Nocturnal Sleep Disturbance Research Articles

Evolution and characteristics of nocturnal knee pain after knee arthroplasty.

Nocturnal knee pain and sleep disorders are two common but poorly studied issues contributing to dissatisfaction following knee arthroplasty. This study aims to evaluate the prevalence and associated factors of nocturnal pain and sleep disturbance in a population undergoing knee arthroplasty. We included in this prospective observational study 111 patients undergoing knee athroplasty (79 TKA and 32 UKA). Sleep quality, nocturnal knee pain (preoperatively, at day 3, at 3 and 6 weeks, at 3 months and one year after surgery), pain during mobilization and neuropathic pain were evaluated by scores. Painkillers and sleeping pills intake were recorded. Potentially predictive factors for postoperative nocturnal pain evolution were studied. Poor sleeping quality rate was 54% for the pre-operative patients and was still 53% at one year after surgery. The prevalence of nocturnal knee pain was 38,74% before surgery and 2,9% at one year after arthroplasty. This study has been performed at the University Hospital Saint Luc Brussels. Evolution and Characteristics of nocturnal knee pain after knee arthroplasty. Nocturnal pain after knee surgery was significantly associated with higher pain scores at rest during activity and at night. Nocturnal pain was significantly associated with a higher PSQI and DN4 scores and a higher consumption of painkillers or sleeping pills at W6. The multiple variable regression showed a statistically significant correlation between preoperative and postoperative nocturnal pain at D3 and W3. Compared to TKA, UKA patients reported significantly less nocturnal pain at W3 and W6. Bad sleeping quality is present in 54% of knee arthroplasty patients before and after surgery. Nocturnal pain is present in 39% of knee arthroplasty patients before surgery and this drops to 3% after one year. Nocturnal pain is associated with higher pain intensity, neuropathic symptoms, increased medication consumption and poor sleeping quality. Night pain disappeared faster after UKA than TKA, with a tipping point around 6 weeks postoperatively.

The latest research progress on the relationship between obstructive sleep apnea–hypopnea syndrome and metabolic syndrome

AbstractObstructive sleep apnea–hypopnea syndrome (OSAHS) is the most common subtype of sleep‐disordered breathing, characterized by symptoms such as snoring, nocturnal sleep disturbances, and excessive daytime sleepiness. OSAHS is defined by recurrent upper airway collapses during sleep, leading to apneas or hypopneas. These episodes result in intermittent nocturnal hypoxia and sleep fragmentation, which provoke sympathetic activation, oxidative stress, and systemic inflammation, ultimately causing chronic damage across multiple bodily systems. OSAHS significantly increases the risk of various cardiovascular and metabolic disorders, including atherosclerosis, hypertension, obesity, insulin resistance, and dyslipidemia. In China, approximately 176 million individuals are estimated to have OSAHS, with about 60 million experiencing moderate to severe forms of the condition. This paper reviews the epidemiological characteristics of OSAHS, the evolution of diagnostic criteria, and the association between OSAHS and metabolic syndrome (MetS), emphasizing the high prevalence of MetS among OSAHS patients. Through cross‐sectional analysis, cohort studies, and interventional studies, the complex interactions between OSAHS and MetS are examined, proposing therapeutic strategies to improve these metabolic anomalies, including continuous positive airway pressure therapy and weight management.

Wake up to gastro-oesophageal reflux disease: The interplay between arousal and night-time reflux.

This review examines the temporal association between nocturnal gastro-oesophageal reflux and sleep-arousal cycles. Most nocturnal gastro-oesophageal reflux events occur during the awake cycle, and arousals precede most nocturnal gastro-oesophageal reflux events, indicating that arousal from sleep predisposes to nocturnal gastro-oesophageal reflux. This sheds light on the complex relationship between nocturnal gastro-oesophageal reflux and sleep, and has implications for managing nocturnal gastro-oesophageal reflux symptoms. The appearance of symptoms and the pathophysiology of nocturnal gastro-oesophageal reflux are influenced by sleep hygiene, sleep disturbances and the misalignment of circadian rhythms. Nocturnal gastro-oesophageal reflux and its related sleep disorders are prevalent and negatively impact the quality of life. There is conflicting evidence on whether nocturnal gastro-oesophageal reflux and sleep disturbances are causally linked, and whether sleep disturbances drive nocturnal gastro-oesophageal reflux. Poor sleep quality increases oesophageal hypersensitivity and overall acid exposure. The nocturnal gastro-oesophageal reflux is linked to the more severe forms of gastro-oesophageal reflux disease, especially with atypical/extra-oesophageal manifestations and complications of mucosal damage such as oesophagitis and stricture, Barret's oesophagus, and oesophageal adenocarcinoma. This review highlights the role of sleep problems in presenting nocturnal gastro-oesophageal reflux, and the potential benefits of treating sleep disturbances in enhancing patient care and quality of life.

518 - Interaction of sleep disturbance and nocturnal scratch in atopic dermatitis patients

Abstract Introduction/Background Itch, scratch and poor sleep are often cited as key symptoms of Atopic Dermatitis (AD). Although approximately 10-41% of children and 7-48% of adults in the general population experience sleep disturbances, this figure climbs to 47-80% in children with AD and 33-90% in adults with AD (Bawany et al., 2021). While great effort has been done to characterize and validate nocturnal scratch and sleep, the relationship between the two remains poorly characterized. Objectives We hypothesize that nocturnal scratch is the reason for the sleep disturbances in patients with AD. Literature suggests that these symptoms are linked, albeit not necessarily causal. Here we investigate the interaction between nocturnal scratch events and sleep disturbances in study participants with AD compared to a healthy cohort. Methods Patients with AD (n=185) and without AD (n=40) aged between 2 to 75 years were recruited across three different studies. Study participants spent the night in a qualified sleep lab while being under observation with thermal videography and polysomnography (PSG). The thermal videography was annotated for both scratch and non-scratch movements by two trained annotators independently with any conflicts being resolved by an arbitrator. The PSG was scored by a credentialed technologist in 30-s epochs per revised American Academy of Sleep Medicine scoring guidelines. The study participants also wore a wrist-worn accelerometer on both the left and right wrists. Results It was noted that sleep disturbances were associated with the observed scratch events, and that the temporal relationship between sleep disturbance and scratching seemed to differ between the AD and healthy cohorts. Surprisingly, however, it was also noted that within a few study participants with AD, scratch events occurred while the patient was in stable REM sleep, most often in the children with AD. Further investigation will provide additional information as to whether this was an artifact or in fact a true observation. We also present an overview of sleep, as well as nocturnal scratch and non-scratch movements in the AD and healthy cohorts, noting specifically how the behaviors differ between the groups, and over the course of the sleep opportunity, across sleep stages and sleep cycles, as well as their relationships to sleep disturbances. Conclusions Nocturnal scratching is often associated with sleep disturbances in AD; however, the causality is not always clear. Moreover, in some cases scratching was observed during stable REM sleep in AD, an observation that requires further investigation.

192 Assessing treatment effect of baricitinib in atopic dermatitis using digital endpoints derived from actigraphy data: nocturnal scratch and sleep disturbance

192 Assessing treatment effect of baricitinib in atopic dermatitis using digital endpoints derived from actigraphy data: nocturnal scratch and sleep disturbance

The therapeutic potential of opioids in narcolepsy type 1: A systematic literature review and questionnaire study

ObjectiveNarcolepsy type 1 is a primary sleep disorder caused by deficient hypocretin transmission leading to excessive daytime sleepiness and cataplexy. Opioids have been suggested to increase the number of hypocretin-producing neurons. We aimed to assess opioid use and its self-reported effect on narcolepsy type 1 symptom severity through a literature review and questionnaire study. MethodsWe systematically reviewed literature on opioid use in narcolepsy. We also recruited 100 people with narcolepsy type 1 who completed an online questionnaire on opioid use in the previous three years. The main questionnaire topics were the indication for use, and the possible effects on narcolepsy symptom severity. Structured follow-up interviews were conducted when opioid use was reported. ResultsThe systematic literature review mainly showed improvements in narcolepsy symptom severity. Recent opioid use was reported by 16/100 questionnaire respondents, who had used 20 opioids (codeine: 7/20, tramadol: 6/20, oxycodone: 6/20, fentanyl: 1/20). Narcolepsy symptom changes were reported in 11/20. Positive effects on disturbed nocturnal sleep (9/20), excessive daytime sleepiness (4/20), hypnagogic hallucinations (3/17), cataplexy (2/18), and sleep paralysis (1/13) were most pronounced for oxycodone (4/6) and codeine (4/7). ConclusionsOpioids were relatively frequently used compared to a similarly young general Dutch sample. Oxycodone and, to a lesser extent, codeine were associated with self-reported narcolepsy symptom severity improvements. Positive changes in disturbed nocturnal sleep and daytime sleepiness were most frequently reported, while cataplexy effects were less pronounced. Randomised controlled trials are now needed to verify the potential of opioids as therapeutic agents for narcolepsy.

Towards data‐driven video analysis for quantification of nocturnal sleep disturbance in dementia

AbstractBackgroundSleep disturbance is common among people living with dementia as well as their caregivers. Non‐contact video technology can be used to characterise such disturbances as well as quantifying sleep quality by measuring the number of sleep body positions (poses). Such an approach may be beneficial for home‐based longitudinal clinical monitoring of sleep pattern changes and disturbances at all stages of dementia. Here we present our pilot results of a personalised data‐driven method applied to video data for quantification of sleep disturbance comparing older and younger participants.MethodData were collected in two separate studies which included an overnight 10‐12 hour laboratory sleep recording from thirteen older (65‐80 years, 9 male:4 female) and eleven younger (18‐34 years, 7 male:4 female) participants in a dedicated sleep facility. A data‐driven analysis using Principal Component Analysis and k‐means clustering was applied to infrared video data extracted from a clinical polysomnography (PSG) system. The data‐driven analysis automatically determined statistically significant groupings or clusters of unique body poses for each individual. Pose number, number of pose transitions, pose duration, and pose transition duration were computed for each participant.ResultThe number of data‐driven poses in older and younger participants was remarkably similar with 15.2±3.9 and 15.8±1.8 (mean±SD) poses per participant, respectively. However, the older group had a higher number of pose transitions (33.0±8.82) compared to the younger group (23.9±6.83) (p = 0.03). A significant 20% difference (p = 0.03) in the average duration of each body position was observed, with 62.3±7.1 minutes and 78.9±15.9 minutes for the older and younger groups, respectively (see Figure 1 and Figure 2). Pose transition duration was 19.2±7.25 seconds and 14.6±4.32 seconds for the older and younger groups, respectively where they were not significantly different.ConclusionAlthough the number of body positions did not vary significantly between the two cohorts, the older group changed body position more frequently and it took them longer to do so. Data‐driven automated analysis of video‐based sleep monitoring holds significant promise for quantifying age‐related and inter‐individual differences in sleep behavior.

The complex interplay of hypoxia and sleep disturbance in gray matter structure alterations in obstructive sleep apnea patients.

Obstructive Sleep Apnea (OSA) characteristically leads to nocturnal hypoxia and sleep disturbance. Despite clear evidence of OSA-induced cognitive impairments, the literature offers no consensus on the relationship between these pathophysiological processes and brain structure alterations in patients. This study leverages the robust technique of structural equation modeling to investigate how hypoxia and sleep disturbance exert differential effects on gray matter structures. Seventy-four Male participants were recruited to undergo overnight polysomnography and T1-weighted Magnetic Resonance Imaging. Four structural outcome parameters were extracted, namely, gray matter volume, cortical thickness, sulcal depth, and fractal dimension. Structural equation models were constructed with two latent variables (hypoxia, and sleep disturbance) and three covariates (age, body mass index, and education) to examine the association between gray matter structural changes in OSA and the two latent variables, hypoxia and sleep disturbance. The structural equation models revealed hypoxia-associated changes in diverse regions, most significantly in increased gray matter volume, cortical thickness and sulcal depth. In contrast, sleep disturbance. Was shown to be largely associated with reduce gray matter volume and sulcal depth. This study provides new evidence showing significant effects of OSA-induced hypoxia and sleep disturbance on gray matter volume and morphology in male patients with obstructive sleep apnea. It also demonstrates the utility of robust structural equation models in examining obstructive sleep apnea pathophysiology.

Challenges in Diagnosing Narcolepsy and Idiopathic Hypersomnia

Narcolepsy and idiopathic hypersomnia are central disorders of hypersomnolence accompanied by excessive daytime sleepiness, which are not caused by nocturnal sleep disturbance, sleep deficiency, or circadian rhythm sleep disorders. Several studies have questioned the repeatability of the Multiple Sleep Latency Test (MSLT) in type 2 narcolepsy (NT2) patients. After two or more repeated MSLTs, the diagnosis of type 1 narcolepsy (NT1) is maintained in more than 90% of cases, while only half of the NT2 patients retain their original diagnosis. The diagnosis of NT2 may shift to idiopathic hypersomnia based on the MSLT results, making the differential diagnosis of NT2 and idiopathic hypersomnia particularly challenging. Therefore, this study suggests the need for new tests in addition to the MSLT for diagnostic consistency in NT2 and idiopathic hypersomnia.

Eczema among adolescents in Kuwait: Prevalence, severity, sleep disturbance, antihistamine use, and risk factors

BackgroundEczema (atopic dermatitis) is a common inflammatory skin disease that is more prevalent in children and adolescents than adults. In Kuwait, there is a lack of empirical knowledge on eczema epidemiology among adolescents. Therefore, this study aimed to estimate the prevalence of eczema symptoms and severity, assess the frequency of eczema-related nocturnal sleep disturbance and its relation to antihistamine use, and determine factors that are associated with eczema prevalence and eczema-related nocturnal sleep disturbance. MethodsA school-based cross-sectional study enrolled adolescents (n = 3864) aged 11–14 years across Kuwait. Information on eczema symptoms and clinical history, use of antihistamines, parental history of eczema, mode of delivery, and childhood life-style factors and exposures were reported by parents. Current eczema was defined as chronic or chronically relapsing itchy dermatitis with characteristic morphology and distribution in the past 12 months. Among subjects reporting current itchy rash, frequency of nocturnal sleep disturbance due to itchy rash in the past 12 months was reported as: never, <1 night per week, and ≥1 nights per week. Associations were assessed by applying a modified Poisson regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). ResultsThe prevalence estimate of current (past 12 months) itchy rash was 20.5% (735/3593) and current eczema was 10.2% (388/3791), with 19.5% (736/3775) reporting history of ever doctor-diagnosed eczema. Among subjects with current itchy rash, nocturnal sleep disturbance due to itchy rash affected 21.7% (157/724) of participants for <1 night per week and affected 12.7% (92/724) of participants for ≥1 nights per week. Antihistamine use at least once per month increased as the frequency of nocturnal sleep disturbance due to itchy rash increased (Ptrend <0.001). Factors that demonstrated association with current eczema prevalence included underweight body mass index (aPR = 1.71, 95% CI: 1.16–2.53), Cesarean section delivery (1.29, 1.01–1.65), and maternal (1.72, 1.35–2.19) and paternal (1.83, 1.44–2.32) history of eczema. Frequent (≥1 nights per week) nocturnal sleep disturbance was associated with Cesarean section delivery (1.98, 1.37–2.85), exposure to household tobacco smoke (1.70, 1.18–2.47), and dog-keeping (1.93, 1.06–3.52). ConclusionsEczema symptoms are common among adolescents in Kuwait, with similar epidemiological patterns as those observed in western countries. A large proportion of affected adolescents reported nocturnal sleep disturbance due to itchy rash. Modifiable risk factors were associated increased prevalence of eczema and night awakenings.

The Relationship between Sleep Quality and the Incidence of Gastroesophageal Reflux Disease (GERD): A Study on Clinical Clerkship Students, Faculty of Medicine, Universitas Prima Indonesia

Gastroesophageal reflux disease (GERD) is defined as a gastrointestinal motility disorder caused by the reflux of gastric contents into the esophagus or oral cavity. This results in symptoms or complications if persistent, resulting in a significant reduction in quality of life and morbidity. Several studies have reported an association between nocturnal GERD and sleep disturbances, which can significantly affect the quality of life. This study explores the relationship between sleep quality and the incidence of GERD in clinical clerkship students at the Faculty of Medicine, Universitas Prima Indonesia. This study is a cross-sectional observational study involving 144 clinical clerkship students. The GERDQ was used to diagnose GERD, and the PSQI questionnaire was used to measure sleep quality. Respondents who did not suffer from GERD with good sleep quality were 32 respondents (22.2%). Those who did not suffer from GERD with poor sleep quality were 65 respondents (74.8%), who suffered from GERD with good sleep quality only 1 respondent (10, 8), and 46 respondents (36.2%). There is a significant relationship between sleep quality and GERD in clinical clerkship students at the Faculty of Medicine, Universitas Prima Indonesia.

Relationship between Neuroticism and Gastrointestinal Symptoms in Irritable Bowel Syndrome: The Mediating Role of Sleep.

We aimed to explore the relationship between the sleep and gastrointestinal symptoms in patients with irritable bowel syndrome (IBS) from the perspective of personality factors. Overall, 167 patients with IBS- from First Affiliated Hospital of Nanjing Medical University in Jiangsu Province of China in 2019 were included. Gastrointestinal Symptom Score (GIS), Chinese version of Pittsburgh Sleep Quality Index (PSQI) and Eysenck Personality Questionnaire (EPQ) were used to assess gastrointestinal symptoms, sleep and personality. We use mediator variables analyze to explore the relationship between sleep, neurotic personality and gastrointestinal symptoms in IBS patients. 48.5% of IBS patients had sleep disorders. IBS patients with high neuroticism had higher total PSQI scores, longer sleep latency, worse sleep persistence, more nocturnal sleep disturbances and daytime dysfunctions, and more use of sleep medication (P<0.05). Stomach distention, cramping epigastric pain, loss of appetite, and epigastric pain were more prominent in IBS patients with high neuroticism (P<0.05). In addition, neurotic personality was significantly predictive of sleep and some gastrointestinal symptoms, and sleep was a complete mediator of neurotic personality and gastrointestinal symptoms in IBS patients. High neurotic personality in IBS patients leads to more prominent gastrointestinal symptoms by causing sleep disturbance.

Impact of a person-centered bowel program on the frequency of nights with bowel movement in dependent elderly people in nursing home: A single-centre randomized controlled trial

IntroductionBowel movements and sleep disturbances in the elderly impact their quality of life and dignity. The management of bowel movements is one of carers' main activities in nursing homes. This activity is under-recognized. It is routinely managed with laxatives or anti-diarrhea treatments, rather than being targeted at each resident's habits. We hypothesized that the implementation of a daytime person-centered bowel program in dependent elderly nursing-home residents could reduce nocturnal bowel movements and sleep disturbance due to night-time care activities. Our study evaluated the impact of a bowel program on the frequency of nights with bowel movement. MethodWe conducted a single-center randomized controlled trial in two parallel groups: a control group with usual management versus an experimental group with the implementation of the person-centered bowel program. ResultsFifty dependent elderly residents of nursing homes for over one month were included. The implementation of the person-centered bowel program significantly impacted the frequency of nights with bowel movement: 12.0 (7.0; 15.5) in the control group versus 3.7 (2.0; 6.0) in the experimental group (p < 0.000). The strategy had no significant impact on laxative intake (p = 0.470). ConclusionsThe introduction of a daytime person-centered bowel program significantly reduces the frequency of nights with bowel movements for dependent nursing-home residents. This person-centered strategy restores a key role to this basic need care. Further studies could explore the impact of this program on respect, dignity, comfort and night-time rest. It also offers carers new perspectives on care, with respect to the human being. Study registrationThe study was registered in ClinicalTrials N°NCT03118401. Tweetable abstractA daytime bowel program significantly reduces the number of nights with bowel movements for dependent nursing-home residents.

Sleep spindle and slow wave activity in Parkinson disease with excessive daytime sleepiness.

Excessive daytime sleepiness (EDS) is a common and devastating symptom in Parkinson disease (PD), but surprisingly most studies showed that EDS is independent from nocturnal sleep disturbance measured with polysomnography. Quantitative electroencephalography (EEG) may reveal additional insights by measuring the EEG hallmarks of non-rapid eye movement (NREM) sleep, namely slow waves and spindles. Here, we tested the hypothesis that EDS in PD is associated with nocturnal sleep disturbance revealed by quantitative NREM sleep EEG markers. Patients with PD (n = 130) underwent polysomnography followed by spectral analysis to calculate spindle frequency activity, slow-wave activity (SWA), and overnight SWA decline, which reflects the dissipation of homeostatic sleep pressure. We used the Epworth Sleepiness Scale (ESS) to assess subjective daytime sleepiness and define EDS (ESS > 10). All examinations were part of an evaluation for deep brain stimulation. Patients with EDS (n = 46) showed reduced overnight decline of SWA (p = 0.036) and reduced spindle frequency activity (p = 0.032) compared with patients without EDS. Likewise, more severe daytime sleepiness was associated with reduced SWA decline (ß= -0.24 p = 0.008) and reduced spindle frequency activity (ß= -0.42, p < 0.001) across all patients. Reduced SWA decline, but not daytime sleepiness, was associated with poor sleep quality and continuity at polysomnography. Our data suggest that daytime sleepiness in PD patients is associated with sleep disturbance revealed by quantitative EEG, namely reduced overnight SWA decline and reduced spindle frequency activity. These findings could indicate that poor sleep quality, with incomplete dissipation of homeostatic sleep pressure, may contribute to EDS in PD.

Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study.

In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.

0406 Efficacy of Once-Nightly Sodium Oxybate (ON-SXB; FT218) Across Stimulant Use Subgroups: Post-hoc Analyses From the REST-ON Trial

Abstract Introduction In the REST-ON trial (NCT02720744), once-nightly sodium oxybate (ON-SXB; FT218) was associated with significant improvement vs placebo for mean sleep latency on the Maintenance of Wakefulness test (MWT) and Clinical Global Impression of Improvement (CGI-I) rating in the overall population (both P&amp;lt;0.001) and in subgroups of participants taking concomitant stimulants (both P&amp;lt;0.05). Post-hoc analyses of ON-SXB efficacy on disturbed nocturnal sleep (DNS) and Epworth Sleepiness Scale (ESS) score were conducted. Methods Participants (≥16 years of age) with narcolepsy type 1 or 2 were randomized 1:1 to ON-SXB (1 week, 4.5 g; 2 weeks, 6 g; 5 weeks, 7.5 g; 5 weeks, 9 g) or placebo. Mixed-effects models for repeated measures calculated P values for change from baseline vs placebo at weeks 3 (6 g), 8 (7.5 g), and 13 (9 g) in ESS score, sleep shifts (ie, number of shifts from N1, N2, N3, and rapid eye movement [REM] sleep to Wake and from N2, N3, and REM sleep to N1), nocturnal arousals (NA), and patient-reported outcomes of sleep quality and refreshing nature of sleep on a 100-point visual analog scale. Results In the modified intent-to-treat population (n=190), 119 participants took concomitant stimulants (ON-SXB, n=66; placebo, n=53); 71 did not take stimulants (ON-SXB, n=31; placebo, n=40). Improvements with ON-SXB vs placebo were reported: ESS (stimulants: all doses, P≤0.01; no stimulants: 6 g, directional improvement; 7.5 g, P&amp;lt;0.01; 9 g, P&amp;lt;0.001), sleep shifts (stimulants: 6 g, P&amp;lt;0.01; 7.5 and 9 g, P&amp;lt;0.001; no stimulants: all doses P&amp;lt;0.001), NA (stimulants: 6 g, directional improvement; 7.5 g, P&amp;lt;0.01; 9 g, P=0.001; no stimulants: 6 and 7.5 g, P&amp;lt;0.05; 9 g, P=0.01), sleep quality (stimulants: 6 and 7.5 g, P&amp;lt;0.01; 9 g, P&amp;lt;0.05; no stimulants: all doses P&amp;lt;0.001), refreshing nature of sleep (stimulants: 6 and 9 g, P&amp;lt;0.05; 7.5 g, P&amp;lt;0.001; no stimulants: 6 and 7.5 g, P&amp;lt;0.01; 9 g, P=0.001). Conclusion Data from these post-hoc analyses were consistent with the previously reported results from REST-ON and support the efficacy of ON-SXB for EDS and DNS, as measured by objective and subjective endpoints whether or not stimulants were concurrently used. Support (If Any) Avadel Pharmaceuticals

0060 Sleep disparities by race/ethnicity during pregnancy: an Environmental influences on Child Health Outcomes (ECHO) study

Abstract Introduction Poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. Racial/ethnic minoritized groups in the United States experience worse sleep than non-Hispanic Whites (nHW), likely due to downstream effects of systemic and structural discrimination. Nonetheless, the extent of sleep disparities in the perinatal period remains understudied. In this analysis we estimated the prevalence of subjective measures of sleep in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Methods Participants self-reported their race and ethnicity and were grouped into four categories: 1)nHW, 2)non-Hispanic Black/African American (nHB/AA), 3)Hispanic, 4)non-Hispanic Asian (nHA). Our analysis examined trimester-specific nocturnal sleep duration, sleep quality, and sleep disturbances (derived from the Pittsburgh Sleep Quality Index and the ECHO maternal sleep health questionnaire) by race/ethnicity. A total of 1119,2409 and 1284 participants in the first (T1), second (T2) and third trimesters (T3) reported on sleep duration. 1107,1742 and 783 participants in T1,T2 and T3 reported on sleep quality. 1112,1758, and 787 participants in T1,T2 and T3 reported on sleep disturbances Linear or multinomial regression were used to estimate associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index (BMI) and age. We repeated analyses within education strata (high school degree, GED/equivalent; some college and above) Results nHB/AA participants reported shorter sleep duration (T2: β=-0.55 [-0.80,-0.31]: T3: β=-0.65 [-0.99,-0.31]), and more sleep disturbances (T2:β=1.92 [1.09,2.75]; T3:β=1.41 [0.09,2.74]) compared to nHW. Hispanic participants reported longer duration compared to nHW (T1: β=0.22 [0.00004, 0.44];T2: β=0.61 [0.47,0.76];T3: β=0.46 [0.22,0.70]), better sleep quality (Compare to Very good quality OR for Fairly good T1: OR=0.48 [0.32,0.73], T2: OR=0.36 [0.26,0.48], T3: OR=0.31 [0.18,0.52]; Fairly bad T1:OR=0.27 [0.16,0.44], T2:OR=0.46 [0.31,0.67], T3: OR=0.31[0.17,0.55]), and fewer sleep disturbances (T2 β=-0.5 [-1.0,-0.12]; T3 β=-1.21 [-2.07,-0.35]). Differences persisted within the subsample of high SES women. Conclusion These findings highlight racial/ethnic disparities across multiple domains of sleep health during pregnancy. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities, such as downstream effects of systemic and structural discrimination Support (If Any)

0400 Sleep Onset REM Period (SOREMP); Beyond the Diagnostic Marker

Abstract Introduction Shortened mean sleep latency and multiple Sleep Onset REM Period (SOREMP) on MSLT has been used as a characteristic marker for narcolepsy and incorporated in all editions of International Classification of Sleep Disorders. Epidemiologic studies have shown that SOREMP could occur in general population especially those with sleep insufficiency and shift work. However the physiological meaning of SOREMP besides the diagnostic marker is not well clarified. We searched for subjective and objective sleep variables independently associated with the number of SOREMPs. Methods Participants were 769 consecutive sleepy patients or controls who gave written informed consent and underwent PSG followed by MSLT in Seiwa Hosiptal or Koishikawa Tokyo Hospital from October 2014 to November 2021. We excluded those with obvious nocturnal sleep disturbances (AHI≥10, PLMI≥15), with medication affecting sleep and with severe first-night effect at the time of PSG. We analyzed data from resultant 580 participants (male/female=312/268, age 25.3±8.4 years old, BMI 21.6±3.3). They were subdivided into 4 groups according to the number of SOREMPs on MSLT (used as ordinal scale). Subjects with 3 or more SOREMPs were merged into one group to increase number enough for statistical analyses. We dichotomized participants into narcolepsy type 1 (NT1) (n=50) and others (n=530) to adjust the effect of NT1 diagnosis. Epworth Sleepiness Scale (ESS) as well as conventional sleep variables on PSG and MSLT were compared by ANOVA and variables associated with the number of SOREMPs were further analyzed by regression analyses to determine the independent association after adjustment of covariates (age, sex, BMI and dichotomized diagnosis). Results Number of SOREMPs on MSLT was positively associated with ESS score (p=0.010), Total Sleep Time (TST) (p=0.03), REM %TST(p&amp;lt;0.001), and negatively associated with Sleep Latency (p&amp;lt;0.01), REM Latency (p&amp;lt;0.001), MSLT mean Sleep Latency (p&amp;lt;0.001) and MSLT REM Latency (p&amp;lt;0.001) and subjective sleep latency on PSG night. Conclusion Our data indicate that the number of SOREMPs have physiological significance besides narcolepsy diagnosis. More SOREMPs reflects higher sleep propensity and REM propensity as well as subjective sleepiness. The number of SOREMPs can be a marker reflecting one aspect of sleepiness. Our study will also contribute to better understand the meaning of SOREMP in diagnostic criteria of central disorders of hypersomnolence. Support (If Any) This study was partly supported by JSPS KAKENHI Grant Number JP21H02856.

Insomnia disorder diagnosed by resting-state fMRI-based SVM classifier

BackgroundThe main classification systems of sleep disorders are based on the subjective self-reported criteria. Objective measures are essential to characterize the nocturnal sleep disturbance, identify daytime impairment, and determine the course of these symptoms. The aim of this study was to establish a resting-state fMRI-based support vector machine (SVM) classifier to diagnose insomnia disorder. MethodsWe enrolled 20 patients with insomnia disorder and 21 healthy controls, and obtained their simultaneous polysomnographic electroencephalography and functional magnetic resonance imaging (EEG-fMRI) recordings. The SVM classifiers were trained to capture insomnia. Classifier performance was quantified by a 5-fold cross validation and on independent test dataset. ResultsThe fMRI-based SVM classifier was able to diagnose insomnia with an accuracy of 89.3% (sensitivity of 90.9%, specificity of 87.7%). The robustness of SVM classifier was encouraging. ConclusionsWe established an encouraging resting-state fMRI-based SVM classifier to automatically diagnose insomnia disorder. As an objective measure for assessing insomnia disorder, it would be of additional value to the current self-reported subjective criteria.

A Micro-Longitudinal Study of Naps, Sleep Disturbance, and Headache Severity in Women with Chronic Migraine

ABSTRACT Objective To examine the relationship between headaches, naps, and nocturnal sleep in women with chronic migraine (CM) using micro-longitudinal data from diaries and actigraphy. Methods 20 women with CM and 20 age and sex-matched healthy controls (HC) completed self-report questionnaires, electronic diaries, and wrist actigraphy over a 4-week period. Between-group comparisons were conducted with naps (frequency and duration) as the primary variable of interest. Within-group analyses were conducted on the CM group using hierarchical linear mixed models to examine the temporal relationships between headache severity, sleep behaviors, and sleep parameters. The primary variables of interest were naps (number and duration) and nocturnal sleep efficiency (diary and actigraphy). Results The CM group reported significantly more days with naps (25.85%) compared to the HC group (9.03%) during the study period (p = .0025). Within-group analyses in CM revealed that greater headache severity was associated with longer nap duration (p = .0037) and longer nap duration was associated with lower sleep efficiency measured using diaries (p = .0014) and actigraphy (p < .0001). Conclusions Napping is more frequent in CM than HC and nap duration in CM is associated with headache severity and nocturnal sleep disturbance. These findings provide initial support for the hypothesis that daytime napping is a behavioral coping strategy used in CM that could contribute to insomnia.