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Sleep
Journal Prestige (SJR): 2.37
Citation Impact (citeScore): 5
Number of Followers: 29  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0161-8105 - ISSN (Online) 1550-9109
Published by Sleep Research Society Homepage  [1 journal]
  • 0978 I Cannot Stay Still - A Case of Sleep-Related Rhythmic Movement
           Disorder

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      Pages: A431 - A432
      Abstract: IntroductionSleep-related rhythmic movement disorder (SRRMD) is characterized by repetitive rhythmic motor behaviors involving large muscle groups that occur predominantly during stage N1 sleep. SSRMs are common in infants and children but they usually spontaneously resolve before adolescence. This case presents a rare adult case of SRRMD.Report of case(s)A 60-year-old man initially presents to clinic for evaluation of repetitive movements needed to initiate sleep. Patient reports the problem starting in his childhood, where he needs to rock and roll intentionally in bed to fall asleep. He had been prescribed clonazepam 2mg and had been taking this along with doxylamine and melatonin nightly, but still reports frequent nocturnal awakenings due to body rolling. He specifically denies any hypnic kicking/jerking, or discomfort in legs while falling asleep. Patient has no excessive alcohol consumption, marijuana, or illicit drug use. Differentials for the patient’s condition include hyperarousal, chronic anxiety, iron deficiency, sleep-related breathing disorder, and rhythmic movement disorder. Patient consequently underwent an in-lab diagnostic polysomnography study which showed no evidence of sleep-related breathing disorders with AHI of 1.6 (AASM 3%). Sleep efficiency was low at 60.8% and sleep architecture showed decreased REM sleep and decreased N3 sleep. Rhythmic movements were noted during sleep and it was manifested by excessive transient muscle activity in both limb & chin EMG leads and also whole body rocking in the video recording. Moderate periodic limb movements were noted with PLM index to 17. Patient was seen in clinic 6 months later with persistent symptoms and his dose of clonazepam was increased slowly to 2.5 mg and then 3 mg. On the 3 mg of clonazepam, patient had resolution of symptoms.ConclusionOur case describes a patient who had SRRMs that commenced in childhood persisting well into adulthood. Reported adult cases of SRRMD are few, and have been associated with sleep apnea, REM sleep behavior disorder, and RLS, while many remain idiopathic such as the case with this patient. While benzodiazepines are still first line for SRRMD, further work up and investigation into possible comorbid conditions could yield insight into the etiology and offer alternative treatment options to patients.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0978
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1031 OSA management with RME device in pediatric patient with GBS on IVIg
           and non surgical candidate due to immunomodulated status

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      Pages: A452 - A453
      Abstract: IntroductionAdenotonsillectomy is considered the standard of care in pediatric populations diagnosed with OSA and adenotonsillar hypertrophy. For non-surgical and specific populations, Rapid maxillary expansion, a technique that consists in increasing the transverse diameter of the hard palate with the use of a fixed orthodontic appliance, has recently been used, with evidence of improvement of signs and symptoms of the disease, AHI normalization, and overall PSG parameters improvement.Report of case(s)Patient with a history of Chronic inflammatory demyelinating polyradiculoneuropathy and Guillain Barre syndrome, diagnosed at 8 years of age, posterior to gastrointestinal viral infection. MRI of the lumbosacral spine showed inflammatory changes at the cauda equina, conus and epiconus consistent with GBS. She also has CIDP, first diagnosed by Electromyography. The same year she had witnessed snoring and apneic episodes and underwent a PSG which showed an AHI of 2/hr. On Physical exam, she had tonsils 2+ and was referred to an ENT specialist for tonsillectomy. A repeat PSG at the age of 9 years revealed an AHI of 1.6/hour with no central apnea/hypopnea. At that time, due to clinical worsening of her neurologic symptoms, with ataxia and lower extremity weakness, she was started on a course of IVIg therapy. Due to IVIg treatment, she was not a candidate for tonsillectomy. In view of excessive daytime sleepiness, concentration difficulties at school and not being a candidate for tonsillectomy, she was referred for Rapid Maxillary Expansion. She has had maxillary expanders since the age of 9 and is now asymptomatic and her snoring has remarkably improved. She is now in the process of being fitted with braces and her lower extremity weakness has also improved with IVIg. Complete resolution of sleep apnea symptoms after rapid maxillary expansion without tonsillectomy.ConclusionAlthough tonsillectomy has been the gold standard for the treatment of OSA in the pediatric population, patients who are not surgical candidates for tonsillectomy can undergo orthodontic treatment and benefit from the outcomes. As reported in our unique case, the patient became completely symptom-free.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1031
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1032 Mixed sleep apnea management in a pediatric patient with Arnold
           Chiari type 1 and septo-optic dysplasia leading to hypopituitarism

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      Pages: A453 - A453
      Abstract: IntroductionMixed Sleep apnea and Central sleep apnea are commonly noted in a patient with Arnold Chiari Malformation and definitive treatment of Arnold Chiari Malformation is surgical decompression.Report of case(s)The patient at the time of diagnosis of Mixed sleep apnea was 7 years old. She had already undergone tonsillectomy and adenoidectomy at the age of 4 years. Due to continued Sleep-disordered breathing, PSG was done in 2016 which showed predominantly mixed and central events. MRI was done which revealed Chiari 1 malformation with cerebellar tonsils extending 6 mm below the foramen magnum. The patient also due to septo-optic dysplasia and hypopituitarism followed with pediatric endocrinology and was on supplementation of Desmopressin, Hydrocortisone, Levothyroxine, and Somatropin. The mother at the time of pregnancy was a substance abuser, was incarcerated and the primary care was assumed by the patient’s legal guardian. The legal guardian was not interested in surgery for Arnold Chiari Malformation as she feared long-term outcomes and requested alternate treatment options. The patient underwent another split study and started on CPAP. The patient did not tolerate the CPAP and was transitioned to BiPAP. During her last clinic visit, the patient’s compliance had improved and she had achieved therapeutic AHI. The patient was also counseled on the effects of GH supplementation and untreated sleep apnea and is regularly followed by Sleep Medicine and Pediatric Endocrinology. The patient after transitioning to BiPAP has responded well to treatment for Mixed sleep apnea. Despite being on GH supplementation, with careful monitoring of hormone levels by Pediatric Endocrinology and symptom control by Sleep Medicine, the patient has shown remarkable improvement.ConclusionMixed and central sleep apnea secondary to Arnold Chiari Malformation responds well to surgical decompression with improvement in sleep-disordered breathing. In a pediatric patient with complicated medical history with needing stress dose steroids, not a candidate for surgery, and intolerant to CPAP, BiPAP as a treatment modality showed good control of Sleep Apnea.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1032
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1033 The link between vision loss and sleep

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      Pages: A453 - A454
      Abstract: IntroductionNon-arteritic ischemic optic neuropathy (NAION) is the most common optic nerve disorder among patients over the age of 50. Several risk factors have been associated with NAION including systemic hypertension, diabetes mellitus, advanced age, and certain optic disc morphologies. A significant association between obstructive sleep apnea (OSA) and NAION has also been reported. Here, we present a case of a middle-aged man with a recent diagnosis of NAION who was subsequently found to have OSA.Report of case(s)A 53-year-old man with a remote history of head injury with concussion and tobacco use was referred to the Sleep Medicine Clinic from Ophthalmology for evaluation of obstructive sleep apnea (OSA). The patient initially presented to Ophthalmology due to acute onset, painless, left-sided, inferior vision loss. The patient was otherwise healthy and denied a history of diabetes mellitus or hypertension. He did report alcohol and cigar use on the night prior to the acute onset vision loss. He denied fevers, chills, joint or jaw pain, scalp tenderness, or jaw claudication. On initial evaluation he was found to have significant left eye optic disc edema. Blood test revealed normal complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-Reactive protein (CRP). His orbit and brain magnetic resonance imaging with and without contrast revealed no significant findings. He was subsequently diagnosed with left NAION. Further review of symptoms was positive for snoring, dry mouth, nighttime awakenings, and unrefreshing sleep, concerning for OSA and leading to referral to our Sleep Medicine Clinic. During initial consultation in Sleep Medicine, he denied symptoms concerning for any other sleep disorders. He subsequently underwent a home sleep test (WatchPAT) which confirmed the diagnosis of OSA. The apnea-hypopnea index (AHI) was 7.9 and the lowest oxygen saturation was 88%.ConclusionGiven the reported association between NAION and OSA, a careful history should be obtained to screen for OSA when NAION is diagnosed.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1033
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1034 A Rare Case of ROHHAD Syndrome

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      Pages: A454 - A454
      Abstract: IntroductionEarly diagnosis of pediatric syndromes that are rare and involve multiple systems can be challenging. Rapid onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysregulation characterizes ROHHAD syndrome which, if undiagnosed, can lead to potentially harmful outcomes including deferring radiological workup for a neural crest tumor (which has an over 50% association) and cardiopulmonary arrest.Report of case(s)A 10-year-old female with a history of obesity, precocious puberty, recurrent hypothermia, recurrent sodium derangements, bilateral ptosis, seizure disorder, and GERD initially presented to sleep clinic as a 4-year-old in 2017 when she recently began snoring with excessive daytime sleepiness as a result of rapid onset of weight gain. BMI at that time was 99th percentile and Epworth was 11. An in-lab polysomnography revealed severe OSA with AHI 26.4 events/hour; nocturnal hypoxemia with TS90 27% and O2 nadir 70%; and sleep related hypoventilation based on elevated pCO2 on end-tidal capnometry. Patient underwent adenotonsillectomy, revision adenoidectomy, and was started on CPAP before transitioning to BiPAP over the span of the next several years with serial polysomnographies ultimately showing significant improvement of sleep apnea with AHI 5.4 events/hour. Sleep-related hypoventilation, however, remained persistent with blood gases showing pCO2 as high as 89. PHOX2B gene testing was negative and secondary causes of hypoventilation were ruled out. During this time, she was also followed by Endocrinology for suspected hypothalamic dysfunction resulting in precocious puberty, deceleration of growth rate, sodium derangements. Autonomic dysfunction was also suspected due to recurrent hypothermia including a recent admission for Temperature < 95F and ophthalmologic abnormalities including bilateral ptosis. At a multidisciplinary care conference, a working diagnosis of ROHHAD syndrome was made based on the rapid onset of obesity, hypoventilation on sleep studies and CBGs, hypothalamic dysfunction, and autonomic degeneration. Workup for neural crest tumor with MRI chest and abdomen unremarkable. Outside academic consultation was sought for management which recommended shared decision-making regarding steroids, immunosuppressive therapy (eg rituximab, cyclophosphamide), and IVIG.ConclusionFor ROHHAD syndrome, there are very few documented cases in the United States and there is no known laboratory marker; diagnosis remains clinical and takes multidisciplinary collaboration, education, and a high degree of suspicion.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1034
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0945 A Robust Hybrid algorithm for automatic respiratory events scoring in
           adults

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      Pages: A417 - A417
      Abstract: IntroductionEven though Polysomnography has many advantages, manual scoring is a labor intensive and time consuming. Therefore, automatic scoring system using a deep learning algorithm has been developed and commercialized for clinical sites. However, it is challenging to explain the results of respiratory events and to measure a precise event’s duration. To overcome these challenges, a new hybrid algorithm was proposed to explain why this event was categorized and provided the accurate duration of respiratory events.MethodsIn order to classify respiratory events - OSA, MSA, CSA, O-hypopnea, and C-hypopnea, the proposed algorithm consists of two algorithms – deep learning and post processing algorithms. Deep learning algorithm was used to detect candidates of respiratory events and post processing algorithm was used to determine the final classification and to measure duration of events. Deep learning model consisted of five layers: a perceptron layer, three consecutive layers of long short-term memory (LSTM) cells, and two more perceptron layers. A total of 1,000 case PSG data were enrolled to develop this algorithm. To classify respiratory events from the results provided by the deep learning algorithm, auto-correlation, peak detection, de-noise filtering and transition detection were used to obtain respiratory rate and measure signal amplitude. Using these algorithm’s results, amplitude and time of baseline breathing and respiratory events were calculated and classified based on the AASM’s guidelines.ResultsTo evaluate the performance of proposed algorithm, 30 PSG data were selected and compared with the results of deep learning algorithm. The test dataset consisted of thirty subjects with 15 OSA, 5 PLMS, 2 insomnia and 8 healthy. The kappa value of deep learning algorithms showed 0.77 (0.759, 0.78) and that of proposed algorithm was 0.838 (0.832, 0.843). They showed better agreement by 0.068 than that of deep learning algorithm. In addition, the proposed algorithm provided the classification results such as OSA, MSA, CSA, O-hypopnea and C-hypopnea and explanations of the reason of event detection.ConclusionThe proposed algorithm showed better agreement and versatile classified results. This algorithm will be adopted for new automatic sleep scoring solution and this solution will be very helpful to use in real clinical sites.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0945
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0991 Dual Therapy to Treat Circadian Rhythm Disturbance in Unique Genetic
           Mutation of Smith-Magenis Syndrome

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      Pages: A437 - A437
      Abstract: IntroductionSmith-Magenis syndrome (SMS) is a rare disorder associated with several genetic mutations. Patients with SMS experience circadian rhythm sleep-wake disorders, which may lead to significant behavioral concerns. A proposed etiology of sleep disturbances is diurnal melatonin secretion. Treatment approaches aim at blocking the abnormal morning secretion of melatonin and providing exogenous melatonin in the evening.Report of case(s)We present a patient with SMS having persistent sleep-wake disturbance despite dual therapy with beta-1 adrenergic antagonist in the morning and over-the-counter melatonin at night. Our patient switched to therapy with beta-1 adrenergic antagonist in the mornings and melatonin receptor agonist, tasimelteon, at night with significant improvement. In addition, our patient has mutations in JAKMIP1 and ZBTB18 genes. ZBTB18 mutation is a novel mutation in the setting of clinical features of SMS.ConclusionTo the authors’ knowledge, this is the first case report of successful combination therapy to optimize treatment of sleep-wake disturbances in patients with SMS.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0991
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0992 Reversible Pediatric Central Sleep Apnea in Hyperhomocysteinemia and
           Cerebral Sinus Venous Thrombosis

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      Pages: A437 - A437
      Abstract: IntroductionPediatric central sleep apnea (CSA) rarely initially presents in adolescent age groups, being more commonly diagnosed in infants. CSA may result from a multitude of neurological insults, such as stroke and brain masses. It may also less often present in metabolic and non-ischemic thrombotic disorders.Report of case(s)A 12-year-old female with history of global developmental delay of unclear etiology, chronic headaches, insulin resistance, and early morning tremors was referred for initial evaluation of possible narcolepsy. Severe daytime sleepiness had acutely worsened over the previous month. She was unable to stay awake during school, despite sleeping 13 hours per 24 hours. Central hypersomnia was suspected and polysomnogram with MSLT was scheduled. The patient presented to the Emergency Department 10 days later for worsening headaches and new oral aversion with 12-pound weight loss. Examination showed ataxic gait and dysarthria. Brain MRI revealed non-occlusive cerebral sinus venous thrombosis (CSVT) involving the superior sagittal sinus, right transverse sinus, right sigmoid sinus, right jugular bulb/vein, and cortical veins overlying both cerebral hemispheres with no stroke. Anticoagulation with enoxaparin was initiated and thrombophilia work-up commenced. Polysomnogram demonstrated a central AHI of 49.9/hr with significant periodic breathing and no obstructive sleep apnea. Oxygen titration sleep study failed to significantly improve CSA and BPAP was initiated. Thrombophilia work-up revealed severe hyperhomocysteinemia. Genetic analysis was consistent with autosomal recessive severe methylenetetrahydrofolate reductase (MTHFR) deficiency. The patient was begun on metabolic treatment with betaine, pyridoxine, hydroxocobalamin, and vitamin C, and transitioned to oral rivaroxaban. At 4 months, blood levels had normalized, and MRI demonstrated resolution of CSVT. Family endorsed BPAP compliance and complete resolution of all sleep symptoms. In addition, there was significant improvement in cognition, interpersonal skills, and abstract thought. Follow up polysomnogram 10 months after presentation demonstrated no CSA nor periodic breathing.ConclusionTo our knowledge, this is the first report of MTHFR deficiency and CSVT resulting in severe CSA. While it is difficult to ascertain which entity ultimately caused the CSA, MTHFR deficiency can produce significant neurologic impairment through white matter disease and defective myelination, while CSVT can provoke venous hypertension, venous stasis, or hypoxia.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0992
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0993 A Senseless Sensing Lead: A Case Of Failed Sensing Lead In
           Hypoglossal Nerve Stimulator

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      Pages: A437 - A438
      Abstract: IntroductionThe hypoglossal nerve stimulator (HGNS) is an implanted device used to treat moderate to severe obstructive sleep apnea (OSA), offering an alternative form of therapy to continuous positive airway pressure. Currently, the Inspire® Upper Airway Stimulation (UAS) system is the only such device approved by the U.S. Food and Drug Administration (FDA).Report of case(s)We present a case of sensory lead malfunction in a 54-year-old man with moderate OSA who underwent HGNS implant in 2018 with the three-incision method and the sensory lead positioned in the 6th intercostal space. December 2022, the patient presented with right sided chest pain and subjective fever at outside hospital. A CT chest performed was significant for trace right sided pleural effusion and concern for pleural penetration of the sensory lead. Device interrogation in our office showed increased impedances and abnormal waveforms prompting discontinuation of therapy and scheduling a surgical revision. He denied any trauma, injury to the area and had been doing well overall but did feel as if the device wasn’t syncing appropriately with his breathing. In addition, his most recent sleep study on fairly high amplitude of 3.6V had persistent severe supine disease. During the surgery, the sensory lead was noted to be in its original placement site with intact anchors and sutures holding it in place. After the lead was removed there was noted to be a discoloration deep to the protective covering suggesting potential lead failure related to compromise of device.ConclusionSince its FDA approval in 2014, over 20,000 HGNS devices have been implanted in the USA and long-term data collection of efficacy and safety is ongoing. The Manufacturer and User Facility Device Experience (MAUDE) is a publicly available database of device-related adverse events reported to the FDA. At the time of this abstract, there are 714 reports related to HGNS of which 147 involve the respiratory sensory lead and 95 of these relate to pain and/or malfunction most commonly due to sensor tip separation and migration from lead body. This case illustrated a presentation of sensory lead malfunction due to presumed electrical leakage from insulation breach.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0993
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0994 Neuroblastoma as the Initial Manifestation of Familial PHOX2B NPARM
           Positive Congenital Central Hypoventilation Syndrome

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      Pages: A438 - A438
      Abstract: IntroductionCongenital Central Hypoventilation Syndrome (CCHS) is a genetic disorder of the autonomic nervous system caused by mutations in the PHOX2B gene. Children with CCHS often present as neonates in hypoxemic, hypercarbic respiratory failure. Most causative mutations are de novo Polyalanine Repeat Mutations (PARMs). Non-Polyalanine Repeat Mutations (NPARMs) have been associated with more severe disease, specifically the need for 24-hour ventilatory support, Hirschsprung disease, and neural crest tumors; however, NPARMs may have variable expressivity and incomplete penetrance, resulting in delayed or atypical presentations. We report a toddler with maxillary sinus neuroblastoma, which led to the diagnosis of familial PHOX2B NPARM positive CCHS.Report of case(s)A two-year-old boy presented with right-sided facial swelling. A facial CT uncovered a right maxillary sinus lytic lesion, and biopsy confirmed neuroblastoma. After full recovery from the procedure, he had persistent nocturnal hypoxemia and hypercapnia requiring bilevel positive airway pressure (PAP) during sleep, raising concern for CCHS. Genetic testing revealed a novel PHOX2B NPARM, c.428dup, which likely causes a frameshift and premature protein termination (p.Val144Glyfs*34). His maternal grandfather, mother and brothers tested positive for the same mutation. Family history revealed that his maternal grandfather and maternal great-uncles had frequent childhood apneic spells associated with syncope, his maternal grandfather is currently on nocturnal bilevel PAP, and his mother almost drowned as a younger child while having a breath-holding contest under water. His six-year-old brother underwent polysomnography which showed hypoventilation, now managed with bilevel PAP. His five-year-old brother also underwent polysomnography and does not require nocturnal ventilatory support at this time.ConclusionWe report a rare case of familial PHOX2B NPARM positive CCHS which initially presented as maxillary sinus neuroblastoma. Additionally, the child and his family display varying disease severity despite having the same NPARM, highlighting the variable expressivity in this novel NPARM.Support (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0994
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0928 The Self-Reported Practice of Light Exposure Recommendations in the
           Morning, Daytime, Evening, and Nighttime

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      Pages: A409 - A410
      Abstract: IntroductionWhile it is well known that ocular light strongly entrains the central circadian clock, there has been a lack of evidence-based recommendations for daytime, evening, and nighttime light exposure for healthy adults. Recently, an expert consensus report with recommendations for light exposure has been published. Although the general population is likely not yet acquainted with these recommendations, we examined the self-reported practice of daily and nightly light exposure based on these published guidelines.MethodsOnline survey data were collected from 168 participants through convenience sampling (age range: 25-80, mean age: 58.9 + 12.6 years, 55% female). The practice of expert, consensus-based light recommendations was assessed with 4 items on an 8-point frequency scale ranging from “Never” to “Every day of the week”. The scale covered 1) indoor daytime light recommendations, 2) indoor evening light recommendations, 3) nighttime light recommendations for the sleep environment, and 4) an additional morning-specific question.ResultsWithin the first hour after waking up, the majority of respondents (53%) reported never receiving exposure to at least 15 minutes of sunlight or simulated bright light, with only 16% reporting exposure every day of the week. Throughout the daytime, 54% of respondents reported receiving consistent natural indoor light or sunlight every day of the week, and 8% reported never receiving any. During the evening, 47% of respondents reported never dimming lights and avoiding bright light starting at least 3 hours before bedtime. However, 24% reported avoiding bright light sources before bedtime every day of the week. While sleeping, nearly 80% of respondents reported keeping their bedroom as dark as possible, no brighter than natural moonlight, every day of the week, with only 10% reporting never doing so.ConclusionSelf-reported practice of recently published light recommendations was poor for both morning and evening light exposure. These findings suggest that sleep and circadian health campaigns should focus on the importance of bright light in the morning upon awakening, and of dimmed light in the late evening before bedtime.Support (if any)SleepScore Labs
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0928
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0929 The Social Determinants of Health and Sleep Health: A Latent Class
           Analysis

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      Pages: A410 - A410
      Abstract: IntroductionSocial determinants of health (SDOH) have been linked to well-being, quality-of-life and health disparities. We aim to investigate, 1) To classify adults based on their SDOH characteristics, and 2) To examine association between SDOH classes and sleep health.MethodsThis study used 2020 National Health Interview Survey data (n=31,568). SDOH was captured by health insurance, well-visits, delayed medical care, neighborhood walkability, social support, food insecurity, food stamp, poverty, and education. Sleep health was captured by: 1) Sleep quantity (hours): very short (< 5), short (5-6), normal (7-8), and long (≥9); 2) Sleep quality: trouble falling asleep or staying asleep; 3) Sleep medication, 4) Feeling well-rested, and 5) Fatigue. Latent class analysis generated a 3-class model with a gradient on all SDOH characteristics. Generalized structural equation modeling was used to examine associations between adverse’ SDOH classes and sleep health, with Class 1 (lowest probability of adverse’ SDOH), as reference category.ResultsAdults in Class 3 were 36% more likely to have short sleep than normal sleep. Classes 2 and 3 were 16% and 24% more likely to have trouble falling asleep on “some days”; 26% and 40% more likely on “most days”; and 28% and 77% more likely every day than never. Classes 2 and 3 were 22% and 23% more likely to have trouble staying asleep on “some days”; 36% and 35% more likely on “most days”; and 48% and 77% more likely every day than never. Class 2 was 19% more likely to take sleep medications on “some days” and 25% more likely every day than never. Classes 2 and 3 were 26% and 86% more likely to never feel well-rested; 30% and 60% more likely to feel well-rested on “some days” than every day. Classes 2 and 3 were 17% and 49% more likely to feel fatigued on “some days”; 43% and 99% more likely on “most days”; 55% and twice as likely to feel fatigued every day than never.ConclusionAdverse SDOH are associated with worsened unhealthy sleep. Further research is needed for the implementation of interventions to improve sleep health among marginalized groups more impacted by adverse SDOH.Support (if any)G1-5524901
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0929
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0971 Case Report: Sleep-Related Painful Erections Treated with Sodium
           Oxybate

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      Pages: A429 - A429
      Abstract: IntroductionSleep-related painful erection (SRPE) is a rare parasomnia characterized by painful penile erections during rapid eye movement sleep. Normal, painless erections continue to occur while awake. Approximately thirty cases have been reported in the literature. Multiple theories about potential pathophysiology have been proposed including neurologic dysfunction of the ischiocavernosus and bulbocavernosus, correlation with obstructive sleep apnea, and/or autonomic dysfunction. There is no known single effective treatment to date resulting in durable response despite multiple attempts at therapy.Report of case(s)A 39-year-old male presented with SRPE. This started in 2018 and occurred in the second half of the night every twenty minutes, contributing to discomfort and poor sleep quality. While awake, his erections were painless. He was prescribed baclofen at doses up to 30mg daily decreasing episode frequency to 1-6 times per night, but disabling somnolence precluded continuation. Pelvic physiotherapy was unhelpful while imipramine and clonazepam provided partial relief. Tadalafil was ineffective and cinitapride was not available in the United States. Oxycodone used for pain after a motor vehicle accident did effectively treat him for five hours per night, so morphine was trialed. This was effective for two weeks, but symptoms returned. In April 2022, he was begun on sodium oxybate. With an initial dose of 2.25 g twice nightly, symptoms were treated for four hours a night. After increasing to 2.75 g twice nightly, the SRPE was effectively treated. As of September 2022, he is taking sodium oxybate 3 g at bedtime, 3 g 3.5 hours later and the final 3 g at the 7th hour, promoting 9.5 hours of sleep without SRPE.ConclusionThis 39-year-old male who presented with SRPE was trialed on multiple therapies without success, and ultimately successfully treated with an appropriate and titrated dose of sodium oxybate. This may represent a new treatment option, which we hypothesize may act by modulating GABA to result in relaxation of the bulbospongiosus and ischiocavernosus muscles. Further studies should include the study of both the efficacy of this drug for SRPE as well as potential mechanisms of action.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0971
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0972 The Utility of CSF Orexin Testing in Investigating for Narcolepsy
           Type-1 in a Patient with Diencephalic Mass

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      Pages: A429 - A429
      Abstract: IntroductionNarcolepsy type 1 (NT1) is characterized by pathologic hypersomnolence, REM intrusion phenomena, including cataplexy, and orexin deficiency. The diagnosis of NT1 is established based on the presence of bone fide cataplexy and supportive PSG and MSLT testing which requires patients to achieve sufficient sleep duration and regularity and discontinue centrally acting medications that might alter REM sleep. In cases where there is a high index of suspicion for NT1, CSF orexin deficiency is helpful to support the diagnosis of NT1. This is particularly true when PSG-MSLT are not feasible, CNS medication cannot be discontinued, or cataplexy cannot be validated.Report of case(s)A 16 year old girl presented for evaluation of excessive daytime sleepiness in the setting of suprasellar germinoma which was resected and treated with chemoradiation at age 11. She subsequently developed panhypopituitarism and severe hypersomnolence in the setting of sleep-wake schedule irregularities, variability of sleep duration, refractory delayed sleep phase disorder, and snoring. She reported episodic weakness in the setting of negative triggers, which was atypical for cataplexy. Her medications included modafinil, amphetamine-dextroamphetamine, and the SSRI fluoxetine. Physical examination depicted normal airways. Epworth Sleepiness Scale score was 18. Screening polysomnography showed a sleep efficiency of 78%, sleep latency of 46.5 minutes, REM latency 2 hours, AHI of 0/hr, and periodic limb movements of 35/hr without arousals. While the REM latency on polysomnography was inconsistent with NT1, the clinical history of a diencephalic mass and chemoradiation was suggestive of secondary NT1. She was unable to proceed with PSG-MSLT due to her psychiatrist's advice against discontinuing her SSRI and her difficulty in maintaining sleep-wake regularity. An evaluation for CSF orexin was performed establishing a normal level of 337 pg/mL (reference level of 200 pg/mL in healthy individuals), ruling out orexin deficiency /narcolepsy type 1. The patient was subsequently improved with wake-promoting antidepressants and light therapy in the AM.ConclusionThis case illustrates the value of CSF orexin testing in the setting of diencephalic lesions in patients unable to undergo formal narcolepsy testing.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0972
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0973 HGNS Sensing Lead Damage After 3D Mammogram Requiring HGNS IPG and
           Lead Re-Implantation

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      Pages: A429 - A430
      Abstract: IntroductionObstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, nocturnal hypoxemia, and daytime fatigue. Standard therapy is with positive airway pressure (PAP) therapy. If this is unsuccessful or poorly tolerated, a hypoglossal nerve stimulator (HGNS) can be surgically implanted for treatment. The goal of HGNS treatment is to advance the tongue with each respiration during sleep to relieve oropharyngeal obstruction causing OSA. This therapy has been shown to be efficacious and well tolerated for moderate to severe sleep apnea with a low complication rate.Report of case(s)A 61 year-old female with history of obesity and severe OSA presented to the sleep clinic with complaint of excessive daytime sleepiness and persistently elevated apnea-hypopnea index (AHI) of 42 events/hour despite adequate usage of CPAP therapy. She underwent an HGNS placement for treatment. Following HGNS activation she used it nightly and three months after implantation underwent an HGNS titration study which was successful (AHI 5.7) and the patient was started on optimal treatment settings with resulting resolution of OSA symptoms. After a period of successful device usage, she presented for follow up and reported complaints of excessive fatigue and sleepiness that was sudden. She attributed these changes to a 3D mammography study she underwent for breast cancer surveillance. Repeat home sleep apnea testing showed sudden worsening of her AHI to 50.6. During a thorough investigation of her device, HGNS sensing waveforms indicated possible sensing lead fracture. The patient was taken to the operating room for implanted pulse generator removal and replacement with new sensing and stimulation leads. Intra-operatively, it was noted that the distal sensing lead had several tears of the polyurethane insulation near the hub of the sensor. Following successful re-implantation sensing returned to normal and she has continued HGNS treatment.ConclusionWe present a case of an unusual complication of HGNS sensing lead damage following a 3D mammography study. This led to surgical exploration with removal of a torn sensing lead and re-implantation of the HGNS generator and leads. Attention should be brought to patients and providers in the future regarding this rare, but potentially serious complication.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0973
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0974 Limitations of Hypoglossal Nerve Stimulation in Patients with Down
           Syndrome

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      Pages: A430 - A430
      Abstract: IntroductionObstructive sleep apnea (OSA) is a common sleep disorder affecting up to 80% of people with Down Syndrome (DS). Tonsillectomy and adenoidectomy (T&A) are commonly utilized as the first line of treatment of OSA in patients with DS. However, even after T&A, OSA can persist in up to 60% of patients. Positive airway pressure (PAP) compliance is low in patients with DS, limiting treatment efficacy. Hypoglossal nerve stimulation (HNS) is FDA-approved for the treatment of select adult patients with OSA. Limited research is available on HNS in people with DS; however, the limited data suggests that HNS may be a safe and effective treatment in this patient population. We describe two cases of patients with DS and HNS with unique challenges with treatment.Report of case(s)Case 1: A 36-year-old male with a history of DS presented for follow-up after activation of the HNS. The patient had been living part-time in a group home. While the patient’s mother thought he was using HNS every night, the download from the remote showed 41% usage over a three-week time frame. With further investigation, it was determined that the device was turned on the nights when the patient was at home with his parents, but not when he was at the group home despite detailed caregiver education. Case 2: A 19-year-old male with OSA and DS returned for a follow-up of his HNS. Upon exam, the patient’s HNS was already “on” in clinic, which the mother was unaware of. Download from the remote showed a usage time of 13+ hours, and the HNS was commonly “on” into the afternoon well after the patient had left for school in the morning, indicating that the HNS was commonly left on while the patient was awake. Despite significant education, the caregiver was not correctly turning the HNS off.ConclusionHNS offers a therapeutic alternative in patients with DS, who are refractory to T&A and PAP. The success of the treatment is dependent on multiple factors, including therapy mechanics, patient tolerance, and caregiver education/compliance. Additional caregiver instruction may be necessary to ensure optimal use.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0974
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1011 Heart racing case of dysautonomia in pediatric hypersomnia

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      Pages: A444 - A445
      Abstract: IntroductionCentral disorders of hypersomnolence are rare sleep disorders that are commonly misdiagnosed in the pediatric population. Autonomic dysfunction is commonly associated with narcolepsy and may be underrecognized. To our knowledge there is only one case study in the literature, discussing both dysautonomia and pediatric narcolepsy in the setting of hyperhomocystinemia. We present an 18-year-old female undergoing gender transformation with suspected narcolepsy type 2, major depression, suicidal ideation and dysautonomia (dizziness, tachycardia, and near syncopal episodes).Report of case(s)At age 16 years, he was evaluated for excessive daytime sleepiness (EDS). Polysomnography (PSG) recorded an apnea hypopnea index (AHI) of 4/hour. Given previous tonsillectomy and adenoidectomy, he was titrated on continuous positive airway pressure (CPAP) which was not well tolerated. Two years later his daytime sleepiness and PAP intolerance continued. A repeat PSG with added mean sleep latency test (MSLT) recorded the following: AHI of 7.9/hr, mean sleep onset latency of 14.8 minutes with one sleep onset REM period (1/5 naps). The study was completed while on psychiatric medications (Abilify, Cymbalta) due to concerns for suicide. Subsequently, he was started on auto-PAP and was referred to sleep psychology for PAP desensitization. Given the concern of psychiatric medications compromising the results of the MSLT, wake promoting pharmaceuticals (stimulants, Modafinil, Strattera) were prescribed due to continued EDS which failed. Additional relevant diagnostics included a positive anti-nuclear antibody (ANA) and normal brain MRI. Reports of tachycardia while awake and palpitations during sleep further warranted a cardiology referral given previously recorded tachycardia during clinic encounters. Cardiology evaluation concluded severe autonomic dysfunction with neurocardiogenic syncope resulting in treatment with Florinef and proponaolol which improved symptoms.ConclusionDiagnosis and management of central disorders of hypersomnolence can be challenging and complex especially in those with underlying psychiatric disorders. Careful consideration for screening for autonomic dysfunction in this population should be considered in order to help improve overall quality of life.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1011
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1012 Sleep disordered breathing in children with Congenital Myasthenic
           Syndrome

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      Pages: A445 - A445
      Abstract: IntroductionCongenital Myasthenic Syndromes (CMS) include a group of heterogeneous disorders encompassing the neuromuscular junction. These disorders have a wide range of clinical presentations according to the degree and group of muscles involved. While some children can present with modest muscle weakness, others present with significant hypotonia, or even respiratory failure. The natural history of CMS, and in particular, the diagnostic role of polysomnography (PSG) in these children, is not well documented.Report of case(s)Retrospective chart review via EMR in a large tertiary center. Patient 1. 19-month-old male with VAMP-1 gene mutation, treated with pyridostigmine, underwent a PSG to evaluate for sleep disordered breathing (SDB). The PSG demonstrated an AHI of 17.7. Repeat PSG post adenoidectomy showed an obstructive apnea hypopnea index (OAHI) 8.6, and central apnea index (CAI) 1.2. He was started on 0.5 LPM oxygen for sleep. Patient 2. 2-year-old female with GFPT1 gene mutation, chronic respiratory failure, tracheostomy/ventilator dependent had a PSG with tracheostomy uncapped on room air which showed an OAHI 1.7, and CAI 0.3. Four years later, split night PSG was started on room air which showed an OAHI 2.8, and CAI 4.6. The ventilator was added at patient’s home settings which improved sleep quality and resolved respiratory events. She was continued on home ventilator settings for sleep despite pharmacological treatment with pyridostigmine. Patient 3. 3-year-old male with CHRNE gene mutation and treated with pyridostigmine. He was evaluated for SDB due to snoring. The PSG demonstrated an OAHI 3.4, and CAI 1.4. Repeat PSG post adenotonsillectomy showed an OAHI 0.4, and CAI 0.4. A third PSG at age 5 was normal.ConclusionWe present 3 children with various mutations leading to CMS. The heterogeneity in the clinical course, response to therapy, and outcome may be related to genetic mutations, severity of the disorder and muscles involved, time of diagnosis and medical response to treatment. Polysomnography is an important modality for diagnosis of SDB as well as to monitor response to treatment over time. We conclude that patients with CMS should have a PSG completed given this increased risk.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1012
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1013 A familial and benign case of REM behavioral sleep disorder'

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      Pages: A445 - A446
      Abstract: IntroductionREM sleep behavior disorder (RBD) is a rare condition characterized by abnormal sleep behavior, such as dream enactment. Loss of atonia during REM sleep is noted in polysomnography (PSG). Failure to suppress spinal motor neurons is considered its pathophysiology. Etiologies include neurodegeneration, orexin deficiency, structural brain lesions, or medication effects. Although studies have shown that most patients with RBD develop neurodegenerative disorders, the variable etiologies suggest that prognosis of RBD can potentially be variable. We report a case of RBD with a significant family history without development of a neurodegenerative disorder.Report of case(s)A 64-year-old woman with hypertension, diabetes, body mass index of 29 kg/m2, and tobacco use presented with dream enactment for 10 years. She was referred by her neurologist, who she had seen for intermittent hand tremors but had no focal abnormalities on her neurological exam. She complained of snoring, daytime sleepiness, and unrefreshed sleep. Her medications were aspirin, hydrochlorothiazide-valsartan, metformin, and pantoprazole. She denied any traumatic experience. Family history was relevant for dream enactment in her younger sister and both parents, with an age of onset in their early 50s in all. None of these relatives had any reported neurological issues. Labs revealed abnormal SPEP, an IgG kappa band, which can an early presentation of monoclonal gammopathy of undetermined significance (MGUS). She had PSG with an extended electroencephalogram (EEG) monitor, which showed REM atonia consistent with RBD. She shouted, talked, and moved limbs during REM sleep. No evidence of sleep apnea was seen. She took melatonin 3 mg without any improvement. A trial of clonazepam 0.25 mg reduced the frequency of dream enactment and helped her anxiety. We plan to increase melatonin dosing and observe her response.ConclusionOur patient had dream enactment for over 10 years but has not developed any neurological abnormalities to date. She has a family history of dream reenactment with the age of onset in early 50s without any neurological associations. Due to variable etiologies of RBD, this case may be a subtype of RBD with a benign clinical course.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1013
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1014 The PANDA Monster Under the Bed

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      Pages: A446 - A446
      Abstract: IntroductionPediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is an acute-onset constellation of symptoms including obsessive-compulsive disorder and concurrent neuropsychiatric symptoms including anxiety, emotional lability, and behavioral regression. Sleep disturbances are common in PANDAS, suspected of post-infectious inflammation that can decrease serotonin, increase dopamine, and prevent the production of melatonin. OCD fears and rituals can create may impede sleep onset and impair sleep maintenance. Abnormal motor manifestations during sleep include restlessness, stereotypies, paroxysms or periodic limb movements during sleep. This case report highlights the clinical time course of sleep disorders found in chronic PANDAS, refractory to immunomodulatory interventions.Report of case(s)We present the case of an 11-year-old male who presented with behavioral insomnia of childhood sleep-onset association type in the setting of personality changes and deterioration of school performance coinciding with streptococcus infection two months earlier. The patient was supported with prophylaxis antistreptococcal therapy as well as Omega-3 fatty acids. Parents noted heightened anxiety during the day, fear of obsessive and intrusive thoughts about becoming sick, and social seclusion but refusal to sleep alone and be away from home. He was also diagnosed with a tic disorder, chronic migraine, and postural orthostatic tachycardia syndrome (POTS), which likely exacerbated insomnia. The patient was referred for Cognitive behavior therapy utilizing exposure/response prevention ERP modality and psychoeducation. However, it was not until clonidine was introduced that the patient demonstrated a significant clinical response. Clonidine was initiated at 50ug and increased to 100ug QHS. It likely promotes sedation by decreasing norepinephrine release via negative feedback by agonism of the α2-adrenergic receptors at the level of the locus coeruleus.ConclusionSleep disorders in PANDAS syndrome remain elusive and challenging to manage due to the lack of well-developed pharmacologic guidelines to treat insomnia in children. Our case illustrates the importance of the integration of pharmacologic treatments to augment behavioral strategies and promote better patient outcomes. More studies are needed to investigate the pharmacologic management of sleep ­disorders in children in general, but appraise the safety and efficacy of specific medications such, as clonidine, in particular.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1014
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1015 Chasing after Sleep in ROHHAD syndrome

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      Pages: A446 - A446
      Abstract: IntroductionRapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation, (ROHHAD) syndrome is a childhood disorder consisting of rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation. Sleep disordered breathing, obesity hypoventilation, and daytime hypersomnia are common sleep conditions found in this syndrome. The purpose of this case report is to review the polysomnography findings and propose a multidisciplinary approach in treating a patient with ROHHAD syndrome.Report of case(s)This is a case of a 5-year-old female with a clinical presentation consistent with ROHHAD who experienced daytime hypersomnia and worsening obesity hypoventilation due to the progressive nature of her disease. We report the use of several wake-promoting pharmacological agents, in conjunction with positive airway pressure (PAP) therapy to improve quality of life and reduce burden of disease.ConclusionEarly detection and treatment of sleep disorders in patients with ROHHAD syndrome are essential to improve health outcomes. Given the complex, evolving clinical course of this disease, these patients are best served by coordinated, multi-specialty care.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1015
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1016 Jerky Night: Propriospinal myoclonus at sleep onset after
           Metoclopramide use during pregnancy

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      Pages: A446 - A447
      Abstract: IntroductionPropriospinal myoclonus (PSM) at sleep onset is characterized by jerks of axial muscles, spreading caudally and rostrally, during the transition from wakefulness to sleep1. We present a rare case of a patient who suffered severe sleep-onset insomnia due to PSM after metoclopramide use during pregnancy.Report of case(s)A 30-year-old woman with a history of well-controlled herpes simplex virus (HSV) and a resected atypical serous borderline ovarian tumor with microinvasion, presented after a 2-year bout of insomnia due to electrical, jerking sensations in her torso, spreading to the legs just before falling asleep. The symptoms began after an 18-week trial of metoclopramide 20mg, for severe reflux with esophagitis during pregnancy, and persisted after discontinuation of metoclopramide, and postpartum, periodically worsening with menses. On first presentation, the neurological exam was unremarkable; polysomnography was conducted, showing brief myoclonic jerks of the upper extremity, with increased EMG tone and muscle artifact, preventing sleep onset, allowing a total sleep time of merely 1 hour 10 minutes. Event - related recordings on simultaneous electromyogram (EMG)/electroencephalogram (EEG), showed mixed movement disorder and suggested mild CNS hyperexcitability with some volitional muscle jerks, and some myoclonic jerks. An earlier trial of clonazepam 1mg nightly partially improved her symptoms, but caused panic, suicidal ideation, and depression. Month-long, nightly Diphenhydramine 50mg and Trazodone 100mg initially helped with insomnia, while Doxepin 10mg/mL, Daridorexant 25mg, Tizanidine, Gabapentin 900mg, Zolpidem, Cyclobenzaprine, Levetiracetam 500mg, Carbidopa-Levodopa, and sleep restriction all proved ineffective. Eventually, she underwent another trial of clonazepam at 0.25mg with slow titration to 0.75mg while adding melatonin 10mg, without adverse effects noted.ConclusionOur case of PSM at sleep onset was in the context of metoclopramide use during pregnancy. Uniquely, adverse effects were associated with a higher and rapid titration of Clonazepam, but later improved with a lower dose and slower titration, coupled with Melatonin. Notably, both dopamine agonists and antagonists, also cannabis, nitric oxide, interferon, ciprofloxacin, bupivacaine, spinal anesthesia, all have reportedly caused medication-induced myoclonus. Further, reports on similar cases may aid in understanding better the pathophysiology of this rare, disabling condition, and lead to more rapid, effective treatment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1016
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1017 Laughing in the Face of Laughter: Narcolepsy with severe cataplexy
           refractory to medication: A case report

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      Pages: A447 - A447
      Abstract: IntroductionCataplexy, a transient muscle atonia, typically occurs in response to positive emotions such as laughter or mirth. Cataplexy occurs in association with hypocretin deficiency/narcolepsy type 1 (NT1) and involves descending REM sleep-motor inhibition pathways. 1. Here we present a case with late – onset NT1, refractory to medication.Report of case(s)A 65-year-old man with a normal BMI presented to the autonomic clinic for presumed syncope, facial and leg weakness, occurring up to 50 times daily, triggered by laughter and a stressful life event from 4 years prior. Tilt testing and brain magnetic resonance imaging, were unremarkable, while sleep–deprived electroencephalogram was concerning for cataplectic versus functional attacks. He underwent diagnostic polysomnography (PSG) that showed severe obstructive sleep apnea (OSA) and was treated with bilevel positive airway pressure (BPAP). A repeat PSG after his OSA was controlled on BPAP, followed by a multiple sleep latency test the next day, showed a mean sleep latency of 2.7, and sleep onset rapid eye movement in 3 of 5 naps; cerebrospinal fluid hypocretin was undetectable and DQB1*06:02 was positive. He denied sleep paralysis and sleepiness, and jovial by nature, he joked as a hobby, leading to cataplexy. Trials of sodium oxybate was ineffective causing vivid dreams and hallucinations. Venlafaxine was subsequently added, initially controlling his cataplexy, but lost efficacy, warranting a trial of duloxetine, also ineffective. He was then started on solriamfetol, which improved sleepiness. We attempted to enroll him in a clinical trial of Reboxetine, thereby discontinuing duloxetine; severe OSA disqualified him from the trial. Subsequently, status cataplecticus ensued, leading to abolished reflexes and multiple falls. Clomipramine 100mg and Modafinil 200mg was started, reportedly reducing the frequency of cataplexy to 12 episodes daily.ConclusionOur case is notable because of the challenges working through the differential of drop attacks, and his late onset of severe NT1. One suggestion is an associated functional component to the disease could be involved, and though the diagnosis is solid, an additional functional overlay, or his joking personality, render symptom control unusually difficult. This case illustrates complexities of some cases with late-onset NT1.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1017
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1018 Finally Awake: Treatment of Severe REM-Isolated Obstructive Sleep
           Apnea

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      Pages: A447 - A448
      Abstract: IntroductionObstructive sleep apnea (OSA) is typically treated with positive airway pressure (PAP) therapy in symptomatic patients with ≥ 5 obstructive respiratory events (apneas, hypopneas or respiratory effort related arousals) per hour of sleep. In this case, we present a patient with severe OSA isolated to REM sleep who demonstrated significant symptomatic improvement on PAP therapy, despite an overall apnea-hypopnea index (AHI) of less than 5 events/hour.Report of case(s)A 73-year-old obese male with history of SVT, hypertension, and diabetes presented with symptoms of snoring, witnessed apneas, non-restorative sleep, restless sleep, excessive daytime sleepiness, and fatigue. A baseline polysomnogram (PSG) demonstrated severe OSA exclusively in REM sleep (overall AHI 2.9, REM AHI of 37.3, minimum SpO2 of 84%). A subsequent PAP titration study tested CPAP 5-17 and BPAP 19/15 cm of water but was unable to identify an effective pressure during REM sleep. Pressures as low as CPAP 5 cm of water appeared effective in NREM sleep. Ultimately, as the patient was unwilling to undergo a re-titration study, empiric treatment with auto-BPAP (min EPAP 5, max IPAP 25, PS 4) was initiated. With excellent adherence to BPAP therapy, the patient experienced profound symptomatic benefit, with resolution of daytime symptoms, less restlessness during sleep, and more restorative sleep.ConclusionThis case highlights a gap, and potential pitfall, in current practice. Our patient 1) did not meet the overall AHI criteria for diagnosis of OSA yet had typical symptoms and high pretest probability for OSA; 2) had a PSG which showed severe OSA exclusively during REM sleep; and 3) experienced resolution of symptoms with PAP therapy. Presently, there is no consensus on whether REM-dependent OSA should be treated if the overall AHI is < 5 events/hour. In fact, there is no standardized definition for REM-dependent OSA. This patient with cardiovascular risk factors was able to receive PAP therapy through the Veterans’ Affairs, and access to PAP therapy changed the Veteran’s quality of life dramatically. Obtaining a PAP device for this patient through private payors would have been nearly impossible. More research is needed to understand the clinical implications of this condition.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1018
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0908 Multi-modal Recruitment of Individuals with REM Sleep Behavior
           Disorder into a Longitudinal Prodromal Parkinson’s Study

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      Pages: A400 - A400
      Abstract: IntroductionIn 2010, The Michael J. Fox Foundation launched the Parkinson’s Progression Markers Initiative (PPMI) to study how Parkinson’s disease (PD) starts and changes over time. Volunteers participate in clinic, online or both. PPMI is now prioritizing recruitment of individuals with possible or probable REM sleep behavior disorder (RBD) without a PD diagnosis (goal of 500 in clinic). As 30% of people with RBD and smell loss receive a PD diagnosis within four years, RBD may provide a model to understand the evolution of the prodromal phase of PD. This presentation will describe diverse recruitment strategies utilized since 2020 to enroll individuals with RBD, to inform best practices for engaging this population in research.MethodsA key strategy for identifying individuals with possible RBD was the dissemination of educational content on the disorder and its connection to PD. Materials emphasized that not everyone with RBD develops PD but that, in some people, RBD is an early symptom of the disease. Educational materials and messages (with associated calls to actions) were shared via webinars, print and online publications, emails, animated videos, radio, TV, and paid social media ads. Materials included scientific, participant and influencer spokespeople and were targeted to both individuals with RBD and bed partners. PPMI study sites sought referrals from sleep physicians.ResultsMore than 535 individuals with a self-reported diagnosis of RBD (without PD) have enrolled in the online PPMI platform (59.4% male, 68.1% aged ≥60). Nearly 185 have been screened for site enrollment; 111 are contributing data at a study site. Foundation-led emails (16.1%) and paid social media ads (9.3%) were highest drivers to online enrollments. The most common referral sources to a PPMI RBD information and screening phone line were email (38%), social media (19%), and family/friend referral (19%). Approximately one-fourth of clinic enrollments were from physician referrals.ConclusionMulti-modal recruitment strategies, linked to tailored educational content, are critical for enrollment of individuals with RBD in clinical research studies including, but not limited to, those investigating and aiming to prevent other neurologic disorders.Support (if any)PPMI – a public-private partnership – is funded by the Michael J. Fox Foundation for Parkinson’s Research.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0908
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0909 Pitolisant Pregnancy Registry: An Observational Study of the Safety
           of Pitolisant Exposure in Pregnant Women and Their Offspring

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      Pages: A400 - A401
      Abstract: IntroductionWAKIX (pitolisant) is a potent and highly selective histamine 3 receptor antagonist/inverse agonist approved for the treatment of excessive daytime sleepiness or cataplexy in adult patients with narcolepsy. The safety of pitolisant in pregnant women has not been established. Available case reports from clinical trials and postmarketing experience have not demonstrated a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. The registry is a prospective, observational cohort study designed to evaluate the association between pitolisant exposure during pregnancy and subsequent maternal, fetal, and infant outcomes.MethodsThe primary study population consists of 3 cohorts: pregnant women with a diagnosis of narcolepsy who are exposed to pitolisant during pregnancy, pregnant women with narcolepsy who are unexposed to pitolisant but exposed to comparator products during pregnancy, and pregnant women with narcolepsy who are neither exposed to pitolisant nor comparator products. Comparator products include modafinil, armodafinil, sodium oxybate, oxybate mixed salts, solriamfetol, methylphenidate, and amphetamines. Outcomes of interest include major congenital malformation (primary outcome), minor congenital malformation, pre-eclampsia, eclampsia, spontaneous abortion, stillbirth, elective termination, small for gestational age, preterm birth, postnatal growth deficiency, and infant developmental deficiency. Data are collected from enrolled pregnant women and healthcare providers involved in their care or the care of their infants, if applicable. Only data that are routinely documented in patients' medical records during usual care are collected. Participation in the registry is voluntary and participants may withdraw their consent to participate at any time. The registry design follows current FDA guidance for designing and implementing pregnancy exposure registries.ResultsThe registry was initiated in May 2021. Presently, data are insufficient to assess an association between pitolisant exposure and any endpoint of interest. Study completion is planned in 2030.ConclusionHealthcare providers are encouraged to discuss this voluntary pregnancy registry with their eligible patients and assist women who are interested in enrolling. The study is registered on Clinicaltrials.gov (ID# NCT05536011).Support (if any)This study is sponsored by Harmony Biosciences LLC.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0909
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0959 Use of a Memory Foam Mattress Improves Sleep Quality and Consistency

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      Pages: A422 - A423
      Abstract: IntroductionPrevious research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, the structure and firmness of a mattress may play a role in sleep quality. More empirical research is needed to establish the impact of particular mattresses on both objective and self-reported measures of sleep. This study compared sleep on a memory foam mattress to participants’ prior sleep on their original mattress.MethodsHealthy adults (65% female, ages 24-59) participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, they used a Sleepy’s Memory Foam mattress at home. 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 1,000 nights of tracked sleep across 25 participants. Objective sleep measurements showed many nightly improvements during the intervention compared to baseline: less WASO, both in duration (-7 minutes, p<.001) and proportion of the night (p<.001); fewer awakenings (p=.002); and better sleep efficiency (p<.001) and sleep maintenance (p<.001). Improvement also was observed in SleepScore, a measure of sleep quality (p=.008). Self-report measures revealed greater comfort when using the memory foam mattress, as well as improvement in a variety of perceived sleep outcomes, including time to fall asleep, waking less often, spending less time awake after initially falling asleep, longer sleep duration, better sleep quality, and feeling more rested in the morning (ps<.05).ConclusionObjectively-measured sleep and self-reported sleep improved in quality and consistency when using the memory mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable.Support (if any)Mattress Firm INC
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0959
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0960 Use of an Innerspring Mattress Improves Deep Sleep and WASO

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      Pages: A423 - A424
      Abstract: IntroductionPrevious research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, the structure and firmness of a mattress may also play a role when it comes to sleep quality. More empirical research is needed to establish the impact of particular mattresses on both objective and self-reported measures of sleep quality. This study compared sleep on an innerspring mattress to participants’ prior sleep on their original mattress.MethodsHealthy adults (68% female, ages 23-69) participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, they used a Sleepy’s by Sealy mattress at home. 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 757 nights of tracked sleep across 18 participants. Objective sleep measurements showed decreased WASO, both in duration (-13 minutes, p=.024) and proportion of the night (p=.025). Also, there was an increase in deep sleep (+12 minutes, p=040). Self-report measures revealed that the innerspring mattress felt more comfortable (p<.001). Improvements also were found for a variety of perceived sleep outcomes, including time to fall asleep, waking less often, spending less time awake, longer sleep duration, better sleep quality, and feeling more rested in the morning (ps<.05).ConclusionObjectively-measured sleep and self-reported sleep improved when using the innerspring mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable.Support (if any)Mattress Firm INC
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0960
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0961 Applying Fractal Analysis Towards the Understanding of
           Long-COVID-Induced Insomnia

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      Pages: A424 - A424
      Abstract: IntroductionAs part of the recent international COVID Sleep Study-II, long COVID syndrome was found to be associated with chronic insomnia. However, an article submitted for publication out of the Hôpital Hôtel-Dieu found no significant difference between long-COVID-related insomnia and standard insomnia with respect to routine polysomnographic (PSG) parameters. In light of these findings, we seek to better understand the difference between long COVID insomnia and standard chronic insomnia by conducting a fractal analysis of the raw PSG signals of our subjects.Methods15 long COVID patients with complaints of chronic insomnia were included as subjects, as well as 34 matched controls without long COVID who had similar complaints of chronic insomnia. All participants underwent one night of polysomnographic recording. We perform our analysis on movements of the abdomen (as an approximation of deep breathing quality) and on EEG waves, considering that shortness of breath and cognitive dysfunction are commonly associated with long COVID. Building upon an existing repertoire of medical research using the fractal dimension (FD) of patients’ signal data to differentiate pathologic and physiologic processes, we make use of Detrended Fluctuation Analysis (DFA) to calculate the FD of the abdomen (FDA) and of an aggregated EEG wave (FDE) for each patient.ResultsWe find a decrease in the FDA (p=0.036) and increase in the FDE (p=0.012) of long COVID insomniacs with respect to those of our control group. These results are shown to be significant after applying a Holm-Bonferroni correction for multiple hypotheses.ConclusionDespite our small data sample, an in-depth analysis of PSG signals shows significant differences in the fractal nature of long-COVID-related insomnia with respect to standard chronic insomnia. Our results furthermore match our expectations, given that related research outside of the COVID domain indicates a decrease in the FD of muscle movements and an increase in the FD of EEG waves in unhealthy individuals. Further research could employ more participants in order to extend our results to other data channels outside of EEG signals and the abdomen.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0961
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0962 Depression And Sleep Health In A Nationwide Survey: Implications For
           Depression Therapy During the COVID-19 Pandemic

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      Pages: A424 - A424
      Abstract: IntroductionSleep disturbances are linked to detrimental health outcomes, including mental health and cardiovascular health. A bidirectional relationship between depression and sleep health is well documented in the literature. However, little is known regarding which sleep health dimensions is associated with depression. The purpose of this study is to investigate the relationship between depression and multiple sleep health dimensions; more specifically sleep duration and insomnia symptoms among US adults from January to December 2020.MethodsWe analyzed data from the 2020 National Health Interview Survey (NHIS) conducted among a representative sample of 31, 568 adults. First, we used binary logistic regression models to examine the association between self-reported diagnosis of depression and insomnia variables. Then, a multinomial regression assessed the association between depression symptoms and sleep duration. Our models statistically adjusted for sociodemographic factors (age, sex, marital status), health risk behaviors (smoking and alcohol use status), race/ethnicity, general health condition.ResultsThe mean age was 53.50 [±18.04] years. Women represented 54% of the sample and twice as likely to report depression symptoms (67.51 vs 32.49, p< 0.001) relative to men. Binary logistic regression indicated that participants with symptoms of depression had higher odds of having difficulty staying asleep (OR:1.58; 95%CI: 1.43-1.74, p<.0001), difficulty falling asleep (OR:1.46; 95%CI: 1.30-1.62, p<.0001), and feeling unrested (OR:1.70; 95%CI: 1.50-1.93, p<.0001) respectively. Multinomial logistic regression showed that participants with symptoms of depression reported higher odds of having both short sleep (≤ 6 hours) (OR: 1.10; 95% CI: 1.0-1.21, p=0.0424) and long sleep (> 9 hours) (OR: 1.72; 95% CI: 1.50- 2.0, p<.0001).ConclusionOur research is among the first to confirm strong associations between depression and several dimensions of sleep in the US general population during US COVID-19 pandemic. Our findings underline the importance of sleep health in treating depression as the nation battles the current mental health crisis.Support (if any)Funding sources: R01HL152453-01 R01HL142066, R01HL095799, RO1MD004113
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0962
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0987 Asking the Right Questions: A Case of Restless Legs Syndrome and
           Spinal Muscular Atrophy

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      Pages: A435 - A435
      Abstract: IntroductionThe association between iron deficiency and restless legs syndrome (RLS) is well established. However, there is limited data on the association between motor neuron diseases such as spinal muscular atrophy (SMA) and RLS. A forty-three-year-old with Type 2 SMA presented to clinic for management of chronic respiratory failure. She had recently undergone surgery and chemotherapy for newly diagnosed anal cancer. However, she reported persistent abdominal pain, anorexia, weight loss, and rectal bleeding. She reported “muscle twitching” and bilateral lower extremity pain and tingling that was worse at night. Her husband would awaken every 2 hours to massage her legs. She assumed these symptoms had emerged as a result of an increase in motor function due to risdiplam, a survival motor neuron 2 splicing modifier drug. Further questioning led to the diagnosis of RLS. Bloodwork revealed severe iron deficiency anemia (hemoglobin of 6.0 g/dL, iron 13 mcg/dL, and ferritin 3 ng/ml). She received a blood transfusion and underwent sigmoidoscopy for evaluation of cancer recurrence given the report of bleeding. Fortunately, her cancer remained in remission. Her symptoms of RLS significantly improved after blood transfusions and iron supplementation.Report of case(s)n/aConclusionRLS is a complex sensorimotor syndrome. The diagnosis of RLS is clinical, relying on diagnostic criteria that requires lower extremity movement. The case is a reminder of the variable presentation of RLS in individuals with neuromuscular disorders, including SMA. How are symptoms of restless legs disclosed in patients with the inability to move and with potentially altered sensorium' The focus of the patient encounter could have anchored on the common and expected sequalae of SMA, chronic respiratory failure. Unfortunately, anchoring bias would have delayed the diagnosis and treatment of what could have been a potentially fatal disease – metastatic cancer. Ironically, the patient’s longing for motor function repressed her ability to lament. To the patient, symptoms of frequent nighttime awakenings and limb discomfort were perceived as a desired side effect of a medication that would increase movement. This case emphasizes the importance of the patient interview and its value of uncovering subtle complaints that may broaden the differential diagnosis and guide further work-up.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0987
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0988 Vagal Nerve Stimulation and OSA

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      Pages: A435 - A
      Abstract: IntroductionWe present a case of obstructive sleep apnea (OSA) worsened by implantation of a vagal nerve stimulator (VNS). A 22-year-old M with PMH of autism and refractory epilepsy s/p VNS implantation was diagnosed with moderate OSA. His parents noted that his sleep-disordered breathing worsened after VNS implantation. He was started on APAP 4-12 cm H2O. Review of adherence data revealed an elevated residual apnea-hypopnea index (AHI) despite nightly usage. PAP titration study was obtained with improvement of AHI on 16 cm H2O. Despite consequent use of determined pressure settings, residual AHI remained elevated. In consultation with the patient’s neurologist, VNS settings were gradually down titrated. Residual AHI improved and remained low as CPAP settings were subsequently weaned.Report of case(s)The vagus nerve is part of the parasympathetic nervous system. Afferent fibers project to cortical regions involved in seizure activity. Vagal nerve activation leads to desynchrony, thereby decreasing seizure activity.3 VNS, an adjunctive non-pharmacologic treatment of refractory epilepsy, consists of a generator with multiple adjustable settings and a lead connected to the left vagus nerve.1 VNS activation, in conjuction with medical therapy, can lead to decreased seizures. However, VNS may cause complications such as vocal cord dysfunction, laryngeal spasm, and dyspnea.2 In this case, VNS was noted to cause OSA due to increased airway obstruction, though the pathophysiological mechanism behind this has not been clearly delineated. 3ConclusionBased on current evidence of precipitation or worsening OSA with VNS activation, screening and diagnostic testing for OSA in patients under evaluation for VNS placement should be considered. A multidisciplinary approach between Sleep Medicine and Neurology in conjunction with patient goals can lead to a balanced optimization of both epilepsy and OSA management via adjustments of VNS settings, anti-epileptics, and CPAP.Support (if any)1. VNS therapy epilepsy. Epilepsy Foundation. https://www.epilepsy.com/sites/default/files/atoms/files/516VNS_VNS_FINAL.pdf. December 20, 2022. 2. Ebben MR, Sethi NK, Conte M, Pollak CP, Labar D. Vagus nerve stimulation, sleep apnea, and CPAP titration. J ClinSleepMed. 2008 Oct 15;4(5):471-3. PMID: 18853706. 3. Parhizgar F, Nugent K, Raj R. Obstructive sleep apnea and respiratory complications associated with vagus nerve stimulators. J ClinSleepMed. 2011 Aug 15;7(4):401-7. doi: 10.5664/JCSM.1204. PMID: 21897779.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.5664/jcsm.1204. pmid: 21897779.
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0989 Hello From the Other Side: A Grandmother’s Eternal Love

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      Pages: A436 - A436
      Abstract: IntroductionSleep-related hallucinations (SRH) may arise at sleep onset or on awakening from sleep and represent sleep-state dissociation with the abnormal intrusion or persistence of dreams into wakefulness. These multisensory experiences are usually visual but may be tactile and colored by emotions such as grief. We describe a patient who presented with episodes of visual and tactile hallucinations of being comforted by his late grandmother at sleep onset shortly after her death.Report of case(s)A 20-y/o male with a history of autism spectrum disorder (ASD) presented with sleep onset insomnia related to disturbing multisensory hallucination temporally associated with the passing of his grandmother two years earlier. He sleeps for 5 hours nightly and experiences more frequent spells when sleep-deprived. The spells manifest within an hour of sleep onset and consist of the patient experiencing quasi-visual and tactile sensations of his grandmother wrapping her hands through his hair and hugging him. The episodes are associated with longing and sadness as this was customary for his grandmother as she comforted him to sleep when she was alive. The patient’s interpretation was that the episodes might represent his grandmother's attempt to communicate with him and keep him safe. Polysomnography depicted REM sleep latency of 107 minutes without evidence of REM sleep without atonia. There was no evidence of obstructive sleep apnea.ConclusionSensory and quasi-sensory experiences of the deceased (SED) is an inclusive and neutral term used to describe multisensory experiences of the presence of the deceased. Phenomenologically, post-bereavement hallucinations are more closely aligned with the ICD-3 classification of SRH. The patient’s spells of SED were likely facilitated by sleep deprivation. Emerging data also supports the presence of unusual somatosensory experiences leading to supernatural attribution to these experiences in ASD. With the passing of his grandmother, the combination of grief and sleep deprivation along with altered central sensory processing likely contributed to the SED. SED and SRH represent a spectrum of abnormal hallucinations following bereavement and are facilitated by sleep deprivation. In ASD, the episodes might emerge in response to altered central limbic sensory processing and represent an important mechanism of impaired REM sleep in Autism spectrum.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0989
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0990 Obstructive Sleep Apnea in Patient with White-Sutton Syndrome
           Presenting with Secondary Polycythemia

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      Pages: A436 - A437
      Abstract: IntroductionWhite-Sutton syndrome is a rare autosomal dominant genetic disorder associated with POGZ de novo genetic variants. Patients with White-Sutton syndrome experience a wide spectrum of disease most common being neurocognitive delays, however various sleep disturbances have also been reported. The incidence of obstructive sleep apnea in patients with White-Sutton syndrome has been previously only defined in cohort studies utilizing subjective screening questionnaires.Report of case(s)We present a case of a 14-year-old male with past medical history of White-Sutton Syndrome who was referred to the sleep clinic by Pediatric Hematology-Oncology for an evaluation of sleep disordered breathing as part of a secondary polycythemia work-up. Patient’s height was 173.6 cm, weight was 111.8 kg, and BMI was 37.1. Patient’s prior laboratory work-up was remarkable for polycythemia with hematocrit of 50.5% and hemoglobin of 16.8 g/dL. He also had a reassuring bicarbonate level of 22 and no documented daytime oxygen desaturations. The PSG was scored using adult criteria due to the patient’s height and weight. He was diagnosed with moderate obstructive sleep apnea with an apnea-hypopnea index (AHI) of 15.5 per hour and a nadir oxygenation saturation of 89%.ConclusionTo the author’s knowledge, this is the first case report of a pediatric patient with White-Sutton syndrome with diagnosed obstructive sleep apnea via polysomnography. This is also the first case report of a pediatric patient undergoing polycythemia work-up who was subsequently diagnosed with obstructive sleep apnea.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0990
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1043 A Rare Case of Non-24-hour Sleep-Wake Rhythm Disorder in A Sighted
           Patient

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      Pages: A457 - A458
      Abstract: IntroductionNon-24-hour sleep-wake disorder is a circadian rhythm sleep disorder which causes failure of endogenous circadian rhythm cycles to synchronize to a 24-hour day. Despite an unknown prevalence in sighted people, it's thought to be rare. We present a case of a sighted patient with concurrent bipolar disorder who presented with excessive sleepiness since preadolescence, and was later found to have N24SWD.Report of case(s)A 29 year old woman with bipolar disorder presented with excessive daytime sleepiness and irregular sleep schedule since age 12. During her teenage years she often fell asleep at school, and she felt the sleepiness could be associated with psychotropic medication. As she grew up, despite her bipolar disorder was well-controlled, the daytime sleepiness persisted, which caused great challenge concentrating at work and difficulty holding a job. She denies cataplexy, hypnagogic hallucinations, sleep paralysis, or restless legs syndrome symptoms. She had no history of shift work or abnormal movements during sleep. Her bedtime advanced and cycled through a 24-hour period according to sleep diary. Her rise time maintains a consistent interval with her bedtime. Previously she had multiple sleep latency test and polysomnogram, after which she was diagnosed with idiopathic hypersomnia. She was treated with several stimulants without much improvement. She was offered CBT-I but hasn’t gone. She failed trial of a standardized schedule and found it stressful. She tried melatonin and light therapy for a short time without much of success, she was subsequently started on tasimelteon and the clinical response is to be followed.ConclusionN24SWD is reportedly rare in the sighted population, with a possible different mechanism from that of the blind population. Behavioral and environmental factors might contribute to the dysynchrony between a normal central circadian pacemaker and a non-24-hour sleep-wake behavioral pattern. Our patient's sleepiness persisted despite her psychiatric disorders were in remission. Altered circadian rhythms are not uncommon in patients with psychiatric disorders, and circadian rhythm dysfunction may be a trait marker of bipolar disease. Some antidepressant are also found to cause potential iatrogenic circadian rhythm sleep disorders. Psychosocial interventions that target stabilizing daily rhythms in patients with concurrent psychiatric illness can be helpful.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1043
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1044 Spinal Muscular Atrophy and Sleep: Double-Trouble

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      Pages: A458 - A458
      Abstract: IntroductionSpinal muscular atrophy (SMA) is a rare neuromuscular disorder which leads to progressive muscular weakness and respiratory impairment. Affected patients experience a variety of sleep problems including obstructive sleep apnea, nocturnal hypoventilation, and increased sleep disturbances. As of 2019, the first gene therapy was approved to treat patients with SMA under the age of 2, onasemnogene abeparvovec-xioi (ZolgensmaTM), with expedited approval due to findings of improved motor function and milestone achievement as well as survivability. We describe an unusual case of twins with SMA whom developed worsening obstructive sleep apnea after gene therapy.Report of case(s)The patients are a set of 3-year-old male twins with past medical history significant for premature lung disease related to extreme prematurity at 24-weeks and SMA type 2. They were initially referred for polysomnography (PSG) at 1 year of age for evaluation of snoring and as a precaution related to their underlying diagnosis. Physical examination findings were significant for tongue atrophy with fasciculations and generalized muscular weakness which spared the face. Neither twin achieved gross motor milestones of standing or walking to that point. Both patients would receive the gene therapy infusion at 1 year, 8 months with subsequent improvement in hypotonia and ability to ambulate independently. For twin A, baseline PSG at age 1 showed mild obstructive sleep apnea (apnea-hypopnea index (AHI)= 3.24 events per hour) without any signs of hypoxemia or hypoventilation. By comparison, the patient’s post-gene therapy PSG (around 1.5 years post-infusion) at age 3, showed progression to moderate obstruction (obstructive AHI of 6.03 events per hour). For twin B, baseline PSG showed moderate obstructive sleep apnea (AHI=9.09 events per hour) which progressed into the severe range (AHI= 11.90 events per hour) over the same time course.ConclusionSleep-disordered breathing in SMA is a commonly diagnosed entity. While airway obstruction related to hypotonia would be an expected contributor, our case suggests that despite recovery of motor function through use of gene therapy, clinicians should maintain a high level of suspicion for sleep problems with strong consideration for PSG due to the risk of sub-clinical progression of sleep obstruction.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1044
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1045 Resolution of Sexsomnia with Positive Airway Pressure

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      Pages: A458 - A458
      Abstract: IntroductionSexsomnia is an infrequently encountered non-rapid eye movement (NREM) arousal disorder that can overlap with obstructive sleep apnea (OSA). Treatment of underlying OSA has been reported to resolve sexsomnia episodes.Report of case(s)A 26-year-old overweight man was referred to our Sleep Disorders Center for evaluation of possible “REM sleep behavior disorder.” The patient’s wife reported that he would fondle her breasts while he slept. Episodes began 6 months prior to his referral and occurred once every 1-2 months. During episodes, the patient did not get out of bed. He did not recall the events and denied dream recall. The patient had an infant at home with resultant sleep deprivation. He slept between 5-7 hours a night and stated episodes were more common with decreased total sleep time. Additionally, he reported recent increase in stressors after moving in with his in-laws. On evaluation, patient endorsed bruxism for which he wore a mouth guard. He reported history of sleepwalking in elementary school. He denied excessive daytime sleepiness, snoring, witnessed apneas, gasping arousals, morning headaches, unrefreshing sleep, insomnia, or substance use. He was advised to increase total sleep time and pursue a baseline polysomnogram to evaluate for sleep-disordered breathing. The polysomnogram demonstrated moderate OSA (apnea/hypopnea index of 17). Excessive arousals out of N3 sleep were not reported. He was initiated on auto-titrating positive airway pressure (APAP) and maintained moderate adherence for 2 months. At his follow-up visit, he reported no further episodes of nocturnal fondling after PAP initiation despite persistent sleep deprivation and home stressors.ConclusionThis case highlights the importance of screening for sleep-disordered breathing which can coexist with NREM parasomnias such as sexsomnia. Even in patients without clear symptoms of sleep-disordered breathing, the evaluation, diagnosis, and treatment of possible OSA could decrease the frequency of sexsomnia episodes. Although this case study was mainly limited by short follow-up duration, the patient’s resolution of sexsomnia in that time demonstrates the importance of treatment of concurrent sleep-related breathing disorders.Support (if any)None.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1045
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1046 Severe hypoventilation in a child with rapid onset weight gain

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      Pages: A458 - A459
      Abstract: IntroductionPediatric sleep-related hypoventilation is a clinical pattern in which ventilatory insufficiency occurs in the setting of either severe OSA (obstructive hypoventilation) or obesity hypoventilation (sleep related hypoventilation). We are reporting a case describing the management of overlapping obstructive hypoventilation due to uncontrolled severe OSA and pediatric obesity hypoventilation syndrome.Report of case(s)The patient is a full term African American 5 y/o male with past medical history of obesity and prediabetes who was referred to discuss sleep related problems after rapid onset of weight gain.He gained 76 lbs over 8-month period; during this time his aunt noticed apneic events with the development of loud snoring.Initial workup was negative for abnormal findings,MRI w/w/o was unremarkable and TSH, cortisol, GH, IGF-1 and prolactin were all within normal limits. X-ray bone age study showed skeletal age appropriate for patient's chronologic age.Upper airway exam showed severe tonsillar hypertrophy 3+ with Mallampati class 4.The diagnostic PSG demonstrated the presence of 12 obstructive, 151 central, and 61 mixed apneas.There were 214 hypopneas resulting in an Apnea\Hypopnea Index of 60.5 events per hour.Mean oxygen saturation was 91.3%.The lowest oxygen saturation during sleep was 64.0%.Time spent ≤88% oxygen saturation was 119.7 minutes (26.2%). End tidal CO2 range was between 50-100 mmHg for 30% of study.The titration study revealed that the optimal treatment modality was BiPAP ST.ConclusionThis case focuses on a five-year-old male who experienced rapid onset weight gain and presented with snoring, excessive daytime sleepiness and apneic events and was found to have profound hypoventilation with hypopnea predominant severe obstructive sleep apnea.The initial differential diagnosis of pediatric sleep-related hypoventilation includes ROHHAD, congenital central hypoventilation syndrome, primary central sleep apnea and obesity hypoventilation syndrome.The most common cause of hypoventilation during sleep in children remains OSA.The stepwise approach to management in such a case includes tonsillectomy with adenoidectomy,along with use of BiPAP. After the T&A the patient should have repeat PSG with capnography, if hypercarbia persists on post procedure PSG, he will need to continue BiPAP therapy with appropriate weight loss program. Early recognition evaluation, and treatment of obstructive sleep apnea in the pediatric population is imperative to prevent long-term consequences.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1046
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0890 Multiple Sleep Measures and Cognition by Race/Ethnicity and Age

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      Pages: A392 - A392
      Abstract: IntroductionDisturbed sleep may affect cognition directly (e.g., through sleep fragmentation) and indirectly through effects on related health outcomes (e.g., cardiovascular health). However, investigations of sleep and cognition among diverse racial/ethnic samples and women are sparse.MethodsWe analyzed longitudinal associations among 50,000 Sister Study participants (enrollment: 2003-2009) who reported on short (< 7 hours) and long sleep duration (>9 hours), sleep debt (≥2-hour difference between longest and shortest sleep duration during the week), frequent napping (≥3 times/week), and insomnia symptoms. Participants completed an eight-item Dementia Screening Interview during two follow-up periods (2012-2014; 2017-2019). Poor cognition was quantified as a change in cognitive function indicative of impairment in ≥2 items. Adjusting for sociodemographic and health behavior characteristics, we used log-binomial regression to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between sleep dimensions and cognition, by race/ethnicity and age.ResultsMean age was 55±8.9 years, 83% self-identified as Non-Hispanic [NH]-White, 9% NH-Black, and 5% Hispanic/Latina. Compared to NH-White women, NH-Black and Hispanic/Latina women reported higher prevalence of all poor sleep dimensions but lower prevalence of poor cognition. Participants with short and long sleep duration, sleep dept, napping, and insomnia symptoms had a higher prevalence of poor cognition (RR=1.09 [95% CI: 1.03-1.16]; RR=1.19 [1.06-1.35]; RR=1.18 [1.11-1.25]; RR=1.27 [1.18-1.39]; RR=1.33 [1.26-1.41], respectively). Estimates for short sleep with poor cognition were higher among minoritized racial/ethnic groups (RRNH-Black=1.15 [0.91-1.45]; RRHispanic/Latina=1.48 [1.09-2.03]; RRNH-White=1.08 [1.01-1.15]), although interactions terms were not statistically significant (p-value= 0.37 and 0.07, respectively). Patterns were similar for insomnia. Sleep debt and insomnia symptoms estimates with poor cognition were higher among younger than older groups (sleep debt: RRAge 26-55 years=1.20 [1.11-1.31]; RRAge 56-76 years =1.14 [1.05-1.25]; insomnia: RRAge 26-55 years=1.39 [1.27-1.51]; RRAge 56-76 years =1.27 [1.18-1.38]). Interaction terms were non-significant (p-value= 0.96 and 0.26, respectively).ConclusionPoor sleep health was associated with poorer cognition, and associations may be stronger among minoritized and younger women. Future studies using a life course perspective among large, more diverse populations can elucidate how early-life and later-life factors (e.g., psychosocial experiences; environmental conditions) accumulate to impact sleep health and contribute to differential cognitive risk in adulthood.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0890
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0891 Sex-Specific Differences in Polysomnographic Biomarkers of Sleep
           Disruption and Sleep Disordered Breathing in Migraine

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      Pages: A392 - A393
      Abstract: IntroductionThe importance of sex as a biological variable on the relationship of migraine and sleep disturbance has not been well-characterized. Given evidence of 1)bidirectional relationships of poor sleep and migraine severity and 2)greater activation of brain regions involved in emotional processing in women compared to men with migraine, we hypothesized that sleep architectural disruption may contribute to sex-specific differences in quality of life measures, particularly those attributed to emotional processing.MethodsThis was a retrospective cohort study of migraine patients aged >18 years seen in the Cleveland Clinic headache program with polysomnogram data. Migraine burden was measured by the 20-item migraine-specific quality of life(MSQOL) encompassing three domains: emotional function(EF), role function-preventative, and role function-restrictive. Linear regression models were used to assess the association of each MSQOL domain with sleep architectural measures and the statistical interaction with sex was examined. Coefficients and 95% confidence intervals were estimated and compared with adjustment of age, race, body mass index(BMI) and comorbidities.ResultsOf 245 patients with migraine,37(15.1%) were male. Males had higher AHI (10.0 [5.3, 18.5] vs. 5.7[1.8, 11.4], p=0.006). The difference in MSQOL-EF scores was not statistically significant (males:73.3[53.3,86.7] vs. females:60.0 [33.3,80.0], p= 0.066). There was no statistical difference in percent N2 or REM between sexes, though males had greater %N1, and lower %N3 (10.9[5.9,19.2] vs. 6.6[4.1,11.9],p=0.039). The association of MSQOL-EF with percent of N2 and REM sleep differed by sex. For each 5% increase in N2, there was a 5% reduction of MSQOL-EF 2.08 (-2.08, 95%CI [-6.86,2.70],p=0.39) in females compared to a 6.84 reduction in males (-6.84, 95%CI [-15.9,2.22],p=0.14), p-value for interaction=0.044. For each 5% increase in REM, MSQOL-EF increased 1.26 (1.26, 95%CI [-3.68,6.21],p=0.61) in females, and increased by 6.27 in males (6.27, 95%CI [-3.11,15.6], p=0.19),p-value for interaction=0.044.ConclusionAlthough males had greater sleep disruption compared to females, there was no significant difference in MSQOL-EF scores. However, sex-specific differences of extent of sleep stage composition and MSQOL-EF were observed suggesting influence of sleep architectural alterations on greater responsivity of migraine emotional processing in men versus women. Future investigation should better characterize longitudinal relationships and underlying neurobiological mechanisms underlying these findings.Support (if any)Association of Migraine Disorders
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0891
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0892 Insomnia and poor sleep efficiency predict cognitive decline among
           non-demented elderly: findings from the Cretan Aging Cohort

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      Pages: A393 - A393
      Abstract: IntroductionPrevious cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the longitudinal associations between sleep quality/quantity with cognitive progression in non-demented community-dwelling elderly.MethodsA sub-sample of 105 participants (77.5% females) from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years; baseline) were followed up 8 years later (follow-up). All participants underwent neuropsychiatric/neuropsychological evaluation on both phases. At baseline, subjective sleep complaints and objective sleep variables based on 3-day 24 hour actigraphy were assessed. The impact of baseline objective sleep characteristics and/or insomnia (as defined by at least two subjective sleep complaints) on cognitive progression was assessed with univariate and multivariate models controlling for confounders.ResultsAt baseline 50 participants were diagnosed as CNI and 55 as MCI; at follow-up 60 participants (57.1%) displayed clinically significant cognitive deterioration while the remaining showed relatively stable cognitive status. The frequency of persons reporting insomnia symptoms at baseline was higher among those who displayed cognitive deterioration (31.7%) than those in the cognitively stable group (13.3%, p=0.037). Logistic regression analysis showed that participants with insomnia symptoms at baseline, were significantly more likely to deteriorate cognitively at follow-up (p=0.05, OR=2.90). Also, among objective sleep variables added to the model, it was poor sleep efficiency that was associated with cognitive deterioration (p=0.035, OR=3.48).ConclusionMore than half of the participants displayed significant cognitive deterioration over 8 years and this decline was predicted by insomnia symptoms and objective poor sleep efficiency at baseline. Improving both quality and quantity of sleep may significantly delay the deterioration of cognitive function in non-demented community-dwelling elderly.Support (if any)National Strategic Reference Framework (NSRF) - Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0892
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0893 Long objective sleep duration is a marker of cognitive impairment
           among older elderly: findings from the Cretan Aging Cohort

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      Pages: A393 - A394
      Abstract: IntroductionWe have previously shown that although sleep duration is similar between cognitively non-impaired (CNI) elders and patients with Mild Cognitive Impairment (MCI), long sleep duration is associated with disease severity in patients with multi-domain MCI and Dementia. Our aim was to examine the associations between sleep duration and cognitive status in subjects with CNI and MCI followed 8 years later.MethodsA sub-sample of 110 participants (77.3% females) were recruited from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years). Participants with an initial diagnosis of CNI (n=57) and MCI (n=53) (mean age at baseline=72.7 years [SD=6.8]) were followed-up 8 years later (mean age at follow up=80.5 years [SD=6.7]). All participants underwent neuropsychiatric/neuropsychological evaluation (baseline & follow-up) and a 7-day 24h actigraphy (follow-up). Sleep duration measured as night Total Sleep Time (TST) at follow-up was compared between the diagnostic groups using ANCOVA controlling for age, gender, depression symptom severity, psychotropic medication. Long sleep duration was defined by values >75% percentile of the total sample distribution on each sleep index.ResultsAt follow up 62.7% of participants have deteriorated cognitively with 29 being diagnosed with CNI, 49 with MCI and 32 with dementia. Patients with dementia had significantly longer night TST (mean=493, SD=106 min) than persons with MCI (mean=453, SD=68 min, p=0.05) who in turn had longer night TST than CNI participants (mean=409, SD=58 min, p=0.02). Also, long night sleep duration was significantly more prevalent among dementia patients and MCI compared to CNI individuals [67.7% vs. 36.7% vs. 10.3%, respectively; all p< 0.02)].ConclusionOur study confirms and expands previous findings that objective long sleep duration is a marker of worse cognitive status in elderly with MCI or Dementia and that this association is even stronger in old-old individuals.Support (if any)National Strategic Reference Framework (NSRF)-Research Funding Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod: MIS 377299 HELLENIC FOUNDATION FOR REASEARCH AND INNOVATION (HFRI)- Research Funding Program: ELIDEK entitled “Sleep Apnea (OSA) and poor sleep as Risk Factors for decreased cognitive performance in patients with Mild Cognitive Impairment: the Cretan Aging Cohort (CAC)”, Grant Cod: HFR1-FM17-4397
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0893
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0934 An Analysis of 5,212 Sleep Medicine Providers’ Online Patient
           Reviews

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      Pages: A412 - A412
      Abstract: IntroductionOnline provider rating websites are an increasingly popular medium for patients to provide reviews & feedback and obtain information about varying healthcare providers. There have yet to be studies on what factors significantly impact sleep medicine provider ratings. Healthgrades is a popular healthcare provider rating database with over 11 million patient reviews. This study analyzes various dimensions to determine what factors correlate with average sleep medicine provider ratings to improve patient satisfaction.MethodsData were collected on 5,212 sleep medicine providers’ online profiles using web data extraction software. Factors such as medical degree, gender, age, and ethnicity were compared to online ratings using Pearson correlation and ANOVA analysis via statistics software.ResultsVariables with positive correlation in provider rating include the presence of a headshot (pc=0.106, p< 0.01), designation of trustworthiness (pc=0.152, p< 0.01), and presence of care philosophy statement (pc=0.105, p< 0.01). The only variable with a negative correlation in provider rating was increasing age (p=-0.109, p< 0.01). A one-way ANOVA revealed that there was a statistically significant difference in mean rating between different healthcare degrees (F(122.271, 5062.570)=[17.955], p=<.001). Tukey’s HSD Test for multiple comparisons found that the mean value of ratings was significantly different between allopathic physicians and sleep medicine dentists (p=0.000, 95% C.I.=[-0.943,0.070]), physician assistants (p=0.000, 95% C.I.=[-1.268,-0.239]), and nurse practitioners (p=0.000, 95% C.I.=[-0.941,-0.188]). There was no statistically significant difference in mean online rating between allopathic physicians and osteopathic physicians (p=0.505), sleep psychologists (p=0.344), or foreign medical graduates (p=0.998), respectively.ConclusionThis study suggests patients perceive sleep medicine providers’ online profiles with headshots, care philosophy statements, and designation of trustworthiness as contributing factors when rating. Additionally, degree type and age matter when rating online. Patients do not value factors such as ethnicity or gender strongly when rating their sleep medicine provider. Further study is needed to determine factors influencing non-physician providers’ higher ratings when compared to U.S. medical graduates. This study demonstrates the importance of building an online presence for sleep medicine practices and identifying characteristics patients value. The expectation is that this information can be used to improve the quality of care delivered in the field of sleep medicine.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0934
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0935 An Investigation of ICU Ambient Noise Levels as a Potential Source
           for Poor Sleep Outcomes in a Community Hospital Setting

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      Pages: A412 - A413
      Abstract: IntroductionPatients in the intensive care unit (ICU) are subject to multiple necessary diagnostic and therapeutic interventions throughout the course of their treatment that contribute to sleep deprivation. These measures increase ambient noise, impacting patient morbidity and mortality by exacerbating confusion, ICU-related delirium, recovery time, and long term sequelae associated with Post-Intensive Care Syndrome. The World Health Organization suggests critically-ill patients not exceed exposure to sound levels higher than 35-40 decibels (dB). In this study, we measured ICU sound levels in a community hospital setting to support intervention with conservative bundle measures or behavior modification with a visual noise monitoring device.MethodsThis study took place over two months (October-November, 2021) in the critical care unit of St Agnes Medical Center in Fresno, CA. Ambient noise was monitored using a sound decibel meter (Gain Express Holdings, SLM-25) connected to recording software that measured the decibel levels at 1-minute intervals for 24 hours in three areas: two central stations (Station A and B) and one occupied patient room, equidistant to both central stations. The monitor data was exported to Microsoft Excel (2020 version; Microsoft Corp, Redmond, WA, USA) for analysis. Data from each sample was expressed as M±SE (95% confidence interval).ResultsBoth central stations had average levels of 44.1dB± 4.7 and 48.0dB± 4.3, with a frequency range of 40-50 dB greater than 50% of the time. Station A had a frequency range of 50-60 dB approximately 11% of the time and Station B at 30% of the time. The occupied patient room had average levels of 48.0dB± 5.4, with frequency of 40-50 dB greater than 50%, and levels 50-60 dB greater than 30% of the time.ConclusionICU’s with higher than recommended ambient sound levels may benefit from appropriate intervention such as visual noise monitoring devices or order-sets with protocols on equipment/staff phone volume, earplugs for patients, and limiting staff conversation to distances away from the bedside.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0935
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0936 Characteristics and predictors of prescription sleep medication use
           in a national sample of Veterans with chronic pain

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      Pages: A413 - A413
      Abstract: IntroductionInsomnia and other sleep problems commonly occur in patients with chronic pain. While behavioral approaches are recommended first-line treatments for conditions such as insomnia, patients with sleep complaints often receive sleep medications. Thus, we aim to understand patterns of prescription sleep medication use in Veterans with chronic pain receiving care at the Veterans Health Administration (VHA).MethodsWe reviewed electronic medical records to identify patients with moderate/severe chronic pain receiving care at a VA hospital between FY2019—2021. Multivariate logistic regressions examined associations between 14 patient demographic and clinical variables on sleep medication prescription. Short-term prescriptions associated with upcoming procedures were excluded.ResultsOf the 1,706,214 moderate/severe patients with chronic pain (88% male, 66% White), 14% had comorbid diagnosis of insomnia, 30% sleep disordered breathing, and 19% were prescribed sleep medications. Trazodone (40%), melatonin (23%), and benzodiazepines (14%) were most commonly prescribed. Although 14% of patients without insomnia or sleep apnea diagnostic codes were prescribed medication, patients with insomnia were four times more likely to use sleep medication (odds ratio (OR) = 4.05, 95% CI [4.01-4.09]). Strongest predictors of medication use were insomnia (adjusted OR = 2.84, 95% CI [2.81-2.86]), PTSD (adjusted OR = 2.77, 95% CI [2.75-2.79]), depression (adjusted OR = 1.89, 95% CI [1.87-1.91]), bipolar disorder (adjusted OR = 1.84, 95% CI [1.81-1.87]), and ongoing opioid use (adjusted OR = 1.82, 95% CI [1.80-1.84]). Prevalence of medication use was similar across gender, age, and racial/ethnic groups.ConclusionSleep medication use is common in Veterans with chronic pain, with highest rates among patients with insomnia diagnoses. Additionally, a large number of patients without a sleep disorder diagnosis also receive medications. Findings highlight need to connect chronic pain patients with behavioral sleep interventions. Notably, we observed a wide variety of medications without strong patterns across demographic characteristics.Support (if any)This work was conducted as a non-research quality improvement effort supported by Quality Enhancement Research Initiative (PEC 13-001) and the VA Office of Patient Centered Care and Cultural Transformation. YIL is supported by a VA MIRT Fellowship. JAC is supported by a VA HSR&D CDA (IK2 HX002866). LMD is supported by a VA HSR&D CDA (CDA 18-187).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0936
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0937 Developing a Protocol for Abbreviated Daytime Sleep Studies for
           Positive Airway Pressure Acclimation

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      Pages: A413 - A413
      Abstract: IntroductionDuring the COVID pandemic, there was a decrease in the number of in lab positive airway pressure titration studies as well as in person DME company guided mask fittings due to COVID related restrictions. We wanted to assess the utility of daytime abbreviated sleep studies for PAP acclimation and mask fitting on patient compliance to therapy.MethodsWe assessed patients that were seen consecutively in our sleep lab for abbreviated sleep studies for positive airway pressure acclimation and mask fittings. Compliance rates 30 days prior to encounters were compared to compliance rates over the 30 days after the PAP acclimation and mask fitting took place.ResultsWe found that the majority of patients that did undergo an encounter had improvement in their compliance rates. Despite this, we recognized that there was a lack of uniformity in the patient encounter as well as documentation as there was no formal protocol in place for physicians and sleep technicians to follow during these encounters. We sought to developed a new protocol that would allow for more uniform encounters and optimized patient care as well as clear and concise documentation of the encounter.ConclusionIt is reassuring to see that daytime abbreviated PAP acclimation and mask fitting sessions do seem to improve compliance to therapy, but we recognize that the development of a new protocol is important to determine the clinical significance of this finding. This new protocol will allow us to improve the quality of care delivered to patients during in laboratory daytime abbreviated PAP acclimation and mask fitting sessions. With a new protocol in place we can reduce variables during the encounter and it will hopefully serve as a better platform to analyze how these sessions impact overall patient compliance to PAP therapy.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0937
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0983 Hand Dominance in Sexsomnia: A Clue to Pathophysiology'

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      Pages: A433 - A434
      Abstract: IntroductionSexsomnia is a variant of confusional arousal, a NREM parasomnia (NREMP), typically consisting of sexual behaviors manifesting upon partial arousal from deep NREM sleep; however, its pathophysiology is not well understood, and literature is limited. We present a series of patients with non-dominant hand sexsomnia behaviors that may reveal important new clues about the neurophysiologic mechanisms of sexsomnias.Report of case(s)Case 1: 22 y/o right-handed (RH) female, no history of NREMP, or snoring. Presenting complaint (PC): 8-year history of sleep masturbatory behavior (MB) including partial awakening from MB with bloody fingers (left hand) during her menstrual period in the setting of delayed sleep phase disorder. Case 2: 30 y/o ambidextrous male with a history of NREMP. PC: MB involving the left hand, observed by bed partner (BP) in the setting of weight gain and apneas. PSG: AHI 17/h and PLMI 23/h. Case 3: 33 y/o RH female with a history of NREMP. PC: left-handed sleep MB observed by BP in the setting of multiple sclerosis with C2-3 and C4 right posterolateral demyelinating lesions on C-spine MRI. Case 4: A 44 y/o RH male with OCD, depression, and no history of NREMP. PC: bilateral MB and dream enactment behaviors observed by BP, in the setting of sertraline. Events resolved upon switching to quetiapine. Case 5: A 59- y/o RH female with multiple system atrophy (MSA) and RBD, no previous NREMP. PC: sleep MB, noted by BP involving the left hand in the setting of worsening dysautonomia. Dream enactment occurred bilaterally. PSG: AHI 34/h, PLMI: 70/h and REM sleep without atonia. Spells improved with melatonin and PAP.ConclusionThis case series highlights a pattern of adult sleep MB involving the non-dominant (left) hand in 4/5 cases and the left hand in one ambidextrous patient. There was no evidence of gender predilection. We speculate that sexsomnia originates from central pattern generators in the brainstem and spinal cord, as opposed to the cerebral cortex (which would likely involve the dominant hand). The lack of involvement of cerebral motor control is further substantiated by amnesia for sexsomnia events.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0983
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0984 Near Drowning: A Complex Case of Somnolence and Weakness

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      Pages: A434 - A434
      Abstract: IntroductionNarcolepsy is a disorder of sleep characterized by pathologic daytime sleepiness classically divided into two major subtypes – those with or without cataplexy. The underlying pathophysiologic mechanism is thought to be related to hypocretin/orexin; pathologically low levels of hypocretin characterize narcolepsy with cataplexy. We present a complex case of weakness in a patient evaluated for narcolepsy.Report of case(s)A 38 year-old male with a BMI of 33 presented with a decade of daytime sleepiness and sudden debilitating attacks of muscle weakness. He underwent level III home sleep testing revealing a respiratory event index of 5.3/h. After an unsuccessful trial of mandibular advancement, he was started on positive airways pressure (PAP) but continued to experience daytime sleepiness and episodes concerning for cataplexy including sensation of legs feeling stiff and falling with stress. He also described episodes of weakness while swimming with inability to stand or stabilize, prompting evaluation for narcolepsy with cataplexy. Sleep diary showed average nightly sleep of 6.5 hours, low sleep latency, and refreshing napping. He underwent PSG while using CPAP 8 cm H2O showing AHI 0.2/h, sleep time 6.2 hours, sleep latency 5.5 minutes and REM latency 33 minutes with evidence of REM sleep without atonia. He underwent MSLT showing a mean sleep latency of 7.6 minutes and 3/5 REM sleep onset periods. Therapeutic trials of venlafaxine and pitolisant did not result in symptomatic improvement, and further genetic testing with HLA DQB-1 was negative. CSF hypocretin measurement was normal (329 pg/mL, reference > 200 pg/mL). These effectively ruled out cataplexy as the cause of his weakness. He continued on PAP therapy, venlafaxine, and modafinil 200 mg for hypersomnia/narcolepsy without cataplexy with good response.ConclusionWe present a complex case highlighting the utility of HLA and confirmatory CSF testing in the evaluation of cataplexy with episodes of acute weakness accompanying stress and strong emotion, with particularly dangerous events during swimming. Due to lack of therapeutic response despite positive MSLT, further testing with HLA and CSF hypocretin were pursued. This case highlights the limitations of history alone in the diagnosis of cataplexy, and the utility of advanced testing.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0984
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0985 Oxybate induced mania

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      Pages: A434 - A435
      Abstract: IntroductionHypersomnia sleep disorders are characterized by overwhelming daytime sleepiness. Treatment options include sodium oxybate the sodium salt of γ-hydroxybutyric acid (GHB). Oxybate, an endogenous metabolite of GABA, acts through GABAB noradrenergic and dopaminergic neurons, as well as at thalamocortical neurons. < 1% may experience suicidal ideations or psychosis.Report of case(s)A 17-year-old female with obesity, spina bifida occulta follows with sleep for idiopathic hypersomnia with long sleep (TST 12.6 hours on polysomnography) and a delayed circadian rhythm. Her typical sleep zone is 11:00PM to 10:00AM, but she can easily sleep until 2:00PM. She started sodium oxybate to minimize her sleep burden and improve daytime wakefulness. She initially developed insomnia with concern for mania and migraines with photophobia and phonophobia. After 26 days, oxybate was discontinued. Her migraines persisted daily. Her sleep schedule and mood returned to baseline within 17 days thereafter. A 48-year-old female with anxiety/depression, PTSD has follows with sleep since age 42 for unspecified hypersomnia, either narcolepsy type 1 with long sleep versus idiopathic hypersomnia. Initial polysomnography/MSLT on fluoxetine revealed AHI 1.6, with a mean sleep latency of 6.4 minutes without SOREMPs. Her typical sleep zone was 8:00PM to 9:00AM. She was started on sodium oxybate for her cataplexy and daytime sleepiness. She had remarkable improvement in her symptoms after 4 days. After 35 days on 9 grams nightly she developed anxiety, extracorporeal sensations, and paranoia. The dose was decreased to 7.5 grams nightly. By 7 months of therapy her paranoia progressed to the point where she threatened her landlord and was facing legal consequences. Sodium oxybate was discontinued. At 53-years-old she was trial on mixed-salts oxybate. After three months of therapy, she became hypomanic with severe pressured speech despite a euthymic mood. She reported going without sleep entirely for 3-4 days at a time using this oxybate. Mixed-salts oxybate was discontinued and 36 days later with in addition to quetiapine, her hypomania was nearly resolved and she was able to get 8-9 hours of restful sleep.ConclusionHypomania appears to be a rare but serious side effect of oxybate in long-sleepers. Discontinuing oxybate may not be sufficient therapy.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0985
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0986 The Kid Who Slept in Detention: Delayed Narcolepsy Type II Diagnosis

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      Pages: A435 - A435
      Abstract: IntroductionNarcolepsy is a sparsely found disease with a prevalence of 0.02-0.07% worldwide. Most patients are diagnosed much later than symptom onset with a gap of several years to even decades. The inability to diagnose and lack of awareness of narcolepsy leads to poor quality of life for the patient and family, poor school performance, and increased medical and socioeconomic burden. Hence, we report a case of a child inflicted with these woes looking for an improved quality of life.Report of case(s)A 12-year-old boy with past medical history of mild intermittent asthma, tonsillectomy, and adenoidectomy, initially presented to Allergy-Immunology for asthma management where it was revealed he was dealing with snoring and excessive daytime sleepiness since age 9. Patient was sent for Polysomnography (PSG) which revealed an Apnea Hypopnea Index (AHI) of 0.4 and Oxygen Nadir of 91%. Patient was referred to Pediatric ENT for evaluation, but further surgical intervention was not indicated. Patient continued to deal with excessive daytime sleepiness (Epworth Sleepiness Scale of 20/24) and multiple detention visits due to sleeping in class. Mother was distressed from daily conversations with school officials. Patient was referred to Sleep Medicine and found to have no cataplexy episodes, episodic symptoms, hypersexuality, or hyperphagia. Multiple Sleep Latency Test (MSLT) was ordered. Patient’s PSG night prior to MSLT revealed an AHI of 0.8 and Oxygen Nadir of 91%. Urine Drug Screen prior to MSLT was negative. MSLT revealed 2 naps demonstrating Sleep-Onset REM Periods and average mean sleep latency of 5 minutes. Patient was started on Methylphenidate ER 10mg with increase in alertness. Further treatment modification and workup is ongoing.ConclusionOur patient experienced a delay in diagnosis of nearly three years. The patient dealt with multiple detention visits and the mother experienced harassment from the school. Increasing awareness in the school system and patient population is necessary to mitigate prejudice against the pediatric narcolepsy population. Furthermore, increased research into new biomarkers and technologies for Narcolepsy type symptoms will be critical to decreasing the gap in diagnosis.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0986
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0795 Implementation of the Pediatric Craniofacial Screening Tool for Sleep
           Disordered Breathing (PCSS): An Observational Pilot Study

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      Pages: A350 - A351
      Abstract: IntroductionPediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors not routinely assessed. We developed the Pediatric Craniofacial Screening Tool for Sleep (PCSS) to assess which craniofacial risk factors are closely correlated with SDB symptoms in children.MethodsPilot study of children ages 5-12y recruited from eight dental sites across the country to participate in the PCSS screening by dental providers. The primary outcome was SDB measured by the validated PSQ-SRBD questionnaire (22 items, range 0-1, and >0.33 signifying increased SDB risk). The predictors included PCSS total score and individual items comprising of 21 craniofacial features. Neighborhood socioeconomic status (NSES) was characterized by using the Area Deprivation Index (ADI). Correlation and regression analyses modeled the association between PSQ-SRBD and total PCSS score. To assess inter-rater reliability, a subset of subjects had a second PCSS screen by a second dental provider.ResultsThe sample included 97 children (94%-Non-Hispanic-White, 4% Hispanic, 2% other; 49%-female), with a mean age of 8.6±2.2. PSQ-SRBD scores were elevated in 20 (20.6%) participants. Three children were reported to overweight (on item specific question of PSQ-SRBD scale). Children with elevated PSQ-SRBD (>0.33) had lower NSES compared to children with PSQ-SRBD scores < 0.33. PSQ-SRBD was associated with total PCSS score (OR=1.17 CI[1.01-1.36], p=0.033) and individual features including, narrow vaulted palate (OR=3.22, CI[0.94-10.93], p=0.03), forward head posture (OR=3.13, CI[1.11, 9.30], p=0.03), tongue thrust (OR=7.04, CI[1.20, 47.67], p=0.03), tongue tie (OR=7.58, CI[1.88, 33.58], p=0.005) and heart-shaped tongue (OR=11.21, CI[1.81, 98.11], p=0.01) after adjustment with age, sex, race and ethnicity. The correlation between total PCSS score and PSQ-SRBD was low (R=0.39, p= < 0.01), however in subjects with at least one positive craniofacial feature, the correlation between significant PCSS features and PSQ-SRBD was moderate (R=0.54, p= < 0.01). There was high inter-rater reliability (kappa=0.75) in a subset of 53 subjects with second PCSS screens.ConclusionMultiple craniofacial features assessed during routine dental visits were associated with increased risk for pediatric SDB. This study points to the utility of a craniofacial scale to assess SDB risk in children. This pilot study will be expanded to include a more diverse patient population.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0795
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1035 Joubert Syndrome and severe central sleep apnea treated with
           noninvasive ventilation: A case report

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      Pages: A454 - A454
      Abstract: IntroductionJoubert syndrome is an autosomal recessive heterogenous ciliopathy characterized by cerebellar vermis hypoplasia resulting in ataxia, hypotonia, developmental delay, neonatal respiratory dysregulation, and abnormal eye movements. It is typically accompanied by the pathognomonic “molar tooth sign” on brain MRI. Primary central sleep apnea has been described in case reports about this condition, however given the rarity of this disease, there are very few studies conducted on these patients. Our goal is to share our treatment approaches for the sleep disturbances seen in these patients.Report of case(s)A 6-year-old female from Kuwait with a history of Joubert syndrome and global development delay presented at UCMC for evaluation of sleep issues. During the history taking, patient’s mother reported that the patient was born with acute respiratory failure shortly and required CPAP therapy in the NICU. She later developed tachypnea and cyanosis during feedings, which prompted further evaluation. A subsequent brain MRI demonstrated a molar tooth sign consistent with Joubert Syndrome. Patient required supplemental oxygenation due to nocturnal desaturations found on pulse oximetry. Due to persistent apneas and chokings during sleep, the patient underwent a repeat diagnostic polysomnogram with an electroencephalogram at our institution demonstrating severe central sleep apnea most predominant during NREM sleep. An extended montage of the EEG did not show any epileptiform discharge. This was followed by a mask de-sensitization and an inpatient PAP titration study during which BPAP therapy ST mode with a backup rate of 8 breath/minute successfully treated the patient’s primary central sleep apnea. Patient also underwent a multidisciplinary consultation with PM&R, speech therapy and ophthalmology due to her ataxia, speech delay, and need to assess for retinal dystrophy, respectively.ConclusionSleep disordered breathing in the neonatal period is an early presentation in Joubert syndrome with central sleep apnea being the primary sleep disordered breathing. Fortunately, the clinical course of sleep disordered breathing does improve with treatment overtime, as in our case. Treatment options include conservative treatment, oxygen supplementation or PAP therapy. In our case, BPAP with ST mode was the most effective modality despite the need for mask desensitization and initial hesitation with using a PAP device.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1035
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0796 Safety and efficacy of the combination of atomoxetine and oxybutynin
           for OSA treatment in children with Down Syndrome

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      Pages: A351 - A351
      Abstract: IntroductionChildren with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA), with a prevalence of OSA of 50-79%. Current OSA treatments for children with DS have limited effectiveness, as positive airway pressure therapy is poorly tolerated and adenotonsillectomy is not curative in most children with DS. The combination of atomoxetine and oxybutynin (ato-oxy) is a promising OSA treatment in adults. Ato-oxy has been shown to improve upper airway hypotonia, a key feature of OSA in children with DS, thus it may be particularly effective for OSA in children with DS.MethodsWe performed a randomized, double-blind, crossover pilot trial examining the short-term efficacy of ato-oxy in 15 children aged 6 to 17 years with DS and OSA. Participants received 4 weeks of low dose (0.5 mg/kg atomoxetine and 5 mg oxybutynin) as well as 4 weeks of high dose (1.2 mg/kg atomoxetine and 5 mg oxybutynin) in random order. Participants underwent polysomnography as well as parent-reported health-related quality of life assessment using the OSA-18 at baseline and at the end of each dosing period. The primary study endpoint was reduction in obstructive apnea-hypopnea index (oAHI) from baseline. Paired t-tests were used to compare baseline to low and high dose ato-oxy.Results15 participants qualified for randomization and 11 participants had complete data at all points. Baseline oAHI was 7.4 ± 3.7 (mean ± standard deviation), oAHI with low dose ato-oxy was 3.6 ± 3.3 (p=0.001 vs baseline) and oAHI with high dose ato-oxy was 3.9 ± 2.8 (p=0.003 vs baseline). There were no differences in sleep architecture or sleep efficiency between baseline and either dose of ato-oxy. OSA-18 total score was 51.5 ± 18.5 at baseline; improved to 44.6 ± 17.0 (p=0.09) at the end of 4-weeks of low dose ato-oxy; and improved to 45.5 ± 15.7 (p=0.37) at the end of high-dose ato-oxy therapy. The most common adverse effects were irritability and fatigue, and these were generally mild.ConclusionAto-oxy is a promising treatment for OSA in children with DS.Support (if any)Funding provided by NIH (HL151254 and HD109777) as well as the Lumind-IDSC foundation.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0796
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1036 Traumatic Complications of Unrecognized Somnambulance in a Pediatric
           Patient

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      Pages: A454 - A455
      Abstract: IntroductionParasomnias are unusual, disruptive, and abnormal verbal or motor events that occur during sleep or between wake and sleep transitions. They can occur in non-rapid eye movement (NREM) or rapid eye movement (REM) sleep stages. NREM parasomnias are typically more prevalent in pediatric populations. One such NREM parasomnia is sleep walking or somnambulance. One study estimates somnambulance has a prevalence of 17% in ages 3-13 years¹. Somnambulance typically occurs during stage 3 sleep which is clustered in the first half of sleep when REM is less prevalentReport of case(s)A 4-year-old previously healthy male presented to clinic for a somnambulance consult. Around 6 months prior, his parents awoke around 3 AM to check on their crying infant, a sibling of our patient, and noticed the patient was missing. They noticed the back door open. Two blocks away they saw police lights and found he had been hit by a vehicle. He was admitted to the hospital for polytrauma, including bilateral pulmonary contusions with acute respiratory failure, grade 4 liver and kidney lacerations, grade 3 adrenal injury, and right parietal lobe parenchymal and subarachnoid hemorrhages. He was later discharged in stable condition with persistent but improved spasticity, impaired mobility, and cognition. His parents had not noticed any prior episodes of somnambulance. However, they did report other frequent parasomnias: somniloquy and confusional arousals. These episodes were worse following late evenings. There was a strong family history of somnambulance in the parent’s siblings. They denied any sleep disordered breathing symptoms. Parents were reassured and educated about parasomnia's self-limited nature but to keep a safe environment and avoid sleep deprivation.ConclusionThe majority of parasomnia in children have benign outcomes and eventual self-resolution with age. However, rare circumstances arise where these events can be hazardous including sleep-cooking, risking fire and burns or, as in this case, unknowingly walking into traffic. A sleep study is not always needed as parasomnias are a clinical diagnosis. However, it’s important to note that if a patient has a history of parasomnias parents should be educated on the importance of keeping a safe environment to prevent possible harm.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1036
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0797 Correlation between Obstructive Sleep Apnea and Echocardiography
           Parameters in Infants and Preschool Children with Down Syndrome

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      Pages: A351 - A351
      Abstract: IntroductionDown syndrome (DS) is one of the most common genetic disorders caused by the Trisomy of chromosome 21. Children with DS secondary to the unique airway anatomy and hypotonia, are at risk for obstructive sleep apnea (OSA). Untreated OSA in children can lead to serious complications because of chronic hypoxia leading to Pulmonary hypertension (PHTN) and Cor pulmonale. An overnight polysomnogram (PSG), the gold standard for diagnosing OSA in children, should be performed within 4 years per American Academy of Pediatrics recommendations. However, OSA in DS has been observed at a much younger age.MethodsIn this single-center retrospective study, data was collected by reviewing the medical records and PSG REDCap database from 2019-2021. Patients with ICD code 10 diagnosis of DS between 0 to 4 years of age who underwent PSG and echocardiography were included. Our primary aim was to assess the severity of OSA in preschool children and describe echocardiogram parameters in DS patients with OSA. We hypothesized that there will be differences in polysomnogram parameters of DS children with and without PHTN.Results61 patients met the criteria for the study with the mean age being 11.3 months. 3 patients (5.4%) did not have OSA (apnea hypopnea index (AHI)< 1/hr), 11 patients (19.6%) had mild OSA (AHI 1-4.9/hr), 12 patients (21.4%) had moderate OSA (AHI 5-10/hr), 30 patients had severe OSA (AHI >10/hr). Five patients with missing AHI values were excluded for subsequent analyses. Echocardiogram parameters were compared using the described AHI cut offs to define severity of OSA. OSA was observed to be significantly higher in the group with elevated RV systolic pressure.ConclusionAlthough our study did not find any difference in PSG findings in young children with DS with and without PHTN, obstructive apnea index was significantly elevated in young children with elevated RV systolic pressure. OSA is a significant contributor to the development of PHTN in children with DS. Children with DS are at higher risk for PHTN due to their unique pulmonary vasculature. As PHTN is a significant comorbidity of DS, it is important to perform PSGs early during childhood to detect and treat OSA.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0797
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1037 Central sleep apnea due to high altitude periodic breathing

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      Pages: A455 - A455
      Abstract: IntroductionMany popular tourist destinations are at high-altitude. Visitors commonly report poor sleep quality during the first few nights after arriving, but some do not resolve over time and daytime symptoms may develop that require medical attention.Report of case(s)A previously healthy 76-year-old American man presented with progressive fatigue and frequent nocturnal awakenings to a clinic in Bogota, Columbia (altitude 2640 meters), where he had been living for eighteen months during the COVID-19 pandemic lockdown due to limited ability to travel. An arterial blood gas on room air revealed hypocapnia with a partial pressure of CO2 of 25 mmHg. A polysomnography (PSG) performed in Bogota demonstrated an apnea-hypopnea index (AHI) of 98 events/hour consisting of predominately central as well as obstructive respiratory disturbances (Figure 1). After a titration study, he was placed on treatment with continuous positive airway pressure (CPAP) at 10 cmH2O along with oxygen 1 L/min, but he had difficulty acclimating to treatment. The patient presented to our institution two months after returning to the USA with significantly improved symptoms despite remaining off CPAP. Repeat PSG revealed a substantial reduction in the AHI at 15 events/hour consisting of only central respiratory disturbances in the supine position during transitional N1/N2 sleep (Figure 2). Positional therapy was recommended. A repeat home sleep study performed three months later to reassess disease severity during non-supine sleep showed resolution of respiratory disturbances (Figure 3). High-altitude periodic breathing is a common phenomenon, characterized by alternating periods of absent respiratory efforts with periods of hyperventilation without another etiology (1, 2). It occurs due to the interaction of hypocapnia and increased loop-gain (2). Central sleep apnea (CSA) is considered a disorder only when associated with symptoms, not simply due to an elevated central apnea index (3). The more rapid ascent and the higher the altitude, the greater risk of developing periodic breathing. Descending to a lower altitude will often resolve apnea after few days but the phenomenon can persist for up to months (2, 4) as our patient.ConclusionCSA develops commonly upon ascent to high altitude. When feasible, symptomatic patients should be encouraged to descend to a lower altitude.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1037
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0771 An Innovative Intervention on Parental Sleep Beliefs and Practices:
           Its Effects on Children's Short-Term Sleep

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      Pages: A340 - A340
      Abstract: IntroductionInadequate parental sleep beliefs and practices have been associated with the development and maintenance of sleep difficulties in children. Disrupted sleep at a young age leads to adverse child outcomes and affects parents' sleep and family functioning. Our goal was to evaluate the effects of improved parental sleep beliefs and practices on child and parent sleep in the short term. Hence, we designed an innovative intervention for developing parenting skills in children's sleep management.Methods15 caregiver-child dyads with preschool-age children were recruited through daycare centers and placed in small groups for a two-hour intervention and a follow-up. Children's and parents' sleep were respectively measured using the Children’s Sleep Habits Questionnaire (CSHQ) and the Pittsburgh Sleep Quality Index (PSQI). Parental beliefs were assessed by three subscales (Setting Limits, Anger, Doubt) of the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ). Parental practices were measured by two factors (Sleep Conflict, Sleep Dependence) of the Parent-Child Sleep Interactions Scale (PSIS). Data were collected before the intervention and two weeks later. Paired-sample t-tests were used to measure changes in each variable.ResultsSignificant improvements were observed in scores on CSHQ subscales measuring Bedtime Resistance (t(14)=3.15, p=.004; M=11.3 vs M=9.47), Sleep Onset Delay (t(14)=3.21, p=.003; M=2.40 vs M=1.67), Parasomnias (t(14)=2.35, p=.017; M=10.9 vs M=9.87), and Daytime Sleepiness (t(14)=2.90, p=.006; M=13.0 vs M=11.3). Accordingly, total CSHQ scores were significantly lower (t(14)=4.70, p<.001; M= 55.7 vs M=49.5) reflecting less sleep disturbance in children. Parents' sleep was of superior quality, with global PSQI scores marginally decreased (t(14)=1.75, p=.051; M=6.93 vs M=6.20). Lower Sleep Conflict scores (t(14)=3.44, p=.002; M=7.67 vs M=4.8) and total PSIS scores (t(14)=3.59, p=.001; M=13.3 vs M=9.00) indicated better parental sleep practices.ConclusionThese preliminary results show that parental interventions on children’s sleep management can improve child sleep and parental sleep practices. These results also highlight that parental practices about their child’s sleep can change independently of their beliefs. Long-term measures will help verify the course of changes in parents' sleep and beliefs regarding their child’s sleep.Support (if any)This project was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0771
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1038 Treating Obstructive Sleep Apnea Without Batting an Eye: A Case of
           Lacrimal Duct Air Regurgitation Complicating CPAP Therapy

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      Pages: A455 - A456
      Abstract: IntroductionDacryocystorhinostomy (DCR) is a surgical procedure that re-opens the nasolacrimal duct in patients with nasolacrimal duct obstruction and relieves symptoms of epiphora (watery eyes) by allowing tear drainage back to nasal mucosa. This procedure, however, can present a unique challenge for patients with obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP).Report of case(s)We present a 65 year-old man with a history of nasolacrimal duct obstruction status-post DCR who initially presented with daytime hypersomnolence and multiple nighttime awakenings. He underwent polysomnography (PSG) demonstrating moderate OSA with Apnea-hypopnea index (AHI) 18.5 events per hour. After initiation of CPAP, he reported eye pain, dryness and a sensation of air blowing into his eye. Both mandibular advancement device and BPAP (bilevel positive airway pressure) were attempted, unfortunately neither was found to be sufficiently effective.ConclusionThis patient experienced a potential complication of DCR called lacrimal duct air regurgitation (LADR), which occurs due to the potential for reflux of air through the relatively dilated anastomosis from nasopharynx to puncta of the eye. By reducing end expiratory pressure, BPAP may in theory relieve expiratory LADR. A total-face mask was then employed as, covering the eyes allows for pressure equalization across the duct with resultant LADR improvement. This improved eye discomfort, but adherence was limited due to bulkiness of the mask. Lacrimal duct plugging may also be explored to reduce air reflux. This is an example of an uncommon complication of PAP therapy and highlights the unique challenges in maintaining adherence in this setting.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1038
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0772 Associations of Sleep Duration and Maternal Postnatal Depression in
           Infants with Autistic Siblings

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      Pages: A340 - A341
      Abstract: IntroductionEvidence suggests sleep differences emerge in the first three years of life for autistic individuals (MacDuffie et al., 2020) and may be a possible endophenotype in unaffected siblings (Naeem et al., 2021). In neurotypical samples, postnatal depression has also emerged as a potential contributor to infant sleep challenges (Dias & Figueiredo, 2021). Questions remain on the associations between infant sleep duration, maternal postnatal depression, and family history of ASD as well as how these variables interact to predict future autistic traits.MethodsParticipants (N=74) were enrolled in a prospective longitudinal study on early autistic traits and included infants with an autistic sibling (n=33, EL) and with no familial history of ASD (n=41, LL). At 6 months, caregivers completed the Edinburgh Postnatal Depression Scale (EPDS) and a 24-hour retrospective sleep log. At 12 months, clinicians administered a standardized observation of autistic traits (SORF) the includes scores related to deficits in social communication (SCD) and restrictive and repetitive behaviors (RRBs).ResultsAt 6 months, EL infants spent significantly more time asleep during the day than LL infants, (t(45)=2.89, p<.01). There were not significant differences in nighttime sleep duration or EPDS scores between groups. In examining the influence of self-ratings of maternal depression and likelihood status on sleep duration, the model was significant for daytime sleep (F(2, 36)=4.27, p=.02), but not nighttime sleep. Likelihood status, not EPDS score, predicted more hours spent asleep in the daytime. When assessing the role of status and sleep-related variables on future autistic traits, only decreased nighttime sleep duration at 6 months was related to greater RRBs at 12 months (F(3, 10)=15.26, p=.02), regardless of likelihood status.ConclusionThe results of this study suggest that EL infants may sleep more in the daytime at 6 months. Reduced nighttime sleep at 6 months possibly signal future autistic traits, regardless of likelihood status. Future research should examine actigraphy data and its relationship to the etiology of ASD in larger samples.Support (if any)Funded by K23-MH120476, R21-DC071252, and T32GM081740.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0772
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1039 The Progression of Sleep-Related Breathing Disorders in a Patient
           with Joubert syndrome

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      Pages: A456 - A456
      Abstract: IntroductionJoubert syndrome (JS) is a rare autosomal recessive disease characterized by malformations of the cerebellar vermis, hypotonia, developmental delay, and respiratory variability. Among the potential health challenges that children with congenital malformations of the central nervous system including JS, may face, sleep concerns are frequent and may include sleep-related breathing disorders (SRBDs).Report of case(s)A 17-month-old female with JS was referred to the pediatric pulmonary clinic due to disrupted and fragmented sleep. She had frequent nocturnal awakenings, snoring, mouth breathing, and witnessed apneas. There was no family history of SRBDs. Physical exam was notable for high-arched palate, diffuse hypotonia, and intermittent periods of tachypnea followed by apneas, even when awake. Her polysomnography (PSG) demonstrated an apnea-hypopnea index (AHI) of 27.1/hour, with the obstructive apnea-hypopnea index (oAHI) of 18/hr with central apnea index (CAI) of 9.1/hr and nadir oxygen saturation (SpO2) of 87%. An attempt was made to initiate supplemental oxygen; however, the patient did not tolerate the cannula. At that time, neither adenoid nor tonsillar hypertrophy were noted and surgical intervention was not indicated. The repeat PSG one year later demonstrated AHI of 9.1/hour, oAHI of 4.7/hr with CAI of 4.4/hr and nadir SpO2 of 84%. At this time, she did demonstrate enlarged adenoids and tonsils and underwent adenotonsillectomy with some clinical improvement in snoring. Her mother noted continued pauses in breathing and post operative PSG demonstrated AHI of 12.8/hour, oAHI of 1.4/hr and CAI of 11.4/hr and nadir SpO2 of 79%. The patient had demonstrated worsening episodic tachypnea and central apneas and the decision was made to attempt initiation of a respiratory assist device to regulate breathing and ventilation. Due to the patient’s age, intensive therapy desensitization is required to allow her to tolerate positive airway pressure therapy.ConclusionPatients with JS are at high risk for complex SRBDs as part of their clinical presentation. It is therefore important to carefully monitor the character of sleep-disordered breathing, offering appropriate treatments where indicated. It is important to note the added challenges of young pediatric patients who often require deliberate desensitization interventions to proceed with successful treatment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1039
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0773 Behavioral sleep characteristics may differ in toddlers with epilepsy
           compared to children without epilepsy

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      Pages: A341 - A341
      Abstract: IntroductionSleep is cited as a prominent concern by many caregivers of children with epilepsy. Few studies have examined this issue systematically.MethodsCaregivers of 11 toddlers (12-36 months old) were recruited from two academic Pediatric Neurology clinics and responses were compared to children without epilepsy (n=343). Caregivers responded to a novel questionnaire being developed for infants and toddlers. Two domains were analyzed (Caregiver/Child Behavior and Comfort Object/Bedtime Routine). The domain score equaled the sum of the scores for each item divided by the number of items answered. Items in the Caregiver/Child Behavior domain were: 1.“My child’s total sleep time and sleep routine are problematic for me”; 2.“I am frustrated by my child’s sleep problem”; 3.“I worry about my child’s health due to their sleep problem”; 4.“My child wakes up shortly after they have fallen asleep”; 5.“My child wakes up distressed in the middle of the night”; 6.“My child’s sleep is restless”; 7.“My child does not seem well rested during the day”; 8.“My child requires a parent/caregiver's presence to fall asleep (e.g. in the room, in the bed)”; 9.“My child moves their legs in a cycling pattern, or kicks and moves their legs excessively in the middle of the night”. Items in the Comfort Object/Bedtime Routine domain were: 1. My child requires a parent/caregiver's presence to fall asleep (e.g., in the room, in the bed)”; and 2.“My child requires the presence additional comfort measures (e.g., aromatherapy, noise machine, weighted blanket, music) to fall asleep”.ResultsThe Caregiver/Child Behavior score was higher (worse) in toddlers with epilepsy (3.40; SD 0.72) compared with controls (1.94; SD 0.93) p< 0.0001. Yet, toddlers with epilepsy had lower (better) scores in the Comfort Object/Bedtime Routine domain (2.23; SD 1.25) compared with controls (3.20; SD 1.25) p=0.01.ConclusionSleep behavior is complex in toddlers with epilepsy and can lead to parental frustration and worry in comparison to toddlers without epilepsy. Further investigation into this relationship could provide opportunities for effective interventions to improve sleep and quality of life for children with epilepsy.Support (if any)NIH2T32HL110952-06
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0773
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1040 Sleep Hypoventilation with Daytime Eucapnia in COPD May Predict
           Hypercapnia During Exacerbation

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      Pages: A456 - A456
      Abstract: IntroductionPatients with severe Chronic Obstructive Pulmonary Disease (COPD) are known to be at risk for nocturnal hypoventilation1. We present a case of patient with severe COPD with near normalization of PaCO2 levels after exacerbation but persistent nocturnal hypoventilation.Report of case(s)71-year-old woman with COPD Group 4D, on home oxygen, was seen in pulmonary clinic after two hospitalizations for hypercapnic respiratory failure, PcO2 >100 mm Hg requiring acute Noninvasive ventilation (NIV) support. Three weeks after discharge, ABG improved to 7.39/49/140 on 32% Fio2, preventing her from qualifying for long-term home NIV. Sleep study was negative for sleep apnea but showed hypoventilation during sleep. Wake supine transcutaneous CO2 was 45-47 mmHg, increasing to 51-55 mmHg during sleep, worse with supplemental oxygen to 66-67 mm.ConclusionChronic hypercapnia is a poor prognostic indicator in COPD4. In patients with persistent hypercapnia following COPD exacerbation, NIV prolongs time to re-admission or death within 12 months2. Blunting of chemoreceptor response has been noted in hypercapnic patients3, possibly causing subsequent daytime hypercapnia and overt respiratory failure. However, nocturnal hypercapnia is present in some patients and may be a risk factor for profound, life-threatening hypercapnia during exacerbation. Future studies are needed to better phenotype patients such as ours who may be seemingly eucapnic in between exacerbations, but markedly hypercapnic during exacerbation, to determine if there is benefit in treating these patients with NIV as well.Support (if any)1. The American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Report of American Academy of Sleep Medicine Task Force. Sleep 1999:22:667-689 2. Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA. 2017:317:2177 3. Scano G,Spinelli A, Duranti R, et al. Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia. Eur Respir J 1995:8:78-85 4. Cooper CB, Waterhouse J, Howard P. Twelve-year clinical study of patients with hypoxic co pulmonale given long term domiciliary oxygen therapy. Thorax 1987:42:105-110
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1040
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0780 Iron Sucrose Infusions for Pediatric Sleep Related Movement Disorders

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      Pages: A344 - A344
      Abstract: IntroductionSleep related movement disorders (SRMD) such as restless leg syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep disorder (RSD) are common diagnoses among children referred to pediatric sleep clinics, particularly among children with neurodevelopmental disorders such as ASD. These disorders have been associated with low iron status, and evidence demonstrates clinical response to iron supplementation. Oral iron supplementation is often used as a first step in management, although some children do not manifest an adequate response in serum ferritin levels, or do not tolerate oral iron due to side effects or taste. For these children, iron infusions may be an attractive therapeutic strategy.MethodsWe performed a retrospective chart review of children referred for iron infusion between January 2021 to November 2022 at Kaiser Permanente Northern California Pediatric Sleep Clinics. Children carried a diagnosis of RLS, PLMD, or RSD. Iron sucrose was used, with a target dose of 6-7mg/kg, with a maximum dose of 200mg per infusion. We reviewed the number of infusions, pre- and post-infusion ferritin levels, and clinical response based on clinic notes and/or secure message communication after infusion.ResultsA total of 11 children were identified who received at least one iron infusion. Mean age at time of first infusion was 7.2 (4.5) years, 63.6% were male, and 45.5% were diagnosed with ASD. The most common diagnosis was PLMD (54.5%), followed by RLS (27.3%), and RSD (18.2%). Mean infusion dose of iron sucrose was 130.5mg (41.6) and children received an average of 2.0 (1.1) infusions. Mean ferritin prior to infusion was 30.1 (20.1) and 62.6ng/mL (41.1) post infusion. Based on chart review, 63.6% of families reported symptomatic improvement following iron infusions. No children were reported to have worsening of sleep or significant side effects following iron sucrose infusion.ConclusionIron infusions are an effective strategy for management of sleep related movement disorders who are recalcitrant to oral iron. This can be an especially attractive therapeutic option in children with neurodevelopmental disorders such as ASD. Further research exploring optimal dosing and formulation of iron is warranted.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0780
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1041 Recurrent Retropharyngeal Ganglioneuroma in a Pediatric Patient

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      Pages: A456 - A457
      Abstract: IntroductionGanglioneuroma is a rare benign subtype of peripheral neuroblastic tumor that arises from sympathetic ganglion cells. Fewer than 10% of these cases occur in the head and neck and are rarely seen in pediatric patients. Clinical symptoms and treatment are dependent on mass location and extension. The authors present a case of recurrent retropharyngeal ganglioneuroma in a pediatric patient.Report of case(s)Patient is a 2-year-old previously healthy female who presented with progressive snoring and found to have retropharyngeal lymphadenopathy during tonsillectomy. Differential diagnosis included retropharyngeal abscess; however, after no improvement with antibiotics, malignancy was suspected. Pathology results from a needle biopsy confirmed the diagnosis of ganglioneuroma. CT imaging showed extension of mass to bilateral retropharyngeal, posterior mediastinal and paraspinal, and retroperitoneal spaces. Given concerns for significant morbidity with complete resection, patient underwent partial resection of mass, followed by chemotherapy to decrease tumor burden. Patient initially did well, then developed nine-month progressive snoring, positional apnea, persistent stertor, and dysphagia. Sleep study showed severe obstructive sleep apnea (OSA) with apnea hypopnea index (AHI) 74, oxygen nadir 66%, and maximum transcutaneous carbon dioxide (CO2) level of 58 mmHg. Repeat CT imaging showed regrowth of the tumor with large right-sided retropharyngeal mass, mass effect on right oropharynx and associated vasculature, and moderate narrowing of airway. Supplemental oxygen via nasal cannula was initiated as inpatient, due to concerns that noninvasive positive pressure support would further compromise the critical airway. Urgent repeat debulking of the tumor with partial pharyngectomy was completed. Post-operatively, patient's oxygen dependence, stertor, and positional apnea resolved within 24 hours. Repeat sleep study showed considerable improvement with mild OSA, AHI 1.4, oxygen nadir 89%, and maximum transcutaneous CO2 level of 47 mmHg. Her dysphagia and residual mild intermittent snoring are improving with no signs of recurrence of the mass.ConclusionUpper airway obstruction secondary to neck mass in pediatric patients is rare and even less commonly found to be recurrent ganglioneuroma. This case offers further understanding of the complexities of diagnosing and treating insidiously growing retropharyngeal tumors and the prompt management of critically obstructed airways.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1041
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0781 Relationship between Bedtime Routines with Sleep, Development, and
           Parenting Stress in Toddlers

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      Pages: A344 - A345
      Abstract: IntroductionInstitution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods.MethodsCaregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p<.05.ResultsToddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns.ConclusionBedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning.Support (if any)This study was partially funded by the Simms/Mann Institute
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0781
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1042 Cognitive Behavioral Therapy for Insomnia (CBT-I) in Patient with
           Neurological Symptoms of Unclear Etiology

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      Pages: A457 - A457
      Abstract: IntroductionFor those experiencing neurological symptoms and being evaluated for multiple sclerosis (MS), it is important to assess whether sleep disturbance is primary or secondary to neurological disease. In this case, CBT-I was initiated to rule out a sleep disorder as an underlying cause of neurological symptoms.Report of case(s)The patient is a 61-year-old, White, female with chronic insomnia, excessive daytime sleepiness, and mild OSA comorbid with abnormal brain MRI (significant non-specific lesions). Patient is followed by neuroimmunology for management of neurological symptoms with unclear etiology (fatigue, paresthesia, neuropathic pain, and impaired cognition). She was referred to sleep medicine by her neurologist who suspected severe fatigue and sleepiness may be contributing to complex medical presentation. Patient endorsed a history of sleep-maintenance insomnia associated with drowsy driving (1 MVA and 3 near-misses). Of note, patient discontinued CPAP use for mild OSA in spring 2022 due to device recall. Her sleep physician recommended CBT-I to increase TST prior to OSA re-evaluation. Patient presented as anxious and distressed regarding safety while driving. She initiated CBT-I and engaged in stimulus control, cognitive restructuring, sleep diaries, relaxation, motivational interviewing, and supportive therapy. Baseline sleep diaries showed average WASO=146 minutes, SE=58%, and TST=4.1 hours. At week 7, average WASO=60 minutes, SE=86%, and TST=6.0 hours. Though no baseline measure was obtained, sleep disturbance (PROMIS Sleep T Score) was WNL (T=54) at week 7. Depression, anxiety, and pain-related disability decreased: PHQ-9 (11-moderate to 8-mild), GAD-7 (6-moderate to 4-mild), PDI (41 to 33). Measures of daytime sleepiness remained in the severe range (ESS 20 to 18), suggesting the need for OSA re-evaluation. Although sleep quality improved, patient reported new and worsening neurological symptoms including dysphagia and falls at home. CBT-I treatment is ongoing.ConclusionAs individuals diagnosed with MS and other neurological disorders are more likely to experience insomnia than the general population, assessment of sleep disorders and evidenced-based treatments should be part of comprehensive neurological evaluation. In this case, the patient’s sleep parameters improved with CBT-I, but neurological symptoms persisted and worsened, suggesting the need for continued assessment and follow-up with neurology and sleep physicians.Support (if any)None.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1042
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0767 INSIGHT Responsive Infant Parenting Intervention and Child Sleep at
           Age 6 Years

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      Pages: A338 - A339
      Abstract: IntroductionThe Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behaviors and objectively-measured sleep at child age 6 years.MethodsMothers (n=279) were randomized to the RP or control intervention, delivered by nurses at home and clinic visits through child age 2.5 years. Sleep content focused on establishing bedtime routines, age-appropriate bedtimes, and promoting self-soothing at bedtime and after night wakings. At 6 years, children completed wrist actigraphy (Spectrum Plus) for 7 days during the school year. Children with ≥3 valid days were included in analyses (n=162). Mothers (n=173) completed the Children’s Sleep Wake Scale and Children’s Sleep Hygiene Scale. Study group differences for 10 sleep actigraphy variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time), as well as survey scores, were examined.ResultsChildren (mean age 6.7 years, 96% non-Hispanic White) slept on average 8.8 hours ± 33 minutes per night, with 40% meeting the minimum recommendation of 9 hours. The mean sleep onset time was 9:14 pm ± 50 minutes. There were no significant study group differences in any actigraphy variables. RP mothers reported higher scores for Total Sleep Quality (4.6 ± 0.5 vs. 4.4 ± 0.6, p=0.03), ‘Going to Bed’ subscale (4.3 ± 0.8 vs. 4.0 ± 0.9, p=0.03), which captures child compliance with bedtime, and ‘Reinitiating Sleep’ subscale (4.6 ± 0.9 vs. 4.2 ± 1.1, p=0.005), which captures the child’s ability to go back to sleep on their own after waking. Total Sleep Hygiene score did not differ between groups.ConclusionThe INSIGHT intervention targeting sleep in infancy was associated with improved parental perception of bedtime stalling and self-soothing behaviors at age 6 years. However, this did not translate into differences in sleep duration, timing, or quality measured by actigraphy. Future research should examine strategies to maintain the impacts of the RP intervention on infant sleep into middle childhood.Support (if any)R01DK088244, KL2TR002015
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0767
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0845 Individuals with Persistent Low Back Pain Have Less Time in Deep
           Sleep Stage than Asymptomatic Controls

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      Pages: A372 - A373
      Abstract: IntroductionSleep consists of stages of light sleep, deep sleep, and rapid eye movement (REM), which have different characteristics. These stages are thought to be associated with different physiological and psychological processes. Pain is an unpleasant sensory and emotional experience generated by neural activity that potentially impacts several networks in the brain. There is limited information regarding the potential association between objectively determined sleep characteristics and persistent low back pain (pLBP). The purpose of this study was to examine whether sleep characteristics differ between individuals with pLBP and asymptomatic controls.MethodsIndividuals in a current episode of back pain with symptoms impacting function and persisting greater than 3 months (pLBP group, n=20) and asymptomatic individuals (control group, n=16) participated in the study. They wore a home sleep test device (Zmachine® Insight+, General Sleep Corporation) for three nights.ResultsThe pLBP and control groups had similar age (24.8 ± 5.8 and 25.4 ± 4.3 years, respectively; mean ± SD), height, weight, and waist and hip circumferences. The two groups also had similar total sleep time (6.0 ± 1.2 and 6.6 ± 1.0 hours, for pLBP and control groups, respectively), sleep efficiency (82.8 ± 8.8% and 84.9 ± 5.7%), and wake time after sleep onset (35.8 ±27.4 and 31.5 ±18.1 minutes). The duration in REM (1.5 ± 0.5 and 1.5 ± 0.6 hours) and light sleep (3.1 ± 0.7 and 3.4 ± 0.9 hours) stages were also similar. However, the pLBP group had less deep sleep time (1.4 ± 0.4 hours) than the control group (1.7 ± 0.3 hours) (p = 0.029).ConclusionIndividuals with pLBP had less deep sleep time than asymptomatic controls, although other objectively determined sleep characteristics appear to be similar. These results suggest an association between the deep sleep stage and persistent low back pain that requires further investigation.Support (if any)National Institutes of Health R01HD095959 and University of South Carolina ASPIRE 80004373.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0845
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0768 Melatonin use for sleep disturbance in school-aged children and
           adolescents: An Australian pharmacy perspective

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      Pages: A339 - A339
      Abstract: IntroductionMelatonin is a widely used pediatric sleep aid. While readily available internationally, regulatory changes in Australia have only recently allowed over-the-counter access for patients aged over 55, triggering renewed public interest in melatonin. However, melatonin access for younger patients with sleep disturbances remains a prescription-only medicine. Furthermore, pharmacist opinions about the use of melatonin in pediatric patients remain unexplored. This study aimed to investigate Australian community pharmacists’ perspectives toward melatonin use in school-aged children and adolescents.MethodsA qualitative study was conducted in a convenience sample of community pharmacists/interns practicing in metropolitan Sydney. Participants completed an online questionnaire capturing demographic information and practice context. Participants subsequently indicated their interest in participating in an in-depth semi-structured interview. Interviews were guided by a schedule of questions exploring pharmacists’ knowledge, beliefs, and attitudes toward melatonin use in pediatric patients. The interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach to identify emergent themes. Recruitment continued until thematic saturation was reached.ResultsTwenty-four interviews were conducted with pharmacists (n=19) and interns (n=5). Participants were mostly female (67%) with a mean age of 29.8 (range: 22-56) years. Pharmacists managed 25.3 (1-300) sleep-related inquiries per day on average and received direct product requests for melatonin 15.9 (2-100) times per week. Preliminary analyses identified three key themes: Conflicting Opinions on Safety, Product Cost and Formulation Availability, and Gaps in Clinical Education. Pharmacists’ involvement in pediatric melatonin use has largely been within the domains of dispensing or compounding prescriptions. While melatonin was perceived as a “better choice over other sedatives” for children, pharmacists expressed uncertainty about the evidence base concerning long-term use in younger age groups, relying heavily on physicians for prescribing discretion and patient supervision. The need for affordable proprietary products with flexible dosing options and targeted education around melatonin and circadian sleep health was also expressed by participants.ConclusionFindings allude to the need for greater availability and accessibility of pediatric-specific melatonin formulations, as well as refinement of clinical education resources that specifically address the use of melatonin among school-aged children and adolescents.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0768
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0872 Periodic limb movements during sleep and hypertension: A systematic
           review and meta-analysis

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      Pages: A384 - A384
      Abstract: IntroductionSeveral studies suggest an association between periodic limb movements during sleep (PLMS) and hypertension; however, a systematic evaluation of this relationship is lacking.MethodsWe conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio, comparing the risk of hypertension in persons with PLMS (defined by the level of periodic limb movements per hour of sleep depended on individual studies) versus those without PLMS. After assessing heterogeneity and bias, the pooled risk ratio and 95% confidence intervals (CIs) were determined using a random-effect, generic inverse variance method of DerSimonian and Laird.ResultsOut of 572 potentially relevant articles, six eligible cross-sectional studies were included in the data analysis which included 8,949 participants. The statistical heterogeneity of this study was insignificant, with an I2 of 0%. A funnel plot showed no publication bias. The pooled risk ratio of hypertension in patients with PLMS was 1.26 (95% CI, 1.12–1.41).ConclusionOur analysis demonstrates an increased hypertension risk among patients with PLMS. Prospective or interventional studies are needed to confirm this association.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0872
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0769 Multidimensional Sleep Health in Adolescents from the General
           Population: Definition, Thresholds and Construct Validity

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      Pages: A339 - A340
      Abstract: IntroductionThe RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures.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. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported.ResultsThe mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p< 0.05) and identifying as non-Hispanic white (r=-0.14, p< 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p< 0.01), less disturbed sleep (r=-0.28, p< 0.01) and higher arousal (r=-0.21, p< 0.01) scores were associated with higher MSH scores.ConclusionOur data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents.Support (if any)NIH (R01HL136587,UL1TR000127)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0769
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0873 Physical Activity, Sleep, and Depressive Symptoms Among Cognitively
           Impaired Older Adults

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      Pages: A384 - A385
      Abstract: IntroductionCases of depressive symptoms are highly prevalent among older adults. Moreover, depression among older adults is strongly associated with cognitive impairment, with a prevalence of approximately 8% to 16% of aging adults (Blazer, 2003). Therefore, this study sought to investigate and examine the interplay between physical activity, insomnia, and depressive symptoms among cognitively impaired older adults without dementia using data from the Health and Retirement Study.MethodsDepressive symptoms and insomnia levels are based on self-reports. We used a negative binomial to assess these relationships and present the incident rate ratios (IRRs) and 95% confidence intervals from our analysis of depressive symptoms associated with insomnia and moderate physical activity.ResultsWe observed that insomnia (IRR: 1.18, 95% CI: 1.13-1.24) and moderate physical activity (IRR: 1.13, 95% CI: 1.07 – 1.19) are positively associated with an increase in depressive symptom levels among older adults. Model Two included an interaction term for insomnia and physical activity; results indicate that the interaction term is negative (IRR: .97 95% CI: .94 - .99). Model three tested gender to moderate the relationship between physical activity and depressive symptoms.ConclusionThe results from the non-significant interaction term suggest that this relationship is non-significant. Similarly, the interaction term (gender x physical activity) results show that the link between physical activity and depressive symptoms did not vary by gender.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0873
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0770 The Effect of In-Home Sleep Extension on Insulin Sensitivity for
           Habitually Short-Sleeping Adolescents

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      Pages: A340 - A340
      Abstract: IntroductionThe interplay of physiological and behavioral factors of adolescence that result in dramatically insufficient sleep may confer a notable cardiometabolic risk. Increasing sleep duration reverses the negative metabolic consequences of insufficient sleep in adults, but this has not been examined in youth. Thus, the current study aimed to evaluate the impact of in-home sleep extension on insulin sensitivity (Si) in habitually short-sleeping adolescents.MethodsTwenty-six healthy adolescents obtaining ≤7h sleep on school nights (age=16.6±1.1, 69% female, 73% non-Hispanic White) completed a randomized crossover trial consisting of one week each of Typical Sleep (usual school schedule) and Sleep Extension (≥1h additional time in bed) during the academic year. Sleep was estimated via actigraphy, and an intravenous glucose tolerance test (IVGTT) measured Si following each condition. Spearman and Kendall correlations assessed associations and paired samples t-tests and Wilcoxon signed-rank tests examined change in variables from Typical Sleep to Sleep Extension.ResultsA significant association between sleep and insulin sensitivity was observed during Typical Sleep, with poorer Si associated with longer sleep onset latency (rho=-0.29, p=0.04), and greater variability in waketime (rho=-0.44, p=0.02) and sleep duration (rho=-0.43, p=0.03). During Sleep Extension, participants significantly increased sleep duration by 1.4±0.7h (Typical Sleep=5.59±0.82, Sleep Extension=6.95±0.83 h; p< 0.001) by shifting bedtimes to an earlier clock hour (Typical Sleep=00:34±01:12; Sleep Extension=23:10±00:57; p< 0.001). Si did not significantly change between conditions (p=0.52). However, a trend was observed for a decrease in fasting glucose during Sleep Extension compared to Typical Sleep (Typical Sleep=92.5±8.87; Sleep Extension=88.48±12.06 mg/dL; p=0.055).ConclusionHabitually short-sleeping adolescents were successful at increasing sleep duration during an in-home intervention, but Si did not change compared to Typical Sleep. Notably, sleep duration during Sleep Extension was still less than the 8-10 h of sleep per night recommended for adolescents. A sufficiently early bedtime that supports adequate sleep is a biological challenge for adolescents when wake times are fixed due to early school start times. Future research is recommended examining whether combining sleep extension with a circadian health intervention can have a larger impact on sleep and cardiometabolic outcomes in adolescents.Support (if any)NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1TR002535
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0770
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0898 Title: Test - Retest Reliability of the Multiple Sleep Latency Test
           in Non-cataplectic Central Hypersomnia Disorders

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      Pages: A395 - A396
      Abstract: IntroductionDifferentiation of narcolepsy type II (NT2) and idiopathic hypersomnia (IH) is challenging in clinical practice. Diagnostic criteria rely on the multiple sleep latency test (MSLT), previously shown to have poor reproducibility in these disorders. We leveraged a large polysomnographic database to study test-retest reliability in non-cataplectic central hypersomnia disorders.MethodsPatients evaluated at Cleveland Clinic Sleep Disorders Center from 2008-2021 with suspected central hypersomnia disorders excluding narcolepsy type I with >1 PSG/MSLT were included. Studies not meeting validity criteria (< 7hr sleep time on PSG, < 5 MSLT trials, use of REM suppressants/alerting medications within 14 days) were excluded. Diagnostic groupings included NT2, IH and Normal/Indeterminate based on ICSD-3. Reliability and correlation between tests was performed using intra-class and Spearman’s correlations, respectively. Data is presented as mean+SD or median [25th,75th percentiles] for continuous variables and N(%) for categorical variables.ResultsA total of 58 patients (62.1% female, age 31.9 yr [18.5, 48.6]) were included. Interval between MSLTs was 3.6 + 3.18 yr (same diagnosis on both tests: 3.24 + 3.15; changed diagnosis: 3.98 + 3.22). Diagnosis based on MSLT 1 was NT2 8(13.8%), IH 20(34.5%) and Normal/Indeterminate 30(51.7%). Overall, 33(56.9%) patients remained in the same diagnostic category including 3(5.2%) NT2, 12(20.7%) IH and 18(31.0 %) Normal/Indeterminate. Of 25(43.1%) cases changing diagnosis, 3(5.2%) changed from NT2 to IH and 2(3.4%) to Normal/Indeterminate; 4(6.9%) changed from IH to NT2 and 4(6.9%) to Normal/Indeterminate; 5(8.6%) changed from Normal/Indeterminate to NT2 and 7(12.1%) to IH. Median MSL on tests 1 and 2 were 10.8 [4.6,12.9] and 9.0 [4.5,13.1], respectively. Correlation was moderate MSL [0.59 (0.39, 0.73), p< 0.001] and fair for SOREMPs [0.32 (0.07, 0.53), p=0.015]. Intra-class correlation showed moderate reliability in test-retest for MSL [0.56 (0.36, 0.72)] and SOREMPs [0.54 (0.33, 0.70)].ConclusionMSLT test-retest reproducibility in non-cataplectic central hypersomnias was moderate in a tertiary care clinic population. While more favorable than prior studies, these findings underscore diagnostic challenges that may contribute to misdiagnosis of patients with hypersomnia.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0898
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0727 Association of sleep quality with memory functions among
           dementia-free, middle- and older-age, rural Indians

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      Pages: A320 - A320
      Abstract: IntroductionSleep is known to be involved in cognitive processes, such as memory consolidation. Poor sleep is a potential risk factor for dementia. However, whether it is associated with decreased memory functions among dementia-free individuals is not well known. This study aims to investigate the effect of sleep quality on memory functions among middle and older-age adults from a rural Indian population.MethodsParticipants were dementia-free, rural Indians (≥ 45 years) recruited as part of an ongoing, prospective, aging cohort study, namely Srinivaspura Aging, NeuroSenescence, and COGnition (SANSCOG) study. Cross-sectional (baseline) data on sleep quality was obtained using Pittsburgh Sleep Quality Index (PSQI). Memory functions (at baseline) were assessed using subtests, namely immediate recall, delayed recall, name-face association, semantic fluency, phonemic fluency, and semantic association, from a culturally validated computerized neurocognitive test battery. Clinical Dementia Rating (CDR) was used to classify subjects based on their cognitive status into cognitively healthy (CDR=0) and MCI (CDR=0.5). Linear regression models, unadjusted and adjusted with cognitive status, age, gender, and depression, were used for analysis.ResultsIn the unadjusted linear regression model 1, we found no association between sleep quality and the different subtests of memory. However, in model 2 (adjusting for cognitive status), sleep quality in persons with MCI was significantly associated with memory functions. Model 3 (model 2 + age) found that sleep quality in higher ages in MCI explained a significant variance in the association between sleep and subtests of memory function compared to cognitively healthy individuals. Model 4 (model 3 + gender) suggested that with increasing age, gender was significantly associated with sleep quality and memory among individuals with MCI compared to cognitively healthy individuals. Further, model 5 (model 4+ depression) found that depressed individuals with MCI showed a significant association between sleep quality and memory functions compared to those without depression.ConclusionWhen adjusted for cognitive status, age, gender and depression, there was significant association of sleep quality and memory functions, pointing to the important role of sleep in memory functions among middle and older-aged individuals without dementia.Support (if any)SANSCOG study is funded through the Centre for Brain Research by Pratiksha Trust
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0727
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0728 Does Short Sleep Duration Increase Risk for Postpartum Weight
           Retention'

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      Pages: A320 - A320
      Abstract: IntroductionAbout 75% of mothers in the United States have postpartum weight retention (PWR), which increases risk for adverse health outcomes in mother and child. Short sleep duration is an important health behavior linked to risk of weight gain in the general population. Although short sleep duration is common in postpartum, findings from the few studies examining sleep duration and PWR are mixed. Thus, we aimed to examine whether sleep duration at 6 months postpartum is associated with PWR at 12 months. We also explored agreement between self-reported and actigraphy-derived sleep duration.MethodsThis is a secondary analysis from a prospective cohort study investigating postpartum pelvic floor outcomes. Participants were healthy, age ≥18 years, and primiparous with a singleton birth. We measured sleep duration by triaxial, wrist accelerometer (Actigraph GT3X+) and by self-report using the Pittsburgh Sleep Quality Index (PSQI). Excessive PWR was defined as ≥7% of pre-pregnancy weight. Log-binomial regression assessed the relationship between sleep duration and PWR, adjusted for pre-pregnancy body mass index, gestational weight gain, and breastfeeding. We analyzed agreement between self-reported and actigraphy-derived sleep duration using Bland-Altman analysis and paired t-test.ResultsParticipants (N=467; mean age=29.5±4.78 years; pre-pregnancy BMI= 24.4±5.03 kg/m2) were mostly White (91%) and educated (93%). After adjustment, sleep duration by actigraphy (Risk Ratio (RR)=0.96, 95% confidence interval (CI)=(0.87,1.06), p=0.44,) and by PSQI (RR=0.95, 95%CI=(0.84,1.07), p=0.38) was not associated with PWR. There was a statistically significant correlation between sleep duration by actigraphy and by PSQI (r=0.19, 95% CI=(0.10,0.28), p< 0.001). The limits of agreement were wide (-3.41 to 3.57 hours), and self-reported versus actigraphy-derived sleep duration was not statistically different (bias=0.08 hours, p=0.3313) indicating no pattern of underestimating or overestimating.ConclusionIn contrast to some previous findings, sleep duration at 6 months postpartum was not associated with PWR at 12 months. The assessment of additional sleep dimensions, such as timing or efficiency, may further refine our understanding of how sleep affects PWR. Self-reported and actigraphy-derived measures of sleep duration evidenced wide discrepancies in postpartum women, suggesting that the method of sleep measurement may contribute to mixed findings related to sleep in this population.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0728
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0899 Use of Artificial Intelligence for Early Characterization of Patients
           with RBD/RWA

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      Pages: A396 - A396
      Abstract: IntroductionThe prevalence of polysomnography (PSG) confirmed REM sleep behavior disorder (RBD) has been estimated at 0.68% of the general population, and that of probable RBD at 5.65%. Isolated RBD is considered a pre-clinical marker of neurodegeneration with strong predictive value. Large longitudinal cohort studies demonstrate 81–91% of idiopathic RBD patients, followed for ≥14-years, will develop a definite neurodegenerative disease or mild cognitive impairment. Furthermore, high prevalence of sleep apnea (SA) exists in patients with RBD/REM without atonia (RWA), which can confound analysis of EMG tone and arousal activity. We demonstrate predictive AI models for RBD/RWA in subjects with and without SA.MethodsPatients with known RBD/RWA who underwent PSG were divided into sub-groups with (n=86, RBDSA) and without SA (n=19, RBDNSA). Patient demographics, PSG characteristics, and co-morbid conditions were reviewed. Random forest (RF) models of PSG indices and Deep Learning (DL) methods identified predictive characteristics of RBD/RWA, sensitivity and specificity for RBD/RWA detection were estimated, and feature importance analysis was performed.ResultsSubjects with RBDSA compared to RBDNSA demonstrated greater BMI, AHI, Arousals (ArI), and Periodic Limb Movements (PLMs). In a Parkinson’s disease subgroup (n=12, RBDPD) compared to non-Parkinson’s sub-group, sleep was more fragmented, showing higher WASO, ArI, and PLMs. RF modeling demonstrated sensitivity/specificity of 67%/96% for RBDNSA subjects, and 79%/52% for RBDSA. Feature importance analysis resulted in several top-features for RBDNSA: N3 time, TST, AHI, REM duration, and sleep latency, while different top-features were observed for RBDSA: ratio of leg events in REM vs. non-REM, TST, ratio of arousals in REM vs. non-REM, REM duration, and REM time.ConclusionAI approaches including RF models produced high specificity and moderate sensitivity for RBDNSA subjects. Observed specificity was lower for RBDSA patients. We hypothesize the performance difference attributable to similarity and additional complexity in sleep disturbance characteristics between RBD and SA. Broad implementation of AI methods show potential to expand early detection and diagnosis of RBD and associated neurodegenerative conditions through expanded analysis, and follow-up, including RWA spectrum patients that don’t meet clinical thresholds for diagnosable RBD.Support (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0899
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0729 Grandparents Raising Grandchildren: Does Caregiving Status Moderate
           the Relationship between Stress and Sleep

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      Pages: A320 - A321
      Abstract: IntroductionThe close relationship between high stress and poor sleep is well known. Less is known whether this relationship is stronger for a certain population group who may experience more stress. Grandparents responsible for raising their grandchildren are such a vulnerable group, as increased caregiving responsibilities are associated with increased stress levels. To test this hypothesis, we examined whether grandparent caregiving status moderated the relationship between subjective stress and sleep.MethodsThe sample was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and stress variables of interest. Participants included grandparents who reported having been responsible for the care of their grandchildren for at least 1 year (N=63, age M=61.80, 64% female) and grandparents who were not responsible for their grandchildren (N=423, age M=62.98, 56.2% female). Multiple regressions (SPSS PROCESS) examined whether caregiving status (1=yes, 0=no) moderated associations between subjective stress (Perceived Stress Scale) and sleep (subjective Sleep Onset Latency-SOL and sleep quality) over the past month. Analyses controlled for age and gender.ResultsCaregiving status interacted with stress (t(1, 484)=3.81, p=.04) in its association with SOL (R2=.15, p=.001). Specifically, increased stress was associated with greater SOL in caregiving grandparents and to a lesser (but not significant) extent in non-caregiving grandparents (Z =1.49, p=.13). Caregiving status interacted with stress (t(1, 484)=5.76, p=.02) in its association with sleep quality (R2=.33, p< 001). Specifically, increased stress was associated with worse sleep quality in caregiving grandparents and to a less extent in non-caregiving grandparents (Z =2.67, p=.01).ConclusionThese results suggest that caregiving status may contribute to an increase in the positive relationship between subjective stress and sleep problems. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships as well as examine physiological measures of stress. In addition, studies should investigate whether addressing stress in behavioral sleep treatments may improve caregiving grandparents’ sleep.Support (if any)National Institute on Aging (P01AG020166, R37AG027343; McCrae, PI: R01AG061976)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0729
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0920 Enrichment and Patterns of Comorbidities in the Electronic Health
           Record of Patients with diagnosed Obstructive Sleep Apnea

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      Pages: A406 - A406
      Abstract: IntroductionObstructive Sleep Apnea (OSA) is the most common respiratory disorder of sleep and an independent risk factor for multiple other medical conditions related to poor quality of life and increased mortality and morbidity. The current study utilized the electronic health record (EHR) to examine relationships between OSA and common comorbidities within a large-scale dataset.MethodsCases with OSA and non-cases (controls) were defined using a validated EHR case identification algorithm, and matched based on age, sex, and observation period. We collapsed International Classification of Disease codes into PheCodes representing common etiologies and identified the top 20 most common comorbidities in the EHR among cases. We then compared overall and annual prevalence between matched cases and controls using conditional logistic regression. Latent class analysis (LCA) was used to identify subtypes of cases defined by specific combinations of comorbidities.ResultsOverall, 60,586 EHR-defined cases and 60,586 matched controls (from a total of 1,226,755 EHR-defined controls) were identified. Matched pairs had a median (IQR) age of 54 (45-63) years and 57.4% were males. BMI was higher in cases (median [IQR] = 35.9 [29.6, 41.0] kg/m2) than matched controls (28.0 [24.0, 32.0] kg/m2). Patients with OSA were at significantly greater risk of having each of the top PheCodes when compared to matched controls, with odds ratios ranging from 3.1 to 30.8 in the full matched set and 1.3 to 10.2 after controlling for BMI in the subset with available data. LCA identified 5 distinct subgroups based on comorbidities, labeled as High Comorbidity Burden, Cardiovascular Comorbidities, Depressive and Inflammatory Conditions, Low Comorbidity Burden, and Obesity and Cardiometabolic Dysregulation.ConclusionOur study demonstrates the power of leveraging the EHR to understand the relative health burden of OSA. In addition to showing enrichment for a number of comorbidities, we identified 5 subtypes defined by specific combinations of comorbidities in the EHR. These results could be informative for understanding likely disease outcomes and improved prevention and clinical care.Support (if any)National Research Service Awards (NRSA) T32 HL07713 National Institutes of Health (NIH) P01 HL094307
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0920
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0790 Sleep, Early Solid Introduction, and Allergic Disease in Infancy

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      Pages: A348 - A348
      Abstract: IntroductionEarly complementary (solid) food introduction (< 6 months) is at times recommended to reduce the risk of allergic disease, specifically food allergy. However, little is known about solid food introduction and allergic disease as they relate to sleep problems during infancy. Thus, the purpose of this study was to assess the association of sleep problems with early solid food introduction and allergic disease during the first year of life.MethodsMothers of 300 infants (0-11.9 mos, M=5.87) completed an online questionnaire about infant sleep, solid food introduction (non-milk, -juice, -formula), and allergic disease (including atopic dermatitis, itchy/dry skin, food allergies). Prevalence of sleep problems was compared in the context of presence or absence of early solid food introduction and allergic disease, using chi-square.ResultsOverall, 29.3% of infants were reported to have a sleep problem, 29.0% atopic dermatitis and/or itchy/dry/flaky (AD/IDF) skin, and 10.7% food allergies. Of infants who were 6 months or older at the time of the study, 24.4% were introduced to solids early (< 6 months). Those infants with early solid food introduction were less likely to have a reported sleep problem (19.5%) compared to those introduced to solids starting at 6 months or later (37.8%), p < .05. For all infants, sleep problems were more likely to be reported in association with AD/IDF than those without those skin conditions (39.1% vs 25.4%), p < .05. No statistically significant differences were found in sleep problem rates between those with a food allergy (40.1%) and those without a food allergy (28.0%), p > .05.ConclusionOverall, lower sleep problem rates were associated with early introduction (before 6 months) of solid foods. Presence of sleep problems was associated with reports of atopic dermatitis and itchy/dry/flaky skin. Sleep problems were unrelated to food allergies, although overall rates of food allergies were low in this study.Support (if any)Johnson & Johnson Consumer Inc., Skillman, NJ, USA
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0790
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0921 Insomnia Symptoms and Environmental Disruptors: A preliminary
           evaluation of Veterans within a VA subacute rehabilitation unit

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      Pages: A406 - A407
      Abstract: IntroductionInsomnia symptoms during rehabilitation admission are associated with slower rehabilitation progression, increased healthcare utilization, worse functional recovery one-month post discharge, and decreased survival rates one-year post discharge. Insomnia symptoms are complex, multifactorial (e.g., insomnia severity, sleep need, daytime sleepiness), and are often unintentionally worsened by rehabilitation admission due to environmental factors (e.g., light, noise) and behavioral factors (e.g., increased time in bed). The aim of this clinical innovation project was to conduct a preliminary evaluation of Veterans’ sleep at admission and discharge in a VA subacute rehabilitation unit for the purposes of informing clinical interventions.MethodsVeterans admitted to the VA subacute rehabilitation unit between March and August 2022 (N=67) were approached within 7 days of admission to complete a brief evaluation (Insomnia Severity Index [ISI], Sleep Need Questionnaire [SNQ], Epworth Sleepiness Scale [ESS]). Veterans also answered questions regarding environmental sleep disruptors. Following the evaluation, Veterans were offered sleep resources and behavioral treatment options. Veterans repeated the evaluation within 7 days of discharge and were offered outpatient referrals for their sleep difficulties. Pearson correlations were used to determine associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge.Results33 of 67 (49.2%) Veterans (Mage=73.3±8.8; 96.9% male; 78.8% white) completed admission and discharge evaluations. Over 80% of Veterans reported at least 1 environmental disruptor at admission and discharge. The number of environmental disruptors at discharge was correlated with ISI (r =.549, p=.001) and SNQ (r =.475, p=.005) scores at discharge. LOS was correlated with ESS scores at discharge (r =.524, p=.002).ConclusionThis preliminary evaluation demonstrated relationships between higher numbers of environmental disruptors and greater insomnia severity and sleep need at discharge from a VA subacute rehabilitation unit. Additionally, longer durations of admission were associated with higher levels of daytime sleepiness at discharge. Future evaluations should include larger sample sizes to determine causality between these variables in Veteran populations. Given the impact of insomnia symptoms on rehabilitation progression, future evaluations should also consider physical function and sleep variables post-discharge.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0921
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0791 The Association of Sleep with Developmental and Behavioral Factors in
           Premature Infants

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      Pages: A348 - A349
      Abstract: IntroductionChildren with neurodevelopmental conditions often experience sleep problems. Whereas sleep is a predictor of behavioral outcomes in children, there is limited evidence regarding sleep as an indicator of neurodevelopmental concerns. This study examined the prevalence of sleep issues and neurodevelopmental conditions in children with a history of prematurity, as well as the role of sleep as a potential indicator for future developmental and behavioral concerns.MethodsElectronic health records of 57 young children (M = 31.9 gestational weeks, range = 23 to 40 weeks; 35.1% girls) presenting to a neonatal follow-up clinic were reviewed. Caregivers completed the Brief Infant Sleep Questionnaire (BISQ-R) between 6-16 corrected months (Mage = 11.6 mos) and then completed the Modified Checklist for Autism in Toddlers (M-CHAT) between 16-26 corrected months (Mage = 20.9 mos). Caregivers also completed the Survey of Wellbeing of Young Children (SWYC; n = 56; Mage = 20.9 mos) and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; n = 32; Mage = 17.4 mos).ResultsApproximately one-quarter (26.3%) of subjects had a caregiver-perceived child sleep problem at ages 6-16 corrected months. A total of 40.4% of children had clinically significant autism concerns on the M-CHAT and 67.9% had clinically significant concerns on the SWYC. Subsequent caregiver ratings showed that 25.0% of children exhibited challenging behaviors and 34.4% lower social-emotional competency on the BITSEA. Children who demonstrated clinically significant autism risk on the M-CHAT were more likely to have a prior caregiver-identified child sleep problem. Those who later failed the M-CHAT also had increased night waking frequency (2.43 vs 1.82 wakings) earlier in development. Logistic regression indicated that caregiver-identified sleep problems significantly predicted subsequent challenging behaviors on the BITSEA but not later neurodevelopmental concerns on the SWYC or social-emotional competencies on the BITSEA.ConclusionThese pilot data suggest that a caregiver-identified child sleep problem at age 6-16 months corrected is linked to more frequent challenging child behaviors in toddlerhood (16-26 corrected months). Caregiver-identified child sleep problems and more night wakings also predicted later neurodevelopmental concerns. Sleep problems in premature infants may thus be an early indication of later behavioral and neurodevelopmental issues.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0791
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0942 Sleep duration benefits for Spanish-speaking Hispanic/Latine
           respondents of the 2020 BRFSS

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      Pages: A415 - A416
      Abstract: IntroductionHabitual sleep duration is associated with many aspects of health. Previous studies show that some groups of Hispanic/Latine Americans are somewhat protected from sleep disparities seen in other groups, but also that this may depend on acculturation. This study expanded this finding to nationally-representative data and explored some potential pathways that may link acculturation and sleep in Hispanics/Latinos.MethodsData from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used (N=309,548 provided complete data). Habitual sleep duration was self-reported in hours and converted to minutes for analysis. Race/ethnicity was self-reported as Non-Hispanic White, Black/African American, Hispanic/Latine, Asian/Pacific-Islander, American Indian/Alaskan Native, and Multiracial/Other. The Hispanic/Latine group was further divided into those who chose to complete the survey in English versus Spanish. Covariates included age, sex, education level, household income, employment status, overall health, and mental health. Linear regression examined sleep duration (minutes) as the outcome, with race/ethnicity as the predictor. Race/ethnicity-by-covariate interactions were explored.ResultsCompared to non-Hispanic Whites, Blacks/African Americans reported 7.4 minutes less sleep (p< 0.0005), English-speaking Hispanics/Latine reported 4 fewer minutes (p=0.038), Spanish-speaking Hispanic/Latine reported 16.9 more minutes (p< 0.0005), Asians/Pacific Islanders reported 4.7 fewer minutes (p=0.042), no difference was seen for American Indians/Alaskan Natives, and Multiracial/Others reported 9.5 fewer minutes (p< 0.0005). Significant interactions were seen for age, education, income, employment, health, and mental health (all p< 0.05). Sleep duration benefits of speaking Spanish were evident especially in younger groups (under age 50, peaking age 30), those with more education, those with higher income, those in better health, those with fewer mental health problems, and those who were employed or were students.ConclusionSpanish-speaking Hispanics/Latine Americans were the only race/ethnicity group to report more sleep than non-Hispanic White adults and showed markedly different relationships versus when including English-speaking Hispanic/Latine adults. This advantage was differentially experienced, though, and depended on age, socioeconomics, and health status. Also, the BRFSS did not ask about primary household language nor English fluency. Future research is needed to explicitly explore acculturation-related explanations and develop linguistically- and culturally-targeted interventions for sleep health, especially for addressing apparent generational and socioeconomic differences.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0942
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0792 TigerCHAT: A School-Based Health Education Program Promoting Wellness
           and Sleep Health in a Rural Community

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      Pages: A349 - A349
      Abstract: IntroductionThere is increasing awareness of the importance of sleep for overall health and wellness in children. However, many children are still not getting the recommended hours of sleep necessary for optimal school functioning. The purpose of this project is to describe a school-based health education program (TigerCHAT) and identify common barriers to sleep in 10-11 year old students.MethodsTigerCHAT is a school-based health education program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after parental consent approved. It was implemented in a rural elementary school in Alabama in the fall of 2018. Eighty-two nursing students over 10 weeks led small groups of students in brief educational modules, including one on sleep, during their scheduled gym period. Before education began, 5th and 6th grade students (10-11 years old) filled out a 22 question “What Keeps Me From Sleeping Well” Questionnaire modified for children from the Sleep Environment Inventory that asked students to circle yes/no/NA.ResultsFrequencies and percentages were run on the data to determine common reasons for disrupted sleep. Children ages 10-11 years in 5th and 6th grade (n=363, 47% female, 53% male, 45.3% Black, 50.8% White, 0.4% Hispanic, 1.5% Asian or Pacific Islander, 68% classified as economically disadvantaged) in a rural elementary school filled out questionnaires. The most frequently cited reasons for not sleeping well included: Noise inside the house (55%, n=198); Room too hot or cold (50%, n=181); Phone calls or text messages during the night (49%, n=176); Needed to go to the bathroom (49%, n=177); The TV, radio, or computer was on (44%, n=160); and Worried about my family (41%, n=149).ConclusionStudents in this sample overwhelmingly endorsed environmental disrupters as reasons for not sleeping well (temperature of room, presence of noise, phone/technology in room), rather than other stressors on the questionnaire (worry about grades, worry about friends) or physical factors (stomach ache). Environmental factors such as the use of phones and social media should be examined further in this population, as it may be a significant, and potentially modifiable, reason for poor sleep in school age children.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0792
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0793 Effect of Sleeping Position on Obstructive sleep apnea in Children
           Undergoing Polysomnography

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      Pages: A349 - A350
      Abstract: IntroductionObstructive sleep apnea (OSA) in children is characterized by partial or complete upper airway obstruction during sleep, associated with gas exchange abnormalities and disrupted sleep with well-recognized neurobehavioral, neurocognitive, cardiovascular consequences. Positional obstructive sleep apnea (POSA) is defined as a lower AHI (by 50%) in the non-supine position than in the supine position. POSA has been well described in adults, affecting about 55% of adults with OSA. This occurs because airway collapse is maximal in the supine position compared to lateral or prone positions in this subset of patients with significant reduction in airway dimension occurring antero-posteriorly compared to circumferential reduction in airway dimension. However, POSA has not been well studied in children.MethodsIn this single center retrospective study, data was collected from one hundred consecutive polysomnographic studies from children (6-18 years) with moderate and severe OSA. Mean age was 10.7 years with 50% males in our cohort. Regression analysis was performed to study the relationship of sleeping position with the following variables: Age, sex, BMI, neck circumference, AHI, and desaturation index (DI) in supine and non-supine positions.Results60% of the patients in our study had significantly lower (by 50%) AHI and DI in non-supine position. This effect was seen in both moderate and severe OSA, though the effect was higher with increasing AHI and BMI. The effect of sleeping position persisted even when corrected for time spent in each position.ConclusionMost of the children in our cohort showed significant reduction in OSA in non-supine sleeping position. Positional therapy (PT), being a low-cost and non-invasive intervention is a reasonable approach in patients who demonstrate differences in AHI, oxygenation, and ventilation. Identifying the OSA phenotype and the subset of OSA patients likely to benefit from non-supine position increases the success of PT. PT may be helpful in situations where adenotonsillectomy may not be indicated and CPAP may not be well tolerated, not desired by the patient, and/or not sufficient to improve OSA. We intend to perform further analysis to study the effect of position on gas exchange and identify the phenotype who may benefit from PT in a larger cohort.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0793
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0943 Sleep Medicine Tweet-by-Tweet, an Electronic Platform for
           Collaborative Medical Education

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      Pages: A416 - A416
      Abstract: IntroductionTwitter is a novel and accessible platform for the dissemination of medical education, and it is used by many medical practitioners (1). Many physicians have used Twitter as a means of meeting continuing medical education needs. This can manifest as Twitter-based Journal Clubs, curated conference data and webinars (2).MethodsI have created a Sleep Medicine Medical Education Twitter account @SleepyNeuroDoc to share complex cases in all areas of sleep medicine, including sleep-disordered breathing, movement disorders in sleep, circadian rhythm disorders and nocturnal epilepsy. I share notable images of polysomnogram outputs, home sleep apnea tests, compliance data, neuro-imaging, electroencephalogram, cardiopulmonary coupling and more. This digital education platform allows rapid circulation of unique cases and promotes in-depth scholarly discussion, with no geographical limit. Polls are conducted for complex topics to facilitate knowledge exchange and consumer engagement. This educational twitter is followed by the entire spectrum of professions within the sleep medicine care team, including physicians, allied health, and researchers. To date, there are 40 cases posted.ResultsWe conducted online questionnaires with consumers of this Twitter account, and the results so far indicate greater practitioner comfort with management of various sleep medicine conditions. Some consumers report having changed their approach to practice.ConclusionOur work suggests that this unique use of a social medical platform is beneficial for continuing medical education and knowledge exchange in the field of Sleep Medicine. References: 1. Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011;305(6):566-568. 2. Thamman R, Gulati M, Narang A, et al. Twitter-based learning for continuing medical education' Eur Heart J. 2020;41(46):4376-4379.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0943
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0944 Telemedicine (TM) to provide outpatient care for sleep disorders in
           complex neurological patients in an academic Medical Center

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      Pages: A416 - A417
      Abstract: IntroductionSince the widespread adoption of telemedicine (TM) as a reimbursable option for the delivery of healthcare, (particularly clinic visits), the field of sleep medicine has been a beneficiary. In complex neurological patients, it was hypothesized that physical and cognitive constraints would limit the use of TM. This analysis was undertaken to evaluate patient care strategies in an academic neurology department based in a large metropolitan cityMethods2964 adult patients who opted for neurology clinic visits via video TM in the last 6 months were included from electronic medical record review at the University of Texas Health Sciences Center in Houston. Of these, 557 were seen in sleep medicine specialty. A successful visit was defined as a simultaneous connection of at least 2 parties for a minimum duration of time defined by institutional guidelines. Patients were analyzed in age subgroups (< 30, 31-50, 51-70 and >70 years of age) as well as race (Asian, Black, Hispanic, White and Others). Neurological diagnoses in these patients included stroke, epilepsy, movement disorders, cognitive disorders, neuromuscular conditions and less commonly multiple sclerosisResultsSleep medicine providers comprise of 2/53 (3.7%) of the department’s clinical providers, but accounted for 18.7% of TM visits. 97% (182/186) of new patients and 95% (354/371) of established patients had successful TM visits. Among general neurology patients, these numbers were 89% and 88% respectively. There was a statistically significant difference between successful visits in the sleep medicine and overall neurology patient groups (p value 0.0003 for new, 0.0001 for established patients). Among sleep medicine patients, percentage failures were 2.9, 3.3, 4.1 and 3.9 among the respective age groups. Percentage failures across the respective racial groups were 0, 6.1, 4.8, 4.2 and 1.9. Reasons cited for unsuccessful visits included camera, microphone and general hardware failures. Surprisingly network failure was not reportedConclusionThe success of telemedicine clinic visits for the management of sleep disorders is not impacted by physical and cognitive impairment in patients with complex neurological conditions. Further analysis to include success of sleep diagnostics and treatment of sleep disorders (start-to-finish pathway), via telemedicine in this complex population is underwaySupport (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0944
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0794 Effect of Surgical OSA Treatment on Periodic Limb Movements of Sleep
           in Pediatric Patients

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      Pages: A350 - A350
      Abstract: IntroductionThe relationship between obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS) is not completely understood, especially among pediatric patients. Previous research describes varied changes in PLMS following OSA treatment, including increased, decreased, or unchanged PLMS frequency. This study aimed to evaluate the effect of surgical OSA treatment on the periodic limb movement index (PLMI) in pediatric patients with OSA and significant PLMS.MethodsRetrospective chart review was performed to identify pediatric patients who had polysomnography demonstrating significant PLMS (PLMI ≥ 5/hour) and OSA (obstructive apnea-hypopnea index (OAHI) ≥ 1.5/hour) that was treated with upper airway surgery. Patients aged 1-18 years were included if significant PLMS was present on either pre-treatment or post-treatment polysomnograms between 1/1/2010 and 7/31/2022. Patients were evaluated for changes in PLMI and OAHI between a pre- and post-treatment polysomnogram, each obtained within 12 months of OSA treatment. Patients with inadequate sleep time (< 2 hours) were excluded. Data are reported as mean ± standard deviation and results from mixed effect linear models.ResultsMedical record review identified 198 patients. The average age was 5.3±3.8 years (range 1.1-16.9 years) at pre-treatment polysomnogram, including 129 (65.2%) male patients. Adenotonsillectomy was the most common OSA treatment (n=136). For the whole group, the OAHI decreased from 12.3±15.3 to 5.3±8.1/hour and the PLMI increased from 5.5±8.5 to 7.0±8.7/hour after treatment, for an average PLMI increase of 1.5/hour (SE=0.7, p=0.04). Sub-group analysis of patients with decreased OAHI following treatment (n=152) showed an average PLMI increase of 2.3/hour (SE=0.8, p=0.004), while patients with increased OAHI following treatment (n=44) did not show a significant change in PLMI. There were 74 patients (37.4%) who developed significant PLMS following treatment and 36 patients (18.2%) with significant PLMS before and after treatment.ConclusionEffective OSA treatment led to increased PLMI among a majority of children, highlighting the potential for unmasking of PLMS in some pediatric patients with OSA. Furthermore, over one third of patients developed polysomnographic criteria for significant PLMS after OSA management. This may suggest a sub-group of children with OSA who have a PLMD phenotype that may not become apparent until appropriate OSA treatment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0794
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0714 Machine learning model for Predicting phenoconversion in patients
           with Rem behavior disorder using clinical markers

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      Pages: A313 - A314
      Abstract: IntroductionIdiopathic Rapid eye movement (REM) sleep behavior disorder is a condition that can be an early sign of alpha-synuclein-mediated neurodegenerative diseases, and the course of the disease can vary greatly from patient to patient. It is important to identify patients who are at risk of developing neurodegenerative diseases in the future for the purpose of future clinical trials and for patients to plan their lives accordingly. Previous research has identified various risk factors for phenoconversion in RBD patients, but these studies are not practical for use in clinical settings due to resource availability or the rarity of certain features. Additionally, most of these studies have been conducted on non-Asian populations, which may have different genetic backgrounds than Asian populations. This study aimed to develop a machine learning model to predict survival in RBD patients using clinical features commonly available in routine clinical settings.MethodsThis study recruited patients diagnosed with RBD based on polysomnography results and collected 34 features for each patient. Missing data were imputed and various models were applied to the data to improve performance. The model's predictive performance was evaluated using an integrated Brier score and the concordance index. Mean performance indicators were calculated from 5-fold cross-validation results. A web application hosting the final prediction model was developed and deployed on a server for use by physicians or patients.Results173 patients were included in the study. We used the likelihood ratio test to calculate the p-values of all variables and selected the following 8 variables with p-values less than 0.1: UPDRS part III, age, history of antidepressant use, history of alcohol use, MoCA (Montreal Cognitive Assessment), PSQI-TST (Pittsburgh Sleep Quality Index - total sleep time), AHI-REM (apnea-hypopnea index - REM sleep), and education level. The random survival forest model had the best mean IBS of 0.07 and the best C-index of 0.93ConclusionWe showed that it is possible for a machine learning model to predict phenoconversion in patients with RBD using features that are commonly available in routine clinical settingsSupport (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0714
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0839 Does CBT-I Dose Improve Depression and Anxiety in Patients Diagnosed
           with Breast and Prostate Cancer'

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      Pages: A369 - A370
      Abstract: IntroductionIt has been widely reported in the literature that insomnia, depression, and anxiety are reciprocally related, and that CBT-I not only improves insomnia but also symptoms of depression and anxiety. With respect to cancer, patients of-ten report high co-morbidity of insomnia, fatigue, depression, and anxiety, with fatigue occurring in almost all patients diagnosed with cancer (irrespective of diagnoses and staging) and extending well into survivorship. The underlying mechanisms of fatigue are not well understood and, as such, there could be many contributing factors (e.g., insomnia and mood disturbance). The present analysis is based on a pilot study evaluating whether sleep continuity and CRF is improved by CBT-I dose (4 & 8 [Low dose] vs 10 & 12 [High dose] sessions). The present analysis evaluates whether dose of CBT-I effects depression and anxiety in patients diagnosed with breast and prostate cancer.MethodsThis descriptive analysis (percent change from pre to post treatment) includes 12 adult subjects (83.3% female, Mage 58.4±7.5yrs.; [Low dose, n=6], [High dose, n=6]). CBT-I was provided by a master therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries and weekly measures of fatigue (FACIT), insomnia severity (ISI), depression (PHQ-9), and anxiety (GAD-7).ResultsOn the PHQ-9, subjects in the Low dose group exhibited a 57% improvement and subjects in the High dose group had a 52% improvement. On the GAD-7, this corresponded to a 26% improvement (High dose group) and 25% improvement.ConclusionAs increasingly reported in the literature, CBT-I produced robust effects on depression as assessed by the PHQ-9. The effects on anxiety appear to be less robust. This may be the case because CBT-I’s effects on fatigue are likely to impact a variety of depressive symptoms, where this is less the case for anxiety. Analyses are ongoing, where the relative effects will be adjusted for insomnia-related items and rendered in terms of effect sizes.Support (if any)5T32HL00795320;K24AG055602
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0839
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0715 Machine Learning Model to Predict Isolated REM Sleep Behavior
           Disorder Phenoconversion Time and Subtype using EEG

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      Pages: A314 - A314
      Abstract: IntroductionMore than 80% of patients of isolated rapid eye movement (REM) sleep behavior disorder (iRBD), a prodromal disease of α-synucleinopathies, progress to neurological disease like Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Resting-state EEG measurements taken at baseline have been related to the phenoconversion. The timing of the conversion and the disease to which it will convert are crucial issues in iRBD. This work used baseline EEG in iRBD to create a prediction model for the phenoconversion time and subtype of α-synucleinopathy.MethodsResting-state EEG and neurological assessments were performed at baseline on patients with iRBD. EEG spectral power, Shannon entropy and weighted phase lag index were employed as features. Four models were used to predict subtypes for the PD-MSA and DLB groups, and three models were used to predict survival. External validation was also performed.Results29 patients out of 143 who were followed up to nine years (mean 3.4 years) later developed α-synucleinopathies (14 PD, 9 DLB, 6 MSA). With a concordance index of 0.8130 and an integrated Brier score of 0.0921, the random survival forest was the best model for predicting survival. For the subtype prediction analysis, the model with the highest accuracy, extreme gradient boosting, had an accuracy of 86.52%. Both models indicated a high importance on EEG slowing related features.ConclusionIt is possible to predict the timing and subtype of phenoconversion in iRBD using machine learning models of using EEG biomarkers. To confirm our findings, further study is required, including large sample data from various countries.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0715
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0860 Comparative description of sleep, thyroid-stimulating hormone and
           calcium metabolism in 5 vitiligo patients under phototherapy

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      Pages: A379 - A379
      Abstract: IntroductionVitiligo is an autoimmune skin disease represented by melanocytes destruction. Clinically, it evolves with spots that are lighter than normal skin color. Periodical evaluation of patients is recommended, including thyroid function. Phototherapy is its gold standard treatment, consisting in specific range of ultraviolet B (UVB) light sections. Sleep may play an immunological role, and should be investigated in vitiligo. The study aimed to compare results of thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium and vitamin D 1.25(OH)2D and 25(OH)D; and Pittsburgh Sleep Quality Index (PSQI) scores of vitiligo patients before and after phototherapy period.MethodsFive individuals with vitiligo were evaluated at a University Dermatology Service, following ethical guidelines. Blood collection and PSQI application were performed before and after phototherapy. Laboratory elements were those related to calcium metabolism (PTH, calcium and vitamin D) and TSH.ResultsThe sample included 4 female individuals with 21, 46, 65 and 70 years old; and a 57 years old male. Three of them had large skin involvement and 2 had localized vitiligo. After 6 months under phototherapy, patients returned for reassessment. All showed skin lesions improvement. Quantitative increase in TSH, PTH, 1.25(OH)2D and 25(OH)D was observed; serum calcium varied among the sample. Regarding PSQI before phototherapy, all 5 scores were >5 (1 score>10). The PSQI was reapplied only in 3 of the 5 volunteers after phototherapy; 2 scores reduced, and 1 score increased. This results, although from few individuals, alert to the possible role of UVB phototherapy on TSH and calcium metabolism substrates. Vitamin D increase may be associated to improvement of subjective sleep of 2 individuals. It was described that vitamin D in sufficient concentration could be related to better sleep quality. Phototherapy, by acting on clinical improvement of vitiligo, may influence subjective sleep, as reported in PSQI; and it could influence on melatonin and circadian rhythm.ConclusionThe interaction between vitiligo/autoimmunity, phototherapy, vitamin D and sleep is complex and may have interrelated pathways. A better understanding of this pathophysiology through larger studies is worthy for benefiting clinical management of vitiligo and associated sleep disorders.Support (if any)AFIP, CAPES and CNPq.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0860
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0716 Quality of Life in Idiopathic REM Sleep Behavior Disorder and
           Isolated REM Sleep Without Atonia

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      Pages: A314 - A314
      Abstract: IntroductionIdiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) can affect quality of life (QOL) for both patient and bed partner; isolated REM sleep without atonia (iRSWA) has been less well-studied. We aimed to investigate whether QOL changes over time in those with either iRBD or iRSWA, as well as compare these changes to one another. Additionally, we attempted to demonstrate whether certain QOL changes were associated with phenoconversion to neurodegenerative illness.MethodsWe prospectively analyzed data from the “REM Sleep Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS)” cohort both at baseline and then at follow-up evaluations. We utilized the Neuro-QOL self-reported questionnaire to ascertain subjects’ level of QOL.ResultsThere were 6 with iRSWA and 33 with iRBD, with an average age of 61.9 ± 13.0 years, with 13 women and 26 men. Significant QOL changes were found in both iRSWA and iRBD group. Among those who phenoconverted, fatigue and social functioning were the main QOL issues that that worsened over time.ConclusionThis is the first time the Neuro-QOL has been studied in iRBD and iRSWA. QOL can be affected in both conditions; fatigue and social functioning seem to be of particular importance as they may be associated with phenoconversion.Support (if any)Grant from a private individual
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0716
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0861 Does Cognitive Behavioral Therapy for Insomnia Reduce Productivity
           Loss in Cancer Survivors with Cognitive Impairment'

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      Pages: A379 - A380
      Abstract: IntroductionInsomnia and perceived cognitive impairments (PCI) affect 1 in 4 cancer survivors and negatively affects work productivity. This study explores the impact of cognitive behavioral therapy for insomnia (CBT-I) on work presenteeism and absenteeism in cancer survivors with comorbid insomnia and PCI.MethodsA sub-sample of 42 Atlantic Canadian survivors with insomnia disorder and PCI who were currently working for pay were analyzed as part of a larger randomized clinical trial. Participants completed 7 virtual sessions of CBT-I. The Work Productivity and Activity Impairment Index Specific Health Problem Questionnaire (WPAI: SHP) was administered pre-and post-treatment. Absenteeism was defined as the percentage of time absent from work, while presenteeism was defined as the extent to which health problems affected productivity at work in the past 7 days. Costs were calculated by the human capital method. Significant changes in productivity loss were defined at ≥15% or 20% change in absenteeism and presenteeism, respectively. Descriptive statistics and paired samples t-tests were used to measure changes in productivity following treatment. Average net benefit was calculated by subtracting the average treatment cost from average treatment benefits after 1 year to reflect cost savings after CBT-I. The cost of treatment was estimated in terms of average cost per session and lost time at work.ResultsParticipants (76% Female) were, on average, 50.4 years old with 16.6 years of education. Breast cancer was the most reported cancer type (43%). Overall rates of presenteeism were significantly lower at post-treatment (p=<.001, d=0.55), with 52.4% reporting significant reductions. Absenteeism rates from pre- to post-treatment were not significant (p=.11, d=0.20). Reduced productivity loss post-treatment was associated with an average savings of CAD$10,979/person/year. Average net benefits for the first-year post-treatment equaled CAD$9348/person.ConclusionCBT-I can improve work productivity in cancer survivors. Investments to increase and provide access to evidence-based treatment may lead to significant savings for individuals and businesses.Support (if any)Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0861
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0717 Restless sleep associated with low ferritin levels: A Retrospective
           Study in a Pediatric Sleep Center

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      Pages: A314 - A315
      Abstract: IntroductionA significant challenge in diagnosing Restless Leg Syndrome in children is the child’s inability to verbally describe their symptoms. In our pediatric sleep clinic, it has been recognized that restless sleep is a routine element of the clinical history for children presenting with a wide range of sleep disturbances. A literature review showed substantial literature about the prevalence and characteristics of restless sleep in children, but there is little showing the effect of ferrous sulfate on symptoms in children. A deficiency of brain iron stores results in a reduction of dopamine production and the clinical expression of RLS. Brain iron stores cannot be directly quantified for clinical purposes but can be evaluated indirectly by measuring serum ferritin. In the clinical framework of RLS, it is generally accepted that a serum ferritin < 50 ng/ml is too low, despite still being considered within normal range for most reference labs and replacing this with oral elemental iron should be considered the first line treatment.MethodsA retrospective chart review was performed of patients seen in the Sleep Clinic at Arkansas Children's Hospital from 2018-2021 who had a report of restless sleep and a serum ferritin drawn. If the ferritin was lower than 50 ng/ml, they were treated with ferrous sulfate for a minimum of three months. After three months, patient’s symptoms were reevaluated, and ferritin levels drawn to determine if improvement had occurred.ResultsIn total, 1,000 charts were reviewed. Ferritin levels < 50 ng/ml were found in 75.2% of the patients. Of the patients with a serum ferritin >50 ng/ml after treatment with ferrous sulfate, 62.8% reported an improvement in restless sleep and 37.2% reported no change in symptoms.ConclusionLow ferritin levels were found in a large number of our pediatric patients with restless sleep. The administration of ferrous sulfate in the patient population showed an improvement in symptoms of restless sleep in a majority of patients.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0717
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0758 Initial Efficacy of a Brief, Trauma-Informed Sleep Intervention for
           Children in Foster Care

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      Pages: A334 - A335
      Abstract: IntroductionChildren in foster care experience impairing sleep problems that contribute to greater attachment, emotional and behavioral problems concurrently and over time. Sleep nonetheless remains a critically neglected aspect of health among this vulnerable group. To address the unique sleep needed of this population, we developed a brief, telehealth-delivered behavioral sleep intervention for caregivers of young children currently or formerly in foster care, called Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T). The current study examined the initial efficacy of SAFE-T.MethodsN = 25 foster or adoptive foster parents with a 2- to 5-year-old child (M = 3.9; SD = 1.7) were recruited from the state of Texas. After a baseline assessment including the Children’s Sleep Habits Questionnaire (CSHQ) and Parenting Stress Index (PSI), families were randomized to SAFE-T or an active control group. SAFE-T families (n = 14) received 3 telehealth-delivered sessions with a therapist who provided information about healthy sleep and trauma-informed suggestions for reducing child sleep problems. Control families (n = 11) were sent an informational booklet about sleep to keep. A post-treatment assessment was completed approximately one month after he initial assessment.ResultsCompared to the control group, the SAFE-T group evidenced greater reductions in total CSHQ sleep problem scores (η2 = .14), including Sleep Anxiety (partial eta squatted = .16), Sleep Onset Delay (η2 = .08), Bedtime Resistance (η2 = .09) and Daytime Sleepiness (η2 = .07) scores at post treatment. Based on the PSI, caregivers in the SAFE-T group reported greater reductions in Difficult Child scores (η2 = .35), Parent-Child Dysfunctional Interactions (η2 = .31) and Parenting Stress (η2 = .16) compared to the control group.ConclusionMedium to very large effects were found for reductions in caregiver-reported child sleep problems as well as parenting stress following intervention with SAFE-T. These promising results suggest that a brief, trauma-informed sleep intervention may be effective in improving child sleep health and caregiver well-being in foster families.Support (if any)This study was funded by the Grant to Enhance and Advance Research (GEAR) from the University of Houston.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0758
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0894 Impulsivity across early stages of synucleinopathy: from high-risk
           relatives, REM sleep behavior disorder to Parkinson’s disease

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      Pages: A394 - A394
      Abstract: IntroductionIncreased impulsivity is a common neuropsychiatric feature in patients with Parkinson’s disease (PD), especially attributed to the use of dopaminergic medications. Interestingly, emerging evidence suggested that impulsivity had changed in drug-naïve PD patients. However, it remains unclear whether impulsivity has been altered in prodromal stage of PD, namely isolated rapid eye movement sleep behavior disorder (iRBD) and their high-risk relatives.MethodsThis was a cross-sectional study with four groups of subjects, including early drug-naive PD patients, patients with iRBD and their first-degree relatives (iRBD-FDRs, a high-risk group with potential prodromal RBD features), and controls. A panel of neuropsychological computerized tasks, including go/no-go task, four-choice serial reaction time task (4CSRTT), beads task, balloon analogue risk task (BART) and delay/effort discounting task, would measure various dimensions of motor and decisional impulsivity.ResultsA total of 331 subjects were recruited, including 27 early drug-naïve PD patients (mean age ± SD: 70.1 ± 5.8 years, 77.8% man), 152 iRBD patients (67.2 ± 6.6 years, 77.6% man), 68 iRBD-FDRs (63.2 ± 6.4 years, 51.5% man), and 84 controls (67.4 ± 8.1years, 61.9% man). Early drug-naïve PD and iRBD patients had fewer numbers of extracted beads in beads task 1 (P< 0.001) and task 2 (P< 0.001) in making decisions and fewer numbers of pumps of unexploded blue balloons in BART (P< 0.001) than controls and iRBD-FDRs, suggesting a higher level of reflection impulsivity and a lower level of risk taking, respectively. In addition, early drug-naïve PD and iRBD patients had more no-go errors in go/no-go task (P=0.023), suggesting a marginally lower level of response inhibition in PD and iRBD groups. Early drug-naïve PD and iRBD patients had more premature responses in 4CSRTT than iRBD-FDRs (P=0.008). The delay and effort discounting indexes were comparable among four groups.ConclusionWhile risk taking and response inhibition decreased, reflection impulsivity actually increased in iRBD and drug-naïve PD patients. These novel findings indicated that a complex construct of altered impulsivity has already occurred at the earlier stage (at iRBD) of α-synucleinopathy, which will have implications for pathophysiology and clinical management.Support (if any)This study has been supported by the General Research Fund (14116119).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0894
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0759 Multidimensional Sleep Health is Associated with Emotional Well-being
           in Adolescents

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      Pages: A335 - A335
      Abstract: IntroductionMultidimensional sleep health (MSH) is a population-based approach to capture the 24-hour experience of sleep by incorporating measures of nighttime sleep and daytime functioning that promote physical and mental well-being. We have updated the existing adolescent MSH model to incorporate objective and subjective sleep measures and, in the present study, examined its utility in identifying associations between MSH and behavioral and emotional well-being.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. Using the RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – we derived an MSH composite score based on actigraphy-measured and self-reported sleep data. We examined the associations between MSH and scores on both the adolescent version of the Child Behavior Checklist (CBCL) and on the Pediatric Behavior Scale (PBS). CBCL’s internalizing, externalizing, thought and attention problems scores were self-reported, while similar behavioral and emotional cluster scores on the PBS were parent-reported.ResultsHigher MSH scores were associated with lower thought (r=-0.21, p< 0.001), externalizing (r=-0.18, p< 0.001), attention (r=-0.16, p< 0.01) or internalizing (r=-0.12, p< 0.05) problems. Higher MSH scores were associated with lower scores on the rule-breaking (r=-0.27, p< 0.001) and aggressive (r=-0.21, p< 0.001) externalizing subscales. For the internalizing subscales, higher MSH scores were associated with lower anxious-depressed (r = -0.17, p< 0.01), withdrawn-depressed (r=-0.14, p< 0.01), and somatic complaints (r=-0.12, p< 0.05) scores. Analyses based on parent reports on the more fine-grained PBS cluster scores replicated CBCL’s associations; for example, higher MSH scores were associated with lower depression (r=-0.19, p< 0.01) and inattention (r=-0.12, p< 0.05) as observed by parents.ConclusionOptimal sleep health, when considered as a multidimensional construct, is associated with emotional well-being and better behavioral outcomes in adolescents. Our MSH model, derived from objective and subjective sleep metrics, is able to capture similar trends from self-report and parent-report measures of emotion and behavior.Support (if any)National Institutes of Health (R01HL136587, UL1TR000127)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0759
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0895 Pharmacokinetics of pitolisant in breast milk and serum of healthy
           lactating women

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      Pages: A394 - A395
      Abstract: IntroductionPitolisant is a potent and highly selective histamine-3-receptor antagonist/inverse agonist approved for the treatment of excessive daytime sleepiness or cataplexy in adult patients with narcolepsy. A phase 4, open-label study was conducted to evaluate the pharmacokinetics (PK) of pitolisant and its major metabolite, BP1.3484, in breast milk and serum following a single dose of pitolisant administered to healthy lactating women.MethodsIn this study, eight healthy lactating women (aged 22-42 years) who met eligibility criteria were enrolled and received a single oral dose of pitolisant (35.6 mg). Serial breast milk samples were collected at pre-dose on Day 1 and at various intervals through 24 hours post-dose. Serial blood samples for PK analyses were collected at pre-dose and through 120 hours post-dose. Since the total infant dosage calculated from single dose data may be under-estimated, steady-state serum concentrations were predicted using noncompartmental methods and then multiplied by the 24-hour breast milk:serum ratio (AUCBM/S) to estimate a more appropriate total infant dose.ResultsPitolisant was excreted in breast milk, with mean CmaxBM/S and AUCBM/S ratios of 85.2% and 123%, respectively. Concentrations of pitolisant in breast milk were only slightly lower than concentrations in serum. However, since the volume of breast milk was low, the percentage of the maternal dose expressed in breast milk was very low. Steady state calculations for a 6-month-old infant resulted in a mean total infant dosage of 0.005 mg/kg/day (SD 0.002), which is 1.15% of the maternal dose. For BP1.3484, maternal exposure and the calculated mean daily infant exposure were much lower than pitolisant. All subjects completed the study as planned. Five subjects (62.5%) reported a total of 8 treatment-emergent adverse events, which were mild in severity and resolved by end of the study.ConclusionPitolisant is present in human milk, but the mean daily infant dosage in a 6-month-old infant after steady-state dosing of pitolisant in healthy lactating women was estimated to be very low. Overall, a single oral dose of pitolisant 35.6 mg was well-tolerated in healthy lactating women.Support (if any)The study was sponsored by Harmony Biosciences LLC.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0895
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0760 Applying machine learning to examine settling down period for
           children with and without sensory hypersensitivities

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      Pages: A335 - A336
      Abstract: IntroductionChildren with sensory hypersensitivities have poorer subjective sleep health than their peers. However, traditional actigraphy variables (e.g., sleep efficiency, sleep duration) do not adequately capture these sleep deficits. In qualitative interviews, caregivers of children with sensory hypersensitivities identified the settling down period prior to sleep as a major family stressor, potentially indicating a novel target for intervention. We applied machine learning techniques to thoroughly characterize and discriminate differences in the settling down period for children with and without sensory hypersensitivities.MethodsChildren (ages 6-10) with sensory hypersensitivities (n=20) and children without sensory hypersensitivities (n=29) wore the GT9X Actigraph continuously for 2 weeks and caregivers completed daily sleep diaries. Settling down period (caregiver reported start of settling down until actigraphy indicated sleep onset) was isolated for each night and 7 features were extracted from the activity data (mean magnitude, maximum magnitude, kurtosis, skewness, Shannon entropy, standard deviation, interquantile range). Ten-fold cross-validation with random forests were used to determine the accuracy, sensitivity, and specificity of differentiating groups.ResultsWe achieved an 83% accuracy in classifying children with sensory hypersensitivities versus those without hypersensitivities (sensitivity = 84%; specificity = 82%). Feature importance maps showed that the most important feature for differentiating groups was maximum activity count magnitude during the settling down period; children with sensory hypersensitivity had higher maximum bouts of activity during settling down. The hypersensitive group also showed a higher variance in activity during settling down, as demonstrated by greater interquartile range (variance within the time window), standard deviation of activity, and Shannon entropy (the amount of uncertainty in the time window).ConclusionOur novel machine learning analysis successfully uncovered objective features within the settling down period that differentiate children with sensory hypersensitivity from their peers. Our data highlights exciting new potential targets for intervention: children with sensory hypersensitivities have larger and sporadic bouts of activity during their settling down period that clearly set them apart from their peers without hypersensitivities.Support (if any)T32 HL082610, University of Pittsburgh School of Rehabilitation Science Doctoral Award (PI Hartman), Sensory Integration Education PhD Student Grant (PI Hartman).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0760
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0918 Elevated stress during the first-year of medical school negatively
           impacts sleep quality

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      Pages: A405 - A405
      Abstract: IntroductionPoor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Stress contributes to poor sleep quality and is commonplace in medical education. This study sought to understand how stress impacts sleep among first-year medical students.MethodsA one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Highly prevalent anxiety was defined as feeling nervous/anxious/on edge for more than half of the days during the previous two weeks. Odds ratios (OR) include 95% confidence intervals and were determined using binary logistic regression. Statistical significance was considered a p-value ≤0.05.Results138 of the 209 students (66%) in the first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. Short sleep was prevalent with a mean (standard deviation) sleep time of 6.85 (0.86) hours. Additionally, more than three-quarters reported suboptimal sleep: 56% rated quality as average, and 21% rated quality as poor/very poor. 33% of respondents reported difficulty falling asleep at least once per week. A lack of restorative sleep was also common: 38% felt that sleep was rarely or never refreshing. Over half of respondents (51%) attributed poor sleep to either stress or school, and 29% of students reported elevated or highly prevalent anxiety. Elevated anxiety predicted suboptimal sleep quality (OR 14.67, 1.70-126.76, p=0.015) and a lack of restorative sleep (OR 6.00, 1.52-23.71, p=0.011). Similarly, suboptimal sleep quality was associated with highly prevalent anxiety (OR 44.0, 4.62-418.93, p< 0.001) and difficulty falling asleep (OR 4.14, 1.76-9.75, p=0.001).ConclusionPoor sleep and stress are both prevalent during the first year of medical school, with students directly linking stress from their academic workload to impaired sleep quality and insufficient sleep duration. Due to the pervasiveness of stress within medical education, future interventions should help students improve their sleep during both low and high stress time periods.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0918
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0761 Differences in Sleep Barriers Between Summer and School in
           Adolescents with Type 1 Diabetes

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      Pages: A336 - A336
      Abstract: IntroductionSleep is recognized as an important component of health for people with type 1 diabetes (T1D), with significant associations identified between sleep quality, glycemic outcomes, and diabetes self-management. Adolescents, who are particularly vulnerable to insufficient sleep and have difficulty meeting glycemic targets, typically experience differences in sleep during the summer versus school months. We examined barriers to sufficient sleep during summer and fall months amongst adolescents ages 11-17 with T1D.MethodsAdolescents (n=10, mean age 14.1 years, 40% female, 80% non-Hispanic White) with T1D participated in qualitative, semi-structured interviews to explore seasonal differences in barriers to sleep. Interviews were audio and video recorded, transcribed using Otter-AI software with manual review for accuracy, independently coded by two trained research staff, and themes were identified.ResultsInterviews were completed by five adolescents during the summer and five during school months. Barriers to achieving sufficient sleep for both time periods included diabetes-related issues (e.g. hypoglycemic episodes, glucose variability, fear of hypoglycemia, and device use), peers, activities, and family factors. School, activities, family and diabetes disruptions were equally prominent barriers during the school year, whereas diabetes disruptions were the most common barriers during the summer. While device alarms disrupted sleep at both times, adolescents reported that diabetes technologies had an overall net positive impact on sleep during the school year due to reduced worry, but a neutral impact during the summer. Adolescents agreed it would be helpful to talk about sleep concerns or ways to improve sleep.ConclusionDiabetes management is a consistent reason for insufficient sleep duration in adolescents with T1D. In addition, similar to adolescents without T1D, academic, social, and family obligations were barriers to obtaining sufficient sleep during the school year. While some sleep disruptors may not be modifiable, assessment by a clinician who can provide guidance on methods to improve sleep health may be beneficial and well received. Because diabetes health care providers have frequent contact, routine visits provide an opportunity to identify sleep concerns and provide both diabetes and non-diabetes guidance to address sleep health. Further exploration of sleep behaviors and barriers in adolescents with T1D is warranted.Support (if any)5-ECR-2022-1179-A-N, JDRF and Helmsley
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0761
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0919 EMR-Integrated Clinical Pathway Improves Familiarity with Obesity
           Hypoventilation Syndrome Among Inpatient Clinicians

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      Pages: A405 - A406
      Abstract: IntroductionObesity hypoventilation syndrome (OHS) is an underrecognized chronic respiratory condition characterized by obesity (BMI > 30kg/m2) and hypoventilation (PaCO2 > 45mmHg) in the absence of other causes of hypoventilation. In OHS, obesity causes mass loading on the respiratory system, leading to CO2 retention, diminished ventilatory response, progressive hypoxia/hypercapnia, and eventual cardiopulmonary arrest. OHS is typically diagnosed while inpatient, wherein 18-month mortality approaches 23%. Non-invasive ventilation (NIV) improves OHS symptoms & prognosis which subsequently decreases healthcare utilization and mortality. With the proper tools and training, inpatient providers can facilitate accurate diagnosis and prompt treatment of OHS. Our team developed an EMR-integrated clinical pathway to increase recognition and facilitate treatment of OHS in hospitalized patients on the general medicine service.MethodsThe OHS Pathway was implemented among a large group of hospitalists at a tertiary academic medical center. A multi-disciplinary team of physicians, respiratory therapists, and care coordinators designed the pathway structure and content. Prior to integrating the OHS pathway into the EMR, hospitalists were surveyed to assess existing knowledge and experiences caring for patients with OHS. Hospitalists then participated in an educational series on OHS with orientation to the pathway. 12-months into the intervention, hospitalists were re-surveyed.ResultsSurvey data analysis revealed that providers were significantly more familiar with the diagnostic criteria for OHS after (n=40) the introduction of the clinical pathway rather than before the introduction (n=24) of the pathway (t (62) = 2.88, p = .0027). Subjective success rates for prescribing NIV to patients upon discharge did not significantly improveConclusionOHS diagnosed in the inpatient setting carries significant morbidity and mortality. Proper detection and prompt treatment of OHS are essential to improving the care and prognosis of this high-risk population. We demonstrate that our multi-disciplinary based, EMR-integrated clinical pathway increased provider familiarity with the diagnostic criteria for OHS. While treatment success did not significantly improve, numerous systems factors were at play, and further investigations are needed to address access to treatment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0919
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0762 Early life sleep characteristics and their associations with 1 to 5.5
           years old respiratory and allergic multi-trajectories

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      Pages: A336 - A337
      Abstract: IntroductionSleep troubles have been associated with respiratory and allergic health problems in children, however the time line of their association is overlooked. The current study examined the associations between: (1) sleep patterns at age 1 year and respiratory and allergic multi-trajectories between 1 and 5.5 years; (2) respiratory and allergic multi-trajectories between 1 and 5.5 years and sleep patterns at age 5.5 years in a French birth cohort.MethodsClusters of sleep characteristics at age 1 year (nocturnal sleep duration (NSD), day sleep duration (DSD), sleep onset difficulties (SOD), night awakenings (NA)) and at age 5.5 years (NSD, SOD, NA) and respiratory and allergic symptoms multi-trajectory groups between 1 and 5.5 years (wheezing, asthma medication, eczema, allergic conjunctivitis) were identified using unsupervised methods. Associations between sleep clusters at each age and multi-trajectory groups were assessed using multinomial regressions adjusted for potential confounding factors among 9,577 children.ResultsTwo sleep clusters were identified at both age 1 and 5.5 years: C1a (79.9%, age 1 year) and C1b (83.1%, age 5.5 years) characterized by adequate sleep duration and good sleep quality; C2a (20.1%, age 1 year) and C2b (16.9%, age 5.5 years) characterized by shorter sleep duration and poorer sleep quality. Four multi-trajectory groups were also identified: G1 (no/few symptoms, 44.4%), G2 (persistent non-respiratory allergic symptoms, 23.1%), G3 (transient early respiratory symptoms, 25.2%), G4 (persistent respiratory and allergic symptoms, 7.3%). Belonging to cluster C2a was associated with an increased odds of belonging to G3 (adjusted odds ratio [95% interval confidence]; 1.14 [0.99-1.31]) and G4 (1.29 [1.05-1.59]). After accounting for sleep clusters at age 1 year, belonging to G4 was associated with an increased odds of belonging to cluster C2b (1.21 [0.98-1.5]).ConclusionSleep disturbances at 1 year were associated with poorer respiratory and allergic health between 1 and 5.5 years and respiratory and allergic problems between age 1 and 5.5 years were associated with sleep troubles at 5.5 years suggesting bidirectionality. Further research is needed to explore potential coevolution of sleep and allergic and respiratory troubles during early childhood.Support (if any)ANR-21-CE36-0001-01
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0762
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0763 EFFECT OF RACIAL AND SOCIOECONOMIC DISPARITIES ON SLEEP DURATION IN
           CHILDREN

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      Pages: A337 - A337
      Abstract: IntroductionNational Survey of Children’s Health is a population-based, nationally representative online and paper survey of primary caregivers of noninstitutionalized U.S. persons aged ≤17 years. Data from 2016-2018 survey (MMWR 2021) published by the Center for Disease Control (CDC) highlighted the racial and economic disparities in sleep duration among children. Children from Black and Hispanic ethnicities had significantly lower sleep duration compared to their white counterparts. Short sleep duration was also more prevalent among families with lower income or lower parental educational attainment. We analyzed the data from questionnaires administered to parents of children presenting for polysomnogram.MethodsWe analyzed a consecutive sample of caregiver completed questionnaires (n=252) of patients between 4- 18 years referred for polysomnogram to our Pediatric Sleep Program. Questions ranged from demographic information to sleep wake times, sleep duration, sleep environment and parental knowledge of age-appropriate sleep requirement. Regression analysis was performed to study the effect of parental education and ethnicity on sleep duration and parental knowledge of sleep requirement.ResultsChildren born to mothers with college education or higher had significantly longer duration of sleep (p< 0.05). Mothers with college education or higher were also more aware of age-appropriate sleep requirements. (p< 0.05). Children of Asian, White, and Mixed ethnicity were more likely to have age-appropriate sleep duration compared to Black and Hispanic (p< 0.05). Parents of Asian and White ethnicity were more aware of age-appropriate sleep requirement (p< 0.05). Parental marital status or father’s education status did not show similar effects on sleep duration or knowledge about sleep requirement.ConclusionMaternal education and family ethnicity had a significant effect on sleep duration as well as awareness of age-appropriate sleep requirement. Children from families with lower parental educational attainment and Black and Hispanic ethnicities have shorter sleep duration. Findings from our small community-based study mirrored data from large population-based data collected by CDC. Sleep disparity associated with various social determinants of health can increase family stress resulting in environmental and psychological factors that negatively affect sleep duration. Targeted education regarding age-appropriate sleep duration should be provided for ethnic minorities and families with lower income and lower parental education attainment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0763
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0955 Evaluating state-of-the-art algorithms for sleep-wake classification
           using wrist-worn wearable devices

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      Pages: A421 - A421
      Abstract: IntroductionOver the last 40 years, a variety of algorithms have been proposed to classify sleep-wake from wrist acceleration data. Input features into these algorithms have been activity counts or raw acceleration. The algorithms proposed range from a single heuristic rule to logistic regression to machine learning and deep learning. The purpose of this work is to evaluate and compare the accuracy of these algorithms against polysomnography (PSG) annotations on a common dataset from a sleep laboratory.MethodsThe Newcastle PSG dataset was used to compare the various sleep-wake prediction algorithms to concurrent PSG annotations in thirty second epochs. This dataset contains 28 patients, 27 of which had wrist acceleration data for both the right and left wrist and one which had data for the left wrist only. Twenty of the participants had at least one sleep disorder. Sleep disorders included idiopathic hypersomnia, restless leg syndrome, sleep apnea, narcolepsy, sleep paralysis, nocturia, obstructive sleep apnea, RBD, parasomnia and insomnia.ResultsThe domain adversarial convolutional neural network (DACNN) model showed the best overall results (sens=83.9, spec=57.6, f1=81.7, WASO-RMSE=80.9). The next best performing model according to WASO-RMSE was Cole-Kripke (sens=81.4, spec=50.3, f1=78.0, WASO-RMSE=90.4). This was followed by the van Hees heuristic model (sens=83.6, spec=47.5, f1=79.1, WASO-RMSE=91.1). The fourth best performing model was the Random Forest model (spec=77.5, sens=55.5, f1=76.4, WASO-RMSE=93.0). The fifth best performing model was Sadeh (sens=82.6, spec=49.7, f1=78.5, WASO-RMSE=93.6). The sixth best performing model was the LSTM model (sens=78.6, spec=58.9, f1=77.8, WASO-RMSE=93.9). The worst performing model was the CNN model (sens=79.8, spec=54.2, f1=77.8, WASO-RMSE=99.8). * sens=sensitivity, spec=specificity, WASO=wake after sleep onset, RMSE=root mean squared errorConclusionThe DACNN algorithm outperformed all other algorithms on sleep-wake classification from wrist acceleration data. Despite being vastly different in input features’ types and algorithm complexity, all other algorithms performed similarly on the dataset, with f1 scores ranging from 76.4 to 79.1 and WASO-RMSE ranging from 90.4 to 99.8.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0955
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0764 End of daylight saving and sleep children 4-24 months

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      Pages: A337 - A337
      Abstract: IntroductionDaylight saving time (DST) imposes a twice yearly 1h change in local clock time. Although it may seem a small adjustment, there is increasing awareness of the potential acute and long term effects at the individual and population level. Several studies have shown detrimental effects on sleep patterns, but mostly focusing on adults. Only one study has looked at the effect in infants’ sleep of change from standard time (ST) to DST, reporting negative effects. One study limitation was the reliance on parental reports of infant sleep. In addition, effects of the change from DST to ST are unknown. We hypothesize that the change from DST to ST would lead to earlier rise times, leading to sleep loss in the week following the change.MethodsCaregivers of 510 children ages 3-24 mos (M=9.8 mos) tracked their child’s sleep using Nanit baby-monitor. Sleep metrics analyzed were: Nighttime sleep duration (NSD) and midpoint, number of night-wakings and sleep efficiency. Wilcoxon rank sum tests compared the average of each sleep metric for the week preceding the time change (Oct 31st-Nov 4th 2022, Baseline) with sleep metrics for each night of the following week (Nov 7-11 2022, post-DST week). Analyses were repeated stratifying by age group (4-6,7-12 and 13-24 months).ResultsAfter the time change, there was no change in NSD or sleep efficiency. There was a significant decrease in the number of night-wakings for infants 3-6 months, with an average of 0.5 fewer wakings per night compared to Baseline (Baseline mean=5 wakings). Midpoint was significantly earlier for all ages by an average of 10min, every day of the post-DST week.ConclusionThe return to ST affected infants’ sleep midpoint. Observed effects were minor compared to those reported in previous literature for the ST to DST change, in line with other fields like cardiovascular health. This easier adjustment could be attributed to the fact that during DST there is an increased mismatch between body clock and social clock time, thus infants more readily adjust to a return to ST which minimizes this mismatch.Support (if any)This research was supported by Nanit
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0764
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0956 Evaluation of a novel automated oxygen desaturation analysis

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      Pages: A421 - A422
      Abstract: IntroductionThe oxygen desaturation index (ODI) quantifies the number of desaturations per hour of sleep and is a valuable parameter in diagnosing sleep-related breathing disorders. While oximetry alone is insufficient for an accurate diagnosis, it provides meaningful insights for Obstructive Sleep Apnea (OSA) and the ODI has been shown to correlate with the Apnea-Hypopnea Index (AHI). The close relationship between the ODI and other parameters is especially interesting for home-based sleep studies and/or screening, which typically use a limited set of sensors (but almost always include oximetry) and are becoming increasingly more prevalent. An accurate and automated tool for oximetry analysis will thus be paramount for the sleep clinician.MethodsThe current study aims to evaluate a novel automated solution for oxygen desaturation scoring, provided by Somnilog. We selected 20 overnight recordings, a mix of hospital- and home-based recordings from a dataset from the Antwerp University hospital and an internal database collected from several French sleep centers. The analyzed population (10 females, age 53.0±16.7 years old, BMI of 28.8±4.8 kg/m²) had a variety of diagnoses, including non-apneic snoring and central and obstructive sleep apnea. Each recording was also scored for oxygen desaturations by a sleep expert, using the AASM guidelines and a 3% drop criterion.ResultsThe automated solution accurately detected desaturation events with a precision and recall of 0.97 and 0.96, respectively. The reported ODI had an intraclass correlation (ICC) of 0.99 with the index found by the expert. The difference in the number of events reported by the automated solution and the expert was not significant between the lab- and home-recorded patients (p=0.23). We furthermore validated the novel solution with another well-used commercial package and obtained similar performance metrics: precision and recall of 0.96 and ICC of 0.99.ConclusionThe current study demonstrates the validity of the novel commercial package for oxygen desaturation scoring. The automated tool achieved near-perfect agreement with the sleep experts, and a similar performance to another existing solution in the market. The tool is robust for home-based recordings which are typically more artifact-prone, thereby supporting the increasing demand for out-of-centre overnight studies.Support (if any)n/a
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0956
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0765 Enlarged perivascular spaces in infancy: associations with autism
           diagnosis, cerebrospinal fluid volume, and later sleep problems

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      Pages: A337 - A338
      Abstract: IntroductionSince the re-discovery of the glymphatic system, there has been an increased interest in perivascular spaces (PVS) and cerebrospinal fluid (CSF) characteristics in relation to sleep. Enlarged PVS (ePVS) are associated with neurological disorders and sleep problems, and excessive extra-axial CSF (EA-CSF) volume is associated with autism spectrum disorder (ASD). However, ePVS has not been studied in infancy in relation to autism, EA-CSF volume, or sleep problems. The objectives of this study, therefore, are to examine whether ePVS is 1) more prevalent in infants who later develop ASD, 2) related to EA-CSF volume, and 3) associated with later sleep problems.MethodsThe study was conducted on a prospective, longitudinal cohort from the Infant Brain Imaging Study (IBIS). Participants underwent neuroimaging at 6-, 12-, and 24-months of age, and parent-reported Children’s Sleep Habits Questionnaires (CSHQ) were collected at a follow-up visit at school age (age range = 7-12 years, M = 10.0). A total of 311 participants were included: 47 infants at high familial likelihood for ASD who were later diagnosed with ASD (HL+), 180 high likelihood infants not diagnosed with ASD (HL-), and 84 low likelihood control infants (LL-). The CSHQ was available on a subset of 109 participants.ResultsSignificant group differences in ePVS rates were found at 24 months of age (p=0.041), with 44.7% of the HL+ group having ePVS, compared to 26.7% in the HL- group (p=0.017) and 26.2% in the LL- group (p=0.031). ePVS at 24 months was associated with greater EA-CSF volume from 6-24 months (p=0.002) and greater sleep disturbances at school-age (p=0.006), regardless of ASD diagnosis.ConclusionThe presence of ePVS during infancy was associated with ASD diagnosis, elevated EA-CSF volume, and more frequent sleep disturbances. Results suggest that infants with ePVS should be monitored for early signs of ASD and potential long-term sleep problems, particularly sleep disturbances. Further examination is needed to establish whether early ePVS is ASD-specific or an indication of early glymphatic system dysfunction that can put infants and children at risk for atypical brain development and later sleep problems.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0765
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0957 Sleeping for one week on a temperature-controlled mattress cover
           improves slow wave sleep, heart rate, and heart rate variability

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      Pages: A422 - A422
      Abstract: IntroductionBody temperature should be tightly regulated for optimal sleep. A decline in core temperature during sleep onset can increase slow wave sleep (SWS) and decrease heart rate (HR). Passive solutions such as high-heat capacity mattresses are difficult to maintain temperature control during sleep. Thus, we examined how sleeping on an active temperature-controlled mattress cover (TCMC; i.e., the Eight Sleep Pod) for one week affected sleep and cardiovascular health.Methods49 participants [24 men, 25 women; mean±SD (range): age = 34.4±11.5 (21.8-64.6) years] slept for 16 nights each (784 total nights) with TCMC temperature-control off (OFF) for the first week as baseline, TCMC temperatures on (ON) at their desired temperatures for the second week, and TCMC OFF for two nights. Participants wore a home sleep test device (HST) for eight nights total: four nights during each OFF and ON for ground truth sleep-staging. Participants wore a Fitbit device throughout the study to collect nightly HR and heart rate variability (HRV). Paired t-tests compared each participant’s sleep and HR/HRV for TCMC ON vs. OFF, separating for biological sex and TCMC temperature. A multiple linear regression was used to evaluate the percent change in SWS from OFF to ON.ResultsFour factors explained 64% of the variance in the percent change in SWS from OFF to ON (r2=0.64; P< 0.001): participants’ baseline SWS during OFF, age, average mattress-cover temperature, and sex. Men sleeping at cooler temperatures (< 26°C) increased SWS by 17 min (P=0.0001; cohen’s-d=0.65), decreased HR by 1.5 beats/minute (P=0.007, cohen’s-d=0.20), and increased HRV by 13% (P=0.045; cohen’s-d=0.23). Women’s sleep was unaffected by TCMC ON (all P>0.05); however, sleeping at warmer mattress-cover temperatures (>27°C) decreased HR by 1.5 beats/minute (P=0.021; cohen’s-d=0.18).ConclusionSleeping on an active temperature-controlled mattress cover at cooler temperatures significantly improved SWS in males, especially those with below-average SWS at baseline and increasing age. One week of sleeping on the TCMC improved HR in both sexes similar to exercise-training.Support (if any)Eight Sleep, Inc.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0957
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0675 Levels of Depression Differentially Affect Sleep in People Who Have
           Had Cancer: Findings from the National Health Interview Survey

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      Pages: A296 - A297
      Abstract: IntroductionCancer survivors experience an increased stress burden. Twenty-five percent (25%) of cancer survivors experience persistent depressive and anxiety symptoms and 40% are afflicted with chronic sleep problems. Analysis of this relationship between survivors’ mental health and sleep may elucidate components of stress burden in a particularly vulnerable population. This study examined the relationship between anxious and depressive symptoms and frequency predicting sleep patterns, comparing individuals with a cancer history versus those without.MethodsData emanated from the 2020 National Health Interview Survey dataset (n=31,568). Six percent (n=1936) of respondents reported a cancer history. The primary outcome was sleep duration, based on the average hours of sleep per night an individual reported over the past month, which was coded into “healthy” (7-8 hrs.) vs “unhealthy” (< 7 hrs. or > 9 hrs.) sleep. Level of anxiety and depression as well as frequency of reported symptoms were included in the models as predictors. Binary logistic regression models were performed to determine the discrete impact of depression and anxiety on sleep duration among individuals with and without a cancer history. Adjusted models included the demographic covariates of age, sex, education, household income, and race.ResultsIn adjusted models, frequency of anxious feelings (OR = 1.19, p<.01,), frequency of depressive feelings (OR =1.29, p<.01,), level of anxious feelings (OR = 1.38, p<.01,), and level of depressive feelings (OR=1.15, p<.01) significantly predicted unhealthy sleep in the full sample. However, among individuals with a cancer history, frequency of anxious feelings (OR =1.16, p<.01,), level of anxious feelings (OR = 1.28, p<.01,) and frequency of depressive feelings (OR = 1.23, p<.01,) significantly predicted unhealthy sleep duration, but level of depressive feelings did not (OR = 1.08, p=.13,).ConclusionMental health and sleep are closely and bidirectionally connected in the general population, but among individuals with a history of cancer the link between level of depression and healthy sleep were not significant. Further research is needed to understand the complex relationship between mental health and sleep among people with a cancer history.Support (if any)K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0675
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0958 Use of a Hybrid Mattress Improves Objective and Perceived Sleep
           Outcomes

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      Pages: A422 - A422
      Abstract: IntroductionPrevious research has shown that comfort, including comfort of the sleep surface, is essential to sleep quality. In addition to comfort, the structure and firmness of a mattress may also play a role when it comes to sleep quality. More empirical research is needed to establish the impact of particular mattresses on both objective and self-reported measures of sleep quality. This study compared sleep on a hybrid mattress to participants’ prior sleep on their original mattress.MethodsHealthy adults (81% female, ages 25-67) who reported sleeping hot participated in a 10-week field study, using a pre-post intervention design. During the 4-week baseline period, participants used their regular mattress at home. During the 4-week intervention period, which occurred following a 2-week adjustment period, they used a Serta iSeries mattress at home. This hybrid mattress includes materials designed to help the user feel cool. 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 1,400 nights of tracked sleep across 39 participants. Objective sleep measurements showed increased time in bed (+10 minutes, p=.001) and total sleep time (+14 minutes, p=.002), as well as increased REM, both in duration (+6 minutes, p=.004) and proportion of the night (p=.023). Improvements also were observed in two objective sleep quality measures: SleepScore (p=.002) and MindScore (p=002). Self-report measures revealed that the hybrid mattress felt cooler (p<.001) and more comfortable (p<.001). Improvements also were found for a variety of perceived sleep outcomes, including time to fall asleep, waking less often, spending less time awake, longer sleep duration, better sleep quality, and feeling more rested in the morning (ps<.05).ConclusionObjectively-measured sleep and self-reported sleep improved when using the hybrid mattress compared to healthy adults’ original mattresses. Furthermore, qualitative and quantitative self-report results suggested that the intervention was perceived as comfortable and felt cool. These perceptions likely are what led to more time in bed, which in turn led to the key sleep improvements.Support (if any)Mattress Firm INC
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0958
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0676 Sleep medication prescribing among patients receiving opioid use
           disorder treatment with comorbid insomnia

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      Pages: A297 - A297
      Abstract: IntroductionPeople initiating treatment for opioid use disorder (OUD) report insomnia to be a high priority, and insomnia is associated with compromised OUD treatment outcomes. However, insomnia treatments have yet to be investigated in the OUD clinical setting. Knowledge of prescribing patterns for sleep medications among OUD treatment patients is an essential first step to advance therapeutic development at the insomnia-OUD comorbidity. This retrospective cohort study used administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases (2006-2016) to investigate the prevalence of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. In doing so, we assess sex differences in prescription receipt within this unique patient population, given the known sex-based disparities in insomnia among other adult populations.MethodsWe included people aged 12-64 years with diagnoses of insomnia and OUD initiating buprenorphine during the study timeframe. The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g., hydroxyzine, trazodone, and mirtazapine). Descriptive analyses present prescription prevalence for the total sample as well as separately for males and females. Lastly, associations between sex and insomnia medication prescription receipt were estimated using Poisson regression models.ResultsOur sample included 9,510 individuals (female n=4,637; male n=4,873) initiating buprenorphine for OUD who also had insomnia, of whom 6,569 (69.1%) received benzodiazepines, 3,891 (40.9%) Z-drugs, and 8,441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR=1.17 [1.11-1.23]), Z-drugs (RR=1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR=1.07, [1.02-1.12]).ConclusionSleep medications are commonly being prescribed to individuals with insomnia in OUD treatment, especially females. These findings juxtapose the known increased overdose risk with benzodiazepine use and lack of efficacy data for these pharmacologic insomnia treatments in this growing patient population in the opioid crisis.Support (if any)National institute of Drug Abuse: K23 DA053507 (CEM), UG1DA050207 (FGM). National Institutes of Health: R25 MH112473-01 (HP), T32 DA015035 (KYX), R21 DA044744 (RAG and LJB). National Center for Advancing Translational Sciences: UL1 TR002345 (Washington University), UL1TR002649 (Virginia Commonwealth University)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0676
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0677 Blunted daily light rhythm amplitude in adults with opioid use
           disorder (OUD)

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      Pages: A297 - A298
      Abstract: IntroductionAccumulating evidence implicates sleep and circadian rhythm disruption in substance use disorders, including opioid use disorder (OUD). Blunted amplitude in daily rhythms of circadian-relevant variables (e.g., activity, light) may be a marker of psychopathology, as depressed adults demonstrate a smaller activity amplitude compared with healthy controls. The present study compared the light and activity amplitudes of adults with OUD with healthy controls.MethodsLight and activity data were collected from adults with OUD who were recently stabilized on medication-assisted treatment (N=27; Mage=44.25±13.21). Participants wore an Actiwatch for an average of 14.5 (SD=4.14) days. Light and activity data collected from healthy adults (N=15; Mage=22.88±2.76) who wore an Actiwatch an average of 11.59 (SD=1.07) days in a separate study were included as a comparison group. Light and activity amplitudes for each day and a composite amplitude for the sampling period were calculated using non-orthogonal spectral analysis.ResultsResults of mixed model ANOVA with subject as a random factor and group and day as fixed factors revealed a significant main effect of group on daily light amplitude (p<.01), such that the OUD group exhibited lower daily light amplitudes compared to healthy controls, and a trend-level main effect of group on daily activity amplitude (p=.09), such that the OUD group exhibited lower daily activity amplitudes compared to healthy controls. With age included as a covariate in the model, the main effect of group on light remained significant, whereas the trend-level effect on activity became non-significant. Results of between-subjects t-tests indicated significantly lower composite light and activity amplitudes during the entire sampling period in the OUD group compared to healthy controls (p’s<.05).ConclusionThese findings indicate that OUD is characterized by blunted light amplitude, which could both reflect and contribute to disruptions in circadian physiology in OUD. Light amplitude may be a novel target for behavioral OUD interventions. Future research is needed to determine whether blunted light amplitude is associated with OUD treatment outcomes and to further examine activity amplitude in OUD with larger sample sizes.Support (if any)U01 HL150596; T32 HL149646; CTSA Grant UL1 TR002535; Office of Naval Research MURI N00014-15-1-2809
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0677
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0979 Obstructive Sleep Apnea in a Patient with Cerebellar Ataxia with
           Neuropathy and Vestibular Areflexia Syndrome (CANVAS)

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      Pages: A432 - A432
      Abstract: IntroductionCerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a rare disorder caused by an autosomal recessive biallelic pentanucleotide repeat expansion in the replication factor C subunit 1 (RFC1) gene. Clinical features include gait disturbances, impaired vibratory sensation, autonomic dysfunction, cough, and slow disease progression. Spinocerebellar ataxias are frequently associated with sleep disturbances, including REM sleep behavior disorders, insomnia, obstructive sleep apnea (OSA), and central sleep apnea. This is thought to be secondary to involvement of several nervous system structures including the cerebellum. OSA is caused by repeated obstruction of the pharyngeal airway leading to sleep disturbances and fatigue. It is likely that cerebellar insults such as CANVAS may play a role in upper airway obstruction and resultant OSA. However, there is little characterization of this relationship in the medical literature.Report of case(s)We report a case of a 52-year-old female with a past medical history of CANVAS, anxiety, and depression who was referred to sleep medicine for evaluation of worsening daytime fatigue and fragmented sleep. She reported daytime sleepiness, morning headaches, and gasping arousals. Her Epworth sleepiness scale score was markedly elevated at 19 (normal < 10), and she was subsequently referred for home polysomnography testing for sleep apnea. Home sleep testing revealed an apnea-hypopnea index of 12.5 events/hour and a minimum oxygen saturation of 85%.ConclusionThis patient is at higher risk for sleep disruption due to her diagnosis of CANVAS. She presented with excessive daytime sleepiness and was found to have mild OSA on home sleep testing. Little is known about the presentation of OSA in patients with CANVAS. OSA treatment has the potential to improve sleep symptoms, quality of life, and mood disruption in this patient with an otherwise progressive and disabling neurologic disorder. Therefore early recognition and intervention of OSA are important in the care of patients with CANVAS. Given the disease’s progressive nature and lack of a cure, it is necessary to ameliorate quality of life however possible. OSA leads to persistent fatigue and may result in psychiatric disturbances, therefore, it is necessary to address sleep disturbances secondary to movement disorders to combat these outcomes.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0979
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0710 Effects of tonic motor activation (TOMAC) therapy on sleep quality
           for refractory restless legs syndrome

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      Pages: A311 - A312
      Abstract: IntroductionTonic motor activation (TOMAC) is a noninvasive medical device therapy that has been shown to reduce symptoms of refractory restless legs syndrome (RLS). Here, we evaluated the effects of TOMAC on subjective sleep quality.MethodsOne hundred and thirty-three adults with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for 4 weeks. Participants were instructed to self-administer a 30-minute TOMAC session bilaterally over the head of the fibula to electrically stimulate the peroneal nerve whenever RLS symptoms presented. Sleep quality was assessed through prespecified analysis of changes to Medical Outcomes Study Sleep Scale (MOS-Sleep) Sleep Problems Index I (MOS-I) and II (MOS-II) scores from baseline to Week 4. Post hoc t-tests were conducted on each MOS-Sleep item included in the MOS-I or MOS-II.ResultsMOS-I score changed by -11.8 points (48.5 to 36.7) for TOMAC and -2.8 points for sham (44.5 to 41.7), a difference of -9.0 points (p< 0.001). MOS-II score changed by -13.7 points (52.5 to 38.9) for TOMAC and -4.0 points for sham (48.3 to 44.3), a difference of -9.7 points (p< 0.001), which exceeds the proposed minimal clinically important difference (MCID) of 6 points. Post hoc analysis demonstrated statistically significant reductions in trouble falling asleep (item #7; -34.0% for TOMAC vs. -5.8% for sham; p< 0.01) and trouble staying awake during the day (item #9; -33.6% for TOMAC vs. -2.1% for sham; p< 0.05), which exceeded the standard MCID threshold of 30% relative to baseline.ConclusionFor adults with refractory RLS, TOMAC improved subjective sleep quality, sleep latency, and daytime somnolence relative to sham control. Each of these improvements represented clinically important improvements. These data demonstrate that TOMAC can provide meaningful improvements to sleep quality and daytime functioning for patients with refractory RLS.Support (if any)Funding was provided by Noctrix Health, Inc.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0710
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0980 A Child with Achondroplasia, Cervicomedullary Junction Compression,
           Severe Obstructive Sleep Apnea and Pulmonary Hypertension

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      Pages: A432 - A433
      Abstract: IntroductionAchondroplasia is a short stature autosomal dominant skeletal dysplasia. Children with Achondroplasia are at risk for multiple medical comorbidities including sleep disordered breathing due to midface hypoplasia and craniocervical junction compression. Recent guidelines from American Academy of Pediatrics on health supervision of children with achondroplasia recommend routine clinical screening for symptoms of obstructive sleep apnea (OSA) and craniocervical junction compression in which case a polysomnogram should be considered.Report of case(s)The patient is a now 15 month old male who was initially seen in sleep medicine clinic at age 4 months for snoring and respiratory distress while awake. Polysomnogram 2 days later demonstrated severe OSA. The study demonstrated an oAHI of 25.1/hour, O2 nadir of 77%, and TcCO2 with evidence of significant hypoventilation with TcCO2 max of 67mmHg. This was adequately treated with supplemental oxygen. The patient subsequently presented to the emergency department at age 7 months with hypoxemic respiratory failure and signs of right heart failure and was started on CPAP. Echocardiogram demonstrated significant pulmonary hypertension. Subsequent CPAP titration study during admission demonstrated adequate treatment of OSA and his pulmonary hypertension significantly improved with the patient requiring no pulmonary hypertension treatment at discharge. At age 9 months, the patient was again admitted with hypoxemic respiratory failure and subsequent brain MRI demonstrated foramen magnum stenosis requiring subsequent surgical decompression. He was discharged on CPAP, however, was not tolerating this at home. Therefore, repeat polysomnogram was obtained that demonstrated severe OSA that was not responsive to supplemental oxygen. The patient was then started on BPAP therapy which he has since been tolerating well.ConclusionChildren with achondroplasia are at increased risk for sleep disordered breathing and craniocervical junction compression. Our patient experienced significant complications from OSA at a young age. His sleep apnea worsened significantly in a short period making it unresponsive to previous treatment recommendations. There is a need for further studies to determine better screening guidelines for craniocervical junction narrowing and OSA. This case highlights the dynamic nature of sleep disordered breathing in achondroplasia and need for close follow up and monitoring of symptoms at all clinical encounters.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0980
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0711 Health-Economic Implications of Tonic Motor Activation (TOMAC)
           therapy for RLS: An Exploratory Analysis based on the RESTFUL study

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      Pages: A312 - A312
      Abstract: IntroductionRestless legs syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Recently, the RESTFUL study demonstrated significant improvement in RLS severity following treatment with a novel non-invasive neuromodulation treatment (Tonic Motor Activation; TOMAC). Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for the observed changes in symptom severity.MethodsThe RESTFUL study randomized n=133 subjects 1:1 to active TOMAC treatment and sham control, with change in International Restless Legs Scale (IRLS) scores reported at four weeks at the end of the randomization period. Functional relationships between IRLS and HRQoL and resource utilization were derived from two prior health-economic studies (Happe et al. 2009 and Durgin et al. 2015). Model-projected quality-adjusted life year (QALY) gain and events avoided at a five-year analysis horizon were calculated based on assumption of maintained treatment effect.ResultsFrom baseline of 25.2, change in IRLS at four weeks was -7.2 for the active and -3.8 for the sham group (between group difference -3.4, p< 0.01). Based on this effect size, TOMAC was projected to add 0.16 QALYs over 5 years (0.39 when considering reduction from baseline). Based on lower symptom severity, TOMAC was projected to avoid 3.80 (8.05) health care provider visits, 0.29 (0.62) ER visits, and 0.12 (0.26) hospitalizations over 5 years, resulting in a relative risk (RR) of composite healthcare utilization of 0.94 (0.88).ConclusionThe findings of this exploratory analysis suggest TOMAC-associated improvements in RLS severity as observed in the RESTFUL study may lead to meaningful improvements in patient quality-of-life and concurrent reductions in healthcare utilization. Further investigation is warranted.Support (if any)Wing Tech Inc. (AMR, KNC, JBP) received consulting fees from Noctrix Health. AR is an investigator in the RESTFUL study.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0711
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0981 Complex Sleep Apnea in a Patient with ROHHAD

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      Pages: A433 - A433
      Abstract: IntroductionRapid onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare disorder associated with sleep disordered breathing. Patients often have obstructive sleep apnea (OSA) and nocturnal hypoventilation (NH). We present a case with a unique sleep disordered breathing pattern demonstrating both severe central and obstructive sleep apnea demonstrated on two separate polysomnograms with no evidence of significant NH.Report of case(s)The patient is a now 8 year old girl who was initially diagnosed with ROHHAD in October 2020 at age 5 years with symptoms of rapid weight gain, hypothalamic dysfunction (hyperprolactinemia), and autonomic dysfunction (recurrent fever, and hypertension). Diagnostic polysomnography in May 2020 demonstrated severe OSA (oAHI 23.4/hr) as well as central sleep apnea (CAI 63.9/hr). The SaO2 nadir was 88% with 15 minutes spent below 90%. There was no evidence of NH, however the CO2 was greater than 50 mmHg for 9.5% of total sleep time. Subsequent titration study recommended BPAP ST of 14/10 cmH20 with back up rate (BUR) of 12 bpm. The patient had a repeat split night study in May of 2022 at age 7 years. During the diagnostic portion, she demonstrated persistent severe OSA (oAHI 39/hr) and central sleep apnea (CAI 21/hr). There was no evidence of NH with a max TCO2 of 50 mmHg and CO2 > 50 mmHg for 0.2% of total sleep time. BPAP ST of 18/10 cmH20 with BUR of 12 bpm led to resolution of obstructive and central apnea events.ConclusionROHHAD remains a rare disease which is often associated with sleep disordered breathing. While there have been rare reports of CSA in ROHHAD, there have been none of this severity. CSA may be a representation of autonomic dysfunction, and previous literature has described central pauses in breathing in ROHHAD patients while awake. While she did not have evidence of hypoventilation on either polysomnogram, which is one of the hallmarks of this disease, it has been described that nocturnal hypoventilation may develop later in the course of the disease. Thus, it remains important to routinely screen patients with polysomnograms as their sleep disordered breathing evolves.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0981
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0712 Improved Circadian Rest-Activity Patterns after Treatment with PAP
           therapy in the Patient with Idiopathic RBD and Comorbid OSA

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      Pages: A312 - A313
      Abstract: IntroductionSeveral studies suggest that sleep and circadian rhythm disruptions, and physical activity changes may serve as risk factors for the occurrence of Parkinson’s disease and its prodromal features. Obstructive sleep apnea (OSA) is commonly found in patients with RBD. The comorbid OSA is associated with non-motor symptoms, including daytime sleepiness, cogntive decline and autonomic nervous system dysfunction. Therefore, we investigated whether circadian rest-activity patterns and RBD-related symptoms will be improved after positive airway pressure (PAP) therapy in patients who had iRBD with comorbid OSA.MethodsSeven patients were diagnosed as iRBD with OSA (AHI ≥ 10) confirmed by video-polysomnography. The patients wore actigraphy devices for 14 consecutive days befor and after PAP therapy for 3 months. The mean motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphic data. Non-parametric circadian rhythm activity including inter-daily stability(IS), intra-daily variability, least 5 average, most 10 average and relative amplitude were anlayzed. In addition, we obtainted the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I).ResultsFour of 7 patients had good compliance of PAP usage (average usage > 4hr during sleep), and three patients had poor compliance of PAP usage. In good compliance group, score of RBD-3M decreased ( p=0.029) and value of IS were increased (p=0.029 ) significantly. Also, 3 of 4 patients answered “Very much improved or much improved” in a questionnaire of CGI. In poor comliance group, there was no any significant change in all values. In addition, only one patient answered “ much imrpoved” and two patients answered “minimally improved” in CGI.ConclusionThe PAP treatment of OSA in iRBD can be role as a lifestyle modifier that improves circadian rest-activity patterns and, it may be of value as a disease-modifying effect of behavioral or lifestyle changes that have been reported to be associated with decreased risk of neurodegenerative disorder. We will continue enroll the data and will investigate not only improvement of circadian rhythm, but also decreasing of motor activities during sleep after PAP therapy.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0712
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0982 Atrial fibrillation diagnosed from a home-based sleep study in a
           patient with REM behavior disorder

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      Pages: A433 - A433
      Abstract: IntroductionAtrial fibrillation (A-Fib) is the most common form of cardiac arrhythmia and is a major cause of stroke. Obstructive sleep apnea (OSA) is an established risk factor of A-Fib, but sleep disruption with frequent awakenings was recently identified as another risk factor, independent from OSA. Home sleep apnea test (HSAT) is widely used to diagnose OSA with low cost and short wait time, and HSAT that uses peripheral arterial tonometry (PAT) can reveal cardiac arrhythmia. Here we report a case of A-Fib detected by PAT-based HSAT in a patient with REM sleep disorder.Report of case(s)A 60-year-old man with hypertension, depression, anxiety, tobacco and alcohol use disorders presented to sleep clinic for frightening vivid dreams and violent dream enactments that gradually developed over the last two years. A diagnostic polysomnography study showed mild OSA, normal heart rhythm, and no epoch of REM sleep without atonia (RSWA). In the following four years, he used CPAP therapy, imagery rehearsal therapy, high-dose melatonin, doxepin and hydroxyzine. However, the frightening dreams and dream enactments persisted despite full adherence to CPAP. To reassess OSA, the patient took a PAT-based HSAT, which showed not only mild OSA, but one episode of irregularly irregular PAT-derived pulsation variations that lasted three hours and started and stopped abruptly. We therefore ordered longitudinal cardiac monitoring, which showed multiple asymptomatic episodes of A-Fib during nighttime. After treatments for A-Fib were started, a polysomnography study with effective CPAP titration showed one episode of A-Fib with rapid ventricular response that lasted 2.5 hours during non-REM sleep, and multiple epochs of RSWA. The diagnosis of REM sleep behavior disorder (RBD) was thus established.ConclusionWe reported concurrent developments of RBD and asymptomatic paroxysmal A-Fib in a man in his early sixties. Our case suggests a potential association between RBD and A-Fib, which has not been studied but is conceivable, given that RBD causes frequent awakenings with surges of sympathetic activity. Our case also highlights the advantage of PAT in capturing not only OSA but cardiac arrhythmia. Clinical interpreters of PAT-based HSAT can seize the opportunity to diagnose A-Fib and prevent stroke.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0982
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0713 Long-term response to tonic motor activation (TOMAC) therapy for
           refractory restless legs syndrome

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      Pages: A313 - A313
      Abstract: IntroductionThere is a large population of patients who have become refractory to first-line treatments for Restless Legs Syndrome, partially due to augmentation to dopamine agonist medications. For patients with refractory RLS, tonic motor activation (TOMAC) is a noninvasive medical device therapy with promising short-term safety and efficacy. Here, we evaluated the response to TOMAC over a longer duration of >24 weeks.MethodsIn the RESTFUL study, 133 patients with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for weeks 1 to 4 followed by open-label TOMAC for weeks 5 to 8. The final 50 participants to complete the RESTFUL study were invited to continue TOMAC treatment for an additional 24 weeks (weeks 9 to 32) in an extension study. Participants were instructed to self-administer one 30-minute TOMAC session bilaterally over the peroneal nerve whenever RLS symptoms presented. Efficacy was assessed by comparing responses from baseline (RESTFUL study entry, week 0) to week 32 on Clinician Global Impressions-Improvement (CGI-I) responder rate, Patient Global Impressions-Improvement (PGI-I) responder rate, and International RLS Study Group Rating Scale (IRLS) total score. Additional analyses compared responses from week 8 (RESTFUL study completion) to week 32.ResultsOf the 50 eligible participants, 44 consented to the extension study and 42 completed. CGI-I responder rate relative to baseline increased from 64% at week 8 to 76% at week 32. PGI-I responder rate relative to baseline increased from 68% at week 8 to 77% at week 32. IRLS total score reduced from 24.5 at baseline to 17.1 at week 8 to 12.9 at week 32, a reduction of 11.6 points from baseline to week 32. There were no moderate or severe device-related AEs.ConclusionTOMAC resulted in substantial and clinically significant reduction in RLS symptom severity that was maintained through >24 weeks of treatment. Furthermore, there was a trend towards increased efficacy with continued use of TOMAC. These data suggest that TOMAC could represent a potential long-term treatment for the chronic condition of refractory RLS.Support (if any)Funding was provided by Noctrix Health, Inc.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0713
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1027 Title: Hypersomnolence following resection of a craniopharyngioma

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      Pages: A451 - A451
      Abstract: IntroductionCraniopharyngiomas are rare tumors that arise from Rathke’s pouch remnants along the pituitary-hypothalamic axis. The tumor and its treatment can lead to significant neurological and endocrinological complications including alterations in appetite, endocrine insufficiency, circadian rhythms and sleep. We report the case of a woman who developed hypersomnia following resection of a craniopharyngiomaReport of case(s)This 38-year-old female with neither significant past medical history of sleep, medical, neurological, or psychiatric disorders nor a family history of narcolepsy presented with galactorrhea and amenorrhea. Imaging showed a pituitary tumor. She underwent resection of the tumor with a tissue diagnosis of an adamantinomatous craniopharyngioma. MRI post procedure showed post-surgical changes without new lesions. Diabetes insipidus and panhypopituitarism developed for which appropriate replacement therapy was initiated. She gained approximately one hundred pounds in the weeks post-surgery. Her family described new onset snoring in supine sleeping position and witnessed apneas. She denied hypnagogic hallucinations, cataplexy, or sleep paralysis. She presented to the sleep medicine clinic a few months later for evaluation of persistent hypersomnolence.ConclusionThe most common sleep disorders post craniopharyngioma resection are sleep-related breathing disorder, hypersomnia, and circadian rhythm disorder. Sleep and appetite are felt to be altered because of direct surgical compression, injury or vascular compromise of structures involved in the control of sleep, wakefulness, and appetite. This can produce hypothalamic dysfunction induced obesity with secondary sleep-related breathing disorder and worsening hypersomnolence. In this woman the temporal relationship between the surgery and the onset of symptoms is most suggestive of this hypothalamic injury, resulting in abnormal regulation of both appetite and sleep. Improvements in weight control and hypersomnia with use of stimulant therapy in the setting of secondary obstructive sleep apnea have been reported and in addition to standard positive airway pressure therapies give hope for the management of these complications of craniopharyngioma resection.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1027
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0798 Frequency of Sleep Disordered Breathing and Comorbidities Among
           Pre-school Aged Children with Down Syndrome

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      Pages: A351 - A352
      Abstract: IntroductionChildren with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. Data describing PSG parameters in this age group is limited. The purpose of this study is to examine the frequency of SDB, gas exchange abnormalities and comorbidities in this patient population.MethodsThis is a retrospective chart review of children ages 2-4 years with DS who underwent first PSG at Seattle Children’s Hospital from 2015-2021. Data collected included demographics, comorbidities and PSG parameters: obstructive apnea hypopnea index (oAHI), central apnea index (CAI), time spent with CO2 levels > 50 mmHg, percentage of time spent with saturations < 88% and saturation nadir. Data is presented by descriptive statistics and comparison by unpaired t test.ResultsA total of 154 children underwent PSG during the study period and 75 met the inclusion criteria. Mean age was 3.03 years (SD 0.805), 56% were male and 54.7% were caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%) and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). 94.7% met criteria for pediatric OSA, 9.5% met criteria for central apnea, and 9.5% met criteria for hypoventilation. Only 1 child met criteria for hypoxemia. 60% had surgical intervention with 89% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages and no significant difference in OSA or CSA in children with or without hypothyroidism or dysphagia (p>0.05).ConclusionChildren with DS ages 2-4 years have high frequency of OSA. The most commonly encountered comorbidities were cardiac and dysphagia. Among those with OSA, more than half underwent surgical intervention, highlighting the importance of early diagnosis. Our previously published work showed that in infants with DS, dysphagia is correlated with severity of OSA. However, this was not shown in this abstract suggesting a potential larger contribution of other factors, such as adenotonsillar hypertrophy.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0798
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1028 Congenital Central Hypoventilation in a patient with MCEP2
           duplication syndrome

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      Pages: A451 - A452
      Abstract: IntroductionCongenital central hypoventilation (CCHS) is a rare disorder due to impairment of autonomic nervous system clinically defined by a significantly reduced or abolished ventilatory response to hypercapnia and hypoxemia in the absence of pulmonary, neuromuscular, or cardiac disease. There is limited knowledge on associated respiratory manifestations and sleep-disordered breathing in children with the MECP2 duplication syndrome. Although sleep-disordered breathing and nocturnal hypoventilation are currently not well recognized in these children, we present a case of a patient with MECP2 mutation and congenital hypoventilation syndrome.Report of case(s)24-week-old male born full-term via c-section presented with recurrent respiratory problems, laryngeal cleft, dysphagia, snoring and apneic episodes. Previous genetic work up showed chromosome 15q11.2 microdeletion. Past medical history was significant for neonatal ICU stay for respiratory distress immediately following birth. Tonsils are 1+ on exam. PSG showed profound central sleep apnea (CAI 300/h) with average apneic episodes lasted for 7 seconds and very significant periodic breathing (88%) and mild obstructive apnea. Mild hypoxemia was also seen with SpO2 in low 90s without any significant hypercapnia. Bradypnea with resp rate 10-20/m was seen. PHOX2B gene testing was negative. Genetic testing with SNP array showed MECP2 duplication syndrome. His development is delayed, currently at the age of 20 months, including cognitive, speech and motor function for which he is on therapy. Tracheostomy was recommended, however family preferred to continue with non-invasive ventilation while awaiting diaphragmatic pacing.ConclusionRespiratory manifestations in MECP2 duplication syndrome patients are common, with important impact and even a possible fatal outcome. Although sleep-disordered breathing and nocturnal hypoventilation is currently not cited as an important symptom in these children, there have been several case reports of CCHS associated with this. PSG should be considered in patients with MCEP2 duplication syndrome for timely diagnosis. Different treatment modalities (ENT surgery, CPAP and NIV) can be applied successfully to treat respiratory conditions associated with MECP2 duplication syndrome.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1028
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0799 Impact of Highly Effective Modulator Therapy on Obstructive Sleep
           Apnea in People with Cystic Fibrosis

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      Pages: A352 - A352
      Abstract: IntroductionObstructive sleep apnea (OSA) is frequently seen in people with cystic fibrosis (PwCF). The presence of upper airway pathology including adenotonsillar hypertrophy and chronic sinusitis is a known risk factor for OSA in PwCF. The widespread use of highly effective modulator therapy (HEMT) such as elexacaftor/tezacaftor/ivacaftor has led to improvements in nutritional status, lung function, and sinus disease among PwCF. However, the impact of HEMT on OSA is still unknown.MethodsWe conducted a single center retrospective review of polysomnographic data in PwCF between 1/1/2009-10/31/2022.ResultsFifty-three children with CF had undergone diagnostic polysomnography during the study period. Twenty-eight (53%) patients had OSA. Frequency of OSA did not differ by race or mutation type (p>0.5). Eighteen (34%) patients were on HEMT at the time of polysomnography. Mean ages of PwCF in the post-HEMT vs pre-HEMT were 11.6±5.4(sd) vs 6.4±3.5 years respectively, p=0.001. Mean body mass index percentile was 70.8±27.4 vs 55.8±31.2 respectively, p=0.09. Mean forced expiratory volume in 1 second as a percent predicted was 97.1±22.5 vs 87.0±20.9 respectively, p=0.2. Frequency of OSA was 67% in the post-HEMT group and 46% in the pre-HEMT group (p=0.1). Snoring was present in 91% of PwCF in the pre-HEMT group and 78% of those in the post-HEMT group (p=0.2). Frequency of mouth breathing was 77% and 56% in the pre-HEMT and post-HEMT groups respectively (p=0.1). Large adenoids were present in 37% of PwCF in the pre-HEMT group as compared to 11% of those in the post-HEMT group (p=0.046). Frequency of large tonsils in the pre-HEMT and post-HEMT groups was 43% vs. 28% (p=0.3). There were no differences in frequency of chronic sinusitis between the groups (p=0.7).ConclusionFrequency of OSA among PwCF continues to be high even in the post-HEMT era. PwCF on HEMT showed a trend towards more frequent OSA despite having less upper airway pathology. The better nutritional status afforded by HEMT could be contributing to the high frequency of OSA in this population. Larger studies are needed to formally test this hypothesis.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0799
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0800 Pediatric PSG Flagging Etiologies and Impact on Clinical Timeline

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      Pages: A352 - A353
      Abstract: IntroductionThere is a paucity of literature regarding “flagged PSGs”, a term used to triage emergent PSGs for expedited scoring and reporting. Given the morbidity and multi organ-system dysfunction of untreated OSAS in children, it is extremely important to identify and treat expediently. The aim of this study was to review flagged PSGs at a tertiary level pediatric sleep center, including management and intervention timelines.MethodsThis is an IRB-approved retrospective chart review of flagged PSGs (N=266) over a three-year period (2019-2022) at a pediatric sleep center. PSGs were flagged based on laboratory protocols and provider discretion. Demographic, clinical, and PSG data were obtained from EMR.ResultsPatients with flagged studies were white (49.2%), non-Hispanic (87.2%), males (66.9%) with (mean ± SD) age (6.9 ± 6.0) years and BMI of (23.3 ± 11.6) kg/m2, respectively. Reasons for flagging studies were repetitive brief oxygen desaturations < 80% (46.6%), sustained desaturations < 85% (32.3%), sustained EtC02 >60mmHg (5.6%), or other concerning events (15.5%). Most common comorbidity was pulmonary (41.4%), followed by genetic (30.5%), cardiac (23.3%), and neuromuscular (11.7%). 23.3% children were obese. 30.1% had prior airway surgeries; most commonly being adenotonsillectomy (70.0%). Mean Apnea-hypopnea index was 47.2 ± 36.1 events/hr. 35% children had hypoxemia and 36.8 % had hypoventilation. Time duration from flagging study to finalized report, surgical, or medical intervention was 4.3 ± 6.0, 78.2 ± 105 and 26.6 ± 93.0 days, respectively. Medical (40.6%) and surgical (37.9%) intervention were similar in frequency; however, children < 8 were more likely to undergo surgery (p< 0.001). Most frequent surgical intervention was adenotonsillectomy (82.1%). Patients with AHI>30 had less time between PSG and surgical intervention (65.3 ± 96.7 days vs 112 ± 119 days, p=0.04).ConclusionMost frequent reason for flagging PSG was repetitive brief desaturations. Time to surgical intervention was longer than medical intervention; however, they occurred in similar frequency. Pandemic staffing shortages and PAP machine recalls impacted both interventions. Patients with higher disease severity experienced quicker scoring, report finalization, and surgical intervention. Future directions include establishing protocols between sleep laboratory and surgical teams, assess the impact of this and further streamline care.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0800
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1029 Inspire Confidence In CPAP

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      Pages: A452 - A452
      Abstract: IntroductionObstructive sleep apnea (OSA) is defined as the repetitive episodes of complete or partial occlusion of the airway occurring during sleep. OSA is thought to play a role in many different diseases including anxiety, depression, excessive day time sleepiness, and GERD. Treatment of OSA can often be difficult as many patients cannot tolerate CPAP.Report of case(s)The patient is a 76-year-old male who was diagnosed with OSA in 1991. He had undergone Uvulopalatopharyngoplasty in 1997 and maxillomandibular advancement in 1999 but continued to have snoring and witnessed apneas and excessive daytime sleepiness (EDS). A repeat PSG in 2019 showed severe sleep apnea with an AHI of 37.3. The patient had been unable to tolerate his CPAP at home due to discomfort from the pressure. He was then referred for evaluation and subsequent placement of a hypoglossal nerve stimulator known as inspire by ENT. On follow-up at the sleep clinic, the patient complained that he was still having daytime sleepiness and snoring despite compliance with INSPIRE. A home study was done to evaluate the effectiveness of INSPIRE and his AHI was found to be 46. INSPIRE was reconfigured and a repeat sleep study was done which showed similar results. A decision was made to try combination therapy with INSPIRE and CPAP at a lower pressure than previously. His original CPAP settings were 12cmH20 and with combo therapy we were able to change this to autoPAP 7-10, which the patient tolerated well and showed good control of his sleep apnea with an AHI of 4.6.ConclusionFor those with moderate to severe OSA, the gold standard therapy is CPAP, but not every patient can tolerate CPAP therapy. One of the reasons is the CPAP pressure being too high. In 2014 the FDA approved a new treatment option for those with moderate to severe sleep apnea with the hypoglossal nerve stimulator. In our patient, multiple different INSPIRE configurations were attempted but he still had uncontrolled OSA and EDS. We were able to use combination therapy with INSPIRE and CPAP to adequately control his OSA without needing the high pressure that he could not tolerate previously.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1029
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0620 Dim Light Melatonin Onset Analysis in Individuals Diagnosed with
           Delayed Sleep-Wake Phase Disorder (DSWPD)

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      Pages: A272 - A273
      Abstract: IntroductionWe are conducting a double-blind, randomized, clinical study in Delayed Sleep-Wake Phase Disorder (DSWPD) participants with extensive clinical phenotyping. We evaluated screening Dim Light Melatonin Onset (DLMO) assessments in participants with a DSWPD diagnosis to determine the proportion of participants with and without a circadian delay.MethodsDelayed DLMO is DLMO occurring after or within 30 minutes before desired bedtime, and after 21:30. Each DLMO assessment consisted of eight saliva collections performed at five, four, three, two, and one hour before bedtime, at planned bedtime, and one and three hours after bedtime. Salivary DLMO assessments were distributed to participants at Visit 1 (screening) and Visit 3 (treatment) with a questionnaire to record planned and actual collection times. Participants were instructed to wear blue-light blocking glasses during the assessment period. The Morningness-Eveningness Questionnaire (MEQ) was also completed by participants at V1 to evaluate circadian and sleep rhythm patterns. DLMO was calculated for each phase assessment and defined as the clock time when the melatonin concentration exceeded the mean of three low consecutive values, plus twice the standard deviation of these points.ResultsThirty-four participants with DSWPD completed the screening DLMO assessment, 33 of which had a delayed DLMO (97.06%). Sub-analyses were conducted on participants with DSWPD who had delayed DLMO (n = 33). Within this subset, the average DLMO time was 23:52 (SD = 1:58) and the average MEQ score was 34.27 (SD = 10.39). Of these 33 participants, 14 had a DLMO time after 00:00 (42.42%).ConclusionThese initial data indicate that, on average, participants with DSWPD that completed the screening DLMO assessment had delayed DLMO. Further analyses show that almost half of this subset had a significantly delayed DLMO (00:00 or later). This study is currently ongoing and blinded. Further data will be analyzed as more participants enroll. ‘Phase typing’ will be important in further understanding the underlying pathophysiology and in the treatment selection for patients with DSWPD.Support (if any)This work was supported by Vanda Pharmaceuticals Inc.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0620
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1030 Alice in wonderland: A rare side effect of montelukast

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      Pages: A452 - A452
      Abstract: IntroductionAlice in wonderland syndrome (AIWS), also known as Todd’s syndrome, is a neuropsychological condition that causes a set of symptoms with alteration of body image. These distortions include appearing smaller(micropsia) or larger(macropsia) or appearing to be closer or farther than they are. The exact cause of AIWS is currently unknown. Some associations include, migraine, temporal lobe epilepsy, brain tumors, psychoactive drugs or Epstein-Barr-virus. The treatment for this disease primarily aims at treating the underlying reason as to why the patient had the event.Report of case(s)7-year-old boy presents to sleep clinic for nighttime hallucinations. Nightly episodes described as body parts that seem abnormally large or small and people talking very fast. Events lasted 15 minutes. Patient had full recall and developed anxiety when falling asleep. Medications at presentation: vitamins, melatonin, Montelukast. Montelukast was discontinued. Referred to neurology for video EEG, which was negative for frontal lobe seizures. Due to restless sleep and snoring, sleep study and ferritin was ordered. He was found to have mild OSA with an AHI of 2.2 and a ferritin level of 28. The patient was not considered a surgical candidate for his mild OSA; therefore, watchful waiting and re-initiation of montelukast proceeded with initiation of oral iron. At sleep clinic follow up, family noted improvement of hallucinations for 2-3 months and then restart, with worsening. Upon medication review, Montelukast was the inciting factor to the presence and resolution of hallucinations.ConclusionIn this patient the montelukast seemed to be the triggering factor of AIWS. It has been suggested that the inhibition of leukotriene receptors in the brain could be responsible for this drug reaction. No other obvious triggers, or results of work up were able to better explain his resolution once he discontinued montelukast. This just further promotes close pharmacologic vigilance in the pediatric population.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1030
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0621 A machine learning model to predict the risk of perinatal depression
           from sleep data in healthy pregnant women

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      Pages: A273 - A273
      Abstract: IntroductionPerinatal depression (PND) is a complication of pregnancy associated with serious health consequences for both mothers and their babies. Identifying predisposing factors for PND during early pregnancy is key to early detection of women who may be at greater risk of developing this condition. Machine Learning (ML) techniques have recently been applied in a few studies, mostly to predict postpartum depression. None of them, however, considered sleep data in model building, neither focused on PND.MethodsBy analyzing data from a multicenter, prospective cohort study on sleep and mood changes during the perinatal period (the “Life-ON” study), we constructed a ML model for PND risk prediction and tested it in a cross-validation setting. PND was assessed using an EPDS score >12 during 9 visits from early pregnancy until 6 months postpartum. In a bivariate analysis, 47 sociodemographic, psychological, blood-based, medical/gynecological, and subjective sleep variables, collected from 439 pregnant women (33.7±4.2 yrs.) during the first trimester of gestation, as well as 33 polysomnographic (PSG) parameters, recorded from 353 women (33.6±4.2 yrs.) during the second trimester, were correlated with PND. A support vector machine (SVM) model was then trained using the 10-features with the highest permutation importance to predict the individual risk of PND for each woman.ResultsAmong all variables considered, sleep quality (PSQI) and insomnia symptoms (ISI) (p< 0.001), daytime sleepiness (ESS) and RLS severity (IRLS) (p< 0.05), as well as the PSG parameters Apnea Index (p=0.001), number of central hypopneas and percentage of sleep stage N2 (p< 0.05), were all positively correlated to PND. The PSQI and ISI scores were also selected by the SVM classifier, which achieved a mean AUROC of 0.777 and an AUPRC of 0.393, corresponding to a sensitivity of 54.3% and a specificity of 82.6% in identifying women at risk for PND.ConclusionIn our data-driven ML model to predict the risk of PND during early pregnancy, subjective poor sleep quality and insomnia symptoms identified women at greater risk of developing PND, while none of the PSG variables improved model performance.Support (if any)Swiss National Science Foundation (grant: 320030_160250/1). The Italian Ministry of Health and Emilia-Romagna Region (grant: PE-2011-02348727).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0621
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0836 Chronic Pain worsens Daytime Sleepiness, Insomnia and Quality of Life
           in Veterans with Obstructive Sleep Apnea

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      Pages: A0 - A0
      Abstract: IntroductionChronic noncancer pain (CP) commonly co-occurs with obstructive sleep apnea (OSA) and may contribute to greater symptom burden. The study aim was to examine differences in sleepiness (Epworth Sleepiness Scale, ESS), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form Health Survey 20, SF-20) in veterans with OSA with or without pre-existing CP.MethodsAn observational, cross-sectional, study of veterans with newly diagnosed, untreated OSA was conducted. Unadjusted between-group comparisons (i.e., OSA-only versus OSA + CP) were conducted using the Welch’s t-test and Pearson Chi-Square. Regression analyses were performed to determine the influence of self-reported CP on sleep-related symptoms and quality of life while controlling for potential confounders (i.e., age, sex, OSA severity, body mass index, percentage of total sleep time spent with SpO2 < 90%, and presence of psychiatric/mental health comorbidities). The Hochberg (step-up) method was used to control for the family-wise error rate at 5%.ResultsThe final sample included N=111 participants with complete survey responses. Compared to the group with OSA-only (n=40), veterans with comorbid OSA and CP (n=71) experienced significantly higher ESS (12.7 ± 5.5 vs 10.2 ± 5.2; p = .021) and ISI scores (18.1 ± 6.2 vs. 13.7 ± 7.4; p = .002), and worse quality of life across all SF-20 domains. Of note, clinically significant insomnia (ISI score > 15) was most common among veterans with comorbid OSA and CP (68.7% vs. 45.5%, p = .010). In adjusted analyses, CP diagnosis was significantly associated with higher ESS (adjusted mean difference [95% CI] = 2.72 [0.55, 4.88], p = .014) and ISI scores (adjusted mean difference [95% CI] = 3.82 [1.27, 6.37], p =.004).ConclusionThere is a high prevalence of CP among veterans with OSA and symptom burden is higher in patients with OSA and CP. Future investigations should address symptom response and burden to OSA treatment in comorbid OSA and CP to guide outcome expectancies and residual OSA symptom treatment plans.Support (if any)SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0836
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0646 Psychological distress as predictors of disturbed sleep among college
           students

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      Pages: A284 - A284
      Abstract: IntroductionPoor sleep quality is prevalent among college students and has a significant impact on their daily activities. Further, college students are under extreme pressure to excel in an academic, occupational and social context, and psychological distress often exacerbate sleep quality. This study aimed to examine relationships between psychological stress and sleep quality among undergraduate students.MethodsBaseline data were obtained from students who completed self-report measures as part of a larger study (n=56; mean age 20.23 (1.5); 83.9% females). Poor sleepers were categorized when participants had at least 2 of the following indicators: excessive daytime sleepiness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), and poor sleep quality (Pittsburgh Sleep Quality Index). The Beck Depression Inventory-II assessed depressive symptoms, the PCL-5 determined posttraumatic stress disorder (PTSD) symptomatology, and the Generalized Anxiety Disorder-7 (GAD) scale assessed for anxiety symptoms. Binary logistic regression analyses identified the association between poor sleepers, PTSD, GAD, and depressive symptoms, while adjusting for sex and body mass index (BMI).ResultsApproximately 33.9% of students experienced excessive daytime sleepiness, 30.4% suffered from insomnia, 89.3% had poor sleep quality, and 62.5% of the sample experienced one or more psychological stressors. Forty-eight percent of the students were categorized as poor sleepers. Using binary logistic regression, after adjusting for sex and BMI, students who experienced PTSD (OR= 1.075, 95%CI [1.023, 1.130]), GAD (OR=1.227, 95%CI [1.072, 1.406]), and depressive (OR=1.105, 95%Cl [1.023, 1.192]) symptoms had an increased risk for being poor sleepers.ConclusionFindings indicate that mental health is a core component of well-being and sleep health, and that early assessment and treatment of psychological distress may be an important strategy for intervention of poor sleep quality and disturbed sleep among college students.Support (if any)This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0646
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0856 Are African-Americans/Blacks with Asthma getting the recommended
           amount of sleep'

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      Pages: A377 - A378
      Abstract: IntroductionAsthma is one of the leading respiratory illnesses in the United States. African Americans/Blacks are particularly vulnerable to the long-term effects of this condition. In addition to general healthcare inequities, African Americans/Blacks may also have an increased vulnerability to the deleterious effects asthma may enact on health behaviors such as sleep. Comparison between races for how much asthma affects sleep health would be useful to address these vulnerabilities.MethodsAnalysis was performed on the 2020 National Health Interview Survey, the most recently collected data (n=31,568.) The sample was stratified to include only asthmatics using the survey variable that asked “Have you ever been diagnosed with asthma'” 8.6% of the sample reported having asthma (n=2123). Adjusted binary logistic regression was performed to determine how race predicts sleep health in this population. Covariates included age, sex, education, household income, and physical activity. “Healthy Sleep” was coded as self-reported 7-8 hours of sleep, and “Unhealthy Sleep” was coded as either less than 6 hours or more than 9 hours, as literature establishes short and long sleep have deleterious effects on health. “Race” was coded as White, Black, American Indian/Alaskan, or Asian. In the regression, White was used as the reference category.ResultsIn the adjusted model for race predicting healthy sleep, only African-Americans/Blacks showed significance compared to other races. The model showed that Blacks who are asthmatic are 54% (p<.01) less likely to sleep for 7-8 hours per day. Asian asthmatics (p=.815), and American Indian asthmatics (p=.761) did not demonstrate significance in the model predicting healthy sleep.ConclusionThese analyses show a pronounced connection between black racial status and unhealthy sleep amongst asthmatics. The results are in line with literature that demonstrates blacks sleep less in general and are more commonly afflicted with sleep conditions such as OSA, but there is a dearth of research examining how asthma affects sleep in this population. Further studies are needed to examine the underlying factors that may drive these vulnerabilities.Support (if any)K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0856
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0647 Rest-activity pattern in Major depressive disorder - a case control
           study

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      Pages: A284 - A285
      Abstract: IntroductionDisruption of rest-activity pattern are important behavioral manifestations in patients with major depressive disorder (MDD). Actigraphy provides accessible and objective measurement on physical activity, sleep, and circadian rhythm, but it was not widely used in studying patients with MDD, especially among Asian population.MethodsRest-activity pattern was recorded by Actiwatch Spectrum Plus/PRO for 7 continuous days. Physical activity and sleep estimation was processed by Philips Actiware software 6. Circadian rhythm characteristics were generated by using the “cosinor” and “nparACT” packages in R to perform the cosinor and nonparametric analysis respectively.ResultsA total of 70 MDD subjects, and 59 age- and sex-comparable controls were included in the actigraphy data analysis. The mean age of MDD subjects was 51.24 ± 10.39 years, and 71.4% of MDD subjects were female. Of these MDD subjects, 54.3% were unremitted for their depressive illness. For sleep and circadian features, MDD subjects had higher Insomnia Severity Index (ISI score, MDD: 10.29 ± 5.70; controls: 6.05 ± 5.20, P < 0.001) and lower reduced Morningness-Eveningness questionnaire (rMEQ score, MDD: 13.19 ± 4.62; controls: 16.07 ± 3.28, P < 0.001) than controls. The percentage of mobility measured by actigraphy was significantly lower in MDD patients than controls (MDD: 58.58%; controls: 62.27%, P < 0.001), albeit the difference only occurred during rest period. MDD subjects had later acrophase (P = 0.024), M10 midpoint (P = 0.040) and a trend of delayed sleep midpoint (P = 0.076) and longer sleep duration (P = 0.067) than controls. When the comparison was performed among three groups, unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint than remitted MDD group (P = 0.021) and higher intra-individual variability for sleep duration than controls (P = 0.016).ConclusionMDD subjects had increased insomnia and eveningness than controls, which was supported by the acitgraphy data at which MDD had a tendency of longer major rest interval and delayed circadian phase. Unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint and sleep duration. These actigraphy parameters may be useful markers for phenotyping and monitoring of MDD.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0647
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0857 Associations between Functional Vision and Sleep Performance

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      Pages: A378 - A378
      Abstract: IntroductionConserved early visual pathways set visual perception and sleep consolidation and timing, but the associations between functional vision and sleep are not well established. Here, we determine these associations in a nationally-recruited adult cohort and contrast them with health outcome covariates.MethodsData were drawn from 5973 adults aged 20 to 85 years (M=41.32, SD=21.82), obtained from the US National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008 cohorts. Adults reported demographics, sleep duration, vision, body size (body mass index; BMI), depression (Patient Health Questionnaire-9), and social support information. Spearman’s rank correlations were performed to determine the association between self-reported measures of functional vision and self-reported typical nightly sleep duration. To determine the influence of covariates thought to moderate health outcomes on this association, ordinal logistic regression was performed with sleep as the predictor and ‘general eyesight condition’ or ‘vision limiting activities’ as the dependent variables; and age, BMI, depression, and emotional support as covariates.ResultsTypical nightly sleep duration correlated very weakly with general eyesight condition (r=-.07, p<.001), vision limiting activities (r=-.03, p=.001), eyesight worry (r=-.09, p<.001), difficulty reading newsprint (r=-.06, p<.001), and difficulty discriminating objects (r=-.03, p=.007). For general eyesight condition, (exponentiated) odds ratios were minorly improved with increasing typical nightly sleep duration (B=.93, p<.001), but these effects were eclipsed by psychosocial factors such as PHQ-9 depression score (B=1.11, p<.001) and emotional support availability (B=.71, p<.001), while ageing had a minor effect (B=1.02, p<.001) and BMI did not associate (p=.29). For vision limiting activities; odds ratios were not influenced by typical nightly sleep duration (p=.086), psychosocial factors such as PHQ-9 depression score (B=1.13, p<.001) and emotional support availability (B=0.63, p<.001) meaningfully enhanced odds ratios, while ageing (B=1.03, p<.001) and BMI had minor effects (B=1.01, p=.009).ConclusionDespite shared sensory pathways, the neuroprotective effects of sleep on functional vision appear limited. Unlike for many disorders, BMI and ageing did not meaningfully associate with functional vision deficits. Psychosocial support mechanisms had the strongest beneficial association with functional vision, and such mechanisms should be given more consideration during optometric care.Support (if any)BBRF NARSAD (#28056). KTEF Career Starter (#NNO). NAM Catalyst (#2000012740).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0857
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0648 Retinal responsivity is associated with light and season-related
           cognitions in older adults with seasonal depression

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      Pages: A285 - A285
      Abstract: IntroductionMaladaptive cognitions associated with lower light availability in winter and the changing of the seasons are elevated in winter depression and are treatment targets in psychotherapy. Mechanisms underlying the development of SAD-specific cognitions may be related to seasonal variation in melanopsin-driven retinal responsivity to light. Prior work has shown reduced retinal responsivity to light during the winter in seasonal depression. We hypothesized maladaptive seasonal cognitions would be associated with reduced retinal responses to light. We also tested whether age moderated this relationship, hypothesizing that this learned association may only appear in older individuals who have experienced a greater number of seasonal depressive episodes.MethodsParticipants ages 19-65 (M=36.13, SD=12.81) with seasonal depression (n=37) and non-depressed controls (n=32) completed assessments in winter months (21st December to 21st March). Maladaptive seasonal cognitions were measured by the Seasonal Beliefs Questionnaire (SBQ). Melanopsin-driven retinal responsivity was assessed using the post illumination pupil response (PIPR). Net PIPR as a percent of baseline was averaged across the 10-30 seconds post-stimulus for use in analyses. Using multiple regression, we tested (1) if seasonal beliefs predict the PIPR and (2) if an interaction between seasonal beliefs and age predicts the PIPR, controlling for gender, the pupillary light reflex (PLR), and circadian time of testing from Dim Light Melatonin Onset.ResultsSeasonal beliefs were not associated with the PIPR (b= -0.86e-5, SE=0.27e-3, p=0.98). There was a significant interaction between seasonal beliefs and age on the PIPR (b= -0.56e-4, SE=0.23e-4, p=0.02), in which greater seasonal beliefs were associated with reduced PIPR in older individuals but not younger individuals. The Johnson-Neyman interval indicated that in participants above age 49, greater seasonal beliefs were significantly associated with lower retinal responsivity (PIPR; p< 0.05).ConclusionGreater seasonal beliefs were associated with reduced retinal responsivity, but only in older adults with seasonal depression. It is possible that reduced retinal responsivity creates learned maladaptive schemas regarding seasonal changes that are reinforced with annually recurring winter depressive episodes. However, longitudinal data focused on changes in seasonal beliefs resulting from reduced retinal sensitivity is necessary to test whether retinal responsivity is a mechanism in the formation of these seasonal-specific cognitions.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0648
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0862 Effect of meditation and relaxation on physiological markers of
           stress and sleep

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      Pages: A380 - A380
      Abstract: IntroductionBoth breathing based meditation (interoceptive) and relaxation by improving blood circulation using heat and massage (exteroceptive) are known to reduce physiological stress. In this study, we determined the effect of stress-reduction on sleep. Our main population of interest was peri- and post- menopausal women who may develop sleep disorders correlated with early-life physical abuse.Methods20 adults (15 peri- and post-menopausal females), 13 with high risk of sleep apnea (determined by Berlin questionnaire, age mean±SEM, 54±3 years, waist-by-neck 2.6±0.07, BMI 26±1 kg/m2, Insomnia Severity Index (ISI) Scale 5.71±1.23, Generalized Anxiety (GAD-7) Score 5.33±1.22, Early Trauma Inventory Self-Report Short Form (ETISR-SF)physical 3±0.17. Dreem3 headband was used to get breathing rate (BR), sleep efficiency, sleep staging. Plethysmography was used to obtain mean and nadir oxygen saturation %, heart rate (HR), oxygen desaturation (4%) event index (ODI). BMI, age, waist/neck were recorded. Baseline sleep measures were compared against sleep after administration of 10 minutes rest, 10 minutes relaxation and 10 minutes of Ujjayi pranayama with repeats of 4 in-, 4 hold-, 6 out- breaths. ETISR-physical was correlated with all measures. Paired t-tests were conducted on sleep measures at baseline and after meditation/relaxation. One-sample t-tests were conducted on average % changes during meditation/relaxation compared to rest.ResultsEarly-life physical trauma correlated positively with BR during REM sleep (Pearson R= 0.68). Deep sleep significantly (p=0.04) increased by 5% on the sleep after meditation/relaxation. Both meditation and relaxation techniques significantly (p< 0.01) lowered HR by 1.5% and 4.5%, and BR by 20% and 15% respectively during Ujjayi pranayama and relaxation. We observed significant increase (p< 0.05) in oxygen saturation with the Ujjayi pranayama by 0.3%.ConclusionEarly-life physical abuse was correlated with faster breathing during REM sleep validating existing literature. Both HR and BR were reduced during meditation and relaxation techniques, thus validating their stress-reduction effects. % of deep sleep improved on the night when meditation/relaxation session was administered. Mind-body practices could improve deep sleep if practiced regularly even in peri- and post-menopausal women having early-life physical abuse trauma.Support (if any)Sleep Research Society (SRS) Small Research Grant 2022.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0862
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0649 Sex Differences in the Effects of TMS on Depression

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      Pages: A285 - A286
      Abstract: IntroductionAs part of a larger study to examine the effects of repetitive transcranial magnetic stimulation (rTMS) over a single node of the default mode network (DMN) on sleep quality, we also examined secondary effects on depression. We hypothesized that rTMS would be more effective in females, rather than males, due to previously established higher rates of depression in the female population.MethodsWe administered continuous theta burst stimulation (cTBS) rTMS or sham stimulation, in a counterbalanced order separated by at least 5 days, over the left inferior parietal node of the DMN in 20 participants with clinical insomnia, 8 males (Mage=31.6, SD=6.7) and 12 females (Mage=23.8, SD=4.3). Beck Depression Inventory (BDI) scores obtained immediately before and after the stimulation sessions were compared using mixed (condition x time x sex) ANOVA to determine the effectiveness of rTMS in reducing symptoms of depression between the sexes.ResultsOverall, there was a large effect size (ηp2=0.207, p=0.077) in BDI scores between scores after the sham cTBS TMS session (M=12.47, SD=2.54) and scores after the active cTBS TMS session (M=10.00, SD=2.01). However, when separating for sex, males did not show a statistically significant reduction in depressive symptoms for the active session compared to the sham session (ηp2=0.08, F(1,6)=19.00, p=0.508). While the treatment did not significantly change depressive symptoms in females, large effect size was observed (ηp2=0.261, F(1,7)=18.06, p=0.16), suggesting potential efficacy of the treatment. Post-hoc pairwise comparisons reveal a greater change in depression symptom scores for active vs sham cTBS TMS in women (M=-4.00, SD=2.00), than men (M=-0.71, SD=1.43).ConclusionAn intervention using cTBS rTMS to improve sleep also led to a trend toward reduced depression, that was more evident among women. As reported elsewhere, this treatment significantly improved polysomnographic sleep, and the present preliminary results suggest that it may also be useful for modestly improving depressive mood, but further research will be necessary due to the limited sample size. It is not clear whether the trends toward mood among women was due simply to higher baseline depression scores in that group, but the findings suggest that additional work is warranted.Support (if any)W81XWH2010173
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0649
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0698 Contrasting Painful and Painless Restless Legs Phenotypes: An Adult
           Twin Family Study

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      Pages: A307 - A307
      Abstract: IntroductionSeveral studies characterized painful and painless restless legs syndrome (RLS) phenotypes based on clinical, topographical, polysomnographic, and genetic background. One pediatric twin family study demonstrated a clear contrast between these two forms of RLS. The painful pediatric RLS being familial, probably genetically influenced, and associated with primary pain disorders (non-migraines headaches; recurrent abdominal pain), the painless pediatric RLS being familial but probably not genetically determined, and associated with iron deficiency, female gender, and persistent/chronic pain disorders. The current study investigated these contrasting painful and painless RLS phenotypes in the adult population.MethodsThe Twins Research Australia database was used to recruit adult twins and their families. The subjects were surveyed and responded to questions related to their demographics, the Cambridge-Hopkins diagnostic questionnaire for RLS diagnosis and categorization into painful and painless RLS subgroups, the history of physician-confirmed iron deficiency, the presence of selected chronic and primary pain disorders, and also other medical, non-pain conditions associated with RLS. Association analyses, using logistic regression with application of generalized estimating equations to control for twin influences, and adjusting for gender and age, were conducted.ResultsA total of 1449 adult subjects responded to the RLS diagnostic questionnaire and to pain related and other medical conditions questions (64.4% females). A total of 1327 adult subjects responded to the iron deficiency pertinent questions (65.7% females). Numbers of dizygous twins and painful RLS subjects were insufficient for heritability testing and for association analyses with medical conditions. Painless RLS was associated with iron deficiency (OR= 1.59; p=0.003), while painful RLS was not (OR=1.26; p=0.444). Painful RLS was associated with migraine (OR=2.35; p=0.004), recurrent abdominal pain (OR=1.96; p=0.026), growing pains (OR=2.13; p=0.050), diverse chronic pain (OR=2.88; p=0.017), chronic spinal pain (OR=3.65; p=0.001) and dysmenorrhea (OR=2.46; p=0.009). Painless RLS was not associated with any pain disorder.ConclusionThis study further confirmed contrasting associations in adults with painless and painful phenotypes of RLS (association with iron deficiency and multiple pain disorders, respectively).Support (if any)This work was supported by the School of Women's and Children's Health, Medicine, University of New South Wales, Kensington 2052, NSW, Australia; Private donors.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0698
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0863 Evaluation of sleep apnea among consecutive patients with all
           patterns of atrial fibrillation

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      Pages: A380 - A380
      Abstract: IntroductionAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and financial burden. Obstructive sleep apnea is more common in individuals with AF and may impair AF treatment efficacy including with catheter ablation. However, the prevalence of undiagnosed OSA in all-comers with AF is unknown.MethodsThis pragmatic, phase IV prospective cohort study will test 250-300 consecutive ambulatory AF patients with all patterns of atrial fibrillation (paroxysmal, persistent, and long-term persistent) and no prior sleep testing for OSA using the WatchPAT system, a home sleep test.ResultsWe report the design, methodology, and results from the initial pilot enrollment of approximately 25% (N=52) of the planned sample size. The primary outcome is the prevalence of undiagnosed OSA in all-comers with AF. Additional outcomes of interest include the sensitivity and specificity of clinical screening instruments for OSA in the AF population and AF-related quality of life measurements among those with and without OSA. Results of the pilot dataset demonstrate a 77.5% prevalence of at least mild (AHI≥5) OSA or greater in all-comers with AF.ConclusionBased on our preliminary dataset representing one quarter of the planned total enrollment size of 250-300, there is a high prevalence of OSA in all-comers with AF.Support (if any)Zoll Medical
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0863
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0802 Quantifying Screening Efficacy and Referral Patterns in Well Child
           Visits

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      Pages: A353 - A353
      Abstract: IntroductionSleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits.MethodsWe queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers.ResultsBefore the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022.ConclusionThe introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options.Support (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0802
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0699 Longitudinal Assessment of Buprenorphine Effectiveness for Severe
           Restless Legs Syndrome and Dopaminergic Augmentation

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      Pages: A307 - A308
      Abstract: IntroductionOpioids are a consensus second-line treatment for moderate-to-severe restless legs syndrome (RLS). Due to its partial mu-opioid receptor agonist mechanism, buprenorphine (bup) has lower risk of respiratory depression, euphoria, and dependence than full-agonist opioids. We hypothesize that with long-term administration for severe RLS, bup is both effective and well-tolerated and can facilitate successful weaning off dopamine agonists (DA) for patients with augmentation.MethodsWe conducted a longitudinal examination of a retrospective cohort of patients prescribed bup over a 21-month period by a tertiary RLS specialist. Patient-reported outcomes were administered through patient-completed electronic health record-based questionnaires or by clinician interview: International RLS Study Group(IRLS-SG,primary outcome), Clinical Global Impressions of Improvement(CGI-I), Epworth Sleepiness Scale(ESS), Insomnia Severity Index(ISI), Patient Health Questionnaire(PHQ-9), and Patient-Reported Outcomes Measurement Information System-Sleep Disturbance domain(PROMIS-SD). A linear mixed model assuming compound symmetry correlation structure was used (least square means,95%CI) to test the change from baseline to 6-week, 3-month, 6-month, and 1-year intervals, and the final visit, irrespective of time from baseline, with adjustment of age, sex, other RLS meds at final visit, and administration of iron infusion.Results55 patients (56.4% female, 64.9±12.1 years) started bup for RLS, and 42(76.3%) remained on bup at the final visit. IRLS-SG was 27.8(25.3,30.3) at baseline and was significantly reduced at every interval (p of trend < 0.001), including 11.4(7.4,15.4) at 1 year. Of the 39(70.9%) patients that were on a DA with augmentation at baseline, 32(82.1%) had discontinued DAs with 5(12.8%) on a reduced dose at the final visit. Of those remaining on bup at the final visit, 93.8% were CGI-I responders, There was a statistically significant longitudinal trend in 1-year improvement in ESS:9.9(8.0,11.8) to 6.9(4.5,9.4),p=0.003, ISI:18.0(15.9,20.1) to 15.0(11.6,18.3),p=0.048, PHQ-9:10.4(8.2,12.5) to 6.1(3.6,8.6),p< 0.001, and PROMIS-SD:63.0(60.2,65.7) to 53.8(49.8,57.8),p< 0.001. 13(23.6%) discontinued bup with nausea, cognitive complaints, and dizziness as the most common side effects.ConclusionIn this largest cohort to date to examine buprenorphine in severe RLS, our findings show buprenorphine markedly reduced RLS symptoms, effectively enabled the elimination of dopamine agonists in patients with augmentation, improved sleep and other health quality measures, and was tolerated comparably to other RLS medications.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0699
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0700 Parasomnia-related homicides: A systematic review and a critical
           analysis of the medical literature

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      Pages: A308 - A308
      Abstract: IntroductionCases of homicide allegedly committed during sleep have been described since ancient history. The strongest link between violence and sleep disorders is represented by the so-called parasomnias, a group of sleep disorders characterized by episodic undesirable behaviors and/or mental experiences that arise during sleep.MethodsWe conducted a systematic search according to the PRISMA guidelines with 4 different search engines (Pubmed, Scopus, Embase and Cochrane) with the aim of gathering and critically evaluating all described cases of homicides associated with parasomniasResultsWe identified over 30 cases of homicide allegedly committed during a parasomnia episode. The diagnosis was of NREM sleep parasomnia for all cases except one, which received a diagnosis of REM-sleep behavior disorder (RBD). Victims were more often female family members, killed by firearms or sharp objects, usually nearby the bed. Aggressors often reported delusional/hallucinatory mental experiences associated with their episodes and rarely made any effort to cover up the crime. In the majority of the cases, no objective sleep data were available. Only a minority of patients had a positive childhood or family history. The court judgement was not uniform across cases.ConclusionAlthough rarely, homicides could be committed during parasomnias episodes. Despite being more frequently associated with violent behaviors, RBD less likely led to fatal aggressions. According to the observed behaviors, subjective reports and current neurophysiological knowledge, patients are only partially conscious and largely disconnected from the external environment, and could not be considered guilty for their actions.Support (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0700
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0821 Nighttime Average and Dipping Blood Pressure Can Differ Based on the
           Temporal Distribution of Ambulatory Measurements at Nighttime

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      Pages: A361 - A362
      Abstract: IntroductionAmbulatory blood pressure (BP) monitoring is recommended in preference to office BP as it enables BP assessments across the night and quantification of the degree of nocturnal BP dipping (dipping” = nighttime/daytime BP of < 0.9; non-dipping = ≥0.9). Both nighttime BP and dipping% are independent predictors of adverse cardiovascular events. Standard guidelines recommend at least ≥20/7 daytime/nighttime measurements for reliable ambulatory BP monitoring, but newer reports suggest ≥8/4 daytime/nighttime measurements are sufficient. Considering BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. To test whether this new recommendation holds for extreme examples of temporal distribution, we compared average nighttime BP and dipping% when using BP measurements only in the first (1st-half) vs. only in the second half (2nd-half) of the night.MethodsSeventeen females and twenty-six males (50±10 years [mean±SD]) without cardiovascular disease or severe sleep disorders wore an ambulatory BP monitor for 24 hours, programmed to measure BP every 20 minutes when awake and every 30 minutes during a self-selected 8-hour time-in-bed for nighttime. We compared the nighttime BP averages and the calculated dipping% when using the first four measurements from the 1st-half of the nighttime, from the 2nd-half of the nighttime, and all measurements during the nighttime (All nighttime, AN). Repeated measures ANOVA was conducted with significance set as p< 0.05.ResultsSystolic BP was higher using 1st-half than 2nd-half but similar to AN (111±9 vs.107±11 vs. 109±9 mmHg, p< 0.01), while systolic BP dipping% using 1st-half was lower than 2nd-half and AN (9.7±7.4 vs.13.0±7.6 vs. 11.4±6.7 %, p< 0.01, respectively). Diastolic BP and diastolic dipping% were similar among the 1st-half, 2nd-half, and AN segment (63±6 vs. 63±7 vs. 62±7 mmHg, p=0.19) and (17.2±7.6 vs. 17.2±8.8 vs. 18.4±8.8 %, p=0.16), respectively.ConclusionIn adults without cardiovascular disease or severe sleep disorders, nighttime BP and dipping% may depend upon when BP measurements are taken. The minimum threshold of 4 measurements for a reliable nighttime BP readout should be used cautiously.Support (if any)NIH F32-HL131308, R01HL163232, R01HL125893, R35HL155681, Medical Research Foundation, and OHSU OFDIR fellowship.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0821
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0701 Perceptions of People with Restless Legs Syndrome on the Effect of
           Exercise on Symptoms: Results of a Nationwide Survey

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      Pages: A308 - A308
      Abstract: IntroductionRestless legs syndrome (RLS) is a prevalent, sensorimotor sleep disorder that significantly disrupts sleep and is associated with increased risk of cardiovascular disease, hypertension, stroke, depression and anxiety, and causes overall poorer health. As two key diagnostic features of RLS include the worsening of symptoms at rest and relief by movement, there is increasing interest in utilizing physical activity and exercise to manage symptoms. The present study describes personal perceptions of the effects of exercise on symptoms of RLS.MethodsParticipants (N=528) completed a mixed-methods, nationwide survey including items assessing personal experiences with exercise and RLS (both positive and negative) as well as RLS diagnosis, RLS severity, and demographic and clinical characteristics.ResultsMost respondents (72%) perceived that exercise improves RLS symptoms with only a small proportion (13%) perceiving exercise only makes symptoms worse. Participants described any abrupt change in exercise would almost always elicit RLS symptoms (e.g., hiking for a long time, stopping an exercise routine) and that a consistent pattern of exercise seemed to be associated with improvements in RLS symptoms and an overall beneficial effect on frequency of symptomatic bouts. Most (55%) perceived exercise in the morning (4AM to noon) improved their symptoms and 56% perceived exercise in the afternoon/evening (4PM to 11 PM) made symptoms worse. Participants described several questions that they wanted answered regarding the evidence for exercise in RLS and specific exercise prescription recommendations.ConclusionOur results suggest that there is individual variation in the response to exercise, whereby some people experience improvements in symptoms with exercise, while others experience worsening of symptoms with exercise. Such individual differences and specific attributes should be considered in exercise-based management to further optimize personalized treatment plans to prevent and manage symptoms in people with RLS.Support (if any)This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952].
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0701
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0817 Associations between Sleep Health and Injuries among Adults in the
           US: Findings from the National Health Interview Survey

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      Pages: A359 - A360
      Abstract: IntroductionIn 2020, 55.4 million Americans sought medical attention due to nonfatal, preventable injuries. Injury-related death rate was 15.7% higher than in 2019. Poor sleep health is associated with increased risk of injuries (e.g., falls, sports, and motor vehicle-related injuries). This study examined the associations between sleep health and injuries among adults (≥18 years).MethodsThis study utilized the 2020 National Health Interview Survey (n=31,568). The primary outcome encompassed sustained bodily injuries in the past 3 months. Secondary outcomes were fall-related, sports-related, and motor vehicle (MV)-related injuries. Sleep health in the past month was measured via 1) sleep quantity: very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours); 2) sleep quality: trouble falling asleep and trouble staying asleep; 3) feeling well-rested upon waking-up; and 4) sleep medications. Response categories included never, some days, most days, or every day. Adjusted multivariable logistic regression was used to examine associations between injuries and these four domains of sleep health.ResultsOverall, 9.1% of respondents sustained an injury. Among injured adults, 47.4% had fall-related injuries, 29.1% had sport-related injuries, and 6% had a MV-related injury. Adults with very short, short, and long sleep were 37%, 15%, and 22% more likely to be injured than adults with healthy sleep (p< 0.05). Adults with trouble staying asleep were 36% more likely to be injured than adults who never had trouble staying asleep (p< 0.01). Adults who woke up never rested or rested on some days were 49% and 36% more likely to be injured (p< 0.01) Adults who took medications for sleep on some days or every day were 24% and 36% more likely to be injured (p< 0.05; p< 0.001). Adults who had trouble staying asleep some days were 22% more likely to have a fall-related injury (p< 0.05). Respondents with long sleep were 43% less likely to have sports-related injuries (p< 0.05). Those who had trouble staying asleep were 3.5 times more likely to have experienced a MV-related injury (p< 0.01).ConclusionSleep health is strongly associated with injuries among adults. Further studies are needed to determine causality in the observed associations.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0817
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0702 Suicidality in Patients Using Opioid Medications to Treat Severe,
           Refractory Restless Legs Syndrome: Prevalence and Associations

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      Pages: A308 - A309
      Abstract: IntroductionPrior investigations demonstrate a high prevalence of suicidal ideation and behavior in Restless Legs Syndrome (RLS) patients, particularly those with depression and severe RLS symptoms. The present study examines the prevalence of, and associations with, active suicidal ideation (ASI) and passive suicidal ideation (PSI) in patients using prescribed opioids for severe refractory RLS.MethodsThe National RLS Opioid Registry is an observational longitudinal study consisting of individuals taking a prescribed opioid for diagnosed RLS, nearly all with previously augmented symptoms. Information on opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric symptoms, and opioid abuse risk factors were collected at baseline and every 6 months thereafter by REDCap surveys. Two years following enrollment, the C-SSRS was utilized to assess both PSI and ASI in the previous year, whereas the last question on the PHQ-9 assessed PSI in the past two weeks.ResultsAt baseline, participants reported a reduction in previous suicidality following initiation of opioids: ASI from 22.0% to 7.0%, and PSI from 36.7% to 13.4%. At the 2-year PHQ-9 survey, 10.1% of registry participants reported PSI within the two previous weeks. At that same 2-year assessment, on the C-SSRS, 7.8% of participants reported both PSI and ASI in the past year. Overall, suicidality was associated with depression, anxiety, female sex, and perceived opioid stigma. PSI was less likely to be present in those taking methadone. Serial mediation analysis found that both RLS severity and depression severity moderated the relationship between methadone use and PSI. Specifically, methadone use was associated with decreased RLS severity, which was associated with decreased depression severity, and then further, less PSI.ConclusionMaximal treatment of RLS symptoms and approaches which mitigate the other clinical features associated with ASI and PSI in this population (anxiety, depression, stigma) are worthy of independent therapeutic attention. Similarly, this data may be useful for prescribers when assessing the appropriateness of opioid treatment for individual patients.Support (if any)The National RLS Opioid Registry has received support from the RLS Foundation, the Baszucki Brain Research Fund, Florence Petrlik Family Foundation, Diane and Richard Brainerd, and the Blakeley Foundation.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0702
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0703 The burden of obstructive sleep apnoea and periodic limb movements
           during sleep on symptoms of parasomnia

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      Pages: A309 - A309
      Abstract: IntroductionBoth obstructive sleep apnoea (OSA) and periodic limb movements during sleep (PLMS) may trigger arousals which could induce parasomnias. However, the burden of OSA and PLMS in parasomnia is not fully understood. The aim of the study was to understand the prevalence of OSA and PLMS and their association with symptoms of parasomnia in patients referred with parasomnia for an inpatient polysomnography (PSG).MethodsIn this retrospective project we analysed demographics, medical history and PSG data of 94 patients with parasomnia. The relationship between symptoms of parasomnia, OSA and PLMS were analysed with logistic regression analyses. Data are expressed as odds ratio /95% confidence intervals/.ResultsForty-seven patients were diagnosed with OSA and 19 with PLMS. Parasomnia symptoms consisted dream enactment (n=28), abnormal movements (n=35), sleep talking (n=36), confusional arousals (n=27), sleep walking (n=36), night terrors (n=18), nightmares (n=15), sleep eating (n=8) and sexsomnia (n=2). Based on symptoms and PSG results, 45 were diagnosed with REM-parasomnia, 63 with non-REM parasomnia, 14 had overlap (both REM and non-REM parasomnia). Interestingly, non-REM parasomnias were inversely related to both OSA (-0.89 /-1.77-0.00/) and PLMS (-1.60 /-2,69- -0.55/, p< 0.01). More particularly, OSA was less prevalent in patients with night terrors (-1.52 /-2.72- -0.32, p< 0.01), whilst PLMS was more prevalent in patients with dream enactment (1.26 /0.21-2.30/, p=0.03), but was less prevalent in patients with nightmares (-2.30 /-5.164-0.56/, p=0.03), and with sleep walking (-1.96 /-3.49- -0.42/, p< 0.01).ConclusionBoth OSA and PLMS are prevalent in patients with parasomnia, however their association with specific diseases and symptoms is less evident. Further studies are necessary to understand if they could be treatable traits in parasomnias.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0703
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0820 Integrated Polysomnographic and Sleep Symptom-Based Cluster Subtypes
           Associated with Incident Atrial Fibrillation

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      Pages: A361 - A361
      Abstract: IntroductionWhile sleep disorders are implicated in atrial fibrillation (AF), the interplay and overlap of these disorders in AF risk remains unclear and a risk stratification challenge. Sleep-based clusters associated with AF can account for this complexity and translate to actionable approaches to identify at-risk patients. We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.MethodsCleveland Clinic patients (age>18) who underwent PSG 11/27/2004-12/30/2015 were retrospectively examined. Clusters were identified using latent class analysis of 23 symptoms (e.g. related to sleep disordered breathing (SDB), sleepiness, REM intrusion, NREM parasomnias), Epworth Sleepiness Scale (ESS) score, and 24 measures of SDB and sleep architecture from PSG reports. Outcome was 5-year incident AF. Cox-proportional hazards models were adjusted for age, sex, race, body mass index, cardiovascular disease and risk factors, tobacco use, chronic obstructive pulmonary disease, anti-arrhythmic medication use, and positive airway pressure use.ResultsThe sample included 43,433 patients: age 51.8±14.5, 51.9% (n=22,548) male, 74.4% (n=32,313) White, 7.3% (n=3,151) with baseline AF, and 4.3% (n=1,875) developed 5-year incident AF. Five clusters were identified and ranked by strength of AF association: 1) Hypoxemic (n=3,245): highest %time SaO2< 90% (T90), 2) Apneas+Arousals (n=4,592): most witnessed apneas, highest apnea hypopnea index (AHI), highest arousal index, least hypopneas, 3) Short sleep+NREM (n=6,126): shortest sleep time, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep+REM (n=26,809): longest sleep time, shortest REM latency, highest %REM. Compared to ‘Long sleep+REM’, ‘Hypoxemic’ had 47% higher AF risk (HR=1.47,95%CI=1.27-1.69), and ‘Hypopneas’ did not differ (HR=1.05,95%CI=0.86-1.28).ConclusionOf five clusters identified, the ‘Hypoxemic’ subtype conferred the strongest AF risk with the highest degree of hypoxemia (highest T90, lowest minimum and mean SaO2), maximum end-tidal CO2, heart rate, and ESS score. Consistent with prior evidence of hypoxemia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation should focus on external validation of these findings.Support (if any)Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation Pilot Grant, Transformative Research Resource Development Award
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0820
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0828 Greater sleep variability is associated with higher systemic
           inflammation in type 2 diabetes

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      Pages: A364 - A365
      Abstract: IntroductionCircadian misalignment increased systemic inflammation in sleep experiments and in those performing shift work. Milder degree of circadian misalignment such as day-to-day shift in sleep timing, i.e. sleep variability, was related to inflammation in population studies. Further, other sleep disturbances and glycemic control can contribute to inflammation. This pilot study explored if sleep variability was associated with inflammation in type 2 diabetes (T2D).MethodsSubjects included 35 non-shift working T2D patients with and without diabetic retinopathy (DR) who were participating in a clinical study (NCT04547439). Sleep pattern was assessed by 14-day actigraphy, yielding sleep duration and efficiency. Standard deviation of sleep duration across the night was used to represent sleep variability. Sleep apnea severity was assessed by an overnight home monitor. Neuropathy pain, statin use, serum creatinine, low-density lipoprotein (LDL), HbA1C and by high-sensitivity c-reactive protein (hs-CRP) were collected. Spearman’s correlation analyses and multiple regression analysis (using natural-log transformed values) were performed to establish an independent association between sleep variability and hs-CRP.ResultsMean (SD) age was 54.3 (6.4) years, 54.3% were female and 62.9% had DR. Median (interquartile range) of sleep variability was 69 (56,84) minutes. Median A1C was 7.5 (6.6, 8.7)% and hs-CRP was 2.4 (1.4, 4.6) mg/L. Higher hs-CRP was significantly associated with higher sleep variability (r=0.342, p=0.04), HbA1c (r=0.431, p=0.01) and LDL (r=0.379, p=0.03), but not with sleep duration, sleep efficiency, sleep apnea severity, DR status or other variables. Multiple regression analysis showed that higher sleep variability (B = 0.91, p=0.034) and higher HbA1c (B = 1.51, p=0.035), but not LDL, contributed to higher hs-CRP.ConclusionHigher sleep variability in non-shift working T2D patients was shown to be independently associated with higher systemic inflammation, conferring higher cardiovascular risk. This data supports the role of even a mild degree of circadian misalignment on systemic inflammation. Further investigations are needed to determine whether sleep intervention to increase sleep regularity can reduce systemic inflammation and improve cardiometabolic health.Support (if any)NEI R01EY029782 The University of Illinois Chicago Center for Clinical and Translational Science, which is supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002003.”
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0828
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0704 A PSG Study of the Effect of Clonazepam and Melatonin on REM Sleep
           without Atonia in Isolated REM Sleep Behavior Disorder

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      Pages: A309 - A310
      Abstract: IntroductionAlthough very few prospective clinical trials are available assessing the benefits of drugs in isolated REM sleep behavior disorder (iRBD), clonazepam and melatonin are considered as the first-line treatment options. However, while evidence supporting the efficacy of these two compounds on the clinical behavioral outcomes seems to be clear, it is not clear if they are able to significantly modify the main polysomnographic (PSG) feature of iRBD, i.e. REM sleep without atonia (RSWA). For this reason, we carried-out an observational cross-sectional retrospective PSG study of the effects of clonazepam and melatonin on RSWA.MethodsA total of 83 iRBD patients (70 males and 13 females, age range 50.9-83.2 years) were enrolled in this study: 43 drug-free, 21 patients taking at bedtime chronically (>6 months) clonazepam (0.5-2 mg), seven patients taking melatonin extended-release alone (2-3 mg), and 12 taking a combination of clonazepam and melatonin extended-release (same doses as above). PSG studies were assessed for all subjects, including the measurement of the automatic REM sleep atonia index (RAI) and periodic leg movements during sleep, as well as a series of demographic and clinical variables, such as age, age at onset, disease duration, clinical global impression scale (severity and improvement), mini-mental state evaluation, and RBD severity scale.ResultsNone of the outcomes considered in this study showed significant differences between the groups considered. All showed low average values of RAI, as expected, and there were no differences between patients taking clonazepam, melatonin, or a combination of them (drug-free 0.778±0.184, clonazepam 0.797±0.183, clonazepam+melatonin 0.692±0.224, melatonin 0.673±0.228; ANOVA F = 1.329, p = 0.271), despite the clinical global impression scale-improvement was reported to be “much improved” or “minimally improved” in all treated patients.ConclusionThis study confirms our previous findings in smaller patient series taking only clonazepam and suggest that both clonazepam and melatonin might be beneficial on some clinical manifestations of iRBD but are unable to modify its underlying neurophysiology. This might also indicate that these agents do not seem to interfere with the core mechanisms of this disease and other disease modifying drugs need to be discovered for iRBD.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0704
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0705 Restless sleep disorder and periodic limb movement disorder in
           children with history of prematurity

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      Pages: A310 - A310
      Abstract: IntroductionChildren with history of prematurity are at higher risk of complications, comorbidities and iron deficiency, including restless legs syndrome and periodic limb movements of sleep (PLMS). In this study we assess the prevalence of restless sleep disorder and PLMS in children with history of prematurity.MethodsRetrospective chart review of sleep studies in children aged 1-18 years, with history of prematurity, from July 2021 to July 2022 at Seattle Children's Hospital. Only diagnostic studies in children without diagnosis of a genetic syndrome or airway surgery were included.ResultsDuring the study, 2,577 sleep studies were conducted, 162 were in children with history of prematurity (6%): 25 were split or titration studies (14%), 29 children had syndromes (Down, Prader Willi, Wiedmann Beckmann, Achondroplasia), 4 tracheostomy studies, 6 in infants aged < 12 months and 6 were post airway intervention. Ninety-two diagnostic studies were included in analysis. Median birth age was 31 weeks, interquartile range (IQR) 27-34 weeks. Thirty-two (34.8%) children were referred for restless sleep and 55 (59.8%) for snoring; 18% had PLMS index >5/hour, 14% fit the criteria for restless sleep disorder (RSD). There were no statistically significant differences in PSG parameters between the children with RSD, PLMS and the remaining group, except for lower obstructive apnea/hypopnea index (Kruskal-Wallis ANOVA 8.621, p=0.0135) in the RSD group (median 0.7, IQR 0.3-0.9) than in the PLMS (median 1.7, IQR 0.7-3.5), or than in the nonRSD/nonPLMS group (median 2.0, IQR 0.8-4.5). Altogether, children with RSD and those with PLMS had restless sleep as an indication for the sleep study in 70% of cases while snoring was the indication in only 26.7% of them.ConclusionWe have previously reported that in the Seattle Children's Hospital Sleep Center the prevalence of RSD is 7.7% and that of PLMS is 9.3%; in this new analysis we found a higher frequency of RSD and elevated PLMS in children with history of prematurity. Premature children are higher risk of iron deficiency, among other complications and comorbidities. These new results confirm the previous reports of increased PLMS and add new knowledge on the prevalence of RSD in these childrenSupport (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0705
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0829 Insomnia with Objective Short Sleep Duration is Associated with
           Hypertension

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      Pages: A365 - A365
      Abstract: IntroductionInsomnia with objective short sleep duration (ISSD) has been proposed as the most biologically severe phenotype of the disorder associated with cardiometabolic morbidity in population-based samples.MethodsIn this study, we investigated the association between ISSD and hypertension in a large clinical sample. We studied 348 patients diagnosed with chronic insomnia disorder (CID) based on International Classification of Sleep Disorders (ICSD-3) criteria and 150 normal sleepers. Objective short sleep duration was defined by the median total sleep time (TST) of the sample (< 7 hours) measured with 1-night polysomnography. Hypertension was defined based on blood pressure (BP) levels, antihypertensive medication use and/or a physician diagnosis.ResultsAfter adjusting for potential confounders, patients with CID who slept < 7 hours were associated with 2.8-fold increased odds of hypertension compared to normal sleepers who slept ≥7 hours (odds ratio [OR]=2.81, 95% confidence interval [95%CI]=1.068–7.411) or < 7 hours (OR=2.75, 95%CI=1.005-7.542), whereas patients with CID who slept ≥ 7 hours (OR=1.52, 95%CI=0.537-4.285) or normal sleepers who slept < 7 hours (OR=1.07, 95%CI=0.294-3.904) were not significantly associated with increased odds of hypertension compared to normal sleepers who slept ≥ 7 hours. Linear regression analyses showed that, for every hour decrease in TST, systolic and diastolic blood pressure increased by 1.014 mmHg (p=0.045) and 0.923 mmHg (p=0.015), respectively, in patients with CID but not in normal sleepers.ConclusionOur findings further support that ISSD is a risk factor for hypertension and objective short sleep duration may be a useful marker of the biological severity of CID in clinical practice.Support (if any)This study was supported by the National Natural Science Foundation of China (81970087), Guangdong Province Science and Technology Special Fund Project (200115165870512), and the 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (2020LKSFG05B). The authors report no conflict of interest.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0829
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0594 Hybrid Decentralized Recruitment Approach to a Rare Disease Registry
           for Pediatric Patients With Narcolepsy: The CATNAP® Registry

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      Pages: A260 - A261
      Abstract: IntroductionLimited information is available on the natural history, presentation, and management of pediatric narcolepsy. CATNAP® is a retrospective and prospective, longitudinal, multicenter, web-based pediatric narcolepsy registry (NCT04899947). The primary objectives are to improve understanding of the natural history of pediatric narcolepsy, characterize symptom presentation and diagnosis, and understand treatment practices and outcomes. After registry initiation, an innovative decentralized approach was added to adapt to the post-COVID-19 environment and reach additional participants via social media.MethodsEligible children/adolescents (< 18 years) with confirmed narcolepsy were recruited. Participants, caregivers, and clinicians, leveraging web-based portals, answered questions on sociodemographic characteristics; diagnostic, medical, and treatment history; comorbidities; and disease progression. Participants continue to answer follow-up questions annually until they reach 25 years of age or decline to participate. Since registry initiation in September 2020, 17 sites have been activated, including a virtual site launched in August 2022. Hybrid decentralized recruitment required a new web interface, Institutional Review Board submissions, and 7-week social media campaign (press release, 5 targeted posts) to accompany the virtual site launch.ResultsA total of 126 participants have been enrolled (signed consent), including 75 participants at 16 physical sites over the first 2 years and 51 participants at the virtual site over 10.6 weeks. Rates of engagement (eg, clicks, likes, and shares) for Instagram (3.2%), LinkedIn (7.2%), and Twitter (2.4%) exceeded “good engagement rate” benchmarks for these platforms. Although the engagement rate for Facebook was below benchmarks (< 2%), the absolute number of “clicks” (29) was the largest among social media platforms in the campaign.ConclusionA hybrid recruitment approach for CATNAP demonstrates incorporation of patient-driven considerations into clinical trial design and increases access to future real-world data registries and studies. Decentralization likely increases enrollment and may enable representation from more diverse regions and populations. This is especially important for rare diseases. The CATNAP Registry provides valuable information on the experience and management of pediatric narcolepsy, which will benefit patients and caregivers, inform clinical decision-making, and potentially contribute to development of new treatments. This successful implementation of a hybrid approach with physical and virtual sites could inform design of future registries.Support (if any)Jazz Pharmaceuticals
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0594
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0840 Exploring the relationship between sleep disturbances and
           Alzheimer’s disease using machine learning

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      Pages: A370 - A370
      Abstract: IntroductionAlzheimer’s Disease (AD) is one of the most common neurological diseases, affecting about 50 million people worldwide. Despite its prevalence and many promising recent developments, the factors that contribute to AD are still poorly understood. In this study, we examined the influence of sleep disturbances (sleep apnea, insomnia, and poor sleep quality) on the chances of developing AD and conversion from normal cognitive functioning (NL), to mild cognitive impairment (MCI) to AD, using the ADNI dataset and state-of-the-art machine learning models.MethodsWe conducted a series of Random Tree classifiers to determine whether sleep disturbances predicted changes in cognitive status (NL, MCI, or AD). Using three sleep target variables OSA, insomnia, and Neuropsychiatric Inventory’s sleep related questions (NPIK) markers, participants that were surveyed for sleep patterns (n=1848) self-declared if they have insomnia (n=49), obstructive sleep apnea (OSA) (n=65), or poor sleep quality via NPIK (n=114). NPIK contains 11 variables, including OSA and NPIK, we explored a total of 7089 observations. Following that, a logistic regression and k-nearest neighbor (KNN) model using only the NPIK questionnaire as NPIK provides a rich and coherent inventory of sleep parameters.ResultsBased on Random Tree classifiers, the best model predicted a change from MCI to AD with an accuracy of 70%. Logistic regression and KNN models predict that caregiver distress, frequency of sleep disturbances and excessive daytime sleepiness play important roles in worsening the cognitive functioning status from MCI to AD. For the MCI patients, a random forest model with 60% accuracy predicted re-conversion from MCI to NL. Caregiver distress, frequency of sleep disturbances, and OSA predicted re-conversion from MCI-NL, and was most pronounced among males.ConclusionOur research broadly suggests that sleep disturbances increases Alzheimer's disease risk. However, the data on sleep in the ADNI dataset has limitations. All markers for sleep were subjectively reported by the patients or their caregivers and were not verified with objective observations. Further research under clinical conditions would be of value to find conclusive evidence of sleep disturbance as a risk factor for Alzheimer's Disease.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0840
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0595 Long-term efficacy on cataplexy attacks and excessive daytime
           sleepiness in open-label extension study (NLS-1022) of mazindol ER

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      Pages: A261 - A261
      Abstract: IntroductionMazindol ER (extended-release), the first partial orexin-2 receptor agonist and triple mono-aminergic reuptake inhibitor, has demonstrated efficacy and safety in significantly reducing excessive daytime sleepiness (EDS) and cataplexy attacks in narcolepsy type 1 (NT1) and type 2 (NT2) patients (POLARIS, Study NLS-1021). This efficacy was further studied in an open-labeled extension (OLE) study (ClinicalTrials.gov Identifier: NCT04923594).MethodsA multicenter, 6-month, OLE study with 51 narcolepsy patients previously enrolled in a double-blind mazindol ER study. Patients were administered 3mg mazindol ER once daily in the morning. Narcolepsy symptoms and adverse events were recorded. Safety measures included monthly physical and laboratory examinations. The primary efficacy measure was the change from baseline in EDS using the Epworth Sleepiness Scale (ESS). Secondary measures included weekly cataplexy attacks, the overall disease severity as rated by the investigators (Clinician Global Impression of Severity) and patients (Patient Global Impression of Severity).ResultsMazindol ER at 3 mg once-daily doses, produced overall improvements in EDS and narcolepsy within 1-2 weeks of starting dosing. Reported improvements included diminished daytime sleepiness (p < 0.001); significant decreases in cataplexy attacks (p < 0.001); and multiple improvements in symptoms severity and function. Adverse events were generally mild and patients showed no evidence of tolerance.ConclusionMazindol ER is a convenient, safe, well-tolerated and effective treatment for narcolepsy. Its anticataleptic and wake-promoting effects indicate that it may be a new therapeutic option for patients with NT1 or NT2 similar or better than various combinations treatments currently available.Support (if any)NLS Pharmaceutics
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0595
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0841 Feasibility of Actigraphy during a Daytime Bright Pilot Study in the
           Medical ICU

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      Pages: A370 - A371
      Abstract: IntroductionMedical intensive care unit (MICU) light patterns are inadequate for proper circadian alignment. Sleep disruption and circadian misalignment are observed in MICU patients and adversely impact patient outcomes. We sought to establish the feasibility of using longitudinal actigraphy to measure diurnal rest-activity patterns, as a in the context of a pilot study evaluating daytime bright light (DBL). In an exploratory manner, we analyzed diurnal rest-activity characteristics.MethodsPatients >50 years admitted to the MICU without pre-existing circadian disruption were enrolled. An actigraph was placed (wrist) on study day 1 (D1) and remained for up to 5 days. DBL exposure (>1200 lux, 5000K) began at 09:00 on D2 and continued until D5 (varied lengths of exposure among patients). Actigraphy feasibility was assessed via (1) total recording duration and (2) proportion of total recording with activity data (e.g., proportion of epochs on wrist with data capture). In an exploratory analysis, we evaluated rest-activity characteristics from D1 and D2 for fit with gamma distribution cosinor analysis. Characteristics included ratio of day/total activity, mesor (midline estimation statistic of circadian rhythm), and circadian quotient (normalized amplitude/mesor).ResultsThirteen of fourteen enrolled patients completed actigraphy. Mean (SD) age was 74 (11) years. Mean APACHE II illness severity score was 21 (4). Patients had a mean 3.7 (1.3) days of actigraphy recording and a mean activity data proportion of 92% (16%). There were only two reports of temporary actigraph removal related to patient care. All actigraphy patients had fit using cosinor analysis. D1 median (IQR) day/total ratio was 0.76 (0.68,0.82), mesor was 10.31 (6.36,13.00), and circadian quotient was 0.82 (0.48,0.99). D2 (after DBL start) median (IQR) day/total ratio was 0.76 (0.64,0.78), mesor was 11.90 (8.97,15.83), and circadian quotient was 0.89 (0.65,0.95).ConclusionHere we demonstrate the feasibility of actigraphy as a measure of diurnal rest-activity patterns in MICU patients based on successful collection and analysis of data in all patients. While cohort size remains a limitation of this study, Actigraphic rest-activity patterns are being explored in an ongoing RCT evaluating the impact of DBL versus usual light exposure on circadian rhythms in critical illness.Support (if any)K23HL138229, AASM Foundation
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0841
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0596 Overlap of Psychiatric Disorders with Central Hypersomnia

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      Pages: A261 - A262
      Abstract: IntroductionIn sleep clinics, hypersomnia is a frequently encountered condition. While narcolepsy and idiopathic hypersomnia are discrete diagnoses that typically do not have co-existing psychiatric co-morbidities, sleep practitioners often have to address mental illness and/or psychotropic medication needs in these patients with hypersomnia. The reasons for co-occurrence of idiopathic hypersomnia and narcolepsy with psychiatric disorders is not well understood. This study aimed to assess the degree of overlap between psychiatric diagnoses with central hypersomnias and the temporal relationship between the development of hypersomnia and psychiatric conditions.MethodsUsing the University of Utah EPIC database, patients with diagnoses of idiopathic hypersomnia or narcolepsy encountered over the last decade were identified. Out of the 307 available medical records, only those that met strict criteria for diagnosis of narcolepsy and idiopathic hypersomnia were included. Medical records were reviewed for the presence of psychiatric disorders and psychotropic medication use, and to assess the prevalence of mental illness with central hypersomnia.ResultsOut of 119 patients that met ICSD-2 criteria for central hypersomnia, 37 were diagnosed with narcolepsy type 1 (T1N), 59 with narcolepsy type 2 (T2N) and 23 with idiopathic hypersomnia (IH). There were 69/119 (58%) patients with central hypersomnia that had psychiatric comorbidities with 23/37 (62%) of T1N, 32/59 (54%) of T2N and 14/23 (60%) of IH experiencing psychiatric problems. Approximately 45% were prescribed antidepressants or a mood stabilizer either before, during or after diagnosis of a central hypersomnia. 46% of patients on stimulants alone vs. 23% of patients on sodium oxybate had a concurrent psychiatric diagnoses or psychotropic medication use.ConclusionGiven the degree of overlap between psychiatric disorders and central hypersomnias, further research is necessary to understand whether this overlap is a result of common neurological substrates driving these disorders or whether the hypersomnia is from comorbid psychiatric disorder or psychotropic medication use. The highest prevalence of psychiatric illness was seen with T1N. Patients with hypersomnia on sodium oxybate had lower rates of psychiatric co-morbidities. Whether these findings point to more optimal diagnosis and treatment of underlying hypersomnia with reduced need for psychotropic medication needs to be understood.Support (if any)None
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0596
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0854 Observation-based Diurnal Sleepiness Inventory (ODSI) is associated
           with Objective Sleepiness via Psychomotor Vigilance Task

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      Pages: A376 - A377
      Abstract: IntroductionThe Epworth Sleepiness Scale (ESS) is commonly used to assess excessive daytime sleepiness, but its accuracy is limited. In this study, we aim to compare the ESS with the Observation-based Diurnal Sleepiness Inventory (ODSI), a subjective measure of sleepiness that has been validated using the ESS in older adults, to objective measures of sleepiness obtained through the Psychomotor Vigilance Task (PVT). Despite being validated with the ESS, the ODSI has not yet been tested with objective measures of sleepiness. By comparing subjective measures of sleepiness (ODSI and ESS) to objective measures (PVT), we aim to expand the usage of ODSI to other populations.Methods91 persons with newly diagnosed obstructive sleep apnea and not yet treated on continuous positive airway pressure (CPAP) were administered the ESS, ODSI, and PVT sleepiness tests, and the results were analyzed for correlations using linear regression. The average age was 50.48 ± 12.74, the mean body mass index (BMI) was 35.9 ± 9.3, the mean apnea hypopnea index was 30.9 ± 23.7, and 53.5% were male. The ESS and ODSI scores were run against PVT lapses and transformed average reaction time, which are the two primary outcomes of PVT.ResultsPVT lapses were significantly different between sleepy and non-sleepy individuals as defined by both ESS and ODSI categorization. Both the ODSI and the ESS were significantly correlated to the transformed average reaction time. The second question on the ODSI was also significantly correlated to PVT lapses as well as the transformed average reaction time.ConclusionThe ODSI and ESS correlated well with objective measures of sleepiness through the PVT. The ODSI is a suitable measure of sleepiness appropriate for usage in middle-aged adults with obstructive sleep apnea.Support (if any)R00NR014675-05 (PI: Pak)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0854
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0597 Path to Diagnosis and Impact of Narcolepsy on Quality of Life: A
           Survey of People Living With Narcolepsy

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      Pages: A262 - A262
      Abstract: IntroductionResearch was undertaken to better understand the path to a narcolepsy diagnosis, common symptoms, and the impact of narcolepsy on work, social interactions, and mental health.MethodsIn February 2022, an email invitation to an online, 27-question survey was sent to US members of MyNarcolepsyTeam, a social network of >9,800 members.ResultsIn total, 110 members completed the survey. 38% of respondents started to experience symptoms before reaching 16 years of age. Most commonly experienced symptoms included excessive daytime sleepiness (EDS; 93%) and fatigue (84%). In total, 72% were also experiencing some form of sleep disturbance and 67% were already suffering from cognitive/memory challenges. 68% who were eventually diagnosed with narcolepsy type 1 (NT1) had cataplexy attacks. For 31%, getting to a narcolepsy diagnosis took ≥10 years. In fact, 64% were initially under- or misdiagnosed with something other than narcolepsy, including depression (73%), sleep apnea (36%), or attention-deficit/hyperactivity disorder (16%). 74% of patients with NT1 have continued to experience cataplexy, with 46% having some form of a cataplexy episode a few times per week. Cataplexy episodes were triggered by a wide range of emotional situations, including over-tiredness (70%), anger (48%), being startled (46%), laughter (46%), fear (44%), excitement (38%), or crying (33%). 76% of respondents indicated that the impact of narcolepsy on daily life is extremely or very severe. The far-reaching impact on quality of life was evident in that most respondents reported that narcolepsy interfered with work (82%), social life (86%), everyday chores (85%), and exercise (85%) and has limited career options (76%). The emotional toll of narcolepsy manifested in feeling isolated (83%), depressed (81%), anxious (80%), or embarrassed (75%).ConclusionPatients routinely experienced a misdiagnosis or a “missed” diagnosis based on common symptoms experienced. Being able to quickly identify narcolepsy as the root cause for symptoms of EDS, fatigue, and sleep disturbances can lead to getting the patient on the best treatment path as early as possible. Understanding the physical, emotional, and quality-of-life impact of narcolepsy can help clinicians provide a more holistic approach to treating their patients.Support (if any)Avadel Pharmaceuticals
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0597
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0855 Patient-reported sleep symptoms across four cycles of chemotherapy
           among adults with lymphoma: A pilot study

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      Pages: A377 - A377
      Abstract: IntroductionSleep disturbance is one of the primary symptoms reported by cancer survivors before, during, and after treatment. To better understand trajectories of sleep disturbance over the course of chemotherapy, we evaluated patient-reported symptoms among adults being treated for lymphoma.MethodsParticipants were 18-74 years old, English-speaking, and scheduled to be treated with a full course of anthracycline-based chemotherapy. Among other assessments, participants completed a battery of patient-reported outcome measures prior to the first cycle of chemotherapy (T1) and on the final days of the second (T2) and fourth (T3) cycles. Sleep symptoms were assessed with the Insomnia Severity Index (ISI), PROMIS Sleep Disturbance (PROMIS-SD), and PROMIS Sleep-Related Impairment (PROMIS-SRI) measures. Given the small sample size, descriptives and effect sizes were calculated rather than conducting inferential analyses.ResultsParticipants were 9 adults with Hodgkin’s (n=5) or Non-Hodgkin’s (n=4) lymphoma, mean age 41 years (SD=13.9), mostly male (89%), White (78%), and non-Hispanic (89%). The majority had higher scores on the ISI (85.7%), PROMIS-SD (71.4%), and PROMIS-SRI (71.4%) at T2 than T1, demonstrating more sleep disturbance mid-chemotherapy than prior to chemotherapy. Conversely, the majority had lower scores at T3 than T2 (ISI: 80.0%, PROMIS-SD: 80.0%, PROMIS-SRI: 100.0%), demonstrating less sleep disturbance at late-chemotherapy than mid-chemotherapy. For most participants scores remained higher at T3 than T1 (all 3 measures: 75.0%), indicating more sleep disturbance at late-chemotherapy than pre-chemotherapy. Averaged across participants, differences in scores from T1 to T2 were small-to-medium (ISI: Hedges’ g=0.42, PROMIS-SD: g=0.44, PROMIS-SRI: g=0.62), from T1 to T3 were small (ISI: g=0.26, PROMIS-SD: g=0.26, PROMIS-SRI: g=0.23), and from T2 to T3 were medium-to-large (ISI: g=0.98, PROMIS-SD: g=0.73, PROMIS-SRI: g=0.53).ConclusionPatient-reported sleep symptoms worsened over the first two cycles of anthracycline-based chemotherapy. Symptoms improved over the subsequent two cycles; however, for most participants they remained worse than baseline levels. Pending replication in a larger sample, intervening before initiating chemotherapy or during the early cycles thereof may be beneficial to diminish sleep disturbance among patients with lymphoma.Support (if any)The project described was supported by the Robert H. Lurie Comprehensive Cancer Center. RSF was supported by NCI grant #K08CA247973. EH was supported by NHLBI grant #K01HL152009.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0855
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0638 Comparison of social jet lag between individuals with seasonal
           affective disorder and controls

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      Pages: A280 - A281
      Abstract: IntroductionSocial jet lag (SJL) occurs when a person’s social time (weekdays) is out of phase with their circadian time (weekend). Not much is known about the relationship between Seasonal Affective Disorder (SAD) and SJL; however, the sleep/wake cycle is very vulnerable to disruption by external factors. In a previous study in adolescents and young adults, self-reported chronotype was used to calculate SJL, and winter mood variation and SJL were found to be higher after the time change in fall and winter. Our study will directly compare SAD and non-depressed controls in the winter on SJL calculated with actigraphy in a sample of adults.MethodsParticipants (N=46) ages 21-64 were recruited during winter months and included individuals with SAD (n=21) and nonseasonal, never depressed controls (n=25). Midsleep timing was measured using actigraphy (average number nights = 7), and SJL was calculated by subtracting average week midsleep from average weekend midsleep corrected for number of days. Regression analysis included diagnostic group as a predictor, age and gender as covariates, and SJL as the outcome.ResultsWhile the seasonally depressed group had a slightly higher average SJL (M =61.8 minutes, SD = 181.2 minutes) than the control group (M = 60.6 minutes, SD = 165 minutes; mean difference 1.2 minutes), there was no significant difference in SJL between the participants with seasonal depression and the controls (p=0.778). However, age was a significant predictor, as the younger half of the sample had a mean SJL of 94 minutes (SD=180 minutes) and the older half of the sample had a mean SJL of 24 minutes (SD= 156 minutes; mean difference= 70 minutes). There was no group*age interaction in post-hoc tests.ConclusionThis is the first study to test whether individuals with SAD have greater SJL than non-depressed controls, and the data do not support such a hypothesis. Results do, however, confirm prior findings that SJL decreases with age. Future studies should compare SJL in individuals with SAD during winter compared to spontaneous summer remission to test whether a change in SJL correlates with winter depression onset.Support (if any)NIMH K.A.R. MH103303
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0638
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0864 Evolution of Sleep Symptoms over Time Among Youth with
           Craniopharyngioma

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      Pages: A380 - A381
      Abstract: IntroductionCraniopharyngioma is a non-malignant tumor that arises in the suprasellar region of the intracranial compartment. Hypothalamic dysfunction is common and associated with diabetes insipidus, hormone deficiencies, neurocognitive impairment, sleep disturbance, obesity, and decreased health-related quality of life. Patients with craniopharyngioma commonly have excessive daytime sleepiness, and are often diagnosed with narcolepsy without cataplexy and even obstructive sleep apnea (OSA). This study examined the change in apnea/hypopnea index (AHI) and prevalence of disorders of hypersomnia among pediatric patients with craniopharyngioma, from the time of diagnosis to 3 years after the completion of proton therapy.MethodsA total of 110 pediatric patients diagnosed with craniopharyngioma were prospectively evaluated on a protocol of limited surgery and proton therapy or observation. Prior to proton therapy , patients age ≥4 years completed a baseline overnight polysomnography (PSG) and the next day multiple sleep latency test (MSLT) when age ≥7 years. Follow-up PSG and MSLT were repeated 3 years later. Patients were excluded from the analysis if they did not complete the sleep study at either time points.Results71 completed the baseline and 3-year PSG/MSLT. A paired samples t-test determined the change between time points. When compared to baseline (M=1.30, SE=.22) the AHI significantly increased at the 3-year evaluation (M=3.00, SE=.60), with a difference of t=-1.69, (p=.002). Fifty-one patients completed the baseline and 3-year MSLT. At baseline, 8 patients did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical disorder and 13 were diagnosed with narcolepsy due to medical disorder. At the 3-year MSLT, 2 of the 51 did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical condition and 19 were diagnosed with narcolepsy due to medical condition.ConclusionPediatric patients with craniopharyngioma have disorders of hyposomnolence at diagnosis. The number impacted by hypersomnia increase with time, with the added burden of hypothalamic obesity and OSA. Interventions should be initiated early after diagnosis for promotion of wakefulness and prevention of obesity to deter the onset of OSA.Support (if any)This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0864
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0639 Delayed Presentation of Sleep Disruption and Depressive Symptoms in
           Males Post Mild Traumatic Brain Injury (mTBI)

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      Pages: A281 - A281
      Abstract: IntroductionThe relationship between sleep disruption and depressive symptoms is well established. Mild traumatic brain injury (mTBI) is commonly associated with emotional dysregulation and decreased sleep quality. Less is known about the course of mTBI and its association with mood symptoms over time. We hypothesized that those in acute stages of mTBI (2W; 1M) would significantly differ in sleep quality and depressive symptoms compared with healthy controls. As there are often sex differences in sleep and depression, we focused here exclusively on males with mTBI.MethodsThis study included 56 healthy males, split into six groups. The sample included 15 healthy males (Mage=23.67, SD=5.066) and 41 males (Mage=26.88, SD=8.509) with mTBI, at differing stages post-injury: 2 weeks and 1, 3, 6, and 12 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Index (BDI-II) to assess sleep disturbance and mood, respectively. Higher scores on both measures indicate a more severe presentation of disruptive symptoms. We conducted a one-way ANOVA to examine how the mean score for both measures varied at each time point.ResultsCompared to healthy controls there was no significant variance in average depression scores at 2W, 1M, 6M, and 12M (p>.05). However, at 3M post-mTBI males reported significantly higher depression scores than healthy controls M =9.8, SD=9.48, p=.035. Participants with mTBI reported greater sleep disruption when compared to healthy controls at 3M M =7.30, SD=3.16, p=.035 and 12M M=7.0, SD=3.39, p=.037, but not at other time points.ConclusionContrary to our hypotheses, we found that males did not significantly vary from healthy controls for either measure in the acute stages of mTBI. These results indicate that males may not initially present depressive symptoms and sleep disruption post-mTBI, which could result in an inaccurate assessment of injury severity and an improper treatment plan moving forward in recovery. Further research conducted with a larger sample size would be useful in establishing that males suffering from mTBI experience the most severe presentation of symptoms roughly 3M after injury. Future work will need to examine whether these same trends are present among females.Support (if any)W81XWH-12-1-0386
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0639
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0640 Depression Symptom Outcomes After a Self-Guided Mobile Application
           CBT-I Intervention Among College Students

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      Pages: A281 - A282
      Abstract: IntroductionPrevious research has shown that approximately 78% of college students who suffer from insomnia also endorsed depressive symptoms. Students with depression were 9.5 times more likely to have insomnia than students who did not have depression. There has also been evidence that Cognitive Behavioral Therapy for Insomnia (CBT-I) can reduce depression symptoms. However, the effectiveness of a self-guided mobile version of CBT-I (iCBT-I) in reducing depression among college students has yet to be evaluated. This study aims to assess depression symptoms among students who engaged in a self-guided iCBT-I intervention.MethodsThe study uses a between- and within-subjects design to assess biweekly changes in depression symptom severity before and after completing a four-week mobile intervention for insomnia (i.e., CBT-I Coach). Participants included 39 University of Arkansas college students with a baseline insomnia severity index score ≥ 15. Participants were randomized into the intervention group or a wait-list control group. Participants in both groups are asked to use the CBT-I Coach app for 4 weeks (control group began intervention after a four-week delay). Every four weeks, the Center for Epidemiological Studies Depression Scale was administered to assess depressive symptomology.ResultsPreliminary analyses showed a reduction in CES-D mean scores between baseline (M = 28.3) and week four (M = 25.4) of the intervention group. The intervention group also experienced a depression score rebound at week eight (M = 28.9). The wait-list control group experienced little change in mean CES-D scores from pre-to-post intervention, baseline (M = 23.4), week four (M = 24.2), week eight (M = 23.7).ConclusionThese results may lend evidence for the short-term effectiveness of iCBT-I in reducing depression symptoms. This could allow for wider dissemination of this treatment modality across a population who suffer from comorbid insomnia and depression.Support (if any)K23 HL141581
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0640
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0865 Feasibility of a Disposable Home Sleep Test Device in a Chronic Pain
           Population Prescribed Opioids

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      Pages: A381 - A381
      Abstract: IntroductionOpioids are a common pain treatment in the United States with approximately 143 million prescriptions dispensed in 2020. Long-term opioids for chronic pain increase risk of misuse and overdose. Opioids can also disrupt sleep and cause respiratory depression while poor sleep can exacerbate pain. In-lab polysomnography is the standard for diagnosing sleep disorders. However, polysomnography is less effective for observing patterns over multiple days and is not always representative of at-home sleep. This study investigates the feasibility of using a disposable home sleep test device with adults prescribed opioids for chronic pain and its ability to screen for sleep disorders and overnight oxygenation.MethodsParticipants were recruited from clinics and public advertisements. Key inclusion criteria were: ≥18 years of age, moderate daily level of pain (≥5 on the 0-10 Numeric Pain Scale [NPS]), prescribed opioids, and internet access. The NightOwl mini disposable home sleep test (Ectosence, Leuven, Belgium) was used to record total sleep time (TST), time in bed (TIB), sleep efficiency (SE), oxygen saturation (SaO2) and apnea-hypopnea index (AHI) for 5 consecutive nights.ResultsAll enrolled participants (N=9) completed 5 days with no missing data. The sample was 66% female with an average age of 60±12 (Mean ± SD). Mean NPS scores indicated moderate pain intensity (6.3±1.9). Participants spent an average of 8.0±1.4h TIB and slept for 5.4+/-1.3h TST resulting in a SE of 68.5±17.9%. On average, AHI was 7.3±7.7 (mild range for sleep apnea). 56% of participants displayed a SaO2 nadir below 88%, the recommended threshold for supplemental oxygen. All individuals agreed that they were at least somewhat satisfied with the ease and amount of time participating in the study. All agreed or strongly agreed that they felt comfortable participating.ConclusionParticipants used the disposable sleep test device at home with relative ease as indicted by complete data recording, values within expected norms, and satisfaction survey responses. The device could be an acceptable screening tool for sleep disorders and respiratory events that may otherwise go undetected in this population prescribed opioids and at risk for apnea and respiratory depression.Support (if any)NCATS/NIH # Ul1 TR002319 and The Rayce Rudeen Foundation
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0865
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0641 Difficulty Maintaining Sleep and Sleep Quality mediate the
           Relationship between Sleep Disturbances and Depression

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      Pages: A282 - A282
      Abstract: IntroductionPrior epidemiological research has established the relationship between sleep disturbances and depression. Sleep disturbances are also common prodromal features of and comorbid with depression. However, limitations exist across past studies, including the frequent focus on “sleep disturbances” over well-defined facets of sleep, inattention to mediators, and a lack of focus on special populations. As such, there is a need to delineate the relationship between sleep disturbances and depression across specific facets of sleep, particularly in special populations. The current study examined multiple sleep facets as mediators of the relationship between general sleep disturbances and depression severity in college student athletes.MethodsStudent athletes (N = 993) from the Pacific Athlete Conference-12 completed the Athlete Sleep Screening Questionnaire-Sleep Difficulty Subscale (ASSQ-SDS) and Patient Health Questionnaire-9 (PHQ-9). Parallel multiple mediator models were conducted to examine whether the relationship between sleep disturbances and depression severity was mediated by sleep duration, sleep quality, sleep onset latency, and difficulty maintaining sleep.ResultsUsing bootstrapping with 5,000 resamples, the indirect effect of sleep disturbances on depression severity was significantly different from zero through sleep quality (indirect effect = .17, SE = .07, 95% CI [.04, .31]) and difficulty maintaining sleep (indirect effect = .12, SE = .03, 95% CI [.06, .19]). Sleep disturbances were associated with sleep quality (b = .29, SE = .01, p < .001) and difficulty maintaining sleep (b = .16, SE = .01, p < .001). Sleep quality (b = .59, SE = .16, p < .001) and difficulty maintaining sleep (b = .78, SE = .17, p < .001) were associated with depression severity. No other mediators reached statistical significance.ConclusionResults demonstrate that perceived sleep quality and difficulty maintaining sleep mediate the relationship between general sleep disturbances and depression severity in college student athletes. Findings suggest that sleep quality and difficulty maintaining sleep may be more impactful on depression than other facets of sleep and may be clinically useful targets of intervention for depression.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0641
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0866 Geographic Insufficient Sleep Duration and Cardiometabolic Risk Among
           Adolescents and Adults in the T1D Exchange Clinic Registry

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      Pages: A381 - A382
      Abstract: IntroductionIndividuals with type 1 diabetes (T1D) are at a heightened risk for cardiometabolic disease and associated risk factors. Insufficient sleep duration (< 7 hours) may accentuate this risk, but little is known about its geographic distribution. Insufficient sleep is disproportionately distributed across the United States. We sought to determine whether the geographic distribution of insufficient sleep was associated with individual cardiometabolic risk among 18,620 adolescents and adults ages 13-90 years in the T1D Exchange Clinic Registry.MethodsWe linked residence zip codes with prevalence of insufficient sleep generated from the Population Level Analysis and Community Estimates (PLACES) dataset. We examined associations between geographic patterns of sleep duration (area-level) and individual cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index) using multivariable linear regression adjusting for age, sex at birth, T1D duration, and race/ethnicity.ResultsGeographic areas with shorter sleep duration experienced multiple individual cardiometabolic risk factors. Specifically, shorter geographic level sleep duration was associated with higher glycemia (□= .156, p < .001, R2 = .144), higher body mass index (□ = .037, p < .001, R2 = .125), higher low density lipoprotein cholesterol (□ = .022, p < .001, R2 = .031), and higher systolic blood pressure (□ = .021, p < .001, R2 = .142), even after adjusting for covariates (age, sex, type 1 diabetes duration, and race/ethnicity). There were significant differences in age, race/ethnicity, and sex. The association between shorter area-level sleep duration and diastolic blood pressure was no longer significant after adjusting for covariates.ConclusionAdolescents and adults with T1D living in areas with a higher prevalence of insufficient sleep had higher cardiometabolic risk even after considering covariates. Future studies are warranted to unravel underlying mechanisms contributing to cardiometabolic risk at the individual level (e.g., sympathetic dysregulation, discrimination, insulin insensitivity, and inflammation) as well as other geographic contributions (e.g., air, light noise pollution, redlining). Understanding the determinants of geographic variability would enhance the utility of these data for public health campaigns.Support (if any)This research is supported by the National Institute of Nursing Research (R00NR018886).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0866
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0658 Is Evaluating for Dreams and Nightmares during Clinically Indicated
           Polysomnography Useful'

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      Pages: A289 - A290
      Abstract: IntroductionThe incidence of nightmares and dreams during clinically indicated polysomnography (PSG) is rarely reported. We sought to (1) describe the incidence of nightmares and dreams during PSG, (2) PSG characteristics of nightmares and dreams, and (3) identify clinical correlates.MethodsNinety-three patients undergoing an initial clinically indicated PSG had a post-PSG and initial intake questionnaire reviewed. Questionnaires included Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and Nightmare Disorder Index (NDI), as well as a structured post-PSG dreams and nightmares questionnaire. Dreams were self-reported, and a nightmare was differentiated from a bad dream if the former caused a patient-reported awakening.ResultsOverall, 87.1% were Active Duty and 89.2% reported the presence or absence of dreams. In total, 50.5% (47) reported no dreams, 22.6% (21) reported a dream, 2.2% (2) a bad dream, and 14% (13) a nightmare with 12/13 reporting details of their nightmare. The mean total NDI differed significantly between groups (6 ± 5 vs. 7 ± 6 vs. 12 ± 0 vs. 11 ± 5, respectively) (p=0.029). The groups were not significantly different based on sex, age, BMI, diagnosis of depression, anxiety, PTSD, TBI, chronic pain, being prescribed a sleep aid or psychoactive medication, or their ESS and ISI values. PSG characteristics including REM percentage did not differ significantly between groups. Of those reporting a nightmare 75% (9) reported associated autonomic symptoms and 5 (41.7%) reported a trauma related nightmare (TRN). Of those with a TRN, one was related to combat, one sexual assault, two an accident, and one related to death. Two patients with TRN reported their nightmare was an accurate replay of the trauma, 2 reported a mix of replay/non-replay events, and one did not answer.ConclusionDespite rare reports of nightmare capture in sleep labs, our cohort uniquely demonstrated that at least half of first time PSG patients at a military sleep center experience a dream or nightmare during their PSG. Higher NDI scores may predict who is more likely to suffer from a bad dream or nightmare in the sleep lab. Assessing for the occurrence of dreams or nightmares during PSG is likely indicated.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0658
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0867 Lower Bedtime HRV is Associated with Higher WASO in Middle-Aged
           Adults with Chronic Insomnia

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      Pages: A382 - A382
      Abstract: IntroductionShort sleepers (< 6 hours per night) represent a unique phenotype of insomnia associated with more severe biological implications compared to insomnia with normal sleep duration. A primary contributor to shorter sleep duration is more time spent awake after sleep onset (i.e., WASO), which has deleterious effects on long-term cardiac physiology. For instance, short sleepers with higher WASO have lower parasympathetic activity at sleep onset compared to those with lower WASO or greater sleep duration.MethodsResults presented here are derived from baseline assessments collected as a part of a clinical trial comparing three modalities of cognitive behavioral therapy for insomnia in middle-aged adults (50-65yrs) with chronic insomnia (N = 23). During their baseline assessment, individuals first completed one night of in-home polysomnography. Total sleep time was PSG derived. The following night, they wore an Equivital Harness equipped with an electrocardiogram (ECG) for 24 hours. In this investigation, inter-beat intervals were derived from ECG in 10-minute segments just before and just after bedtime (i.e., when the individual tried to sleep). WASO was calculated using sleep diaries during the night they wore the Harness and the following week.ResultsPreliminary data N = 23) show that high frequency (0.15-0.4Hz) heart rate variability (HRV; i.e., parasympathetic activity) at bedtime is not associated with WASO that night or WASO averaged across the following week. However, when the sample was narrowed to short sleepers only (□6hours; n = 7), lower levels of bedtime HRV (B = -.81, p = .028) is associated with greater WASO during the following week. In short sleepers, mean score of both before and after bedtime HRV predicted 65% of variance in WASO averaged across the next seven nights (R2 = .653, F (1, 5) = 9.41, B = -0.81, p = .28). These effects were not significant in individuals with sleep durations longer than 6 hours.ConclusionIn this small sample, short sleepers display a unique, inverse relationship between cardiac vagal activity and sleep continuity, replicating similar findings regarding parasympathetic activity at sleep onset and subsequent WASO.Support (if any)This project is supported by the Psychology Department at the University of Arizona.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0867
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0659 Nightmares in the acute aftermath of trauma predict later suicidal
           ideation in trauma survivors

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      Pages: A290 - A290
      Abstract: IntroductionNightmares are a common occurrence after experiencing a traumatic event and are a symptom of post-traumatic stress disorder (PTSD). Additionally, nightmares are associated with higher levels of suicidal ideation, attempt, and death from suicide. Nightmares may be an early sign of suicide risk in populations that have experienced trauma, however, there are no studies that have investigated this potential link. This study aims to determine whether more severe nightmares in the aftermath of trauma will prospectively predict later suicidal ideation, independent of comorbid insomnia.MethodsWe recruited adults that were admitted to the intensive care unit at Henry Ford Hospital in Detroit after experiencing a DSM-5 Criterion A traumatic event (N = 76, Mage = 38.39, 65.8% male). Participants completed study surveys at three time points: T1 (an average of 6 days after trauma), T2 (two weeks after T1), and T3 (1 month after T1). Nightmare and insomnia severity were measured at T2 with the Nightmare Disorder Index (NDI) and Insomnia Severity Index (ISI), respectively. Suicidal ideation was measured at T3 using item nine on the Patient Health Questionnaire (PHQ-9).ResultsMore severe nightmares in the acute aftermath of trauma (T2) predicted more severe SI two weeks later at T3 (β = 0.49, SE = .17, p = .004, R2 = .22). This association remained even after adjusting for T1 SI, T2 ISI, age, and sex (β = 0.36, SE = .18, p = .044, R2 = .31).ConclusionMore severe nightmares in the acute aftermath of trauma predicted more severe SI one month after trauma, independent of comorbid insomnia symptoms and baseline suicidal ideation. These findings suggest that the onset of nightmares immediately after trauma may confer a unique risk for SI. In clinical practice, it may be useful to detect nightmares in the aftermath of trauma using brief measures such as the NDI. Trauma survivors that develop frequent and severe nightmares within the acute recovery phase could then be given targeted nightmare treatment to reduce the risk of later SI.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0659
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0900 A Community-based Survey of Personal Perspectives Regarding Prodromal
           Sleep Screening for Neurodegenerative Disorders

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      Pages: A396 - A397
      Abstract: IntroductionSleep markers can assess prodromal risk for neurodegenerative disorders (NDD). In a recent study conducted by the Mayo Clinic, most isolated REM sleep behavior disorder patients preferred knowing about their risk for parkinsonism or dementia. In their email survey, patients indicated a strong preference for disclosure of prognostic NDD risk in order to spur family discussions and plan for the future. For this pilot study, the Mayo questions were modified in order to investigate the perspectives and preferences of community-based adults about potentially being at-risk of a NDD and how it might impact their lives.MethodsA brief survey was administered to Rotary Club attendees prior to a presentation on sleep and neurodegenerative disease. Each question offered five responses: strongly disagree, disagree, neutral, agree, or strongly agree. Personal identifiers were not obtained. Thirty-four surveys were completed from approximately equal numbers of older men and women with estimated ages above 50 years. Personal information were not obtained (e.g., age and sex).ResultsWhen asked whether it was important to know their NDD risk given the fact that there are no known methods to prevent or cure the disease, most (83%) strongly agreed or agreed, while only 18% preferred not to know their NDD risk. The majority felt they would be more pessimistic about their future if identified as being at risk of NDD the (62% strongly agreed/agreed). Most believed their priorities and plans for living life would change (68% strongly agreed/agreed). Further, the vast majority felt that knowing NDD risk would help them plan for the future (89% strongly agreed/agreed), including planning for health resources and support (88% strongly agreed/agreed).ConclusionEighty-three percent of those surveyed reported they would benefit from knowing if they were at risk of NDD, even though the majority would feel more pessimistic about their future. The vast majority (89%) responded that knowing their NDD risk would help them plan for the future. These results suggest that most community adults might be receptive to future sleep screening for NDD with results. Investigations are underway to confirm these findings in a broader community-based study.Support (if any)NIA-R44AG050326
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0900
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0660 Identifying Patients at Risk of Acute Sleep Disturbances Within the
           Immediate Aftermath of Trauma

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      Pages: A290 - A290
      Abstract: IntroductionAcute sleep disturbances are a common, modifiable consequence of trauma that, if left untreated, increase risk of PTSD by nearly two-fold. This suggests acute sleep disturbances after trauma are an important contributor to the etiology of PTSD that could be targeted early to prevent the disorder. Yet, effective strategies to prevent PTSD cannot currently be implemented because we cannot identify who is most at risk of acute sleep disturbances after trauma, thus obstructing the ability to identify high-risk groups in need of early intervention. This study will test sleep reactivity – a trait predisposition to experience sleep disturbances after stress – as a predictor of posttraumatic sleep disturbances within one month following trauma exposure.MethodsWe recruited patients admitted to Henry Ford Hospital’s intensive care unit in Detroit for traumatic injury (e.g., gunshot wound) (N = 88, M age = 39.53, SD = 14.31). While hospitalized, patients reported their pre-trauma sleep reactivity (Ford Insomnia Response to Stress Test; FIRST) and insomnia symptoms from the past two weeks (Insomnia Severity Index; ISI). Patients then completed the ISI again one month later (n = 48). We tested high sleep reactivity (FIRST > 21) as a prospective predictor of clinically significant posttraumatic sleep disturbances (ISI > 10).ResultsPatients were mostly black men (67%), and nearly half reported an annual income < $20,000 (47.7%). Motor vehicle collisions were the most common trauma that precipitated patients’ hospital admission (42%), followed by assaults with a weapon (30.7%). While adjusting for age and pre-trauma sleep disturbance, high sleep reactivity predicted increased odds of sleep disturbances one month after trauma (b = 2.08, SE = .98, p = .033, OR = 8.01, CI = 1.19 – 54.15).ConclusionIndividuals with high sleep reactivity are at increased susceptibility of clinically significant sleep disturbances after trauma. The 9-item FIRST is a brief and clinically useful indicator that offers providers the ability to predict the onset of acute sleep disturbances after trauma, which are novel targets for early intervention. This might enable the early identification of potentially vulnerable individuals who might develop PTSD, toward whom sleep-focused preventive efforts can be targeted.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0660
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0901 An odd presentation of a hidden curse

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      Pages: A397 - A397
      Abstract: IntroductionCongenital central hypoventilation syndrome (CCHS) is a rare disorder of respiratory deficiency due to a mutation in the PHOX2B gene. Clinical presentation may be mild in certain individuals due to different levels of ventilatory dysregulation.MethodsWe present the findings of exogenous ventilatory challenge testing and polysomnography (PSG) performed on a normocapnic adult female with late-onset (LO) CCHS patient.ResultsThe patient was exposed to four separate ventilatory challenges. During exposure to hyperoxia using 100% oxygen (O2) administration, patient showed an inconsistent ventilatory response with a blunted and delayed increase in regional tissue oxygen saturation (rSO2). During hyperoxic hypercapnia with 5% carbon dioxide (CO2) and 95% O2, she demonstrated a reduced ventilatory response based on respiratory rate and tidal volume. During hypoxic hypercapnia, 7% CO2 and 14% O2, patient demonstrated a delayed and markedly attenuated ventilatory response. Hypoxia; 100% nitrogen inhalation did not result in increased ventilation. Ve slope, change in minute ventilation/change in end-tidal CO2 (EtCO2), with hypercapnia challenges was 4.88, which is lower than normal. Ventilatory EtCO2 threshold was 36 mmHg. PSG showed apnea-hypopnea index 3.3 with hypoxemia during rapid eye movement (REM), with an oxygen saturation nadir of 84%. EtCO2 baseline was around 36, peak was 50 and was associated with REM-related apnea events. Arterial blood gas was unremarkable.ConclusionCCHS is characterized by abnormal respiratory response to exogenous ventilatory challenge testing. Hyperoxia silences peripheral chemoreceptors (PC) responsible for stimulating ventilation in normal individuals. Hyperoxic hypercapnia silences PC but stimulates central chemoreceptors (CC). Hypoxic hypercapnia stimulates hyperventilation via both PC and CC. Our patient demonstrated inconsistent and reduced ventilatory responses to all four challenges. As expected, the classic chemosensory parameter, Ve slope, for hypercarbia challenge was markedly reduced. However, the ventilatory EtCO2 threshold fell well below threshold typically observed in CCHS. PSG noted greater alveolar hypoventilation during REM compared to non-REM, which is also atypical for CCHS. In conclusion, exogenous ventilatory challenge testing demonstrated derangements in ventilatory control typical in CCHS. Despite this, our patient had no evidence of daytime hypoventilation with normal CO2 threshold. This case illustrates the phenotypic variability present in LO-CCHS.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0901
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0661 Natural History of Nightmares from Childhood to Young Adulthood: A
           Longitudinal, Population-based Study

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      Pages: A290 - A291
      Abstract: IntroductionNightmares are common in childhood and typically become less prevalent in adulthood. However, little is known about the natural course of nightmares as children grow into adulthood. The purpose of this study was to examine the longitudinal trajectory of nightmares from childhood to adulthood to determine population-based remission, incidence, and persistence rates.MethodsThe Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline) who returned for follow-up visits during adolescence and young adulthood. For the current study, 258 young adults (25.1±2.7 years old, 53.9% female, 24.8% minority population) completed their follow-up visit (15.9±2.0 years later). Nightmares were defined by parent-report in childhood and self-report in adulthood, based on severity. Rates of persistence, remission, and incidence for nightmares were computed.ResultsThe persistence rate was 28% for mild childhood nightmares and 23% for moderate-to-severe childhood nightmares. About 13% of children with mild nightmares experienced a worsening into moderate-to-severe adult nightmares. The full remission rates was 58% and 32% for mild and moderate-to-severe severe childhood nightmares, respectively. About 45% of children with moderate-to-severe severe nightmares experienced partial remission into mild adult nightmares. Among children without nightmares, 32% and 8% developed mild and moderate-to-severe nightmares, respectively, in adulthood.ConclusionModerate-to-severe nightmares only fully remit in about a third of children in by young adulthood. In addition, about one out of ten children with mild nightmares will worsen in severity by young adulthood. Furthermore, a significant number of children will newly-develop significant nightmares in young adulthood. Given the association of nightmares with adverse mental health outcomes, nightmares should become a focus of independent research and prevention practices.Support (if any)National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0661
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0902 Comparative Analysis of Sleep Apnea Patients Selected from the Stroke
           Unit vs Outpatient Clinic

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      Pages: A397 - A398
      Abstract: IntroductionTo our knowledge, there have been studies actively looking for patients with suspected SA in the Stroke Unit (SU), but most of them were conducted using a portable polysomnography (PSG), and no study has performed Level 1 PSG (L1PSG) to date. We conducted L1PSG to the acute stroke patients selected in the SU, and conducted L1PSG to patients who visited the Neurology Outpatient Clinic (NOC) with subjective SA symptoms at the same time. By comparison, we tried to find out the SA characteristics of acute stroke patients.MethodsThis study was conducted on patients admitted to SU from April 1, 2021 to October 31, 2022, and patients who visited NOC during the same period and underwent L1PSG. Among patients admitted to the SU, trained night shift nurses selected patients with SA symptoms with a modified mallampati score of 3 or higher. Cases under intracranial pressure control or other interventions were excluded. Outpatients were enrolled in patients who underwent L1PSG by visiting the NOC to examine only SA. The results of the pre-sleep questionnaire and L1PSG were compared.ResultsOf a total of 829 stroke patients admitted to SU, 31 SU patients received L1PSG, and during the same period, 74 patients received L1PSG for SA testing at NOC. The average age of SU and NOC was 56 and 57 years, and the median BMI was 26.9 and 26.4. In the survey, the ISI (7 vs 12, p=0.04) and PSQI (5 vs 7, p=0.021) scores were statistically significantly higher in NOC patients. As a result of the L1PSG, AHI (38.8 vs 23.1, p=0.027), AHI in Supine (59.3 vs 25.6, p=0.004) and NonREM AHI (36.3 vs 20.9, p=0.027) were statistically significantly higher in SU patients.ConclusionPatients screened SA at SU overlooked their symptom and thought their sleep quality was better than that of NOC patients, but the actual AHI was higher. In particular, acute stroke patients show a large difference in AHI in supine compared to NOC, so lateral position can be recommended when absolute bed rest is needed in situations where SA is suspected in SU. More follow-up studies will be needed.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0902
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0690 People without any sleep complaints achieve results that exceed the
           cut-off thresholds in standardized sleep assessment

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      Pages: A303 - A304
      Abstract: IntroductionWith increasing prevalence of sleep problems in the general population, a question arises on whether standardized clinical sleep assessment shows results exceeding the cut-off thresholds in healthy subjects who do not report any sleep complaint. The aim of this ongoing study is to assess a sample of healthy subjects who report good sleep quality, for each gender in age groups 18-30, 31-40, 41-50, 51-60, 61-75 years old.MethodsUp to now 70 healthy subjects have taken part in the project (38 females, 32 males, mean age 39.5 ±12.5, median 37 years). Assessment of sleep, and mental health related symptoms was performed using actigraphy, sleep diaries and clinical ratings scales: the Insomnia Severity Index (ISI), Epworth Sleepiness Scale(ESS), Morningness Eveningness Questionnaire(MEQ), Ford Insomnia Response to Stress Test (FIRST), International Physical Activity Questionnaire (IPAQ), STOP-Bang Questionnaire, Sheehan Disability Scale (SDS), Quick Inventory of Depressive Symptoms (QIDS-16SR), Generalized Anxiety Disorders Scale (GAD7), World Health Organization Quality of Life Scale (WHOQOL-BREF).ResultsIn ISI scale 20 subjects (28,6%) reported mild and 2 subject (2,8%) moderate insomnia symptoms. In ESS 7 subjects (10.0%) were found to have mild, 5 (7,1%) moderate and 3 (4,3%) severe excessive daytime sleepiness. Anxiety symptoms reported 15 (21,4%) subjects and depressive symptoms 18 (22,9%) subjects. Moderate for risk for sleep apnea was found in 9 (12,8%) and high in one (1,4%) subject. In sleep diaries sleep latency above 30 minutes was found in 4 (5,6%) subjects, WASO above 30 minutes in 7 (10.0%) subjects, total sleep time below 6,5 hours in 22 (31,4%) subjects. Average time in bed was 474 ±55 minutes and average sleep efficiency 86,8 ±7,5%. ISI correlated with FIRST (r=0.496, p< 0.001), GAD-7 (r=0.445, p< 0,001), QIDS-SR16 (r=0,483, p< 0.001), sleep latency (r=0,313, p< 0,05), WASO (r=0,270, p< 0,05). ESS corelated with FIRST (r=0.316, p< 0,01), GAD-7 (r=0,275, p< 0,05).ConclusionSubstantial proportion of subjects from the general population who did not initially report any sleep complaints obtained results exceeding suggested threshold in standard clinical scale and sleep parameters below normal valse in sleep diaries. Poor sleep indices are most related to scales measuring stress, anxiety and depressive symptoms.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0690
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0691 Quality of life and subjective sleep characteristics among a
           middle-aged population in Korea

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      Pages: A304 - A304
      Abstract: IntroductionSleeping problems are associated with physical and mental conditions as well as quality of life (QoL). This study aimed to evaluate the association between sleep characteristics and QoL in a middle-aged population.MethodsThis cross-sectional study included 4051 adults (1751 males and 2300 females) aged 30-50 who were selected through a multi-stage stratified sampling based on sex, age, and region between 2017 and 2019. Sociodemographic, sleep characteristics, and QoL were evaluated and compared. Sleep characteristics were determined using the Pittsburgh Sleep Quality Index, and were defined as sleep duration (SD), sleep quality (SQ), sleep efficiency (SE), and sleep latency (SL). QoL was evaluated using the SF-12, which calculated physical and mental QoL. Degrees of insomnia symptoms were classified into 0-3 by summing up the number of cases of sleep duration (≤6.5 hours), sleep efficiency (< 85%), and sleep latency (> 30 min). We used linear regression models to estimate the relationship between sleep characteristics and degrees of insomnia symptoms with QoL, adjusting for sociodemographic covariates.ResultsSleep characteristics of the participants include average sleep duration 6.8 hours (≤6 h short, 45%; ≥9 h long, 3%), sleep quality 4.6 points (poor SQ, 29%), sleep efficiency 94.5% (< 85% SE, 11%), and sleep latency 19.7 minutes (>30 min SL, 9%). About 26% had one insomnia symptom and 11% had two or more insomnia symptoms. All sleep characteristics showed significant associations with physical and mental QoL. Particularly, physical QoL was associated with long SD (coefficients [B]: -1.56, 95% confidence interval [CI]: -2.77, -0.35), low SE (B: -2.32, 95% CI: -2.94, -1.7), and long SL (B: -3.3, 95% CI: -3.97, -2.6), and mental QOL was associated with low SE (B: -3.3, 95% CI: -4.0, -2.5) and long SL (B: -5.1, 95% CI: -5.8, -2.5). Physical and mental QoL was significantly linearly decreased with number of insomnia symptoms (for physical QoL, B: -0.87, -2.87, and -4.24; for mental QoL, B: -1.1, -4.01, and -5.9, by number of insomnia symptoms 1, 2, and 3, respectively).ConclusionPoor sleep characteristics were negatively associated with QoL in Korean middle-aged adults.Support (if any)This was funded by the Korea Institution of Oriental Medicine, KSN2023120.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0691
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0903 CPAP adherence rate in patients with ischemic stroke

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      Pages: A398 - A398
      Abstract: IntroductionAlthough treatment of OSA in patients with ischemic stroke is important for secondary prevention of stroke and improving neurologic outcomes, patients with stroke often are not adherent to nasal CPAP. The aim of the study is to examine the adherence rate and explore the predictive factors for CPAP compliance in patients with a recent history of ischemic stroke.MethodsWe reviewed the medical records of patients with ischemic stroke who were diagnosed with OSA after the onset of stroke and those who were recommended to use nasal CPAP at a single university Hospital from March 2020 to November 2022. Demographic information, neurologic functional status, and polysomnographic data were reviewed. For patients who agreed to use CPAP, CPAP compliance data were analyzed using cloud data run by various CPAP companies.Results76 patients with cerebral infarction or transient ischemic attack were diagnosed with OSA and were recommended to use nasal CPAP (mean age, 60.8±12.6, male 60). Night PSG was performed after the onset of the stroke as the evaluation process for risk factors for stroke based on clinical symptoms such as snoring or apnea. The acceptance rate for nasal CPAP was 88.1% (67/76) at the first visit after the PSG. The adherence rate was 55.2% (37/67). No difference between the adherent and non-adherent groups was found in polysomnographic variables, including AHI, RDI, and subjective sleep scales such as PSQI, ISI, and ESS. No difference in the neurologic functional deficit was found between the groups. The adherent group was younger but not statistically significant (58.4±13.10 vs. 63.6±11.65, p=0.10). Female patients with ischemic stroke were more intolerant to CPAP (24.1% vs. 11.7%).ConclusionThe patients in our study performed a PSG due to the risk evaluation of stroke rather than pursuing treatment for sleep apnea symptoms. Half of the patients were not adherent to CPAP, although they agreed to try CPAP. The proper screening of sleep apnea and education on sleep apnea and its impact on the neurologic outcome would be mandated to increase CPAP adherence in patients with ischemic stroke.Support (if any)Basic Science Research Program through NRF funded by the Ministry of Education(2021R1I1A1A01059791)
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0903
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0692 Relationships Between Sleep and Social Cognitive Biases in
           Schizophrenia-Spectrum and Bipolar Disorders

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      Pages: A304 - A304
      Abstract: IntroductionPeople with schizophrenia-spectrum disorders (SSDs) and bipolar disorders (BDs) experience difficulty with social cognition, or the mental processes that underlie social interactions, but determinants of social cognitive impairment are still under investigation. Research suggests that poor sleep quality is related to reduced social cognitive ability in BDs, but it is unclear if sleep quality is related to social cognition in SSDs and if sleep may be related to different types of social cognition (e.g., emotion recognition, biases) in different ways. This study aimed to examine relationships between sleep and different types of social cognition in SSDs and BDs. Given known relationships between blaming and untrustworthiness biases and paranoia in these populations, paranoia was also examined as potential mediator of these relationships.MethodsParticipants (SSDs n=91; BDs with psychotic features n=87) completed tasks of social cognitive ability (e.g., facial and multi-modal emotion recognition, attributional bias, untrustworthiness bias). Participants self-reported their sleep quality. Paranoia was assessed via clinical interview.ResultsIn the BD group, poor sleep quality (r=-.23, p=.04) and shorter sleep duration (r=-.25, p=.02) were associated with a bias towards untrustworthiness. For those with SSDs, increased use of sleep medication was associated with poorer multi-modal emotion recognition (r=-.22, p=.04). Additionally, poor sleep quality and overall poor sleep were associated with increased blaming (r=.22, p=.03; r=.21, p=.04) and untrustworthiness biases (r=-.24, p=.03; r=-.24, p=.03) in this group. Higher daytime tiredness was also associated with untrustworthiness bias (r=-.23, p=.03) in SSDs. Regarding mediation results, paranoia did serve as a mediator in the relationships between sleep and blaming and untrustworthiness biases across the sample.ConclusionResults suggest that poor sleep quality is linked to increased attributional and untrustworthiness biases, and that these relationships may be at least partially explained by paranoia symptoms. Of note, however, is that indirect effect sizes in mediation models were small. Contrary to expectations, poor sleep quality was not consistently associated with reduced social cognitive ability in the current sample. Findings from the current study require further exploration and replication.Support (if any)This work was supported by the National Institute of Mental Health (grant number R01 MH116902-04 awarded to C.A.D).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0692
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0922 Interference of racial and socioeconomic factors in the sleep of a
           large Brazilian city: lessons for comparisons between countries

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      Pages: A407 - A407
      Abstract: IntroductionInvestigation on the effects of racial and socioeconomic parameters on sleep has markedly increased along the years. The vast majority of these studies take place on countries in North America or Europe, thus making it necessary that new initiatives are conducted in developing nations. The objective of this study was to evaluate how race and socioeconomic factors influence sleep in the city of São Paulo, Brazil.MethodsHealth and sleep parameters of participants of the EPISONO (2007) study were assessed with validated questionnaires and a night of polysomnographic examination. Data regarding their self-identified race was collected during this protocol. Among the applied questionnaires, scores in the Critério de Classificação Econômica Brasil (CCEB) questionnaire were adopted in this analysis. General Linear Models were used to investigate the relationship between objective sleep parameters and the racial and socioeconomic classification according to the CCEB questionnaire.Results1,008 participants of the EPISONO were included (mean age=42.3 years; 574 women). Class C Blacks had greater total sleep time (TST) than Class A Whites, while Class C Asians presented less TST. Indigenous participants had reduced wake after sleep onset (WASO) time when sided to Whites and, similarly, Class D Blacks presented lower WASO compared to Class A Whites. Arousal index was lower in Class B and C individuals when comparing to Class A individuals and higher in Class C Blacks when compared to Class A Whites.ConclusionThe variety of results when comparing socioeconomic and racial factors highlights the richness of the interplay between these parameters. While some findings are similar to those of North American and European studies, there are differences underlining the necessity of evaluating the socioeconomic and racial background of each population cautiously. Future research on sleep patterns of the Brazilian population concerning the effect of race and socioeconomic status is essential and a promising frontier of investigation to be explored.Support (if any)Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0922
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0693 Rest-activity rhythm in Methadone and Buprenorphine-maintained
           patients

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      Pages: A304 - A305
      Abstract: IntroductionOpioid use disorder (OUD) is a chronic relapsing disorder with a high overdose death rate. In OUD, sleep and circadian disruptions are highly prevalent, interfere with retention in opioid maintenance treatment (OMT) and increase relapse. Growing evidence suggests a link between sleep/circadian disruptions and dopaminergic (DA) signaling which accounts for addictive properties of drugs of abuse. The current study investigated rest-activity rhythm in Methadone and Buprenorphine-maintained patients and how it relates to DA changes in patients.MethodsTo access rest-activity rhythm, twenty-five OUD patients (9 Females; age 44.34±11.97; 60% White, 32% Black; 18 Methadone; 7 Buprenorphine) and thirty-four age, sex, race and BMI-matched healthy controls wore wrist accelerometers for one-week and completed questionnaires for sleep and chronotype. Among OUD patients, sixteen of them completed [11C]NNC112 and [11C]raclopride PET scans for the assessments of D1R and D2R availability, respectively. Negative mood was accessed as secondary outcomes.ResultsOur preliminary data showed that compared to healthy participants, OUD patients undergoing OMT reported greater sleep problems and showed greater sleep irregularity measured by actigraphy, but no differences in other parameters such as sleep duration, rhythm timing or physical activity. Among patients, greater eveningness and irregularity were associated with higher level of negative mood including depression and anxiety. There is a tendency of a positive correlation between later phase and greater D1 receptor availability and a negative association between sleep irregularity and D2 receptor availability.ConclusionOur finding suggests that a link between altered rest-activity rhythm and DA signaling in OUD patients. Circadian/sleep interventions that regulate rest-activity rhythm might benefit mood improvement and promote OUD recovery by normalizing DA transmission.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0693
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0923 Poor sleep hygiene is widespread among first-year medical students

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      Pages: A407 - A408
      Abstract: IntroductionPoor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Sleep hygiene is broadly defined as the sleep-adjacent behaviors and beliefs that significantly contribute to sleep quality. This study sought to determine the prevalence of various sleep hygiene related behaviors among first-year medical students.MethodsA one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Mean bedtimes were grouped based on when students drank their last caffeinated beverage and compared using one-way analysis of variance (ANOVA) with the Turkey HSD test. Statistical significance was considered a p-value ≤0.05.Results138 of the 209 person (66%) first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. While only 15% of students reported pulling an all-nighter (obtaining less than 2 hours of sleep over 24 hours) during the current academic year, many other behaviors associated with poor sleep hygiene were prevalent. Large proportions of students reported using social media (78%), texting (68%), watching television (41%), and thinking (53%) in bed more than three times per week. Caffeine use was also high. Only 12 respondents (8.7%) reported never consuming caffeinated products, while just over 50% consumed caffeine at least once per day. Furthermore, of the 126 students who reported caffeine use at least once per month, 74 (59%) drank their last caffeinated beverage after 2:00 p.m. Intriguingly, average weekday bedtimes did not differ based on when students consumed their last caffeinated beverage (p=0.059), suggesting that caffeine consumption is driven by factors other than predicted bedtime.ConclusionPoor sleep hygiene is widespread among first-year medical students. Future interventions should seek to increase awareness among medical students about sleep hygiene and its importance while providing them with feasible tips for how to incorporate them into their lives.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0923
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0694 Sleep Disorders and Serious Mental Illnesses: Comorbidity, Treatment,
           & Demographic Factors in VA Health Record Data

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      Pages: A305 - A305
      Abstract: IntroductionPeople diagnosed with serious mental illnesses (SMI), including schizophrenia-spectrum disorders, bipolar disorders, and major depression with psychosis, report high rates of clinically significant sleep disturbance. Yet, examination of how demographic- and health-related factors impact diagnosis and treatment in this group is scarce. We aimed to fill this gap by examining medical records of Veterans receiving treatment in VA VISN 4 healthcare facilities.MethodsWe used VA health record data to examine comorbidity between SMI and sleep diagnoses and receipt of sleep treatment from 2011-2019 (total N=573,974). A combination of descriptive and statistical techniques were used to investigate prevalence of sleep disorders, receipt of sleep treatment, and associations with demographic- and health-related factors.ResultsIn 2019, 21.8% of Veterans with SMI were diagnosed with sleep disorder(s) in the medical record. White Veterans with SMI were more likely to have a sleep disorder than Veterans identifying as racial minorities. Veterans with SMI and sleep disorders were also younger, had higher BMIs, and had more medical comorbidities. Veterans with SMI were more likely to receive sleep treatment than Veterans without SMI, primarily driven by higher rates of sleep medication. Importantly, in contrast to findings regarding sleep disorder comorbidity, Veterans identifying as racial minorities received sleep treatment at a higher rate than White Veterans, and Veterans with higher BMIs received sleep treatment at a lower rate. Demographic factors including sex, age, and rurality were also associated in varying ways with rates of sleep treatment.ConclusionOur findings suggest that Veterans with SMI are being treated for sleep disorders at higher rates than Veterans without SMI. However, diagnosis and treatment are differentially impacted by demographic and health-related factors. Work is needed to better understand drivers of demographic differences and to examine any potential inequities in diagnosis or treatment of sleep disorders in Veterans with SMI.Support (if any)This work was funded by the Veterans Health Foundation (Co-PIs: Bonfils & Longenecker). Additional support was provided by pilot project funds (PI: Bramoweth) from the Department of Veterans Affairs VISN 4 Mental Illness Research, Education and Clinical Center and the Mississippi Center for Clinical & Translational Research (U54GM115428).
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0694
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0924 Poor sleep regularity is widespread among first-year medical students

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      Pages: A408 - A408
      Abstract: IntroductionPoor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Sleep regularity is increasingly recognized as a key driver for sleep quality and health. This study sought to determine the prevalence of and the factors that contribute to irregular sleep among first-year medical students.MethodsA one-time, 130-item survey was distributed to the first year medical school class three months into the first semester. Quantitative and open-text questions asked about various sleep health related topics, including sleep regularity across weekdays (WDs) and weekends (WEs) for the past two weeks. Likert scale responses were treated as continuous data and reported as mean ± standard deviation. Means for WD and WE times were compared using paired t-tests. Statistical significance was considered a p-value ≤0.05.ResultsOut of 209 medical students in the first-year class, 58% (n=121) completed the sleep irregularity items on the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. The differences between WD and WE times for getting into bed (1.03 hours ± 0.90 hours), falling asleep (0.92 ± 0.80 hours), waking up (1.62 ± 0.84 hours), and getting out of bed (1.89 ± 0.93 hours) were significant (p< 0.001). Furthermore, 49.3% of participants reported significant bedtime or wake time variability (>3 hours difference from one day to another) at least once per week during the past 3 months. This occurred despite respondents expressing a strong belief in the importance of sleep consistency (7.1 ± 2.25 on a 10-point Likert scale; 0=Strongly Disagree, 5=Neutral, 10=Strongly Agree).ConclusionPoor sleep regularity is widespread during the first year of medical school. While students are aware of the importance of consistent bedtimes and wake times, they rarely follow this knowledge suggesting that external factors encountered during medical school such as poorly balanced academic workloads or stress might be to blame. Future studies should seek to better understand the factors contributing to poor sleep regularity in medical school and develop interventions to help students address any barriers.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0924
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0695 The Association Between Social Support at Work and Sleep Quality

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      Pages: A305 - A306
      Abstract: IntroductionSocial support, including support received by coworkers, is associated with one’s emotional well-being. Poor sleep quality among employees is associated with worse employee health, increased workplace injury and is a growing occupational health problem. Social support at home is known to positively impact sleep quality. However, whether social support at work affects sleep quality is unknown. We examined whether social support at work is associated with sleep quality.MethodsThe Worksite Blood Pressure study is a multi-site study of psychological factors and ambulatory blood pressure. The study recruited 472 participants without major cardiovascular disease from 10 New York City worksites during 4 waves over 11 years. The current analysis was restricted to 189 employed participants at Wave 4 and provided complete data. Participants completed the Job Content Questionnaire which assessed psychosocial and social characteristics of jobs, including social support received from coworkers and supervisors, and a sleep questionnaire. The sleep questionnaire assessed sleep quality, self-reported sleep duration, alertness, and sleep habits. For this analysis, items related to sleep quality were summed. Higher scores indicated worse sleep quality. A linear regression model was specified predicting sleep quality from social support at work. Study site, age, race/ethnicity, marital status, total number of people at home, and years of education were included as covariates.ResultsOf the 189 participants, 72.5% were male, 16.4% were Black, 7.4% were Hispanic/Latinx, and 73.0% were married. Mean age was 50.1 years (SD = 7.0), mean years of education was 17.8 (SD = 3.2), and median number of people at home was 3 (Range 0, 6). Mean support at work was 23.3 (SD = 3.9) and mean sleep quality was 8.6 (SD = 4.4). Social support at work was not significantly associated with sleep quality, B = 0.12, 95% CI -0.29, 0.05, p = 0.16. Sensitivity analyses that examined support from supervisors and from coworkers separately were also not significant, p > 0.20.ConclusionSocial support at work was not significantly associated with sleep quality in our cohort. Factors beyond social support at work should be investigated to evaluate their associations with employees’ sleep quality.Support (if any)P01HL47540
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0695
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0696 The Moderating Role of Sleepiness among Intraday Passive and Active
           Suicidal Ideation

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      Pages: A306 - A306
      Abstract: IntroductionDisrupted sleep has been linked to suicidal thought and behavior. Less is known regarding underlying mechanisms of this relationship. A more nuanced understanding of the link between sleep and suicide may help inform treatment decisions and the development of prevention and intervention strategies. We examine prior day sleepiness as a moderator to the relationship between passive and active suicidal ideation (SI).MethodsYoung adults (mean age=21.04; SD=2.22) endorsing SI (n=59) at least twice in the past two weeks were enrolled in a trial examining potential iatrogenic effects of the ecological momentary assessment (EMA) of SI. A baseline battery collected data on past suicidal thought and behavior, demographics, and psychological distress. EMA surveys were administered randomly five times per day over four weeks and assessed sleepiness and current emotional state including occurrence and severity of SI and passive/active ideation.ResultsAltogether, 835 daily average EMA entries were utilized in the present analysis. A significant relationship (p<.05) was observed between sleepiness and passive SI and its impact on the intensity and duration of SI. Specifically, the association between passive and active SI was stronger on days that participants endorsed greater sleepiness. There was also a significant interaction such that one’s desire to die and a low desire to stay awake significantly interacted (p<.05) to predict same-day perceived controllability of SI. Meaning that when participants had a lower desire to stay awake, there was a stronger relationship among perceived ability to control one’s SI and lower desire to live.ConclusionThis study examined the impact of daily sleepiness on relationships among passive and active SI among young adults endorsing suicidal thought. Findings indicate that the relation between daily passive and active SI severity grows stronger the sleepier one is relative to their average level of sleepiness. Future studies should incorporate objective measures of sleep to further explore these findings and clinical implications.Support (if any)This study was funded by the American Psychological Foundation. This work was also supported, in part, by the VA Center of Excellence for Suicide Prevention.
      Authors ’ views do not necessarily represent those of the Department of Veterans Affairs or the United States Government.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0696
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0925 Population Health and Data Analytics as an Opportunity for Improving
           Care Quality in Sleep Medicine

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      Pages: A408 - A408
      Abstract: IntroductionThe volume and diversity of sleep-related and quality of life complaints in sleep medicine has increased through improved availability of data from wearables and public education on sleep health. Future shifts away from quantity and towards quality-based compensation by insurance payors will require practices to understand and actively monitor population health and outcomes data and implement data-driven practices to improve diagnostic efficiency. Currently, prevalence and population health data benchmarks are incomplete or absent in many aspects of sleep disorders treatment. The integrated care model of sleep medicine, with board-certified primary sleep physicians, an in-house Positive Airway Pressure (PAP) Therapy clinic and certified sleep medicine Dentist, is uniquely positioned to improve care by characterizing the impact of clinical decision-making on care cost and quality.MethodsPopulation health data was gathered in the course of patient care in the integrated care model. Baseline/Diagnostic Home Sleep Apnea Test (HSAT) results from 2018-2021 were included. Diagnostic severity was categorized based on AASM treatment guidelines. Matched therapy visits were included from PAP Therapy Initiation or Compliance visit and treatment outcomes, as well as non-PAP treatments for sleep-disordered breathing, Oral Appliance (OA) and Inspire Therapy.Results20% of 8531 Diagnostic HSAT results were non-diagnostic for sleep apnea, 35% were Mild, 21% Moderate and 24% Severe. Of non-diagnostic tests, 81% had no sleep apnea treatment associated. Of Mild diagnostic tests, 49% had associated PAP initiation or compliance, 9% had associated OA, and 42% had no treatment associated. The relationship between diagnostic severity and associated treatment was significant (Χ2 < 0.0001). Further, Moderate and Severe resulting diagnostic tests had no associated treatment in 24% and 28% of cases, respectively.ConclusionSleep medicine patients are commonly symptomatic and often have major quality of life complaints. Yet as these data demonstrate, there is a substantial proportion of patients who do not have an associated treatment after a positive diagnostic home sleep apnea test. Future studies should include additional demographic and follow up data to better understand care pathways both for patients who receive a positive diagnostic test but pursue alternative treatment methods, as well as more complicated non-diagnostic sleep disorders patients.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0925
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0697 The Relationship Between Anger Expression and Sleep

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      Pages: A306 - A307
      Abstract: IntroductionIncreased anger expression (AE) is linked to worse health outcomes. Short sleep duration and poor sleep quality are linked with increased anger. However, few data have examined whether increased AE may lead to disturbed sleep. We examined if AE is associated with objectively and subjectively-assessed sleep measures in two cohort studies.MethodsThe Masked Hypertension Study (MHTN, n=888) is a multi-site study of the prevalence and predictors of masked hypertension. Participants completed the Spielberger Anger Expression Scale (SAES) and the Pittsburgh Sleep Quality Index. Sleep duration and percent of time awake after sleep onset (%waso) during a 24-h period were derived from wrist-worn actigraphy (ActiWatch; Phillips Respironics), supplemented by diary reports. The Worksite Blood Pressure study (WSBPS, n=472) is a multi-site study of psychological factors and ambulatory blood pressure. Participants completed the SAES and a sleep quality questionnaire. In MHTN, linear regression models were estimated for each sleep outcome with age, sex, race/ethnicity, and anxiety as covariates. In the WSBPS, the analysis was conducted for sleep quality only, controlling for age, race/ethnicity, anxiety, sleep apnea , and study site.ResultsParticipants in MHTN (n=782) were 59.5% female, 11.5% Hispanic/Latinx. Mean age was 45.5 years (SD = 10.4). Mean AE was 34.7 (SD = 6.6 ). Mean sleep duration was 6.3 hours (SD = 1.1), mean %waso was 7.1% (SD = 4.0), and mean sleep quality was 5.6 (SD = 3.2). AE was not significantly associated with sleep duration, B = 0.01, 95% CI -0.01, 0.02, p = .30, waso, B = 0.02, 95% CI -0.03, 0.07, p = .43, or sleep quality, B = 0.01, 95% CI -0.03, 0.05, p = .71. Participants in WSBPS (n=278) were 23.7% female, 6.1% Hispanic/Latinx and mean age was 53.1 years (SD = 8.5 ). Mean AE was 46.8 (SD = 5.0). Mean sleep quality was 8.4 (SD = 4.4). AE was not significantly associated with sleep quality, B = -0.014, 95% CI 0.14, 0.07, p = 0.50.ConclusionAE was not associated with objective or subjectively-assessed sleep measures. Our findings may suggest that clinicians should focus on other factors rather than AE to improve sleep.Support (if any)P01HL47540
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0697
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0946 CIRCUL: VALIDATION OF A SMART RING FORM OXIMETER IN INDIVIDUALS WITH
           DARK SKIN PIGMENT

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      Pages: A417 - A417
      Abstract: IntroductionThe potential impact of skin pigmentation on the accuracy of oximetric assessment has long been known to be a clinically relevant matter. During the COVID pandemic it became apparent that oximeters may underestimate oxyhemoglobin saturation in darkly pigmented individuals. Validation data for SaO2 is not generally available for the many consumer wearable oximeter devices. Circul® (Bodimetrics Corp, Los Angeles, CA), a wearable oximeter with a form factor of a ring, measures several variables for cardiorespiratory assessment (SpO2, movement, heart rate). We aimed to evaluate the accuracy this device in the measurement of SaO2 compared to a simultaneous values obtained by measurement of SaO2 by arterial blood gases.Methods24 subjects (8 Black, 16 Non-Black) participated in the validation of the Circul device. In an operating suite they had catheters inserted into their radial arteries. They were administered nitrogen rich air which made them hypoxic in steps to an SaO2 of 70%. Arterial blood was sampled at various levels of hypoxia and simultaneous readings were obtained from the Circul device. We compared SaO2 obtained by Circul vs measurement of ABGs by a medical grade blood gas analyzer.ResultsThere was excellent correlation between SaO2 measured by the ring oximeter and ABGs in both Black (y = 1.0174x - 1.573; R² = 0.9414) and Non-Black (y = 1.0209x - 2.5607; R² = 0.9207) subjects. No significant differences were found in comparing the intercept and slopes of the regressions. At ABG of 70% and 100% the SaO2 measured by the ring was calculated to be 69.6% and 100.2% for the Black subjects and 68.9% and 99.5% for the non-Black subjects.ConclusionResults from this study confirmed that Circul oximetry accuracy seems to be independent of the skin tone.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0946
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0750 Earlier bedtimes mediate the effect of a brief behavioral
           intervention on children’s BMIz

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      Pages: A331 - A331
      Abstract: IntroductionWe demonstrated that a brief behavioral intervention enhanced children’s sleep; those with clinically meaningful improvements in sleep (> 30 m/night), had improvements in body mass index (BMI) and BMI z-scores (BMIz). Given emerging evidence regarding the potential importance of not only sleep duration but sleep timing (i.e., bedtimes) for obesity risk reduction, we explored whether sleep duration and/or sleep timing mediated effects of intervention on BMI and BMIz. We hypothesized that the effect of the intervention on 8-week BMI/BMIz would be mediated by earlier bedtimes and longer sleep duration at 2 weeks post-randomization.MethodsParticipants were 71 children 8-11 years old (mean (SD) age = 9.72 (1.00); 69% female; mean (SD) BMIz = 0.91 (0.935)) who slept < 9.5 h/night and were randomized to a 4-session behavioral intervention to increase nocturnal sleep duration (primarily via advancing bedtimes) or to a control (4 sessions; continue with sleep as usual). Sleep was assessed via 7-day actigraphy; height and weight were measured to calculate BMI/BMIz at baseline, 2- and 8-weeks post randomization. We assessed mediation using the medflex R package. Models predicting 8-week BMIz and BMI controlled for baseline BMIz and BMI, respectively. Duration (mean actigraph sleep period) and bedtime (mean actigraph sleep onset) were entered as continuous variables in models.ResultsRelative to control, the behavioral intervention decreased children’s 8-week BMIz by -0.027 (SE = 0.013) via its effect on week 2 bedtimes (z = -2.066, p = 0.039). There was no direct effect of intervention on 8-week BMIz (z = 1.584, p = 0.113), and although of marginal significance, week 2 sleep duration did not mediate effects of intervention on 8-week BMIz (z = -1.937, p = 0.053). Findings focused on BMI, although consistent, did not reach statistical significance.ConclusionA behavioral intervention designed to enhance school-aged children’s nocturnal sleep had a positive impact on children’s weight status via its effect on bedtimes, and to a lesser degree, sleep duration. Findings add to emerging work supporting the potential importance of sleep timing in weight regulation.Support (if any)R01HL092910; P20GM139743
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0750
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0948 End-to-End utility of the Cardiopulmonary Coupling Sleep Spectrogram
           in Sleep Medicine

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      Pages: A417 - A418
      Abstract: IntroductionTechnology has improved the diagnosis and therapeutic tracking of sleep disorders, but remains fragmented. For example, the laboratory polysomnogram and home sleep apnea test is disconnected from the data available from therapy devices. Remote patient monitoring has focused more on apnea metrics rather than sleep quality. There is some value to a device or system which can be used for diagnosis, risk stratification, and tracking of clinical outcomes across different sleep disorders.MethodsA method which offers the potential of end-to-end utility in sleep medicine is the cardiopulmonary coupling (CPC) spectrogram. Originally an ECG-base device, the current form is that of a Ring oximeter (finger) with an integrated activity monitor. The oximeter data is processed via Bluetooth in a smartphone, and then transferred to a Cloud-based analysis (www.sleepimage.com). The CPC analysis integrates heart rate variability and ECG or photoplethysmography-derived respiration. Outputs include a Sleep Quality Index and percentage of stable sleep (high frequency coupling which covaries with delta power on the electroencephalogram and is associated with blood pressure dipping), unstable sleep (low frequency coupling), an apnea-hypopnea index, oxygen desaturation index, heart rate profile across the night (dipping or non-dipping heart rate), total sleep time and sleep efficiency. Data from two clinical systems were used: Empower Sleep (an Internet-based “digital sleep clinic”) and Sleep Continuum (a sleep tracking service offered by Neurocare, Inc, in the Boston area).ResultsData from over 500 patients across a range of sleep disorders show end-to-end utility of the SleepImage system. These include diagnosis of sleep apnea including multi-night recording, sleep apnea phenotyping (high loop gain and sleep fragmentation), remote patient monitoring during CPAP or oral appliance use, supportive information for diagnosis of hypersomnia, tracking medication effects (sodium oxybate, sedative-hypnotics, acetazolamide), sleep-wake instability in mood disorders and Long-Covid, impaired sleep quality in chronic fatigue syndrome and restless legs syndrome, off-label therapies for central sleep apnea (oxygen, acetazolamide, buspirone), and sleep fragmentation in Long-Covid and parasomnia. Examples from each of these clinical use cases will be shown.ConclusionThe CPC-based SleepImage Ring system can provide complete diagnostic, phenotyping, and tracking functions.Support (if any)The Institute for Personalized Sleep Health, BIDMC, Empower Sleep
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0948
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0751 Early Childhood Sleep Associated with Adolescent Sleep Physiology
           among Youth with ADHD

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      Pages: A331 - A332
      Abstract: IntroductionSleep complaints are prevalent and impairing symptoms among adolescents with ADHD. Our recent work has shown that key aspects of sleep physiology differentiate adolescents with ADHD from healthy controls (HC), including reduced slow-wave sleep percentage (SWS%) and relative delta power (rDelta) and increased stage 2 percentage (N2%) and relative sigma power (rSigma) after accounting for sleep duration. ADHD-related sleep problems may emerge as early as toddlerhood, yet little is known about the trajectory of sleep disturbances over time in ADHD. The current study examines relationships between early childhood sleep problems and adolescent sleep physiology in ADHD and HC.MethodsSixty-two medication-free adolescents (31 with ADHD, mean age=15.3, 50% female) completed a diagnostic interview (Mini International Neuropsychiatric Interview) and 3 nights of at-home polysomnography. Spectral analysis was conducted on a single O1-C3 channel. Caregivers reported on participants’ sleep problems during toddlerhood and preschool (Child Behavior Questionnaire; CBQ). Linear regressions controlling for age, sex, and pubertal status examined relationships between early childhood sleep problems and aspects of sleep physiology implicated in adolescent ADHD (SWS%, rDelta, N2%, rSigma) and whether associations differed between groups.ResultsAdolescents with ADHD had greater caregiver-reported early childhood sleep problems compared to HC (t(60)=3.71, p<.001). In the full sample, greater caregiver-reported sleep problems in early childhood were associated with reduced SWS% (β=-.28, p=.04) and rDelta (β=-.27, p=.04), and increased rSigma (β=.33, p=.02), in adolescence. An early childhood sleep by group interaction was observed for rDelta (β=1.09, p=.04), such that the association was significantly stronger for adolescents with ADHD than HC.ConclusionThe current study found that sleep problems in early development were associated with disruptions in sleep physiology in adolescents, including relatively less time spent in SWS, reduced delta power, and increased sigma power. Results suggest that ADHD-related sleep problems may begin early in life and persist into adolescence. Screening for and treating sleep problems during early development may be important for supporting sleep health among adolescents with ADHD, and future studies should assess this possibility. Future studies employing longitudinal designs may clarify the contribution of sleep disturbances to the onset and persistence of ADHD symptoms across development.Support (if any)K23MH108704; R34MH128440
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0751
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0949 Real-time acoustic apnea event detector by training a deep learning
           model with home noise added data

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      Pages: A418 - A418
      Abstract: IntroductionFor diagnosis and management of Obstructive Sleep Apnea (OSA), long-term multi-night monitoring is crucial. Convenient detection of OSA at home is required for this purpose. Using sound recorded by smartphone can provide a convenient way to detect OSA. In this study, we present a sound-based OSA detection deep learning model that can detect OSA in real-time even in a home environment where various noises exist. The model is trained with home noise simulated sound to be robust for detecting home noises.MethodsTwo types of data were used for training and testing. The first type was sleep breathing sound data collected at the hospital while patients underwent a PSG. It included 1,154 and 297 nights recorded by a PSG microphone and a smartphone, respectively. We split them into 150 nights of smartphone data for testing and the rest for training. The second type was home noise data, which included 22,500 noises that might occur in a residential environment. The proposed acoustic apnea event detector inputs Mel spectrograms of sleep breathing sounds and outputs OSA event classes for each epoch (APNEA, HYPOPNEA, or NO-EVENT). The home noises were used to make the model robust to a noisy home environment. The performance of the prediction model was assessed by epoch-by-epoch prediction accuracy and OSA severity classification based on the apnea-hypopnea index (AHI).ResultsOur model achieved 86 % epoch-by-epoch agreement (0.75 in macro F1) for 3-class event detection task. The model had an accuracy of 92% for NO-EVENT, 84% for APNEA, and 51% for HYPOPNEA. Most misclassifications were made for HYPOPNEA, with 15% and 34% of HYPOPNEA being wrongly predicted as APNEA and NO-EVENT, respectively. The sensitivity and specificity of OSA severity classification (AHI ≥ 15) were 0.85 and 0.84, respectively.ConclusionOur study presents a real-time epoch-by-epoch OSA detector that works in a variety of noisy home environments. Based on this, additional research is needed to verify the usefulness of various multi-night monitoring and real-time diagnostic technologies in the home environment.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0949
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0752 Later chronotype, insufficient and disturbed sleep are linked to
           menstruation problems in early adolescent girls

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      Pages: A332 - A332
      Abstract: IntroductionAdolescence in girls is a vulnerable transitional period, characterized by substantial hormonal and physical development, the onset of menarche, dramatic brain development and changes in behavior, including sleep. Menstrual problems, including painful menses, are common among female adolescents, and contribute to school absenteeism. They may also be symptoms of gynecological conditions, which can negatively affect reproductive and general health of women. Limited work has linked sleep disturbances and menstrual problems in adolescents. Here, we examined the association between sleep behavior and menstrual problems in a large sample of adolescent girls in the Adolescent Brain Cognitive Development (ABCD) Study®.MethodsWe fitted linear mixed effect models to examine the associations between sleep behavior and menstrual problems in 1837 post-menarcheal girls (Year 3, Mean-age = 13.03, [12-15] years), assessed as part of the ongoing ABCD Study®. Sleep was assessed with the Munich Chronotype questionnaire (youth-report) and the sleep disturbance scale for children (caregiver-report). Girls answered questions about menstrual cycles and associated problems. We considered age, time since menarche, BMI, use of hormonal contraceptives, and socio-demographic characteristics in the models.ResultsShort sleep duration was related to higher menstrual pain intensity (p<.01), irregular menstrual cycles (p<.01) and more premenstrual symptoms (p=.01). Higher total sleep disturbance score (caregiver-reported) was also associated with higher menstrual pain intensity (p<.01) and greater impact of menstrual pain on usual activities (p<.01). Participants with a later chronotype (p=.04) and later wake-up time (p=.02) were more likely to experience an irregular menstrual cycle. Later wake-up time was also related to higher menstrual pain intensity and impact on daily life (p<.01). Girls with recent menarche reported heavier menstrual flow (p=.02), higher menstrual pain intensity, more premenstrual symptoms, and a greater overall impact of menstrual pain on their usual activities (p<.01).ConclusionOur results indicate multiple associations between sleep behavior and menstrual problems in adolescent girls. Both menstrual problems and insufficient sleep/sleep disturbances are important for female adolescent health and should be routinely screened for by healthcare providers and school health education providers. Future work is needed with longitudinal analyses to determine directionality of the associations we found between sleep and menstrual problems.Support (if any)NIH U01DA041022
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0752
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0950 Sound-based Sleep Staging at Home Using Smartphone via Deep Learning

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      Pages: A418 - A419
      Abstract: IntroductionDaily sleep tracking at home is growing in demand as more and more people are aware of the significance of sleep. The objective of this study is to propose a sound-based sleep staging model based on deep learning that works well in home environments with recorded audio data from general smartphones.MethodsThree different audio datasets were used. A labeled hospital dataset (PSG and audio, N=812) and an unlabeled home dataset (audio only, N=829) were used for training. A limited number of labeled sound data from home (PSG and audio, N=45) were used for testing. Our proposed HomeSleepNet has three components: (1) supervised learning using the labeled hospital data that trains the model to make correct predictions in hospital environments; (2) unsupervised domain adaptation (UDA), which used both the labeled hospital data and unlabeled home data, and transferred the sleep staging power from hospital domain to home domain by adversarial training; (3) unsupervised data augmentation for consistency training (UDC), which augmented hospital data by adding home noise and trained the model to make consistent predictions on original and augmented data. After all training, HomeSleepNet is expected to make robust sleep staging despite the home noise presence.ResultsHomeSleepNet achieved 76.2% accuracy on the sleep staging task in home environments for the 3-stage classification case (Wake, NREM, REM). Specifically, it correctly predicted 63.4% of wake, 83.6% of NREM sleep, and 64.9% of REM sleep. The contributions of UDA and UDC were demonstrated by the following results. The accuracy of the model trained without both was 69.2%. Either addition of UDA or UDC training to the model improved the performance, with increased accuracy of 69.3% for UDA and 73.5% for UDC. As expected, using both UDA and UDC (i.e., HomeSleepNet) achieved the best performance, with a 7% increase in accuracy compared to the model trained without both components.ConclusionTo the best of our knowledge, this is the first sound-based sleep staging study conducted in home environments. Moreover, the sounds were recorded by commercial smartphones and not through professional devices. Our proposed model introduced a reliable and convenient method for daily sleep tracking at home.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0950
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0753 Mothers’ sleep and executive function: Downstream implications for
           parenting and toddlers’ executive function

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      Pages: A332 - A332
      Abstract: IntroductionMothers’ sleep is positively associated with positive parenting (e.g., responsiveness) — what has not been established is how mothers’ executive function (EF) could mediate this association, and how, in turn, mothers’ parenting could influence the development of their toddlers’ EF.MethodsMothers and toddlers (N = 351) were followed at child ages 30, 36, and 42 months. Mothers were M = 32.70 years old (SD = 5.03); 49% of toddlers were male. The sample was largely middle class and 90% White. Fifteen percent of mothers were single. Thirty-one percent of mothers did not work outside the home, and 28% worked full time. Mothers’ sleep was measured via actigraphy. Mothers’ positive parenting was measured both in the home and the lab. At home, the toddlers’ bedtime routine was observed and rated for mothers’ responsiveness and involvement. In the lab, mothers’ positive affect during free play with their toddler was coded (with independent, inter-rater reliability of ICC = .80). The lab measure was correlated with the home visit measure (r = .22, p < 0.01). Mothers’ EF was measured via self-report on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF), which assesses everyday metacognition, behavior regulation, and emotion regulation. The average, where higher scores reflect worse EF, was used. Toddlers’ EF was measured by coders’ ratings of toddlers’ ability to sustain focused attention during independent free play in the lab visit (ICC = .83).ResultsCross-sectionally, mothers’ sleep was associated with their EF (B = .12, p<.05). In a structural equation model across time, mothers’ actigraphic sleep that was shorter, later, and more variable predicted worse EF (B = 0.07), which in turn predicted less positive parenting (B = - 0.08), at levels trending towards significance. Mothers’ positive parenting was associated with toddlers’ observed sustained, focused attention, both within (r = .13, p < 0.05) and across time (r = .13, p < 0.05).ConclusionThese findings suggest that a mother’s sleep can affect her EF and parenting, which can then support toddlers’ sustained attention development, an important aspect of executive function.Support (if any)Grants MH099437 from NIMH and HD073202 from NICHD
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0753
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0754 Sleep Ecology in Low-Income Mexican American Toddlers

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      Pages: A332 - A333
      Abstract: IntroductionHealthy sleep is critical for child development, yet disparities exist, with Latino children disproportionately affected by deficient sleep. Most of what is known about sleep ecology and interventions to improve sleep in young children is based on studies of primarily White, non-Latino, and economically-advantaged families. To ensure the effectiveness of interventions, it is important to understand the contribution of socioecological factors on sleep among toddlers in low-income Mexican American families.MethodsThis study employed in-depth interviews with a purposeful sample of low-income Mexican American Spanish-speaking (n=10) and English-speaking mothers (n=10) of toddlers (18-34 months old). Interviews focused on daily sleep routines, perceptions of toddler sleep behaviors, and environmental contributors. Transcripts were coded by two investigators and analyzed using a content analytic approach.ResultsFor sleep-related parenting practices, 70% of mothers reported late child bedtimes (≥9:00 pm), 75% reported room/bed sharing, and almost a third of children fell asleep at bedtime with a bottle or cup. Maternal beliefs about child sleep included concerns that child crying during the night might disturb neighbors or wake siblings, and child sleep quality improved when the child is not hungry. Contextual factors impacting sleep included schedules, neighbors, and siblings. Specifically, later weekday bedtimes were attributed to maternal (but not paternal) work schedules, while wake times were often a result of a sibling’s school schedule. Weekend bedtimes were commonly reported to be delayed for toddlers due to families watching movies. Noisy neighbors, in particular upstairs neighbors, were identified as disrupting children’s sleep. Siblings were identified as both facilitating sleep (e.g., helping with routines) and disrupting sleep (e.g., distracting child at nap time).ConclusionFindings provide insights on socioecological factors and parental beliefs about sleep ecology in low-income Mexican American toddlers that have implications for the design of interventions to improve child sleep. For example, commonly used behavioral sleep interventions have children sleeping in their own room, or require some crying during the night. However, these approaches may not be a good fit or feasible for this population. To address sleep health disparities, further work is needed to understand socioecological factors that require inclusive adaptations to pediatric sleep interventions.Support (if any)R01HL163859
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0754
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0951 Inter-Scorer Reliability between Somno-Art Software and 5 Sleep
           Centers

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      Pages: A419 - A419
      Abstract: IntroductionA number of studies have evaluated epoch-by-epoch agreement between 2 technologists in scoring individual sleep stage. Scoring for the specific sleep stages average agreement ranged from 20% to 90% in different studies. The goal of this study is to evaluate the validity of the Somno-Art analyses against a pool of scorers including validated automated system for scoring polysomnograms.MethodsSixty polysomnography recording nights, representative of clinical practice (participants who are healthy or suffering from obstructive sleep apnea [OSA], or insomnia or major depressive disorder [MDD]), were scored by 5 different sleep scoring centers and by the Somno-Art Software (total of 6 scorers). Intra-class correlation coefficient (ICC) and Wilcoxon Signed-Rank Test were calculated between each scorer and the average value of the 6 scorers. In addition, epoch-by-epoch agreements between scorers were analyzed.ResultsSomno-Art Software estimation of sleep efficiency, wake, N1+N2, N3 and REM sleep belonged to the interscorer range for the full dataset and the participant groups, except N3 sleep in OSA patients. Somno-Art Software tended to overestimate sleep latency with a significant difference to the average scoring for insomniacs (4.7±1.6 min). On the full dataset, Somno-Art Software had good or excellent ICC scores for all sleep parameters except N3 sleep (moderate score). 4-stages epoch-by-epoch agreement ranged between 78.5-88.7% for the visual scorers and 69.9-71.2% for Somno-Art Software. For the healthy participants, visual scorers agreed between 68.9 and 86.9%, while Somno-Art Software overlapped this range with an interscorer agreement between 62.0 and 71.4%.ConclusionSomno-Art solution provides results that are comparable to manual and automatic scoring for commonly used metrics in sleep medicine. It shows a robust interscorer reliability in the range of the 5 polysomnography scorersSupport (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0951
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood
           Pressure During Late Adolescence

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      Pages: A333 - A333
      Abstract: IntroductionElevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence.MethodsThis secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions.ResultsThis sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p < 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model.ConclusionThis secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group.Support (if any)1st author - NHLBI T32HL105349 & NICHD 5T32HD101397-03
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0755
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0952 A Long Winter’s Sleep: What Does Big Data From Consumer Sleep
           Technology Tell Us'

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      Pages: A419 - A420
      Abstract: IntroductionLight is the most powerful zeitgeber influencing sleep-wake patterns, and winter’s shorter days have profound effects on mood, energy, and metabolic function. Here, we leverage big data from consumer sleep technology to examine the relationship between objectively measured sleep in winter versus summer months in the United States.MethodsThe dataset included 21,101 users residing in the US across 1,255,518 nights (age range: 17-90, mean age: 46.6 ± 16.7 years, 59% female). Data were extracted from 01 January 2019 until 31 August 2022. Seasons were defined according to the Northern Hemisphere’s meteorological calendar and included winter (December - February) and summer (June - August). USA public holidays were mapped and removed from the data. The relationships between objectively measured sleep and winter versus summer were examined using linear regression models, controlling for age and gender.ResultsA shift to later average monthly wake times were observed in both summer and winter, peaking in summer. Similarly, bedtimes shift later in summer and winter, yet the shift in summer was greater than winter (winter vs summer: waketime: 07:06 vs 07:07, ß = -0.46, SE = 0.023, p< 0.001, bedtime: 23:17 vs 23:23, ß = 0.12, SE = 0.006, p< 0.001). Although bedtime and wake times delay during the winter and summer seasons, measures of sleep health including sleep duration, sleep efficiency, and SleepScore peak in winter and slowly decline to their lowest point during the summer months (winter vs. summer: SleepScore 78.4 vs 77.6, ß = -0.89, SE = 0.17, p< 0.001; sleep duration 359.6 min vs 352.8 min, ß = -4.8, SE = 1.02, p< 0.001; sleep efficiency 77.5 vs 76.6, ß = 0.86, SE = 0.038, p< 0.001).ConclusionBedtime and wake time delays were greater in summer than winter, likely contributing to small improvements to sleep quality, duration, and efficiency in winter compared to summer. These findings are generally supported by previous research examining sleep-wake patterns in locations with extreme seasonal differences, such as Northern Norway, where, despite midnight sun and polar nights, researchers have found little variation in sleep-wake timing.Support (if any)SleepScore Labs
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0952
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0756 Amount and Timing of Sedentary Behavior and Physical Activity
           following Experimental Sleep Extension in Adolescents

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      Pages: A333 - A334
      Abstract: IntroductionShort sleep and sedentary behavior (SB) are both associated with negative health outcomes including increased risk of metabolic syndrome and obesity. Adolescence is a period characterized by decreased physical activity (PA), increased SB, and chronic short sleep. Literature about the impact of sleep duration on PA in adolescents is limited. The goal of this study was to examine changes in the amount and timing of PA and SB following a one-week sleep extension manipulation.MethodsThe sleep, PA, and SB of 34 short-sleeping (≤7h on school days) and habitually sedentary (< 3h of physical activity per week) healthy-weight adolescents (age=16.4±1.1 years; 68% female; 73% non-Hispanic White) were objectively measured in a randomized cross-over study during the academic year. Participants completed one week of Typical Sleep (usual school schedule) and one week of Sleep Extension (≥1h time in bed each school night). Sleep was estimated using wrist-worn actigraphy; PA and SB were measured using a thigh-worn accelerometer. Paired t-tests compared total minutes and time blocks of PA and SB during each condition.ResultsTotal SB decreased from 750.4±109.08 to 699.32±91.76 min/day during Sleep Extension compared to Typical Sleep (p= 0.018). Specifically, SB significantly decreased during Sleep Extension in the 6PM-12AM (Typical Sleep=223.1±66.6, Sleep Extension=193.8±46.2 min; p=0.04) and 12AM-6AM (Typical Sleep=22.2±36.9, Sleep Extension=5.8±9.5 min; p=0.02) time frames. There were no significant changes in light, moderate, or vigorous PA between conditions (p>0.05).ConclusionAdolescents significantly decreased time spent in SB by nearly 1h per day during Sleep Extension with no change in PA, similar to prior research. Notably, the decrease in SB occurred during the 6PM-6AM time frame, suggesting that the additional sleep displaced time otherwise spent in SB. Reallocation of time spent in SB to PA is associated with positive health outcomes, but no research has examined reallocation to sleep time. Additional studies are needed to identify the related health effects of increased sleep duration and reduced SB in adolescents.Support (if any)NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1 TR002535
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0756
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0953 A Novel Active Humidifier for Non-Invasive Ventilated Patients

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      Pages: A420 - A420
      Abstract: IntroductionThe RespirAq® humidifier is a novel, active heated humidifier that humidifies without the need for additional water. Within milliseconds, the humidifier switches between a super-hydrophilic state to capture moisture during expiration, and a super-hydrophobic state, returning moisture during inspiration. The device delivers gases at 37°C/100% relative humidity to individuals requiring humidification, including those with tracheostomies. We demonstrated the device meets EN ISO 80601 2 74:2020 during bench testing. This study aimed to compare the performance of the novel humidifier with a heated humidifier - HH (MR850™ Fisher & Paykel Healthcare) and a heat and moisture exchanger - HME (DAR™ Covidien) in healthy volunteers during non-invasive ventilation (NIV) using a non-vented full face mask.MethodsTen healthy volunteers were recruited. NIV was performed at different settings (inspiratory positive airway pressure (IPAP) range 5-20cmH20, expiratory positive airway pressure (EPAP) = 5cmH20) over a one-hour period. Humidity and temperature were collected continuously during the study.ResultsSixty per cent of participants were female. Mean age of 35.6 ± 5.89 years (M±SD, n=10). Absolute humidity inside the face mask increased from 22.55 ± 2.41 mg/L without humidification to 30.18 ± 2.07 mg/L with an HME, and 39.09 ± 1.05 mg/L and 38.23 ± 1.78 mg/L when using a water-based heated humidifier and the novel humidifier, respectively. When comparing the performance of the humidification devices head-to-head, the two heated humidifiers significantly outperformed the HME (HME vs Novel = P < 0.0001, HME vs HH = p < 0.0001) and there was no significant difference seen between the two active humidifiers (p =0.2047).ConclusionResults show that the device meets the 12 mg/L absolute humidity established by the EN ISO 80601-2-74:2020 standards and that there is no significant difference in performance compared to traditional heated humidification. This suggests that the novel device can deliver the performance of a heater humidifier at the size, reliability and ease of use of a heat and moisture exchanger. Due to the mechanism of action, droplet/aerosol transmission of COVID-19 may also be mitigated. Further studies are warranted to confirm these findings.Support (if any)This research was supported by Tier 2 KiwiNet funding.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0953
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0757 Associations between Objective Sleep Health and Cardiovascular Health
           in Adolescents with Type 1 Diabetes

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      Pages: A334 - A334
      Abstract: IntroductionAdolescents with type 1 diabetes (T1D) are at risk for early-onset cardiovascular disease due to increased arterial stiffness, decreased endothelial function, and early-stage hypertension compared to healthy peers. Poor sleep health has been associated with greater glycemic variability, increased insulin resistance, and poorer cardiovascular health; however, the relationship between sleep and vascular health has not been studied in adolescents with T1D. The aim of this study was to evaluate associations between objectively measured sleep and cardiovascular health in this population. We hypothesized that better sleep health would correlate with better cardiovascular health.MethodsTwenty-four adolescents with T1D completed the study during the academic year. Sleep was monitored for one week at home with actigraphy. Watchpat-assessed apnea hypopnea index (AHI) and vascular measures were obtained during an overnight study visit. EndoPAT estimated reactive hyperemia index (RHI) and augmentation index (AI). Dynapulse measured systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), heart rate (HR), pulse wave velocity (PWV), and brachial distensibility and resistance (BrachD, BrachR). Correlations between sleep and vascular measures were examined.ResultsParticipants were an average age of 15.5±1.1 years (54.2% female, 83.3% White non-Hispanic, BMI 58.8 ±25.8%ile, HbA1c 7.5±1.2%). Average school night (weekday) sleep duration was 6.7±0.8 hours and average sleep efficiency (SE) was 82.8±6.9%. The majority (87.5%) of participants slept less than the clinical recommendation of 8-10 hours per night. Worse actigraphy-estimated SE was associated with higher DBP (r=-0.52, p=0.02; mean= 59.2±6.7mmHg) and MAP (r=-0.46, p=0.04; mean= 79.5±7.5mmHg). Higher AHI was associated with higher BrachR (r=0.81, p< 0.001). No significant associations were identified between sleep variables and RHI, AI, HR, PWV, or BrachD (all p>0.05).ConclusionPoorer SE and higher AHI were associated with poorer indicators of vascular health in adolescents with T1D, consistent with prior literature linking poorer sleep health with risk factors for hypertension in adults with T1D. Further research is needed to determine if improving sleep can improve cardiovascular comorbidities in adolescents with T1D.Support (if any)JDRF 2-SRA-2019-848-S-B; JDRF 2-SRA-2022-1144-M-B; Ludeman Center for Women’s Health Research COVID-19 Relief Supplemental Grant; Colorado Clinical & Translational Research Center Maternal & Child Health Pilot Award; CTSA UL1 TR002535
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0757
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0954 CORRELATION OF PULSE RATE VARIABILITY (PRV) AND HEART RATE
           VARIABILITY (HRV) METRICS DURING SLEEP IN SUBJECTS SUSPECTED OF OSA

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      Pages: A420 - A421
      Abstract: IntroductionWhether photoplethysmography (PPG)-derived pulse rate variability (PRV) metrics can be surrogates for ECG-derived heart rate variability (HRV) is a decade-long debate. Very few studies have assessed the performance of PRV metrics in wearables. We aimed to evaluate the performance of time- and frequency-domain PRV metrics derived from the Belun Ring (BR) in subjects suspected of sleep apnea.MethodsUsing Pearson’s correlation coefficient (PCC), we retrospectively analyzed the relationship between concurrent BR-PRV and PSG ECG-HRV metrics (standard deviation of NN intervals [SDNN], root mean square of successive RR interval differences [RMSSD], percentage of successive RR intervals that differ by more than 50 ms [PNN50], HF [high frequency] power, LF [low frequency] power, VLF [very low frequency] power, and LF/HF ratio) in 73 subjects suspected of OSA. Subgroup analyses were performed based on demographic information, OSA, co-morbidities, and HR-affecting medication status.ResultsAge (SD) 50.1 (13.4); female 68%; black 52%; BMI (SD) 36.1 (9.7); 56% OSA; mean AHI (SD) 14.7 (17.3). Nine (12%) subjects had significant arrhythmias (defined as having any arrhythmias in ≥25% of all 12-second segments.) Key findings: There was a unitary linear relationship between BR PPG-pulse rate and ECG-heart rate in the overall group. In those without significant arrhythmias (N=64), PRV-SDNN, PNN50, HF, LF, and VLF had excellent correlations (PCC ≥0.90) with corresponding HRV metrics in all subgroups. PRV-RMSSD and PRV-LF/HF also had a strong correlation (PCC ≥0.80) with ECG HRV-RMSSD and HRV-LF/HF in all subgroups except for LF/HF in the diabetes group. In those with significant arrhythmias (N=9), PRV performed less well, with most metrics having PCC < 0.90 or wide CI, except for PNN50. All PRV metrics had PCCs ≥0.90 in subjects on HR-affecting medications except for LF/HF.ConclusionBR-PRV metrics can serve as surrogates for ECG-HRV in patients suspected of OSA who do not have significant arrhythmias. PRV-RMSSD and LF/HF may be less robust than the rest of the PRV metrics but still showed strong correlations in most subgroups. BR-PRV can be a useful clinical and research tool in assessing autonomic nervous system function.Support (if any)This study is supported by a Grant from Belun Technology Company
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0954
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0530 Efficacy of obstructive sleep apnea treatment by a unique oral
           appliance and effect of concurrent myofunctional and CPAP therapy

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      Pages: A233 - A234
      Abstract: IntroductionCurrent treatment options for obstructive sleep apnea (OSA) include positive airway pressure, oral appliances, and upper airway surgery. The Day and Night Appliance (DNA) is a component of a dentist-guided system (Complete Airway Repositioning and Expansion [CARE], Vivos Therapeutics) that leads to gradual increases in upper airway volume. This study examines the effects of DNA treatment on OSA in patients before and after use of the device; we also examined how DNA treatment was impacted by concurrent myofunctional and CPAP therapy.MethodsData from a prospectively-collected clinical database (Vivos Airway Intelligence Service [AIS]) were reviewed, and 94 adult OSA patients who met DNA use criteria and had pre- and post-treatment sleep studies without the device in place were included. We compared the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) pre- and post-treatment using a paired t-test and fit linear regression models with change in AHI and ODI as dependent variables.ResultsMean patient age was 47.8±14.7 years and 44.7% were men. Pre- and post-treatment sleep studies were conducted 15.2±7.0 months apart. 24.5% of patients were treated with DNA and myofunctional therapy (14.1% exclusively myofunctional, 10.4% myofunctional plus another treatment, e.g., tonsillectomy, frenectomy). 17.0% of patients were treated with CPAP (12.8% exclusively CPAP, 4.2% CPAP plus another treatment). For both pre-treatment and post-treatment, mean AHIs were 22.3±19.4 and 12.7±11.2 respectively (p< 0.0001) and mean ODIs were 11.6±13.7 and 7.8±9.1 respectively (p< 0.0001). Excluding patients who had undergone myofunctional therapy and another treatment modality and adjusting for patient age, BMI, and gender, we found myofunctional therapy was associated with a -10.4 change in AHI (p=0.038). However, myofunctional therapy was not associated with a significant change in ODI (p=0.905). Concurrent CPAP use did not have a significant association with change in either AHI (p=0.47) or ODI (p=0.61).ConclusionThis study shows that DNA use significantly improved post-treatment OSA severity, and that concurrent myofunctional but not CPAP therapy may result in further OSA improvement. An oral appliance system that provides palatal expansion with consequent improvement in OSA severity but does not require permanent nightly use has advantages over conventional oral appliances; however, further investigation is warranted.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0530
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1019 New onset OSA after long term Vagus Nerve Stimulator implantation in
           a patient with Lennox-Gastaut syndrome: A case report

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      Pages: A448 - A448
      Abstract: IntroductionImplantable vagus nerve stimulation (VNS) is an established treatment for drug resistant epilepsy. New onset obstructive sleep apnea (OSA) is a rare side effect of VNS. There are few studies describing VNS induced sleep apnea in adults. [1-2] A study of 16 patients with drug-refractory epilepsy found 5 patients with normal AHI develop mild OSA after VNS treatment for 3 months. [2] However, no literature exists regarding OSA after long term VNS implantation. Untreated OSA in patients with epilepsy can impact epilepsy outcomes. We report a case of new onset OSA after long term VNS implantation, refractory to PAP therapy.Report of case(s)A 36 year-old man with Lennox-Gastaut syndrome presented with gasping during sleep and daytime hypersomnolence. He underwent VNS implantation at the age of 12. A prior PSG in 2018 showed no sleep apnea. Repeat PSG showed VNS-induced OSA (AHI 10.1/hour). After failed CPAP titration, BPAP-S at 25/16 cm H2O improved OSA. Review of therapy data on follow up showed AHI of 13.7/hour and CAI of 10.9/hour, which is concerning for treatment induced central sleep apnea on BPAP. Diagnostic study with VNS turned off revealed mild OSA (AHI 5.8/hour). A multidisciplinary approach involving ENT for drug-induced sleep endoscopy to optimize VNS stimulation parameters along with neurology and sleep involvement is planned. The optimized VNS setting could be used during planned sleep times using a VNS device with dual-programming capability.ConclusionTo our knowledge, there is no literature on development of sleep apnea after long term VNS implantation. Although the exact mechanism is unknown, VNS can cause sleep apnea or worsen sleep apnea in patients with a preexisting diagnosis. [1] This case demonstrates need for continuous monitoring and screening for sleep apnea in patients who have been implanted with VNS, even if baseline and follow up PGSs are normal. Current literature suggests discontinuation of VNS to resolve VNS-induced OSA, but we describe a case here where VNS is needed for ongoing management of epilepsy. Further studies are needed to identify treatment options for patients that cannot discontinue VNS therapy who also cannot be successfully treated with PAP if they develop VNS-induced OSA.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1019
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0552 Predictive Characteristics of Run-In Period Adherence in a Randomized
           Controlled Trial

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      Pages: A243 - A243
      Abstract: IntroductionThe run-in period has been used in randomized controlled trials in obstructive sleep apnea (OSA) to assess continuous positive airway pressure (CPAP) adherence. We hypothesize that there are differences in participant characteristics and PAP adherence between those excluded after the run-in period and those included in the final analytic sample of the Sleep Apnea Stress Study (SASS, NCT00607893), a trial designed to examine effect of PAP treatment on intermediate cardiovascular outcomes.MethodsThe SASS trial was designed to include a 2-week run-in period with a 1-month wash-out period. Patients with CPAP adherence >4 hours of CPAP use for 70% of run-in period nights were randomized. Demographic factors were compared among groups using analysis of variance (ANOVA) or Kruskal-Wallis test in continuous variables, Pearson’s chi-square test or Fisher’s exact test was used for categorical variables. Bonferroni correction was applied for pairwise comparisons. SAS version 9.4 (The SAS Institute Cary, NC) was used to perform all analyses.ResultsFifty-nine participants(30.8%) who did not meet PAP adherence threshold were excluded after run-in period and compared to Sham and CPAP treatment group(n=74 in each group). Results are presented as excluded vs sham treatment vs CPAP treatment. Participants excluded after the run-in period were more likely to be female than those who proceeded to randomization: 66% vs. 47% vs. 45%,p=0.031 and of Black race:73% vs. 42% vs. 47%, p=0.002. Participants excluded after the run-in period and those non-adherent to treatment in sham and CPAP were younger than adherent participants: excluded: 48.9±12.0, sham non-adherent 49.7±12.3, CPAP non-adherent 47.7 ± 13.2, sham adherent 58.3±9.3, CPAP non-adherent 54.3 ± 9.4, p=0.014. In the run-in period, participants who were excluded had the median of number of days using the device 12 (IQR 7-15), mean of average daily use 2.8±2.1 hours and median percent of days with 4+ hours use 18.2% (IQR 0-57.1%).ConclusionWe identify that age and race are predictors of run-in period non-adherence to PAP therapy underscoring the need to develop pre-randomization PAP adherence optimization strategies specific to these subgroups to ensure representation in the trial.Support (if any)This work was supported by NIH HL079114-02.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0552
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1020 Modafinil Induced Psychosis

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      Pages: A448 - A448
      Abstract: IntroductionModafinil has been used for the treatment of numerous different conditions, including daytime somnolence (EDS). Modafinil is a non-amphetamine central nervous system (CNS) stimulant with wakefulness-promoting properties. There have been few reported cases of psychosis associated with modafinil use, however a large majority of those were seen in patients with a history of primary psychiatric disturbances.Report of case(s)We present a case of a 48 year old female coming for evaluation of excessive daytime somnolence. She completed polysomnography and a multi sleep latency test (MSLT) which revealed mildly elevated AHI, but no sleep onset rapid eye movements (SOREMPs). A diagnosis of idiopathic hypersomnia was subsequently made and 200mg of modafinil up to twice daily was prescribed for her. Patient initially tolerated the modafinil well, however she began having delusions and she subsequently required psychiatric evaluation. These delusions primarily consisted of her believing she was under surveillance and had conspiracy theories against her. She also described having auditory hallucinations as well, especially voices telling her about these conspiracy theories. She also demonstrated poor insight into her medical condition as she refused to discontinue modafinil. Upon evaluation, routine labs including complete blood count, chemistry profile and urine drug screens were completed to rule out any secondary causes of psychosis. It was therefore recommended by psychiatry to discontinue modafinil as there was concern that the delusions were occurring secondary to medication use. The patient's psychotic delusions seemed to dissipate after this. A multidisciplinary meeting was held regarding management of patients' excessive daytime sleepiness (EDS) and a decision was made to begin the patient on pitolisant, a histamine receptor antagonist. The patient was able to achieve great benefit with this medication.ConclusionThe presented case illustrates a patient who began having psychosis after beginning modafinil 200mg twice daily. Psychosis is a much more rare side of modafinil and providers should become aware of it. Therefore, patients who are prescribed modafinil should be carefully followed for psychosis development, even when they are previously healthy and have no history of any primary psychiatric conditions.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1020
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0553 Prevalence of Insomnia and Anxiety in a National Sample of Patients
           with Obstructive Sleep Apnea and Depression

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      Pages: A243 - A244
      Abstract: IntroductionInsomnia and anxiety are highly comorbid both with depression and with obstructive sleep apnea (OSA). This retrospective study sought to characterize patients with these conditions among a national sample of individuals with depression and comorbid OSA.MethodsA national sample of administrative claims data of OSA patients was used for this analysis. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to OSA diagnosis and before initiation on positive airway pressure (PAP) therapy for treatment of OSA. Anxiety, insomnia, and other comorbidities were identified by the presence of at least one ICD-10 code associated with healthcare encounters in the year prior to starting PAP therapy. Age, sex, and insurance coverage were characterized at the time of the first OSA diagnostic sleep test. Healthcare resource utilization was assessed for the year prior to starting PAP therapy.Results36,668 patients with depression and comorbid OSA were included. 56% had comorbid anxiety, 28% had comorbid insomnia, and 35% had neither anxiety nor insomnia. Compared to those without anxiety or insomnia, patients with anxiety or insomnia were more commonly female (64% vs 57%) and had a higher prevalence of asthma (25% vs 20%), psychotic (14% vs 7%) and other mood disorders (24% vs. 14%), fibromyalgia (11% vs 7%) and GERD (43% vs 33%). Relative to individuals with insomnia or anxiety, patients without insomnia or anxiety experienced fewer ER visits, all-cause hospitalizations, depression-related hospitalizations, specialist visits, and self-harm events in the year prior to PAP initiation. Relative to patients with comorbid insomnia, those with comorbid anxiety demonstrated slightly higher healthcare resource use in the year prior to PAP initiation.ConclusionAnxiety and insomnia are prevalent comorbidities in patients with depression and obstructive sleep apnea, with more than half of patients suffering comorbid anxiety and a quarter of patients having comorbid insomnia. Future research should examine comprehensive patient care strategies that can be used in patients with comorbid anxiety or insomnia to encourage healthy sleep behaviors and successful acclimation to OSA treatment.Support (if any)ResMed
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0553
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1021 An 8-year-old child with ROHAAD syndrome and its comorbid association
           with narcolepsy, cardiomyopathy, and malignant catatonia

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      Pages: A448 - A449
      Abstract: IntroductionRapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare disease with an unknown etiology. It manifests with varying clinical signs making the diagnosis challenging. We present a case of ROHHAD syndrome with narcolepsy, heart failure with cardiomyopathy, and malignant catatonia.Report of case(s)An 8-year-old boy with speech and developmental delay presents to sleep clinic at 4 years of age, with snoring, witnessed apneas during sleep, daytime somnolence and obesity for evaluation of obstructive sleep apnea. At three years of age, he started to gain weight rapidly; with an increase in BMI from 26 to 30 over a period of few months. His weight gain was initially attributed to a high caloric diet and sedentary lifestyle. A baseline polysomnogram revealed mild obstructive sleep apnea without hypoxemia or hypoventilation (oRDI of 4.2, oxygen nadir 90%, CAI 1). Over time, he was admitted multiple times for hypernatremia, respiratory failure with hypoxemia and hypercapnia, psychosis, and fever of unknown origin. After a thorough evaluation, the diagnosis of ROHHAD was made based upon his history of rapid weight gain, hyperthermia, respiratory failure with hypercapnia, hypopituitarism, and hypothyroidism. During one of his admissions for altered mental status the patient manifested agitation, auditory and visual hallucinations, and excessive daytime sleepiness. Due to these behavioral changes, cerebral spinal fluid was obtained showing a hypocretin of < 50pg/ml. Based on the low hypocretin levels, daytime sleepiness, and hallucinations; a diagnosis of narcolepsy type 1 was made. He subsequently developed heart failure with severely dilated cardiomyopathy and depressed contractility. The patient was deemed not a candidate for heart transplant due to his underlying comorbidities. He unfortunately died at the age of 8 years due to complications from advanced heart failure.ConclusionROHHAD is a rare and fatal disease that can manifest in several ways. ROHHAD with coexistent narcolepsy, malignant catatonia and cardiomyopathy is extremely rare presentation. Providers need to be aware of the varying clinical presentations and have a high index of suspicion in diagnosing this condition. Early diagnosis might improve the morbidity and mortality.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1021
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0576 Characterization of Patients With Narcolepsy Treated vs Not Treated
           With Sodium Oxybate: A Propensity Score–Matched Cohort Study

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      Pages: A253 - A253
      Abstract: IntroductionNarcolepsy is a chronic sleep disorder with multiple comorbid conditions. Sodium oxybate (SXB) is strongly recommended for treatment of narcolepsy. This study used aggregate electronic health record (EHR) data to characterize demographic characteristics and comorbidities of patients with narcolepsy treated with or without SXB.MethodsAn EHR-based search identified first-time Mayo Clinic patients between 1975–2020. Patients had ≥1 narcolepsy-specific ICD-9/-10 code and ≥1 diagnostic mention of narcolepsy in clinical notes (natural-language-processing algorithm). Patients with narcolepsy treated with SXB were age/sex matched with a cohort without SXB treatment. Common comorbidities were identified using ICD-9/-10 codes and compared between cohorts (odds ratio [OR]).ResultsOf 4387 patients identified, 8% received SXB treatment (n=351; mean [IQR] age at first diagnosis code observed at Mayo Clinic, 32 [23.2-46.1] y; 65.5% female; 92.3% white); 4036 patients had no SXB treatment (mean [IQR] age at first diagnosis code observed at Mayo Clinic, 44.8 [29.8-59.0] y; 58.0% female; 88.9% white). The 10 most commonly reported comorbidities (overall population) were insomnia (46.6%), fatigue (46.3%), depression (42.2%), hypertension (36.2%), hyperlipidemia (34.2%), obstructive sleep apnea (32.3%), diabetes mellitus (31.3%), arrhythmia (27.3%), idiopathic hypersomnia (IH; 26.8%), and coronary artery disease (17.6%). A cohort of 351 patients without SXB were age/sex matched to patients with SXB for comparison of comorbidities. In the unadjusted analysis, P values were significant for differences between cohorts (OR [95% CI] SXB vs no SXB) for fatigue (0.72 [0.54-0.97]; P< 0.05; adjusted P>0.9) and IH (0.60 [0.43-0.84]; P< 0.01; adjusted P=0.29). After P value adjustment (Bonferroni correction), there were no significant differences between these cohorts in ORs for any comorbidity. The matched cohorts, which were younger than the overall population, had numerically lower rates of these diagnoses vs the overall population, except fatigue and IH in patients without SXB and depression in patients with SXB.ConclusionAmong age-/gender-matched cohorts of patients with/ without SXB, there were no significant differences in comorbidities. Prevalence of comorbid IH/narcolepsy diagnoses highlight the diagnostic challenge in differentiating IH from narcolepsy type 2. SXB is highly effective but used by < 1:10 patients with narcolepsy in the Mayo Clinic health system.Support (if any)Avadel Pharmaceuticals
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0576
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1022 Two Teenagers with New Onset Insomnia post COVID

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      Pages: A449 - A449
      Abstract: IntroductionSleep disturbances are increasingly seen in COVID-19 infection. Multiple reports have described the onset of insomnia, excessive daytime sleepiness, and fatigue in patients with both acute COVID infection and long COVID syndrome. Most of these are limited to adults. We report the cases of 2 teenagers with new onset chronic insomnia post COVID-19 infection.Report of case(s)The first patient is a 14-year-old male who presented with sleep onset and sleep maintenance insomnia, excessive daytime sleepiness, difficulty concentrating, fatigue, and chronic cough, with onset five months prior presentation to the sleep clinic. He developed these symptoms after testing positive for COVID-19. He had significant impairment with multiple school absences and tardies for which he required accommodation. He completed a 2-week actigraphy test which showed prolonged sleep latencies and insufficient sleep. He was scheduled for polysomnography (PSG) followed by a multiple sleep latency test (MSLT) but could not proceed to MSLT due to insufficient sleep the night before. The PSG did not reveal either obstructive sleep apnea or periodic limb movements of sleep. His laboratory testing was significant for a low ferritin level of 21. He was referred for IV iron infusion due to intolerance for oral iron. He was started on melatonin without benefit. He was offered clonidine and trazodone but declined. The second patient, a 17-year-old male, presented with insomnia of 3 months duration which started after an acute COVID infection. In addition to insomnia, he had comorbid mood symptoms. He went from being engaged in school and work to being unmotivated and listless. His actigraphy testing revealed he was having sufficient sleep on several days during which he reported not getting any sleep. He failed trials of multiple medications including melatonin, trazodone, hydroxyzine, and gabapentin. He also denied benefit with CBT-I.ConclusionThese case reports link COVID 19 and chronic insomnia in pediatric patients. While it is yet unclear whether the development of sleep disturbances post COVID is as a result of an intrinsic characteristic of the COVID-19 virus or the biopsychosocial effects of the pandemic, it is important to develop and implement targeted interventions focused on recognizing and treating insomnia early.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1022
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0577 Clinically Meaningful Improvements With Pitolisant in Adults With
           Narcolepsy: Pooled Analysis of Randomized Clinical Trials

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      Pages: A253 - A254
      Abstract: IntroductionNarcolepsy is characterized by symptoms indicative of sleep–wake dysregulation, notably excessive daytime sleepiness (EDS) and cataplexy. In 2021, the American Academy of Sleep Medicine (AASM) updated its clinical practice guidelines on the treatment of central disorders of hypersomnolence. The AASM identified clinical significance thresholds (CSTs) of a 2-point reduction in Epworth Sleepiness Scale (ESS) score and a 25% reduction in the frequency of cataplexy, amongst others, to compare posttreatment effects between intervention and placebo. This post hoc analysis evaluates the efficacy of pitolisant in the treatment of patients with narcolepsy using these updated CSTs.MethodsData were pooled from 2 randomized, placebo-controlled, 7- and 8-week studies (HARMONY-1, HARMONY-CTP) of pitolisant in adults with narcolepsy. Pitolisant was individually titrated over a 3-week period (maximum potential dose, 35.6 mg/day), and the dose remained stable thereafter. The analysis population for EDS included all patients who received pitolisant or placebo (ESS score ≥12 required for study inclusion). The analysis population for cataplexy included treated patients who experienced ≥3 attacks per week at baseline. The end-of-treatment value for the ESS was the score at the last study visit (last observation carried forward [LOCF]). The cataplexy endpoint was the weekly rate of cataplexy (WRC) during the stable dose period (LOCF).ResultsData from 166 patients for EDS (pitolisant, n=85; placebo, n=81) and 122 patients for cataplexy (pitolisant, n=64; placebo, n=58) were analyzed. Mean (SD) baseline ESS score was 17.6 (3.0) in the pitolisant group and 17.9 (3.1) in the placebo group. Mean (SD) baseline WRC was 12.4 (10.7) and 9.9 (9.0), respectively. At the end of treatment, ESS score reduction of ≥2 points was observed in a significantly greater percentage of patients in the pitolisant group (72.9%) as compared with the placebo group (45.7%; P< 0.001). The percentage of patients with a reduction in WRC of ≥25% was significantly greater with pitolisant (78.1%) versus placebo (34.5%, P< 0.001).ConclusionPitolisant provides statistically significant and clinically meaningful reductions in EDS and cataplexy in patients with narcolepsy, based upon the CSTs associated with the updated AASM clinical practice guidelines.Support (if any)Bioprojet Pharma and Harmony Biosciences, LLC.
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.0577
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 1023 A Case of Stridor in the Sleep Clinic

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      Pages: A449 - A450
      Abstract: IntroductionMultisystem atrophy (MSA) is a neurological degenerative progressive disease affecting multiple systems. These patients are frequently seen in the sleep clinic at specialty centers by sleep neurologists for co-management of sleep disordered breathing and nocturnal respiratory issues. Stridor is a life-threatening condition seen in these patients and requires emergent action. We present a case of MSA with worsening stridor that was missed in the era of virtual telemedicine.Report of case(s)A 53-year-old female with a history of obstructive sleep apnea (OSA) on BiPAP S and multiple system atrophy with parkinsonian subtype presented virtually to sleep clinic for follow up evaluation of her sleep disordered breathing. Six months prior to her visit she was noted to have bilateral vocal fold hypomobility without stridor. At that time, she had a residual apnea-hypopnea index (AHI) of 1.4 with BiPAP-S 16/13 cm H2O and no nocturnal stridor. She was wheelchair bound. She had routine follow up visits with various providers however these were telemedicine visits with her husband doing most of the talking due to weakness. Over the next 5 months she had worsening fatigue and was using BiPAP S during the day intermittently and was referred to the sleep medicine clinic for consideration of supplemental oxygen at night. A repeat overnight oximetry revealed residual oxygen desaturation index (ODI) of 2.5/hr while on BiPAP S. Repeat pulmonary function testing was ordered and patient was recommended to return for immediate in person follow up. When seen in person, patient was noted to have significant stridor which had been ongoing and worsening over last few months including being appreciated while on PAP therapy. Emergent same-day ENT consultation was arranged by sleep providers. Posterior cordectomy was performed shortly thereafter. The patient was scheduled for an AVAPS titration study.ConclusionIn cases with progressive neuromuscular disease, stridor may be missed during virtual appointments for a variety of reasons including technical difficulties, or the virtual medium not being sensitive enough to convey stridor. This case highlights the importance of having a high index of suspicion for stridor and impending respiratory failure requiring emergent intervention in patients with neuromuscular disease.Support (if any) 
      PubDate: Mon, 29 May 2023 00:00:00 GMT
      DOI: 10.1093/sleep/zsad077.1023
      Issue No: Vol. 46, No. Supplement_1 (2023)
       
  • 0504 STOP BANG FAN, A Novel Screening Tool of OSA in Sleep Clinic

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