep disturbance after cancer diagnosis. Sleep aid use was reported by 26%, and pain medication use in 41%. In the 116 with ESS, daytime sleepiness was noted 56%. In the 101 with PSQI, 65% reported poor sleep. PSG was performed in 52%. Daytime sleepiness was inversely correlated with anxiety (OR 0.3, 95% CI 0.8 to 0.84). Poor sleep was associated with anxiety and COPD, but it was not significant. PROs did not have an impact on overall survival.ConclusionSleep disturbances can contribute to symptom burden in lung cancer patients. Daytime sleepiness and poor sleep based on PROs was prevalent in our cohort. Although not significant, anxiety and COPD were associated with poor sleep, whereas daytime sleepiness was inversely associated with anxiety. Most of our patients had sleep-related breathing disorder while only a few had insomnia. Education about sleep health and proactive screening for sleep symptoms would be beneficial in lung cancer patients.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0907
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0997 Preliminary Analyses of Sleep and Psychotic-like Experiences in a
           Clinical High-Risk Sample

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      Pages: A427 - A428
      Abstract: AbstractIntroductionWhile sleep disturbances are common in individuals with psychotic disorders, and are shown to exacerbate symptoms and cognitive deficits, less is known about sleep in youth at heightened clinical high risk (CHR) for psychosis. The goals of the present study were to identify CHR individuals using well-established clinical criteria, quantify sleep using wearable technology, and investigate the relations between objective measures of sleep with endorsed psychotic-like experiences (PLEs) and associated distress.MethodsParticipants were recruited from the Psychosis-risk Intervention, Education, and Research (PIER) Program. While data collection is ongoing for this longitudinal study, current analyses were based on 9 participants (67% female, 11% male, 22% non-binary, ages 13-33). Self-reports on the Prodromal Questionnaire-Brief were used to quantify PLEs and associated distress. Sleep was measured at home with an EEG headband (Sleep Profiler) and scored according to standard AASM criteria.ResultsPreliminary analyses reveal great variability in sleep efficiency (56-97%) and Wake After Sleep Onset (5-101 min). Contrary to our predictions, we observed no significant relations between sleep duration, efficiency, or architecture and PLEs (all p’s >.5).ConclusionIn this group of help-seeking individuals we did not observe significant relations between sleep indices and self-reported PLEs. The current study has several limitations such as a small sample size and clinical heterogeneity, and relied on self-reported measures of PLEs completed by participants online. With data collection still under way, future plans include obtaining objective clinical phenotypes (e.g., utilizing the Structured Interview of Psychosis-risk Syndromes to categorize clinical high risk status) and investigating how sleep and PLEs change over time.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0997
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0998 Sleeping It Off: Alcohol, Cannabis, and Alterations in Bedtime and
           Waketime in Women with Sleep and Pain Complaints

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      Pages: A428 - A428
      Abstract: AbstractIntroductionAlcohol and cannabis are among the most used psychoactive substances. Many people use alcohol and cannabis with the belief that they will promote sleep, but both substances are linked to sleep problems. However, the relationships between alcohol and cannabis consumption and fluctuations in circadian rhythm are less clear. Hence, we examined the intraindividual associations between alcohol and cannabis consumption on a given day and subsequent deviations from typical bedtime and waketime.MethodsTwo hundred and fifty-one adults with sleep and pain complaints (Mage = 42.14 yrs, SD = 13.75 yrs, range = 18-81 yrs, 100% female) completed two weeks of daily sleep diaries. Mean bedtimes and waketimes were calculated in minutes, and daily calculations were performed to determine one’s daily deviation from mean bedtime and waketime. Multi-level models examined associations between the number of alcoholic drinks per day, the number of times consuming cannabis per day, and daily deviation from mean bedtime and waketime. Analyses controlled for daily usage of sleep medications (yes/no) and weekends (yes/no).ResultsGreater numbers of alcoholic drinks on a given day were associated with later waketimes on the following day (B = -8.15, SE = 1.77, p <.001), and greater numbers of alcoholic drinks were trending significance (p = .07) with daily deviation in bedtime. In context, every additional drink for an individual on a given day was associated with a nearly 8-minute delay in that individual’s waketime on the following morning. Number of times using cannabis was not associated with deviations from typical bedtime (p = .80) nor waketime (p = .90).ConclusionOur daily level analyses conducted in a large sample of women suggest that more alcoholic drinks on a given night are linked to later waketimes. Results are dose dependent such that heavier drinking is linked to a larger shift in waketimes (5 drinks = 40 minutes) relative to lighter drinking (1 drink = 8 minutes). Future research could include experimental techniques like alcohol administration and polysomnography to better understand the relationship between alcohol and circadian rhythm.Support (if any)National Institute of Nursing Research (NR01768; Clinical trial: NCT03744156; PI: McCrae).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0998
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0999 Stress, Sleep Disturbances and Coping Strategies Among Taiwanese
           Primary Family Caregivers in Intensive Care Units

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      Pages: A428 - A429
      Abstract: AbstractIntroductionThe primary family caregivers in the intensive care unit (ICU) often experience stress and sleep disturbances. Exploring coping strategies for these caregivers is crucial for preventing burnout and alleviating adverse psychological and health outcomes. This study aimed to examine stress, sleep disturbances, and coping strategies among primary family caregivers in the ICU.MethodsData were extracted from the baseline assessment of an ongoing pilot experimental study conducted in four adult ICUs in a teaching hospital in central Taiwan. Eligible participants were (1) unpaid primary family caregivers acknowledged by either patients or their family members and (2) individuals with a family member who underwent mechanical ventilation for more than 48 hours while in the ICU. Participants completed a set of study questionnaires, including the Impact of Events Scale-Revised (IES-R), General Sleep Disturbance Scale (GSDS), Brief COPE, and Multidimensional Scale of Perceived Social Support (MSPSS).ResultsEight primary family caregivers were recruited from 12 November 2023 to 8 December 2023. The mean age of these caregivers was 55.5±10.17 years, and 3 (37.5%) of them were female. The primary family caregivers experienced high stress levels (mean IES-R score > 32), sleep disturbance (mean GSDS score > 3), and poor sleep quality (mean subscale score of GSDS > 3). The primary family caregivers most often used acceptance, active coping, and positive reframing strategies to manage stress, and they received more social support from their families than from friends. Those caregivers who perceived higher stress levels reported more sleep disturbances (rs = .74, p < .05) and poorer sleep quantity (rs = .95, p < .05). They also relied more on self-distraction (rs = .79, p < .05), emotional support (rs = .76, p < .05) and planning coping to manage stress (rs = .77, p < .05).ConclusionThe results of this ongoing study showed that primary family caregivers in the ICU experienced heightened stress perception and sleep disturbance. Future studies should focus on exploring effective coping strategies to help primary family caregivers in the ICU to manage stress.Support (if any)This work was supported by Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, TTCRD112-30.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0999
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1217 A Complex Case of Progressive Hypercarbic Respiratory Failure

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      Pages: A519 - A519
      Abstract: AbstractIntroductionProgressive hypercarbic respiratory failure in the absence of overt intrinsic lung disease, thoracic cage abnormalities, CNS depressants, or neuromuscular disease poses a unique diagnostic challenge. Furthermore, continued respiratory failure in patients compliant with non-invasive ventilation warrants additional evaluation for alternative diagnoses. We present a case which produced a unique diagnostic challenge to the inpatient sleep medicine service.Report of case(s)A 46 year-old female with a past medical history significant for T2DM, COVID pneumonia, and seizures presented for acute on chronic hypercarbic respiratory failure in the setting of left hemi-diaphragm paralysis. She experienced multiple (greater than ten) hospitalizations requiring intubation for hypercarbic respiratory failure. Initial work up revealed negative inspiratory force of -40 cm H20. Pulmonary function tests revealed a restrictive pattern with FEV1/FVC of 70%. CT Chest revealed no parenchymal abnormalities. Admission ABG of 7.30/56. She was started on non-invasive ventilation through average volume assured pressure support mode with goal volumes of eight cc/kg. Despite effective ventilatory support with excellent compliance she had increasing requirements leading to near twenty-four hours of total use. Repeat hospitalization occurred for respiratory failure and new left arm weakness which raised concern for underlying neuromuscular disease as etiology. MuSK antibodies were sent and resulted positive at a titer of 1.35nmol/L, consistent with a diagnosis of Myasthenia gravis. The patient was treated with prednisone, plasma exchange, and rituximab with marked improvement in clinical and respiratory status. The patient was successfully weaned down to nocturnal use of non-invasive ventilation with preserved eucarbia.ConclusionMyasthenia gravis can lead to marked respiratory muscle weakness and respiratory failure. Common triggers of crisis include infection, medications, electrolyte abnormalities, and thyroid disease. Up to twenty percent of patients present with myasthenic crisis as their initial symptoms. Continued evaluation of forced vital capacity, and negative inspiratory force are important measures to follow for signs of disease progression. This case proved difficult in the setting of recurrent admissions believed to be secondary to hemidiaphragm paralysis and previous COVID infection. It is imperative to maintain a broad differential in working up respiratory failure and consider myasthenia in the proper clinical context.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01217
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1218 To Order, or Not to Order Pre-Operative Adenotonsillectomy
           Polysomnography, That Is the Question

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      Pages: A519 - A519
      Abstract: AbstractIntroductionAdenotonsillectomy (AT) is one of the most-commonly performed surgery with over 500,000 cases in children under 15 years of age annually. Two of the most common indications include sleep disordered breathing (SDB) and recurrent tonsillitis. Prior to surgery, preoperative polysomnography is commonly ordered to identify high risk patients for postoperative complications. We report a case of postoperative complication following an elective adenotonsillectomy in a patient suspected of sleep disordered breathing.Report of case(s)elective Adenotonsillectomy. He was evaluated by otolaryngology for a 1-year history of snoring, witnessed apneas, night terrors in the setting of 3+ tonsillar hypertrophy. No recurrent infections or prior sleep study. Intraoperative findings of adenotonsillar hypertrophy which resulted in adenotonsillectomy without any complications. Post-op complication included hypoxemia (oxygen saturations in the mid 80s while asleep). He was admitted for overnight observation and placed on a facemask with 5 L/min oxygen to keep his saturations >90%. Due to persistent desaturations with sleep, patient was transferred to ICU for a trial of PAP therapy with sleep. Postoperative CXR with ultrasound of the diaphragm demonstrated right hemidiaphragm paresis. Echocardiogram was unremarkable. Patient was discharged home with BPAP, steroids, oral antihistamine/steroid nasal spray with plans on outpatient polysomnogram.ConclusionThough, adenotonsillar hypertrophy is the most common cause of SDB; tonsillar size does not always correlate with the severity of SDB. A polysomnography is the gold standard to diagnose and assess the severity of SDB. The 2011 American Academic of Otolaryngology-Head and Neck Surgery guidelines recommend pre-AT PSG in children with SDB and high-risk comorbidities, including obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidosis. Pre-AT PSG guides medical decision-making, assess surgical candidacy, and optimize peri-operative monitoring in pediatric patients. Currently, there are no standardized guidelines for perioperative screening for SDB in children. Several barriers contribute to obtaining pre-AT PSG which includes access to pediatric sleep labs, long wait times, and high cost for PSG. Nevertheless, pre-AT PSG in pediatric patients to identify high-risk patients needs to be standardized to provide safer and efficacious pediatric care.Support (if any)None
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01218
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1219 Diagnosing Narcolepsy by MSLT Without Taking in the Full Picture

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      Pages: A519 - A520
      Abstract: AbstractIntroductionNarcolepsy is typically diagnosed by symptoms and an abnormal multiple sleep latency test (MSLT). However, many factors can affect the results of the MSLT, leading to an overdiagnosis of narcolepsy.Report of case(s)A 37-year-old female was referred with prior diagnoses of narcolepsy, depression, post-traumatic stress disorder, polysubstance abuse, obstructive sleep apnea (OSA), and hypertension. The patient obtained the diagnosis of narcolepsy by polysomnography/MSLT through another facility and was prescribed amphetamine/dextroamphetamine. The overnight polysomnogram demonstrated: total sleep time 285 minutes, rapid-eye movement (REM) latency 223 minutes, overall apnea-hypopnea index (AHI) 6/h, and REM AHI 45/h. The next day MSLT demonstrated a mean sleep latency of 7 minutes and 2 sleep-onset REM periods on the second and fourth naps. A urine drug screen (UDS) was not obtained. She reported 4-6 hours of sleep/day at the time of her MSLT. She denied cataplexy, sleep paralysis, or sleep-related hallucinations.ConclusionThis case is one of many seen at our tertiary referral center of patients presenting with a diagnosis of narcolepsy by MSLT, but the MSLT was performed in invalid conditions. Many medications, substances, insufficient sleep, inappropriate timing of testing, untreated OSA, and other medical conditions all have the potential to lead to an abnormal MSLT that would appear consistent with narcolepsy, but often these factors are not considered. Insufficient sleep at home or on the preceding polysomnogram can lead to an abnormal MSLT. Though our patient had a history of polysubstance abuse, a UDS was not obtained. The American Academy of Sleep Medicine enjoins a polysomnogram for a duration of a 7-hour minimum (with 6 hours of sleep) prior to conducting an MSLT. Our patient only slept for 4.75 hours in the overnight polysomnogram. Her polysomnogram also showed OSA. A combination of these factors likely contributed to the patient’s daytime sleepiness. Her insufficient sleep, OSA, and use of sedating medications/substances should have been addressed first before performing an MSLT. We strongly encourage providers to ensure the MSLT is done in valid conditions to prevent the misdiagnosis of narcolepsy and initiation of unnecessary treatment.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01219
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1220 Polysomnography in Children with Joubert Syndrome

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      Pages: A520 - A520
      Abstract: IntroductionJoubert syndrome is autosomal recessive, clinically and genetically heterogeneous with multiorgan involvement. Classic breathing symptoms include episodes of hyperpnea followed by apnea and periodic breathing. Gas exchange abnormalities include hyperventilation with low CO2s and intermittent desaturations. Purpose of this abstract is to report prolonged survival, describe the PSG findings and treatment modalities in 2 cases.Report of case(s)8-year-old female with Joubert syndrome, global developmental delay, hydrocephalus, hypotonia, cortical blindness presented for initial evaluation of sleep apnea. PSG revealed primarily central sleep apnea with upper airway resistance with snoring with arousal and few episodes of obstructive and mixed apnea and hypopnea. Gas exchange demonstrated episodic, brief desaturations, associated with central apneas. Repeat PSG at 13 years showed intermittent hyperpnea followed by apnea, low ETCO2s with self-limiting desaturations and periodic breathing. Gas exchange revealed low ETCO2 and desaturations. She was treated with clinical observation. PSG at age 20 year demonstrated intermittent hyperpnea followed by episodes of prolonged central apneas, with low ETCO2s and desaturations, and few obstructive hypopneas. Most central apneas associated with self-limiting desaturations, with significant number associated with oxygen saturation below 90%. Gas exchange demonstrated low ETCO2s and episodic desaturations. Supplemental oxygen was prescribed. 20-month-old female with diagnosed Joubert syndrome, cleft lip, polydactyly, hypotonia, dysphagia, and developmental delay presented for loud snoring and gasping during sleep and apneas while awake. Sibling with Joubert Syndrome and a tracheostomy had died. Presented for a second opinion for tracheostomy due to PSG at OSH demonstrating OSAHS with AHI of 18.2, OAI of 3.9 and CAI of 14.3, minimal hypoxemia, normal ETCO2 and SaO2 nadir was 75%. Repeat sleep study done at our center; AHI of 27.7 and OAI of 0.83. ETCO2 was normal, SpO2 nadir was 75% and minimal hypoxemia. Overall PSG demonstrated primarily central apneas with a few obstructive apneas and hypopneas and minimal O2 desaturations. Subsequently underwent BLPAP titration study and treated with non-invasive modality.ConclusionPSG in Joubert syndrome demonstrated intermittent hyperpnea and prolonged central apneas with low ETCO2's and brief desaturations. All events were predominantly present in REM sleep. Patients did well with low respiratory support and did not require tracheostomy.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01220
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1221 Multiple Sleep Latency Testing in Patients with Comorbid Psychiatric
           Conditions: A Case Report

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      Pages: A520 - A521
      Abstract: AbstractIntroductionExcessive daytime sleepiness (EDS) has an estimated prevalence of 10-25%. Disorders of central hypersomnolence such as narcolepsy and idiopathic hypersomnia pose a diagnostic challenge since commonly used psychotropic medications can alter REM sleep parameters on polysomnography (PSG). The American Academy of Sleep Medicine has published protocols for the multiple sleep latency test (MSLT), including a 2-week medication discontinuation period (MDP) prior to testing, however discontinuation must be carefully considered.Report of case(s)A 22-year-old female with obsessive compulsive disorder, attention deficit hyperactivity disorder, and optic nerve hypoplasia presented with episodic EDS for several years. Epworth was 14 despite amphetamine-dextromphetamine 30mg twice daily. These episodes would last for 1-2 weeks without associated hypersexuality, increased food seeking behaviors or changes in cognition. Additionally, she would experience periods of not sleeping for days at a time, but not decreased need for sleep. She denied cataplexy, sleep-related hallucinations, or sleep paralysis. No symptoms of bipolar disorder reported. Initial polysomnography showed 432 minutes of sleep, REM latency of 39.5 minutes and AHI of 0.1. MSLT showed a mean sleep latency of 11.5 minutes without sleep onset REM periods. She reported later that she was unable to complete the MDP for escitalopram. The diagnosis at that time was hypersomnolence related to a mental disorder, and referred back to psychiatry. She returned 20 months later with more persistent hypersomnolence and a MDP was attempted again, this time with confirmation. She stopped venlafaxine and stimulant per protocol. PSG was again unremarkable and MSLT showed mean sleep latency of 7 minutes across 5 naps and SOREMP in 4 naps, resulting in the diagnosis of type 2 narcolepsy.ConclusionSleep symptoms are common in patients with comorbid psychiatric conditions, and MDP can pose safety risks or be poorly adhered to. Longitudinal follow-up, repeat testing for persistent and worsening symptoms of EDS, and careful questioning about adherence to MSLT protocol can help clarify the eventual diagnosis.Support (if any)None.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01221
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1222 These Boots Were Made for Walking, but Not Sleeping

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      Pages: A521 - A521
      Abstract: AbstractIntroductionSomnambulism occurs during slow wave sleep, prompted by an arousal, followed by sitting up or walking, disorientation with no recollection of the event, and falling back asleep. While somnambulism/sleepwalking is a parasomnia that is not typically associated with Ehlers-Danlos syndrome (EDS), it was the presenting sleep disorder in a patient, with multiple etiologies of insomnia.Report of case(s)A 54-year-old female with a history of chronic insomnia, attention-deficit/hyperactivity disorder (ADHD), EDS, and osteoporosis presents with somnambulism. Patient reports sleepwalking since childhood and continuing to sleepwalk into adulthood. Fifteen years prior, she became a paramedic, worked 24-hour shifts, and developed insomnia. Patient started her first insomnia treatment with zolpidem 5 years ago, which increased her sleepwalking frequency from twice a week to daily and included more complex behaviors like preparing food. Patient retired with disability 4 years prior due to recurrent fractures and joint deformities secondary to her osteoporosis and EDS. She took cyclobenzaprine, methocarbamol, oxycodone-acetaminophen, and pregabalin for chronic pain, and dextroamphetamine-amphetamine for ADHD. Patient presented to Sleep Medicine clinic July 2023 where zolpidem was changed to clonazepam. At her follow up December 2023 visit, exam was notable for her wearing a left post operative short boot. Her sleepwalking had ceased, but insomnia worsened. It was taking her 3 hours to fall asleep after her 6PM bedtime, and 1 hour to fall asleep after nocturia-related awakenings 1-2 times per night. Since her surgery three weeks prior, she had been dozing off during the day, likely from her sedative pain medications. We recommended delaying her evening pain medications and bedtime and ordered a sleep study.ConclusionChronic pain, fatigue, and pain medications used to treat EDS contribute to this population's higher rates of sleep disorders like insomnia. They also have higher rates of obstructive sleep apnea due to nasal-maxillary cartilage changes, that are successfully treated with nasal CPAP. Psychiatric disorders, including anxiety, mood disorders, and ADHD are also more common in this population, and carry their own sleep pathology. While the patient’s primary sleep complaint was somnambulism, it was important to evaluate for and treat underlying sleep disorders for optimal outcomes.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01222
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1223 REM-related Leg Cramps

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      Pages: A521 - A521
      Abstract: AbstractIntroductionNocturnal leg cramps are common in the general population and is reported in 30% of adults. It is described under sleep related movement disorders in the International Classification of Sleep Disorders. It is a painful sensation in the legs that occurs during sleep or out of sleep but is not necessarily associated with a particular stage of sleep, relieved by stretching. We present a case of nocturnal leg cramps occurring during REM sleep.Report of case(s)Patient is a 53-year-old female reporting a history of waking from sleep with leg cramps. She underwent a CPAP titration study at our facility for a previously documented obstructive sleep apnea (AHI of 28, REM AHI of 74.1). On video, she was seen to wake abruptly out of each of the three REM sleep episodes, sitting and rubbing her calves, and reporting to the technician that she was having leg cramps. She would then get up and walk around to relieve the cramps but was able to return to sleep. Each episode lasted 3-5 minutes and was only relieved with movements or massage. No leg cramps were reported from non-REM sleep during this study. She denied symptoms of restless legs syndrome. Her periodic limb movements of sleep indices during her diagnostic and CPAP polysomnograms were 2.0 and 5.1 respectively and occurred during non-REM sleep. Medical history includes asthma and COPD (oxygen supplementation as needed), heart disease, prior polysubstance use disorder, and treated infective endocarditis in 2011.ConclusionOur case characterizes nocturnal leg cramps that occurred at a particular sleep stage, in this case strictly during REM sleep. Nocturnal leg cramps have been reported in the literature in association with various medical comorbidities including vascular disease and OSA. Further, it has been reported that CPAP therapy for OSA results in near or total elimination of leg cramp burden. It is unclear what is the mechanism of REM-related leg cramps, but it could be the REM OSA. To our knowledge, this is the first documented case of REM-related nocturnal leg cramps. We hope to add to the present literature on the mechanism of this disorder.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01223
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0944 National Sleep Foundation’s 2024 Sleep in America Poll: Sleep
           Health and Depressive Symptoms in Teenagers

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      Pages: A405 - A405
      Abstract: AbstractIntroductionA mental health crisis has been recognized among US teenagers, highlighted by high rates of mood disturbances. While a well-documented connection exists between sleep and mood, evidence largely comes from convenience samples of adults. Much less is known about the link between sleep and mental health in teenagers and even less is known about this important connection among the general teenage population. The overarching goal of the present study was to examine the associations among sleep health and depressive symptoms in teenagers.MethodsA random sample of 1,124 US teenagers aged 13 to 17 years were recruited to complete surveys online in English or Spanish, including the Sleep Health Index, the Sleep Satisfaction Tool, and the Patient Health Questionnaire-9 for adolescents, a commonly employed screening tool assessing the presence and frequency of depressive symptoms in adolescents. Data were weighted via iterative proportional fitting to approximate population distributions. Analyses included both z-tests and t-tests to examine depressive symptom differences between individuals with varying levels of sleep health. Results have a margin of sampling error of plus or minus 4.1 percentage points.ResultsThirty-seven percent of 13- to 17-year-olds reported symptoms consistent with at least mild levels of depression and just 8 percent of teens reported achieving nightly sleep durations recommended by the National Sleep Foundation (i.e., 8-10 hours). Teens with minimal or no depressive symptoms reported significantly more weekday sleep (7.4 hours) compared to those with mild (7.0 hours) and moderate-to-severe depressive symptoms (6.6 hours; p’s<.05). Teens who were dissatisfied with their sleep were 22 percentage points more apt than sleep-satisfied teens to report moderate-to-severe depressive symptoms (27 vs. 5 percent, p<.05). Seventy-three percent of teens reported their emotional well-being was negatively impacted when they slept less than usual.ConclusionSleep health and mental health are strongly linked in teens. When considering avenues to curb the teen mental health crisis, sleep health education should be a priority. Public health campaigns aimed at improving sleep health in teens should include efforts to start school later, reduce nighttime electronic use, and encourage family prioritization of sleep health.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0944
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0945 Sleep Health and Suicide Ideation in the US: Data from the National
           Sleep Foundation Sleep in America Poll

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      Pages: A405 - A406
      Abstract: AbstractIntroductionPrevious studies have shown that poor sleep is generally associated with suicide ideation. But few studies have examined this relationship in the general population across many dimensions of sleep health, and it is not clear which sleep variables are most salient.MethodsData were collected as part of the National Sleep Foundation Sleep In America Poll. The population-based sample (N=1,042) provided data on a range of sleep questions, as well as each item of the PHQ9 depression scale. For the present analyses, PHQ item 9 (suicide ideation) was examined as a binary outcome, with population-weighted regression analyses adjusted for age, sex, race/ethnicity, education, income, and PHQ2 depression score. Independent variables included sleep satisfaction, feeling refreshed, daytime energy, difficulty falling asleep, frequent nighttime awakenings, difficulty resuming sleep, satisfaction with weekday and weekend sleep duration, ability to feel relaxed, overall sleep quality, weekday and weekend bedtime, waketime, time in bed, sleep duration, perceived sleep need, and days/week (0-7) of: feeling well-rested, having trouble falling or staying asleep, sleep impacts functioning, daytime sleepiness, and sleep medication use. Bonferonni correction (0.05/26) was used.ResultsPopulation-weighted analyses adjusted for age, sex, race/ethnicity, education, income, and PHQ2 depression score showed that elevated likelihood of suicide ideation was associated (all p< 0.0019) with days/week: feeling well rested (OR=0.80/day), trouble falling asleep (OR=1.26/day), trouble staying asleep (OR=1.18/day), and sleep impacts functioning (OR=1.46/day). Weekday sleep duration (OR=0.73/hr), weekend sleep duration (OR=0.75/hr), “Very Dissatisfied” with sleep (OR=6.92), “Not energized at all” (OR=7.46), “A great deal” of trouble falling asleep (OR=6.91), “Very often” waking during the night (OR=5.75), “Very dissatisfied” with weekday (OR=6.95) and weekend (OR=7.81) sleep duration, and “Very difficult” to relax before bed (OR=10.04) were also associated. Stepwise analyses revealed that the variables that explain the most unique variance are (in order) days/week that sleep impacts functioning (R-squared 0.089) and satisfaction with weekend sleep duration (R-squared 0.012).ConclusionMany indicators of sleep health were associated with suicide ideation, implicating sleep duration, quality, efficiency, and daytime effects of sleep. Efforts might ideally focus on the daytime impacts of sleep as well as nighttime experiences.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0945
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0946 Examining the Directional Effects of Insomnia, Anxiety, and
           Depression Symptoms: Results from a Longitudinal Study

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      Pages: A406 - A406
      Abstract: AbstractIntroductionAlthough there is evidence supporting high comorbidity rates among insomnia, anxiety, and depression, the temporal relationship among them is less clear. Prior research supports that the onset of depression is often preceded by symptoms of anxiety and insomnia, but the current study is the first to look at the temporal relationship among all three symptoms in an adult sample representative of the general population. Determining the temporal progression of these problems is important for prevention and intervention efforts, in that early treatment for insomnia and anxiety may reduce the risk of developing depression.Methods2,666 adult participants (Mage = 47.0, 79.0% female, 84.1% white) were recruited for an online study on health, resulting in a nationally representative sample. Well-validated instruments were used to measure symptoms of depression (CES-D), anxiety (STAI), and insomnia (ISI). Data was collected via Qualtrics surveys administered online at two time points (i.e., baseline and follow-up), with assessments conducted twice daily for two weeks in the morning and evening. Auto-regressive cross-lagged models were used to provide the best representation for how these data were collected, and allowed for temporal ordering at every pathway by examining the longitudinal relationship between each variable.ResultsAuto-regressive cross-lagged models revealed an indirect effect of anxiety symptoms on depression symptoms through insomnia symptoms. Tests of indirect effect were performed in two ways, using both insomnia T1 and insomnia T2 to provide temporal ordering between all three variables. The indirect effect of anxiety T1 on depression T2 through insomnia T1 was significant (β = 0.253, p < 0.001). The indirect effect of anxiety T1 on depression T2 through insomnia T2 was also significant (β = 0.265, p < 0.001). The almost-identical values for the two tests of indirect effect provide support for the presence of the temporal relationship between these three variables.ConclusionResults support the theory that insomnia may be one mechanism by which individuals with anxiety are at greater risk for developing depression. This is the first study to empirically evaluate a model in which insomnia symptoms explain the indirect effect of anxiety symptoms on depression symptoms in adults.Support (if any)Vargas: K23HL141581
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0946
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0947 Suvorexant Improves Symptoms of Opioid Withdrawal and Depressive
           Symptoms Through Changes in Oscillatory Band-power

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      Pages: A406 - A407
      Abstract: AbstractIntroductionOpioid withdrawal exacerbates depressive symptoms and poor sleep. Previous findings demonstrate suvorexant’s ameliorative effect on sleep disturbances during this period, but is unknown whether these changes also confer benefit for depressive or withdrawal symptoms. therefore, we aimed to examine the effects suvorexant oscillatory sleep-EEG power during inpatient opioid withdrawal, and to examine their association with withdrawal severity and depressive symptoms.MethodsParticipants with Opioid Use Disorder (N=38: age-range = 21-63years, 87% male, 45% white) underwent an 11-night withdrawal (3-night stabilization, 4-night buprenorphine taper, 3-night buprenorphine post-taper) and were randomly assigned to suvorexant (20mg [n=14] or 40mg [n=12]), or placebo [n=12], while ambulatory sleep-EEG data was collected. Linear mixed-effect models were used to test associations between sleep-EEG band power change, depressive symptoms, and withdrawal severity.ResultsAcross the 11 night withdrawal period, reductions in oscillatory delta power were observed in all study groups, and increases in beta power (20mg: β = 2.579, pval = 0.009 40mg (β = 5.265, pval < 0.001) alpha power (20mg: β = 158.304, pval = 0.009 40mg: β = 250.212, pval = 0.001) and sigma power (20mg: β = 48.97, pval < 0.001 40mg: β = 71.54, pval < 0.001) were observed in the two suvorexant groups. During the four-night taper, decreases in delta power was associated with decreases in depression (20mg: β= -190.90, p = 0.99 40mg: β= -433.33, p = < 0.001 [*Bonferroni corrected]), and withdrawal severity (20mg: β= -215.55, p = 0.006* 40mg: β= -192.64, p = < 0.001*), in both suvorexant groups and increases in sigma power were associated with decreases in withdrawal severity (20mg: β= -357.84, p = 0.004* 40mg: β= -906.35, p = < 0.001*). Post-taper decreases in delta (20mg: β= -740.58, p = < 0.001* 40mg: β= -662.23, p = < 0.001*) and sigma power (20mg only: β= -335.54, p = 0.023*) were associated with reduced depressive symptoms in the placebo group.ConclusionResults highlight a complex and nuanced relationship between sleep EEG power and symptoms of depression and withdrawal. Changes in oscillatory delta power may represent a mechanism influencing depressive symptoms and withdrawal.Support (if any)UG3DA048734
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0947
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1191 A Pediatric Case of Treatment Emergent Central Sleep Apnea During
           High Flow Nasal Cannula Polysomnography

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      Pages: A509 - A509
      Abstract: AbstractIntroductionHigh flow nasal cannula (HFNC) is an alternative therapy to continuous positive airway pressure (CPAP) in pediatric populations with behavioral intolerance or contraindications to CPAP. Studies evaluating HFNC as a treatment modality in the pediatric literature have been limited.Report of case(s)A previously healthy 12-year-old male with a history of obesity presented with partial and full thickness burns to his face, neck, chest, and bilateral upper-extremities following a bonfire accident. His burns covered 15% of his total body surface area. He required hospitalization for acute burn management and skin grafting. During his hospitalization, he was observed to have snoring, witnessed apneas, and nocturnal hypoxemia concerning for underlying obstructive sleep apnea. He was unable to utilize a non-invasive positive pressure mask interface due to his extensive facial dressings and pressure sensitive skin grafts. He was discharged home on high flow nasal cannula at 10-15 Liters/minute. The patient experienced weight gain following hospitalization, possibly related to Cyproheptadine use for burn-related itching. Approximately 10 months after discharge, the patient underwent split-night HFNC polysomnography. The diagnostic portion of his study revealed severe obstructive sleep apnea with an OAHI of 28.8 events/hour. There were no observed central or mixed respiratory events and no REM stage sleep during the diagnostic portion of the study. After initiating HFNC at 40 L/minute and 34 degrees Celsius per sleep laboratory protocol, the OAHI decreased to 0.0 events/hour despite REM rebound, and the CAHI increased to 16.8 events/hour. This study was conducted at approximately the same altitude as the patient’s home.ConclusionThis patient experienced treatment emergent central sleep apnea during HFNC polysomnography. Treatment emergent central sleep apnea with HFNC has previously only been described in a limited number of pediatric patients with underlying chronic lung disease, developmental delay, or genetic syndromes. This case highlights HFNC as an alternative treatment modality to CPAP as well as the need for further understanding of HFNC titration in pediatric sleep laboratories.Support (if any)The Breathing Institute at Children’s Hospital Colorado
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01191
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0895 Greater Sleep Reactivity and Poorer Sleep Efficiency Are Associated
           with Increased Medical Expenditures

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      Pages: A384 - A385
      Abstract: AbstractIntroductionInsufficient sleep costs the U.S. economy over $411 billion per year in lost productivity. However, most studies investigating the economic costs of sleep rely on flawed retrospective measures of sleep (e.g., typical sleep patterns in the past month). These measures are prone to recall bias and do not accurately capture daily variability in sleep patterns. To address these gaps, we examined how sleep metrics captured from prospective sleep diaries were associated with medical claims approximately one year later.MethodsParticipants were 452 World Trade Center 9/11 responders enrolled in the World Trade Center Health Program in 2017 (mean age = 52.22 years, SD = 8.73, 10.6% female). At baseline, participants completed 14 days of self-reported sleep and stress measures each morning. Mean sleep efficiency, variability in sleep efficiency, as well as a novel measure of sleep reactivity (i.e., how much people’s sleep efficiency changes in response to previous-day stressors) were used to predict total yearly medical claims, physical health claims, and mental health claims approximately one year later , covarying for participant age and sex.ResultsGreater sleep reactivity to stress was associated with more total medical claims (b = $7,742.63, p < .001), more physical health claims (b = $1,421.87, p < .001), and more mental health claims (b = $2,682.81, p < .001). Lower mean sleep efficiency was associated with more total medical claims (b = -$7,669.63, p = .018), more physical health claims (b = -$2,103.42, p = .026), and more mental health claims (b = -$2,494.76, p = .011). Greater variability in sleep efficiency was associated with more total medical claims (b = $14,020.82, p = .010) and more mental health claims (b = $7,035.91, p < .001).ConclusionIndividuals with greater sleep disturbances engage in more healthcare utilization. Given the steep costs of insufficient sleep, it may be important to proactively address sleep problems to prevent downstream social and economic consequences.Support (if any)NIOSH U01OH011321 (PI: Kotov)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0895
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1198 Acute Onset Vision Loss in a Patient with NAION and OSA

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      Pages: A511 - A511
      Abstract: AbstractIntroductionNon-arteritic anterior ischemic optic neuropathy (NAION) is the most common optic neuropathy in middle-aged and older-aged adult. There are an estimated 6000 new cases per year and is most commonly diagnosed in patients between 61-72 years of age. It affects men and women equally. There is a slightly higher incidence in white patients. 55-59% of patients with NAION also have OSA.Report of case(s)A 51-year-old man with a past medical history of hypertension and erectile dysfunction developed painless left inferior altitudinal visual field loss and blurriness in April 2023. He was seen in the Ophthalmology Department and was found to have left unilateral optic disc swelling on fundoscopic examination. An MRI of his brain, orbits, and face were normal. He was referred to Neuro-Ophthalmology where a slit lamp and fundus exam was performed and was significant for 360 degrees of disc swelling with heme seen inferiorly and normal appearing vessels and macula. A follow up fundoscopic examination one month later was significant for a hyperemic nerve and nasal blurriness in the left eye. No changes were seen in the right eye. Based on these findings, he was diagnosed with NAION. A HST was ordered by his Ophthalmologist that showed moderate OSA with an AHI of 24.3/h, an O2 nadir of 81%, and an ODI of 32.3. He was then seen in the Sleep Medicine clinic and prescribed CPAP. At his two month follow up appointment, he had an improvement in his daytime sleepiness and concentration but still had residual visual deficits in his left eye, including blurriness, light sensitivity, and difficulty focusing.ConclusionNAION is a rare condition with untreated OSA as a known risk factor due to nocturnal hypoxia decreasing perfusion to the optic nerve. This case reinforces the notion that the hypoxic burden of untreated OSA is a systemic problem and can lead to damage throughout the body. In this case, the benefit of treating this patient’s OSA is that his contralateral eye, the right eye, is also vulnerable to developing the same ischemic optic neuropathy that the left eye suffered from.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01198
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1199 A Novel Approach to REM Sleep Behavior Disorder Safety Measures

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      Pages: A512 - A512
      Abstract: AbstractIntroductionRapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. Behaviors include yelling, punching, kicking, and complex or violent movements causing a fall out of bed and result in injury to the patient or their partner. The American Academy of Sleep Medicine recommends maintaining a safe environment for patients. For patients with uncontrolled severe symptoms, recommendations include having partners sleep separately from patients. This may not be practical for small living spaces, may result in loss of intimacy between partners, or delay response to injuries caused by RBD. We present the case of a patient devised novel approach to keep their partner safe while maintaining close-proximity while sleeping.Report of case(s)A 63-year-old man with a past medical history of moderate obstructive sleep apnea (OSA) on CPAP presented to sleep clinic with symptoms of dream enactment. Behaviors included yelling, punching, and kicking. He had kicked his wife and had fallen out of bed resulting in an injury. He underwent a polysomnogram that showed REM sleep without atonia and was diagnosed with RBD. He was advised on safety precautions and started high dose melatonin. Clonazepam was added, but symptoms were not eliminated. He and his wife did not want to sleep separately, so he pushed two twin beds together and separated them with a large sheet of plexiglass. He reported he had hit the plexiglass many times without inuring himself and prevented injury to his wife. The patient’s wife was able to safely sleep near him which helped maintain their sense of intimacy.ConclusionWe report a novel approach to create a safe environment for patients with RBD while maintaining partner proximity and intimacy. As patients struggle with progressive neurodegenerative disease, it is important to have their partners nearby overnight when patients are at risk for falling and self-injury. With two twin beds separated by plexiglass, a patient can safely sleep next to their partner and significantly reduce the risk of injuring them. This may be a useful technique for patients with severe, refractory symptoms of RBD.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01199
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1200 Overstimulated: A Case of Hypoglossal Nerve Stimulator Over-titration

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      Pages: A512 - A512
      Abstract: AbstractIntroductionHypoglossal nerve stimulation (HNS) is an effective treatment for obstructive sleep apnea (OSA) that stimulates nerves that protrude the tongue and move the hyoid bone anteriorly to restore airway patency during sleep. After implantation, the stimulator voltage is titrated to an optimal therapeutic level. We describe the case of a patient whose OSA was effectively treated at a lower voltage and then demonstrated worsening sleep apnea after over-titration to a higher voltage.Report of case(s)A 37-year-old healthy man with a body mass index of 32 kg/m2 presented with snoring. A polysomnogram revealed an apnea hypopnea index (AHI) of 53.9 events per an hour consistent with severe OSA. He was intolerant of continuous positive airway pressure (CPAP) and trial of a mandibular advancement device (MAD) was ineffective. The patient subsequently underwent hypoglossal nerve stimulator implantation without complications. After an appropriate healing period, his device was activated with a noted functional amplitude of 0.8V and an allowed range of 0.8V to 1.8V. During self-titration, the patient noted improvement of snoring and apneas at an amplitude of 1.6V. However when he increased the amplitude further he noted recurrence of his OSA symptoms. He underwent an attend polysomnography titration study that revealed an estimated AHI of less than 10 with his HNS set to 1.6V representing an appropriate treatment response. However, when his HNS was titrated up to 1.7V, his estimated AHI increased to 26.4 consistent with moderate OSA. The patient’s device was set to a voltage of 1.6V.ConclusionHNS is an important treatment option for patients with OSA who are intolerant of CPAP. After implantation, attention must be given to careful titration of the stimulation voltage during an attended polysomnogram to avoid over titration which can lead to an increased number of obstructive events in some patients. While the mechanism of this phenomenon is currently unknown, theoretical mechanisms include stimulation of the lateral division of the hypoglossal nerve triggering tongue retraction at higher voltages and genioglossus muscle fatigue.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01200
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0900 Comparing a Lifestyle Plus Sleep Extension to a Lifestyle
           Intervention in Adults with Short Sleep and Prediabetes

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      Pages: A386 - A386
      Abstract: AbstractIntroductionThe purpose of this study was to evaluate the extent to which a sleep extension intervention optimized the well-established effects of a diet and physical activity lifestyle intervention on improved metabolic outcomes in adults with prediabetes (hemoglobin A1c ≥5.7% and ≤6.4%) and short sleep duration (≤6.5 hours/night actigraphy-estimated sleep).Methods157 eligible adults (mean age=52.16 years, 69% female, 66% White, 36% Black, 11% Asian, 7% other race) were randomized to an 8-week lifestyle plus sleep extension (n=88) versus lifestyle control (n=69) condition. Participants completed pre and post assessments of device-estimated glucose, sleep, and waist circumference. Self-reported sleep quality and daytime sleepiness were also assessed. Paired sample t-tests modeled pre to post-intervention changes in these measures.ResultsDevice-estimated sleep duration increased significantly in both conditions [intervention condition 17.04 (SD=42.98) minutes; control condition 24.18 (SD=38.10) minutes]. Sleep onset time, sleep midpoint, and weekend sleep midpoint advanced in the intervention condition only [-16.71 (SD=52.48) minutes, -9.40 (SD=38.82) minutes, -20.83 (SD=54.30) minutes, respectively]. Sleep quality improved clinically and significantly in the intervention condition; mean Pittsburg Sleep Quality Index score decreased from 8.32 (SD=2.82) to 4.77 (SD=2.55). Sleep quality improved significantly in the control condition from 7.75 (SD=2.97) to 6.35 (SD=2.88). Between group differences in sleep quality change scores showed greater improvement in intervention versus control participants (p< 0.001). Daytime sleepiness decreased significantly in both conditions (-3.15 intervention versus -1.18 control). Between group differences in daytime sleepiness showed greater improvement in intervention versus control participants (p< 0.001). On average, waist circumference decreased by -0.74 (SD=5.19) cm. in the intervention and -1.56 (SD=5.21) cm. in the control condition; these changes scores did not differ significantly between conditions. There were no statistically significant improvements in devise-estimated glucose measures.ConclusionAdding sleep extension to a lifestyle change intervention improved several dimensions of sleep, beyond sleep duration, that have been associated with poor metabolic health (e.g. sleep times, sleep quality). The two conditions did not differentiate in terms of increasing sleep duration or decreasing waist circumference suggesting that individuals should at least have lifestyle interventions as a component of care. Neither condition improved glycemic outcomes.Support (if any)NIH (R00NR017416)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0900
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0901 Effects of a Physical Activity Intervention on Sleep Among Cancer
           Survivors in the Cancer Prevention Study-3

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      Pages: A387 - A387
      Abstract: AbstractIntroductionDisruptions to sleep have been reported in many cancer survivors, with lasting impacts reported several years after treatment. Physical activity (PA) has been shown to improve sleep outcomes. We evaluated the effects on self-reported and device measured sleep outcomes within a PA intervention among cancer survivors.MethodsThe Health and Energy through Active Living Every Day (HEALED) intervention was a randomized controlled trial of 415 cancer survivors identified from the American Cancer Society (ACS) Cancer Prevention Study-3 (CPS-3) cohort enrolled in a year-long, web-based, PA intervention to increase social support, improve exercise self-efficacy, and facilitate self-monitoring of PA. Participants were randomized 2:1 to an interactive PA website (intervention) or a static balance and flexibility website (controls). Sleep was assessed through PROMIS 6-item Sleep Disturbance Scale and SATED sleep questionnaire. In addition, participants were provided a Fitbit Charge 5 to self-monitor PA and sleep. We conducted an intent-to-treat analysis and calculated t-tests to evaluate change in sleep outcomes between the two groups at the end of the 1-year study period.ResultsA total of 351 participants completed the year-long intervention. Most participants were White (93%), female (94%), had a history of breast cancer (73%), were on average 62 years old (sd=8) and 6 years (sd=2) post-diagnosis. At baseline, both control (5 (metabolic equivalent task) MET-hours/day) and intervention (4.9 MET-hours/day) self-reported similar levels of moderate to vigorous physical activity (MVPA). Both groups reported good sleep quality at baseline with a SATED score of 8.0 (sd=1.8) and PROMIS of 48 (sd=7.5) in controls and 7.8 (sd=1.8) and 49 (sd=7.6), respectively, in intervention. The intervention group reported higher MVPA after 1 year (6.7 MET-hours/day vs 5.4 MET-hours/day, p=0.01). There were no statistically significant changes in self-reported sleep quality.ConclusionLong-term cancer survivors, with relatively healthy sleep quality at baseline, randomized to a PA intervention did report increased MVPA after a year, but this had little impact on sleep. Results with device-based MVPA and sleep measures are forthcoming.Support (if any)The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 cohort. This analysis was also supported through an unrestricted research grant from Sleep Number Corporation.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0901
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0917 Excessive Daytime Sleepiness and Health-related Quality of Life in
           Adolescent Patients with PCOS

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      Pages: A393 - A394
      Abstract: AbstractIntroductionPatients with polycystic ovary syndrome (PCOS) have been reported to have an impaired quality of life (QoL). A high prevalence of sleep disorders has also been reported in this group. This study seeks to evaluate the degree of excessive daytime sleepiness and sleep related QoL in adolescent patients with PCOS.MethodsPatients seeking treatment at our multidisciplinary PCOS clinic who were evaluated by Sleep Medicine from July 2023 to December 2023 and completed the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) and OSA-18 questionnaire were included in this study. The ESS-CHAD is an 8 question, validated measure of daytime sleepiness in children 12-18. Scores >10 suggest excessive sleepiness. The OSA-18 is an 18-item questionnaire that uses a Likert-type scoring system to collect information about 5 subscales that are elements in QoL: sleep disturbance, physical symptoms, emotional symptoms, daytime function, and caregiver concerns. A summary score is calculated that ranges from 18 (no impact on QoL) to 126 (major negative impact). Scores lower than 60 suggest a mild impact on QoL, scores between 60 and 80 suggest a moderate impact, and scores greater than 80 suggest a large impact. Descriptive statistics include means (SD) and n (%).ResultsSixteen subjects, mean age 16.68 years (SD 1.65), mean BMI 41.8 (SD 11.02) met inclusion criteria. Ten (62%) reported excessive daytime sleepiness as assessed by the ESS-CHAD. OSA-18 scores ranged from 23 to 84 with 2/16 (12.5 %) of subjects having a moderate or severe impairment and 14/16 (87.5%) subjects having a mild impairment.ConclusionAmong adolescent patients seeking treatment at a multidisciplinary PCOS clinic, the majority reported excessive sleepiness with mild impact on their QoL as assessed by disease specific questionnaires. Future studies will further investigate the contribution of sleep disordered breathing and evaluate the impact of obesity and insulin resistance on excessive sleepiness and health related QOL as measured by ESS-CHAD and OSA-18 scores.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0917
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0918 A Cross-sectional Study on the Cytokine Profiles and Immunological
           Relationship Between Vitiligo and Sleep Quality

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      Pages: A394 - A394
      Abstract: AbstractIntroductionVitiligo is an autoimmune skin disease. Psychological disruption can lead to clinical worsening and impact sleep quality of patients, in a bidirectional manner. Sleep regulates the immune system, and cytokines expression, including interleukin (IL)-6 and IL-17A (pro-inflammatory) and IL-4 and IL-10 (anti-inflammatory), which are linked to circadian rhythm and vitiligo immunopathogenesis. This study aimed to analyse cytokine profiles in a vitiligo sample; and verify any association with subjective sleep.MethodsThe study comprised 30 patients with vitiligo, and 26 healthy controls, following ethical guidelines. Quality of life and sleep questionnaires were completed: Dermatology Life Quality Index (DLQI), Short-Form Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Seven serum cytokines were measured through a 7-plex kit: IFN-γ, IL-4, IL-6, IL-10, IL-12 p40, IL-17A and TNF-α. Previous treatment with ultraviolet B phototherapy was registered. Generalized Linear Model test was used for statistical analysis.ResultsPSQI total score and domain 4 (sleep efficiency) were statistically worse in the vitiligo sample (both p=0.01). The PSQI means were 9.07 (vitiligo) and 6.66 (controls). Final scores of SF-36 and ISI were not statistically different between groups, although numerically worse in vitiligo group. The SF-36 domains “body pain”, “social aspects”, “physical limitation” and “emotional limitation” were statistically worse in vitiligo group. The DLQI mean (vitiligo group) indicated mild to moderate impact on quality of life (5.57). Cytokine levels were not different between groups, nor when analysed with PSQI. Regarding ISI, higher scores were related to increased IL-17A in vitiligo group (p=0.01). Increasing IL-4, IL-6 and IL-10 were associated with previous phototherapy (p=0.03; p=0.03 and p=0.04, respectively).ConclusionThe vitiligo group presented worse sleep, as expected. Body pain predominated in vitiligo sample; hyperalgesia can occur in poor sleep, impairing quality of life. Emotional limitation can be enhanced by or aggravate physical limitation and pain. Elevated ISI scores (more severe insomnia) were related to increased IL-17A levels. The IL-4, IL-6 and IL-10, with circadian behaviour, were associated to phototherapy, which has immunomodulatory role. Poor sleep and impaired vitiligo may interact bidirectionally; cytokine regulation should be further investigated in this complex relationship.Support (if any)AFIP, CAPES, CNPq and FAPESP.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0918
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0919 Shaking up the Night: PCD &amp; Sleep-Related Movement Disorders

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      Pages: A394 - A394
      Abstract: AbstractIntroductionPrimary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The literature on sleep movement disorders in PCD is limited, especially for Hispanics. This pilot study aims to assess the presence of sleep movement disorders and other comorbidities in patients with the RSPH4A PCD founder mutation [c.921 + 3_921 + 6delAAGT] in Puerto Rico. Our specific aim is to identify sleep-related movement disorders in PCD patients with the Puerto Rican founder mutation. Recognizing the importance of early diagnosis and prevention of PCD-related sleep disorders in pediatric and adult patients with PCD will help increase the knowledge of this condition and its comorbid manifestations.MethodsWe performed a prospective case series of fourteen PCD patients (n=15; seven pediatric and eight adults) at the Puerto Rico PCD Center and Neurosleep Sleep Laboratory in San Juan, Puerto Rico. Both pediatric and adult patients were interviewed for sleep disturbances and sleep-related movement during the night. Sleep questionnaires such as the Epworth Sleepiness Scale, and STOP-Bang (including the Pediatric Modified) were administered. Finally, polysomnography (PSG) was performed on every PCD patient to evaluate for sleep-related disorders.ResultsOur preliminary data showed that most patients with RSPH4A [c.921 + 3_921 + 6delAAGT] PCD founder mutation presented a high risk for sleep-related movement disorders or manifestations, including Sleep-Related Bruxism, Periodic Limb Movement of Sleep, Hypnagogic Foot Tremor, Rhythmic Movement Disorder. However, there were additional manifestations presented in both history-taking and PSG results such as Alpha-Delta Sleep, NREM Parasomnias, and others presented with Obstructive Sleep Apnea.ConclusionPCD is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The mechanism for the development of sleep-related movement disorders due to this ciliopathy is not well understood. Further research involving Multiple Sleep Latency Tests, Actigraphy, and additional comprehensive neurophysiologic testing and evaluation is needed to make an early diagnosis and prevent further clinical deterioration. Additional studies are needed in multicentric clinical trials to answer whether these sleep manifestations are related to a neurodevelopmental or neurodegenerative process due to this rare ciliopathy like PCD.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0919
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0923 Prospective Bidirectional Relationship Between Sleep Duration and
           PTSD Symptoms Following Acute Coronary Syndrome

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      Pages: A396 - A396
      Abstract: AbstractIntroductionSleep disturbance is a “hallmark” symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD when PTSD is induced by an acute health-related event. We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year following hospital evaluation for acute coronary syndrome (ACS).MethodsParticipants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration (“During the past month, how many hours of actual sleep did you get at night'”) and PTSD symptoms related to the cardiac event/hospitalization (PTSD Checklist; PCL) were assessed at 1-, 6-, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms.ResultsThe sample included 1,145 participants. Mean (SD) age was 61.4 (12.6) y and 46.5% were female. Mean sleep duration was ~6.1 hours, with ~57% of participants reporting short sleep duration (i.e., < 7 hours). Mean PCL score was ~24.19, with ~16% of participants screening positive for probable PTSD related to the cardiac event/hospitalization (PCL score ≥33) at each assessment (17.2%, 16.3%, and 15.7% at 1-, 6-, and 12 months). Higher PTSD symptoms predicted shorter sleep duration at the next timepoint (i.e., 1 to 6 months and 6 to 12 months), B=-0.14 hours/10-point difference, se=0.03, p<.001. Shorter sleep duration was associated with higher PTSD symptoms at the next timepoint, B=-0.25 points/hour, se=0.12, p=.04. Results were similar when insomnia and nightmare items were removed from the PCL. Higher dream-related PTSD symptoms (i.e., nightmares) had a marginally significant association with shorter sleep at the following assessment, B=-0.09 hours/point, se=0.05, p=.057. Shorter sleep was significantly associated with higher dream-related PTSD symptoms at the next timepoint, B= 0.03 points/hour, se=0.01, p=.001.ConclusionShort sleep duration and PTSD symptoms are mutually reinforcing across the year following ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0923
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0996 Parental Sleep Disturbance and Its Impact on Childhood Medication
           Adherence

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      Pages: A427 - A427
      Abstract: AbstractIntroductionChildhood medication adherence is paramount in treating both acute and chronic medical conditions. Sleep disturbances in children and adults have been linked to cognitive performance, cardiovascular function, immune regulation and behavioral disturbances. Despite documented interactions between concomitant parental substance use, depressive symptoms, and financial strain with sleep, there is limited data on how parental sleep disturbances impact childhood medication adherence.MethodsData was extracted from a mTURK dataset with 740 participants who were 18 years and older with at least one child who had been prescribed a medication within the prior three months. Parental sleep was measured using the PHQ-9 with a scale of 0 for “no trouble”, 1 for “several days”, 2 for “more than half of the days”, or 3 for “nearly all the days”. The Adverse Childhood Experiences (ACE) scale was used to determine a total ACE score (0-10). Children medication adherence was measured based on the following questions, “How often has your child followed his/her medical treatment instructions in the past three months'” and “How often has your child taken medication as prescribed in the past three months'” Responses were coded as “Adherent” if parents responded “Always” to both questions, but were otherwise coded as non-adherent. Statistical analysis was performed using RStudio software. Logistic regression analysis and Pearson’s correlation coefficient were used to test association between variables.ResultsWe found a statistically significant relationship between the parental response to the sleep question on the PHQ-9 and the parent’s report of child’s adherence to medication. For every point increase in PHQ-3, the odds of having high adherence to a child’s medication decreased by 17%, when controlling for parental gender, chronic disease status, and parental ACE status (p< 0.05). There was also a weak positive correlation (0.19) with higher parental ACE score and sleep difficulties as measured by the PHQ-9.ConclusionThere is a positive correlation between parental sleep disturbances and childhood medication adherence; this is a potential area for therapeutic intervention.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0996
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1155 Exploring Vagus Nerve Stimulation (VNS) and Its Relationship with
           Sleep Apnea: Implications and Insights

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      Pages: A495 - A495
      Abstract: AbstractIntroductionObstructive Sleep Apnea (OSA) is characterized by recurrent partial or complete blockage of the upper airway during sleep, leading to disruptions in breathing and intermittent oxygen desaturation, putting patients with epilepsy at risk for seizure exacerbations. However, literature about the development or progression of OSA in patients with a vagus nerve stimulator (VNS) refractory epilepsy is limited.Report of case(s)Case of a 42-year-old female with history of right lobe temporal epilepsy since childhood, temporal lobe surgery for epilepsy, currently on VNS who complained of snoring and daytime sleepiness. An Epworth Sleepiness Scale was obtained with a score of 18/24 (high). Physical examination revealed mallampati score of II, BMI: 24.62 kg/m², 139 lb weight, 14-inch neck circumference, and a STOP-Bang sleep score of 2/8 (low-risk). During the initial polysomnography (PSG), the patient exhibited mild to moderate OSA, with associated hypoxemia and disruption in sleep architecture, as reflected by the baseline apnea/hypopnea index (AHI) of 13.5/hr (normal: < 5/hr). The REM AHI (AASM) was 12.3/hr, and the respiratory events and desaturation pattern exhibited an atypically periodic nature, occurring approximately every 3.6 minutes with fixed respiratory events lasting around 29-30 seconds. This periodicity was likely associated with the activation of the VNS implant.ConclusionTo our knowledge, this case is novel and important in raising awareness of screening for sleep-related disorders, given the limited research about VNS leading to such manifestations. What is significant about this case is that routine tools typically used did not provide sufficient clarity for diagnosing this patient. Instead, a thorough evaluation was required where there are no clear guidelines to evaluate possible VNS-induced sleep-related disorders. The mechanisms involved are complex and diverse. Some proposed causes include respiratory disturbances with changes in airflow, primarily attributable to vocal cord paresis, supraglottic spasm, laryngeal muscle stimulation, or alterations to the brainstem's respiratory center and relay of information, among other possible mechanisms. Further studies are necessary to understand these manifestations, especially in underserved regions like the Puerto Rican and Hispanic populations, where access to sleep studies and research is limited.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01155
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1156 “NIV Nap” to Improve PAP Acceptability and
           Hypoventilation in Neuromuscular Disease

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      Pages: A495 - A495
      Abstract: AbstractIntroductionRespiratory failure is the most common cause of death in patients with several types of neuromuscular disease (NMD), including myotonic dystrophy type 1 (MD1). Non-invasive ventilation (NIV) is the cornerstone of treatment, but consistent use and acceptability remain a challenge. While nap-titrations have improved CPAP adherence in obstructive sleep apnea (OSA), we present a case where increased use and optimization of therapy was achieved through a daytime nap NIV titration.Report of case(s)47-year-old man with MD1, obesity , and mild OSA with long-standing PAP intolerance presented with dyspnea and hypoxia. Blood gas was suggestive of hypoventilation and work-up for hypoxia including CT chest with pulmonary artery protocol and echocardiogram with bubble were unremarkable. BIPAP and supplemental oxygen were applied with subsequent improvement. Pulmonary function testing was also consistent with hypoventilation, featuring MIP of 14 cmH2O (15% predicted), FVC of 3.30L (65% predicted), and no diffusion impairment. Shortly after discharge, patient was transitioned to NIV with iVAPS with EPAP 5 cmH2O, PS 4-12 cmH2O, TV 6cc/kg, and RR 12 with 4L oxygen. Despite consistent use, ongoing hypoxia was noted on home oximetry testing. The patient was then brought into the sleep lab for a daytime NIV titration study, or “NIV Nap.” During this 2-hour study, he was found to have persistent obstructive events, and was titrated to BIPAP S/T with EPAP 10 cm H2O, IPAP 16 cm H2O, RR 16, and I-time of 0.8-1.5 seconds which achieved optimal therapy for his OSA and hypoventilation. Following this titration, he was able to weaned off of nocturnal oxygen and reported improved symptoms. At 30-day follow-up, remote data demonstrated NIV usage 100% of days, >4-hour/day usage of 87%, residual AHI of 1.3/hr, average TV of 519 mL, and average MV of 10.8 L/min.ConclusionWhile daytime nap titrations have been used with good effect in patients with OSA, this tool has been underutilized in patients with neuromuscular disease and complex hypoventilation. Daytime “NIV Naps” can allow for increased acceptability of treatment while assuring safe and effective NIV therapy, and in this case demonstrated an increase in use.Support (if any)N/A
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01156
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1193 Oxycardiorespirogram' More Than a Fancy Word, an Alternate Way to
           Determine Respiratory Support in a Complex Infant

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      Pages: A509 - A510
      Abstract: AbstractIntroductionObtaining diagnostic cardiorespiratory data via a polysomnogram in extremely young infants can be challenging. A multi-channel oxycardiorespirogram (OCRG) can be used to evaluate cardiorespiratory status in infants during wake and sleep states. The study records heart rate and rhythm, respiratory rate, oxygen saturation, and chest wall movement over a course of 4-8 hours. During the study, supplemental oxygen may be provided and adjusted according to the patient’s needs. We present a case of an infant in which the OCRG was able to guide the amount of respiratory support as an alternate diagnostic tool.Report of case(s)Patient is a 2-month-old female born at 35 weeks gestation with prenatally diagnosed myelomeningocele, hydrocephalus (s/p ventriculoperitoneal shunt placement), absent cerebellum, and marked hypoplasia of the brainstem. She was admitted to NICU on room air and then developed frequent episodes of apnea associated with desaturations requiring escalation of respiratory support to intubation with mechanical ventilation. She was gradually weaned to high flow nasal cannula of 2 liters per minute (LPM). Capillary blood gas (CBG) at baseline was normal. A multi-channel OCRG to better characterize her apneic events was ordered. Apneas occurred most frequently during sleep and were associated with oxygen desaturations. Independent episodes of desaturations occurred during feeds and during sleep with an oxygen nadir or 86% and 75%, respectively. The frequency of the apneic/desaturation events improved with 0.5LPM supplemental oxygen given via conventional nasal cannula (NC). With these results, we recommended that she be discharged home on 24 hour supplemental oxygen support of 0.5LPM NC. At subsequent outpatient pulmonary clinic visits at 1-2 month intervals, the OCRG study recorded a decrease in frequency of the apneic episodes associated with desaturations over time. We have been able to wean her daytime supplemental oxygen use to 0.25LPM NC and keep the nighttime supplemental oxygen the same.ConclusionOur case highlights the importance of considering alternative diagnostic and monitoring techniques such as a multi-channel OCRG to determine supplemental oxygen respiratory support needs for patients who have frequent apneic episodes in both awake and sleep states in the neonatal and infant period.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01193
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1194 A Case of Unsuccessful Positive Airway Pressure Titration

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      Pages: A510 - A510
      Abstract: AbstractIntroductionOronasal masks are commonly used interfaces when treating obstructive sleep apnea (OSA). Masks modalities are often chosen based on patient preference and comfort however, oronasal masks may cause worsening of OSA in some individuals.Report of case(s)An 83 year old male presented for snoring, witnessed apneas, and daytime somnolence. A split-night PSG was ordered for evaluation. During the diagnostic portion of the study, the patient exhibited moderate OSA with an apnea hypopnea index (AHI) of 27/hr. The titration portion of the study was initiated with an oronasal (full face) interface. Continuous positive airway pressure (CPAP) pressure was titrated from 5cm H2O to 15 cm H20 with worsening of obstructive events and a residual AHI of 21 to 40/hr. Bilevel positive airway pressure (BiPAP) was then initiated and titrated from 19/15 cm H2O to 21/17 cm H20 with a continued residual AHI of 40/hr. No central apneas were noted. Upon review, suspicion arose whether the oronasal mask exacerbated the patient’s OSA. A repeat titration PSG was conducted with a nasal mask. With this mask a pressure of 8cm H20 resulted in a residual AHI of 0/hr. The patient was prescribed APAP 6-10 cm H20 with a nasal mask which resulted in excellent compliance and a residual AHI of 3.6/hr.ConclusionThis case report presents a patient with worsening OSA due to use of an oronasal interface. Prior studies have suggested that oronasal masks produce less retropalatal airway opening than nasal masks. There may also be an effect on anterior-posterior distance of the mandible in the setting of exhalation. When possible, oronasal masks should be avoided in lab or home titration studies as they may lead to worsening OSA leading to escalation of PAP pressures and/or adjustment in titration modality.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01194
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1195 Sleep-related Hallucinations

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      Pages: A510 - A510
      Abstract: AbstractIntroductionSleep-related hallucinations, encompassing visual and auditory experiences pose a complex clinical challenge. Here, we illustrate 2 cases with diverse underlying etiologies.Report of case(s)Case 1: 76-year-old male with 3 months of nocturnal visual hallucinations, occurring 3-5 nights per week. These ranged from familiar and unfamiliar faces and characters reminiscent of movies. Symptoms occurred when waking up in the middle of the night, with difficulty returning to sleep. Polysomnography (PSG) unveiled moderate obstructive sleep apnea (OSA) without findings indicative of parasomnias and no symptoms on the night of PSG. Brain MRI revealed chronic infarcts involving right basal ganglia and bilateral optic radiations. Lesions of structures that commonly cause visual hallucinations (optic lens, retina, thalamus, midbrain) were absent. The frequency of episodes decreased to 1-2 per month after initiating CPAP therapy. Potential mechanism of improvement could be PAP mediated optimization of perfusion to the ischemic penumbra. Case 2: 93-year-old male with an eight-year history of insomnia due to musical hallucinations (MH). Auditory experiences included church and semi-classical music, with 80% being familiar tunes. The patient, a former church choir member, has a history of progressive hearing loss and tinnitus. Brain MRI/MRA revealed chronic periventricular microvascular ischemic changes. Extended EEG showed no evidence of seizures. Audiometry confirmed moderate-severe bilateral sensorineural hearing loss. No response was seen to Levetiracetam, Gabapentin, Donepezil and behavioral therapy. Home sleep study revealed severe OSA. CPAP therapy did not result in improvement of MH. MH improved significantly with Lorazepam. Hypoacusis, psychiatric disorders, focal brain lesions, epilepsy and intoxication are common etiologies for MH. The etiology in this case is very likely due to hypoacusis. The hypothesis is deafferentation resulting in release phenomenon or spontaneous activity in the auditory pathway, manifesting as MH.ConclusionSleep-related and nocturnal hallucinations warrant a comprehensive evaluation. Differential diagnoses include neurological causes, including stroke, seizure, Multiple Sclerosis, tumor, vascular lesions, and neurodegenerative disorders. Other etiologies include psychiatric disorders, medications, alcohol, otologic and ophthalmic pathologies. It is also reasonable to evaluate for comorbid OSA as appropriate treatment may decrease the frequency of episodes and improve overall sleep in some patients.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01195
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1196 Use of Home Sleep Apnea Testing to Investigate Persistent Hypoxia in
           the Remote Setting

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      Pages: A510 - A511
      Abstract: AbstractIntroductionNocturnal oxygen titrations can be resource intensive, and often require the patient to undergo an attended polysomnogram (PSG). Veterans who live in remote areas are often reluctant to undergo PSG, particularly in those with multiple medical comorbidities that prohibit prolonged travel. We present a case of a veteran with severe OSA and persistent nocturnal hypoxia who underwent a remote oxygen titration using home sleep apnea testing (HSAT) equipment.Report of case(s)79-year-old male with history of hypertension and diabetes diagnosed with severe OSA (AHI 38 events/hour), with significant oxygen nadir of 65%. He was prescribed automatic positive airway pressure (APAP) of 6-16 cmH2O and a follow up 3-night oximetry was ordered which showed persistent nocturnal hypoxia. Remote monitoring showed regular PAP use with AHI < 5/hr during the nights of oximetry. Unfortunately, the patient was unable to travel for attended PAP and oxygen titration study for further diagnostic assessment. It was instead decided to repeat 3-night oximetry with use of supplemental oxygen (1, 2, 3 liters/minute for nights one, two, and three respectively). Results again showed persistent nocturnal hypoxia with AHI < 5/hr on remote data monitoring. 3-night HSAT connected to the patient’s APAP device was ordered, with bleed in oxygen at 2, 3, and then 4 liters/minute over the consecutive nights of the study. Results included the C-flow channel, which surprisingly showed persistent snoring and obstructive events (average AHI of 8/h) despite APAP, a discordant finding to that on remote data monitoring. The decision was made to transition patient to an automatic bilevel positive airway pressure mode with two-liter oxygen bleed in. This resulted in adequate treatment of OSA and nocturnal hypoxia as confirmed by follow up HSAT. It is notable that ongoing diagnostic evaluation of hypoxia is underway.ConclusionAside from its promise in diagnosing moderate to severe OSA, HSAT over oximetry alone may provide additional diagnostic information (C-flow channel) in patients with residual nocturnal hypoxia despite PAP. In patients who are not able to undergo formal attended titration studies such as those who live in remote settings, this is a potential alternative.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01196
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0820 Challenges to Pediatric Patients Sleeping Well in the Hospital:
           Environmental and Practice Considerations

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      Pages: A351 - A352
      Abstract: AbstractIntroductionPediatric oncology and bone marrow transplant (BMT) patients frequently experience poor sleep during their extended hospital stays due to various sleep disruptors. This study aimed to identify specific factors affecting the sleep of our hospitalized patients.MethodsHospitalized BMT / oncology patients aged ≥5 years old (n=25) and their parents completed a survey designed for this study, which involved describing the extent to which factors identified in prior studies / extant literature were barriers or facilitators to patient sleep. Over 5 consecutive days / nights, we measured the light that patients were exposed to and how frequently staff entered patient rooms during the night. Light intensity (lux) was collected via Condor ActTrust actigraphs installed at eye-level by the patient’s bed. Room entries were tracked via paper / pencil logs affixed to the door.ResultsParticipants (median age of 11.2 years) most frequently endorsed barriers related to vital sign checks, room entries, loud sounds, bright lights, medical procedures, and pain. Top sleep facilitators included reducing light in the room, pain / sleep medications, and having family nearby. Average light exposure varied over the course of the day: morning (median = 2.34 lux, range = 0.09-22.17), daytime (median = 15.55 lux, range = 3.49-125.63), evening (median = 10.48 lux, range = 2.64-64.82), and overnight (median = 1.03 lux, range = 0.28-9.44). Staff-recorded room entries averaged 5 per night, with one patient experiencing 18 room entries in a single night.ConclusionParticipants endorsed numerous barriers to getting good quality sleep while hospitalized. Based on both patient / family-report as well as objective measurements, it is evident that staff room entries and bright lights at night are not conducive to sleep. Light levels in patient rooms were routinely too dim during the day to optimally support circadian rhythm entrainment. Given that sleep plays a crucial role in health maintenance and recovery, hospitals should strive to reduce staff-related sleep disturbances where possible and optimize lighting in patient rooms. These efforts would create a more “sleep friendly” environment for both patients and their resident family members.Support (if any)AF is supported by an institutional training grant (National Institutes of Health T32DK063929).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0820
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0821 GPS-derived Green Space Exposure and Sleep Among Elementary School
           Children

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      Pages: A352 - A352
      Abstract: AbstractIntroductionExposure to greenspace has been linked to improved well-being among children such as cognitive restoration and reduced stress. Greenspace is also associated with increased exposure to light, a zeitgeber of the circadian system. Studies examining the association between greenspace exposure and sleep, however, have been equivocal, largely due to methodology related to static measures of environmental context. We address this issue by using GPS-derived measures of greenspace that move beyond static residential contexts, and examine multiple measures of access to greenspace.MethodsSchoolchildren in grades 1-3 in the ongoing Project Greenspace, Sleep, and Mental Health (G-SPACE) study in Rhode Island were recruited to wear a GPS and an accelerometer for seven days. GPS was used to identify stay points if participants spent 15 minutes in a space. We extracted and averaged Normalized Difference Vegetation Index (NDVI) values in 100m, 200m, 300m, 500m, and 1,000m circular buffers surrounding each participant's stay points to calculate greenspace exposure. Sleep measures were derived using actigraphy, and potential association with greenspace exposure was analyzed using a series of linear regression models.ResultsForty-nine participants had 398 valid days of wear-time. On average, participants wore devices for 6.2 days (SD=1.72). The mean sleep values included: Time in Bed, 9.63 hours; Total Sleep Time, 9.17 hours; Sleep Efficiency, 88.78%, and Wake After Sleep Onset (WASO), 37 minutes). Both TIB (hours) (100m β:1.98, p=0.01; 200m β: 1.87, p=0.01; and 300m β: 1.65, p=0.05) and TST (hours) (100m β: 1.94, p=0.01; 200m β:1.67, p=0.01; and 300m β: 1.37, p=0.05) showed positive associations with mean NDVI across smaller buffer distances. However, associations between Sleep Efficiency, WASO and greenspace exposure were not significant.ConclusionGPS-derived greenspace exposures in close proximity to daily activities are associated with total sleep time among elementary school children, with the strength of the association diminishing with each widening radius from the stay point. Our results have implications for urban planning and greening of neighborhoods, but additional analyses are needed with larger sample sizes and control for sociodemographic factors.Support (if any)Project G-SPACE is supported by the National Institutes of Health/National Institute on Minority Health and Health Disparities (R01MD016241) and NIGMS 5P20GM139743
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0821
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0822 The 3-30-300 Rule for Green Space Exposure and Sleep in Elementary
           School Children

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      Pages: A352 - A353
      Abstract: AbstractIntroductionIn 2015, the United Nations identified a target of “universal access to safe, inclusive and accessible, green and public spaces “to be implemented by 2030. However, few guidelines exist to equitably increase access to the health-promoting qualities of high-quality green space. Recently, the “3-30-300” rule was introduced as a benchmark to ensure universal access to green space. This study aimed to use the 3-30-300 benchmark for green space exposure, to determine whether these metrics are associated with sleep phenotypes in elementary school children.MethodsElementary school children in grades 1-3 in the ongoing Project Greenspace, Sleep, and Mental Health (G-SPACE) study in Rhode Island were recruited to wear a GPS and an accelerometer for seven days. The 3-30-300 rule was applied to their residential address. ‘3’ was quantified using the Green View Index (GVI), derived from the panoramic street view from Google. ‘30’ refers to a minimum 30% tree canopy within a 200m buffer of the home;‘300’ is based on home distance to ≥50m² greenspace within 300m. The association between the mean greenspace measurements and sleep measures, Total Sleep Time (TST, hours), Sleep Efficiency (SEF), and Wake After Sleep Onset (WASO, minutes) was analyzed using T-tests.ResultsThere is no statistically significant difference between viewing more than three trees versus less (TST mean 9.19 vs 8.95, SEF mean 88.5% vs 87.9%, and WASO mean: 37.8 vs. 39.6); having ≥ 30% tree canopy versus less ( TST mean: 9.16 vs 9.01, SEF mean 88.1% vs 88.2%, and WASO mean: 38.4 vs 39 ); and having 50m2 greenspace within 300m versus without (TST mean: 8.94 vs 9.18, SEF mean 88.3% vs 88.2%, and WASO mean: 38.5 vs 38.8).ConclusionParticipants that met the benchmarks for the 3-30-300 rule did not have better sleep measures compared to those that did not. Due to the multifactorial nature of sleep, this benchmark may not capture the contextually relevant locations that may influence sleep health profiles among children.Support (if any)Project G-SPACE is supported by the National Institutes of Health/National Institute on Minority Health and Health Disparities (R01MD016241) and NIGMS 5P20GM139743
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0822
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0823 Associations Between Parental Anxiety, Psychological Distress, and
           Infant Sleep Difficulties

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      Pages: A353 - A353
      Abstract: AbstractIntroductionInsufficient sleep in infancy is linked with deleterious health outcomes, encompassing compromised brain development, learning, mental functioning, and emotional states. Whether parents' emotional symptoms influence infant sleep has not been examined at the national level comprehensively. To explore this question observationally, we investigated associations between parental emotional symptoms and disturbances in infant sleep patterns.MethodsThis study utilized data from the National Health Interview Survey encompassing 447 mothers and 304 fathers and their infants (0-1 year; n=751) to examine associations among maternal and paternal anxiety, psychological distress, and infant sleep disturbances. Parents used the Baby Pediatric Symptom Checklist to report their infant sleep symptoms (troubles falling asleep: "Is it hard to put your child to sleep'” and staying asleep: "Does your child have trouble staying asleep'", with responses “not at all” (N), “somewhat” (S), “very much” (V). Predictors included maternal and paternal anxiety levels, gauged by frequency of feelings of worry, nervousness, or anxiety. Psychological distress was measured using the Kessler-6 scale. Multi-group generalized structural equation modeling was employed. Covariates were: age, sex, race/ethnicity (parent/infant), marital status, education, employment, nativity, poverty level, number of children and adults in household, and chronic health conditions (parent).ResultsEndorsement rates for trouble falling asleep were: N=79.6%, S=17.6%, and V=3.4%, and for trouble staying asleep: N=84.5%, S=13.4%, and V=2.1%. Compared with mothers who never experienced anxiety, mothers who reported anxiety a few times a year or weekly were 3.0 and 4.0 times as likely to report their infant having trouble falling asleep. Mothers experiencing anxiety a few times a year, monthly, or weekly, were 3.5, 5.0, and 5.2 times as likely to report their infant having trouble staying asleep. These associations were not evident among fathers. No associations were identified between maternal or paternal psychological distress and difficulties in infant sleep initiation or maintenance.ConclusionResults from this study align with previous clinical research showing differential associations between infant sleep and maternal and paternal mental health symptoms. Future work is needed to better understand why these differences exist in anxiety and to elucidate why psychological distress was not linked with infant sleep.Support (if any)COBRE Award P20GM139743
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0823
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0824 The Association Between Sleeping Arrangements and Breastfeeding
           Duration

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      Pages: A353 - A353
      Abstract: AbstractIntroductionThe World Health Organization recommends that infants be exclusively breastfed for at least the first 6 months of life, and then partially breastfed until 2 years of age and onward, if preferred. However, the choice to breastfeed an infant is influenced by cultural, biological, and social factors. For instance, factors which may promote breastfeeding include bedsharing, but the current literature requires more longitudinal examinations and follow-ups. The current project aims to investigate the associations between bedsharing at 6 months and the duration of breastfeeding.MethodsThe analysis included data from 294 mother-infant dyads (52 bedshared) from the Maternal Adversity, Vulnerability and Neurodevelopment cohort. Maternal reports of their infant’s sleep location were reported at 6 months of infancy. Infants who shared a bed with their mother were considered to bedshare, whereas those who slept in the same room as their mother, in their own room alone, or in their own room with someone else where not considered to bedshare. A retroactive measure of breastfeeding was given to mothers (until infants were 24 months), in which they were asked how old the infant was when they stopped breastfeeding. An independent samples t-test was conducted to compare breastfeeding duration between infants who bedshare and those who do not.ResultsBedsharing infants were breastfed for a longer period (in months; M=12.87, SD=5.21) than infants who did not bedshare (M=10.64, SD=3.97; t(292)=-3.48, p=<.001).ConclusionThese results show that infants who bedshare with their mother are likely to be breastfed for about 2 months more. These results provide support for the protective nature of bedsharing at 6 months on breastfeeding duration. Given these potential benefits, these results highlight the need for clear recommendations for parents to safely practice bed sharing if they are willing to use this sleeping arrangement.Support (if any)Malka Hershon holds a Canada Graduate Scholarship - Master’s program (SSHRC). Dr. Pennestri holds a Chercheur-Boursier Award from the Fonds de recherche du Québec – Santé and a William Dawson Award from McGill University.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0824
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0825 Sweet Dreams Are Made of This: Improving the Family Bond with Better
           Sleep for Children 6 Months to 6 Years Old

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      Pages: A353 - A354
      Abstract: AbstractIntroductionThis comprehensive review explores methods employed to improve pediatric sleep, emphasizing developmental trends, challenges, and health impacts. The narrative navigates through behavioral modification techniques, responsive parenting, and innovative digital therapeutic interventions, offering a holistic perspective on pediatric sleep dynamics. The primary objective is to evaluate the efficacy of responsive parenting techniques within the Batelle Sleep School program in improving pediatric sleep patterns and enhancing overall family well-being. This study aims to contribute evidence-based insights into the complex interplay between sleep quality, parenting styles, and child development.MethodsThe study involves a retrospective analysis of surveys from under 500 families with children aged six months to six years enrolled in the Batelle Sleep School program from October 2022 to March 2023. Quantitative and qualitative data will focus on sleep assessments, parental confidence, sleep latency, and awakening surveys. The intervention spans two weeks, during which parents follow the program's guidelines.ResultsPre-program and post-program data will be analyzed to assess changes in sleep latency and the number of awakenings. Statistical methods, including paired t-tests, will be employed for quantitative analysis, while qualitative data will undergo thematic analysis to identify common themes related to family dynamics and program effectiveness.ConclusionThis research aims to provide evidence-based recommendations for parents, healthcare professionals, and researchers by investigating the integration of responsive parenting techniques with a digital therapeutic in the context of the Batelle Sleep School program. Bridging the gap between pediatric sleep challenges and effective interventions, this study contributes to the evolving landscape of sleep medicine, recognizing the diverse needs of families and offering tailored solutions for improved pediatric sleep.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0825
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0925 A Multilevel Time-lagged Mediation of Nightmare and PTSD Symptom
           Severity Across Time in a Combined Treatment

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      Pages: A397 - A397
      Abstract: AbstractIntroductionThis study sought to contribute to understanding the role of sleep disturbances as a potential hallmark of PTSD through examining the relationship between changes in post-trauma nightmare (PTNM) severity (nightmare frequency and distress) and symptoms of PTSD over time during a combined treatment for PTSD and PTNMs.MethodsIndividuals diagnosed with PTSD and having at least weekly nightmares (n = 84) were randomized into one of three treatment conditions: 12-session Cognitive Processing Therapy (CPT) only (n = 31), CPT followed by 5-session Exposure, Relaxation, and Rescripting Therapy (ERRT) condition (n = 29; CPT+ERRT), or ERRT followed by CPT (n = 24; ERRT+CPT). Multilevel time-lagged mediation models were analyzed to examine if nightmare severity (frequency and distress) measured at an earlier time point (t1; baseline, week 6, week 12) mediated the change in PTSD symptom severity at a later time point (t2; week 6, week 12, or week 17). The reverse relationship was also explored. An exploratory aim focused on examining if the order of treatment (CPT+ERRT or ERRT+CPT) moderated the mediated relationships.ResultsAcross all three treatment conditions, there were statistically significant reductions in PTSD symptom and nightmare severity over time. In the unmoderated mediation models, there were no significant indirect effects detected. When treatment order was included as a moderator, there was a conditional effect of treatment order on the indirect effects of time on nightmare severity at t2 through PTSD symptom severity at t1. Only in the ERRT+CPT condition was there a statistically significant negative relationship of time on nightmare and PTSD symptom severity at t1 (ps < .05). Furthermore, only in the ERRT+CPT condition, there was a statistically significant negative relationship between nightmare severity at t1 and PTSD symptom severity at t2. Therefore, only in the ERRT+CPT condition did PTSD symptom severity at t1 mediate the relationship between time and nightmare severity at t2.ConclusionThese results suggest that earlier increases in PTSD symptom severity are an important mediator of change for the improvement of nightmares specific to receiving ERRT first. Clinicians may glean insight from this study that can impact shared decision making with patients on treatment planning.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0925
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0926 Dreaming Big: Launching a Web-Based Provider Training for Cognitive
           Behavioral Therapy for Nightmares

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      Pages: A397 - A398
      Abstract: AbstractIntroductionFew providers are trained to deliver Cognitive Behavioral Therapy for Nightmares (CBT-N) despite the impact of nightmares on physical and mental health. Reduced access to treatment is partially due to limited training opportunities. Web-based training resources are valuable because they are easily accessible, are cost-efficient, and can be reviewed by providers as needed. This presentation describes the development, testing, and launch of a web-based provider training for CBT-N.MethodsNightmare, trauma, and sleep disorder experts collaborated to develop material for the web-based CBT-N training. Next, 17 providers tested a first draft of the web-site. After feedback was integrated, 50 providers were recruited to complete the updated draft of the website and will complete feedback in January 2024. To assess learning, providers completed multiple-choice questions before and after each of the 10 training modules. Item Response Theory (IRT) analyses were used to identify items of low discrimination and difficulty for further refinement.ResultsOverall, testers had positive reactions to the training content and website. The training content was improved by adding more figures, animations, and therapy demonstration videos and integrating more cultural considerations. Usability was improved by addressing bugs and enhancing intuitive site navigation. Based on IRT analyses of multiple-choice questions, 40 (out of a total 80) items were replaced and will be re-evaluated at the conclusion of beta testing.ConclusionLaunching in June 2024, CBTnightmares.org is a comprehensive, engaging, and accessible training after two phases of development and feedback from almost 70 licensed providers. The final phase of testing, to be conducted in April 2024, will examine the equivalence of online training compared to a live virtual workshop (Target N = 100). Providers will complete questionnaires and a mock session with a standardized patient to examine therapist proficiency and fidelity. The hypotheses are that this web-based course will be equivalent to a live virtual workshop. This project directly addresses the dissemination and implementation cliff of empirically supported treatment for nightmares.Support (if any)This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Review Medical Research Program under Award No. W81XWH-21-1-0576.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0926
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0927 Shining Light on Nightmare Treatment: Expert Panel Recommendations
           for Cognitive Behavioral Therapy for Nightmares

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      Pages: A398 - A398
      Abstract: AbstractIntroductionFew providers are trained to deliver Cognitive Behavioral Therapy for Nightmares (CBT-N) despite the impact of nightmares on physical and mental health. Reduced access to treatment is partially due to limited training opportunities. Web-based training resources are valuable because they are easily accessible, are cost-efficient, and can be reviewed by providers as needed. This presentation describes the development, testing, and launch of a web-based provider training for CBT-N.MethodsNightmare, trauma, and sleep disorder experts collaborated to develop material for the web-based CBT-N training. Next, 17 providers tested a first draft of the web-site. After feedback was integrated, 50 providers were recruited to complete the updated draft of the website and will complete feedback in January 2024. To assess learning, providers completed multiple-choice questions before and after each of the 10 training modules. Item Response Theory (IRT) analyses were used to identify items of low discrimination and difficulty for further refinement.ResultsOverall, testers had positive reactions to the training content and website. The training content was improved by adding more figures, animations, and therapy demonstration videos and integrating more cultural considerations. Usability was improved by addressing bugs and enhancing intuitive site navigation. Based on IRT analyses of multiple-choice questions, 40 (out of a total 80) items were replaced and will be re-evaluated at the conclusion of beta testing.ConclusionLaunching in June 2024, CBTnightmares.org is a comprehensive, engaging, and accessible training after two phases of development and feedback from almost 70 licensed providers. The final phase of testing, to be conducted in April 2024, will examine the equivalence of online training compared to a live virtual workshop (Target N = 100). Providers will complete questionnaires and a mock session with a standardized patient to examine therapist proficiency and fidelity. The hypotheses are that this web-based course will be equivalent to a live virtual workshop. This project directly addresses the dissemination and implementation cliff of empirically supported treatment for nightmares.Support (if any)This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Review Medical Research Program under Award No. W81XWH-21-1-0576.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0927
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0928 Sleep, Mediating the Risk of Cognitive Impairment in Post-traumatic
           Stress Disorder via Noradrenalin Dysregulation

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      Pages: A398 - A399
      Abstract: AbstractIntroductionThere is growing evidence that Post Traumatic Stress Disorder (PTSD) increases the risk of dementia, and sleep impairment in PTSD may contribute to this link. Increased cerebrospinal fluid (CSF) norepinephrine (NE) is associated with glymphatic dysfunction and poor neurocognitive outcomes. To understand the role of sleep in mediating the increased risk of dementia in PTSD, we investigated whether sleep-specific symptoms of PTSD are related to CSF NE level and cognitive function.MethodsWe analyzed a prospective study of combat Veterans with repetitive blast mild traumatic brain injury (mTBI). All underwent CSF sampling and the PTSD and DSM checklist 5 for military (PCL-M), a 17-item self-report measure reflecting DSM-IV symptoms of PTSD. We derived a sum score of each symptom cluster; Questions 1-5: “Re-Experiencing”, 6-12: “Avoidance and Negative Cognition and Mood” and 13-17: “Hypervigilance”. Among the 17 items, questions 2 and 13 are sleep-related symptoms. We calculated correlations of the sum score of each category with CSF NE level with and without sleep-specific questions (2: nightmare and 13: sleep disruption) with CSF NE levels. Trails A (attention and visual motor function) and Trail B (executive function) tests were performed.ResultsA total of 49 mTBI participants were included. A sum score of symptoms related to re-experiencing (r=0.34, p=0.001) and hyperarousal (r=0.3, p=0.03) were weakly correlated with elevated CSF NE. Excluding the sleep-specific symptom questions from these two categories attenuated the correlation (re-experiencing r=0.31, p=0.03; hyperarousal r=0.2, p=0.1). The scores of sleep-specific symptoms were separately examined, the correlation with CSF NE was (nightmare r=0.37, p=0.0009; sleep impairment r= 0.35, p=0.001). The symptom cluster related to avoidance and negative cognition and mood was not associated with NE level (r=0.15, p=0.9). Elevated CSF NE was strongly associated with lower Trials B performance (r=0.34, p=0.001). Trails A performance was not associated.ConclusionPTSD-associated sleep symptoms of nightmares and sleep disruption are most strongly associated with CSF NE. CSF NE is associated with worsening executive function measured by Trails B. Sleep symptoms may be the driver of the poor neurocognitive outcomes in patients with PTSD. Traditional symptom clusters of PTSD may not accurately reflect the risk of cognitive function.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0928
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1159 The Cyclical Daytime Sleeper: A Rare Case of a Sighted Teenager with
           Non-24-Hour Sleep-Wake Disorder

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      Pages: A496 - A497
      Abstract: AbstractIntroductionDaytime fatigue in teenagers may be hand-waved as hours of screen time the night before and it can be difficult for families to accurately describe sleep habits. These factors quite often obscure an underlying sleep disorder. Here we report the rare case of a sighted teenage patient who presented with sleep disturbance and erratic bedtimes and was found to have non-24-hour sleep wake disorder (N24SWD).Report of case(s)16-year-old male with a past medical history of ADHD and insomnia, presented to clinic for evaluation of recurrent and inappropriate sleep time with residual hypersomnolence. Pediatrician first saw the patient for difficulty waking up for school as well as trouble falling asleep at night. Initially, it was suspected to be insomnia due to poor sleep hygiene secondary to significant electronic usage prior to bedtime. When symptoms did not improve, the patient was started on hypnotics including clonidine to help with sleep and daytime stimulant medication was adjusted to help with wakefulness. Pharmaceuticals did not help with sleep symptoms, and the patient’s hypersomnolence led to cyclical absenteeism from school and risk for expulsion. On initial presentation to the sleep clinic, patient and family had difficulty describing his erratic sleep routine. Two weeks of sleep diaries were provided to help characterize the patient’s sleep patterns. No suspicion for sleep disordered breathing, parasomnias nor restless leg syndrome were noted. Sleep diary showed a sleep pattern delaying consistently by 1-2 hours each day. Total sleep each night was 7-9 hours, with sleep onset latency of 30 minutes and no significant awakenings. This activity is classic for non-24 sleep-wake phase disorder. This patient was treated with a combination of timed tasimelteon and bright light therapy along with chronotherapy for resynchronization of the intrinsic circadian rhythm.ConclusionN24SWD is commonly seen in blind individuals affecting up to 50% of that population. It is very rare in sighted individuals, and may be harder to discern when confounded with conditions like ADHD or poor sleep hygiene. Having patients complete a sleep diary is a cost effective and low investment intervention that may elucidate their condition and ensure timely treatment.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01159
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1160 Examining Criteria in Hypoglossal Nerve Stimulation: A Case Insight

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      Pages: A497 - A497
      Abstract: AbstractIntroductionIntroduced in 2001, the hypoglossal nerve stimulator (HGNS) is an implantable device designed to treat moderate to severe obstructive sleep apnea (OSA). FDA-approved on May 1, 2014, it offers an alternative for patients unable to benefit from continuous positive airway pressure (CPAP) therapy. However, not all patients may benefit, leading to the establishment of exclusion criteria based on factors such as body mass index, central and/or mixed apnea index >25%, complete concentric palatal collapse, patient age, and certain comorbidities such as neuromuscular and cardiac diseases. It is important to consider these criteria when screening patients to ensure the appropriate use of the device. Here, we present a case illustrating a patient who received a HGNS device according to established criteria but may not have been an ideal candidate.123Report of case(s)A 55-year-old male with a history of hyperlipidemia, depression, and hypothyroidism status post (s/p) thyroidectomy to treat multinodular goiter, moderate OSA (AHI 16.2 events/hr) s/p uvulopalatopharyngoplasty and failed CPAP tolerance, underwent HGNS implantation. Post-procedure, an abnormal electrocardiogram led to a referral to cardiology, where he was found to have heart failure with a reduced ejection fraction of 20%. A follow-up titration polysomnography showed central events, presumed treatment emergent, following HGNS implantation. He is currently being monitored by cardiology for the optimization of his heart failure. Upon re-evaluation of his initial pre-implantation study, we felt that several of the hypopnea events may have been central hypopneas. Although his OSA is controlled with the HGNS, the patient still has central sleep apnea that is not being treated.ConclusionThere is a lack of routine differentiation between central and obstructive hypopneas in current assessments, which poses a potential oversight in patient selection, impacting treatment planning. Central hypopneas should be included when assessing the 25% threshold of central events that would otherwise exclude a patient from receiving treatment. This case highlights the need for more stringent scoring criteria, specifically incorporating central hypopneas, to better screen high-risk patients and identify optimal candidates for hypoglossal nerve stimulation.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01160
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1189 Intriguing Correlation Between Melatonin and Restless Legs Syndrome

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      Pages: A508 - A508
      Abstract: AbstractIntroductionA temporal relationship between the onset of melatonin secretion at night and the worsening of restless legs syndrome (RLS) symptoms has been described in the literature. As a frequently used adjunctive to help combat insomnia, melatonin continues to be widely used.Report of case(s)A 65-year-old man with RLS, migraines, and onset and maintenance insomnia presented to our clinic with severe insomnia. He takes melatonin 3 mg and falls asleep in his chair while watching television. Then, he moves to the bed and has difficulty falling asleep. He will occasionally take extra doses of melatonin. He wakes up multiple times for a variety of reasons. His wake time is 4.30 AM for work. He had a home sleep apnea test that was negative. He describes crawling and achy feelings in his legs throughout the day. Sensation is associated with an urge to move or walk. These achy feelings are worse at nighttime. He currently takes 1200 mg of gabapentin three times a day. In the last year, his dose tripled despite adequate ferritin levels. Our patient did not recognize any temporal correlation between starting melatonin and worsening of his RLS but was agreeable with stopping melatonin. Within a week of stopping melatonin, his RLS symptoms became controlled and were no longer interrupting his sleep. We continued to work on his sleeping habits.ConclusionThis case adds to increasing evidence of a correlation between melatonin and RLS. No substantial evidence was found during our literature search. One theory suggests that melatonin can inhibit dopamine release by suppressing calcium influx into stimulated nerve endings. Considering the widespread use of melatonin and the detrimental effect of RLS on quality of life, more studies are needed to evaluate this hypothesis.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01189
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1190 Periodic Limb Movement Disorder Masked by Concurrent Focal Aware
           Seizures

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      Pages: A508 - A508
      Abstract: AbstractIntroductionSleep disorders such as sleep apnea and sleep-related movement disorders are more common in patients with epilepsy compared to the general population. Complex rhythmic motor events related to periodic limb movement disorder (PLMD) can overlap with the hypermotor phenomenon of nocturnal seizures, making it a challenging diagnosis solely based on clinical description. The recognition of these repetitive stereotypical movements from seizures would be essential to guide targeted therapy.Report of case(s)We report a patient with focal aware seizures who concurrently experienced sensory symptoms typical of restless leg syndrome (RLS) as her ictal symptoms, as well as paroxysmal nocturnal motor symptoms meeting the diagnostic criteria of PLMD. A 51-year-old right-handed female presented with two years of seizures and nocturnal episodes primarily characterized by creepy crawly feeling in both her upper and lower extremities as well as her trunk with intact awareness. The patient also endorsed non-restorative sleep and daytime sleepiness. During an admission to the epilepsy monitoring unit, several habitual events were recorded that were consistent with fronto-temporal seizures. Interestingly, the majority of her ictal events started with the same creepy crawly sensation. Blood count, serum chemistry, and liver and renal function tests were unremarkable, except for very low serum ferritin levels (4.5 ng/ml) which, in combination with her sensory symptoms raised suspicion for PLMD. Subsequent polysomnography (PSG) showed mild OSA (AHI 9.8/h) and moderate to severe PLMD (43 events/h). Symptoms improved after iron supplementation along with better seizure control (adding lamotrigine to her levetiracetam). A repeat ferritin improved to normal range (46 ng/ml).ConclusionOur case demonstrates that clinical presentation of RLS/PMLD can be indistinguishable from the primary seizure semiology. RLS/PLMD can be a consideration in patients with epilepsy complaining of sensory ictal semiology as seen in this case and may warrant further work-up.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01190
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0882 The Association Between Objective Daytime Sleepiness and Glucose
           Metabolism in OSA Patients: A Metabolomics Study

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      Pages: A378 - A379
      Abstract: AbstractIntroductionObjective, but not subjective excessive daytime sleepiness (EDS) has been proposed to link to cardiometabolic comorbidity in obstructive sleep apnea (OSA). We aimed to examine the joint effect of OSA and objective EDS on glucose metabolism and the underlying mechanisms.MethodsThe multiple sleep latency test (MSLT) and Epworth sleepiness scale (ESS) were used to assess objective and subjective EDS, respectively. Disordered glucose metabolism was defined as either a physician-diagnosis or having fasting blood glucose levels ≥ 5.6 mmol/L. Values of fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) higher or equal to the median values of our sample were defined as high fasting insulin and insulin resistance. Serum metabolomics was used to explore the underlying pathways.ResultsAmong 114 consecutive OSA patients, lower MSLT values was marginally significantly associated with higher levels of fasting blood glucose (β = −0.181, p = 0.052, poor strength), and significantly associated with insulin (β = −0.308, p = 0.002, fair strength) and HOMA-IR (β = −0.321, p = 0.001, fair strength). Furthermore, objective EDS was significantly associated with increased odds of disordered glucose metabolism (OR = 5.781, 95%CI 1.232 - 27.135), elevated fasting insulin (OR = 4.317, 95%CI 1.357 - 13.731) and insulin resistance (OR = 5.621, 95%CI 1.581 - 19.984). Metabolomics analyses showed that dysregulation of valine-related metabolism linked the association between objective EDS and impaired glucose metabolism in patients with OSA. No association between subjective EDS and impaired glucose metabolism was observed.ConclusionOSA with objective, but not subjective EDS is associated with impaired glucose metabolism. Dysregulation of valine-related metabolism may contribute to the association between objective EDS and impaired glucose metabolism in OSA.Support (if any)This study was supported by the National Natural Science Foundation of China [No.81970087; No.82270105; No.82300117] and 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant [2020LKSFG05B].
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0882
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1147 Sleep Enigmas in Primary Ciliary Dyskinesia: An Atypical Case of
           Sleep Movement Disorders and Alpha-Delta Sleep

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      Pages: A491 - A492
      Abstract: AbstractIntroductionSleep disorders are characterized by the impairment of the quality, timing, and amount of sleep, which results in daytime distress and functioning. Primary Ciliary Dyskinesia (PCD) is a rare genetic condition with oto-sino-pulmonary complications associated with various comorbidities, including sleep-related disorders. However, sleep-related research and its implications in PCD are substantially limited.Report of case(s)A 40-year-old Puerto Rican female with a history of RSPH4A [c.921 + 3_921 + 6delAAGT] PCD founder mutation was evaluated for sleeping difficulties. Upon taking history, the patient mentioned that she has been struggling with getting adequate sleep, where she complains of difficulty falling asleep, occasional snoring, and unexplained movements while sleeping. Physical examination presented with Mallampati (4+) but did not show significant neck circumference enlargement, body-mass index, or other neurologic deficits. Diagnostic polysomnogram did not show obstructive sleep apnea (OSA), with a baseline Apnea-Hypopnea Index (AHI) of 1.3/hr. The patient had a prolonged wake after sleep onset (WASO) period, resulting in poor sleep efficiency. The EEG showed alpha delta sleep. Moreover, Periodic Limb Movements in Sleep (PLMS) were present with important sleep fragmentation during the first half of the study (Periodic Limb Movement Index of 15.9/hr); eventually improving when the patient was able to consolidate sleep. Other movements during sleep/drowsiness were appreciated, with large amplitude and rhythmic artifacts in the EEG and legs EMG channels. These movements are most consistent with Rhythmic Movement Disorder, more notoriously in the lower extremities.ConclusionTo our knowledge, this is a unique documented PCD case with the presence of Alpha-Delta Sleep, presenting PLMS, and Rhythmic Movement Disorder. Comprehensive screening protocols, neuropsychiatric evaluation, and additional sleep studies should be considered to evaluate these complexities in patients with PCD. Further studies are required to identify whether these sleep-related disorders are due to neurophysiologic manifestations as seen with Alpha-Delta Sleep, a neurodevelopmental or neurodegenerative process associated with this ciliopathy. Multicentric clinical trials are essential for this type of ciliopathy, especially among Puerto Rican and Hispanic populations.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01147
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1148 Narcolepsy with Cataplexy in a Pediatric Patient with a Thalamic
           Mass: A Case Report

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      Pages: A492 - A492
      Abstract: AbstractIntroductionA female adolescent patient with gradual hypersomnolence.Report of case(s)The patient is a 16-year-old with gradual onset of parasomnias, leg cramps, headaches and history of gastroesophageal reflux, and asthma. Her ferritin was low, and a diagnosis of restless legs was made, the patient was started on oral iron supplements without improvement. Intravenous iron replacement therapy was tried with laboratory improvement (>50 ng/ml) but not clinical. Clonazepam and gabapentin were tried without success. Over time, she developed more tiredness and started to fall asleep in class. A sleep study was done which showed primary snoring without evidence of sleep disorder breathing, PLMD index was 4.4, and REM sleep latency was 120 minutes. The headaches got worse, and she was seen by neurology, MRI showed a hyperintense 6mm rounded lesion on the left side of the thalamus. She started pregabalin and remained stable for almost a year. Sleepiness got worse with sleep attacks. She was sleeping 12-14 hours at night with a 1–2-hour nap in the afternoon. A Multiple sleep latency test (MSLT) showed no evidence of sleep-onset rapid eye movement periods (SOREMPs), and the mean sleep latency was 9.6 minutes. She was diagnosed with primary hypersomnolence. Modafinil and methylphenidate were tried for hypersomnolence and added duloxetine for headaches without improvement. A repeated sleep study and MSLT, showed a mean sleep latency of 4.9 minutes without SOREMPs, Epworth Sleepiness Scale (EPS) of 20. Later she started with jerky legs and tripping/falling in gymnastics practice, diagnosis of narcolepsy with cataplexy was made. Sodium oxybate was started with improvement of hypersomnolence (EPS: 8) and cataplexy.ConclusionThe patient presented with insidious onset of restless legs, migraines, and hypersomnia. In pediatric patients classic narcoleptic symptoms are not always present. Interestingly restless legs and migraines can precede the diagnosis of narcolepsy. Our patient had no SOREMPs on the MSLT on two different occasions but in her last MSLT her mean sleep latency was 4.4 minutes and soon after developed cataplexy. Due to the presence of a thalamic mass, we conclude that this patient has secondary narcolepsy type 1.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01148
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1184 The Leptin Puzzle: Decoding Genes, Morbid Obesity, Sleep-Related
           Disorders and Its Influence

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      Pages: A506 - A506
      Abstract: AbstractIntroductionThe role of early-onset obesity-related genetic predisposition and leptin receptor variants have been studied in previous studies. However, sleep-related disorders related to a genetic predisposition, leading to obesity, and how leptin could play a role in sleep-related disorders have been limited. In this study, we explore a case of how leptin receptor variants could play a role in the relationship between obesity and sleep-related disorders.Report of case(s)Case of a 17-year-old Hispanic female presented with a history of frequent snoring, gasping for air while sleeping, daytime sleepiness, sleep onset, maintenance difficulties, and limb movements at sleep. Polysomnography (PSG) was performed and later diagnosed with Obstructive Sleep Apnea (OSA). Respiratory disturbances were associated with oxygen desaturation down to a nadir of 68 % during sleep and a mean oxygen saturation of 91%, with an AHI of 22.7 events/hr. Additional genetic studies were performed to assess the causes of obesity, presenting with BBS9 heterozygous gene for a sequence variant defined as c.396GC, which is predicted to result in the amino acid substitution p.Gln132His. Furthermore, this patient is heterozygous in the LEPR gene for a sequence variant defined as c.658GA, which is predicted to result in the amino acid substitution p.Val220Ile, which has been reported in the heterozygous state in severe obesity, which increases leptin levels due to mutations in its receptor.ConclusionLeptin dysregulation has been associated with an increased predisposition to obesity, which could lead to sleep-related disorders, such as OSA. What is novel in our case is that our patient has an LEPR gene heterozygous variant, leading to an increase in leptin levels, a greater increase in metabolic dysregulation, and increased body weight, thus worsening her OSA. At the same time, research has shown that conditions such as OSA also increase leptin levels, which could worsen her OSA and prognosis. Further research is needed to assess LEPR and its role in OSA, especially in Hispanic populations, where research is limited.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01184
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0812 Modelling the Impact of Reallocating Sleep and Physical Activity on
           Anxiety and Depression Symptoms in Adolescents

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      Pages: A348 - A348
      Abstract: AbstractIntroductionInsufficient sleep and sedentary behavior, both associated with increased anxiety and depression symptoms, are highly prevalent in US adolescents. Our lab previously found that extending adolescents’ sleep duration decreased sedentary behavior (SB). However, the impact of replacing time spent in unhealthy behaviors (e.g., SB) with healthy behaviors (e.g., sleep, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) on mental health is unknown. Therefore, we aimed to understand the impact of replacing SB and time-in-bed (TIB) with LPA and MVPA on anxiety and depression symptoms in habitually short-sleeping adolescents using isotemporal modeling.MethodsBaseline data from a study of habitually short-sleeping (≤7 hours on school nights) and physically inactive (< 3h MVPA/week) adolescents ages 14-19 years were analyzed. During one week of home monitoring, thigh-worn accelerometry assessed SB, LPA, and MVPA; wrist-worn actigraphy estimated TIB. Participants completed PROMIS Anxiety and Depressive Symptoms scales. Isotemporal substitution modeling, which uses cross-sectional data to predict the effect of reallocating time spent in one activity with an equal amount of time spent on another, was used to estimate the effect of movement behavior reallocation on mental health symptoms.ResultsThirty-four adolescents completed study measures (age=16.0±1.2 years, 70% female, 88% Non-Hispanic White). Reallocating 1 hour/day of SB to an equal amount of LPA within the model was associated with a 4.5-point improved depression T-score (p=0.019) but no difference in anxiety symptoms (p>0.10). Neither replacing 1 hour/day of SB with TIB or MVPA nor replacing 1 hour/day of TIB with LPA or MVPA within the model were associated with changes in depression or anxiety symptoms (all p>0.10).ConclusionReplacing 1 hour/day of SB with LPA but not MVPA was associated with significantly lower depression symptoms in habitually short-sleeping, physically inactive adolescents. However, neither reallocation of SB to TIB nor of TIB with PA was associated with mental health symptoms. As this modeling analysis is cross-sectional in nature, further prospective research is needed to evaluate the impact of replacing SB with healthy behaviors, including meeting recommended sleep and PA guidelines, to determine impacts on adolescent wellbeing.Support (if any)NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; NIH CTSA UL1TR002535
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0812
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1139 The Association Between Sleep and Coronavirus disease-19 Severity

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      Pages: A488 - A489
      Abstract: AbstractIntroductionSleep disturbances are key symptoms of long-COVID syndrome, particularly in patients with severe COVID-19. It is therefore critical to understand the sleep characteristics and the association between sleep and COVID-19 severity in patients diagnosed with COVID-19. The study’s purpose is to investigate 1) self-reported sleep characteristics in patients diagnosed with COVID-19 and 2) the association between sleep characteristics and COVID-19 severity after controlling for depressive symptoms and age.MethodsIn this correlational and cross-sectional study, data were collected via an online survey posted on social media. The sample included 90 patients diagnosed with COVID-19 (female: 47.8%; mean age= 36.6 ± 10.1 years). The survey was completed by participants 308.95 ± 164.7 days after their COVID-19 infection. Self-reported sleep characteristics were measured by the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). COVID-19 severity was measured by hospitalization, use of oxygen therapy, and use of ventilation. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). Descriptive statistics and multiple regression were used to analyze the data.ResultsA total of 66.7% were hospitalized; 57.8% used oxygen therapy, and 66.7% used ventilation. In all, 6.7% and 4.4% had sleep time < 6 hours and > 9 hours, respectively; 17.8% had sleep efficiency < 85%; 54.4% had poor sleep quality (total score of PSQI > 5); and 38.9% had excessive daytime sleepiness (total score of ESS >10). After controlling for depressive symptoms and age, COVID-19 severity (i.e., hospitalization, use of oxygen therapy, and use of ventilation) significantly predicted self-reported sleep time [F(5, 84)= 4.16, p= 0.002, Δ R2= 0.1], self-reported sleep efficiency [F(5, 84)= 2.5, p= 0.037, Δ R2= 0.09], sleep quality [F(5, 84)= 9.23, p < 0.001, Δ R2= 0.04], and daytime sleepiness [F(5, 84)= 14.41, p < 0.001, Δ R2= 0.03].ConclusionPoor sleep quality and excessive daytime sleepiness are common in patients diagnosed with COVID-19. COVID-19 severity was significantly associated with self-reported sleep characteristics, but the effect size is small. A further understanding of sleep problems and the relationship between COVID-19 severity and sleep in patients diagnosed with COVID-19 is required to design interventions to improve sleep.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01139
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1140 The Influence of Daily Rest and Activity on Mental Health Among
           Japanese Adults During the COVID-19 Pandemic

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      Pages: A489 - A489
      Abstract: AbstractIntroductionThe global COVID-19 pandemic has not only presented an unprecedented threat to physical health but has also cast a shadow over the mental well-being of individuals worldwide. Various sleep disturbance symptoms have been reported, including a sense of nonrestorative sleep and poor sleep quality. Promoting the mental health of community residents is critical in their lives. This study examined the relationship between sleep habits, activities of daily living, and mental health symptoms in young to middle-aged Japanese adults.MethodsThe participants were 76 adults not currently attending a psychiatric clinic. Participants kept a sleep diary for at least five days (including two days off), recorded daily activity using Fitbit Sense, and answered questionnaires regarding psychiatric symptoms and sleep. The Patient Health Questionnaire-9 (PHQ-9), State-Trait Anxiety Inventory-S (STAI-S), Beck Depression Inventory (BDI), and Temperament and Character Inventory Harm Avoidance (HA) were used to assess psychiatric symptoms. The Insomnia Severity Index (ISI), Hyperarousal Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were used to assess subjective symptoms. Sleep diary records were averaged over five days and rated for bedtime, waking time, time in bed, sleep duration, sleep satisfaction, and sleepiness upon awakening. The study was approved by the Bioethics Review Committee of Nagoya University School of Medicine.ResultsDaily wakefulness, sleepiness, and subjective sleep efficiency were significantly related to psychiatric symptoms such as PHQ-9, STAI-S, BDI, and HA (Fatigability). Participants with a higher total HA score and HA (Fatigability) score had a significantly lower amount of active time in their daily lives, as recorded by Fitbit.ConclusionDaily rest and activity levels have an impact on mental health during the COVID-19 pandemic in Japanese community residents.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01140
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1173 Unmasking Severe OSA After Transvenous Phrenic Nerve Stimulation for
           Central Sleep Apnea

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      Pages: A502 - A502
      Abstract: AbstractIntroductionIn the absence of reversible etiology, central sleep apnea (CSA) may be treated with positive airway pressure (CPAP or BPAP), adaptive servo-ventilation, or supplemental oxygen. In 2017, a transvenous phrenic nerve stimulator (PNS), the remedē System™, was FDA-approved for moderate-to-severe CSA. Five-year outcomes data confirmed the device’s sustained efficacy, with improvements in symptoms, apnea-hypopnea index(AHI), and central apnea index(CAI). While the device effectively treats CSA, unrecognized upper airway obstruction may hinder clinical success. This case report describes a patient whose polysomnography (PSG) suggested candidacy for PNS; however, his airway collapsibility led to severe obstructive sleep apnea(OSA), unmasked after PNS implantation.Report of case(s)Our patient is a 74-year-old with longstanding severe CSA and chronic insomnia. He has a history of spasmodic dysphonia status post recurrent laryngeal nerve ablation. His unilateral vocal fold paralysis was followed by injection medialization for voice augmentation. He is also an asymptomatic carrier of myotonic dystrophy(MD), identified after his grandchild was diagnosed with MD. He presented to our institution for daytime sleepiness, disrupted sleep and snoring with complaints of PAP intolerance. PSG revealed an AHI4% of 49.1 events/hour with 0 obstructive apneas, 89 central apneas, and 53 unclassified hypopneas. Transthoracic echocardiogram was unremarkable. Pulmonary function tests were normal without evidence of neuromuscular weakness or extrathoracic obstruction. He underwent PNS implantation. Postoperatively, the patient continued endorsing unrefreshed sleep. His PNS titration study demonstrated prolonged flow limitation and an AHI4% of 35.2 events/hour with frequent obstructive events. He is now using a mandibular advancement device (MAD) with the PNS.ConclusionThis case highlights the impact of upper airway collapsibility on PNS treatment response. Although our patient’s history may have indicated greater susceptibility to airway collapse, preoperative PSG did not reveal unequivocal OSA. However, frequent obstructive hypopneas were unmasked after PNS implantation. This patient’s upper airway collapse was underrepresented on PSG, and increased negative intrathoracic pressure during the PNS titration may have worsened the severity. Since differentiating central from obstructive hypopneas can be challenging, PNS may not be ideal for CSA patients with increased hypopnea burdens. If OSA emerges postoperatively, adjuncts like MAD, CPAP, or hypoglossal nerve stimulation may stabilize the upper airway.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01173
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1174 Oromandibular/Faciomandibular Myoclonus; A Rare Sleep-Related
           Movement Disorder Captured on Polysomnography

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      Pages: A502 - A503
      Abstract: AbstractIntroductionOromandibular myoclonus (OMM) also known as faciomandibular myoclonus (FMM) is a rare neurological sleep-related movement disorder characterized by involuntary and repetitive contractions of the facial muscles. Consequences of this disorder include nocturnal tongue and cheek biting, which can mimic signs of seizure disorders. This case report presents a patient with OMM/FMM which was captured on polysomnography.Report of case(s)The patient is a 25-year-old male with a medical history that includes hypertension, obesity (BMI 67), bipolar disorder, and headaches. He presented with the chief complaint of excessive daytime sleepiness. He also endorsed waking up with a sore tongue on nearly a monthly basis without obvious reason. He underwent a split-night polysomnogram with transcutaneous CO2 (TcCO2) monitoring which showed severe obstructive sleep apnea (apnea-hypopnea index of 114.6) and sleep related hypoventilation with TcCO2 levels greater than 55 mm of Hg for more than 10 consecutive minutes. During the titration portion of the polysomnogram, several very brief (less than 250 milliseconds) stereotypical jerk-like contractions of his jaw muscles with characteristics of myoclonus were observed during REM sleep. These occurred as isolated bursts and clusters of irregular bursts of three to five repetitive contractions. Increased amplitude in the submentalis EMG leads, as well as muscle artifact in the EOG and EEG channels were identified during events. EEG showed no epileptiform findings. REM sleep atonia was otherwise preserved.ConclusionOromandibular/Faciomandibular myoclonus is a sleep-related movement disorder characterized by very brief (less than 250 milliseconds) forceful myoclonus of masticatory muscles in sleep. These can occur either as isolated bursts or as a cluster of regularly or irregularly occurring brief bursts. Pathophysiology is considered to be a form of brainstem reticular myoclonus, involving a circuitry of cranial nerve V and VII nuclei along polysynaptic pathways. Tongue biting is widely recognized as a useful clinical diagnostic tool for differentiating between epileptic seizures and nonepileptic events. OMM/FMM typically presents with recurrent nocturnal tongue biting, which can be misdiagnosed as nocturnal seizures. Therefore, appropriate awareness and recognition is important to avoid an epilepsy misdiagnosis which may result in lifelong anti-seizure medication use.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01174
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1175 Alternative Treatment for REM-Sleep Behavior Disorder

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      Pages: A503 - A503
      Abstract: AbstractIntroductionRapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia occurring during REM sleep, characterized by loss of normal REM sleep atonia and dream enactment behaviors. The majority of patients diagnosed with idiopathic RBD will develop an alpha-synucleinopathy neurodegenerative disease, which can complicate the treatment of RBD. First-line treatment with high-dose melatonin or clonazepam can have side effects of daytime sleepiness, dizziness, or nightmares, which can increase risk of harm to patients. This has led some patients to seek alternative treatments. We report a patient who successfully treated symptoms of RBD with edible tetrahydrocannabinol (THC) gummies.Report of case(s)A 67-year-old man presented to sleep clinic with symptoms of daytime sleepiness and dream enactment behavior including yelling, punching and kicking. He underwent a diagnostic polysomnogram that revealed moderate obstructive sleep apnea (OSA) but did not confirm dream enactment behavior or RSWA. He was diagnosed with RBD based on clinical criteria and started CPAP and melatonin 10 mg with initial reduction of dream enactment. At a subsequent visit he reported increased frequency of dream enactment behaviors with morning grogginess which caused him to stop melatonin and start marijuana gummies with 4.2 mg of THC purchased over-the-counter. Since starting this, his wife had reported complete resolution of dream enactment behavior.ConclusionCurrent first-line medications used to treat symptoms of RBD can cause unfavorable side effects of dizziness and daytime sleepiness which can negatively impact patients’ quality of life and compound progressive symptoms of neurodegeneration. Recent studies involving cannabinoids for RBD trialed the use of Cannabidiol (CBD), but showed no reduction in frequency of dream enactment symptoms. Our case illustrates an example of successfully using THC as an alternative treatment for dream enactment behavior, which may be more well-tolerated than first-line agents and is readily available over-the-counter in many states. A possible mechanism for the improvement in symptoms may be related to THC-predominant cannabis mediated reduction in total REM sleep and REM density. More studies are needed to determine if THC can be used as a viable alternative for treatment of RBD.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01175
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1176 Extended Polysomnography Confirms Idiopathic Hypersomnia Diagnoses: A
           Case Series

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      Pages: A503 - A503
      Abstract: AbstractIntroductionIdiopathic hypersomnia (IH) is often underdiagnosed since at least 30-40% have normal mean sleep latency tests (MSLT) and test-retest reproducibility is poor. We report two cases of IH with multiple normal sleep evaluations diagnosed at Cleveland Clinic through extended polysomnography (PSG) using a 32-hr bed rest protocol as published by Evangelista et al., 2018.Report of case(s)Case 1: A 28-year-old female reported daytime sleepiness (Epworth Sleepiness Scale (ESS) 15), fatigue, sleep inertia, habitual sleep duration of 10-14 hr, brain fog and rare sleep-related hallucinations with symptom onset of 10 yr of age. PSG/MSLT evaluations at ages 13, 22 and 26 yr were normal, with MSLT mean sleep latencies (MSL) of 12.9, 15 and 16.8 minutes and 0 SOREMPs after normal PSG with adequate sleep. On extended PSG, total sleep time (TST) was 19.3 hr (1155 min) on the 32-hr recording and 13.1 hr (785 min) on the 24-hr recording. Case 2: A 42-year-old female reported excessive sleepiness (ESS 22), sleep inertia, memory and attention complaints, and rare sleep paralysis associated with sleep-related hallucinations beginning in the 2nd decade of life. Habitual sleep duration was 9.5 hr. PSG/MSLT evaluations at 40 and 41 yr were normal, with MLST MSL of 14.2 and 12.8 min and 0 SOREMPs and negative urine toxicology following normal PSG with adequate sleep and nocturnal sleep of 8-8.5 hr on actigraphy. On extended PSG, TST was 19.1 hr (1147 min) on the 32-hr recording and 11.7 hr (704 min) on the 24-hr recording.ConclusionWe report two cases with IH phenotypes, multiple normal PSG/MSLT evaluations, and debilitating symptoms for over two decades. Both met the 19-hr cutoff for the diagnosis of IH using the 32-hr bed rest protocol based on published criteria and one met the 12-hr cut-off using the 24-hr protocol. This work illustrates the limitations of current IH diagnostic criteria and underscores the need to establish more accurate diagnostic test modalities for IH given the lack of biomarkers.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01176
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1234 Managing Idiopathic Hypersomnia in a Patient Following Sleeve
           Gastrectomy

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      Pages: A525 - A526
      Abstract: AbstractIntroductionSleeve gastrectomy (SG) is a weight loss surgery removing approximately 80% of the stomach1 resulting in a narrower, tubular stomach “sleeve”. It's considered a restrictive procedure wherein weight loss is achieved by limiting the volume of food intake by diminishing the stomach’s capacity. In Roux‐en‐Y(RYGB), parts of the small intestine is bypassed and the remaining portion is connected to a newly created smaller stomach. By surgically bypassing regions of the small intestine, RYGB limits nutrient absorption leading to weight loss. It’s considered both a restrictive and malabsortive procedure; thus RYGB is associated with more pharmacologic/metabolic concerns compared to SG. Although there is minimal literature comparing drug absorption between SG vs RYGB, some data proposes both SG and RYGB lead to nutrional deficiencies suggesting SG may also be a malabsorptive procedure altering drug pharmacokinetics by increasing transit time, altering gastric pH and reducing bioavailability for extended-release formulations.Report of case(s)A 41-year-old female with past medical history of sleeve gastrectomy is seen for management of idiopathic hypersomnia (IH). IH was confirmed after a polysomnogram ruled out obstructive sleep apnea (OSA). The MSLT revealed a mean sleep latency of 6.8 minutes without SOREMPs, and excluded central causes. She has tried multiple combination of medications: dextroamphetamine and amphetamine immediate (IR) and extended release (XR), modafinil, and armodafinil. Currently, she is taking dextroamphetamine and amphetamine IR 30 mg in the morning and 15 mg in the afternoon and modafinil 200mg in the morning. She reports significant sleepiness 2-3 hours after taking her medications.ConclusionWhile SG primarily impacts the stomach, it's crucial to note that the procedure can influence drug absorption with effects such as increased drug transit time, and changes in pH. In bariatric surgery patients, utilizing dosage forms that allows drug disintegration, resistant to acidic environments, and has increased bioavailability—such as liquids or even transdermal formulations—may mitigate altered drug absorption. For this patient, we have discussed smaller and more frequent doses of dextroamphetamine and amphetamine IR formulations e.g 20 mg IR every 3-4 hours (maximum 60 mg today daily dose). If this is not effective, calcium, magnesium, potassium & sodium oxybate can be considered.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01234
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1235 Sleep Architecture in School-age Children with Spastic Cerebral Palsy

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      Pages: A526 - A526
      Abstract: AbstractIntroduction10 cases of school-age children with a diagnosis of spastic cerebral palsy (CP) are described, which are within the APAC. Comprehensive Care Model. where diagnosis, rehabilitation, formal and alternative education are received in which polysomnography (PSG) with the international 10-20 system and simultaneous video was indicated, due to neurological risk factors and a recently implemented diagnostic protocol.Report of case(s)10 children (age: 8.3±1.8; females: n=7 [70%]. An increased sleep latency was shown (32.8 ± 32), with expected REM sleep latency (103.1 ± 37.7), without alterations regarding the sleep macrostructure, with an increased awakening rate (10.9 ± 4.8). Regarding the respiratory part, with a mean apnea-hypopnea index (AHI) of (5.5 ±4.7), 50% of the participants had more than 4 events per hour with a predominance of hypopneas during REM and supine position. Abnormal activity was recorded in 100%, with predominance in the left hemisphere (60%), with detection of motor manifestations in 80%; Only 70% of these patients have treatment for epilepsy. Finally, sweating artifact was detected in 60% of cases.ConclusionThese are school-age children diagnosed with CP who have data on sleep fragmentation associated with the presence of abnormal electroencephalographic activity and obstructive sleep apnea-hypopnea syndrome. Multidisciplinary management of the detected nosological entities is recommended, with the aim of reducing sleep fragmentation, regulating EEG activity and respiratory events; Likewise, continue with rehabilitation plans in order to improve spasticity that would help change position and reduce nocturnal diaphoresis.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01235
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1236 A Challenging Transition Between Volume Assured Modes in a Patient
           with Congenital Lung Abnormalities

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      Pages: A526 - A526
      Abstract: AbstractIntroductionThe advent of volume-assured modes for non-invasive ventilation (NIV) has improved treatment of more complicated sleep-disordered breathing (SDB), although can present challenges in choosing ventilatory modes in patients with abnormal pulmonary anatomy.Report of case(s)Our Patient is a 44 year-old female with hypoplastic right lung, pulmonary hypertension and chronic hypercapnic/hypoxic respiratory failure on nocturnal NIV for complex sleep disordered breathing. She failed CPAP, BIPAP and BIPAP S/T. Average volume assured pressure support (AVAPS) NIV was initiated with stabilization in awake carbon dioxide levels, improved sleep quality and daytime energy . She was transitioned to an iVAPS (intelligent volume-assured pressure support) ventilator when eligible for new NIV. Initial settings were empiric, targeting Alveolar Ventilation 3.3 l/min to approximate similar minute ventilation set on previous AVAPS (Assumed dead space ventilation 1.05 l/min or 70 cc x 15rr). Despite relatively similar recorded pressures and respiratory parameters between the two volume-targeted ventilators, she experienced air hunger, palpitations and increased morning headaches after change from AVAPS to iVAPS. Alveolar ventilation target was increased to 4.5 l/min, yet symptoms persisted. She subsequently returned to AVAPS, with symptom resolution.ConclusionThis case highlights the uncertainty in transitioning volume assured ventilator modes that use different algorithms to achieve ventilatory targets. We hypothesized incorrect dead space estimates in the setting of her abnormal pulmonary anatomy may lead to inequivalent respiratory targets between modes, but this does not appear to be the case based on available data. The sensation of dyspnea is complex, thus it is possible subtle changes in rise time, breath delivery, cycling and triggering may have contributed to air hunger. Furthermore, many assumptions are made when transitioning between intelligent ventilator modes and these assumptions are based on “normal” respiratory dynamics.Support (if any)Note- Chart would not transfer, abbreviated data placed below. Settings- (both modes) EPAP 6, Min ipap 17, max IPAP 30 AVAPS- Tidal volume 300, T insp max 2 second, rise time 200 ms iVAPS- Alveolar ventilation 3.3 l/min, T insp max 2 sec, rise time 200 ms Outcome AVAPS- RR 14-15, TV 301-313, MV 4.3, IPAP 20.6, triggered 36% iVAPS- RR 15-32, TV 300-480, MV 4.5, IPAP 20.6, Triggered 30%
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01236
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0801 The Relationship of Objectively Measured Sleep to Puberty in
           School-Age Children with Familial Autism

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      Pages: A343 - A343
      Abstract: AbstractIntroductionThe onset of puberty brings changes in sleep patterns in neurotypical school-aged children, shifting circadian timing and decreasing total sleep time. Sleep problems affect over 80% of school-aged autistic children. The predominant autism sleep phenotype involves longer sleep onset latency, night wakings, and early morning waking—defining features of insomnia. Research on the relationship of puberty to sleep problems, sleep duration, and sleep onset timing in autistic children is limited.Methods232 school-aged children (age 6-13 years; Male n=142, Female n=90) participated in a sleep study through the longitudinal, multisite Infant Brain Imaging Study (IBIS) network. Participants were ascertained at 6-months-old for having an older autistic sibling (high-likelihood; HL) or no family history of autism (lower-likelihood; LL). The HL group included 47 diagnosed with autism (HL+), 104 without autism (HL-), and an LL comparison group of 81. The participants with actigraphy were categorized as Pre-puberty (n=89) or In-puberty (n=38) based on Tanner Staging. Measures include sleep problems (Children's Sleep Habits Questionnaire, CSHQ), sleep duration and sleep onset time (via 10 days actigraphy and sleep diary).ResultsSleep problems were significantly increased in the HL+ group compared to HL- and LL groups (CSHQ; p< 0.01; χ2=23.736). Sleep onset times were later for the In-Puberty versus Pre-Puberty HL- group by 52.2 minutes (Kruskal-Wallis; p=0.01), and later, but not statistically significant, for the HL+ group by 43.2 minutes and LL group by 6.6 minutes. Sleep duration was lower, but not statistically significant, for the In-Puberty versus Pre-Puberty HL+ group by 36.6 minutes and HL- group by 37.2 minutes, and higher for the LL group by 3 minutes (ns).ConclusionOverall, parent-reported sleep problems were increased in school-age HL autistic children compared with HL- and LL children. Objective measures revealed In-Puberty HL+ and HL- had notably later sleep onset times and decreased sleep duration compared with Pre-Puberty. However, only HL- sleep onset time was significantly later. This pattern suggests sleep characteristics could be associated with familial autism and puberty. Future studies with a larger sample are needed to further evaluate the effect of puberty on sleep in autism.Support (if any)R01 HD101578
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0801
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0802 Adolescents’ In-game Purchase, Problem Gaming, Gambling Game
           Playing Associated with Poor Sleep Quality

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      Pages: A343 - A344
      Abstract: AbstractIntroductionProblem gaming and sleep deprivation among adolescents represent critical issues in public health. Online gaming frequently incorporates monetary features, like microtransactions, blurring the line between gaming and gambling. More than half of parents are worried that their children feel pressured to make in-game purchases (Ofcom, 2023). Research has shown an association between problem gaming and heightened psychological distress as well as reduced sleep quality in adolescents. In Taiwan, there has been a notable increase in online game and gambling game advertisements across both offline and online platforms in recent decades. This study aims to explore the relationships between adolescents' exposure to marketing, parental involvement, in-game purchases, problem gaming, engagement in gambling games, psychological distress, and sleep problems in Taiwan.MethodsData were gathered from a sample of 2595 seventh-grade students across 30 middle schools in both urban and rural areas of Taiwan. A self-administered questionnaire was conducted in 2020. A panel of 8 experts was invited to assess the content validity of the questionnaire. The questionnaires were distributed to students in their classrooms by trained interviewers. Approval was obtained from the Institutional Review Board at National Taiwan Normal University.ResultsThe findings revealed that 94% of adolescents engaged in online gaming, with 38% making in-game purchases, 9% participating in online gambling games, and 32% reporting poor sleep quality. The multiple regression results showed that adolescents exposed to higher levels of gaming marketing, involved in in-game purchases, and experiencing lower levels of active parental mediation were more likely to have problem gaming. Furthermore, adolescents with increased exposure to gambling game marketing, influenced by advertising effects, involved in in-game purchases, and experiencing problem gaming, were more likely to engage in online gambling games and purchase tokens. Additionally, adolescents involved in in-game purchases, problem gaming, and playing online gambling games were more likely to experience higher psychological distress and poor sleep quality.ConclusionAdolescents' engagement in in-game purchases, problem gaming behaviors, and playing online gambling games has been linked to increased risks of psychological distress and poor sleep quality.Support (if any)This research was supported by a research grant from the Taiwan Ministry of Science and Technology.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0802
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0803 Insomnia, Mood, and Quality of Life in Children and Young Adults with
           Congenital Heart Disease

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      Pages: A344 - A344
      Abstract: AbstractIntroductionWhile mortality rates have decreased in patients with congenital heart disease (CHD), numerous comorbidities associated with CHD persist, including decreased health-related quality of life (HRQOL), depressed mood, and sleep problems. Insomnia is known to worsen mood and HRQOL in children without CHD, therefore we examined the relationship between insomnia, mood and HRQOL.MethodsWe recruited 38 individuals with CHD between the ages of 4-25 years and assessed insomnia, health-related quality of life, anxiety, and depression using the Pediatric Insomnia Severity Index (PISI), Pediatric Quality of Life Inventory (PedsQL), Screen for Child Anxiety Related Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). T-tests were used to compare differences in HRQOL, anxiety, and depression in individuals with CHD with and without comorbid insomnia. Logistic regression was used to assess whether the presence of insomnia can predict increased odds of clinically significant anxiety or depression.ResultsIndividuals with CHD and insomnia (PISI score ≥8) demonstrated significantly lower health-related quality of life, more depressive symptoms, and higher total anxiety compared to individuals with CHD without insomnia. Individuals with insomnia had a mean HRQOL score of 63.1 ± 15.6 vs 77.8 ± 18.9 in the group without insomnia (p=0.03). Individuals with insomnia had a mean total depression score on the CES-DC scale of 21.5 ± 14.6 vs 7.3 ± 5.6 for those without insomnia (p=0.009). Clinically significant depression in the insomnia group was 24 times greater (95% confidence interval [95% CI] 2.3-247.4, p=0.008) compared to those without insomnia. The mean total anxiety score for individuals with insomnia was 25.0 ±19.6 compared with 12.4 ± 10.3 in those without insomnia (p=0.03), and the odds of clinically significant anxiety in the insomnia group vs those without insomnia was 4.44 (95% CI 0.9-21.8, p=0.07).ConclusionInsomnia is associated with markedly worse HRQOL, depression and anxiety in individuals with CHD. Further study is needed to evaluate the role of insomnia recognition and treatment in order to improve HRQOL and mood in children and young adults with CHD.Support (if any)No support
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0803
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0876 Obstructive Sleep Apnea Is Associated with Poor Cardiometabolic
           Markers in Type 1 Diabetes

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      Pages: A376 - A376
      Abstract: AbstractIntroductionIn patients with Type 2 diabetes (T2D), obstructive sleep apnea (OSA) is associated with worse cardiometabolic risk factors. Whether the same occur in Type 1 Diabetes (T1DM) has not been well established.MethodsRetrospective cross-sectional study, we assessed T1D patients from our endocrinology clinic between 2015-2022, who had a sleep study done in the Sleep Center. We compared the groups for diabetes duration, glycemic control, complications, and metabolic profile. An unpaired t-test was performed for comparison of means, chi-square test for nominal data, and a p-value of P< 0.05 was considered statistically significant.ResultsWe identified 55 patients with T1D and a sleep study, 33 had OSA based on sleep report and 22 did not. Both groups had similar diabetes duration, BMI, micro and macrovascular complications. Hypertension and dyslipidemia were more frequent in the OSA group (P< 0.05). A1C values were similar between OSA and non-OSA groups (7.5% vs 7.9%). Total daily insulin dose per kilogram was similar too (0.42 vs 0.30). Of the 14 patients with a follow up visit after initiation of PAP therapy, A1c levels remained unchanged before and 3-6 months after PAP initiation (7.7% vs. 7.0%, P=0.25), however, 57% of them improved their A1c level, and only 21% worsened. The OSA group had higher triglycerides (mean 142mg/dl vs 81.7mg/dl, P=0.003) and lower HDL (mean 44.5mg/dl vs 62.7mg/dl, P=0.06) despite similar A1c levels. In terms of liver fibrosis, an FIB-4 score < 1.3 was considered low risk based on ADA guidelines, and we found 14 out of 33 patients in the OSA group (42%) and 4 out of 22 patients in the non-OSA group (18%) had >1.3, (P=0.06).ConclusionIn patients with T1DM, OSA is associated with metabolic features consistent with insulin resistance: trends towards higher BMI, insulin needs and worse lipid profile, despite similar A1c levels. The glycemic impact of OSA treatment in T1DM requires further investigation.Support (if any)Supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0876
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0877 Sleep Quality and Dyslipidemia Among Young and Midlife Women

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      Pages: A376 - A377
      Abstract: AbstractIntroductionSleep quality is associated with poor cardiometabolic health in women and men. However, these associations have been infrequently reported among young and midlife women. Therefore, we examined the influence of poor sleep quality on dyslipidemia in a cohort of women from Michigan.MethodsWe utilized the POUCHmoms Study, a large and socioeconomically diverse community-based cohort of 648 young and midlife women from five Michigan communities. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), a widely used self-report questionnaire with 19 dimensions of sleep. A score >5 on the PSQI was considered indicative of poor sleep quality. Fasting lipids levels were assessed in plasma for all women. Based on clinical guidelines for dyslipidemia, we classified women by high and low lipid levels; High-density lipoprotein < 40 mg/dl, Low-density lipoprotein>160 mg/dl, Total Cholesterol >240mg/dl, Triglycerides>200mg/dl. Health, sociodemographic and lifestyle information was collected through questionnaires. Next, we grouped women by low and elevated (borderline/high) lipids levels and examined associations with poor sleep quality. Bivariate analysis was used for determining the association between the lipid levels with covariates of interest. Logistic regression models, adjusting for sociodemographic, health and lifestyle characteristics, were utilized to assess the association between poor sleep quality and dyslipidemia.ResultsWomen in this cohort had a mean age of 38y and 68% were white. More than half (60%) reported poor sleep quality. The prevalence of low HDL and high total cholesterol was 41% and 30% respectively. Women with poor sleep quality were more likely to have low HDL (adjusted OR=3.17, 95% CI: 1.78, 6.96) than women with good sleep quality. Associations of poor sleep quality with high levels of triglycerides, LDL, and total cholesterol were not statistically significant. However, when we grouped women by elevated/high levels, we found that high triglycerides and low HDL levels were associated with poor sleep quality (adjusted OR=1.94, 95% CI: 1.06, 3.54) and (adjusted OR=2.65, 95% CI: 1.71, 4.12), respectively.ConclusionIn this cohort of young and midlife women, we found significant associations between poor sleep quality, high triglycerides, and low HDL. These findings highlight the potential influence of sleep quality on cardiovascular function among women.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0877
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0878 Particulate Matter Exposure Is a Driving Factor of Oxygen
           Desaturation in Blacks with Central Sleep Apnea

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      Pages: A377 - A377
      Abstract: AbstractIntroductionExposure to particulate matter (PM) in the home environment is a modifiable risk factor for oxidative stress, a common and burdensome symptom of Central Sleep Apnea (CSA), a condition characterized by the brain temporarily not sending signals to the muscles that control breathing during sleep. Although previous research has established a greater likelihood of adverse health outcomes given environmental exposure, the effects of specific air pollutants have not been distinguished from other neighborhood factors. Moreover, recommendations to reduce exposure to PM have not been included in CSA treatment. This study aims to contribute to the development of predictive models that account for the impact of environment on severity of CSA symptoms among Black Americans.MethodsData were collected from 168 Blacks (69% female and 31% male, Mage 47.60 ±16.459yrs) that were enrolled in two NIH-funded community-based sleep studies, ESSENTIAL and MOSAIC. Sleep environment PM levels were assessed objectively with the IQAir device for a period of 7 days. During the same period, SleepImage ring devices were used to measure the number of paused breathing events during a sleep period and a score was generated based on the qualifying events of oxygen desaturation. Analyses of correlation matrices were conducted to explore the associations between CSA and PM exposure. Descriptive statistics were analyzed, and a regression analysis was performed to understand the association between CSA and PM. Analyses were performed using SPSS29.ResultsExposure to PM 2.5 (fine inhalable particles with diameters measuring 2.5 micrometers and smaller) was highly correlated with Central Sleep Apnea (sAHI Central), with at least 10 qualifying events of 3% oxygen desaturation (r(165)=.465,p<.001) and 4% oxygen desaturation (r(165)=.473,p=<.001) during a sleep period. Regression analysis further revealed significant association between PM 2.5 and sAHI Central [β= .032; p< .001]. The model adjusted for age, sex, and an existing Sleep Apnea diagnosis.ConclusionFindings suggest that exposure to PM is a driving factor in oxygen desaturation in Blacks. These findings present an opportunity to influence population health by contextualizing the relationship between CSA and environmental factors among Black Americans.Support (if any)R01AG067523, R01HL142066, and T32HL166609-02
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0878
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0879 Investigating Family Sleep Health in Native Hawaiian and Pacific
           Islander Communities

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      Pages: A377 - A378
      Abstract: AbstractIntroductionNative Hawaiian/Pacific Islander (NHPI) populations have significantly elevated risk for cardiometabolic diseases, which are linked mechanistically to sleep deficiencies. Research suggests that sleep deficiencies are highly prevalent among NHPI adults, including short sleep, insomnia symptoms, and elevated risk factors for OSA (obesity). Although adult sleep practices often begin during childhood, little research has examined sleep among NHPI families. As sleep significantly relates to sociocultural factors (stress, socioeconomics, family dynamics), this study aimed to identify sleep health parameters that affect family members’ sleep and determine community methods to improve sleep.MethodsNHPI adolescents and adults(N=34; 33.3% female) from Utah and Hawaii participated in six online focus groups. Discussed sleep-related topics were duration, sufficiency, environment, routines, household rules/dynamics, beliefs/practices, and disorders. Health-related topics discussed included cardiometabolic disease, stress, technology use, work schedules, and health attitudes/goals. Mixed method data were analyzed using constant comparison approach.ResultsParticipants (adolescent mean age of 15.3 years; adult mean age of 39.4 years) reported an average household of 5.5 members(73.3% included children). Few participants regularly slept in a different home from family members(13.3%). Reported annual household income was $75,000+ by 48% of participants. Education level was 53.3% GED/high school, 43.3% some college/bachelor's degree, and 3.3% master’s degree. Adolescents reported adverse sleep-related factors, including sleep timing, chores, shared sleeping space and noise, sport/school schedules, and sleep insufficiency from homework and sleep onset worry. Adult-focused adverse sleep health repercussions included childcare, temperature, technology use in bed, community/extended family event frequency, financial strain, working multiple jobs, dietary challenges, and social beliefs/practices related to Polynesian culture. Community members identified religious practices, family-driven efforts, changing cultural perception of sleep, and targeting youth as ways to address intergenerational transmission of sleep health values and behaviors.ConclusionFindings reveal feasible areas that community members of all ages can utilize to improve sleep health across generations like limit setting at bedtime, utilizing strong community-driven ties (Polynesian cultural values, religious practices), and enhancing existing familial structure. Future research should address significant barriers to improving sleep health (socioeconomics, environmental influences, extracurricular events, sleep perception) that seem unsurmountable.Support (if any)Health Studies Fund, Department of Family and Preventive Medicine, University of Utah
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0879
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0880 Relationships Between Multimorbidity and Disturbed Sleep Phenotypes
           in Chronic Spinal Cord Injury

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      Pages: A378 - A378
      Abstract: AbstractIntroductionDisturbed sleep is a modifiable risk factor for a variety of co-morbidities. Treatment of sleep disorders can provide a key target for improving cardiometabolic health and overall wellness. Despite evidence suggesting higher prevalence of disturbed sleep in Veterans with spinal cord injury (SCI) compared to the non-injured population, the intersectional effects of sleep-wake disruption remain undefined. The purpose of this study is to examine existing data from the spinal cord injury-pressure injury resource (SCI-PIR) database to assess prevalence and identify relationships among sleep disorders and cardiometabolic risk after spinal cord injury.MethodsThis retrospective longitudinal national database cohort study utilized the VA’s SCI-PIR database containing comprehensive clinical data for 29,000 individual Veterans with SCI with over 120,000 encounters. SCI-PIR data includes clinical characteristics of Veterans with SCI, demographics, and comorbidities identified as being relevant to sleep and cardiometabolic risk. We queried the database for ICD9 diagnosis codes related to cardiovascular, metabolic, psychologic, and sleep conditions to identify sleep disorder subgroups defined by clustering of cardiometabolic risk factors and sleep diagnoses within SCI individuals diagnosed with sleep disorders.ResultsIn the sample of 18,894 Veterans, sleep disturbances were diagnosed in only 16.25% of the sample. Sleep apnea (6.7%) and insomnia (4.3%) were the most common sleep diagnosis. Correspondence analysis of sleep, cardiac disorders, and other co-morbidities demonstrated two clusters. The first cluster showed a robust link between sleep apnea, hypersomnia, heart failure and arrhythmias, and secondary associations with coronary artery disease, chronic kidney disease, obesity, diabetes, and hyperlipidemia. The second cluster showed a strong relationship between insomnia, anxiety, and post-traumatic stress disorder.ConclusionSleep disturbances are common in Veterans with SCI, but underdiagnosed. Our findings support the link between medical complications and consequences of disturbed sleep and cardiometabolic risk. This will enable development of SCI validated sleep instruments and clinical decision tools that identify those at highest risk for sleep disorders lead to the development of targeted interventions and treatments to advance precision health for Veterans with SCI.Support (if any)NIH grant R25 HL105400 and VHA Office of Research, Supplement to Promote Diversity
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0880
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0881 Impact of Statin Withdrawal on Sleep Quality

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      Pages: A378 - A378
      Abstract: AbstractIntroductionStatins are benchmark lipid-lowering drugs, reducing blood cholesterol by controlling its synthesis. There are side effects linked to statins use, including statin-associated muscle symptoms (SAMS). These symptoms typically include myalgia, stiffness, weakness, fatigue and/or cramps. SAMS can lead to a reduction in muscle performance, as well as an altered health-related quality of life. Nevertheless, the potential effects of SAMS on sleep remains poorly documented. The objective of this exploratory work was to assess if measures of sleep disturbances and its consequences improve after drug withdrawal in SAMS self-reporters.MethodsPatients (5 men [M] / 3 women [W], 44.8±6.3 yrs.) in a primary cardiovascular prevention cohort composed two groups: statin users with (SAMS, 2M/2W) or without symptoms (No SAMS, 3M/1W). All patients were required to have a low cardiovascular risk over ten years (i.e. Framingham Risk Score < 10%) and were using different types and doses of statins for more than two months. Sleep was measured objectively by actigraphy and subjectively using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Finally, a 10-point visual analog scale (VAS) was used to self-assess the intensity of SAMS, specifically at night. Measures were taken before and after two months of statins withdrawal.ResultsAfter withdrawal, we observed an improvement of objective sleep quality in the SAMS group (sleep efficiency: +3.79%, effect size [ES]: 0.33 [small effect]; wake after sleep onset: -15.6%, ES: -0.30 [small effect]; number of awakenings after sleep onset: -12.7%, ES: -0.45 [small effect]), concurrent with a decrease of subjective perception of SAMS intensity at night (VAS, from 4.5 to 1.0, ES: -0.79 [moderate effect]). A decrease of subjective daytime sleepiness (ESS, from 11.3 to 8.3, ES: -0.45 [small effect]) and an increase of subjective sleep quality (PSQI, from 7.66 to 6.33, ES: -0.31 [small effect]) were also seen in this group. On the other hand, the No SAMS group showed no change after drug withdrawal for any of the different objective and subjective sleep parameters (ES: -0.08 to 0.15 [trivial effects]).ConclusionOur preliminary data suggest that SAMS are associated with sleep disturbances and impaired sleep quality.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0881
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1157 Obstructive Sleep Apnea Symptoms Caused by an Occult Seizure Disorder
           with a Brain Tumor Focus

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      Pages: A495 - A496
      Abstract: AbstractIntroductionComplex nocturnal behaviors are one of the most difficult diagnostic challenges in sleep medicine. The sensitivity of electroencephalography (EEG) varies with the study duration, epileptogenic lesion location, electrode placement, and the presence of events. A normal isolated EEG is insufficient to exclude an underlying seizure disorder particularly when diagnostic uncertainty remains. Polysomnography (PSG) is the gold standard for the evaluation of obstructive sleep apnea (OSA), and that has demonstrated a bidirectional relationship between OSA and comorbid epilepsy. This case report highlights an adolescent male with seizure-like symptoms initially diagnosed with OSA with refractory nocturnal episodes on continuous positive airway pressure (CPAP) for years until his eventual clinical diagnosis that was prompted by a repeat PSG.Report of case(s)A 14-year-old biological male with a history of snoring and excessive daytime sleepiness reported multiple episodes of unresponsiveness during sleep associated with shaking activity and self-reported desaturation at home. Initial episodes terminated upon repositioning of his body, however episodes and symptoms persisted despite treatment with positional therapy and CPAP. He had no clinical episodes during an unrevealing 72-hour EEG study. A repeat diagnostic PSG demonstrated an apnea-hypopnea index (AHI4%) of 1.1 events/hour, an AHI3A of 5.3 events/hour, and an SpO2 nadir of 92%. When the lights were turned on the patient exhibited repetitive facial movement upon awakening with poly-spikes on the corresponding EEG leads. This was followed by an inpatient admission for continuous EEG that demonstrated focal to bilateral tonic-clonic seizure during sleep of left-sided origin. MRI showed a 1.7 cm left basal temporal lobe tumor that was likely the seizure focus. He was discharged on levetiracetam, and ultimately underwent a posterior temporal lesion resection with resolution of his symptoms, including paroxysmal events and excessive daytime sleepiness.ConclusionSuspected nocturnal seizures often requires comprehensive and repeated testing modalities as an interictal EEG may fail to detect a seizure disorder and the presence of OSA does not eliminate the possibility of comorbid epilepsy. It is paramount to maintain a heightened index of suspicion as untreated OSA and epilepsy may have additive detrimental health effects. Appropriate identification as in our case may have a curative effect.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01157
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1158 Sleep Disorders in a Female with Hypermobility Spectrum Disorder
           Inclusive of Hypermobile Ehlers Danlos Syndrome

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      Pages: A496 - A496
      Abstract: AbstractIntroductionHypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are conditions characterized by joint hypermobility and musculoskeletal complications including pain, atraumatic joint dislocations and joint instability. They are often associated with other comorbidities including but not limited to dysautonomia, GI disturbances, anxiety, depression, sleep disorders and chronic fatigue. There are no known genetic markers for HSD/hEDS, they are clinical diagnoses. The nomenclature for these conditions has evolved recently and there are ongoing discussions regarding the best way to characterize these populations. Data on the prevalence of HSD and hEDS are still limited. We are reporting a case describing multiple, long-standing sleep concerns in a young woman with recent evaluation by a geneticist.Report of case(s)Patient is a 25-year-old Caucasian female with initial past medical history notable for anxiety, depression, asthma, irritable bowel syndrome, POTS, scoliosis and vasovagal syncope. On presentation at age 24, the patient reported a family history of hEDS in an aunt and reported multiple family members with joint hypermobility. She had not seen a geneticist for evaluation but reported symptoms concerning for HSD/hEDS. Patient presented to clinic with multiple sleep concerns including sleep paralysis that had started in childhood, sleep-related hallucinations, snoring, witnessed apneas, unrefreshing sleep, fatigue and crawling sensations in legs that improved with movement. Patient had a home sleep study and was diagnosed with mild obstructive sleep apnea. Patient was initiated on PAP therapy but did not tolerate the mask. She reported some benefit to sleep concerns when she was able to utilize therapy. Lab work showed low ferritin. Patient has not been initiated on iron therapy yet. Patient established care with a geneticist and was informed that her past medical history, symptoms and exam were consistent with HSD inclusive of hEDS.ConclusionThis case focuses on sleep disorders and sleep concerns in a patient with a clinical diagnosis of HSD/hEDS. Diagnosis of these hypermobility joint disorders is evolving and with that sleep disorders in these patients are becoming better characterized. Management of HSD/hEDS is symptomatic at this time and patients would benefit from thorough evaluation so as to improve their sleep and overall quality of life.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01158
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1141 Long-Term Efficacy of Acetazolamide in Treating Central Sleep Apnea
           After Traumatic Brain Injury

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      Pages: A489 - A489
      Abstract: AbstractIntroductionCentral sleep apnea (CSA) is characterized by recurrent cessation of breathing during sleep due to a failure of the physiological mechanisms responsible for the respiratory drive. Risk factors include congestive heart failure, high altitude, opioids, and traumatic brain injury (TBI), particularly brainstem injury. Current mainstay treatments are positive airway pressure (PAP) and oxygen therapy. Medications such as acetazolamide are presumed to enhance respiratory drive or modulate chemosensitivity. Given the high degree of nonadherence to PAP therapy, medications are an appealing alternative treatment for CSA.Report of case(s)A non-verbal 39-year-old man with spastic quadriplegia, intractable epilepsy, and static encephalopathy secondary to a TBI from a motor vehicle accident at age 10 was evaluated in the sleep clinic due to his caregiver’s concern for loud snoring, witnessed apneas, and daytime hypersomnolence. The caregiver denied the use of opioids, sleep aids or a history of parasomnias. Overnight home oximetry results demonstrated nocturnal hypoxemia with a SpO2 nadir of 71%. The initial in-laboratory polysomnography showed an apnea-hypopnea index (AHI) of 144.2 with a central apnea index (CAI) of 131.6 and no Cheyne-Stokes respiration. A subsequent in-laboratory PAP titration was difficult due to the patient’s inability to follow commands. He was then started on treatment with auto-titrating CPAP 5-10 cmH2O with a full facemask. However, the therapy was ineffective due to the patient chewing on several different masks, so he was transitioned to supplemental oxygen therapy. Due to the potential choking hazard, other options such as tracheostomy and medications were considered. Because a tracheostomy would only address the obstructive component of his sleep apnea, the patient was started on acetazolamide 250 mg per G-tube daily. Reevaluation at two months with a repeat in-laboratory polysomnography demonstrated complete resolution of sleep-related respiratory events with an AHI of 0.0 and the caregiver reported improvement in daytime hypersomnolence. Repeat polysomnography 9 months later showed continued efficacy of the therapy with an AHI of 1.7 and CAI of 0.0.ConclusionCurrent literature demonstrates improvement of CSA with short-term use of acetazolamide. This case highlights the potential long-term efficacy of acetazolamide for chronic management of CSA in patients with TBI.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01141
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1142 Atypical Cataplexy and Post LP Headaches in POTS with Features of
           Narcolepsy Type I

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      Pages: A490 - A490
      Abstract: AbstractIntroductionPostural Orthostatic Tachycardia Syndrome (POTS) consists of orthostatic intolerance upon standing resulting in lightheadedness or fainting. Narcolepsy type I (Narcolepsy with cataplexy) is a disorder of hypersomnolence categorized by cataplexy and impaired hypocretin levels in the hypothalamus. The diagnostic criteria for type 1 narcolepsy include the presence of cataplexy or cerebrospinal fluid orexin-A/hypocretin-1 ≤ 110 pg/mL. Recent data reveals the increased prevalence of POTS in narcolepsy, particularly NT1 phenotype. We present two patients with POTS and features of cataplexy with a normal orexin level.Report of case(s)Patient 1: A 19-y/o Caucasian female presented with excessive daytime sleepiness with the onset of symptoms occurring 5 years before her initial evaluation. The patient describes episodes of “feeling weak” and experiencing symptoms of lightheadedness when “laughing a lot.” A lumber puncture (LP) was conducted by an experienced neurologist using a 22G spinal needle drawing 15cc of CSF The patient described severe headaches lasting for 4 days following the LP, which improved with caffeine, hydration, and analgesics. CSF Orexin= 248 pg/mL. Patient 2: A 22 y/o female presented with severe fatigue, EDS, and POTS against a history of Ehlers-Danlos Syndrome despite a total sleep time of 7-8 hours per night. The patient noted a “loss of coordination” and “sudden muscle weakness when she felt excited and upset while standing, Due to the presence of serotonergic agents and suicidality, a CSF orexin level was drawn using a 24G spinal needle drawing 15cc of CSF. The patient also described severe headaches lasting for a week following the LP, which improved with a blood patch. CSF Orexin= 281 pg/mL.ConclusionOur experience illustrates two important findings about patients with POTS who presented for narcolepsy evaluation: (1) reports of atypical cataplexy may be related to autonomic intolerance compared to cataplexy triggers and is positional in nature, and (2) The prevalence of post-LP headaches in POTS might require prophylactic blood patch and conservative measure to prevent CSF leak/spontaneous intracranial hypotension.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01142
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1143 Nuclear Narcolepsy

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      Pages: A490 - A490
      Abstract: AbstractIntroductionThe sleep -wake mechanism is a complex network of structures of the brain and numerous neurotransmitters. Notably, the hypothalamus produces a powerful wake promoting peptide, orexin, which lack thereof results in narcolepsy. Moreover, studies have demonstrated that the thalamus,although not fully elucidated, plays a dichotomous role in the sleep -wake cycle. This case highlights an interesting iatrogenic cause of hypersomnia.Report of case(s)Patient is a 49 year old male who presents for evaluation of hypersomnia. He had some sleepiness throughout his adult life but worsened significantly in the recent years prior to presentation. His Epworth Sleepiness Scale is 21. No hypnagogic/hypnopompic hallucinations, cataplexy, sleep attacks, sleep paralysis reported. Mild snoring is present. His BMI is 24kg/m2. His PMH is notable for essential tremor treated with stereotactic radiosurgery thalamotomy four years prior to presentation. He underwent polysomnography that was overall unremarkable with no evidence of sleep disordered breathing or periodic limb movements, but the study had sleep onset REM of 13 minutes. The following day, an MSLT was performed and demonstrated sleep latency of 3 minutes and 26 seconds and one sleep onset REM. He was diagnosed with secondary narcolepsy and started on pharmacotherapy with modafinil.ConclusionThe patient in this case underwent stereotactic radiosurgery to the thalamus for treatment of essential tremor. Given the proximity of the thalamus to the hypothalamus, it is thought that damage to this structure resulted in loss of orexin causing secondary narcolepsy. Furthermore, excessive daytime sleepiness is a consequence of thalamic lesions such as thalamic stroke further demonstrating the role of the thalamus in the sleep -wake mechanism.Support (if any)Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis. 2021 Apr 1;12(2):570-585. doi: 10.14336/AD.2020.0707. PMID: 33815883; PMCID: PMC7990374. Cheng P, Roehrs T, Roth T. Daytime Sleepiness and Alertness. Principles and Practice of Sleep Medicine. 7th Edition. Elsevier. 2022. Chapter 4, 35-45.e5.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.14336/ad.2020.0707. pmid: 33815883; pmcid: pmc7990374. cheng p roehrs t roth t. daytime sleepines
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1144 Unique Use of PAP Download Data to Identify Non-24-Hour Sleep-Wake
           Rhythm Disorder (N24SWD) in Sighted Individual

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      Pages: A490 - A491
      Abstract: AbstractIntroductionN24SWD is a circadian rhythm sleep disorder (CRSD) in which there is misalignment between the 24-hour light dark cycle and the non-entrained endogenous circadian rhythm of sleep wake propensity. We present case of a sighted individual, incidentally noted to have FN24SWD upon review of his PAP download data.Report of case(s)A 75-year-old sighted, single male with major depressive disorder (MDD), generalized anxiety disorder (GAD), obstructive sleep apnea (OSA), restless leg syndrome (RLS), insomnia and hypertension presented to sleep clinic. Patient after retirement spent most of his time working on small engineering projects and programming. He reported regular use of PAP with average daily use of 7 hours and 11 minutes. PAP data review revealed well controlled OSA with residual apnea-hypopnea index of 3.1/ hour. His time in bed delayed approximately 1 to 2 hours each night and would cycle around every 20 days with 1 to 2 days in a month without any sleep. His Epworth Sleepiness Scale score was 3/24. Medications included gabapentin and ropinirole for RLS, trazodone, melatonin for insomnia, buspirone, citalopram. Based on the patient’s history, corroborated by PAP device data, diagnosis of behaviorally induced Non24SWD was made. Patient reported intermittent insomnia managed by above stated medications and thus reported no impact on his social life. Thus, he deferred treatment to entrain the rhythm.ConclusionTreatment for CSRDs comprises of melatonin in sighted individuals and melatonin receptor agonists in blind. In our patient, melatonin was used ad lib as a sleep promoting agent. Lack of regular daytime bright light exposure and light exposure from screens at night contributed to lack of entrainment . It is usually noted in blind individuals due to lack of photic input to circadian pacemaker. In sighted individuals, delayed sleep phase, decrease light exposure, psychiatric disorders, TBI or dementia is noted. In our case anxiety and depression were noted. This case highlights the unexpected discovery of Non 24SWD on detailed review of PAP download data in case of good PAP adherence, essentially replacing actigraphy. Thus, in CPAP compliant patient, detailed PAP review can help identify circadian disorders especially where actigraphy may be difficult to obtain.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01144
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1197 Cataplexy - Management Conundrums

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      Pages: A511 - A511
      Abstract: AbstractIntroductionCreating a guideline for the management of patients with narcolepsy is complex due to the number of potential mechanisms that could account for the increased risk of perioperative complications: aggravation of narcolepsy itself, dysautonomia, narcolepsy-related medications, anesthesia interactions, etc.Report of case(s)An 80-year-old woman with a history of narcolepsy type 1, depression, restless leg syndrome, obstructive sleep apnea, and atrial fibrillation presented to our sleep clinic to establish care. Her narcolepsy was managed with strategic naps, but no medications. She had previously experienced rare episodes of cataplexy, described as the inability to talk, and syncope. While on anticoagulation for her atrial fibrillation, she sustained a fall during an episode of cataplexy resulting in brain bleed and eye loss, which prompted her to start pitolisant. Subsequent polysomnography showed an apnea-hypopnea index of 72/hr with nadir oxygen of 74%, requiring Adaptive Servo-Ventilation (ASV), which she did not tolerate. She noted cognitive decline and extreme weakness resulting in hospitalization, during which neurology reported frequent myoclonic jerks and excessive sleepiness. Given her untreated sleep apnea, we recommended re-initiation of ASV during the inpatient hospital stay, which improved her symptoms significantly. She subsequently developed an unrelated need for urgent bowel surgery, necessitating cessation of oral intake, which was temporally related to debilitating and refractory cataplexy. Following recovery from this acute hospitalization, she recovered and was again seen in the clinic, with no further episodes of cataplexy and improved sleepiness in the setting of ASV compliance and resumption of her pitolisant.ConclusionThis case emphasizes the importance of controlling even rare cataplexy in the setting of potentially catastrophic outcomes. It also raises concerns about the management of narcolepsy with cataplexy in the perioperative period, which currently lacks quality data and guidelines.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01197
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1095 Adaptation of SIESTA (Sleep for Inpatients: Empowering Staff to Act)
           Protocol for Acute Stroke Rehabilitation

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      Pages: A470 - A470
      Abstract: AbstractIntroductionImproving sleep for patients with stroke is vital due to the importance of sleep for neuroplasticity and functional recovery. While sleep interventions have been successful in reducing nocturnal disruptions for hospitalized patients, few interventions have been tested for patients with stroke in an acute rehabilitation setting. We aimed to adapt the successful hospital protocol SIESTA (Sleep for Inpatients: Empowering Staff to Act) to an acute stroke rehabilitation setting.MethodsSurveys and focus groups with nurses caring for patients with stroke on inpatient floors at Shirley Ryan AbilityLab informed the development of the adapted protocol, SIESTA-Rehab. The protocol included educational video modules for nurses regarding sleep hygiene and sleep apnea screening, sleep enhancing measures (eye masks, quiet signs), a nurse badge card with a checklist reinforcing protocol components, and advocacy for patient sleep at shift handoff. Two nurse champions were recruited to monitor protocol implementation. Periodic re-education was conducted to account for nurse turnover. Ongoing fidelity interviews using the Consolidated Framework for Implementation Research (CFIR) framework assessed intervention perceptions.ResultsWe initially trained 27 (93%) nurses using the training module. Fidelity interviews of over 20 nurses in the years post-implementation demonstrated over 57% of nurses recalled sleep masks and “cluster care” as part of the protocol. Moreover, more than 75% of nurses considered the protocol to be “straightforward” and “part of the workflow.” Nurses perceived the protocol positively, noting it “could be really beneficial for patients and their long-term health,” and have incorporated behavioral changes into their routine since being educated on sleep hygiene. Nurses also reported understanding the importance of sleep for stroke patients, stating sleep “helps in their recovery and feeling well rested for the day so that they can participate in therapy” and understood “how [they] affect that in [their] roles” as nurses.ConclusionThe SIESTA protocol can be successfully adapted to an acute rehabilitation setting for stroke patients, as evidenced by positive staff responses to sleep-promoting interventions, ease of protocol incorporation, and high staff compliance. Ongoing work is investigating patient perceptions and outcomes following implementation of this sleep protocol.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01095
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1096 Attitudes Towards Mental Health Service for Sleep Scale (AMHSUS):
           Development and Psychometric Evaluation

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      Pages: A470 - A470
      Abstract: AbstractIntroductionPoor sleep health is prevalent at the population level and is especially high among college students. There are numerous evidenced-based mental health treatments for sleep disturbance [e.g., Cognitive Behavioral Therapy for Insomnia (CBT-I) and mindfulness-based therapies], but mental health care for sleep continues to be underutilized. The novel Attitudes Towards Mental Health Service Utilization for Sleep (AMHSUS) scale was developed to assess attitudes towards the use of mental health services for sleep disturbance to gain a fuller picture of individual and population-level barriers and facilitators.MethodsAn initial 20-item scale covering four hypothesized dimensions was developed via team consensus, then refined and reduced to 16 items in response to feedback from a graduate student panel. The scale was tested using a sample (n=367) of university students (Mage= 19.0; female= 71.1%; white=43.1%; Black= 31.3%) in the southern region of the United States.ResultsAn exploratory factor analysis yielded four factors: “Severity,” “Facilitators,” “Barriers,” and “Priority.” All but one of the original items were retained. The total scale demonstrated good internal consistency, with a Cronbach’s alpha of .71. Reliability was appropriate for two of the four factors, “Severity” (∝=.83) and “Facilitators” (∝=.82), but questionable for “Barriers” (∝=.63) and poor for “Priority” (∝=.46).ConclusionFuture directions include testing the scale for convergent and discriminant validity, revising the “Barriers” and “Priority” subscales, and removing items as needed. AMHSUS shows strong psychometric potential and, with some modifications, will be a valuable tool for sleep health research.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01096
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1133 IoT and Sleep Health Dynamics: Evaluating Policy Impacts in the
           COVID-19 Era

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      Pages: A486 - A486
      Abstract: AbstractIntroductionThe political determination to prioritize public health can significantly influence disease outcomes. In the United States of America, the partisan divide has notably affected the enactment and adherence to public health policies, particularly during the COVID-19 pandemic. This study examines the impact of politically driven public health initiatives on sleep duration in the US population during the COVID-19 pandemic. Leveraging zero-effort technology and IoT device data, the research identifies variations in sleep patterns associated with political climates, providing the intricate relationship between politics and health outcomes during a global health crisis.MethodsData from 4,405 households in politically distinct cities within California and Texas are sourced from the ecobee ‘Donate Your Data’ (DYD) initiative. The dataset was preprocessed for clarity and consistency and stratified into two periods: pre-pandemic (March 2019 to February 2020) and during the pandemic (March 2020 to February 2021). Sleep duration is quantified using motion sensor inactivity as an indicator of rest periods. A Gaussian mixture model is used to identify the sleep cycle clusters, and inferential statistical methods are applied to evaluate the impact of public health policies on sleep duration across different political affiliations.ResultsA significant decrease in average sleep duration was observed post-pandemic onset, from 8.0±3.71 hours to 7.75±3.87 hours. Different sleep patterns were observed between political affiliations, with Democratic regions showing a consistent decline in sleep duration while Republican regions experienced varied changes.ConclusionThis study highlights how political leanings and consequent health policies significantly impacted sleep health during the COVID-19 pandemic. The integration of IoT data and advanced analytics offers a novel approach to continuously monitor and enhance population health behaviours. The methodologies applied in this approach could inform public health strategies in future emergencies, with political leanings considered as a key factor in sleep health. The findings set a framework for future studies to explore the relationship between political climates and sleep health and to develop demographic- and politics-sensitive predictive tools for sleep health risks. This research supports more robust public health systems capable of sustaining sleep health despite political and societal shifts.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01133
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1134 Post-acute Sequelae SARS CoV-2 Related Sleep Study and Symptom-based
           Factors Associated with Sleep Disturbances

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      Pages: A486 - A486
      Abstract: AbstractIntroductionPost-Acute Sequelae of SARS-CoV-2 (PASC) poses a global public health challenge, manifesting in persistent sleep disturbances beyond four weeks post-acute infection Despite the high prevalence of PASC-related sleep symptoms, there is a critical lack of objective evidence, particularly in sleep study characterization and symptom-based PASC contributors to reported sleep disturbances(SD). We sought to identify distinct sleep study features and PASC-related symptoms associated with patient-reported SD.MethodsThis cross-sectional ReCOVER cohort involved patients presenting with PASC from February 2021-May 2023 who underwent sleep studies following a positive COVID test with PROMIS-Sleep Disturbance(PROMIS-SD) collected within 6 months. Sleep study variables (sleep apnea and sleep architectural indices) and PASC-specific symptoms were stratified by PROMIS-SD score. A dichotomized T-score ≥60 defined moderate-severe SD. Multivariable logistic regression models adjusted for age, sex, race, and COVID hospitalization, assessed the association of sleep study indices and PASC symptom status (never, resolved,recurrent or new) across SD severity group. Statistical interaction of sleep study indices by sex and race were examined.ResultsThe sample included 494 patients(age:49.5±12 years,BMI:35±9 kg/m²,73.1% female,82.5% vaccinated). Of 365 patients completing PROMIS-SD,166(45.5%) reported moderate/severe SD. Of all sleep study indices examined, only lower REM % was associated with higher SD, OR=0.95, 95% CI=0.92-0.99, p=0.01. Notably, males and black patients with moderate-severe SD exhibited higher average heart rate during sleep(statistical interaction p-values=0.01). Recurrent PASC symptoms were more common in moderate to severe vs normal/mild SD respectively: dyspnea(75.2 vs 60.9%,p=0.008),joint aches/pains(47.7 vs 31.1%,p=0.04) and headaches(47.7 vs 33.1%,p=0.03).ConclusionThe sleep architectural alteration of lower percentage of REM sleep is associated with greater degree or patient-reported sleep disruption in PASC. Males and black individuals experiencing moderate-severe SD showed elevated heart rate during sleep, potentially reflecting sleep-related autonomic dysfunction in PASC. PASC-specific symptoms of dyspnea,joint pain and headaches appear to be clinically relevant sleep disruptors in recurrent PASC. Future investigation should focus on enhanced understanding of REM sleep-specific neural circuitry and memory consolidation in PASC as well as sleep-related autonomic fluctuations in predisposed subgroups. Moreover, targeting treatment of specific PASC symptoms such as dyspnea and pain may mitigate compromise in sleep and improve clinical outcomes.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01134
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1135 Predictors of Post-COVID Clinical and Cognitive Consequences

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      Pages: A486 - A487
      Abstract: AbstractIntroduction“Post-acute sequelae of SARS-COV-2 infection (PASC)” is a condition with a wide range of physical and mental health consequences that are present or persist four or more weeks after SARS-COV-2 infection. Fatigue is one of the most common PASC symptoms. It is not known whether underlying OSA and sleep disturbances may influence the persistence of chronic physical, mental health and neurocognitive dysfunction post-COVID. This pilot study will systematically examine whether sleep disturbances and severity of OSA comprise modifiable facets of PASC.MethodsWe prospectively collected sleep quality, sleepiness, quality of life (QoL) and neurocognitive data in patients with post-COVID fatigue (PASC) and OSA, and compared with control patients with OSA but without prior COVID infection. Questionnaires were administered at baseline and after 3 months to evaluate sleep disturbances, sleepiness, and general and disease specific QoL. Cognitive testing included Trail Making Test Part A and B, Paced Auditory Serial Addition Test (PASAT), Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R (HVLT-R), Weschler Abbreviated Scale Intelligence II (WASI), Weschler Memory Scale IV (WSM), and Psychomotor Vigilance Test (PVT), respectively. 6-minute walk test and COVID-infection related medical data were also collected.ResultsThus far, we have enrolled 26 total participants, 16 controls (13 males, 3 females; age: 65.4±11.7 years, BMI: 35.4±12.8 kg/m2, AHI: 49.2±34.6/hr, Education:14.4±3.0 years), and10 patients with PASC (7 males, 3 females; age: 59.3±12.8 years, BMI: 31.7±8.4 kg/m2, AHI: 44.2±33.6/hr, Education:16±2.3 years).Baseline data in controls vs. PASC patients are given as: FSS Total Score: 29.8±16.7 vs. 37.9±11.2, ESS: 8.6±4.7 vs. 8.5±5.6, PROMISE Sleep Disturbance Score: 20.2±10.1 vs. 22.9±11.2, 6-Minute Walk Test Total Distance Walked: 415.5±56.8 vs. 389.1±47.2 meters, FOSQ Total Score: 16.7±3.9 vs. 17.17±3.2, HVLTR Total Recall: 88.2±14.5 vs. 83.2±16.2, WMSIV Visual Reproduction Delayed Recall: 109.2±19.8 vs. 106.2±27.7, TMT-B: 94.2±21.1 vs. 93.0±25.6, Stroop Color-Word Score: 88.7±10.7 vs. 94.5±20.1, WASI-II FISQ4 Score: 97.6±11.2 vs. 96.2±17.2, PASAT Rate 2 Correct: 38.8±25.4% vs. 33.3±33.3%, PVT Mean Reaction Time: 319.2±65.2 vs. 324.7±149.5 ms.ConclusionOur study provides preliminary data on important clinical metrics in patients with post-COVID sequelae. Additional data will allow us to determine future targets for management of PASC.Support (if any)VHA RR&D # RX004396 (SPiRE)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01135
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1136 Sleep Disorders in Children and Adolescents with Long COVID

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      Pages: A487 - A487
      Abstract: AbstractIntroductionRecognition of Long COVID is increasing and sleep disturbances are common to this population. This study describes sleep disorders and associated comorbidities in youth with Long COVID.MethodsThis is a retrospective cross-sectional study of patients initially presenting to the Long COVID clinic. We examined the prevalence of sleep disturbances (SD) and compared those with and without SD in comorbidity and symptomatology. Single-factor regression analyses were used to explore the relationship between SD and patient well-being. Multi-factor regressions analyses with PROMIS SD score as the predictor and age as a continuous covariate were analyzed for the several response variables: child well-being, general fatigue, sleep/rest fatigue, cognitive-fatigue, total fatigue, anxiety, and depression scores.ResultsOf 250 patients: age ranged 3-24 years(mean 14.6± 3.4years), predominantly female(157/250;63%), white(202/81%);and non-Hispanic(204/250;82%). Patients with SD made up 26%(64/250): 28% circadian rhythm disorders, 31% insomnia, and 1.2% hypersomnia. Compared to the non-SD group, the SD group was more likely to report comorbidities: abdominal pain(52% vs37%, p=0.035), nausea(64% vs52% p=0.084), constipation(50% vs26% p< 0.001), anxiety(89% vs53% p< 0.001), depression (48% vs27% p=0.002), ADHD(27% vs27% p=0.008), headaches(88% vs67%, p=0.002), dizziness (83% vs52%, p< 0.001), POTS(28% vs16%, p=0.027), brain fog(47% vs29%, p=0.009), fatigue (95% vs77%, p=0.001), appetite loss(47% vs29%, p=0.007), and fever(47% vs72%, p=0.053). Using regression analyses, higher PROMIS SD scores negatively associated with child well-being scores (β2= -0.71±0.2; F2, 63=6.37, P< 0.001, R2=0.17), sleep/rest fatigue(β2=-0.51±0.26; F2, 63=5.81, P=0.004, R2=0.16), and total fatigue(β2=-0.65 ±0.2; F2, 63=8.05, P< 0.001, R2=0.20). No significant relationships were found with general/cognitive fatigue scores. Positive correlations found between PROMIS SD scores and anxiety and depression t-scores(β2= 0.26±0.10; F2, 63=3.08, P=0.05, R2=0.09; and β2=0.30±0.11; F2, 65=3.74, P=0.03, R2=0.11, respectively).ConclusionSleep disorders are prevalent among youth with long-COVID, often coexisting with higher rates of physical, neurological, and psychological symptoms. Higher PROMIS SD scores predict lower child well-being, and higher mood disorder scores. While other factors likely impact long-COVID outcomes, sleep plays an integral role. These findings suggest that SD is a key factor in the overall health and mood of children with Long-COVID, emphasizing the need for integrated care approaches that address both sleep and psychological health.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01136
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1181 Rock Around the Clock: Non-24 Sleep-Wake Disorder Successfully
           Treated with Circadian Entrainment, a Case Series

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      Pages: A505 - A505
      Abstract: AbstractIntroductionNon-24-hour sleep-wake rhythm disorder (N24SWD) is a circadian rhythm disorder characterized by an inability to entrain to the 24-hour environment. It can occur in both blind and sighted individuals- usually with a longer sleep period, advanced temperature rhythm, and higher sensitivity to light than normal controls. Current therapies, derived from treating N24SWD in the blind and the human phase response curve, typically involve timed melatonin administration. It is more complex in sighted individuals, requiring multiple time cues such as light, melatonin, social interactions, feeding, and activity. We present two cases of non-24 sleep-wake disorder in sighted individuals who were successfully treated with circadian entrainment.Report of case(s)Report of Cases: Case 1: Sighted 31-year-old unemployed male with ADHD, presented with an irregular sleep pattern. He reported a lack of routine, prolonged dim basement computer use, and a circadian rhythm appearing longer than 24 hours. Actigraphy and sleep diaries confirmed N24SWD. Comprehensive measures, including timed light and melatonin therapy, blue light blocking glasses, and activity scheduling, led to a subjective "miraculous" improvement, with follow-up actigraphy confirming resolution. Case 2: Sighted 23-year-old female with autism and affective disorders presented with shifting sleep times alternating with prolonged video-game use. Actigraphy and sleep diaries were consistent with N24SWD. Following a prescribed schedule with light therapy, timed melatonin, and activity scheduling led to circadian alignment, confirmed by sleep diaries and patient report.ConclusionEffectively managing N24SWD in sighted individuals is challenging, as evidenced by limited treatment success and total cases documented in the literature, including challenges in long-term patient adherence. This case series highlights two successful instances of entrainment using a combination of timed melatonin, bright and low light therapy and activity scheduling, supported by actigraphy and diaries reflecting adaptation. These cases provide insights into contributors to the development of N24SWD and methods for resolving them.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01181
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1182 A Case of Hypersomnolence in a Solid-Organ Transplant Recipient

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      Pages: A505 - A506
      Abstract: AbstractIntroductionEpstein-Barr virus (EBV) infects more than 90% of humans worldwide, with no evidence of active infection and persists for life. In pediatric renal transplant recipients, EBV primary infection or reactivation occur more frequently (63% and 44%, respectively). There is limited data to suggest duration of symptoms secondary to EBV and treatment options for pediatric hypersomnia secondary to EBV infection.Report of case(s)We describe a case of hypersomnia in a 7-year-old male with ADHD. He had received a renal transplant three years prior, secondary to renal dysplasia from a deceased donor who was EBV positive. He had a baseline polysomnogram (PSG) completed for symptoms of snoring, witnessed apneas and nocturnal enuresis, and was diagnosed with severe obstructive sleep apnea. He was started on CPAP and demonstrated excellent adherence to positive airway pressure (PAP). At age 9, he developed hypersomnolence, where he would sleep for 12-16 hours a day, fall asleep in school, during meals and vacation trips. The parents reported he was diagnosed with EBV a few months prior (EBV IgG and EBV nuclear antigen positive). Completed diagnostic work up included PAP device interrogation with adherence data, an actigraphy, a diagnostic PSG while on PAP and a multiple sleep latency test (MSLT). All the work up was reassuring, except for the MSLT where the patient had a sleep onset latency of 11 minutes and 3 out of 5 naps with sleep onset REM periods. Over the course of his evaluation, his pediatric daytime sleepiness scale ranged between 20-28 (>15 is significant). He was started on atomoxetine, with some reported improvement in hypersomnolence. Repeat PSG revealed primary snoring; therefore, PAP was discontinued. At age 15, his hypersomnolence had resolved, but conversely, exhibited difficulty initiating and maintaining sleep with higher doses of atomoxetine, therefore it was discontinued after 5 years of treatment.ConclusionIn pediatric solid-organ transplant recipients with EBV infection, it is imperative to screen for excessive daytime sleepiness in order to facilitate therapies to improve overall quality of life, as well as recognize that the excessive daytime sleepiness may be a short-term symptom.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01182
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1183 Chasing Sleep: Circadian Rhythm Sleep Disorder - Free-Running Type

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      Pages: A506 - A506
      Abstract: AbstractIntroductionCircadian rhythm sleep disorder, free-running type (CRSD-FRT) is a disorder caused by a circadian pacemaker that is out of sync with the 24-hour light-dark cycle. CRSD-FRT is rare in sighted persons but prevalent in totally blind individuals. In sighted people, CRSD-FRT can be associated with psychiatric conditions such as depression, but the etiology remains unknown. It is postulated that sighted persons may have reduced light sensitivity for phase-resetting effects. Symptoms of CRSD-FRT include insomnia, excessive daytime sleepiness and functional impairment. Here we present a unique case of CRSD-FRT in a sighted female with a history of depression.Report of case(s)A 27-year-old sighted female with history of depression previously treated with an SSRI presented to the sleep clinic with a chief complaint of chronic insomnia. Historically, she went to bed at 3 A.M. and awoke at 2 P.M. Sleep onset latency was normal. Estimated total sleep time was 10 hours. She denied history of any other sleep disorders. She experienced a similar delayed sleep routine as a teenager and assumed it was due to late-night gaming. She tried multiple sleep aids including trazodone, melatonin, and diphenhydramine, unsuccessfully. She described a “normal” sleeping schedule once per month, but then her sleep schedule began to move later and later, until it was normal again. She worked from home and was self-employed, giving her flexibility over her schedule. Her Epworth Sleepiness Score was 13 at the initial visit. Interestingly, her sibling had a similar sleeping pattern. Actigraphy was done which confirmed patient’s diagnosis of CRSD-FRT. She was advised to start Tasimelteon.ConclusionThe patient was previously misdiagnosed with insomnia. CRSD-FRT is rare in sighted persons and may be underdiagnosed. Our patient’s CRSD-FRT may be linked to her history of depression and SSRI use. According to one study, a clinical dose of SSRI resulted in 47% increase in melatonin suppression, which increases the human circadian system’s responsiveness to light. Her flexible work from home schedule may also be a contributing factor. When changing or eliminating social time cues could precipitate the development of CRSD-FRT due to variations in the length of circadian rhythm.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01183
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0813 Sleep Duration Moderates the Association Between Bullying and Suicide
           Attempts Among U.S. Adolescents

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      Pages: A348 - A349
      Abstract: AbstractIntroductionSuicide is a major public health issue among adolescents in the United States, with rates having more than doubled over the past 15 years. Bullying is a significant risk factor for suicide attempts during adolescence, while sleep insufficiency is concurrently associated with both bullying and suicide attempts. Although joint presence of these exposures may interact to predict suicide attempts, research has not sufficiently investigated whether sleep duration might moderate the association between bullying and suicide attempts.MethodsThis study draws upon data from the 2021 Youth Risk Behavior Surveillance System, comprising a nationally representative sample of 17,134 participants. Multivariable logistic regression was used to evaluate the relationships among bullying (school/electronic), sleep duration, and past-year suicide attempts among adolescents aged 12-18. Covariates included sex, age, race/ethnicity, screen time, and poor mental health. All analyses accounted for complex survey sampling used by the YRBSS.Results15% and 16% of adolescents were bullied at school or electronically, respectively; 10.2% had made ≥ 1 suicide attempt during the past year; 77.3% did not adhere to sleep duration recommendations; and 29.3% reported poor mental health either “most of the time” or “always”. In adjusted models, adolescents who were bullied in school or electronically were three times as likely to attempt suicide vs. those who were not bullied (odds ratio (OR): 3.0, 95% CI:[2.4; 3.7]. Adolescents with ≤4 hours of sleep (10.7%) were twice (OR: 2.6, 95% CI:[1.5; 3.0]) as likely to attempt suicide. Sleep duration significantly moderated the association between bullying in schools and suicide attempts (F5,44=3.1;p=0.019), with those who were bullied showing a higher likelihood of suicide attempts with lower (≤4-6 h) or higher (8-10+h) sleep duration. Those reporting no bullying showed reduced likelihood of suicide attempts as sleep duration increased to 7 hours, and the likelihood remained constant with more hours of sleep. Sleep duration did not moderate this association for electronic bullying.ConclusionBullying (school/electronic) and short sleep duration significantly increase the odds of reported suicide attempts in teenagers. Future research is needed to elucidate why sleep moderates suicide attempts differently among adolescents who are bullied vs. those who are not.Support (if any)COBRE Award Number P20GM139743
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0813
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0814 Light Regularity Associated with Cognitive Performance in Adolescents
           with ADHD

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      Pages: A349 - A349
      Abstract: AbstractIntroductionRegular light exposure may play a key role in cognitive performance via both direct (via arousal) and indirect (via circadian rhythm regulation) mechanisms. Adolescents with ADHD are at risk for both cognitive deficits and circadian dysregulation, including delayed and irregular sleep patterns, and light exposure has been proposed as a critical contributor to ADHD-related impairments via its influence on circadian rhythm regulation. However, whether light irregularity contributes to cognitive impairment in adolescents with ADHD, and whether such relationships are mediated by disrupted sleep patterns, is unknown.MethodsForty-six adolescents aged 13-17 (54% female) completed a diagnostic interview, >5 days/nights of actigraphy, and a cognitive measure (Kaufman Brief Intelligence Test-Second Edition (KBIT-2): Verbal, Nonverbal, and Composite scores). Twenty were diagnosed with ADHD; 26 were healthy controls (HC). Partial Pearson correlations covarying for sex and age examined associations between the light regularity index (LRI: derived from actigraph-measured light exposure) and KBIT-2 performance in the full sample. We further explored whether LRI-cognition associations were specific to the ADHD group, and if so, whether such relationships were explained by shorter (total sleep time, TST), less regular (sleep regularity index, SRI), and delayed (sleep midpoint) sleep patterns.ResultsIn the full sample, lower LRI correlated with poorer composite (r=.34, p=.03) and verbal (r=.42,p=.005), but not nonverbal (r=.08, p=.62), cognitive performance. Adolescents with ADHD displayed lower LRI than HC (β=-.31), and decreased LRI was related to lower SRI (r=.63) and later sleep midpoint (r=-.50) in this group (p’s<.05). In the ADHD group, LRI was associated with composite (r=.67) and verbal (r=.70) cognitive performance (p’s<.01), and these relationships remained significant in sensitivity analyses controlling for SRI, TST, and sleep midpoint (p’s<.05). Associations between LRI and cognition were non-significant in HC (p’s>.10).ConclusionIrregular light exposure is associated with cognitive deficits among adolescents with ADHD, which is not fully explained by disrupted actigraphy-measured sleep patterns. Future studies using additional behavioral and biological measures of circadian function (e.g., Dim Light Melatonin Onset) may elucidate the specific mechanisms by which light regularity supports cognitive performance among adolescents with ADHD and assess whether regularly-timed light exposure chronotherapy improves cognition in this population.Support (if any)K23MH108704, R34MH128440
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0814
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0815 A Machine Learning Approach to Identify Factors Associated with
           Adolescent Sleep Outcomes

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      Pages: A349 - A350
      Abstract: AbstractIntroductionBeyond natural physiological changes coinciding with puberty, several factors perpetuate poor sleep health in adolescents. However, there is limited research examining their relative importance. This investigation used two popular machine learning approaches to identify the relative significance of key factors associated with multiple sleep outcomes, including bedtime, sleep duration, and social jetlag, in a diverse sample of adolescents.MethodsParticipants were 3,381 adolescents from the age 15 wave (M=15.59, SD=0.76) of the Future of Families and Child Wellbeing Study. Sixty-eight factors spanning child- and parent-reported socio-demographics, neighborhood environment, sleep behaviors, activities, psychopathology, family, school, physical health, and dietary patterns, were identified through literature review and author consensus. Variables were entered into lasso penalized regression (LASSO) and random forest machine learning models for variable selection and establishing the order of factor importance. Self-reported social jetlag (sleep midpoint on weekend nights minus sleep midpoint on school nights) and weekday and weekend bedtime and time in bed were dependent variables.ResultsFactors overlapping between LASSO and random forest in their association with sleep outcomes are reported. Delinquent behavior, peer delinquency, consuming sweet drinks, parent removal of adolescent privileges, and smartphone use near bedtime were associated with greater social jetlag. Irregular bedtime routine, delinquent behavior, and peer delinquency were associated with later weekday bedtime. Consuming breakfast and joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekday bedtimes. Delinquent behavior, peer delinquency, and difficulty falling asleep were associated with later weekend bedtimes, while joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekend bedtimes. Consuming breakfast more days was associated with longer weekday time in bed, while irregular bedtime routine, peer delinquency, parent verbal aggression, difficulty falling asleep, and smartphone use near bedtime were associated with shorter weekday time in bed. Delinquent behavior was associated with shorter weekend time in bed.ConclusionAcross both approaches, the most consistent findings draw attention to delinquent behavior, bedtime routine regularity, smartphone use, and difficulty falling asleep as targets to optimize adolescent sleep health. Findings have implications for clinical and policy recommendations.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0815
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0816 Infant Bedtime and Bedtime Variability Are Independently Associated
           with Total Sleep Duration

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      Pages: A350 - A350
      Abstract: AbstractIntroductionSleep-related behaviors in the realm of pediatrics encompass elements that facilitate sleep, such as a regular sleep schedule, following a bedtime routine, and positive parent-child interactions before bedtime. Several studies have shown a positive association between an early bedtime, consistent routines and parent-infant interaction promoting infant independence in falling asleep with longer sleep duration and less night awakenings. Nonetheless, few studies have investigated bedtime regularity. Thus, we examined the relationships among infants' bedtime, bedtime regularity, total sleep time, night awakenings and sleep latency in infants over the course of one month, utilizing subjective and objective sleep dataMethodsWe recruited 253 infants 4-11 months old (mean 6.7±2months), 46% males. Parents completed surveys on socio-demographic information and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Objective sleep measures including average bedtime (BT), total sleep time (TST), number of night awakenings (NA) and the standard deviation for bedtime (BTV), were collected for one month using Nanit auto-videosomography (mean 24±5.3nights). Linear and logistic regressions modeled the relationship between BT and BTV as predictors of objective metrics of TST and NA and sleep latency collected from the BISQ-R. Infant’s sex and age were included as covariates.ResultsCompared to a BTV of 15minutes or less, a BTV of 45minutes to 1 hour was associated with a TST shorter by 28.0±10.2minutes, and a BTV of more than 1hour to TST shorter by 33.5±11.8min. Compared to a BT before 7pm, later BT was associated with a shorter TST. Specifically, TST was 19.7±10 min (p=0.03) less when BT was between 7-8PM, 63.8±10.0 min (p< 0.001) less for BT at 8-9PM, and 126.4±12.7 min (p< 0.001) less when BT was after 9PM. NA were not associated with BT or BTV. BT was associated with sleep latency, with infants going to bed after 9pm being more likely to take more than 16 min to fall asleep compared to infants going to bed before 7pm (OR 9.9 CI 1.22-80.4,p=0.03).ConclusionHigher BTV and BT after 7PM were independently associated with shorter TST in infants. These results provide important information for clinical practice and further work should explore how to incorporate this information in sleep interventions.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0816
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0817 Influencing Factors in the Decision-Making Process of U.S. Parents
           Regarding the Use of Melatonin for Children

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      Pages: A350 - A350
      Abstract: AbstractIntroductionParents are increasingly turning to exogenous melatonin to help children sleep, despite a lack of experimental research examining its efficacy and the safety of long-term use. In the U.S., melatonin is classified as a dietary supplement and no prescription is needed to obtain it. Given recent surges in pediatric consumption, current data on the factors contributing to parents’ decisions to administer melatonin to their children are vital in order to understand perceptions and concerns surrounding its use.MethodsParents of 1039 U.S. children ages 1.0-13.9 years completed an online questionnaire on children’s development, sleep health, and melatonin use. Data on 212 children who either took melatonin in the past 30 days (N = 131) or at some point previously (N = 81) were included in the present analysis. Open-ended questions on why parents administered melatonin and why they stopped (if applicable) were categorized through thematic coding.ResultsAlthough nearly half of children who recently took melatonin had bedtime resistance (51.1%) or difficulty falling asleep (46.2%), 24.4% had no reported behavioral sleep problems. Parents’ most common reasons for giving melatonin were to help children fall asleep (49.3%) or wind down before bedtime (22.7%). Parents also reported administering it to adjust for changes to regular sleep routines (17.5%) or to shift circadian rhythms (11.4%). Parents frequently reported initiating melatonin on their own (50.0%), with less than half following the recommendation of a healthcare provider (48.1%). Parents often stopped giving melatonin when they felt their child didn’t need it anymore (32.0%). Fewer parents discontinued use due to negative side effects (9.3%) or concerns about health and safety (13.3%).ConclusionParents reported giving their child melatonin for a variety of reasons related to sleep and circadian timing. Melatonin use was frequently initiated without the recommendation of a medical professional, which raises concerns about misinformation given the gaps in scientific research and variable quality of over-the-counter supplements. Greater research and wider dissemination of guidelines are needed to support parents in making informed decisions regarding their child’s melatonin use.Support (if any)Eunice Kennedy Shriver National Institute of Child Health & Human Development (F32-HD103390; R01-HD087707)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0817
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers
           and Toddlers from Mexican American Families

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      Pages: A350 - A351
      Abstract: AbstractIntroductionSleep is essential for development, yet best practices in pediatric sleep are based on studies of primarily non-Latino White families, where rates of room-sharing, bed-sharing, and feeding to sleep are relatively low in toddlers. This ongoing study characterizes room-sharing and bed-sharing reasons, beliefs, practices, and sleep among mothers and toddlers in Mexican American families.Methods51 Mexican American mothers (19-43 years; mean education 12.3 + 3.2 years) of toddlers (77% boys; 12-15 months) completed surveys in Spanish (67%) or English. Mothers and toddlers wore an actigraph for 7 nights. Surveys included Bed-sharing and Room-sharing Beliefs (poor parent sleep, poor child sleep, child dependent on parent for sleep, parent preference to have child nearby) and the Brief Infant Sleep Questionnaire (sleep ecology, room-sharing reasons, sleep-related practices).ResultsRoom-sharing was common (88%), with room-sharing reasons including parental preference to have child nearby (PREF, 53%), space/logistics (SPACE, 33%), and child needing parent to sleep (NEED, 13%). All NEED mothers reported bed-sharing with their toddler, with 50% of PREF and 47% of SPACE mothers reporting bed-sharing. SPACE mothers agreed that bed-sharing contributed to poor parent and child sleep more than PREF or NEED mothers (medium effect size). PREF mothers disagreed that bed-sharing made a child depend on parent for sleep more than the other groups (large effect size). Toddlers falling asleep at bedtime while feeding was common among all room-sharing mothers (SPACE=67%, PREF=88%, NEED=100%), although higher in bed-sharing families (96% vs. 65% own bed). Parent sleep timing (midpoint) was delayed 48 minutes for SPACE mothers vs. NEED mothers, while child sleep timing was 30 minutes delayed in bed-sharing toddlers and 54 minutes delayed in toddlers who fell asleep feeding. Toddlers who fell asleep feeding had a 35 minute longer sleep opportunity, but a 33 minute shorter sleep duration than non-feeding toddlers.ConclusionEarly findings from our ongoing study of sleep in mothers and toddlers from Mexican American families suggest sleep ecology beliefs and practices differ from findings in U.S. non-Latino White families. Findings highlight the importance of cultural and ecological sensitivity when designing interventions to reduce sleep disparities and improve overall toddler health.Support (if any)R01HL163859
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0818
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0819 Cultural Adaptation and Preliminary Efficacy Testing of a Sleep
           Intervention (SIESTA) for Urban Latino Children

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      Pages: A351 - A351
      Abstract: AbstractIntroductionLatino children living in urban areas face disproportionate exposure to contextual and cultural stressors that can challenge optimal sleep. School Intervention to Enhance Latino Students’ Time Asleep (SIESTA) is a tailored intervention to improve sleep hygiene and duration in Latino middle school students in the U.S. and Puerto Rico.MethodsUsing Barrera and colleagues’ five stages of cultural adaptation, we identified intervention elements to retain, set refinement goals, and gathered information (literature review, focus groups/interviews, school feedback). Stage 2 involved expert review and integrating information from Stage 1. Stage 3 included an open trial to assess the content and acceptability of the adaptation. Stage 4 involved integration of feedback from the open trial. In Stage 5 (pilot RCT), Latino children (ages 11-13, n=34) and their caregivers were recruited from urban middle schools in Greater Providence and San Juan. Children were randomized to the SIESTA or control condition. SIESTA participants received a virtual group intervention (four sessions about sleep hygiene, duration, environment) and two caregiver-child sessions (sleep environment assessment, goal setting, feedback from daily sleep monitoring). Control participants received basic sleep and health education (equivalent contact time). All participants completed baseline, end-of-treatment (EOT), and 4-month follow-up assessments.ResultsWe identified themes about sleep values and beliefs, urban stressors disrupting sleep (e.g., noise, crowding), and barriers to engagement. Each component was tailored based on experiences relevant to many urban Latino families. SIESTA participants reported high acceptability. Sleep duration measured via actigraphy increased by 13.3% (M=45min; d=0.16) in SIESTA participants vs. 7.2% (M=25min; d=0.14) in controls from baseline to EOT, p=.04. Differences were greater at 4-months (15% increase in SIESTA, 1% in controls). Caregiver- and child-reported sleep disturbances significantly decreased from baseline to EOT and to follow-up for SIESTA vs. controls (p’s<.04). Caregiver- and child-reported sleep hygiene improved significantly for SIESTA vs. controls from baseline to EOT and to follow-up (p’s<.05).ConclusionA rigorous, multi-method approach allowed for tailoring of an innovative intervention to address the sleep needs of urban Latino children. SIESTA shows potential to improve sleep duration and hygiene in this population. A large-scale RCT will evaluate effectiveness and implementation.Support (if any)1R34HL135073
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0819
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0898 Social Vulnerability and Sleep Health in Young Adults with Type 1
           Diabetes

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      Pages: A385 - A386
      Abstract: AbstractIntroductionYoung adults aged 18 to 26 years with type 1 diabetes (T1D) are at high risk for social vulnerability and poor sleep health (sleep disturbance and shorter sleep duration) due to social, economic, and geographic shifts. However, the role of social vulnerability in the sleep health of young adults with T1D is not well understood. The purpose of this quantitative descriptive study was to examine the association between indicators of individual- and neighborhood- level social vulnerability and sleep health among young adults with T1D.MethodsThe Centers for Disease Control/Agency for Toxic Substances and Disease Registry Social Vulnerability Index was used to measure neighborhood-level social vulnerability (socioeconomic status, housing type/characteristics, racial and ethnic minority status, and transportation). Individual-level social vulnerability was measured with a 7-item composite based on the National Patient Social Determinants of Health Risk Assessment Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (race, ethnicity, education, language, income, employment, and stress). Sleep disturbance was measured with the 4-item Patient-Reported Outcomes Measurement Information System was used to measure sleep disturbance and research grade actigraphy over 14 days.ResultsForty-four young adults with T1D (38.6% female, mean age 20.9 years, mean A1C 8.6%) completed the baseline measures of a 12-week interventional study. Higher individual level social vulnerability was associated with higher sleep disturbance in the unadjusted and adjusted models (B = .414, p < .001, R2 = .171; B = .446, p = .010, R2 = .218). Higher neighborhood level social vulnerability was associated with shorter actigraphy-derived sleep duration in the unadjusted models (B = -.326, p = .043, R2 = .106); however, the association was no longer significant in the adjusted models (p = .068). Models were adjusted for sex, T1D duration, and BMI. The associations between individual level social vulnerability and sleep duration or neighborhood level social vulnerability and sleep disturbances were not significant.ConclusionMore research is warranted to better understand the intricate relationship and role of multiple individual and neighborhood-level social drivers in the sleep health of young adults with T1D.Support (if any)National Institute of Nursing Research R00NR018886 & Dean’s Legacy Fellowship Case Western Reserve University.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0898
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0899 Bidirectional Links of Daily Sleep Quality and Duration with Pain in
           Veterans with Alcohol Use Disorder

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      Pages: A386 - A386
      Abstract: AbstractIntroductionMilitary Veterans tend to experience chronic pain and sleep problems of higher intensity and prevalence than the general population, and may be more likely to self-medicate with substances such as alcohol. Research suggests that sleep and pain are interrelated. However, few studies have examined bidirectional links between daily sleep quality and duration with pain among Veterans, especially those with alcohol use disorders. Furthermore, it has not been studied whether daily alcohol consumption (whether they drank or not) moderates everyday associations between sleep and pain among Veterans with alcohol use disorders.Methods114 Veterans with alcohol use disorder (82.5% men: mean age = 38.86 [range 21–67]) completed 14 days of diaries assessing their sleep quality, sleep duration, pain, and drinking quantity. Multilevel modeling examined the effects of daily variability in sleep (within-person effects) and average levels of sleep (between-person effects) on pain the following day. To examine the effects of pain on sleep, multilevel modeling examined the effects of daily variability in pain and average levels of pain on sleep.ResultsRegarding bidirectional links of sleep quality and pain, greater daily (b=−.86, se=.41, p=.04) and average (b=−15.51, se=3.28, p<.001) sleep quality were associated with lower next-day pain. Higher average pain was associated with poorer sleep quality (b=−.01, se=.002, p< .001), but daily pain was not associated with daily sleep quality. Regarding bidirectional links of sleep duration and pain, there was no daily association between sleep duration and pain, but greater average sleep duration was associated with lower pain levels (b=−4.84, se=1.60, p=.003). Daily drinking did not moderate these associations.ConclusionBoth sleep quality and sleep duration are closely associated with pain among Veterans with alcohol use disorder. Fluctuations of daily sleep quality affected Veterans’ pain experience in everyday life regardless of alcohol consumption; in contrast, fluctuation of daily pain did not affect daily sleep quality, implying that Veterans with alcohol use disorder are sensitive to poor sleep quality. The results support that sleep quality may buffer daily pain experiences among this patient population.Support (if any)5K23AA026895
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0899
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0980 Circadian Patterns of Aggressive Behaviors in a Mental Health Care
           Facility

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      Pages: A421 - A421
      Abstract: AbstractIntroductionThere are indications that circadian rhythms regulate certain aspects of emotions and behaviors. Yet, little is known about the potential diurnal rhythm of behavioral problems in individuals at risk for both circadian and emotional deregulation. This study investigates whether the frequency of aggressive behaviors among individuals receiving mental health care in a tertiary psychiatric facility follows a circadian pattern.MethodsThe timing of all “code white” alerts, emergency notifications of aggressive behavior, were documented from the hospital occupational safety team during 2022 and collated for secondary data analysis. A repeated measures ANOVA was performed on the hourly frequency of code white alerts across 24-hours and a Fourier series model was fitted to the data to extract parameters of a putative circadian curve.ResultsPreliminary results reveal a significant time of day effect on code white alerts (F(23, 8349) = 9.58, p <.001). Visual inspection show a sinusoidal pattern in the hourly counts of code white alerts, with an acrophase between 2 PM and 3 PM and a nadir between 3AM and 4AM. This was confirmed by the curve fitting (Adjusted R-square =.91).ConclusionThese initial findings suggest a circadian modulation in the occurrence of aggressive behaviours in people receiving mental health care. While further work is required to understand underlying mechanisms, this phenomenon may be linked to the decrease in alertness and energy levels in the afternoon, which may make emotional regulation and decision-making more challenging. Better understanding of the influence of circadian factors on aggressive behaviors may facilitate self-regulation strategies and guide healthcare teams in preventing and better tailoring their responses to behavioral emergencies.Support (if any)NA
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0980
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0981 Gender Has Inversed Roles in a Model Linking Lifetime Substance Use
           and Sleep

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      Pages: A421 - A421
      Abstract: AbstractIntroductionThe knowledge about the relationship between sleep and substance use constantly undergoes change. Many questions still remain, including how substance use initiation correlates to sleep parameters. In order to expand this body of knowledge, this study aimed at evaluating how lifetime substance use predicts changes in objective and subjective sleep parameters.MethodsVolunteers from the EPISONO 2007, a large-scale epidemiological study assessing sleep in a representative sample from the city of São Paulo, Brazil, filled in questionnaires evaluating their general health, and underwent a full-night polysomnographic exam. For this analysis the first question of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), asking if the individual ever used any of the listed substances, was considered. Age and scores in the Beck Depression and Anxiety Indexes were included as covariates. Gender was also added as an independent variable.ResultsFrom the total 1,042 participants, 876(388 men and 488 women) were included. Volunteers reported use of cannabis(n=181), cocaine(n=79), inhalants(n=69), amphetamines(n=54), sedatives(n=31), alcohol(n=802) and tobacco(n=538). Lifetime use of cannabis, cocaine and sedatives directly correlated to alterations in sleep latency, REM sleep onset latency, sleep efficiency and scores in the Epworth Sleepiness Scale. Gender significantly interacted with substance use, with women who consumed cocaine and cannabis and men who never did presenting increased total sleep time when compared to their counterpart groups (men who ever consumed these substances and women who never did).ConclusionWe found not only an effect of the lifetime consumption of popular drugs, such as cocaine and cannabis, but also identified an important role for gender, which seems to have inversed roles in males and females. These results provide an intriguing lead to unravelling a network in which gender, sleep and substance use are present, and advances in this area will be a major step in the investigation of the importance of sleep in the psychopharmacology scenario.Support (if any)Our studies are supported by grants from the Associacão Fundo de Incentivo à Pesquisa (AFIP) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP – grant #2020/13467-8 to MLA). MLA is a Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) fellowship recipient.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0981
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0982 Quadratic Association Between Ecologically Assessed Sleep Duration
           and Next-day Suicidal Ideation in Youth

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      Pages: A421 - A421
      Abstract: AbstractIntroductionSleeping too little or too much has been linked to adverse mental health outcomes in youth. Most studies that described the link between sleep duration and suicide risk in youth, however, relied on a single assessment of sleep and suicidal ideation, with considerable temporal gaps in between. Characterizing the proximal link between sleep duration and suicide risk in children and adolescents is essential for developing informative, early mobile interventions. We examined the association between ecologically assessed suicidal ideation (SI) and sleep duration in youth recruited after a partial hospitalization program. We also examined contextual factors in relation to sleep duration that are particularly salient for youth, including nighttime social media use and social media use-related self-referential cognitions.MethodsWe used ecological momentary assessment (EMA) 3 times/day over two weeks in discharged partial hospital patients to assess their levels of SI at home (n=79; 62% assigned F at birth; ages 12-15; mean 13.52; sd 1.14 yr). We also asked youth to report their bedtimes and waketimes every morning for two weeks. Social media use was assessed once via a questionnaire.ResultsUsing generalized linear mixed models, we showed a significant quadratic effect of sleep duration on next-day SI (B=–0.04, SE =0.01, p< 0.001). The turning point of the quadratic function was the sleep duration of 10 hours. Specifically, longer sleep was linked to lower next-day SI, with this association reversing at 10 hours of sleep. Nighttime social media use (B=–0.18, SE =0.05, p< 0.001) and engaging in social media use-related self-criticism (B=–0.10, SE =0.05, p< 0.05) were both linked to shorter sleep duration, whereas daytime social media use was not associated with sleep duration (p>0.05).ConclusionThese preliminary findings point to a curvilinear association between how long children and adolescents sleep and how much they think about suicide the following day and highlight the significance of social media use at bedtime. The findings emphasize the potential clinical relevance of daily assessment of sleep duration in developing adaptive, just-in-time interventions to decrease suicide risk in youth.Support (if any)NIMH Career Development (K23MH122587) Award; Bradley Hospital COBRE Center (P20GM139743).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0982
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0983 Reciprocal Relations Between Sleep and Alcohol Use

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      Pages: A422 - A422
      Abstract: AbstractIntroductionPrior studies have established a longitudinal association between sleep disturbance and the development of alcohol use disorder. Experimental research also shows that alcohol intake negatively impacts sleep. The present study evaluated the reciprocal relationship between sleep and alcohol use with intensive longitudinal methods. We hypothesized that sleep disturbance would predict greater next-day alcohol intake and that greater alcohol intake would predict greater same-night sleep disturbance.Methods50 college students (70% female, mean age 24) participated in a two-week study assessing their daily sleep and alcohol use patterns. Participants wore the Phillips Actiwatch Spectrum and completed daily diaries capturing self-reported sleep and alcohol intake. Multi-level zero-inflated binomial models assessed whether prior sleep predicted next-day alcohol use, including the likelihood of abstaining from alcohol the next day and alcohol intake amongst individuals who do drink. Linear multi-level models assessed whether alcohol use predicted daily sleep. All models assessed both within-subject (daily) and between-subject (average) effects because daily variations in sleep may influence alcohol use separately from average patterns and vice versa—models controlled for race, age, and gender.ResultsParticipants with greater average sleep onset latency (SOL) were less likely to drink the next day (OR: 1.02 p < .05). Among those who drank, greater average wake after sleep onset (WASO) and SOL and shorter daily total sleep time (TST) predicted greater next-day alcohol intake (WASO IR: 1.01; SOL IR: 1.01; TST IR: 0.998; p < .05). Higher average alcohol intake predicted increased daily WASO (B = 10.3, SE = 4.4, p < .05), TST (B = 15.0, SE = 5.1, p < .05), and decreased daily sleep quality (B = -0.13, SE = .06, p < .05). Daily alcohol intake did not predict sleep variables.ConclusionThese results suggest there is a dynamic reciprocal relationship between sleep and alcohol use. Individuals with worse average sleep continuity were less likely to drink alcohol. However, among those who chose to drink, lower average sleep continuity and shorter daily sleep duration predicted greater alcohol intake. These results suggest that sleep disturbance is a risk factor for developing excessive alcohol use.Support (if any)Idaho State University, Graduate School; PSI CHI; INBRE.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0983
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0962 Reciprocal Interactions Between Sleep and Mental Health: A Structural
           Equation Analysis in a Digital Cohort

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      Pages: A412 - A413
      Abstract: AbstractIntroductionNew digital tools constitute an opportunity in understanding the interactions between sleep health and mental health. Structural equation analysis applied to these e-cohort allows to study the bidirectional associations between these dimensions. Thus, we aimed to study the reciprocal interactions between behaviors (duration, temporality, regularity) and sleep health (insomnia and somnolence) and mental health (anxiety and depression).MethodsDigital cohort of 3000 participants invited to complete weekly self-questionnaires over 17 days on their sleep health (Epworth and ISI), their mental health (PHQ-9 and PHQ-2) as well as sleep diaries which made it possible to calculate their sleep behaviors (duration, median, and regularity index). The interaction analysis used a longitudinal structure equation model.ResultsThe average age of the participants was 51 years (68% women). The average sleep duration was 7h24, the median sleep time was 3h30 in the morning, the regularity index was 84/100. Among them, 57% reported insomnia (ISI≥15), 41% reported drowsiness (ESS≥11), 19% reported anxiety (PHQ-2≥3) and 18% reported depression (PHQ-9≥15). Sleep behaviors were associated with sleep health and mental health cross-sectionally. Longitudinal structural equation modeling shows bidirectional associations between sleep health behaviors and mental health.ConclusionThe demonstration of these reciprocal interactions confirms the importance of the joint assessment and management of sleep and mental health behaviors and health in digital interventions aimed at modifying them. New interventional studies are awaited to confirm these results in the general population but also in subgroups of individuals at risk.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0962
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0963 An Investigation of Sleep Disturbance, Depression, and Anxiety Among
           Emerging Adults

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      Pages: A413 - A413
      Abstract: AbstractIntroductionSleep disturbances are highly comorbid with psychiatric disorders. Data indicates high comorbidity rates between insomnia and depression and anxiety disorders. However, limited data exist regarding whether sleep disturbance is an independent risk factor for or outcome of psychiatric disorders among emerging adults. This study explored relationships between insomnia, depression, and generalized anxiety.MethodsData were obtained from emerging adults (N=105; Mean age=20.28 (SD=1.9); 81% Female) who completed self-report measures. The Beck depression inventory (BDI-II) assessed for the presence and intensity of overall depressive symptoms. A cutoff score of greater than 20 was derived to determine probable depression. The Generalized Anxiety Disorder (GAD-7) scale assessed for severity and diagnosis of GAD. A cutoff score of 10 or greater was used to determine probable GAD. The Insomnia Severity Index assessed for the nature, severity, and impact of insomnia symptoms, with higher scores indicating greater symptom severity. All statistical analyses were conducted using IBM SPSS version 29.ResultsApproximately 36.2% of the sample had probable depression and 37.1% of the sample had probable generalized anxiety disorder. Data showed significant correlations between insomnia severity and probable depression (rpb=.316 p<.001) and generalized anxiety disorder (rpb=.449, p<.001), respectively. Linear regressions indicated that depressive symptoms (R2=.266, p<.001) and generalized anxiety symptoms (R2=.301, p<.001) were significant predictors for insomnia severity, respectively. Data also showed that insomnia severity significantly predicted depressive and generalized anxiety symptoms (R2=.355, p<.001), with insomnia being a stronger predictor for generalized anxiety symptoms (β=.374, p<.001) than depressive symptoms (β=.291, p=.004). Logistic regressions indicated that insomnia severity increased the odds of having both probable depression (X2=9.54, OR=1.14, p=.002) and generalized anxiety disorder (X2=17.30, OR=1.23, p<.001).ConclusionFindings suggest that insomnia severity is a risk factor for both depressive and generalized anxiety symptom severity and probable diagnoses. Data also indicated that depressive and generalized anxiety symptoms were independent risk factors for insomnia severity. Given the results, longitudinal studies are needed to understand whether there is a bidirectional relationship between sleep disturbance, depression, and generalized anxiety among emerging adults.Support (if any)This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0963
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1122 A Deep Learning Model for Inferring Sleep Stage from a Flexible
           Wireless Dual Sensor Wearable System Without EEG

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      Pages: A481 - A482
      Abstract: AbstractIntroductionIn-lab polysomnography (PSG) is costly and difficult to scale due to a need for specialized personnel for data acquisition and annotation. Numerous novel wearable devices without electroencephalography (EEG) have been developed to improve scalability of data acquisition. However, validated automated approaches to data annotation, including sleep staging are needed. Here, we apply deep learning approaches to the problem of sleep staging using data from the ANNE One (Sibel Health, Evanston, IL), a minimally intrusive flexible wireless dual sensor system measuring chest electrocardiography (ECG), triaxial accelerometry, and temperature, and finger photoplethysmography (PPG).MethodsWe obtained wearable sensor recordings from 281 adults undergoing concurrent clinical polysomnography at a tertiary care sleep lab. PSG recordings were scored according to AASM criteria. PSG and wearable sensor data were automatically aligned using their ECG signals with alignment confirmed by visual inspection. We trained a neural-network model to predict both 3-class (Wake, NREM, REM) and 2-class (Wake, Sleep) sleep stage classifications using a randomly selected 85% of the recordings and tested the model on the remaining recordings. We applied the model to ambulatory wearable sensor recordings from 233 older adults at risk for dementia. Our neural-network employed a convolutional-encoder and autoregressive-decoder architecture. In addition to time domain signals, we also engineered frequency domain features as well as selected scalar and metadata features as input to our model to improve performance. Ensembling of model variants was performed.ResultsOur approach achieved a 2-class macro-F1 of 0.718 with a sensitivity of 0.760 and specificity of 0.763 and a 3-class macro-F1 of 0.585 (wake precision 0.564 accuracy 0.745; NREM precision 0.886 accuracy 0.634; REM precision 0.258 accuracy 0.671). Our feature engineering and training techniques offered a 9% performance improvement from the time domain signals only baseline given the same neural network architecture, while ensembling different model variants offered a further 4% performance improvement.ConclusionA deep learning model can infer sleep stage from an EEG-less flexible wireless system and can be successfully applied to data from older community-dwelling adults at high risk for dementia.Support (if any)The Centre for Aging and Brain Health Innovation, Canadian Institutes of Health Research, National Institute on Aging
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01122
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0875 The Impact of Non-compliance with CPAP Therapy on Mortality in Atrial
           Fibrillation Patients

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      Pages: A375 - A376
      Abstract: AbstractIntroductionAtrial Fibrillation (AF) patients commonly experience comorbidities such as sleep apnea, emphasizing the need for effective management strategies. This study investigates the association between non-compliance with Continuous Positive Airway Pressure (CPAP) therapy and increased mortality in AF patients.MethodsUtilizing data from the Geisinger Health System (2007-2023), we focused on cardiology patients with AF. Inclusion criteria comprised age > 18, AF and OSA diagnosis, and polysomnography with an apnea-hypopnea index (AHI) > 5. Data collected included age, gender, body mass index (BMI), mean AHI, adherence within 1st three months of starting CPAP therapy, Medicare adherence percentage, and CAI.ResultsAmong 29,000 patient encounters, 2,971 unique patients met inclusion criteria. We chart reviewed 100 patients by looking at compliance reports within the first three months of CPAP use. Mean adherence time within the first three months was 5 hours 39 minutes for the alive cohort vs 4 hours 9 minutes for the patients that died (p=0.02). Mean Medicare medical adherence percentage for alive cohort was 73% vs 71% for the patients that died (p=0.361). Deceased patients had higher association of having AHI > 5 (p=0.016). Mean CAI for the alive cohort was 0.81 vs 0.62 for the deceased cohort (p=0.912). All-cause mortality rate was 12.7%.ConclusionOur findings underscore the critical impact of CPAP compliance on mortality outcomes in AF patients. Non-compliance with CPAP therapy within the first three months of use and AHI >5 emerged as a significant predictor of increased mortality, emphasizing the need for targeted interventions to enhance adherence in this population. The implications of our study extend beyond mortality, encompassing broader cardiovascular outcomes and healthcare utilization. Studies have established the relationship between AF and sleep apnea. Sleep apnea, prevalent in up to 50% of AF patients, exacerbates the arrhythmia's progression and increases the risk of cardiovascular events. While CPAP therapy has demonstrated efficacy in ameliorating the cardiovascular impact of sleep apnea, limited research has explored its effect on mortality in AF patients. Studies examining CPAP therapy's impact on AF outcomes have primarily focused on surrogate markers such as AF recurrence and symptom severity.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0875
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0948 Sleep Problems and Mental Health in Bus Drivers: A Cross-sectional
           Study

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      Pages: A407 - A407
      Abstract: AbstractIntroductionPublic transit bus drivers, crucial to urban mobility, face unique challenges such as irregular schedules and prolonged driving hours, making them vulnerable to sleep problems. Despite the acknowledged impact of sleep issues on mental health in the general population, there is limited research exploring the relationship between sleep problems and mental health outcomes within this special population. This cross-sectional study aims to investigate the prevalence of self-reported sleep problems among bus drivers, and to analyze the relationship between sleep problems and mental health.Methods: MethodsA total of 551 bus drivers (99.8% male, mean age: 49.07 ± 5.23 years) participated in the study. They underwent assessments for risk of obstructive sleep apnea (OSA, using STOP-Bang), insomnia symptoms (Insomnia Severity Index, ISI), excessive daytime sleepiness (Epworth Sleepiness Scale, ESS), and mood symptoms (Hamilton Anxiety Rating Scale, HAM-A; Hamilton Depression Rating Scale, HAM-D). Linear regression models were used to examine the associations between sleep problems and mental health, while controlling for age, sex, and BMI.Results: ResultsNinety-eight (18%) drivers were identified as at risk of OSA (defined as STOP-BANG score ≥ 3), 35 (6%) had insomnia (defined as ISI score ≥ 15) and 62 (11%) had excessive daytime sleepiness (defined as EDS score ≥ 10). After controlling for age, sex, and BMI, anxiety symptoms demonstrated positive associations with the risk of OSA (St. β = 0.26, p < 0.001), insomnia symptoms (St. β = 0.52, p < 0.001), and excessive daytime sleepiness (St. β = 0.40, p < 0.001). Furthermore, depressive symptoms were positively associated with insomnia symptoms (St. β = 0.27, p < 0.001) and excessive daytime sleepiness (St. β = 0.01, p = 0.032).Conclusion: ConclusionAmong bus drivers, the prevalence of OSA, insomnia, and EDS is noteworthy. These symptoms are associated with exacerbated mood symptoms. Prompt treatment for sleep problems is crucial to alleviate these effects and enhance overall well-being.Support (if any)This work was funded by Shenzhen People's Hospital clinical research project SYLCYJ202001.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0948
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0990 Examining the Relationship Between Sleep Duration and Depression

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      Pages: A424 - A425
      Abstract: AbstractIntroductionThe full psychological effects of sleep on depression and anxiety are still being investigated. It has been hypothesized that genetic contributions to depressive symptoms increase at both short and long sleep durations. This study aims to see if there is a correlation between duration of sleep and depression and if sociodemographic factors affect this correlation.MethodsA secondary dataset from National Health and Nutrition Examination Surveys conducted during 2015 – 2018 with 11,689 individuals was obtained. Questions were asked in the home by trained interviewers regarding sleep duration with the following questions “what time do you usually go to sleep on weekdays or workdays,” “what time do you usually wake up on weekdays or workdays,” and “how much sleep do you usually get at night on weekdays or workdays'” Depression was assessed with the standard PHQ-9 with 0-4 defined as minimal depression, 5-14 as moderate, and 15-27 as severe depression.ResultsThe unadjusted data analysis showed that those with short sleep duration had 1.72 times higher likelihood for mild to moderate depression (p< 0.001) and 2.05 times higher likelihood for moderate to severe depression (p< 0.001). Those with long sleep duration had 1.54 times higher likelihood of mild to moderate depression (p< 0.001) and 2.01 times higher chance of moderate to severe depression (p< 0.001). When adjusted for the following variables: ethnicity, marital status, education, income, alcohol consumption, obesity, and smoking, those with short sleep duration had 1.63 times higher chance of mild to moderate depression (p< 0.001) and 1.84 times higher chance of moderate to severe depression (p< 0.001) and those with long sleep duration had 1.32 times higher likelihood of mild to moderate depression (p< 0.001) and 1.65 times higher chance of moderate to severe depression (p= 0.002).ConclusionThese results confirm that any change to sleep duration, whether short or long, is correlated with increased rates of either moderate or severe depression. This study reflects correlation not causation therefore it is possible that sleep duration affects depression or vice versa. While there are many sociodemographic factors that can affect this correlation, the correlation persists when adjusting for these factors.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0990
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0991 Fear of Missing out and Sleep Health: A Systematic Review and
           Meta-analysis

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      Pages: A425 - A425
      Abstract: AbstractIntroductionFear of missing out (FoMO) refers to anxiety and apprehension an individual feels when they believe they are missing out on rewarding experience, social interaction, or information. FoMO has been associated with negative psychological and behavioral symptoms and might also impact sleep health. This meta-analysis therefore aimed to examine the existing literature on the relationship between FoMO and dimensions of sleep health.MethodsA systematic literature search across PubMed, PsycINFO, and Web of Science was conducted in August 2023. Primary inclusion criteria were original research studies that test the relationship between FoMO and a dimension of sleep health. Of the primary 268 studies identified, 16 were included in the final analysis.ResultsMeta-analytic results of the random-effects model applied to a total of 3 independent samples showed a positive correlation between FoMO and Bedtime Procrastination (Fisher’s Z = 0.250; 95% CI 0.137, 0.362; Z = 4.348; p <.001). Additionally, meta-analytic results of the random-effects model applied to a total of 5 independent samples showed a positive correlation between FoMO and Sleep Hygiene (Fisher’s Z = 0.268; 95% CI 0.186, 0.350; Z = 6.419; p <.001) and Sleep Quality (Fisher’s Z = 0.305; 95% CI 0.038, 0.572; Z = 2.240; p = 0.025). Additionally, two or less independent samples showed positive significant relations between FoMO and insomnia, later lights out time, problematic sleep, sleep-deprivation, SOL and TST.ConclusionFoMO seems to be related to different dimensions of sleep health. It seems like the constant urge to stay connected or engaged can lead to sacrificing essential sleep hours, resulting in decreased sleep quality and procrastinated bedtime. This can have effects on various aspects of physical and mental health. Therefore, addressing FoMO may be relevant in improving sleep health. While our findings are significant, it's crucial to acknowledge the limitations of drawing conclusions from some of our results, which were based on findings from just one study. This highlights the need for further comprehensive research to establish a better understanding of the relationship between FoMO and sleep health. Future research should additionally focus on conducting longitudinal studies to understand the direction of the relationships betterSupport (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0991
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1052 Impact of CPAP Adherence on Hospitalized Patients Diagnosed with OSA
           on Healthcare Utilization in Rural Settings

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      Pages: A452 - A452
      Abstract: AbstractIntroductionObstructive Sleep Apnea (OSA) is an increasingly prevalent condition with significant implications for cardiopulmonary health. Data suggests that early detection of OSA in hospitalized patients may improve outcomes. However, the effects of CPAP therapy have not been studied for hospitalized patients in a rural population. The primary purpose of this study is to examine the 1-year readmission, ED visit rate, and associated healthcare costs in hospitalized patients screened as high-risk for OSA, diagnosed, and started on CPAP therapy.MethodsThrough a retrospective review of 2042 patients from 08/2019 to 06/2023 in a registry of a hospital-based sleep medicine program, 786 patients were determined as high risk based on their results from apnea link. From there, 341 patients were selected based on their completion of an outpatient polysomnography (PSG), of which 293 were assessed for adherence of CPAP therapy. Composite end point of combined number of hospitalization and emergency department (ED) visits for 1-year were recorded, further separating the outcomes that were cardiopulmonary in nature due to the CPAP’s focus on those organs. Moreover, cost analysis was performed.ResultsOf the 293 assessed for adherence of CPAP therapy, 108 patients were adherent, while 185 were non-adherent. The mean age of patients evaluated was 58 years (12.82) and 57% were males. The average BMI of these patients was 39.7 (10.7). The mean AHI was 25.49 (26). Analyses showed that 1-year composite end point of hospital readmissions and ED visits were significantly higher in non-adherent patients compared to adherent patients. The hazard ratio was determined to be 1.24 with 95%CI 1-1.54(p=0.03). In the multivariate Cox model, adjusting for age and gender, the adjusted HR was 1.27 with 95%CI: 1.02 – 1.58 (p = 0.033). The one-year total cost of healthcare was significantly higher among non-adherent patients (p< 0.001).ConclusionEarly detection of OSA in hospitalized patients in Appalachia and successful treatment may significantly lower healthcare utilization. These may have practical impact on quality of life and cost of healthcare delivery in rural hospitals.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01052
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1071 Knowledge and Attitudes Regarding Obstructive Sleep Apnea Among
           Pulmonologists in South Korea: A Survey Study

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      Pages: A460 - A460
      Abstract: AbstractIntroductionObstructive sleep apnea (OSA) has known associations with cardiovascular and metabolic conditions and is increasingly recognized in chronic lung diseases like COPD and IPF. In South Korea, OSA patients receive care from various specialties, but pulmonologists' involvement is limited. This study aimed to assess the knowledge and attitudes of pulmonologists in South Korea regarding OSA.MethodsAn online survey was conducted in February 2023, targeting all registered respiratory specialists listed in the online directory of the Korean Academy of Tuberculosis and Respiratory Diseases. The survey utilized the "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA), a previously validated instrument. Three email invitations were sent to potential participants to encourage survey participation.ResultsA total of 127 pulmonologists (20.0%) completed and returned the questionnaires. The mean age of respondents was 45.4 ± 8.6 years, with 68.5% being male. Additionally, 71.7% of respondents were affiliated with university hospitals, and 79.5% were working in hospitals with more than 500 beds. The median total knowledge score was 15.0 [13.0;16.0], and the overall proportion of correct answers was 0.8 [0.7;0.9]. Notably, pulmonologists who had experience in managing OSA patients exhibited significantly higher knowledge and attitude scores than their counterparts without such experience. Furthermore, those with OSA treatment experience demonstrated more confidence in OSA screening, OSA diagnosis, and continuous positive airway pressure (CPAP) therapy management. Interestingly, attitude scores tended to be higher among older respondents and those who graduated from medical school and completed pulmonology specialist training earlier in their careers.ConclusionThe knowledge levels of South Korean pulmonologists regarding OSA were found to be comparable to or better than those reported in previous studies. Nevertheless, there remains a need for targeted education and practical exposure to OSA management, especially for younger respiratory physicians, to enhance their proficiency in treating OSA patients effectively.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01071
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1072 Pulmonary Fellows Need More Sleep: A Sleep Disordered Breathing
           Curriculum for Pulmonary Fellows

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      Pages: A460 - A461
      Abstract: AbstractIntroductionSleep medicine training in pulmonary and critical care (PCCM) fellowships varies widely. The lack of formal curriculum and local pilot data demonstrating limited mastery of sleep medicine concepts via typical clinical exposure prompted us to develop, implement, and evaluate a sleep disordered breathing curriculum for first year PCCM fellows.MethodsThis educational study utilizes a historical control pre-test post-test model. The intervention arm consists of first-year PCCM fellows (n = 7) who completed a 10-question evaluation prior to fellowship-level education. They participated in a novel curriculum and are completing the same test upon conclusion of the curriculum. The curriculum is based on five case vignettes covering obstructive sleep apnea, obesity hypoventilation and sleep disordered breathing in COPD, heart failure, and neuromuscular disease. The control arm is comprised of PCCM fellows (n = 6) who have not had exposure to the SDB curriculum. They completed the evaluation at the conclusion of first year and at the beginning of their third year of fellowship. The evaluation was developed by local and national pulmonary and sleep medicine educators with expertise in question-writing.ResultsTest scores amongst the control group remained low at the end of first year of fellowship, with a mean score of 6/10 (60% +/- 8.9) and have remained low at the beginning of their third year of fellowship with a mean score of 5/10 (50% +/- 11.5%). When asked using a 5 point Likert scale (1=totally uncomfortable, 5=totally comfortable), to assess their comfort with the diagnosis and management of obstructive sleep apnea, the overall average response of 3.08 +/- 0.63 suggests limited comfort with these concepts. In regards to the intervention group, the mean pre-test score prior to beginning the curriculum was 3.71/10, (37.1% +/- 26.3%). Post-curriculum testing and data collection is ongoing with the intervention group, but preliminarily suggests an improvement in comfort level.ConclusionWe suspect that the intervention group will demonstrate improved knowledge and comfort in the management of SDB. These results would suggest that our curriculum offers an opportunity to increase the number of pulmonologists who are able to care for the growing population of patients with SDB.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01072
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1101 Long-term Trends in Utilization of Sleep Diagnostic Tests Among
           Medicare Beneficiaries

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      Pages: A472 - A473
      Abstract: AbstractIntroductionEvidence underlines the association between disordered sleep and adverse health outcomes such as, hypertension, cardiovascular and cerebrovascular disease, and metabolic disorders. A variety of sleep test modalities are available, ranging from ambulatory single-channel sleep tests to in-lab technician-supervised polysomnography (PSG). These tests are selected by the clinician based on the patients overall health profile, which sleep disorders are being investigated, and which tests are covered by insurance providers. The aim of this research was to evaluate trends in utilization of different sleep diagnostic tests among Medicare beneficiaries.MethodsA retrospective analysis of sleep test utilization was conducted using a public data set curated by the Center of Medicare and Medicaid Services. Available data included information on services, categorized by HCPCS or CPT code, submitted and paid charges, beneficiary demographics and health characteristics for the years 2011 to 2021.ResultsFrom 2011 to 2021, sleep service utilization among Medicare beneficiaries decreased from 803,280 to 694,375 with a peak of 963,780 procedures in 2018 (-13.6%; Compound Annual Growth Rate (CAGR) = -1.4%). Despite a slight decline in overall sleep studies, unattended type 3 studies / Home Sleep Apnea Tests (HSAT) grew by 632.6% (CAGR = 22.0%), and replaced attended sleep studies as the main diagnostic test for sleep disorders. Attended sleep studies and split-night study utilization almost halved over the period analyzed (-44.9% and -45.6%, CAGR = -5.8% and -5.9%), while the share of unattended studies / HSAT grew from 4.7% in 2011 to 34.5% in 2021. When excluding the pandemic years 2020 and 2021, overall sleep study utilization grew by 18.0%. This development was entirely driven by increased use of unattended type 3 studies / HSAT (+616.5%; CAGR 25.2%), while attended sleep studies and split-night studies decreased by -15.5 and -7.3% respectively (CAGR -2.4% and -1.7%).ConclusionUtilization of sleep diagnostic tests among Medicare beneficiaries underwent significant changes since 2011, with a large shift occurring from in-lab sleep studies to simpler unattended at-home tests. While attended sleep studies, such as in-lab PSG, split-night titrations and vigilance tests were already declining before the pandemic, this event accelerated the transition towards at-home diagnostic testing.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01101
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1102 Museum-Based Sleep Education: Development and Evaluation of Pop-Up
           Exhibits for Children and Families

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      Pages: A473 - A473
      Abstract: AbstractIntroductionMuseums are highly credible communal spaces where people can come together to learn. This immersive environment offers opportunities to engage briefly but meaningfully with the public about sleep health. We developed interactive pop-up exhibits with activities that introduced children to sleep science and encouraged families to change sleep behaviors. We evaluated their efficacy via observational data and visitor survey responses.MethodsWe held 11 pop-up exhibits in a medium-sized children’s museum from June to December 2023. Each exhibit lasted two hours and was designed to communicate three learning objectives: sleep is good, the sleeping brain is active, and changing nighttime behaviors can improve sleep. Pop-up exhibits included professional signage; take home sleep tips and stickers; videos to display sleep laboratory activities and interesting sleep facts; magnetic “electrodes” and a 3D-printed brain for learning about polysomnography; brain maze coloring sheets, and an inflatable dinosaur fitted to a CPAP mask (REM-ee the dino-snore-us). Each exhibit was staffed by 3-4 trainees (undergraduate to post-doctoral level) and observational data were collected by museum staff. Post-visit survey data in adults assessed participant demographics, meeting of learning outcomes, interest in recommending the exhibit to a friend, prioritization of sleep (0 to 100 scale), and changes in one’s perception of what a scientist looks like.Results1,336 people visited the sleep exhibits (32% of total museum visitors). Adult visitors (18+) were invited to complete a post-visit survey (N=102; M=37.25 years; 63.7% female; 37.25% non-white). Survey responses indicated that most learning objectives were met (89.2%), that most visitors would recommend the exhibit to a friend (91.2%), that visitors’ prioritization of sleep changed from 67.9% before the exhibit to 87.5% after the exhibit (p<.001), and that many visitors intended to change their sleep habits (73.5%). More than half of visitors (62.2%) reported that their perception of a scientist had changed (e.g., demographically diverse, friendlier).ConclusionPop-up museum exhibits are a feasible and effective method for communicating sleep information in local communities. Additional work is needed to determine whether permanent installations of sleep exhibits retain their efficacy when sleep experts are not actively staffing the exhibit.Support (if any)National Science Foundation (1920730 and 1943323).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01102
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1103 Outcomes of Interventions to Reduce Pediatric Sleep Study
           Interpretation Time

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      Pages: A473 - A473
      Abstract: AbstractIntroductionNationwide Children’s hospital (NCH) Sleep Center mission is to improve overall health through increased access to diagnosis of sleep disorders. Timely sleep study reporting avoids delay in recognition of sleep disorders and enables early intervention. NCH Sleep center providers completes urgent sleep study interpretations within 24 hours. Delay in sleep study interpretation of non-urgent sleep studies has been a patient and referring provider dissatisfier.MethodsAim Statement: The project will decrease the time to interpretation of non-urgent sleep studies for outpatient NCH ENT referrals from a baseline of 11 days to a goal of 7 days, accomplished by June 30 th, 2023, and sustained for 1 year. Key Drivers: • Provider workload • Provider expectation • Scoring delay • Workflow technical issues Interventions: • Change provider sleep reading rotation to 1 week • Study number/provider capped to 25/week • Study allocation criteria established • Report templates streamlined • Scoring for weekend studies implemented • Request platform for workflow managementResultsA total of 270 children were referred by NCH ENT and underwent non-urgent overnight polysomnograms from January 2023 to July 2023 as compared to 180 children from January 2022 to July 2022. The time to interpretation of non-urgent studies ordered by ENT specialists reduced from an average of 11 days (SD 7.1 days) in 2022 to an average of 4.5 days (SD 3.3 days) in 2023 (Jan-June).ConclusionOur results indicate that process improvement in the pediatric sleep lab using quality improvement methodology can be utilized to improve patient experience and meet referring provider expectations.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01103
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1104 Personalisation of Breathing Comfort for CPAP Users Through a
           Machine-Learning Algorithm

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      Pages: A473 - A474
      Abstract: AbstractIntroductionMany factors impact CPAP adherence, some common issues include trouble falling asleep, difficulty breathing against pressure, and being disturbed by high pressures. Various settings to address breathing comfort have been developed, such as ramp time, reducing pressure during exhalation, and APAP response rate, though evidence of their impact is minimal. We sought to develop a machine-learning model to recommend personalised combinations of comfort settings at setup with the goal of improving CPAP adherence in patients newly starting CPAP therapy.MethodsData sets from 718,421 anonymous OSA patients (myAir, ResMed) were used to create the machine-learning model (MLM). The model was developed using a causal inference approach to control for bias from observational data and utilised features such as age, sex, diagnostic AHI, mask type and start pressure to predict optimal comfort settings for various patient types. These comfort settings can then be applied on an individual level. A proof-of-concept, double-blinded, randomised controlled study was conducted with people newly diagnosed with OSA (AHI≥5) and indicated for CPAP therapy attending a sleep clinic. The primary outcome was treatment continuance after 30 days comparing those set up on MLM vs default comfort settings (control).Results58 patients (26% female, mean age 49.9±14.9, 46.6% non-white, mean diagnostic AHI 43.6±30.4) were included in the study analysis. At 30 days the MLM group had greater treatment continuance vs control (96% vs 80%) though not statistically significant. All other endpoints were also not statistically significant. 54% of MLM group had zero setting changes vs 37% control. In this subgroup, MLM showed increased average daily usage (+46.9min), number of days used (+2.9days), and number reaching CMS compliance (+11%), however these endpoints did not reach statistical significance.ConclusionThis program developed a machine-learning model to predict optimal comfort setting combinations for individual CPAP patients to improve CPAP adherence. The proof-of-concept study did not reveal any harm to patients assigned personalised settings and showed some trends towards positive outcomes. Personalising comfort settings may benefit new CPAP patients, however a larger study is required to fully validate the machine-learning model.Support (if any)Funded by ResMed
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01104
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1137 Sleep Quality of Undergraduate Medical Students During and Post
           Lockdown: A Cross Sectional Study

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      Pages: A487 - A488
      Abstract: AbstractIntroductionThe global upheaval caused by the COVID-19 pandemic significantly influenced healthcare and medical education. Faced with in-person learning restrictions, institutions globally adopted online platforms, disrupting the daily routines and sleep patterns of medical students. This study aims on the assessment of sleep quality among undergraduate medical students affiliated with the National Medical Council in India, exploring effects of COVID-19 lockdown measures on their sleep patterns both in the short and long term.MethodsConducting a cross-sectional survey, participants included undergraduate medical students from NMC-registered colleges, encompassing all genders. Ethical approval and written consent were obtained, employing respondent-driven sampling to recruit 165 participants over six months (October 2021 to March 2022). The study utilized the Pittsburgh Sleep Quality Index (PSQI), a validated questionnaire with 19 self-rated questions and five partner-rated items, if available. Statistical analysis involved SPSSv2021 for descriptive analysis, PSQI score calculations, and tests examining associations between PSQI components and sociodemographic variables.ResultsAmong the 171 participants, 9.4% reported poor sleep quality during the lockdown, decreasing to 4.7% post-lockdown—a substantial 50% improvement. Noteworthy changes were observed in specific PSQI components, such as sleep quality and habitual sleep efficiency, with sleep duration decreasing by 23.4% during lockdown and increasing by 45.6% post-lockdown. Weak correlations between PSQI scores during and post-lockdown suggested persistent sleep challenges for those initially affected. Sociodemographic factors showed no significant associations with PSQI score changes.ConclusionThis study accentuates the pandemic's impact on the sleep quality of undergraduate medical students, revealing a significant 50% enhancement post-lockdown. It underscores the importance of addressing reduced sleep quality among this demographic and emphasizes the need for strategies promoting good sleep hygiene and offline study habits. Future research should delve into the academic consequences of poor sleep during the pandemic and assess students' readiness to seek advice or treatment for sleep-related issues. In summary, the study highlights the critical significance of sleep quality among undergraduate medical students and underscores the imperative for interventions supporting their well-being amid and beyond the COVID-19 pandemic.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01137
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1192 A Case of Worsening Exploding Head Syndrome When Using Positive
           Airway Pressure

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      Pages: A509 - A509
      Abstract: AbstractIntroductionExploding head syndrome (EHS) is a rare parasomnia with unclear etiology. There are limited research studies to confirm the exact predisposing and precipitating factors for its onset and frequency. Some published case reports suggest symptomatic improvement with the treatment of comorbid obstructive sleep apnea (OSA). This case presents a patient who received automatic positive airway pressure (APAP) treatment for OSA with worsening EHS symptoms.Report of case(s)A 41-year-old male with obesity (BMI of 33) and chronic back pain complained of visual and audio sensations of explosion, vibration, and light when falling asleep and waking up in the middle of the night without any associated physical pain. These events would occur twice a month and were accompanied by waking up three to four times nightly due to loud snoring. A home sleep study (HSAT) was completed and consistent with mild obstructive sleep apnea, demonstrating a respiratory event index (REI) of 7.4 events per hour. The patient was diagnosed with exploding head syndrome and OSA. He was started on APAP therapy. At the six-week follow-up, he noted worsening frequency of EHS events to twice a week. During this time, he lost his job. At the three-month follow-up since starting APAP, he reported further worsening of his EHS episodes to three times a week. The patient was not compliant with APAP usage. The compliance data revealed average usage of 2-3 hours a night with residual AHI of 1.2/hour.ConclusionEHS is a rare disorder with unknown predisposing and precipitating factors. This patient noted worsening of his EHS after the initiation of APAP therapy for his obstructive sleep apnea. However, the patient was not fully compliant with PAP therapy. He also underwent further stressors during this period. This case raises consideration regarding the side effects of APAP therapy on the severity of EHS when treating OSA.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01192
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0804 Acceptability and Patient-centered Outcomes for Infant Behavioral
           Sleep Intervention in Black Families

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      Pages: A344 - A345
      Abstract: AbstractIntroductionWhile the efficacy and acceptability of infant behavioral sleep intervention has been developed and tested in White families, less is known about how Black mothers understand and perceive behavioral sleep recommendations. The objective of the Sleep Guidance in Black Families with Infant Children (SLUMBER) study was to evaluate the perspectives of Black mothers with infants on the acceptability and cultural appropriateness of standard infant behavioral sleep recommendations. As part of this study, we examined maternal perspectives on participation in an infant behavioral sleep program and desired patient-centered outcomes.MethodsParticipants were recruited through Black parent groups on Facebook and WhatsApp, along with more general social media campaigns targeting individuals who identified as Black. Semi-structured interviews were conducted with Black mothers (n=18; 55.6% with a college degree) with an infant < 9 months (M=4.5, SD=2.8; 66.7% male). Interview transcripts were analyzed within the NVivo software using a grounded theory thematic descriptive approach.ResultsMany mothers (n=11, 61.1%) indicated a high interest level in participating in a sleep program. Facilitators to participation included addressing current problem areas with their infant’s sleep and social support. The most identified barrier to participation was potential poor alignment between program recommendations and personal values, particularly pertaining to the acceptability of approaches involving infant crying without immediate intervention. Desired program outcomes that mothers most frequently described included a more consistent or predictable sleep/wake pattern, their baby learning to sleep independently, and increased sleep consolidation.ConclusionBlack mothers endorsed high interest in participating in an infant behavioral sleep program, although over one-third were not interested. Personal and cultural alignment with program recommendations is important to parents, supporting the need for culturally sensitive interventions, with particular attention to variability in perceived acceptability of approaches involving infant crying. Infant behavioral sleep intervention programs should focus on achieving patient-centered outcomes, such as schedule consistency and sleep consolidation.Support (if any)This research is supported by The Center for Injury Research and Policy at Nationwide Children’s Hospital through Grant Number R49CE003074 from the Centers for Disease Control and Prevention. Dr. Chung's time is supported by the National Heart, Lung, and Blood Institute under award number 1K01HL169419-01.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0804
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0805 Melatonin Use Among Children in Foster Care: Associations with Sleep
           and Daytime Behavior

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      Pages: A345 - A345
      Abstract: AbstractIntroductionIn recent years, melatonin use has risen steeply in children of all ages. It is also the most commonly recommended intervention for sleep problems among children in foster care (Alfano et al., 2022) despite a lack of evidence of its safety and efficacy for children with a history of maltreatment/trauma. This study therefore investigated and compared aspects of sleep and daytime emotional/behavioral problems among children in foster care who have and have not been administered melatonin.MethodsSurvey data from N=454 caregivers from across the U.S. who were currently fostering children between the ages of 4- and 11-years-old (M=6.39, SD=2.20) were examined (McGlinchey et al., 2023). Caregivers were recruited for an anonymous online survey via private Facebook groups for foster families. Questions included whether or not they had ever administered melatonin to the foster child, aspects of the child’s sleep, and emotional/behavioral problems. Children included in the sample were relatively diverse, with 17% Black/African American and 11% Hispanic children from 46 U.S. states.ResultsForty-eight percent (48%; n = 221) of foster caregivers reported administering melatonin to their child currently or in the past. ANCOVAs controlling for level of foster care (i.e., children with special needs) revealed melatonin use was associated with poorer sleep quality, F(1, 423)=25.118, p<.001, partial η²=.056, and increased severity of daytime behavioral problems, F(1, 410)=21.843, p<.001, partial η²=.051, based on medium effects. However, melatonin use was not associated with child depressive, F(1, 441)=2.151, p=.143, partial η²=.005, or anxiety symptoms, F(1, 422)=1.198, p=.274, partial η²=.003.ConclusionChildren in foster care who are taking/have taken melatonin are reported to have worse quality sleep and more daytime emotional/behavioral problems than children in foster care not taking melatonin, but not more depressive or anxiety symptoms. The extent to which greater daytime problems might be a result of poorer nighttime sleep remains to be understood. Although our study has limitations, it is one of the first to examine behavioral correlates of melatonin use among children in foster care.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0805
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0806 The Effect of a Sleep Promotion Program in Adolescents with
           Insufficient Sleep: A Randomized Controlled Trial

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      Pages: A345 - A346
      Abstract: AbstractIntroductionAdolescent sleep is compressed by early school start times and often competes with school, extracurricular, and social demands. Insufficient and mistimed weeknight sleep contributes to large shifts in weekend-weekday sleep-wake schedules, which may lead to adverse physical and mental health outcomes. The Sleep Promotion Program (SPP) is a brief, scalable, behavioral intervention that aims to increase sleep duration and regularity while building motivation and efficacy to change sleep behaviors. This secondary analysis tested whether the SPP changed actigraphy-assessed sleep.MethodsParticipants (ages 13-15) with insufficient and irregular sleep (N=44) were randomized to the SPP intervention (n=24) or waitlist control (n=20). The SPP included sleep psychoeducation and a face-to-face clinician session, relying on evidence-based strategies for promoting sleep within a motivational interviewing framework. Participants wore an ActiWatch during their baseline and follow-up which occurred after the intervention or the waitlist period. We hypothesized participants randomized to SPP would lengthen and stabilize sleep from baseline to follow-up compared to controls. We tested a group (intervention vs. waitlist) by time (baseline vs. follow-up) interaction on actigraphy-assessed sleep duration, timing, and regularity (weekend-weekday shift in timing) using multilevel models with a random intercept.ResultsWe included 38 participants with at least 4 weekday nights and 1 weekend night of actigraphy (n=23 intervention, n=15 waitlist). The intervention group delayed their weeknight bedtimes (~45 minutes; b=0.69, SE=0.27, p=0.01), delayed their weeknight waketimes (~1 hour; b=0.68, SE=0.32, p=0.03), and simultaneously decreased the difference between weekend-weekday bedtimes (b=-1.1, SE=0.5, p=0.04) compared to controls (i.e., increased regularity). Weekend sleep timing and total sleep time did not change significantly.ConclusionThe SPP intervention regularized weekend-weekday sleep timing in adolescents with insufficient and irregular sleep, likely driven by delaying weeknight sleep times. Given that this study was primarily conducted during the COVID-19 pandemic, when many participants reported delayed school start times, participants randomized to SPP were able to regularize their weekend-weekday sleep schedules while simultaneously adapting their weeknight sleep schedules to better fit their preferred timing. Regularizing sleep may be an attainable first step to improving sleep in adolescents. Future work will examine whether sleep regularization associates with mental health outcomes.Support (if any)K23HD087433, Pittsburgh CTSI
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0806
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0807 Ferric Carboxymaltose versus Iron Sucrose for Pediatric Sleep-related
           Movement Disorders

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      Pages: A346 - A346
      Abstract: AbstractIntroductionIntravenous (IV) ferric carboxymaltose (FCM) and iron sucrose have previously been reported as effective therapies for sleep-related movement disorders (SRMDs) in children. While FCM has a more robust ability to optimize iron stores, iron sucrose is sometimes required instead due to insurance coverage. In this study, we compared clinical and laboratory outcomes of children in our center who underwent either FCM or iron sucrose infusion for SRMDs.MethodsThis was a retrospective study of all children who underwent either IV FCM or iron sucrose infusion in our outpatient infusion center between 1/2023 and 12/2023. While FCM was initially requested for all children, iron sucrose was ordered instead if dictated by insurance coverage. Children were included if the infusion was ordered by a pediatric sleep physician for treatment of confirmed SRMD, there were baseline and follow-up ferritin results available, and there was follow-up clinical information regarding sleep symptoms.ResultsOverall, there were n=40 iron infusions (n=18 FCM and n=22 iron sucrose) that had follow-up clinical and laboratory data available for analysis. There were no significant differences in weight, age, sex, or baseline ferritin level between groups. Children who underwent FCM infusion had significantly higher follow-up ferritin levels compared with iron sucrose (117.9 +/-52.1 vs 69.7+/-38.8 ng/mL, p=0.002) despite longer time to follow-up lab draw (71.3+/- 40.5 vs 28.1+/-37.1 days, p=0.010). Clinical improvement in sleep was noted in children underwent FCM and iron sucrose (72.2% vs 63.6%, p=0.564). Repeated infusions were needed significantly more often with iron sucrose compared with FCM (27.3% vs 0.0%, p=0.024). Each group had 1 case of mild gastrointestinal symptoms during infusion, otherwise no significant infusion reactions were noted. There were no cases of significant hypophosphatemia noted following FCM infusion (mean=4.4+/-0.7, none < 2.0 mg/dL).ConclusionIntravenous iron therapy is a safe and effective treatment modality for pediatric SRMDs. FCM is superior to iron sucrose both in terms of improvement in ferritin level as well as decreased need for repeated infusions.Support (if any)None.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0807
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0808 Nighttime Distribution of Periodic Limb Movements of Sleep After
           Surgical OSA Treatment in Pediatric Population

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      Pages: A346 - A346
      Abstract: AbstractIntroductionIncreased periodic limb movements of sleep (PLMS) can occur in patients with sleep disordered breathing. Changes in PLMS following treatment for obstructive sleep apnea (OSA) are observed, but poorly understood. In adults, PLMS are typically seen in the first portion of the night whereas OSA events occur most frequently during the latter portion. To better understand the link between pediatric PLMS and OSA, we investigated whether nighttime distribution of pediatric PLMS could predict resolution of PLMS following surgical management of OSA.MethodsA retrospective study was performed in children and adolescents aged 1-18-year-olds who had pre-operative PSG showing OSA (OAHI ≥1.5/hr) and significant PLMS (PLM index [PLMI] ≥5/hr) before undergoing surgical treatment for OSA and subsequent post-operative PSG. The cohort was divided into 2 groups based on post-operative PSGs; (1) sustained PLMS with PLMI index >5/hr post-operatively and (2) resolved PLMS with PLM index < 5/hr postoperatively. PLMS distribution was qualified by calculating PLMI during each third of the night of pre-operative PSG. The age, PSG parameters and PLMS distribution were compared between patients with sustained PLMS and resolved PLMS.ResultsTwenty-seven subjects met the criteria for entry into analysis; 14 patients with sustained PLMS and 13 patients with resolved PLMS. Sustained PLMS had higher overall PLMI compared to resolved PLMS (15.13±8.02/hr vs. 9.77±5.88/hr, p=0.03). Sustained PLMS had a higher PLMI during the first third of the night on pre-operative PSG compared to resolved PLMS (15.99±10.37/hr vs. 6.05±8.02/hr, p=0.01). There were no significant differences in PLMS in the middle and last thirds of the night, BMI, age (6.37±4.20 vs. 5.07±4.10 years) at sleep study, AHI, or OAHI (8.11 vs. 6.04).ConclusionChildren with PLMS that resolved after surgical treatment for OSA have less frequent PLMS in the early part of the night and a lower overall PLMI compared to children with sustained PLMS. This suggests that PLMS occurring in the first third of the night are independent of sleep disordered breathing and are likely associated with other conditions such as sleep related movement disorders. The distribution of PLMS may help prioritize children with OSA and PLMS who require further evaluation of RLS/PLMD post-operatively.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0808
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0809 Circadian Phase Delays from School Nights to Weekends and Relates to
           Sleep Characteristics in High School Students

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      Pages: A347 - A347
      Abstract: AbstractIntroductionDevelopmental shifts towards later sleep/circadian timing during adolescence are often at odds with early school start times, resulting in circadian misalignment and sleep restriction, as well as stark differences between sleep timing/duration on school nights versus weekends. While the sleep aspects of this mismatch have been well-characterized, limited objective data addresses within-person changes in circadian phase across the week. In a sample of high school students, this project aimed to (1) characterize within-person changes in circadian phase from school nights to weekend nights, and (2) examine whether later circadian phase relates to other sleep/circadian characteristics across the full week.MethodsSample included 115 high school students (mean age 17.3, 55.7% female, 88.7% White) reporting at least one “standard drink” of alcohol in their lifetime. Participants completed baseline self-report measures, wrist actigraphy for 8 days, and two overnight visits (Thursday and Sunday) for salivary melatonin sample collection. The Munich Chronotype Questionnaire assessed chronotype and social jetlag. Actigraphy measures included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and midsleep timing. Circadian phase was calculated as the dim light melatonin onset (DLMO; 4 pg/ml threshold). Actigraphy and DLMO measures were separately calculated for school nights, weekends, and overall (mean). Linear regression was used to examine associations, covarying for sex, race, and SES.ResultsCircadian phase (DLMO) was systematically later on Sunday (mean 37+/-41 minutes later; d=0.68, p< 0.00). Later school night DLMO was associated with longer SOL (b=0.05,p=0.002), shorter WASO (b=-0.03,p=0.018), and shorter TST (b=-0.18,p=0.001) on school nights, as well as later chronotype (b=-1.72,p< 0.0001). Later weekend DLMO was associated with longer TST (b=0.22,p=0.042) on weekends. Later DLMO (school night, weekend, overall) was associated with larger weekday-weekend differences in actigraphic TST (p’s< 0.001) and more social jetlag (p’s< 0.03).ConclusionCircadian phase shows systematic within-person differences across school nights and weekends, broadly paralleling social jetlag based on sleep timing. While later circadian phase was associated with later chronotype, as well as more difficulty falling asleep and less sleep on school nights, this was specific to circadian phase assessed on school nights. Future studies should consider day-of-week of circadian assessments.Support (if any)R01AA025626(Hasler)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0809
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0810 Impact of Schooling on the Measurement of Multidimensional Sleep
           Health in Adolescence

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      Pages: A347 - A347
      Abstract: AbstractIntroductionMultidimensional Sleep Health (MSH) is an emerging concept in sleep and circadian science that aims to capture the 24-hour experience of sleep and identify individuals in the population with good sleep health. While schooling is one of the most important contextual variables impacting adolescent sleep, little is known about how it impacts the measurement of MSH. In the present study, we examined differences in adolescent MSH while they were either in-school or on-break.MethodsWe studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample, with 63% of the sample (n=236) in-school when sleep data were collected. We used the MSH RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – to derive a composite score of sleep health using actigraphy and self-reports.ResultsAdolescents in-school had a marginally (p=0.07) higher MSH score (3.12±1.2) than those on-break (2.87±1.4). Adolescents on-break were more likely to have optimal alertness (37.8% vs 31.8%, p< 0.05) and duration (37.2% vs 61.5%, p< 0.05), but less likely to have optimal timing (30.8% vs 61.8%, p< 0.001) and efficiency (34.6% vs 50.9%, p< 0.001) compared to those assessed while in-school. The differences observed in the timing and duration domains were driven by on-break adolescents mean sleep midpoint being more than an hour later than those in-school (4:42 am vs 3:36 am, p< 0.001) and having a mean sleep efficiency slightly below the cut-off of 85% (84.3% vs 85.9%, p< 0.05).ConclusionAccounting for contextual factors in adolescents, specifically whether they are attending school or not, is important for the measurement of MSH. Future work should derive cut-offs for optimal sleep health specific to adolescents as well as potentially include other timing dimensions beyond average sleep midpoint, such as social jetlag.Support (if any)NIH Awards Number R01HL136587, UL1TR000127
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0810
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0811 Multidimensional Sleep Health and Its Association with
           Cardiometabolic Health in Adolescence

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      Pages: A347 - A348
      Abstract: AbstractIntroductionMultidimensional sleep health (MSH) aims to promote physical and mental well-being and capture the 24-hour experience of sleep by using measures of nighttime sleep and daytime functioning. We have previously updated the existing adolescent MSH model to incorporate objective and subjective measures and, in the present study, we examine its utility in identifying associations between MSH and Metabolic Syndrome (MetS), a cluster of five established risk factors of cardiovascular disease.MethodsWe studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. We used the RU-SATED framework–regularity, satisfaction, alertness, timing, efficiency, and duration–to derive an MSH score using actigraphy and self-reports. A continuous MetS score was calculated as the sum of sex-and-age adjusted z-scores of waist circumference (WC), mean arterial blood pressure (MAP), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, and HDL.ResultsOverall, better MSH was not significantly associated with lower cMetS (β=-0.07, p=0.22); however, it was significantly associated with lower WC (β=-0.12, p< 0.05). When we examined each MSH dimension and its association with each component of cMetS, good sleep timing was significantly associated with lower WC (β=-0.13, p< 0.05) and higher HDL (β=0.11, p< 0.05) and good sleep efficiency was associated with lower cMetS (β=-0.11, p< 0.05) and lower MAP (β=-0.11, p< 0.05). When we examined each dimension continuously, we found that higher ratings of excessive daytime sleepiness were associated with higher cMetS (r=0.12, p< 0.05) and WC (r=0.11, p< 0.05), more morningness was associated with lower fasting triglycerides (r=-0.10, p< 0.05), later sleep midpoint was associated with lower HDL (r=-0.13, p< 0.05), and longer sleep duration was associated with lower MAP (r=-0.12, p< 0.05) and HOMA-IR (r=-0.11, p< 0.05).ConclusionBetter sleep health is significantly associated with central obesity, the key driver of MetS. Additionally, our analyses demonstrate that specific dimensions of MSH may contribute differently to cardiometabolic health in adolescence.Support (if any)NIH Awards Number R01HL136587, UL1TR000127
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0811
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0892 Roles of Pain Interference, Pain Intensity, and Sleep-partner in
           Insomnia and Daytime Sleepiness Among Veterans

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      Pages: A383 - A383
      Abstract: AbstractIntroductionInsomnia and daytime sleepiness are prevalent in Veterans, many of whom have co-morbid pain. Although ample evidence suggests an association between sleep and pain, the differential roles of pain-related daytime dysfunction (hereafter, “pain interference”) and pain intensity in insomnia and daytime sleepiness are less known. These associations may also be influenced by the presence of a sleep-partner, who has been shown to provide psychological comfort but may also interfere with the physical comfort of one’s sleep environment. Thus, this study examined the unique associations of pain interference and pain intensity, as well as the moderating effects of sleep-partner, with symptoms of insomnia and daytime sleepiness among Veterans presenting to a sleep clinic.MethodsVeterans presenting to the Miami VA sleep clinic for sleep apnea assessment (N=405, M age=50.3 years, 84.3% male) completed the PROMIS-29 (pain interference, pain intensity), Insomnia Severity Index, and Epworth Sleepiness Scale, and reported whether they sleep with a partner or not. Structural equation modeling was used to examine the study aims while controlling for age, gender, and apnea-hypopnea index.ResultsOn average, Veterans reported moderate levels of pain interference, pain intensity, and insomnia severity, as well as mild levels of daytime sleepiness. Over half (59.0%) of the Veterans endorsed sleeping with a partner. Among Veterans who slept without a partner, greater pain intensity was associated with greater insomnia severity (b=.14, p=.002). Among Veterans who have a sleep-partner, greater pain intensity was associated with both greater insomnia severity (b=.09, p=.017) and greater daytime sleepiness (b=.53, p=.038). Pain interference was not associated with insomnia or daytime sleepiness in either group (b<=.02, p>=.084).ConclusionFindings indicated the unique and deleterious role of pain intensity in insomnia and daytime sleepiness in Veterans, particularly among those who sleep with a partner. Such evidence highlights the interdependent nature of sleep and suggests considerations of dyad-level factors in sleep interventions. Further investigations are warranted to elucidate the biopsychosocial factors underlying the current findings.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0892
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0893 Impact of Positive Airway Pressure Therapy on Clinical Outcomes in
           Older Veterans with Comorbid Chronic Obstructive

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      Pages: A383 - A384
      Abstract: AbstractIntroductionCognitive impairment in older Veterans is an independent predictor of subsequent mortality and disability. Pilot data indicate that patients with OSA-COPD Overlap Syndrome (OVS) have reduced sleep quality and quality of life (QoL). However, there are no prior systematic studies evaluating treatment paradigms in patients with OVS. Our ongoing clinical trial is investigating whether, compared with usual care, positive airway pressure (PAP) therapy alleviates sleep disturbances, sleepiness, and improves cognitive function and QoL in older adults with OVS.MethodsThe design is a prospective parallel group randomized controlled trial in Veterans 60 years and older, with moderate-to-severe OSA with concomitant COPD (OVS). 225 eligible participants will be randomized to two treatment groups (PAP and conservative care) in 2:1 ratio for a duration of 6 months. Participants on the conservative care arm are required to follow good sleep habits and sleep hygiene, and on the PAP arm, in addition, are required to be adherent to PAP treatment (CPAP or Bilevel PAP, as required). Sleep questionnaires are administered to evaluate sleepiness, sleep quality, and general and disease specific QoL. Cognitive function is evaluated using Trail Making Test Part A and B, Paced Auditory Serial Addition Test, Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R, Weschler Abbreviated Scale Intelligence II, Weschler Memory Scale IV, and Psychomotor Vigilance Test, respectively. All tests are administered at baseline visit, 3 months, and 6 months.ResultsWe have enrolled 222 participants between Detroit and Ann Arbor VAMC locations, randomized 50 participants (48 males, 5 females; age: 70.5±6.5 years, BMI: 29.2±6.3kg/m2, AHI: 44.4±20.9events/hr, spirometry FEV1: 61.6±14.9% predicted, arterial blood gas (n=37) PaCO2:41.3±3.7 mmHg, ESS: 7.6±4.3, Six Minute Walk Test Total Distance Walked: 389.6±105.7 meters, FOSQ Total Score: 17.0±3.5, SGRQ Total Score: 45.6±22.6;30 participants have completed the study per the protocol. Group analysis will be available at the end of the trial. COVID pandemic has negatively impacted enrollment targets.ConclusionFinal results from our study will determine the effects of treating a novel target (OVS) to maximize daytime function and QoL, while also providing a framework for early treatment of mild cognitive impairment in vulnerable older Veterans.Support (if any)VHA RR&D # 1I01RX003124-01
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0893
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0894 Effects of Chronic Rhinosinusitis (CRS) on Sleep Duration and
           Variability in World Trade Center (WTC) Responders

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      Pages: A384 - A384
      Abstract: AbstractIntroduction43.5% of World Trade Center rescue and recovery workers demonstrate symptoms of chronic rhinosinusitis (CRS). Subjects with CRS report increased sleep complaints and shorter subjective sleep duration compared to those without CRS. Discomfort from nasal symptoms during sleep may result in shorter sleep duration and an increased night-to-night variability. We compare actigraphic assessment of sleep duration and variability in subjects with and without CRS.MethodsWTC-responders in an on-going study assessing sleep apnea and Alzheimer's disease biomarkers underwent 2-week actigraphy with sleep diary before in-lab polysomnography. Demographics, CRS symptoms, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), sleep duration and complaint information were obtained. CRS+ was defined as ≥3 symptoms: facial pain, post-nasal drip, nasal congestion, blocked nose, loss of smell, sneezing, sore throat or hoarseness. Nightly actigraphy data were analyzed using Cole-Kripke algorithm and averaged over all nights to obtain mean total sleep time (TST) and coefficient of variability (CV) across nights. Group comparisons were performed using two-sample t-test with significance level at p< 0.05.Results42 subjects (74%M/26%F, age 64.7±5, BMI 28.6±6kg/m2) had 14 nights (range=11-17) of actigraphy data. Subjective sleep duration and TST by actigraphy were correlated (r=0.4, p=0.02). 19(45%) were CRS+ vs 23(55%) CRS-. Age, sex, BMI, and sleep apnea prevalence did not differ between CRS+ vs CRS- groups. Mean (SD) ISI in CRS+=8.4(5.4), CRS- =5.4(5.4), p=0.08. ESS in CRS+=4.2(2.5), CRS- =4.6(3.0), p=0.6. Although not statistically significant, mean subjective sleep duration in hours was shorter and more variable in CRS+=7.84(1.3) than CRS- =8.34(0.7), p=0.1. Actigraphic sleep duration (TST) in hours was shorter and more variable in CRS+ [6.59(1.2), CV=22.7(9.5)] than CRS- [6.80(0.8), CV=20.7(7.2)].ConclusionWTC-responders with CRS symptoms report shorter subjective sleep and greater insomnia similar to our previous findings. While we did not demonstrate a significant difference in actigraphic sleep duration or variability between CRS groups, we were limited by a small sample size. The high prevalence of CRS and sleep complaints in this population and the association of reduced sleep duration and increased morbidity and mortality highlights the importance of establishing if there is a shorter sleep duration in CRS+ patients through further investigation.Support (if any)NIOSH:U01OH011852, K24HL109156, NCATS:TL1TR004420
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0894
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0972 Rest-activity Rhythm Profiles in Major Depressive Disorder: A Cluster
           Analysis in Chinese Population

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      Pages: A417 - A417
      Abstract: AbstractIntroductionPrevious research has demonstrated that rest-activity rhythm (RAR) profiles, formed by individual RAR characteristics, were linked to the severity of depressive symptoms. Further investigation into RAR profiles could potentially facilitate the identification of depression and validate its role in depression. This study aimed to identify the RAR profiles in samples with and without major depressive disorder (MDD).MethodsActigraphy data were collected from 70 Chinese adults (34 with current MDD and 36 age- and gender-matched healthy controls) aged between 18 and 64. RAR measures were computed based on the collected 7-day actigraphy data, and a data-driven cluster analysis was performed to identify distinct RAR profiles. The associations between the actigraphy-derived RAR profiles and various psychiatric symptom/health-related measures, including anxiety and depressive symptoms, insomnia severity, fatigue, and quality of life, were examined.ResultsTwo distinct groups with different RAR features (“earlier/robust” group: n = 63, 90%; “later/irregular”; n = 7, 10%) were identified from the sample using cluster analysis. The “later/irregular” group exhibited later activity onset and acrophase, along with lower levels of robustness and regularity compared to the “earlier/robust” group. Regarding psychiatric symptom/health-related measures, the “later/irregular” group displayed significantly higher levels of depressive symptoms [t(8.77) = -3.36, p <.05], insomnia severity [t(15.3) = -6.85, p <.05], fatigue [t(8.80) = -2.68, p <.05], and a higher percentage of participants with current MDD [χ2(1) = 4.30, p <.05] relative to the “earlier/robust” group. However, insignificant differences in health-related quality of life [t(7.71) = 2.27, p =.054] were found between two groups.ConclusionThe current findings contribute further evidence on the association between RAR profiles and MDD, suggesting that RAR profiles could potentially be a biological marker for identifying depression. The observed associations between RAR profiles and other related symptoms demonstrated the utility of RAR profiles in detecting other health-related concerns. However, it is important to note that confirmatory studies with larger sample sizes and longitudinal designs are necessary to validate these findings and reveal the underlying mechanisms and temporal relationship between circadian rhythms and depression.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0972
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0973 Romantic Partnership Mitigates the Influence of Anxiety and Mood on
           Sleep Disturbance in Full-Service Sex Workers

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      Pages: A417 - A418
      Abstract: AbstractIntroductionIn the United States, an estimated 1-2 million full-service sex workers (FSSW) face notable physical and mental health challenges, including increased depression, anxiety, and sleep difficulties as compared to the general population (Ramos et al., 2022). The "partnership-health associations" concept suggests that romantic relationships may protect mental and physical well-being (Du Bois et al., 2021). Notably, a recent study found no significant health outcome differences between partnered and non-partnered FSSW at the univariate level (Du Bois et al., 2023). This secondary analysis aims to explore whether partnership buffers the link between mood, anxiety, and sleep disturbance among FSSW.Methods83 FSSW completed the Patient Reported Outcomes Measure Information System-29 (PROMIS-29) online from November 2019-February 2020. Four moderation analyses, utilizing PROCESS, examined anxiety and depression as predictor variables and global sleep disturbance score as an outcome, with partnership status (partnered versus non-partnered) as the moderating variable.ResultsThe sample was primarily white (81.9%), non-Hispanic (77.1%), and cisgender female (66.3%), with a mean age of 28.01 (±4.25) years. The overall model for partnership status as a moderator of the association between anxiety and sleep disturbance was significant (F(3, 79)=17.65,p<.001,R2=.40). The interaction effect showed a significant link between increased anxiety and sleep disturbance for both non-partnered FSSW (b=0.88,SE=0.13,t(79)=6.74, p<.001) and partnered FSSW (b=0.35,SE=0.14,t(79)=2.48,p<.05), with a more pronounced association for non-partnered FSSW. Similarly, the overall model for the association between depression and sleep disturbance was significant (F(3, 79)=12.50,p<.001,R2=.32). The interaction effect indicated a significant link between increased depression and sleep disturbance for both non-partnered FSSW (b=0.75,SE=0.13,t(79)=5.61,p<.001) and partnered FSSW (b=0.34,SE=0.15,t(79)=2.18,p<.05), with a more pronounced association for non-partnered individuals.ConclusionAnalyzing mental-physical health associations at a multivariable level provides a nuanced understanding that partnership may protect against unfavorable mood, anxiety, and sleep health associations in FSSW. Future studies should include a larger sample size and explore specific underlying mechanisms by which romantic partnership relates to a protective effect of low mood and high anxiety on sleep, both in FSSW and other groups who experience health inequities.Support (if any)American Psychological Foundation, The Drs. Rosalee G. and Raymond A. Weiss Research and Program Innovation Grant
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0973
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0974 Sleep Characteristics and Depression and Anxiety Symptoms Among
           Adults with Inflammatory Bowel Disease

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      Pages: A418 - A418
      Abstract: AbstractIntroductionInflammatory Bowel Disease (IBD) is a chronic, immune-mediated condition, encompassing Crohn's disease (CD) and ulcerative colitis (UC). Up to 80% of individuals with IBD report poor sleep quality. However, there is limited information on factors that predict sleep characteristics in this population. This study aims to explore the associations between demographic, clinical, and psychological factors with sleep characteristics in adults with IBD.MethodsWe conducted a retrospective analysis of two IBD sleep studies. Participants aged 18-64 years old with a diagnosis of IBD were recruited from two academic medical centers and completed Patient-Reported Outcomes Measure Information System (PROMIS) depression and anxiety questionnaires and wore a wrist actigraph for 10 days continuously. We employed Independent T-Tests and Pearson’s correlation to assess the association of biologic treatment, IBD type, sex, depression, and anxiety on sleep efficiency (SE), total sleep time (TST), and sleep onset latency (SOL).ResultsWe included 58 participants with a mean age of 35.6 years (SD=12.1). 60.3% were female, and 60.3% were diagnosed with CD. The mean depression score was 51.3 (SD = 10.2) and the anxiety score was 52.2 (SD = 15.5). The mean SOL was 19.3 minutes (SD = 15.5), TST was 413.3 minutes (SD = 53.2), and SE was 83.5% (SD = 5.7). TST was significantly longer in females compared to males (427.4 vs. 391.9 minutes , p< 0.05). SE was significantly higher among females compared to males (85.1% vs. 81.0%, p< 0.001) and among individuals with Crohn's disease compared to Ulcerative colitis ((85.1% vs. 81.0%, p< 0.01). SOL was longer among individuals with Ulcerative colitis compared to Crohn's disease (15.6 vs.25.0minutes , p< 0.05). Depression and anxiety scores were not significantly correlated with any sleep characteristic.ConclusionSleep continuity was poor in people with IBD. Given that we found sex and IBD type impacted sleep continuity, these factors should be considered in future precision sleep health interventions for this population.Support (if any)This study was funded by the University of Washington School of Nursing, NINR (K23 NR020044) (Kendra Kamp, and the American Nurses Foundation (Samantha Conley).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0974
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0975 Mediators of the Insomnia-Suicidality Association

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      Pages: A418 - A419
      Abstract: AbstractIntroductionInsomnia severity is a significant risk factor for heightened suicidality, including ideation, attempts, and death by suicide. As a modifiable risk factor, insomnia is a potential target for suicide prevention; however, the models explaining the association between insomnia and suicidality remain unclear. Our model posits that insomnia hinders sleep’s regional recuperative brain functions, contributing to daytime impairments, including emotional dysregulations. Another model links insomnia to suicidality through additional factors including perceived burdensomeness and thwarted belongingness. Each of these potential factors are associated with both insomnia and suicidality. This study aimed to investigate potential psychological mechanisms in the insomnia-suicidality association, using validated measures in a nationally representative sample.MethodsThrough a Qualtrics survey, participants (N=428) completed the Difficulties in Emotion Regulation Scale to assess emotional dysregulation, Interpersonal Needs Questionnaire to measure perceived burdensomeness and thwarted belongingness, Frequency of Suicidal Ideation Inventory to assess suicidality severity, Insomnia Severity Index, and PROMIS–Depression, and -Anxiety short forms. We used regression analyses to investigate the association between insomnia, suicidality severity, and demographic variables. Structural equation modeling was used to determine whether emotional dysregulation, perceived burdensomeness, or thwarted belongingness mediated the insomnia-suicidality severity association, even when accounting for depression.ResultsInsomnia severity was related to greater suicidality (p< 0.001, CI=0.19–0.31). This association was mediated by depression severity (p=0.836, CI=-0.06–0.08). Emotion dysregulation and perceived burdensomeness partially mediated the insomnia-suicidality severity association (β=0.06, p=0.001; β=0.18, p< 0.001), and when accounting for depression severity, fully mediated the insomnia-suicidality severity association (β=0.04, p=0.045; β=0.24, p< 0.001). Thwarted belongingness did not mediate the association before (β=0.02, p=0.142) or after accounting for depression (β=0.01, p=0.412).ConclusionThis study replicates considerable evidence that insomnia is an important marker and risk factor for suicidality. The mechanisms through which insomnia may confer risk for suicidality include depression, emotion dysregulation, and perceived burdensomeness. Insomnia may be an ideal upstream target for reducing suicidality and its risk factors including depression, emotion dysregulation, and perceived burdensomeness.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0975
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0976 A Brief Non-Pharmacological Insomnia Treatment for Military Suicidal
           Behaviors: A Sham-Controlled, Randomized Trial

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      Pages: A419 - A419
      Abstract: AbstractIntroductionSuicide represents a public health emergency among veterans, who die by suicide at alarming rates and show elevated sleep disturbances. Selective interventions for military suicide indication are scarce, and available treatments remains mismatched to the acute nature of a suicidal crisis. We sought to develop and test preliminary efficacy of a fast-acting, behavioral insomnia intervention for antisuicidal response in the context of a sham-controlled, randomized trial among veterans.MethodsA multicomponent behavioral sleep intervention was developed, integrating: CBT for Insomnia (CBTi) and Imagery Rehearsal Treatment (IRT) within a rapid (4-session) format (SERVE: Sleep Enhancement for Returning Veterans). This was compared to active control, Arousal-Based Treatment of Insomnia (ABTI). Treatments were manualized and matched for therapist contact, materials (manuals, powerpoints, guidesheets), and passage of time. Raters were blind to treatment assignment. Inclusion criteria: (a) age>18, (b) clinically-significant sleep disturbance (Insomnia Severity Index (ISI>10)), (c) DSM-V-Defined Depression, or (d) current suicidal ideation (Columbia Suicidal Severity Rating Scale (CSSRS>1)). A comprehensive data and safety monitoring plan supported standardized risk assessment, safety planning, and triage. Outcomes were assessed at Baseline and Posttreatment (1,3 mos) according to primary (suicidal ideation), secondary (sleep indices), and exploratory (mood, stress indices) outcomes.ResultsRecruitment occurred by way of comprehensive military partnerships, clinic referrals, and community flyering. Of n=753 new contacts, n=436 participants were screened for inclusion. Of these, n=112 were interviewed by full-battery eligibility assessment, resulting in n=77 veterans enrolled and randomized to: Active Treatment (n=39) vs. Active Control (n=38). Feasibility analyses supported high rates of acceptance, tolerability, and safety. For the full sample, t-tests revealed large posttreatment reductions in suicidal ideation (CSSRS, p<.001; Depressive Symptom Inventory Suicidality Subscale (DSISS)), p<.001), sleep, mood, and stress outcomes (ISI, p<.01; DDNSI, p<.01; QIDS-SR, p<.01; PCL, p<.001). Effects were significant compared to control (DSISS, p<.01; ISI, p<.01).ConclusionA brief, non-pharmacological insomnia intervention resulted in antisuicidal response and large posttreatment improvements in sleep and well-being. This is the first known report testing non-medication insomnia treatment within a sham-controlled, randomized trial for military suicidal behaviors, where results support feasibility, safety, and therapeutic impact to suicidal risk.Support (if any)Work was supported by NIH (K23MH093490), DOD/MOMRP/MSRC funding (W81XWH-10-2-0178)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0976
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1063 Predictors of Insufficient Treatment Response to Digital CBT-I:
           Results from the RESTING Study

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      Pages: A457 - A457
      Abstract: AbstractIntroductionTriaged stepped-care approaches start patients in either lower or higher intensity of treatment based on participant characteristics, switching patients who demonstrate insufficient progress in lower intensity treatment to higher intensity treatment. The purpose of the present study was to investigate characteristics of participants who were predicted to benefit from lower intensity treatment (digital CBT-I [dCBT-I]) and made insufficient progress following two-months of dCBTI, compared to similar participants who made sufficient progress.MethodsParticipants were 101 adults aged 50 or older who were triaged to begin treatment with dCBT-I as part of the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Specifically, these participants had to have taken sleep medications < 4x/week, score below clinical cutoffs for moderate-severe mental health comorbidity and daytime sleepiness, and sleep >4.5hrs/night on average. T-tests were used to compare baseline characteristics of participants who made insufficient progress after two months of dCBT-I to those who made sufficient progress. Sufficient progress was defined as ISI ≤ 10 or reduction of at least 50% in sleep medication use.ResultsThose with insufficient progress in dCBT-I (N= 74) had higher insomnia severity index (ISI) scores at baseline than those with sufficient progress in dCBT-I (p=.002, d=.70). There were no significant differences in terms of baseline Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scores (p=.39), chronotype (Morningness-Eveningness Questionnaire: MEQ; p=.32) or sleep medication use (p=.39); effect sizes for the differences were small (d=.19-.23). Further, there was no significant difference in the number of digital modules completed (p=.13, d= .35) between those who did and those who did not make sufficient progress.ConclusionOnly greater insomnia severity at baseline was a significant predictor of insufficient treatment response among participants who were triaged to begin treatment with dCBT-I. Further research is needed to determine if insomnia severity alone or when combined with the RESTING study triage algorithm will improve the identification of those likely to benefit optimally from dCBT-I.Support (if any)R01AG057500
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01063
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1064 Perception of CBTI Treatment Modalities in Older Adults with
           Insomnia: Comparing Digital and Therapist-led Delivery

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      Pages: A457 - A457
      Abstract: AbstractIntroductionA shortage of trained providers limits access to cognitive behavioral therapy for insomnia (CBTI). Supplementing traditional in-person, therapist-led CBTI with telehealth delivery and fully automated digital CBTI (dCBTI) can improve accessibility. Characterizing perceived advantages and disadvantages of distinct delivery modalities among patients with insomnia can inform targeted resource allocation and clinical rollout of CBTI. Thus, the current study aims to describe patients’ pre-treatment preferences for therapist-led (in-person and telehealth-delivered) and automated dCBTI, as well as patient-identified advantages and disadvantages of these modalities.MethodsParticipants (N = 80) 50 years and older (M age = 64.2, SD = 7.9; female = 85.2%) were randomly selected from the RESTING Study, an RCT evaluating a triaged stepped-care model for treating insomnia disorder (DSM-5), to undergo a semi-structured interview at baseline, prior to study treatment assignment and exposure. Interviews were recorded, transcribed, and coded by three raters (inter-rater reliability: 85.0–93.0%). Response themes were identified inductively via qualitative thematic analysis.ResultsApproximately two-thirds of participants (n = 50, 62.5%) preferred therapist-led CBTI, delivered in-person or via telehealth, over automated dCBTI. The most common participant-identified advantage of dCBTI (n = 55; 68.8%) and telehealth-delivered CBTI (n = 65; 81.3%) was convenience. The most commonly reported disadvantages of dCBTI were limited customizability (n = 39, 38.75%) and lack of human connection (n = 40, 50.0%). However, some participants (n = 13, 16.30%) viewed lack of human connection as an advantage, citing the nonjudgmental nature of online programs and reduced social anxiety/fatigue. The main disadvantage identified for telehealth-delivered CBTi was loss of nonverbal communication (n = 20, 25%).ConclusionWhile participants identified advantages and disadvantages of both dCBTI and therapist-led CBTI, findings suggest a general preference for therapist-led treatment among middle-aged and older adults. This study is one of the first to examine participant preferences for and perceptions of CBTI delivery modalities prior to receiving study treatment(s). Findings can guide referring providers’ presentation of insomnia intervention options to patients and inform targeted discussions of perceived barriers to treatment. Moreover, results lay a foundation for future research examining the relationship between pre-treatment preferences/perceptions and longitudinal treatment adherence, engagement, and clinical outcomes.Support (if any)1R01AG057500
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01064
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1083 Association Between Sleep Apnea and Health Service Utilization:
           Results from the Health and Retirement Study

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      Pages: A465 - A465
      Abstract: AbstractIntroductionSleep apnea is associated with several health conditions known to increase the use of health services that may otherwise be preventable (e.g., hospitalization). We investigated the association of sleep apnea and the subsequent use of health services, independent of health conditions and other potential confounders.MethodsWe studied participants aged 50+ years in the 2016 and 2018 Health and Retirement Study (HRS), a nationally representative cohort of approximately 20,000 middle-aged and older adults in the United States. In 2016, participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder (which included sleep apnea). We categorized participants as with and without sleep apnea. In 2018, participants were asked to report on their use of health services, including hospitalization, home healthcare, and nursing home use. We used logistic regression to determine the association between sleep apnea, as reported in 2016, and the use of health services in 2018, after adjusting for demographics, BMI, health conditions, and depressive symptoms.ResultsWe studied N=20,115 HRS participants, of whom 11.8% reported sleep apnea. Compared to those without sleep apnea in 2016, those with sleep apnea had a 21% higher odds of reporting future use of any health service (Adjusted Odds Ratio [AOR]=1.21, 95% Confidence Interval [CI]=1.02-1.43), after controlling for confounders. Specifically, those with sleep apnea had greater odds of hospitalization (AOR=1.21, 95% CI=1.02-1.44), and while not statistically significant, home healthcare services (AOR=1.23, 95% CI=0.99-1.54).ConclusionParticipants with sleep apnea had increased odds for future health service utilization, including hospitalization and home healthcare. Findings highlight the importance of addressing sleep apnea to reduce their burden on the healthcare system.Support (if any)This study was supported by the National Institute on Aging (R01AG079391, K01AG061239, P30AG028740) and the Sleep Research Society Foundation (23-FRA-001).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01083
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1084 Association of Social Determinants of Health and Sleep Study
           Completion Rates in a Large Cohort

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      Pages: A466 - A466
      Abstract: AbstractIntroductionThe effects of social determinants of health (SDH) on health outcomes are well documented. However, the extent to which SDH influences sleep study completion is unknown.MethodsA retrospective cohort study was conducted utilizing sleep study referrals at the Cleveland Clinic Sleep Center from 1/3/2017 to 8/5/2023. Adult patients who underwent sleep testing and completed at least one SDH screening questionnaire including food insecurity, financial strain, housing stability were included. A comparison between sleep study and SDH completion was conducted using Pearson chi-squared tests and Wilcoxon rank sum tests for unordered and ordered variables respectively. Continuous measures were summarized and compared with two-sample t-tests or ANOVA. Univariate logistic regression was used to measure associations between sleep testing completion rates, with SDH measures and demographic variables.ResultsOf 113,843 patients referred for sleep testing, 55% (n=62,569) patients completed at least one SDH screening questionnaire. Of these, 40% (n=25,003) completed a sleep study and 60% (n=37,556) did not. Patients who completed at least one SDH screening questionnaire were older (55.0±15.6 vs 53.5±15.8), of White race (77.7%vs76.3%, p< 0.001), non-Hispanic (95.9%vs94.9%, p< 0.001) and more likely to complete their sleep study (40.0%vs29.6%, p< 0.001) compared to those who did not complete any SDH screening questionnaire. On the other hand, the subset of patients who completed at least one SDH measure and sleep testing were older (56.0±15.65 vs 54.4±15.5, p=< 0.001), had a higher BMI 34.4±8.8vs33.8±8.3, p< 0.001) and were of Hispanic origin (4.4%vs3.8%, p< 0.001) compared to patients who did not complete sleep testing. Likewise, completers reported medium to high financial strain (15.8%vs13.7%, p< 0.001), high risk for housing stability (11.5%vs10.3%, p< 0.001) and food insecurity (9.9%vs8.9%, p=0.027) versus the subset of patients who did not complete sleep testing.ConclusionSDH screening questionnaires are not routinely completed by patients referred for sleep testing. However, patients who completed SDH screening questionnaires and sleep testing reported higher risk for food insecurity, housing stability and financial strain. Systematic efforts are needed to investigate the feasibility and acceptability of implementing SDH screening in sleep clinics to understand the relationship between social needs, access and utilization for sleep testing.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01084
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1105 Relevance of Attributes and Preferences for At-home Diagnostic
           Testing Differ Among Patients with Sleep Disorders

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      Pages: A474 - A474
      Abstract: AbstractIntroductionThe diagnostic workup for assessment of sleep disorders commonly involves an overnight test to assess sleep patterns and identify pathological events. So far, little is known about preferences for the provision of home sleep tests to patients with disturbed sleep. This study aims to close this gap by eliciting preferences and relative importance of attributes of home sleep testing using a discrete choice experiment (DCE).MethodsA DCE with seven attributes of at-home overnight sleep testing and three levels per attribute, which were selected based on previous qualitative research, was developed using a fractional factorial design. Patients with and without previous sleep testing experience were recruited from two large third-level sleep centers in Germany. The DCE was administered to patients with paper-based forms during their visits to the outpatient clinics. Coefficients for attribute levels were calculated using a conditional logit model with effects coding to estimate their influence on choice decisions and calculate the relative importance of each attribute.Results305 patients (age 54.5 ± 13,1 years, male gender 65.3% were enrolled), and 288 surveys with complete data were included for analysis, which resulted in 1,152 choice decisions available for analysis. All of the attributes, except "Diagnostic accuracy" of sleep study had statistically significant influence on choice decisions. Attributes with the greatest relevance were "Waiting time to discuss sleep study results"; "Waiting time to conduct sleep study", and "Sleep quality during measurement". Of lowest importance was "Diagnostic accuracy" of sleep study, followed by "Effort to apply sleep study device", and "Device logistics". Significant heterogeneity in choice behavior was found, including differences by gender, willingness-to-pay for sleep studies, preferred sleep study location, and previous experience with sleep studies. Preferred location for conducting the sleep test was at-home in 50.7% and in-lab in 46.9%.ConclusionPreferences and relative importance of home sleep test attributes vary among different subgroups. Considering those preferences and their relevance is important for clinicians and policy-makers when designing individual patient-centric care pathways and high-level planning of diagnostic testing policies for sleep disorders.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01105
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1106 Patient-Centric Design: Incorporating Patient Input into a Clinical
           Study of Idiopathic Hypersomnia and Narcolepsy

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      Pages: A474 - A475
      Abstract: AbstractIntroductionJazz DUET (Develop hypersomnia Understanding by Evaluating low-sodium oxybate Treatment; NCT05875974) is a phase 4, prospective, multicenter, single-arm, open-label interventional study that comprehensively evaluates low-sodium oxybate effects on sleep architecture and daytime/nighttime symptoms in participants with idiopathic hypersomnia or narcolepsy. Multiple assessments, including overnight polysomnography (PSG), are needed to generate robust, relevant data, but these assessments may impose a burden on study participants. A patient advisory board was convened to understand patient perspectives and assess opportunities to incorporate patient feedback into the study protocol.MethodsAdvisors completed a premeeting survey, then attended a 3-hour advisory board meeting with the study sponsor. Five main topics were discussed: feasibility of oxybate washout for participants entering the study on treatment, burden of assessments, relevance of specific symptom evaluation to participants, value of reporting individualized data back to participants, and burden of overnight visits.ResultsThe advisory board included 2 people with idiopathic hypersomnia and 4 people with narcolepsy. All 6 advisors had experience with patient advocacy, and at least 1 had been a clinical trial participant; these experiences may help give voice to a broader patient community. Premeeting survey responses were reviewed and discussed during the meeting. Based on advisor input, the final study protocol incorporated several points, including support for participants undergoing oxybate washout (eg, transportation, childcare, and meal service, as needed), additional breaks between assessments, moving assessments from evening to morning to reduce participant burden, measuring fatigue separately from sleepiness, and suggestions to make participants more comfortable for overnight visits. Advisors noted the high value of reporting individualized data back to study participants—particularly PSG data, with specific interest in number of awakenings, duration of rapid eye movement sleep, and duration of slow-wave sleep. In addition to these changes, study materials were developed to help participants prepare for overnight visits, and a checklist of items to bring to these visits was created.ConclusionThe final DUET study design incorporated patient-centric elements recommended by a patient advisory board. Implementation of these elements is anticipated to reduce participant burden, improve participant experience, enhance recruitment and retention, and facilitate collection of meaningful and comprehensive data.Support (if any)Jazz Pharmaceuticals
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01106
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1107 Facilitating Accurate Sleep Diary Data Collection and Processing
           Based on Common Participant Data Entry Errors

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      Pages: A475 - A475
      Abstract: AbstractIntroductionSleep diaries are the gold-standard measure of self-reported sleep parameters; however, data utility is contingent upon accurate data entry and clarity of standardized diary terminology/calculations between participants and researchers. Informed by the RESTING study, an effectiveness-implementation RCT of cognitive-behavioral therapy for insomnia, sleep diary dataset, the current study elucidates common participant sleep diary entry errors to inform standardizable research strategies for minimizing post hoc inaccuracies.MethodsRESTING Study participants (N=245) with insomnia disorder completed Consensus Sleep Diaries through REDCap at baseline. Embedded survey data validation prompted participants to check unexpected values (e.g., calculated TIB >10 hours). Researchers reviewed diaries weekly, correcting immediately apparent errors. Post hoc data cleaning scripts flagged sleep diaries with potential inaccuracies based on: (1) 9 hours< Calculated Total Sleep Time (TST)< 4.5 hours, (2) Difference between calculated and self-reported TST >2 hours, (3) 100%< Sleep Efficiency< 45%, (4) Difference between lights out (LO) and bedtime (BT)< 0, or (5) Difference between rise time (RT) and wake time (WT)< 0. Researchers examined internal consistency within flagged diaries and across all entries by a participant.Results3,382 days of sleep diary data were submitted at baseline (98% of expected). During active data collection, researchers corrected errors within 61 (1.8%) unique diaries, completed by 37 participants. Of 503 (14.9%) distinct sleep diaries (among 173 participants) flagged by post hoc scripts, 173 (5.1%) contained at least one error. Examining internal consistency across diary dates when reviewing flagged entries revealed 20 additional diaries with errors, among 2 participants. In sum, 348 errors were made among 119 participants. The most common errors were: confusion between WT and RT (n=150), confusion between BT and LO (n=45), inclusion of multiple sleep parameters within self-reported “wake after sleep onset” (n=29), unambiguous typos (n=29), and AM/PM mix-ups (n=28).ConclusionDespite training participants on sleep diary completion and utilizing survey data validation, 5.7% of diaries contained errors corrected post hoc. This highlights the importance of standardizing use of post hoc data cleaning scripts. Common errors identified can inform best practices for embedded sleep diary data validation and development of sensitive, precise protocols for reviewing diaries throughout data collection.Support (if any)1R01AG057500
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01107
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1108 Prior-night Sleep Predicts Next-day Symptoms over Ten Days Among
           Military Personnel with Sleep Problems

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      Pages: A476 - A476
      Abstract: AbstractIntroductionInsufficient and disturbed sleep are highly prevalent and associated with adverse consequences in the U.S. military. The purpose of this study was to employ remote monitoring/ecological momentary assessment methods to test the hypothesis that prior-night sleep is associated with next-day subjective symptoms among military personnel.MethodsParticipants (N=270) with sleep problems were recruited from two military treatment facilities and completed an intensive ten-day remote monitoring assessment. Prior night sleep was measured using standardized sleep diaries and a commercial wearable sleep tracker (Fitbit Inspire 2). Next-day symptoms were measured using twice-daily symptom surveys (i.e., 20 surveys over ten days). Individual items assessed subjective cognition, energy level, and mood using an “I feel tired” format and scored from 0-4. To determine the lagged impact of prior-night sleep on next-day symptoms, a total of 40 mixed models (MMs) were developed. Individual prior-night sleep diary (total sleep time [TST], sleep efficiency [SE], and sleep quality [QUAL]) and Fitbit (TST, SE) parameters were entered as independent variables, and individual daytime symptoms (feeling alert, clear-headed, refreshed, fatigued, happy, sad, stressed, and relaxed) were entered as dependent variables. All models controlled for age and sex. The Benjamini-Hochberg procedure for correcting false discovery rate (BH-FDR) method was used to correct for multiple comparisons.ResultsLagged MM analyses revealed that all prior-night sleep diary variables were significantly associated with next-day symptoms (all ps< 0.001 with df=2081) over ten days. Specifically, prior-night sleep diary parameters (TST, SE, QUAL) were positively associated with next-day feeling alert, clear-headed, refreshed, happy, and relaxed; and negatively associated with next-day feeling fatigued, sad, and stressed. Prior-night Fitbit sleep parameters were significantly associated with most next-day symptoms (largest p=0.023 with df=1956). Specifically, Fitbit TST and SE were positively associated with next-day feeling clear-headed, refreshed, happy, and relaxed and negatively associated with next-day fatigue. Fitbit TST was negatively associated with next-day stress.ConclusionAmong military personnel with sleep problems, prior-night sleep predicts next-day subjective cognition, energy level, and mood over ten days. Future research should employ remote monitoring approaches to predict treatment response and deliver personalized care to improve sleep and daytime symptoms.Support (if any)DoD W81XWH1990006 (via Medical Technology Enterprise Consortium)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01108
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1145 Stride Along with Stridor in the Setting of CSA: An Unusual
           Presentation of Pediatric Cervicomedullary Ganglioma

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      Pages: A491 - A491
      Abstract: AbstractIntroductionWe describe an unusual presentation of a cervicomedullary ganglioglioma secondary to findings of stridor despite positive airway pressure (PAP) therapy and the presence of treatment emergent central sleep apnea in a pediatric patient.Report of case(s)Patient is an 8 year old male with a history of congenital subglottic stenosis and no history of neurologic problems who presented to the sleep clinic for stridor despite adequate adherence to CPAP. Split night polysomnogram (PSG) showed moderate OSA (OHI 8.3/h) and treatment emergent central sleep apnea. Patient was unable to tolerate BPAP ST and wanted to go back to CPAP. Drug induced sleep endoscopy findings were significant for mild collapse of upper airway with no snoring. Repeat PSG - 6 months later - was significant for severe obstructive and central sleep apnea (OAHI 10.4, CAI 19, REM CAI 54, AHI of 30). MRI of the brain showed cervicomedullary tumor with marked effacement of the foramen magnum. Further workup showed right vocal cord paralysis. Biopsy confirmed ganglioglioma. Tumor was not amenable for surgical resection hence proton radiation therapy was pursued. Repeat titration study was performed which showed BPAP ST settings of 12/6 with BUR of 12 to be effective with residual AHI of 0.7. Patient developed radiation induced tumor psuedoprogression and tumor necrosis with worsening ataxia and recurrence of central and mixed apneas requiring AVAPS for further respiratory support due to progressive neuromuscular weakness. Stridor resolved after AVAPS support.ConclusionStidor in a pediatric patient can involve various anatomical abnormalities of the upper airway. However, in the setting of central sleep apnea, abnormalities of the brain stem can lead to stridor. We present a patient with a prolonged period of central sleep apnea of unknown etiology and persistent stridor despite adequate adherence to PAP therapy that ultimately led to a diagnosis of a cervicomedullary ganglioma before neurologic symptoms developed.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01145
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1146 Polysomnographic Description of Hemifacial Spasm

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      Pages: A491 - A491
      Abstract: AbstractIntroductionHemifacial spasm is characterized by sudden, involuntary, irregular, tonic or clonic motor discharge of the facial nerve (seventh cranial nerve), leading to muscular contraction. Its etiology may be idiopathic or secondary to an irritation of the facial nerve. Possible sources of irritation include vascular malformations, infections, trauma, and tumors. Hemifacial spasms may be a temporary or a permanent sequela from Bell’s palsy. This disorder typically presents unilaterally, although it may be seen bilaterally in about 5% of the cases. This condition affects women more often than men in a 2:1 ratio. To this day, there is minimal information describing hemifacial spasms during sleep using a polysomnogram (Incirli et al. 2019, Montagna et al. 1986 article). The previous studies documented the persistence of hemifacial spasms in sleep but did not offer illustrative polysomnographic images. In this case report, we illustrate the polysomnographic characteristics of hemifacial spasms in order to improve a sleep medicine provider’s ability to identify and recognize these events.Report of case(s)We are able to provide polysomnographic images demonstrating both sustained and intermittent paroxysmal left-sided facial muscle activity in the left mastoid, left EOG, as well as left central and left frontal EEG leads. The occipital EEG leads bilaterally did not demonstrate this finding. Chin EMG also revealed this activity. The muscle activity was most notable during wake but persisted during both NREM and REM sleep (Images will be provided in the poster).ConclusionWe were able to document paroxysmal left-sided facial muscle activity during wake and sleep in a patient who carries a diagnosis of left hemifacial spasm. This description can be used as a visual reference for sleep medicine providers when encountering this unusual polysomnographic appearance.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01146
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0826 Sleep in Parents and Children with Overweight and Obesity

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      Pages: A354 - A354
      Abstract: AbstractIntroductionSleep is fundamental for overall health and well-being. Nevertheless, a substantial portion of school-age children, ranging from 30.0% to 43.7%, experience sleep disturbances as reported by their parents. Children who are overweight or obese have increased sleep disturbances than their normal-weight peers. Research on children and parent’s sleep shows that parental sleep and health characteristics may serve as a risk or protective factor for children's sleep. This study aims to investigate the sleep patterns of parents and their school-age children with overweight and obesity.MethodsChildren (6-9 years) with overweight and obesity wore a wrist-worn actigraph for 7 days. Children’s sleep disturbance was assessed using the parent-report Children's Sleep Habits Questionnaire (CSHQ). Parental subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with parental depressive symptoms measured using the Epidemiologic Studies-Depression Scale (CES-D). General linear models were used to examine the association between parental and child sleep.ResultsOverall, 246 children and parents participated in this study, with 208 (84.6%) children experiencing clinically significant sleep disturbances and 123 (50%) parents reporting poor sleep quality. Higher children's sleep disturbance scores significantly predicted poorer parental sleep quality (b = 0.11, p < .01). Poorer parental sleep quality was associated with more severe sleep disturbances in children (b = 0.46, p < .01). This association was unaffected by children’s actigraphic sleep (all p > .05) and remained significant after adjusting for parental depressive symptoms (b = 0.14, p < .01).ConclusionSleep disturbances are prevalent in both parents and their school-age children who are overweight or obese, with a significant bi-directional association between the two. Healthcare professionals working in school settings should screen for sleep disturbances in parent-child dyads of children with overweight and obesity.Support (if any)This work was supported by the Ministry of Science and Technology, Taiwan, MOST 107-2314-B-002-025-MY3.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0826
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0959 Sleep and Pharmacotherapy in Treatment-Resistant Late-life
           Depression: Findings from the OPTIMUM Clinical Trial

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      Pages: A411 - A411
      Abstract: AbstractIntroductionAdults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems. However, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD or how sleep affects treatment response. We investigated the bidirectional relationship between sleep and treatment outcomes in the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) study, the largest comparative effectiveness trial of pharmacotherapy for TRLLD to date.MethodsThis analysis examined: (1) occurrence of reduced sleep in 634 participants in the OPTIMUM randomized controlled trial; (2) how their sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with consistent insufficient sleep [n = 164], worsened sleep [n = 62], or with improved sleep [n = 158]). We used item #4 (scale 0 – 6) from the Montgomery-Asberg Depression Rating Scale (MADRS) to assess insufficient sleep, representing reduced sleep duration or depth compared to usual sleep pattern. Scores >2 indicate a meaningful reduction in duration or sleep depth. Patients who scored >2 on item #4 throughout the trial were classified as having consistent insufficient sleep; patients who reported an increased score (and >2 at trial end) were classified as having worsened sleep; and patients who reported a decreased scores (and ≤2 at trial end) were classified as having improved sleep. Treatment response was defined as a > 50% reduction in the total MADRS score (minus item #4 ) at trial end.ResultsAbout half (51%, n= 323) of participants with TRLLD reported reduced or insufficient sleep before treatment. At trial end, consistent insufficient sleep and worsened sleep were each associated with treatment non-response. Improve sleep was not a significant predictor of treatment response, however participants with consistent sufficient sleep or improved sleep were three times more likely to experience treatment response compared to patients with insufficient sleep and worsened sleep.ConclusionInsufficient or reduced sleep are modifiable factors that may improve treatment outcomes in TRLLD. Given that sleep complaints including insomnia are associated with greater risk of depressive relapse and treatment non-response, a tailored treatment plan for those at greatest risk of sleep disturbance with concomitant depression may facilitate better outcomes.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0959
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0992 Hippocampal Response to Sleep Sound Moderates Impact of Depressed
           Mood on Daytime Sleepiness in Shift Workers

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      Pages: A425 - A426
      Abstract: AbstractIntroductionShift workers (SW) commonly experience mood symptoms, which is known to be linked to sleep disturbances and disrupted 24-hour rest-activity rhythm (RAR). Altered brain response to sleep-related sound (SS) were reported to be associated with dysfunctional appraisals of sleep and sleep disturbances. In current study, we aimed to investigate differences in brain activity in response to SS between SW and control participants (CON). Furthermore, we explored the moderation effects of brain response to SS on the relationships between daytime sleepiness, mood symptoms and 24-hour RAR in SW.MethodsSW (n=57, female 75.4%) and CON (n=56, female 71.4%) completed questionnaires (Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory). Participants also underwent one-night polysomnography and actigraphy with sleep diary for one week. We calculated 24-hour RAR with cosinor analysis on actigraphy parameters. Functional magnetic resonance imaging was performed while listening to SS and control sounds (CS). We compared brain activation in response to SS (vs. CS) between SW and CON. In addition, we conducted a moderation analysis with ESS as a dependent variable and BDI, BAI, and 24-hour RAR as independent variables. Brain activities with significant differences between SW and CON were used as moderators.ResultsSW showed higher ESS score (t = 2.28, p = 0.025) and lower interdaily stability, relative amplitude, and higher least active 5-hour period (all-ps < 0.001). SW also showed higher activity to SS in right hippocampus (t = 3.61, p < 0.001) and MFG (t = 3.57, p < 0.001) compared to CON. In SW, right hippocampus activity (HA) in response to SS moderated the relationship between BDI and ESS (F = 7.61, adjusted R-squared = 0.265, p < 0.001, high HA; r = 0.433, low HA; r = 0.051).ConclusionCurrent results suggested differential brain activity to sleep-related stimuli in SW. Moreover, the findings indicate that decreased right HA in SW can be associated with increased impact of depression on daytime sleepiness. Therefore, modulating HA and managing depressive symptoms can be helpful in reduction in excessive daytime sleepiness among SW.Support (if any)National Research Foundation (No. 2016M3C7A1904338 and No. 2022R1A2C1008209).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0992
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0993 Impaired Executive Functioning Is Linked to Suicidality in Youth with
           Insomnia Disorder

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      Pages: A426 - A426
      Abstract: AbstractIntroductionSuicide, a critical global mental health issue, has been linked to sleep difficulties. Previous studies have also found that psychological distress and negative thinking styles could contribute to a higher risk of suicide. While cognitive deficit is one of the most common complaints among individuals with insomnia, its impact on suicidality in the context of insomnia has seldom been investigated. The current study aimed to investigate the relationship between executive functioning and suicidality among youth with insomnia.MethodsAdolescents with DSM-5 insomnia disorder were recruited from local schools, universities, and the community in Hong Kong. Eligible participants completed self-reported measures, including Depressive Symptom Index - Suicidality Subscale (DSISS), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Ruminative Response Scale (RRS), and were administered Wisconsin Card Sorting Test (WCST). The total scores of HADS were used to indicate psychological distress. Failure to maintain set (FMS) from WCST was used to indicate distractibility, an aspect of executive function, with higher scores suggesting greater distractibility.ResultsA total of 115 adolescents with insomnia disorder (Age: 18.34 ± 1.56, 14-20, female: 65.22%) were recruited. Multivariate regressions revealed that higher HADS (b=0.06, p=.045), RRS (b=0.05, p<.001), and FMS (b=0.30, p=.035) scores were all significantly associated with DSISS. The results remained significant after controlling for insomnia severity, gender, and age.ConclusionOur findings showed a link between impaired executive functioning, specifically distractibility, and suicidality. Distractibility may be attributed to the reduced suppression of the default mode network, which is associated with depression and rumination, thereby increasing the risk for suicidality. Future neuroimaging research is needed to further explore the underlying mechanism of such associations.Support (if any)This work was funded by General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0993
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0994 Legal Considerations for Sleep and Mental Health: A Review of Foster
           Care Bedroom Guidelines Among 50 U.S. States

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      Pages: A426 - A426
      Abstract: AbstractIntroductionEach year, the foster care system provides out-of-home placement for over 400,000 children, who are temporarily or permanently separated from their families. The prevalence of sleep and mental health problems in this population is well-documented. Persistent sleep problems associated with past and ongoing trauma independently elevate long-term risk for a host of physical and psychiatric disorders. While federal laws provide universal requirements for safe foster placements, the extent to which individual state laws and guidelines address child sleep health and environments varies. The aim of this policy review of administrative codes and guidelines regarding sleep/bedroom arrangements for children in foster care in all 50 U.S. states was to document that variability and examine whether state regulations incorporate sleep research findings.MethodsApplicable bedroom and bed sharing guidelines were retrieved from each state’s government websites, followed by coding, categorization, and a systematic review. Categories included 7 broad themes: Bed Sharing, Room Sharing, Space Requirements, Bed Requirements, Caregiver-Child Requirements, Health, and Miscellaneous.ResultsWhile 39 states (78%) required an individual bed for each child in care, specific guidelines regarding bed and bedroom sharing with other children varied greatly by state. There was an even distribution across states that allowed bed or bedroom sharing for siblings (50%) and those that did not address this topic (50%), but only 6 states stated the importance of keeping sibling groups together when determining appropriate sleeping arrangements. In addition, a few states mentioned history of neglect, abuse, and trauma as factors to consider for sleep/bedroom guidelines. Only 10 states (20%) allowed bedroom sharing with a caregiver during emergencies, such as illness or periods of emotional distress.ConclusionDespite the universal importance of healthy sleep for all aspects of child development, we found striking differences between states regarding rules and guidelines for sleep and bedroom sharing. Most requirements lack consideration of children’s potential history of abuse and trauma, which contribute to sleep problems in this population. Also concerning is the lack of clear regulations regarding caregiver intervention in case of emergencies. We urge policymakers to reconsider current guidelines in accordance with sleep research and evidence-based practices.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0994
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0995 Mental Health and Substance Use Outcomes Associated with Use of
           Cannabis as a Sleep Aid: A Co-twin Control Study

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      Pages: A427 - A427
      Abstract: AbstractIntroductionUsing cannabis as a sleep aid is common. However, little is known about how this practice relates to mental health and substance use. To address this, we examined associations between using cannabis as a sleep aid with mental health and substance use outcomes using a co-twin control design.MethodsParticipants were 3,165 adults (Mage=36.7 (SD=5.3)) from two population-based twin cohorts. Outcomes of interest included mental health constructs (e.g. depression, impulsivity), substance use measures (frequency and problems from use of specific substances), and use of other substances for sleep. First, we conducted regression models to test phenotypic associations between endorsing past month use of cannabis to aid sleep (yes/no) and the above outcomes. Next, we used multilevel models to examine whether significant phenotypic associations were due to between-family effects (genetic and environmental factors shared by co-twins) or within-twin pair effects (genetic and environmental factors which differ between co-twins). All analyses controlled for sleep quality and cannabis frequency.ResultsThe sample was 56.7% monozygotic twins, 39.6% male, and 92.7% Caucasian. Phenotypic associations were significant between endorsement of using cannabis for sleep and most outcomes. All significant associations were in the direction of worse mental health, greater use of other substances for sleep, and greater frequency of, and problems from, substance use. All significant phenotypic effects remained significant at the between-family level, but not all remained significant at the within-family level. At the within-family level, the twin who endorsed using cannabis as a sleep aid (vs. their co-twin who did not) reported more frequent use of alcohol (B=0.44, p<.001) and medication (B=0.26, p=.022) for sleep, greater frequency of alcohol use (B=13.0, p=.018), and more problems from cannabis use (B=0.85, p=.007).ConclusionAssociations between using cannabis for sleep with worse mental health, after controlling for sleep quality and cannabis frequency, are likely due to shared genetic and/or environmental factors. Associations with substance use measures that were not accounted for by shared genetic and/or environmental factors include greater alcohol use frequency, more problems from cannabis use, and more frequent use of other substances for sleep.Support (if any)DA042755, DA057894, DA053693, DA056408, DA032555, DA054212, MH125758 (NIH), 1101101 (ICR)
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0995
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1065 Preliminary Findings of a Pilot Clinician Training Program to
           Integrate Digital CBTi into Routine Therapy

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      Pages: A458 - A458
      Abstract: AbstractIntroductionMany patients who enter treatment for mental health problems experience insomnia symptoms that may hinder their response to general mental health treatment. There is also a shortage of CBTi providers in the United States and worldwide. One method to address the paucity of CBTi providers is to integrate digital CBTi (dCBTi) into general psychotherapy, which, on its own, does not sufficiently address insomnia symptoms. This approach is likely to improve sleep and potentially also mental health outcomes. Integrated dCBTi provides the patient with support around adherence and engagement. This study aims to pilot test and refine a program for training licensed therapists to support their patients undergoing dCBTi. This integrated approach is novel and yet to be tested.MethodsLicensed therapists participate in a 4-hour training. Therapists subsequently enroll 1-2 patients with insomnia symptoms and comorbid depression and/or anxiety to receive integrated dCBTi. Therapists complete measures evaluating the training. At each psychotherapy session, therapists complete a checklist documenting which elements of the integrated dCBTi support they provide and how much time they spend doing so. Patients complete the Insomnia Severity Index, the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders, and qualitative measures about their experience of integrated dCBTi after receiving integrated dCBTi.ResultsAs of December 2023, 11 therapists are enrolled and patient enrollment is ongoing. After the training, therapists rated that they were “well-prepared” to integrate dCBTi into their routine practice, and 100% indicated that they would recommend this training. Regarding the content of dCBTi, therapists expressed understanding of the value of time in bed restriction and importance of monitoring the patient’s engagement and progress continuously. Therapists also noted an improved ability to present the rationale for CBTi components and to answer patient questions about dCBTi. Post training data, including patient data, will be available by June 2024.ConclusionThe integration of dCBTi in general psychotherapy through brief training of licensed therapists may be a viable approach to improve access to CBTi for patients with comorbid depression and/or anxiety.Support (if any)Sleep Research Society Foundation Career Development Award 035-JP-22 and T32MH019938
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01065
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1066 Acceptability and Feasibility of Training to Integrate Digital CBTi
           in Routine Therapy: Evidence from Focus Groups

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      Pages: A458 - A458
      Abstract: AbstractIntroductionOver 31% of patients who enter treatment for mental health problems experience insomnia symptoms, which can be effectively treated using cognitive behavior therapy for insomnia (CBTi). However, routine psychotherapy for mental health problems does not adequately address insomnia symptoms. Integrating CBTi into routine psychotherapy in a feasible and acceptable manner could both extend the reach of CBTi and enhance mental health outcomes. Digital CBTi (dCBTi) is a promising and scalable option for integration. Supported dCBTi programs have better engagement, adherence, and clinical outcomes compared to unsupported programs. Hence, integrating dCBTi into routine psychotherapy, whereby the therapist introduces and provides support for dCBTi among patients receiving general psychotherapy for other mental health problems, may improve adherence and engagement. This study aims to determine the initial feasibility and acceptability of integrated dCBTi to providers.MethodsSix virtual focus groups were conducted with licensed therapists with a range of graduate training. Each focus groups included 6-11 participants and lasted one hour. Inductive thematic analysis was used to extract themes. Therapists also completed a zoom poll at the end of the focus group.ResultsThe sample included 52 licensed therapists (81% female, 81% White). Therapists had a range of graduate training (21 PhD/PsyD, 11 LCSW, 10 MFT, 9 LPC, and 2 MD). 83% of therapists indicated that they want training in integrated dCBTi. Two participants (5%) had some previous training in CBTi; they were the only individuals who indicated no interest in receiving the training. Six participants (12%) were unclear. Two training focused themes arose: desire for receiving CEs and a need for advanced notice to reserve the time required for a workshop. 88% reported seeing the potential value of integrated dCBTi (unclear=12%). Two themes arose regarding content of training: the need to know the contents of dCBTi and the value of consultation. As a feasibility theme, therapist highlighted that they could find 5-10 minutes of session time to provide the support for dCBTi.ConclusionPreliminary analyses indicate that integrated dCBTi is a feasible approach. Therapists are willing to be trained and see its potential value.Support (if any)AASM Foundation 300-BS-23
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01066
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1085 Evaluating Different Message Strategies from the AASM “Count on
           Sleep” Campaign to Promote Awareness About OSA

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      Pages: A466 - A466
      Abstract: AbstractIntroductionThe American Academy of Sleep Medicine (AASM) initiated “Count on Sleep” in 2023, a public health campaign that was awarded to the AASM by the Centers for Disease Control (CDC) ) and Prevention of the U.S. Department of Health and Human Services (HHS) in 2021, with the goal of raising the awareness of Obstructive sleep apnea (OSA) among general practitioners and the public. Three campaign messages were developed and disseminated via social media. We examine the impact of these campaign messages using back-end analytics from the social media platform Meta.MethodsWe downloaded impressions (number of times the message was displayed on a screen), clicks, and shares for each of three public health messages from Meta, including demographic information for users (age, gender). Three message strategies were tested: positive outcome expectations (e.g., “improve your health”); negative outcome expectations (e.g., “increase your risk of health problems”); and partner-focus (e.g., “have you heard your partner snore'”).ResultsThe campaign received a total of 142,607 impressions, divided into positive outcome expectation (n=120,062), negative outcome expectation (n=12,286) and partner-focus (n=10,259) messages. The campaign yielded a total of 3038 link clicks, with the highest number for positive outcome expectation (n=3,006), followed by negative outcome expectation (n=21) and partner-focus (n=11) messages. The total shares were 276, with most shares (165) for the negative outcome post. Female users were more likely to engage with the positive outcome (39% v.28%) and negative outcome (34% v.25%) messages; engagement did not vary by sex for the partner-focus message (36% v.36%). Those 65 years and older had the highest engagement of all age groups (negative outcome: 54%; positive outcome expectation: 47%; and partner-focus: 40%).ConclusionAlthough the positive outcome message strategy received the most engagement and clicks to the website for more information, the message using a negative outcome approach was the most frequently shared message. Females and older adults were more likely to engage with OSA messaging. These results provide information about the reach and uptake of OSA messages with different frames (e.g., negative/positive outcomes, partner-focus).Support (if any)This project was funded by the CDC. Additional support from the NIH (K01HL150339).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01085
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1086 Literacy Profile of Digital Education on Positive Airway Pressure
           Interventions Generated by Machine Learning

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      Pages: A466 - A467
      Abstract: AbstractIntroductionSleep apnea affects over 30 million individuals in the United States and contributes to a multitude of comorbidities among patients. Let alone, there has been a bibliometric increase in clinical research development on understanding and innovating the treatment of sleep apnea. One of the most common sleep interventions is using positive airway pressure (PAP) devices which play a key role in maintaining the oxygen saturation of a patient during sleep. As these devices continue to be used among individuals, it is imperative to ensure patients receive appropriate education on the management of these devices. However, few clinical studies have evaluated the quality of the most commonly used digital educational materials that are designated to specifically answer questions asked by patients regarding PAP devices. This study aimed to evaluate the comprehension and readability of digital patient education materials regarding PAP modalities.MethodsTo address the primary objective of this study, a cross-sectional methodology was employed. It extracted the most frequently asked questions from the Google RankBrain machine learning algorithm and each associated educational article regarding continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices. Following, two independent raters evaluated questions for JAMA Benchmark Criteria and Rothwell’s Classification of Questions. Additionally, these raters also utilized the Flesh Reading Ease scale and Brief DISCERN for each article to evaluate the quality, readability, and understanding of each educational material.ResultsThis study extracted the first 200 frequently asked questions and educational articles on CPAP and BiPAP devices using the algorithm. Rothwell’s Classification revealed 93.0% of questions were classified as “Fact” (n= 186). Within this cohort, digital patient education materials that met grade-reading level recommendations (Flesh Reading Ease ≥ 60) were found in a tighter distribution for CPAP vs. BiPAP. Brief DISCERN scores were not found to be statistically significantly associated with Flesh Reading Ease when scores met grade-reading level recommendations (p = 0.13).ConclusionThe findings of this study indicate that a majority of education materials on PAP devices do not meet US grade-reading level recommendations. These results encourage healthcare providers and educators to integrate techniques that improve healthcare literacy regarding PAP modalities.Support (if any)None
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01086
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1125 Use of a Pillow Designed to Help Users Feel Cool Improves Objective
           Sleep Quality and Perceived Sleep

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      Pages: A483 - A483
      Abstract: AbstractIntroductionComfort and temperature regulation play important roles in sleep quality. This study compared sleep on a pillow designed to help the sleeper feel cool to participants’ prior sleep on their original pillow.MethodsHealthy adults (71% female; ages 24-72, mean age=42) who reported difficulties with sleeping hot or night sweats and frequent awakenings or time spent awake at night, participated in a 9-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular pillow at home. During the 5-week intervention period, following a 1-week adjustment period, participants used Sleepy’s SUB-0 Triple Cooling Pillow. The pillow is made with materials designed to help regulate temperature and draw heat away from the body. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.ResultsThere were 1,175 nights of tracked sleep across 29 participants. Compared to baseline, objective sleep measurements showed increased REM, indicated by 3 metrics: REM in minutes (9% increase, p=.001), REM as a proportion of the night (13% relative increase, p<.001), and MindScore (4% increase, p=001). There also was improvement in SleepScore, a measure of overall sleep quality (3% increase, p=.005). Self-report measures revealed that the pillow felt cooler and more comfortable compared to the original pillow, and participants perceived that they had less intense night sweats, a reduction in the experience of sleeping hot, and increases in sleep quality, feeling more rested in the morning, and satisfaction with sleep (all ps <.001).ConclusionObjectively measured sleep quality and perceived sleep improved when using the cooling pillow compared to the original pillow. Self-report results indicated that the intervention was perceived as comfortable and cool. These perceptions likely are what led to the key sleep improvements.Support (if any)Mattress Firm INC.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01125
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1126 In-Person Expert Mattress Matcher Process Is Associated with Improved
           Objective Deep Sleep and Perceived Sleep

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      Pages: A483 - A483
      Abstract: AbstractIntroductionUnsubstantiated claims about the potential benefits of various mattress types can make it challenging for consumers to choose a mattress that fits their personalized needs. Services that provide information and recommendations regarding mattress selection may help solve this problem. However, more evidence and research are necessary to understand such services' potential to support better sleep. This study examined the sleep of research participants using mattresses selected during an in-store matching process compared to using their original mattresses.MethodsHealthy adults (75% female; ages 27-73, mean=46) participated in a 10-week field study, using a pre-post intervention design. The intervention consisted of being guided in person through the Mattress Firm Mattress Matcher process. During the 4-week baseline period, participants used their regular mattress at home. After being matched at a store near them with a new mattress, participants slept on that mattress for 6 weeks, including a 2-week adjustment period. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.ResultsThere were over 1,189 nights of tracked sleep across 29 participants. Objective sleep measurements showed that deep sleep improved when using the matched mattress compared to baseline, indicated by 3 metrics: deep sleep in minutes (5% increase, p=.003), deep sleep as a proportion of the night (4% relative increase; p=.030), and BodyScore (1% increase; p=.022). Improvements also were found for a variety of self-reported sleep outcomes, including feeling better able to sleep through the night without tossing and turning, waking up feeling refreshed and well-rested, feeling satisfied with sleep more often, and perceiving better overall sleep quality (all ps<.001). Additionally, compared to baseline, the matched mattress felt more comfortable, pressure relieving, supportive, and cooler (all ps<.001).ConclusionObjectively measured deep sleep and numerous aspects of self-reported sleep improved among healthy adults using a mattress selected via an expert, in-person mattress matcher process. The results suggest that this process can support sleep by helping individuals find a mattress that provides an optimal fit for their personal needs.Support (if any)Mattress Firm INC
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01126
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1127 Use of an Adjustable Bed Base Is Associated with Improvements in
           Objective and Perceived Sleep

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      Pages: A483 - A484
      Abstract: AbstractIntroductionPrevious research has shown that comfort of the sleep surface is essential to sleep quality. Additionally, positional adjustment of a sleep surface can help improve sleep and alleviate discomfort. This study compared sleep in an inclined position on an adjustable bed base to participants’ prior sleep when sleeping flat in their usual bed environment.MethodsHealthy adults (71% male; ages 27-75, mean age=44) reporting difficulties with frequent awakenings or time spent awake at night participated in an 8-week field study, using a pre-post intervention design. During the 4-week baseline period, participants slept flat on their regular bed. During the 4-week intervention period, they slept in an inclined position of their choosing using Sleepy’s Adjustable Bed Base. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.ResultsThere were 951 nights of tracked sleep across 27 participants. Objective sleep measurements showed increased total sleep time (+6 minutes, p=.038) and an increase in light sleep duration (+5 minutes, p=.045) compared to baseline. Also, improvement was observed in BodyScore, an objective measure of deep sleep quality (+2%, p=.030). Self-report measures revealed that using the bed base felt more comfortable compared to sleeping flat using the original bed base (p=.011). Improvements also were found for a variety of perceived sleep outcomes, including the perception of falling asleep more easily, less tossing and turning, better sleep quality, and feeling more well-rested in the morning (all ps<.001).ConclusionSeveral important aspects of objectively measured sleep and self-reported sleep improved when using the adjustable bed base compared to sleeping flat on the original bed base. Additionally, qualitative and quantitative self-report results indicated that the intervention was perceived as comfortable.Support (if any)Mattress Firm INC.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01127
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1128 Use of a Recliner Designed for Sleep Improves Perceived Sleep
           Outcomes

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      Pages: A484 - A484
      Abstract: AbstractIntroductionThe positional adjustment of the sleep surface, such as inclining the upper body and/or legs, can potentially contribute to better sleep and alleviation of discomfort associated with a variety of physical problems. This study compared sleep on a recliner designed for sleep to participants’ prior sleep on their original sleeping surface.MethodsAdults (78% female, ages 29-73, mean age=47) who reported already sleeping at least part of the night on a recliner, chair, or sofa, participated in a 6-week field study, using a pre-post intervention design. During the 3-week baseline period, participants slept at home in their usual environment. During the 3-week intervention period, they slept on the Zecliner at home. This recliner enables users to tailor the sleep surface to their preferences by adjusting the position of the upper body and legs. Sleep was measured objectively using a PSG-validated, non-contact biomotion device, SleepScore Max, every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.ResultsThere were 708 nights of data across 23 participants. While objectively measured sleep did not improve, pre-post analyses revealed increases in self-reported sleep quality (+121%) and feeling well rested in the morning (+119%) compared to baseline (all ps<.001). Satisfaction with sleep and feeling well-rested in the morning increased from 1 to 4 days per week on average (all ps<.001). Also, increases in ratings of comfort (+107%), pressure relief (+240%), sense of weightlessness (+327%), and feeling cool (+180%) were observed compared to baseline (all ps<.001).ConclusionPerceived sleep quality at night and feeling well-rested in the morning improved when sleeping on the recliner compared to baseline, likely because the intervention was perceived as more comfortable. Findings highlight the importance of adjustable sleep surfaces in promoting satisfaction with sleep.Support (if any)Flexsteel
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01128
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1161 From Restless to Rest – the Use of Methadone to Treat Complex RLS
           in Patients with Sleep Apnea: A Case Series

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      Pages: A497 - A497
      Abstract: AbstractIntroductionTypically, patients with restless leg syndrome (RLS) respond well to standard therapies such as dopamine agonists and alpha-2-delta calcium channel ligands. However, patients with refractory RLS may require opioids for optimal disease control 1. In the setting of concomitant obstructive sleep apnea (OSA), characterized by upper airway collapse leading to recurrent episodes of upper airflow obstruction and intermittent hypoxemia, opioids can further increase respiratory depression. Consequently, many clinicians may be hesitant to prescribe opioids in such patients. The following cases highlight chronic opioid use in patients with concurrent RLS and OSA.Report of case(s)Case 1: A 77 year-old man with OSA on continuous positive airway pressure (CPAP) presented to sleep clinic for optimization of longstanding RLS. Initial interventions with standard therapy were ineffective. He was started on methadone with good control of his symptoms, but eventually developed central apneas. He was subsequently switched to BiPAP ST with a residual AHI of 2.6 events/hr. His RLS remained stable on methadone 10-12.5 mg night. Case 2: A 72 year-old man with a history of low back pain previously managed with opioids, presented to sleep clinic for severe OSA and RLS. His RLS symptoms were initially controlled with gabapentin and pramipexole, but he experienced augmentation after self-titrating to high doses. His RLS was optimized with methadone 10 mg. However, he could not tolerate CPAP despite multiple interventions. In order to continue methadone, he lost 60 pounds with significant improvement in his OSA on repeat testing (AHI 6.1 events/hr). He was able to maintain weight loss and continue methadone therapy. Case 3: A 77 year-old female with long standing RLS on methadone for 20 years presented to sleep clinic for follow up of RLS. Her RLS was refractory to standard therapy. Since initiation of methadone, she gained significant weight. A repeat sleep study demonstrated moderate OSA (AHI 28.3 events/hr). She did well on CPAP with excellent compliance (Residual AHI 5.8 events/hr). She remained stable on methadone 20-30 mg daily.ConclusionHere we demonstrate that in the right setting, patients with RLS in the setting of OSA can be safely treated with opioid medications.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01161
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1162 Keratoconus in an Adolescent with Obstructive Sleep Apnea

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      Pages: A497 - A498
      Abstract: AbstractIntroductionObstructive sleep apnea (OSA) is common in pediatrics. Signs of OSA vary between patients commonly reflecting an obstructed upper airway with hypoventilation and hypoxemia. There is less knowledge of the ophthalmologic findings in OSA. Corneal thickness is sensitive to oxygen desaturations that occur during sleep and may contribute to the development of keratoconus. Based on the IRIS Registry, the prevalence of keratoconus in adults is 2.9% compared to 0.27% in pediatrics. We describe a pediatric patient with keratoconus, who was found to have severe OSA.Report of case(s)14-year-old male with history of obesity, tonsillar hypertrophy and bilateral keratoconus s/p corneal crosslinking was admitted to the hospital for corneal transplant. Post-operatively, it was difficult to wean the patient off oxygen and inpatient he required 3L oxygen due to significant nocturnal hypoxemia. With concurrent morning headaches, witnessed apneas and weight gain (BMI 52.7, >99th percentile) the patient underwent an inpatient split night polysomnogram. Results revealed severe OSA (AHI 123/hr) and hypoxemia (O2 baseline 89-91%, nadir 64% O2, ODI 105.1/hr, < 90% for 40% of TST) without significant hypoventilation (PETCO2 43 - 54mmHg, >50mmHg for 1% TST). He was titrated to CPAP 15cm H2O with resolution of sleep apnea (AHI 0.7, SpO2 92 - 98%). Echocardiogram showed normal right ventricular size, ejection fraction and negative for signs of pulmonary hypertension. Chest x-ray was unremarkable. He was initiated on PAP therapy, and subsequently underwent adenotonsillectomy 5 months later. He continues to follow with ophthalmology and uses prednisolone eyedrops regularly.ConclusionOcular presentations are a less recognized sign of OSA particularly in pediatric patients. In adults, the intermittent hypoxemia and airflow limitations could contribute to ocular pathology and severity in presentation. Keratoconus has been associated with elevated levels of matrix metalloproteinases and protease inhibitors, which may play a role in corneal thinning in individuals with OSA. Pediatric keratoconus has been described as more aggressive compared to adults leading to more rapid deterioration. The progression of ocular disease in our patient may have been a consequence of untreated OSA. Our report highlights the importance of early recognition and treatment of OSA in pediatric patients.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01162
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0836 Similarities and Differences in Maternal and Paternal Bed-sharing
           Beliefs in Mexican American Couples with Toddlers

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      Pages: A358 - A358
      Abstract: AbstractIntroductionRoom-sharing, but not bed-sharing is recommended for safe sleep, and pediatric behavioral sleep interventions commonly recommend a separate child sleep space, even when room-sharing. However, bed-sharing is more common globally and across cultural groups than in U.S.-based non-Latino White families. Further, most research has focused on maternal beliefs about bed-sharing, with little consideration of paternal beliefs. This exploratory study describes similarities and differences in maternal and paternal beliefs about bed-sharing in Mexican American couples with toddlers.MethodsFourteen Mexican American couples (mothers [27-41 years, mean education 12.8 + 3.7 years] and fathers [27-45 years, mean education 11.1 + 3.4 years]) with toddlers (78.6% boys; 12-15 months) completed the 17-item Bed-sharing Beliefs measure in Spanish (50%) or English. Half of families reported bed-sharing with their toddler. Although data collection is ongoing, we describe dyadic concordance (dyads both agree or disagree) or discordance (one person agrees, the other disagrees) in the current sample.ResultsThe most dyadic concordant responses were parent sleep/privacy items: “bed-sharing interferes with the parents privacy” (100% concordance: 93% agree), “bed-sharing makes the parents sleep poorly” (86% concordance: 64% agree), and “bed-sharing helps the parent sleep well” (79% concordance, 36% agree). Teaching the child to sleep independently items also had strong dyadic concordant responses: “bed-sharing makes the transition to their own bed harder” (79% concordance, 64% agree), “bed-sharing makes it harder for the child to sleep on their own” (79% concordance, 64% agree), and “bed-sharing makes the child dependent on the parent to sleep” (77% concordance, 62% agree). The greatest dyadic discordant responses were related to the child’s sleep quality: 62% discordance for both “bed-sharing keeps the child from sleeping comfortably” and “bed-sharing interferes with the child’s sleep.” No differences between bed-sharing and non-bedsharing dyads were found.ConclusionEarly findings from our ongoing study of sleep beliefs in Mexican American families with toddlers suggest greater parental concordance about the impact of bed-sharing on parental privacy/sleep and toddlers learning to sleep independently, with discordant beliefs about the impact of bed-sharing on child sleep quality. Further exploration of dyadic parental beliefs about bed-sharing and the relationship with sleep location is needed in a larger sample.Support (if any)R01HL163859
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0836
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0952 Subjective Sleep Improvements Following Daily Theta-burst Stimulation
           for Treatment-resistant Depression

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      Pages: A408 - A409
      Abstract: AbstractIntroductionSleep disturbances are commonly observed in individuals with depression, and are associated with severity of depression, treatment outcomes, and risk of relapse. Repetitive transcranial magnetic stimulation, including newer optimized theta-burst stimulation (TBS) protocols, is recognized as a safe and effective intervention for treatment-resistant depression (TRD). Presently, little is known about the impact of TBS treatments on sleep in individuals with depression. We examined changes in subjective sleep and depression in individuals with TRD receiving daily TBS treatments, and the relationship between changes in these symptom domains.Methods50 participants (50% female, mean age 46.82 years) with TRD received four or six weeks of daily TBS treatments targeting the left or bilateral dorsolateral prefrontal cortex while participating in a randomized, double-blind clinical trial. Sleep disturbances and depression severity were measured at baseline, session 20 and session 30 using the Leeds Sleep Evaluation Questionnaire and 17-item Hamilton Rating Scale for Depression (HRSD-17), respectively. Linear mixed models examined whether scores changed significantly throughout treatment. Spearman’s correlations investigated whether changes in depression and sleep were associated.ResultsHRSD-17 scores improved significantly from baseline to weeks 4 and 6 (p< 0.001). We also observed significant improvements in quality of sleep (QOS), ease of awakening from sleep (AFS), and behaviour following wakefulness (BFW) after 4 and 6 weeks of TBS (p< 0.001). After 4 weeks of TBS, improvements in HRSD-17 significantly correlated with BFW scores (p= 0.008). After 6 weeks of TBS, improvements in HRSD-17 scores significantly correlated with improvements in both AFS and BFW scores (p< 0.005).ConclusionParticipants reported improvements in depression, sleep quality, ease of waking, and daytime alertness following TBS. Furthermore, improvements in several aspects of sleep and depression were correlated. These findings suggest that TBS may be an effective intervention for individuals experiencing comorbid depression and sleep disturbances. This also strengthens the view that sleep enhancement may contribute to better mental health outcomes.Support (if any)Support was provided by the Royal’s Institute of Mental Health Research’s Emerging Research Innovators in Mental Health award, the Fonds de Recherche en Santé – Québec Research Scholar Junior 1 grant (grant number 297133), and an anonymous donation.
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0952
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0953 The Interaction Between Insomnia and Excessive Daytime Sleepiness on
           Cognitive and Somatic Depressive Symptoms

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      Pages: A409 - A409
      Abstract: AbstractIntroductionSleep and mental health are Healthy People 2030 Public Health priorities. Emerging adults experience a combination of biosocial and environmental changes that contribute to increased susceptibility to sleep disturbances and poor mental health during the college years. Excessive daytime sleepiness and insomnia represent distinct sleep disturbances, and both have been linked to depressive symptomatology. However, few studies have examined their interactions on specific mood symptoms. This study explored the moderating effect of excessive daytime sleepiness on the relationship between insomnia and cognitive and somatic depressive symptoms.MethodsEmerging adults (N=104, Mean age=20.22± .78, 81.7% Female) completed self-report measures on sleep and depressive symptoms. The insomnia severity index assessed for the nature, severity, and impact of insomnia symptoms, with higher scores indicating greater symptom severity. Excessive daytime sleepiness was assessed using the Epworth sleepiness scale. The Beck depression inventory (BDI-II) assessed for the presence and intensity of overall depressive symptoms, with cognitive and somatic depressive symptoms derived from subscales. Higher scores represented greater depressive severity. All statistical analyses were conducted using IBM SPSS version 29, along with Hayes PROCESS macro for moderation analyses.ResultsData showed a positive correlation between insomnia severity and excessive daytime sleepiness (r=.24, p=.01). We also found significant associations between insomnia severity and overall depressive symptoms (r=.52, p<.001), cognitive depressive symptoms (r=.42, p<.001) and somatic depressive symptoms (r=.58, p<.001). Findings indicated significant main effects of insomnia (b=.95 ±.24, p<.001) and excessive daytime sleepiness (b=.72 ±.31, p=.02) on cognitive depressive symptoms, and excessive daytime sleepiness significantly attenuated the association between insomnia and cognitive depressive symptoms (b=-.05 ±.02, p=.03). Results also indicated a significant main effect of insomnia, but not excessive daytime sleepiness (b=.05 ±.22, p=.81) on somatic depressive symptoms (b=.49 ±.17, p=.01). Additionally, there was no interaction between insomnia and excessive daytime sleepiness on somatic depressive symptoms (b=-.001 ±.02, p=.96).ConclusionData indicates that sleep disturbances are risk factors that need to be considered and addressed when treating depressive symptoms among emerging adults.Support (if any)This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0953
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0954 Associations Between Sleep Duration and Timing and Postpartum Anxiety
           Symptoms

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      Pages: A409 - A409
      Abstract: AbstractIntroductionPostpartum anxiety is understudied and underdiagnosed in postpartum women, despite being more common than postpartum depression. Given associations between postpartum anxiety and adverse maternal and infant outcomes, it is crucial to identify patterns and predictors of postpartum anxiety. We examined the associations between sleep duration and timing and postpartum anxiety over 6 months following delivery.MethodsPregnant women (n=147; 30-39 weeks) with a history of depression completed the Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder Scale-7 monthly following delivery for 6 months. Sleep duration and timing were extracted from the PSQI. Sleep timing was calculated as the midpoint between sleep onset and offset. In a multilevel model, sleep duration and timing were person-mean centered at level 1 (month level) and grand-mean centered at level 2 (participant level). Level 1 included main effects of time, sleep duration and timing, and interactions between time and person-mean centered sleep duration and timing and time and grand-mean centered sleep duration and timing. Level 2 included main effects of sleep duration and timing. Depression symptoms were included as a covariate at both levels.ResultsThe intraclass correlation for anxiety symptoms was .46, supporting the use of a multilevel model. Anxiety symptoms increased over time (p<.001). Months with shorter sleep duration were associated with higher concurrent anxiety symptoms (p<.001). The effect of sleep duration on anxiety symptoms varied over time, such that those with shorter sleep duration reported higher anxiety symptoms than those with longer sleep duration in early postpartum months, whereas anxiety symptoms increased during later postpartum months regardless of sleep duration. Sleep timing was not significantly associated with anxiety symptoms (p>.05).ConclusionPostpartum anxiety increased over time, suggesting such symptoms are not transient features of the immediate postpartum period and highlighting the need to identify predictors. Shorter sleep duration may signal risk for elevated postpartum anxiety on a monthly timescale, particularly during early postpartum months. Treatments aimed at promoting sleep to improve postpartum anxiety may be most effective if targeted at early postpartum months. Future research should replicate these findings with objective sleep measures.Support (if any)Happiest Baby, Inc.; NIH T32 HL149646
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0954
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0955 Correlation Between CPAP Use and Symptoms of Depression, Anxiety, and
           Sleepiness in Patients with OSA

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      Pages: A410 - A410
      Abstract: AbstractIntroductionObstructive Sleep Apnea (OSA) is a prevalent sleep disorder associated with poor health outcomes, including sleepiness, anxiety, and depression. This study aimed to further explore this relationship by looking at outcomes after treatment of OSA with continuous positive airway pressure (CPAP) therapy, using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and Epworth Sleepiness Scale (ESS) questionnaires respectively.MethodsAn observational longitudinal study in which the PHQ-9, GAD7, and ESS questionnaires were administered to adult patients diagnosed with OSA during the initial consultation and after three months of CPAP use. All patients had a diagnosis of OSA by a sleep study. Data collected included demographics, PSG data, and questionnaire results. Patients without follow-up or incomplete data were not included.ResultsOne hundred patients were initially recruited. Thirty-five patients have completed data after three months. The mean±SD age was 50.9±15.4, BMI 36.5±8.9, 54% male and 46% female. Women were older 61.1±14 than men 46.5±14.9, p< 0.001. The percent of CPAP adherence was 68.7±36.7, and hours used per day were 5.5±1.8. The PHQ-9 initially was 10.4±5.6 decreased to 5.32±5.3 p< 0.001. GAD-7 initially 6.4±6.2 decreased to 4.29±4.8 p< 0.001, ESS initially 11.1±5.5 decreased to 5.8±4.3 p< 0.001. Neither age, BMI, or AHI correlated with compliance or hours used. The strongest negative correlation was between post-treatment GAD-7 and compliance (r= -0.45), followed by a mild negative correlation between PHQ-9 and compliance (r = -0.345). A mild positive correlation existed between the initial ESS and the AHI (r = 0.288). There were no statistical differences in questionnaire results between men and women.ConclusionThe study demonstrates that daytime symptoms of sleepiness, depression, and anxiety improved in a cohort of patients with OSA and CPAP. The post-CPAP GAD-7 was moderately and negatively correlated with CPAP compliance percent use, while PHQ-9 was mildly negatively correlated. Initial ESS was mildly correlated with AHI, and although it improved, it was not correlated with compliance.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0955
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1055 Development of a Provider and Patient-Based Sleep Improvement
           Resource for Inpatient Setting

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      Pages: A453 - A453
      Abstract: AbstractIntroductionInsomnia is common among hospitalized psychiatric patients and environmental challenges often increase the severity of sleep disturbances. Pharmacotherapy is often used to treat insomnia symptoms. Few studies have investigated ways to adapt CBT-I to inpatient populations.MethodsA preliminary needs assessment was conducted at Stanford Hospital and Clinics Acute Inpatient Psychiatric units to identify barriers related to the use of non-pharmacological approaches to improve patients’ sleep. We conducted unstructured interviews with staff members, including nurses, occupational therapists, psychologists, and psychiatrists. Based on themes that emerged from the interviews, we developed sleep improvement resources and subsequently refined them based on input from behavioral sleep medicine providers and the inpatient team.ResultsWe developed the following three resources (1) a provider training and education resource, (2) a patient-facing handout, and (3) recommendations on the environment in the inpatient unit. Both the provider- and patient-facing resource consisted of context-sensitive CBT-I recommendations: psychoeducation about sleep regulation, counter control, alerting strategies, strategic napping, daytime activities that support sleep, developing a wind down and morning routine, and optimizing the sleep environment (e.g., utilizing earplugs, eye masks or extra blankets). Additionally, several recommendations were included to address modifiable environmental factors at the unit-level. These included increasing consistency with unit light and wake time schedule, nursing staff to perform visual checks to minimize disrupting patients’ sleep, designated quiet time, dimmable lights in bedrooms, and additional unit-safe sitting areas in bedroom (e.g., bean bag chair).ConclusionAdapting CBT-I principles to specifically target sleep difficulties unique to psychiatric inpatients at all three levels (i.e., patient, staff, and environment) has the potential to support sleep in this vulnerable population. Future research is needed to test efficacy of this comprehensive approach.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01055
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1056 Medical Record Alert to Increase PAP Use in Hospitalized Patients on
           Home PAP for Sleep Disordered Breathing

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      Pages: A454 - A454
      Abstract: AbstractIntroductionMany patients with sleep disordered breathing (SDB) on home positive airway pressure (PAP) therapy are not ordered for PAP treatment when hospitalized. Our quality improvement project evaluated whether establishing an electronic medical (EMR) alert to place PAP orders on patients with home PAP for SDB, could be successfully implemented and lead to an increase in PAP ordering in hospitalized patients.MethodsIn April 2021 the nursing intake assessment was changed to ask if patients had SDB and used PAP at home. In September 2021, an EMR alert was implemented and triggered when a physician or advanced practice provider opened the chart of a patient on home PAP use if PAP therapy was not already ordered. We conducted a retrospective chart review to compare rates of PAP ordering for hospitalized patients with SDB on domiciliary PAP before (August 2021), during (9/7/2021-9/11/2021), and after (October 2021) implementation of an EMR alert. We included all patients admitted to medical and surgical wards of Baystate Medical Center. We excluded patients admitted to ICU and patients who had contraindications to PAP therapy including encephalopathy or vomiting.ResultsThe alert was discontinued after 4 days due to hospitalist feedback that receiving the alert when the chart was first opened was disruptive to workflow. We were unable to link the alert to later steps in the workflow. Rates of PAP orders were 61.4% (148/241, 95% CI: 54.9, 67.6), 66.7% (28/42, 95% CI: 50.5, 80.4), and 65.6% (168/256, 95% CI 59.4, 71.4), respectively. Patients admitted to observation unit were prescribed PAP 46.7% (21/45), 71.4%(5/7) and 55.6% (25/45), respectively. Patients on surgical units were prescribed PAP 63.0% (29/46), 75% (6/8), 70.2% (40/57), respectively. Patients on medical units were prescribed PAP 65,3% (98/150), 63.0% (17/27), 66.9% (103/154), respectively.ConclusionAn EMR alert for providers to prescribe in-hospital PAP therapy for patients on home PAP therapy may increase rates of PAP ordering, but implementation must be congruent with provider workflow. Although surgical and observation units had larger increases in PAP ordering with the alert, variability may due to small sample size so further evaluation is needed. Further studies are needed to optimize alert type and timing and assess utility.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01056
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1075 The Impact of Operating on the Sleep Consistency of Surgeons: Results
           from a Pilot Study

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      Pages: A462 - A462
      Abstract: AbstractIntroductionIt is well known that sleep is essential for health, but not as much attention is given towards aspects of sleep like sleep timing or regularity, both of which are important characteristics of sleep quality. In medicine, surgeries may not always be planned. As a result, many surgeons suffer from poor sleep consistency. This study explores surgeons’ sleep habits and compares sleep regularity on operating days to non-operating days.MethodsTen surgeons were recruited from a large midwestern academic center’s Department of Orthopedics. Each surgeon was given an Oura ring for a 14-day period to track their sleep. After the 14-day study period, overall average bedtimes and wake times, and bedtime and wake time regularity were compared for operating and non-operating days. Regularity was calculated by taking the absolute change in bedtime or wake time compared to the previous day. Paired T-tests were used to analyze the data; statistical significance was considered for p-values ≤0.05.ResultsOf the 10 surgeons recruited, 7 were residents and 3 were faculty; 4 were female, and 6 were male. Through the 14-day period, a total of 95 (67.9%) of the possible 140 nights were recorded, 41 (43.2%) of which were OR days, and 54 (56.8%) were non-operating days. Average bedtimes (p = 0.185) and regularity (p =0.731) between operating and non-operating days showed no statistically significant difference. However, both average wake-up time (p = 0.024) and regularity (p = 0.006) illustrated statistically significant changes. Furthermore, when comparing the number of days wake-up times changed by more than 1 hour on OR days to non-OR days, a significant difference was appreciated (p = 0.016), while that of bedtime regularity remained insignificant (p = 0.082).ConclusionThe significant changes in wake-up times support the idea that many surgeons have poor sleep regularity. While doctors and research stress the importance of maintaining a robust sleeping schedule to their patients, the structure of our healthcare system complicates surgeon’s ability to maintain regular sleep themselves. Future studies should explore how poor sleep consistency impacts the physiological processes of surgeons and other healthcare workers.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01075
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1076 Feasibility of Sleep Staging EEG Acquired by a Dry-electrode Wearable
           Device Using a PSG-trained Algorithm

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      Pages: A462 - A462
      Abstract: AbstractIntroductionSleep monitoring hardware that allows for accurate sleep staging while also being unobtrusive and self-administered has the potential to make reliable EEG-based assessment of sleep quality at home widely accessible. However, for novel hardware utilizing dry EEG electrodes, a question remains regarding the similarity of these signals to traditional polysomnography (PSG), especially when used for therapy development. Here, we investigate how well EEG signals from a wearable dry electrode system can be sleep staged by an algorithm trained on traditional PSG.MethodsThe Dreem 3 headband, a low-profile sleep monitoring device with dry electrode EEG sensors, was used simultaneously with overnight PSG in 75 individuals. A machine learning model that was trained to stage sleep from the EEG signals of PSG, SleepStageML™, was run without modification on both the PSG and headband EEG signals. Each PSG recording was independently staged by 3 registered polysomnographic technologists to generate consensus ground-truth sleep stage labels. We compared the algorithmic performance of the sleep stages generated from the PSG signals to that of the sleep stages generated from the synchronously recorded headband data.ResultsStaging of PSG signals resulted in per-stage positive-percent-agreements (PPAs) of 92.4% for W, 58.4% for N1, 90.7% for N2, 76.0% for N3, and 92.9% for R. Negative-percent-agreements (NPAs) for these stages were 98.6%, 98.1%, 88.4%, 97.5%, and 98.4% respectively. When staging the headband recordings, performance remained high with PPAs for W, N1, N2, N3, and R of 94.4%, 34.7%, 88.2%, 78.6%, and 83.7% and NPAs of 96.2%, 98.9%, 86.5%, 96.3%, and 98.4% respectively. Cohen's Kappa on PSG signals was 0.82, and 0.77 on headband data.ConclusionWe demonstrate that the EEG signals from a dry-electrode sleep monitoring system are similar enough to the EEG signals of a traditional PSG that an algorithm trained to stage PSG can also stage these dry-electrode signals. These results suggest that dry electrodes configured in a comfortable headband montage can capture clinical grade EEG useful for sleep staging with existing paradigms. These findings are promising for the broader investigation of cerebral functioning in sleep pathology, and could simplify the development of sleep biomarkers of neuropsychiatric disease.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01076
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1093 TikTok Made Me Do It: An Analysis of the Scientific Evidence
           Supporting TikTok’s Recommendations for Better Sleep

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      Pages: A469 - A469
      Abstract: AbstractIntroductionLike it or not, the public looks to social media for health advice. In one large survey, adults listed social media as their second place for health information following their primary care provider, and most individuals reported that they do not verify the accuracy of information with a healthcare provider. Given the public’s apparent confidence in health advice shared on social media, it is important that content creators share medically sound advice. To that end, we sought to understand the scientific evidence supporting sleep tips shared on TikTok.MethodsWe transcribed the most-viewed TikTok videos on November 15-16, 2023, that used the tag #sleephacks, #sleephygiene, or #sleeptips. Two researchers coded each video to identify all sleep tips; a third researcher coded >25% of videos for validity. A total of 295 sleep tips (including repeated recommendations) were coded across 58 videos. Tips were then organized by theme and were compared to findings from empirical articles in peer-reviewed journals on Google Scholar. Research-based evidence in support of sleep tips was defined as shorter sleep latency, longer sleep duration, more slow-wave or rapid eye movement sleep, higher sleep satisfaction, or less daytime sleepiness in randomized or non-randomized controlled trials or correlational (cross-sectional regression) associations.ResultsN = 35 unique sleep tips were identified, grouped around 7 themes: calming activities (e.g., breathwork prior to bed), use of electronics (e.g., limiting screen time before bed), environment (e.g., sleeping in a cool, dark room), foods/substances to avoid (e.g., caffeine before bed), foods/substances to use (e.g., magnesium), schedule (e.g., consistent bed and wake times), and other sleep-related behaviors (e.g., mouth taping). Of the 35 tips, we found empirical support for 33, of which 26 had evidence from randomized controlled trials, 2 were supported by controlled trials without randomization, and 5 were backed by correlational associations.ConclusionMost sleep tips shared on TikTok are supported by empirical evidence. While much of the health advice shared on the platform remains unregulated and unreviewed by health professionals, current information about sleep hygiene and sleep environment is generally backed by scientific support.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01093
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1094 Who Gets the Stim': A Demographic Analysis of Hypoglossal Nerve
           Stimulator Patients

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      Pages: A469 - A470
      Abstract: AbstractIntroductionIn addition to traditional demographic analysis, Geographic Information System (GIS) tools, provides a unique methodology that allows us to spatially analyze data and capture geographic data related to HNS patients. This study seeks to create geographic maps related to socioeconomic attributes of HNS patients in addition to relevant demographic and clinical data to better understand potential barriers to care for those seeking treatment for obstructive sleep apnea (OSA).MethodsA retrospective study was performed of patients who underwent HNS implantation at a tertiary care academic hospital from August 2011 to October 2021. Relevant demographic and clinical characteristics were captured for each patient, both pre- and post-operatively. GIS was used to geocode patient addresses and perform spatial analyses to capture socioeconomic dynamics that may produce barriers to care for vulnerable populations. Maps were produced identifying distribution of patients relative to median household income, Area Deprivation Index (ADI), and drive times to the hospital.Results229 patients were included in this study. 167 patients were male and 62 were female. 222 patients implanted during this period identified as Caucasian. When considering median home value, median household income, and Area Deprivation Index, the cluster of patients within Pittsburgh most often lived in more affluent areas. However, more than 50% of patients lived greater than a 30-minute drive from the hospital where surgery and clinic appointments occurred. 90% of patients lived within 60 minutes of the hospital.ConclusionAs hypoglossal nerve stimulation (HNS) continues to expand its footprint in the treatment of patients with obstructive sleep apnea (OSA), there is a dearth of demographic studies related to the populations currently being served by this treatment modality. This study uniquely seeks to meld clinical data with socioeconomic information to better understand recipients of HNS.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01094
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0844 Improving the Care of Pediatric Patients with Narcolepsy

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      Pages: A362 - A362
      Abstract: AbstractIntroductionNarcolepsy is a rare disorder characterized by disabling excessive daytime sleepiness and signs of REM-sleep dissociation. Pediatric narcolepsy has a different clinical presentation and may be difficult assess, but still can lead to severe impairments. Due to the importance of narcolepsy and the effects on quality of life we aimed to analyze and adjust our processes for caring for pediatric patients with narcolepsy to reach 90% compliance or greater with recommended quality measures.MethodsUtilizing the AASM Quality Measures, medical records were reviewed from the Children’s Wisconsin Sleep Disorders Center with a diagnosis of narcolepsy from January 2018 until May 2023. Baseline compliance with recommended quality metrics were established. Those with a compliance rate of 80% or less were selected for the four step Plan-Do-Study-Act cycle. Data was continuously collected and analyzed quarterly to track compliance and address deficiencies in current processes.ResultsPre-intervention data collection from 2017-2018 had compliance of 52% in documentation of the sleepiness assessment. Practice adjustments included educating clinical staff and distributing clinic questionnaires which improved compliance to 100%. With telehealth, compliance decreased to 90% and required an adjustment to clinical providers performing the assessment. Additional changes included developing an EMR Narcolepsy template to include safety counseling and education. Utilization of telehealth allowed annual follow up to remain >90%, even if patients delayed or cancelled an annual visit. For the small population of new patients compliance fluctuated between 0-100% for initiating treatment in part due to parent scheduling and clinic availability.ConclusionIt is essential to ensure proper diagnosis, prompt treatment initiation, regular follow up of symptoms and response to treatment, and safety practices for those with Narcolepsy. With simple adjustments, compliance improved, but due the COVID-19 pandemic care delivery changed. The plan was to temporarily shift to a telehealth model, telehealth enabled us more flexibility to discuss results and manage treatments when necessary. Utilization of online questionnaires through patient portals can update the EMR. Work is ongoing to further explore how technology can be used to reach patients and maintain consistent follow up.Support (if any)Internal funding provided by the Children’s Wisconsin Department of Pediatrics
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0844
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0845 The Contributions of Sleep and Circadian Parameters to Adolescents
           ADHD Symptoms

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      Pages: A362 - A362
      Abstract: AbstractIntroductionAttention-deficit/hyperactivity disorder (ADHD) is a chronic and debilitating disorder that negatively impacts adolescents’ academic achievements and interpersonal relationships. Individuals with ADHD are two to three times more likely to experience sleep problems. It has been proposed that untreated sleep problems exacerbate ADHD. However, empirical evidence regarding the relative contributions of specific sleep issues to the daytime manifestation of ADHD symptoms among adolescents is limited. The objective of this study was to determine the relative contributions of sleep and circadian parameters to adolescents' ADHD symptoms.MethodsA sample of 40 unmedicated adolescents (26 girls, 18 boys) between the ages of 12 to 15 years (M= 13.9; SD = 0.95) with no psychiatric or medical comorbidities participated in the study. Sleep EEG was recorded using a single night of ambulatory sleep EEG (Sleep Profiler) monitoring with frontal derivations during the school week in the child’s home. Automated sleep/wake scoring was performed using the system followed by visual scoring and analysis by an experienced pediatric sleep specialist. In addition, adolescents were asked to complete questionnaires regarding insomnia and circadian problems and ADHD symptoms. Parents were asked to provide demographic information and complete questionnaires regarding their child’s ADHD symptoms, sleep, and daytime behavior.ResultsLinear regression analysis revealed that PSG-based sleep duration, adolescents’ reported insomnia symptoms, and parents' reported Restless Leg Syndrome symptoms contributed to the manifestation of adolescents’ ADHD symptoms above and beyond gender or SES. No other effects were significant.ConclusionAdolescents’ ADHD symptoms were related to different sleep problems requiring different interventional strategies. These findings provide compelling motivation for the development of interventions that use sleep as a means to improve the daytime functioning of adolescents with ADHD. Clinical Implications Given the negative impact of unhealthy sleep on adolescents’ mental, cognitive, and physical health, it is essential that clinicians integrate sleep assessments and interventions into their screening, diagnosis and ongoing care for adolescents, particularly when caring for adolescents with behavioral and functional difficulties.Support (if any)CIHR Grant 418638 to Dr. Reut Gruber
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0845
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0846 Development of a Pediatric Sleep Routine Questionnaire for Black
           Families: A Human-centered Design Approach

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      Pages: A362 - A363
      Abstract: AbstractIntroductionBedtime routines are the hallmark for sleep guidance in young children. Yet, Black children have an 80% increased likelihood of not having a bedtime routine, compared to white children. To promote healthy bedtime routines, a comprehensive assessment tool that capture children’s bedtime routine behaviors and relevant bedtime environment and context is needed to guide the targeting areas for intervention. However, existing sleep routine questionnaires do not capture sleep contexts that are relevant to Black families. Thus, the objective of our study was to develop a comprehensive sleep routine questionnaire that captures child’s bedtime routine behaviors, and household adult-child interaction and bedtime environment that support health bedtime behaviors. As the first step of the measurement development, we focused on study cultural relevance, salience and appropriateness of the three bedtime measures: 1. the Parent-Child Sleep Interaction Scale, 2. Bedtime Routines Questionnaire, and 3. Child Routines Inventory scales, prior to formal administration.MethodsA human-centered design process, Ecological Theory (considering individual, home, black community contexts), and qualitative formative research methods were applied to guide sleep routine questionnaire adaptation. A convenience sample of five Black caregivers with preschool-aged children were interviewed and provided feedback for the bedtime routine surveys. Interview questions were guided by human-centered design, centering the lived experience of the caregivers, as well as multiple-domains of sleep contexts and behaviors to understand child sleep routine practices, household structure, child sleep environment, social-family connection, social support and child sleep decision-making.ResultsThematic areas of caregiver feedback fell into the following three areas: 1. deficit-based and focused on punitive discipline, 2. Do not capture child weekend sleepovers at Grandparent’s house, 3. Two-home households were not reflected, 4. Racial options for mixed children were not reflected and 5. age-appropriate activities were not reflected in the measures.ConclusionCurrent pediatric bedtime routine sleep measures are not culturally tailored for Black families of preschool aged children. Future steps include holding caregiver focus groups to glean relevant survey items/domains for the development of a new comprehensive culturally tailored measure for Black preschool-aged children that can be used to guide the intervention and intervention theory of testing.Support (if any)NIH K01HL169419-01
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0846
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0847 The Role of Pulse Wave Amplitude in Detecting Arousals in Children
           with Hypersomnia

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      Pages: A363 - A363
      Abstract: AbstractIntroductionChanges in pulse wave amplitude (PWA) are a sensitive marker for both cortical and autonomic arousals, and are readily available in conventional polysomnogram recordings. The aim of the current study was to examine electrocortical versus PWA-based arousals in pediatric patients being evaluation for disorders of central hypersomnolence.MethodsPolysomnograms for thirty consecutive patients who underwent multiple sleep latency test (MSLT) were identified. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify arousals. Arousals on overnight polysomnogram were rescored based on PWA drop. Patients were classified based on MSLT results into 3 groups: Narcolepsy group if mean sleep latency < 8 minutes and the presence of 2 or more sleep onset rapid eye movement periods (SOREMP); idiopathic hypersomnia (IH) group if mean sleep latency < 8 minutes and less than 2 SOREM periods; or normal if they did not meet criteria for narcolepsy or IH. Group differences in electrocortical arousal index (AI) vs PWA-based arousal index were examined via ANOVA.ResultsOut of the 30 patients included, there were 19 patients with normal MSLT, 7 patients with narcolepsy, and 4 patients with IH. There were no significant between-group differences for age, total sleep time (TST), sleep efficiency (SE), sleep latency (SL), REM latency, N1, N2, N3 or REM percentages, apnea hypopnea index (AHI), or periodic limb movement index (PLMI). There was were no significant differences between electrocortical AI in normal (9.4+/-4.4), IH (9.1/hr+/-4.9), and narcolepsy (10.6+/-6.6) groups (F(2,27)=[0.156], p=0.857). In contrast, there statistically significant between-group differences in PWA-based AI (F(2,27=[3.765], p=0.036). Post-hoc analysis demonstrated higher PWA-based AI in narcolepsy vs normal (24.2+/-10.4 vs 16.2+/-5.3, p=0.017), a trend for higher levels in IH vs normal (22.3+/-8.5 vs 16.2+/-5.3, p=0.131), and no difference between narcolepsy and hypersomnia groups (24.2+/-10.4 vs 22.3+/-8.5, p=0.674).ConclusionPulse wave amplitude may hold promise as a scoring tool to help identify arousals and sleep disruption in patients with central disorders of hypersomnolence. Further studies are needed to verify these preliminary results and explore the utility of PWA-based AI in other sleep disorders.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0847
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0848 The Utility of Pulse Wave Amplitude to Improve Interscorer
           Reliability

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      Pages: A363 - A364
      Abstract: AbstractIntroductionWhile accurate scoring of arousals is crucial for identification of disrupted sleep architecture and hypopnea scoring, achieving acceptable interscorer reliability represents a major challenge. The drop in pulse wave amplitude (PWA) signal is a sensitive marker for arousals and is readily available in most conventional polysomnogram software. The aim of the current study was to examine interscorer agreement in scoring cortical arousals using EEG alone versus utilizing PWA drop signal as surrogate marker.MethodsArousals were scored using the same data on duplicate studies by the sleep laboratory medical director and education coordinator who is registered polysomnographic technologist (RPSGT). The first study was scored according to the American Academy of Sleep Medicine (AASM) arousal rule only. The second study used the drop in PWA as a marker for a possible cortical arousal in conjunction with the AASM arousal rule. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify possible arousals. Interscorer agreement and Cohen’s Kappa were calculated as measures of reliability.ResultsWhen scored using conventional EEG arousal criteria alone, there was an overall 90.3% agreement for all epochs with a corresponding Cohen’s Kappa of 0.642 (95% CI: 0.580-0.704), representing substantial agreement. When PWA assistance was utilized, agreement was significantly improved to 96.5% overall with a corresponding Cohen’s Kappa of 0.878 (95% CI: 0.840-0.917), representing almost perfect agreement.ConclusionPulse wave amplitude may hold promise as a surrogate tool for identifying cortical arousals and improving interscorer reliability.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0848
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0849 Characterization of Patient Referrals to ED/Inpatient Admission from
           an Outpatient Pediatric Sleep Center

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      Pages: A364 - A364
      Abstract: AbstractIntroductionThe medical complexity of patients referred to our pediatric laboratory has been increasing. These children are at higher risk of severe sleep disordered breathing and/or risk of emergent medical issues during the study. As a result, patients may need to be referred directly to emergency room or inpatient admission from the ambulatory sleep lab. In this single site pediatric sleep lab quality improvement project, we identify the frequency of ED/inpatient referrals from attended, in-lab sleep studies, reasons for referrals, and contributing factors for referral.MethodsThis is a cohort study of patients who had in-lab ambulatory polysomnogram at Boston Children’s Hospital between March 2017 to May 2022 identified through chart review search terms (ED or inpatient diagnostic codes within 24 hours of polysomnogram billing code). We performed chart review for demographics, past medical history, sleep study variables, medications, and disposition. We used chi-square tests to compare age and medical complexity categories.ResultsOf 6724 PSG studies conducted, 95 (1.4%) patients were referred to ED or inpatient admission within 24 hours from the sleep study. Demographics: Patients ranged in age from 1 month to 20 years [mean age 5.5(6) years] and the cohort was 38% female, 53% Caucasian, 12% Black, 2% Asian, 13% Hispanic, 6% other, 14% race/ethnicity not reported. Of the 95 patients referred to ED/inpatient hospitalization, 64% needed continued medical assistance in the morning due to various problems including persistent hypoxia, hypercarbia, altered mental status, difficulty tolerating oral intake, or need for assistance ambulating. Features such as age and patient triage level assigned prior to sleep study did not predict whether patient returned to baseline upon wakening. The reason for referral for ED or admission included severe sleep disordered breathing (e.g. obstructive sleep apnea or central sleep apnea; 33.8%), persistent hypoxia/hypercarbia (23.1%), cardiac (e.g. arrhythmias, worsening heart disease; 10.8%), vomiting/diarrhea (10.8%), neurologic (e.g. seizures, paroxysmal events, altered mental status; 7.7%), infection (e.g. fever/infection concern; 3.1%), allergy/anaphylaxis (1.5%), behavioral/psychiatric (1.5%), and metabolic derangements (e.g. hypoglycemia; 1%).ConclusionThis quality improvement project informs sleep lab policies and procedures regarding staffing, training and management of urgent medical issues that arise during pediatric sleep studies.Support (if any)None
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.0849
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1046 Sleep Problems Predict Pain One Month After Diagnosis and Twelve
           Months Later Among People with Multiple Sclerosis

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      Pages: A449 - A450
      Abstract: AbstractIntroductionSleep problems and pain are commonly experienced by people with multiple sclerosis (PwMS). This study aimed to determine whether sleep problems assessed one month after receiving an MS diagnosis associated with pain intensity and/or pain interference at this time or predicted these pain outcomes 12 months after diagnosis.MethodsThis secondary analysis used data from the prospective observational LAND (‘Life After New Diagnosis’) study and was restricted to those with an MS diagnosis who provided complete Medical Outcomes Study (MOS) Sleep Scale questionnaire data. Linear regression was used to quantify associations between sleep variables (MOS-Sleep problems index and dimension scores ‘sleep disturbance’, ‘sleep adequacy’, and ‘awaken short of breath or headache’) and pain intensity (past-week average, 0-10 Numeric Rating Scale) and pain interference (PROMIS Short Form 6a), adjusted for age, sex, number of years of education, comorbidities, and, in longitudinal models, baseline level of the outcome (pain intensity or pain interference). A p value < 0.05 was used to determine statistical significance.ResultsThe sample (N=174) was predominantly female (69.5%) and white (86.2%), with a mean age of 39.8 years (standard deviation 11.2). The most common MS disease course was relapsing/remitting (52.3%); 35.6% were yet to be categorized. One month after diagnosis, there was a significant, cross-sectional association between MOS-Sleep problems index score and pain intensity (B=0.04, 95% confidence interval (CI): 0.02-0.05, p< 0.001) and pain interference (B=0.17, 95% CI: 0.11-0.24, p< 0.001). Dimension scores for ‘sleep disturbance’, ‘sleep adequacy’, and ‘awaken short of breath or headache’ were also significantly associated with the pain outcomes at this time. In longitudinal analyses, MOS-Sleep problems index score one month after diagnosis predicted pain intensity (B=0.02, 95 %CI: 0.007-0.04, p=0.003) and pain interference (B=0.11, 95% CI: 0.05-0.17, p< 0.001) 12 months after diagnosis. Higher scores for ‘sleep disturbance’ and ‘sleep adequacy’ one month after diagnosis also predicted both pain outcomes 12 months after diagnosis.ConclusionAs a modifiable factor, sleep presents a viable constituent of multicomponent pain management for PwMS. Research is needed to determine whether improving sleep reduces pain in this population.Support (if any)The LAND study was funded by the National Multiple Sclerosis Society (RG4986A1/1).
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01046
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 1138 The Association Between Racial Discrimination During COVID-19 and
           Sleep Quality Among Asian Americans

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      Pages: A488 - A488
      Abstract: AbstractIntroductionThe positive association between racial/ethnic discrimination and poor sleep health has been well documented among racial/ethnic minoritized populations in the US. Although Asian Americans experienced a rise in anti-Asian discrimination during the COVID-19 pandemic, they remain underrepresented in sleep studies. Studies suggest that the positive association between discrimination and poor health outcomes is stronger with increased levels of acculturation among Asian Americans, however, this modifying effect has not been tested in sleep studies. Our aims were to examine the association between racial discrimination experienced during COVID-19 (COVID discrimination) and poor sleep quality(SQ) and test differences in this association by English proficiency, a proxy for acculturation, among a sample of Asian Americans.MethodsUsing survey data from a sample of Korean American adults living in the Southeastern US (n=360), we conducted logistic regression analyses to test the association between COVID discrimination and poor SQ. We progressively adjusted for age, gender, education, nativity status, and English proficiency. We conducted moderation analyses (COVID discrimination*English proficiency) in fully adjusted models. COVID discrimination was assessed using a count of discriminatory experiences reported during the COVID-19 pandemic. Self-reported English proficiency was dichotomized into high and low proficiency. Poor SQ was determined using Pittsburgh Sleep Quality Index scores >5.ResultsMost participants were immigrants (98.61%) and highly educated (79.17%). About half of the sample identified as women (49.33%) and had high English proficiency (55.28%). Mage=40.67 years (SD=12.18). On average, participants reported < 1 experience of COVID discrimination and the majority reported good SQ (68.33%). Every additional COVID discrimination experience was associated with 33% increased odds of poor SQ (OR=1.33, 95%CI: 1.10-1.61, p< 0.001) in fully adjusted models. English language fluency did not moderate this association.ConclusionAlthough the height of COVID-19 pandemic has subsided, these findings shed significant light on the persistent impact of racial discrimination, specifically its adverse effects on the sleep quality of Asian Americans. There is urgent need to advocate for a proactive approach in tackling anti-Asian discrimination. If replicated through larger-scale studies, the findings may suggest that addressing anti-Asian discrimination is essential to supporting good sleep quality among members of the Asian American community.Support (if any) 
      PubDate: Sat, 20 Apr 2024 00:00:00 GMT
      DOI: 10.1093/sleep/zsae067.01138
      Issue No: Vol. 47, No. Supplement_1 (2024)
       
  • 0850 Implementation of the San Diego Sleep Survey (SDSS) in Children with
           Autism

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      Pages: A364 - A364
      Abstract: AbstractIntroductionChildren with autism (CWA) experience a high frequency of sleep disorders, which impact their well-being and development. Polysomnography faces challenges due to sensory sensitivities and communicati