Difference In Total Sleep Time Research Articles

0720 Accuracy of WatchPat Portable Sleep Monitoring and Sleep Assessment in Patients with Atrial Fibrillation

Abstract Introduction Obstructive sleep apnea(OSA) is an established risk factor for atrial fibrillation(AF), necessitating early diagnosis and management. Home-based sleep-monitoring technology has become a mainstream diagnostic modality. Peripheral arterial tonometry (PAT) device is increasingly being used to screen for OSA in patients with AF. Our study aimed to examine the accuracy of Watch-PAT (WP) in OSA evaluation, and night-to-night variability of sleep characteristics as measured by WP when used during consecutive night sleep studies. Methods Patients with history of AF undergoing clinically indicated PSG were prospectively enrolled and had concurrent WP while undergoing PSG. Patients then were studied again using WP over two consecutive days at home. We compared agreement of OSA severity(defined as no OSA[AHI (apnea hypopnea index)<5], mild OSA[15>AHI³5], moderate OSA[30>AHI³15], severe OSA[AHI>30]) and total sleep time(TST) using Cohen’s Kappa(K) for categorical and Bland-Altman plots for continuous variables. To further characterize PSG versus WP, the cohort was stratified into paroxysmal versus persistent AF types. 1A/1B hypopnea scoring criteria was defined as per AASM. Results Our cohort included 24 patients with AF(80% male, mean age 68y). Most patients had clinically defined OSA(AHI³5). Patients with persistent AF had more severe OSA than those with paroxysmal AF (severe OSA present in 60% vs. 29%). Comparison of PSG to concurrently conducted WP in the lab showed substantial agreement in OSA severity by both 1A(K=0.623) and 1B(0.706) criteria. Percent difference in TST between PSG versus WP in the paroxysmal AF versus persistent groups was not statistically significant(p=0.387). Comparing two consecutive at-home WP tests showed substantial agreement in OSA severity measures(1A=0.872,1B=0.889). Bland-Altman plots for TST and sleep architecture showed ³95% of residuals within 2 standard-deviations, suggesting intertester agreement. Confidence intervals were broad in these plots reflecting our small sample size. Conclusion Our findings demonstrate that WP is a reasonable alternative to PSG, particularly if using the 1B criteria to diagnose OSA. Additionally, our results show that persistent versus paroxysmal AF does not seem to affect the results of WP tests. Night to night variability of OSA measures and TST was small. Future studies should verify the results of our study in a larger cohort. Support (If Any)

0140 Operationalizing Sleep for the Military: Advancing an Infrastructure for Fatigue Risk Management with Wearable Technology

Abstract Introduction A recent investigation on fatigue within United States (US) Naval Surface Force by the Government Accountability Office recommended that the US Navy incorporate methods to empirically monitor and manage fatigue-related threats. In response, a feasibility effort was undertaken to assess two commercial wearable devices previously evaluated against polysomnography by our group for potential use within a novel fatigue monitoring system onboard US warships. Methods 501 Sailors from three warships (415 men, 85 women, 1 response missing; 29.1±7.4 years, mean±SD) were included in analyses. During multi-day missions at sea, participants were instructed to continuously wear a wrist-worn Fatigue Science Readiband and an Oura Ring. Participants met with the research team daily to sync wearable devices and complete self-ratings of sleep and fatigue on a tablet. While returning to port, participants completed a user experience questionnaire that included 5-point scales for device comfort and interference with daily activities (larger values indicate greater comfort or interference). Results There were no overall differences in total sleep time (TST) and sleep efficiency (SE) between devices (TST: Ring=352.23±87.1, Readiband=353.89±97.79; p=0.45, d=-0.01; SE: Ring=84.59±7.08, Readiband=84.20±10.24; p=0.06, d=0.04). There were 9 days for TST and 4 days for SE (of 66 total days) that resulted in effect sizes >0.50 between devices (for >0.20: TST, 39/66; SE, 29/66). Preliminary analyses between TST and self-reported exhaustion and inability to function suggest predictive relationships with the wearables (Ring: r=-0.20; Readiband: r=-0.21), with no relationship with SE across devices (both r<0.01). Average comfort ratings for Ring (3.74) exceeded Readiband (3.59), but this difference was small (p=0.04, d=0.12). Interference with daily activities was also similar between devices (Ring=2.10, Readiband=2.20; p=0.14, d=0.08). Conclusion Both commercial wearables performed similarly for their TST and SE assessments, and TST was associated with self-rated fatigue within this operational environment. While the ring form factor was selected more for comfort than the wrist form factor, the difference was small. Collectively, findings indicate that both devices show promise for operational use within fatigue monitoring systems. Further testing is being conducted to better understand the strengths and limitations of wearable devices for monitoring sleep in warship environments. Support (If Any) Military Operational Medicine Research Program

0521 Prevalence and Characteristics of Sleep Disordered Breathing in 12-24 Month Old Children: A Single Center Study

Abstract Introduction To evaluate the prevalence and characteristics of obstructive sleep apnea (OSA) in children with ages between 12 to 24 months. Methods This was a single center, retrospective study that included children with ages 12-24 months who were evaluated for suspected sleep disordered breathing and underwent a full overnight polysomnography in an academic sleep disorders center over a period of 7 years. An apnea hypopnea index (AHI) >1 was used to define OSA, >5 was used to define moderate OSA, and >10 was used to define severe OSA. Results A total of 232 children with ages between 12-24 months were included in this study. The majority (66.4%) were noted to be males, and 56.9% were Caucasian. Snoring (90.1%) and witnessed apnea (53.3%) were the most common presenting symptoms for sleep evaluation. History of prematurity (18.2%) and gastroesophageal reflux (20.2%) were common co-morbidities. OSA was diagnosed in about 79% of the children and it was categorized as mild in 53.5%, moderate in 16.4 % and severe in 30.1%, respectively. There were no statistically significant differences in total sleep time, sleep efficiency, or the stages among these groups. However, statistical significant differences among the groups were noted in median REM% (Q1-Q3) (normal 19.3 (15-22.2) vs. mild 22.2 (18-26.6) vs. moderate 23.1(16-28) vs. severe 21(15-24.6) p=0.013), median REM AHI (normal 1.6 (1-2.8) vs. mild 7.5 (5-10.8) vs. moderate19.4 (12-23.6) vs. severe 51.2 (37-73.4) p<0.001), median OAHI (normal 0.3 (0-0.5) vs. mild 1.1 (1-2.6) vs. moderate 5.5 (4-7.5) vs. severe 20.7 (13-31.9) p<0.001), median supine AHI (normal-0.3 (0.0.6) vs. mild 1.7 (1-3.4) vs. moderate 6.3 (3-8.1) vs. severe 24.3(12-40.4) p<0.001), median SaO2 nadir (normal 94 (90-96) vs. mild 89 (84-91) vs. moderate 86.5 (82-91) vs. severe 80 (73-84) p<0.001), median arousal index (normal 8.9 (7-11.8) vs. mild 11.3 (9-13.5) vs. moderate 13.2 (11-18.6) vs. severe 16.8 (14-23.6) p<0.0001). Surgical treatment was performed in 98 children (53.5% of the children diagnosed with OSA) of which 76 surgeries were adenotonsillectomy. Conclusion In children with ages 12-24 months with suspected sleep disordered breathing, OSA was diagnosed in 79% with moderate to severe OSA in 46.5%. Support (If Any)

Clinical Differences of Insomnia Subtype According to Actigraphy Based Objective Short Sleep, Subjective Short Sleep, and Normal Sleep

Objectives: This study aims to examine the clinical differences between objective short sleep insomniacs (OSSI) and subjective short sleep insomniacs (SSSI). Methods: We enrolled 79 patients (aged 27–74 years) with chronic insomnia disorder (CID) who underwent overnight polysomnography (PSG) and completed sleep-related questionnaires as well as habitual sleep time. All of them completed actigraphy (ACT) recording for one week prior to the PSG study. Objective sleep duration for one-week average sleep was calculated by ACT, and subjective sleep duration was counted through self-reported habitual sleep time. We divided the subjects into three groups; OSSI (<6 h/night), SSSI (objective sleep ≥6 h/night and subjective sleep <6 h/ night), and normal sleep duration insomniacs (NSDI, subjective sleep ≥6 h/night). Results: The three groups namely OSSI, SSSI, and NSDI had 25 (31.6%), 36 (45.6%), and 18 (22.8%) subjects, respectively. The SSSI were significantly older and had higher daytime sleepiness than the OSSI. According to the PSG results, the OSSI showed shorter sleep latency (11.86 min vs. 39.69 min) and N2 sleep % (59.43% vs. 67.96%), and longer rapid eye movement sleep % (20.79% vs. 15.47%) than that in the NSDI. There was no difference in treatment response between groups. Conclusions: 45.6% of CID patients underestimated their sleep relative to objective sleep. However, there were no differences in total sleep time on PSG between groups. The OSSI showed younger age and more daytime sleepiness, and the SSSI showed poorer sleep quality than the NSDI. These findings suggest that long-term ACT recording in a casual environment would be useful to monitor objective sleep in patients with CID, particularly, in subjectively short sleep insomniacs.

Acute mild dim light at night slightly modifies sleep but does not affect glucose homeostasis in healthy men

ObjectiveWe evaluated the effect of acute mild light exposure at night on sleep architecture and glucose homeostasis. Patients/methodsTwenty healthy normal-weight men took part in two conditions of a randomized, controlled, balanced cross-over experimental study: i) two-consecutive nights with 8-h of sleep under dLAN (<5 lux) or ii) total darkness (CON). Sleep was evaluated by polysomnography. In the morning following 'night2', glucose homeostasis was assessed by an intravenous glucose tolerance test (ivGTT) with consecutive measures of glucose, insulin, and c-peptide. Plasma cortisol was measured at night before sleep, after morning awakening, and during mid-afternoon hours. ResultsThere was no significant difference in total sleep time, sleep efficiency, and sleep latency between conditions (all p > 0.66). However, NREM sleep stage N3 latency was prolonged after dLAN (p = 0.02) and NREM sleep stage 2 was decreased after two nights with dLAN (p = 0.04). During the first sleep hour, power in slow-oscillations, slow-waves, and delta bands diminished after dLAN (all p < 0.04). Glucose, insulin, and c-peptide were not altered by dLAN (all p > 0.14). Cortisol was reduced in the afternoon after 'night1' and in the morning after 'night2' (both p < 0.03). ConclusionsdLAN slightly disturbed sleep architecture and quality without impairment of glucose homeostasis. Longer exposure to chronic dLAN might be needed to unmask its hypothesized metabolic consequences.

228 The Association of Prior Mental Health Conditions with COVID-19-related Sleep Changes

IntroductionAmong persons with mental health conditions, the impact of the COVID-19 pandemic on sleep health is underexplored. The present study investigated whether sleep changes related to the COVID-19 pandemic differed among individuals with mood and/or anxiety disorders compared to individuals without these disorders.MethodsA 25-minute online survey, distributed globally to adults aged >18y through social media advertising from 5/28/2020-7/10/2020, examined the association of mental health diagnoses with COVID-19 related sleep changes. Participants reported prior history of mood and anxiety disorders, and pre-COVID-19 and current sleep patterns including bedtime, wake time, total sleep time (TST), sleep efficiency (SE:[TST/time in bed*100%], and nightmare frequency/wk. ANOVA models comparing mental health disorder groups (no diagnoses, mood disorders, anxiety disorders, mood and anxiety disorders) on mean differences in sleep changes were conducted.ResultsAmong 1,048 participants, 71.5% reported no prior mood and/or anxiety disorders9.3% reported anxiety disorders only, 4.3% reported prior mood disorders only, and 14.9% reported both mood and anxiety disorders. There were significant group differences in total sleep time (F (3,670)=4.6, p=0.003) and sleep efficiency (F (3,670) =2.8, p=0.038) such that individuals with both mood and anxiety disorders experienced greater decreases in total sleep time (Mean Difference: 39.0min, SE=13.0) and sleep efficiency (Mean Difference=3.8%, SE=1.6) compared to individuals without any mood or anxiety disorders. In addition, the model for nightmare frequency per week was significant (F(3,654)=5.6, p=0.001) such that individuals with both anxiety and mood disorders (Mean Difference=1.1, SE=0.4) and individuals with mood disorders only (Mean Difference=1.1, SE=0.4) reported greater increases in nightmare frequency compared to participants without any mood or anxiety disorders. There were no group differences in bedtime and wake time.ConclusionAmong a global sample, COVID-19 pandemic-related sleep health significantly worsened among individuals with prior mood and anxiety disorders relative to individuals without these disorders.Support (if any):

Optimizing computation of overnight decline in delta power: Evidence for slower rate of decline in delta power in insomnia patients

ObjectiveTo determine the best of commonly used methods for computing the rate of decline in non-rapid eye movement (NREM) sleep EEG delta power overnight (Delta Decline) in terms of vulnerability to missing data and to evaluate whether this rate is slower in insomnia patients than healthy controls (HC). MethodsFifty-one insomnia patients and 53 HC underwent 6 nights of polysomnography. Four methods for estimating Delta Decline were compared (exponential and linear best-fit functions using NREM (1) episode mean, (2) peak, and (3) total delta power and (4) delta power for all available NREM epochs). The best method was applied to compare groups on linear and exponential rates of Delta Decline. ResultsBest-fit models using all available NREM epochs were significantly less vulnerable to deviation due to missing data than other methods. Insomnia patients displayed significantly slower linear and exponential Delta Decline than HC. ConclusionsComputing Delta Decline using all available NREM epochs was the best of the methods studied for minimizing the effects of missing data. Insomnia patients display slower Delta Decline, which is not explained by differences in total sleep time or wake after sleep onset. SignificanceThis study supports using all available NREM epochs in Delta Decline computation and suggests a slower rate in insomnia.

Sleep Tracking of a Commercially Available Smart Ring and Smartwatch Against Medical-Grade Actigraphy in Everyday Settings: Instrument Validation Study.

BackgroundAssessment of sleep quality is essential to address poor sleep quality and understand changes. Owing to the advances in the Internet of Things and wearable technologies, sleep monitoring under free-living conditions has become feasible and practicable. Smart rings and smartwatches can be employed to perform mid- or long-term home-based sleep monitoring. However, the validity of such wearables should be investigated in terms of sleep parameters. Sleep validation studies are mostly limited to short-term laboratory tests; there is a need for a study to assess the sleep attributes of wearables in everyday settings, where users engage in their daily routines.ObjectiveThis study aims to evaluate the sleep parameters of the Oura ring along with the Samsung Gear Sport watch in comparison with a medically approved actigraphy device in a midterm everyday setting, where users engage in their daily routines.MethodsWe conducted home-based sleep monitoring in which the sleep parameters of 45 healthy individuals (23 women and 22 men) were tracked for 7 days. Total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO) of the ring and watch were assessed using paired t tests, Bland-Altman plots, and Pearson correlation. The parameters were also investigated considering the gender of the participants as a dependent variable.ResultsWe found significant correlations between the ring’s and actigraphy’s TST (r=0.86; P<.001), WASO (r=0.41; P<.001), and SE (r=0.47; P<.001). Comparing the watch with actigraphy showed a significant correlation in TST (r=0.59; P<.001). The mean differences in TST, WASO, and SE of the ring and actigraphy were within satisfactory ranges, although there were significant differences between the parameters (P<.001); TST and SE mean differences were also within satisfactory ranges for the watch, and the WASO was slightly higher than the range (31.27, SD 35.15). However, the mean differences of the parameters between the watch and actigraphy were considerably higher than those of the ring. The watch also showed a significant difference in TST (P<.001) between female and male groups.ConclusionsIn a sample population of healthy adults, the sleep parameters of both the Oura ring and Samsung watch have acceptable mean differences and indicate significant correlations with actigraphy, but the ring outperforms the watch in terms of the nonstaging sleep parameters.

Sleep Quality is associated with Central Arterial Stiffness in Postmenopausal Women: A Cross-sectional Pilot Study

AbstractThis study aimed to investigate the associations between sleep quality and arterial stiffness in healthy postmenopausal women. A total of 31 healthy postmenopausal women aged between 50 and 74 years participated in this study. Objectively and subjectively measured sleep quantity and quality were concomitantly obtained by a waist-worn actigraphy, Pittsburgh Sleep Quality Index (PSQI) questionnaire, and daily sleep diary. Carotid-femoral pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), and femoral-ankle PWV (faPWV) were measured as indices of arterial stiffness. Based on the PSQI score, the participants were divided into good (PSQI &lt; 5.5; n = 21) and poor (PSQI &gt; 5.5; n = 10) sleepers. Self-reported sleep duration was significantly longer in poor sleepers than in good sleepers. However, there was no difference in total sleep time measured by actigraphy between the two groups. Additionally, sleep latency and wake after sleep onset significantly increased, and sleep efficiency significantly decreased in poor sleepers than in good sleepers. The cfPWV and baPWV were significantly higher in poor sleepers than in good sleepers, even after adjustment for risk factors (i.e., age, blood pressure, and physical activity), but no difference in faPWV. These results suggest that decreased sleep quality is associated with an increase in central arterial stiffness in postmenopausal women.

Relationship between sleep architecture and severity of obstructive sleep apnea

To investigate the effect of obstructive sleep apnea (OSA) on different sleep stages, and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events. A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study. OSA patients were classified into 3 groups (mild, moderate and severe) according to the apnea-hypopnea index (AHI). PSG data, AHI and the lowest SPO2 in each stage of sleep were compared among three groups. There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA (all P>0.05). The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group (all P<0.05). The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group (P<0.05). In addition, severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups (all P<0.05). The latency of N3 stage in moderate OSA group was longer than that in mild OSA group (P<0.05). The AHI in N3 stage was markedly lower than that in other sleep stages (all P<0.01), regardless of the severity of OSA. Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1, N2 and rapid eye movement (REM) stages (all P<0.01). Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages (P<0.05 or P<0.01). The lowest SPO2 in N3 stage was significantly higher than that in N1, N2 and REM stages (P<0.05 or P<0.01), regardless of the severity of OSA. s The proportion of N3 stage is lower in OSA patients, and N3 stage has less sleep respiratory events than non-N3 stages. The results suggest that the increased N3 stage proportion may indicate less severity of OSA.

0735 Hyperglycemia Is Associated With An Altered Sleep Structure In Patients With Obstructive Sleep Apnea

Abstract Introduction Although obstructive sleep apnea (OSA) is associated with abnormal glycometabolism, current evidence on the association between hyperglycemia and abnormal sleep structure is still limited among patients with OSA. We sought to evaluate whether hyperglycemia was associated with abnormal sleep architecture. Methods A total of 452 patients with OSA, who were free of previously diagnosed diabetes mellitus, were consecutively recruited. All participants underwent overnight polysomnography and 75-g oral glucose tolerance test. Patients were divided into normal glucose tolerance (NGT) and hyperglycemia (i.e. prediabetes and type 2 diabetes) according to the ADA criteria. The association between hyperglycemia and sleep architecture was examined using logistic regression model. Results Of 452 patients, 283 (63%) had hyperglycemia (age 43.9 ± 11.1) and 169 (37%) had NGT (age 40.1 ± 11.1). Compared to the NGT group, the hyperglycemia group had older age (P &amp;lt; 0.05), higher body mass index (27.5 ± 4.1 vs. 26.33 ± 4.4; P &amp;lt; 0.05) and higher AHI (apnea-hypopnea index) (57.41 ± 28.6 vs. 48.3 ± 28.2; P &amp;lt; 0.05). There were no differences in total sleep time, the percentage of time spent in rapid eye movement (REM) or non-rapid eye movement (NREM) sleep between groups. However, patients with hyperglycemia had more microarousal events, especially during the NREM sleep (214 (range 19-662) events/h vs. 148 (range 37-600) events/h; P &amp;lt; 0.05). In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤80%, were significantly greater during the REM sleep in patients with hyperglycemia (1.4 (total range 0-91.1) % vs. 1.1(0-78.6) %; P &amp;lt; 0.05). After adjusting potential confounders, logistic regression analyses showed that the presence of hyperglycemia was independently associated with the number of microarousals in NREM sleep (OR = 1.01, 95% CI = 1.00-1.02, P = 0.02). Conclusion Hyperglycemia is independently associated with abnormal sleep architecture among patients with OSA. Patients with hyperglycemia have significantly increased sleep fragmentation in NREM sleep and significantly increased hypoxia in REM sleep. Support This work was supported by the National Natural Science Foundation of China (81700087).

0376 Demographic and Socioeconomic Implications of Excessive Daytime Sleepiness in the Community

Abstract Introduction Daytime sleepiness impairs daily functioning and may be directly related to insufficient nighttime sleep. Previous studies have assessed disparities in sleep duration and quality, but community-level disparities in daytime sleepiness using validated measures are lacking. Methods Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults age 22-60. Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Predictors included age, sex, race/ethnicity, education, and social class (“Upper middle class or above,” “Middle class,” “Lower middle class,” “Poor,” or “Very Poor”). One-way ANOVAs evaluated group differences. Stepwise linear modeling evaluated ESS score relative to sociodemographic predictors. Final models included all variables entered together to evaluate independent effects. Finally, habitual sleep duration was entered as an additional covariate. Results ESS score was higher among racial/ethnic minorities (p=0.0006), men (p&amp;lt;0.0001), those with less education (p=0.008) and lower social class (p=0.0007), and those who are retired or unable to work (p=0.03); marginal differences were seen according to age (p=0.06). Using a model-building approach, age, sex, race/ethnicity, education, social class, and employment were evaluated. Only race/ethnicity (F=5.1, p=0.0004), education (F=4.8, p=0.003), and social class (F=2.14, p=0.046) incrementally added variance to model R2. No 2-way interactions were found. In the final model, significant predictors included Black/African-American race/ethnicity (B=0.94, p=0.01), some college (B=0.99, p=0.005), and being very poor (B=2.16, p=0.005). When controlling for nocturnal sleep duration, the increased sleepiness associated with being Black/African was attenuated (p=0.06), but the other relationships were still significant. Conclusion There is a “sleepiness disparity” in the population associated with race/ethnicity and socioeconomics. Daytime sleepiness in the community is associated with being Black/African-American, having some college, and being “very poor.” The race/ethnicity difference in daytime sleepiness may be partially explained by differences in total sleep time. Support This work was supported by a grant from Jazz Pharmaceuticals. The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.

Sleep structure in sleep bruxism: A polysomnographic study including bruxism activity phenotypes across sleep stages.

The aim of the study was to assess sleep structure, phenotypes related to bruxism activity and basic respiratory parameters among a large group of participants with sleep bruxism and without obstructive sleep apnea. Adult participants with clinical suspicion of sleep bruxism and with no other significant medical history were recruited. Video-polysomnography was performed to detect masseter muscles activity. Polysomnographic scoring was performed according to the American Academy of Sleep Medicine Criteria. Finally, 146 participants were included. The participants were divided into three subgroups: severe, mild and no sleep bruxism. There were no differences in total sleep time, sleep latency, sleep efficiency, wake duration after sleep onset, rapid eye movement, and measured respiratory parameters. The severity of sleep bruxism contributed to the increased intensity of all sleep bruxism phenotypes in almost all sleep stages, apart from tonic and mixed activity in non-rapid eye movement stage 3 sleep (slow-wave sleep). Those with bruxism spent more time in rapid eye movement sleep compared to controls; there were no differences in non-rapid eye movement sleep stages. The results confirmed that sleep bruxism does not significantly affect sleep duration, efficiency and continuity (in terms of sleep-wake cycles). Sleep bruxism contributes to a higher percentage of rapid eye movement sleep in the total sleep time. Those with bruxism present more frequent episodes during all stages of sleep; however, in the case of slow-wave sleep, tonic and mixed activity observed in participants with sleep bruxism are comparable to those of healthy people.

Validation of peripheral arterial tonometry as tool for sleep assessment in chronic obstructive pulmonary disease

Obstructive sleep apnea (OSA) worsens outcomes in Chronic Obstructive Pulmonary Disease (COPD), and reduced sleep quality is common in these patients. Thus, objective sleep monitoring is needed, but polysomnography (PSG) is cumbersome and costly. The WatchPAT determines sleep by a pre-programmed algorithm and has demonstrated moderate agreement with PSG in detecting sleep stages in normal subjects and in OSA patients. Here, we validated WatchPAT against PSG in COPD patients, hypothesizing agreement in line with previous OSA studies. 16 COPD patients (7 men, mean age 61 years), underwent simultaneous overnight recordings with PSG and WatchPAT. Accuracy in wake and sleep staging, and concordance regarding total sleep time (TST), sleep efficiency (SE), and apnea hypopnea index (AHI) was calculated. Compared to the best fit PSG score, WatchPAT obtained 93% sensitivity (WatchPAT = sleep when PSG = sleep), 52% specificity (WatchPAT = wake when PSG = wake), 86% positive and 71% negative predictive value, Cohen’s Kappa (κ) = 0.496. Overall agreement between WatchPat and PSG in detecting all sleep stages was 63%, κ = 0.418. The mean(standard deviation) differences in TST, SE and AHI was 25(61) minutes (p = 0.119), 5(15) % (p = 0.166), and 1(5) (p = 0.536), respectively. We conclude that in COPD-patients, WatchPAT detects sleep stages in moderate to fair agreement with PSG, and AHI correlates well.

Multi-Method Assessment of Sleep in Children With Angelman Syndrome: A Case-Controlled Study.

Objectives: To assess sleep quality and timing in children with Angelman syndrome (AS) with sleep problems using questionnaires and actigraphy and contrast sleep parameters to those of typically developing (TD) children matched for age and sex.Methods: Week-long actigraphy assessments were undertaken with children with AS (n = 20) with parent-reported sleep difficulties and compared with age and sex matched TD controls. The presence of severe sleep problems was assessed using the modified Simonds and Parraga sleep questionnaire. Sleep hygiene was measured using the Family Inventory of Sleep Habits.Results: Actigraphy and parent-completed sleep diary data indicated that children with AS had significantly earlier bedtimes (p = .003, Cohen d = .47) and poorer sleep efficiency (78%, p = .04, d = .33) than TD children (84%). No significant differences in total sleep time, sleep onset latency or wake after sleep onset were found between the two groups. The expected relationship between later bedtimes and increasing age found for the TD group (p < .001, β.78) was not evidenced for the AS group (p = .09, β.39). Considerable inter-individual and night to night variation in actigraphy assessed total sleep time and wake after sleep onset was found for children with AS compared to TD children. Parent report indicated that a greater proportion of children with AS had severe night waking problems compared to TD children (81 versus 5%). No significant differences in sleep hygiene and excessive daytime sleepiness were found between the two groups (p > .05).Conclusions: This study reports the largest objective dataset of sleep quality parameters in children with AS. Sleep quality in this group was characterised by poor efficiency and significant intra- and inter-individual variability that warrants further investigation. This variability should inform assessment and intervention for sleep in children with AS, as averages of total sleep, even across a 7 day period may not capture the difficulties with night waking highlighted by parental questionnaire report.

Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case-control study.

To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. Participants included 82 children (5-18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = -40 minutes; 95% confidence interval = -77, -3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.

Actigraphy versus Polysomnography to Measure Sleep in Youth Treated for Craniopharyngioma

ABSTRACT Objective/Background Youth with craniopharyngioma are at increased risk for excessive daytime sleepiness and narcolepsy. Polysomnography (PSG) is the gold standard for diagnosing sleep disorders, but is time-intensive, costly, and does not offer an in vivo measure of typical sleep routine. We determined the sensitivity, specificity, and accuracy of actigraphy compared with PSG in measuring nocturnal sleep in pediatric craniopharyngioma. Participants Fifty youth with craniopharyngioma (age 3–20 years) were assessed by overnight PSG and concurrent actigraphy after surgical resection and before proton therapy. Methods PSG and actigraphy data were synchronized utilizing an epoch-by-epoch comparison method. Sensitivity, specificity, and accuracy were calculated using measures of true wake, true sleep, false wake, and false sleep. Bland-Altman plots were conducted to further assess level of agreement. Results Actigraphy was 93% sensitive (true sleep [TS]) and 87% accurate (ability to detect TS and true wake) in measuring sleep versus wakefulness and was a reliable measure of sleep efficiency (SE) and sleep latency (SL). Specificity (true wake) was poor (55%) and total sleep time (TST) was underestimated by an average of 15.1 min. Wake after sleep onset (WASO) was overestimated by an average of 14.7 min. Conclusions Actigraphy was highly sensitive and accurate and was a reliable measure of SE and SL. Although there were differences in TST and WASO measurements by actigraphy and PSG, our findings provide the basis for future studies on the use of actigraphy to monitor treatment response to wakefulness-promoting medications in youth with craniopharyngioma who demonstrate excessive daytime sleepiness.

2069-P: Energy Expenditure during Sleep Is an Independent Marker of Prediabetes—A Cross-Sectional Study of Overweight/Obese Subjects

Normal sleep is characterized by increased glycogen stores and reduced glucose turnover by metabolically active tissues, thus it is a state of decreased metabolism. It has been reported that reduced sleep quality is associated with disrupted glucose metabolism. However, the relationship between Sleep Metabolic Rate (SMR) and prediabetes defined by the presence of IFG and/or IGT, during 75-g OGTT, has not been clarified. The aim of this study was to investigate the role of SMR in the association between sleep quality and prediabetes. A total of 226 individuals [women 72.1%; mean (DS) age 50.46 (±13.1) years; BMI 33.4 (±8.41) Kg/m2] undergoing the OGTT, were also asked to wear a metabolic holter (Armband) for 3-days, to assess their daily energy expenditure (DEE). The Armband was also capable of measuring the SMR, the Total Sleep Time (TST) and Sleep Efficiency (SE). The SMR has been adjusted for Free Fat Mass (FFM) to reduce the overweight/obesity influence on energy expenditure (SMR/FFM). A total of 78 subjects were identified as prediabetic. No difference in TST, SE, and DEE was observed between NGT and prediabetics. The SMR/FFM was significantly higher in patients with prediabetes (p&amp;lt;.004). Using multivariate logistic regression, with prediabetes status as dependent variable and sleep efficiency, age, fat mass, gender and SMR/FFM as independent variables, the latter resulted an independent marker of prediabetes (OR 1.52, 95% CI 1.03-2.24) p .034, Nagelkerke’s r2: 0.12. The SMR/FFM increase in prediabetic overweight/obese subjects may be explained through several mechanisms such as the increased nocturnal gluconeogenesis and the possible shift towards other substrates utilization (e.g., cori and glucose-alanine cycle). Disclosure D. Tuccinardi: None. G. Rossini: None. E. Maddaloni: Speaker's Bureau; Self; Merck &amp; Co., Inc., Pikdare. D. Maggi: None. L. Monte: None. E. Fioriti: None. S. Kyanvash: None. P. Pozzilli: None. S. Manfrini: None.

Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study.

ObjectiveThe purpose of this study was to determine if transcutaneous electrical nerve stimulation (TENS) improves sleep in chronic low back pain (CLBP).BackgroundThere is uncertainty over the effectiveness of TENS in CLBP. In most studies, pain intensity has been the primary outcome measure. Although sleep abnormalities are common in CLBP, sleep outcomes have not been evaluated in most studies of TENS effectiveness. Subjective and objective sleep measures are often inconsistent in CLBP, suggesting that perception of sleep and actual sleep may differ.MethodsThis retrospective cohort study evaluated TENS for CLBP over 10 weeks. The source database included demographics, pain characteristics, pain intensity and interference on an 11-point numerical rating scale, adherence and actigraphic sleep data from real-world TENS users. Key inclusion criteria were CLBP with self-reported history of back injury and baseline pain interference with sleep ≥4. Study participants were stratified into improved and unimproved groups based on changes in pain interference with sleep (improved ≥1-point decrease). Actigraphic sleep metrics were compared between the two groups for weeks 1–2 and weeks 9–10.ResultsThe inclusion criteria were met by 554 TENS users. There were 282 (50.9%) participants in the improved group and 272 (49.1%) in the unimproved group. The two groups had similar baseline characteristics and high TENS adherence. At the weeks 1–2 assessment, there were no differences among actigraphic sleep. At the weeks 9–10 assessment, there was a difference in total sleep time, with the improved group sleeping 29 minutes longer. In addition, the periodic leg movement (PLM) index was lower in the improved group.ConclusionRegular TENS improved self-reported and objective sleep measures in individuals with CLBP. When compared to the unimproved group, the improved group had longer total sleep time and fewer PLMs. Sleep may be an important outcome for TENS effectiveness in CLBP.

Oral melatonin for non-respiratory sleep disturbance in children with neurodisabilities: systematic review and meta-analyses.

AimTo evaluate the effectiveness of pharmacological interventions for managing non‐respiratory sleep disturbances in children with neurodisabilities.MethodWe performed a systematic review and meta‐analyses of randomized controlled trials (RCTs). We searched 16 databases, grey literature, and reference lists of included papers up to February 2017. Data were extracted and assessed for quality by two researchers (B.B., C.M., G.S., A.S., A.P.).ResultsThirteen trials were included, all evaluating oral melatonin. All except one were at high or unclear risk of bias. There was a statistically significant increase in diary‐reported total sleep time for melatonin compared with placebo (pooled mean difference 29.6min, 95% confidence interval [CI] 6.9–52.4, p=0.01). Statistical heterogeneity was high (97%). For the single RCT with low risk of bias, the unadjusted mean difference in total sleep time was 13.2 minutes (95% CI −13.3 to 39.7) favouring melatonin, while the mean difference adjusted for baseline total sleep time was statistically significant (22.4min, 95% CI 0.5–44.3, p=0.04). Adverse event profile suggested that melatonin was well‐tolerated.InterpretationThere is a paucity of evidence on managing sleep disturbances in children with neurodisabilities, and it is mostly of limited scope and poor quality. There is evidence of the benefit and safety of melatonin compared with placebo, although the extent of this benefit is unclear.What this paper adds Melatonin for the management of non‐respiratory sleep disturbances in children with neurodisabilities was well tolerated with minimal adverse effects.The extent of benefit and which children might benefit most from melatonin use is uncertain.Benefit may be greatest in those with autism spectrum disorder; however, this finding should be interpreted with caution.