Prevalence Of Sleep Disorders Research Articles

0523 Disparities in Discussion of Sleep-related Breathing Disorders with a Physician

Abstract Introduction Race, immigration status and healthcare access have known associations with sleep health in socially disadvantaged groups. The prevalence and severity of sleep disorders, such as obstructive sleep apnea (OSA) are higher among non-whites and underdiagnosed in socially disadvantaged groups. Associations between sleep health and country of birth have also been identified. Certain minority groups are known to be less likely to report symptoms of OSA or insomnia to a physician. It's therefore possible that propensity for sleep disorder self-report plays a role in disparities of sleep health in socially disadvantaged groups. To our knowledge the predictors of sleep disorder self-report have yet to be studied. We aim to assess the predictors of sleep disorder self-report and analyze for associations with race, immigration status and healthcare access. Methods We conducted a cross-sectional analysis of 9,163 adult (age >18) patients in the National Health and Nutrition Examination Survey 2017-2020 database who answered the sleep disorders questionnaire and had race, immigration status and healthcare access data. Any answer to “How often do you snort or stop breathing (during sleep)?” was used as a surrogate endpoint for symptoms of OSA. “Yes” to “Ever told a doctor that you had trouble sleeping?” was used as a surrogate endpoint for sleep disorder self-report. We analyzed this cohort for associations between demographic characteristics, symptoms of OSA and sleep disorder self-report with survey sampling weights in STATA 17.0. Results In patients with symptoms of OSA (24%), measures of limited healthcare access, such as lack of health insurance (OR=1.59, p=0.030), or lack of location routinely visited for healthcare needs (OR=1.77, p=0.024), predicted higher likelihood of sleep disorder symptom non-disclosure, after adjustment for sex, age, and BMI. Non-white race (OR=1.70, p< 0.001) and being an immigrant (OR=2.40, p< 0.001) predicted higher likelihood of sleep disorder symptom non-disclosure in patients without symptoms of OSA, but not in patients with symptoms of OSA, after adjustment for sex, age, and BMI. Conclusion Our findings indicate that patients with limited healthcare access should be considered more strongly for sleep health evaluation and that non-white and immigrant patients are less likely to discuss sleep health with a physician. Support (if any)

0896 Predictors of Total Sleep Duration in Adults with Epilepsy

Abstract Introduction Sleep deprivation is a common seizure trigger in adults with epilepsy (AWE). Yet, few prospective studies explore the relationship between seizure control and sleep duration. We studied factors associated with sleep duration in AWE participating in a prospective, cross sectional study investigating prevalence of sleep disorders. We hypothesized seizure frequency would be inversely associated with sleep duration. Methods Participants were AWE with quantifiable seizures who completed PSG, validated instruments and seizure/sleep diaries for at least 7 days in whom prior knowledge of sleep disorder symptoms was unknown. Linear regression models were fit for Total Sleep Duration (TSD; average sleep duration during the major sleep period) and 24-hour TSD (TSD24; average sleep duration during the major sleep period + daytime naps). Independent variables were monthly seizure frequency excluding auras(MSF), monthly generalized seizure frequency(GSF), epilepsy classification (focal vs. generalized), Beck Depression Inventory(BDI) and Insomnia Severity Index(ISI) scores, age, sex, body mass index(BMI), anti-seizure medication(ASM) number and standardized dose and apnea hypopnea index(AHI). Analyses were performed based on significance level 0.05, using SAS (version 9.4, Cary, NC). Results The sample included 126 participants (age 37.5(IQR:28,49), 67.5% female, BMI 28.0(IQR:24.0,32.3), 74.6% focal epilepsy). TSD was 7.5 + 1.9hr and TSD24 7.5 + 1.9hr. Median MSF was 0.5(IQR:0.0,4.0) with 75% having >1 seizure/mo. Median GSF was 0.75 + 9.1 with 19% having >1/mo. Median standardized ASM dose was 1.8(IQR:0.8,2.5) and 46.8% took monotherapy. After adjustment, female sex and ISI were inversely associated with TSD (female sex -1.01, 95%CI[-1.56,-0.17]; ISI -0.09, 95%CI[-0.15,-0.02]) and TSD24 (female sex -1.44, 95%CI[-2052,-0.37]; ISI -0.09, 95%CI[-0.17,-0.01]). GSF>1 was associated with longer TSD24 than those with GSF < 1(2.26, 95%CI[1.03,3.50] vs. 0.43, 95%CI[-0.49,1.35]). With every 1-unit increase in GSF, TSD24 increased 0.22hr(coefficient 0.22, 95%CI[0.07,0.36]). Other epilepsy-related variables were not associated with sleep duration. Conclusion In this first detailed analysis of TSD in AWE, female sex and higher insomnia severity were associated with shorter TSD and TSD24, and higher GSF was associated with longer TSD24. Neither TSD nor TSD24 were associated with MSF. These findings may inform future studies investigating sleep in AWE. Support (if any)

0358 Prevalence of Insomnia Symptoms and Insomnia Disorder within VA Subacute Rehabilitation

Abstract Introduction Approximately 40% of Veterans report insomnia symptoms and 12% of Veterans have a formal insomnia disorder diagnosis. While these numbers reflect outpatient prevalence rates, there is little data on the prevalence of insomnia symptoms and insomnia disorder among the 32,000 Veterans receiving care within VA Community Living Centers (CLC) (rehabilitation and long-term care facilities) each year. The present analysis provides an initial step in understanding the prevalence of insomnia disorder vs. insomnia symptoms within a local VA CLC subacute rehabilitation unit. This analysis is part of a clinical innovation project that evaluated Veterans’ sleep during admission for the purposes of informing clinical interventions. Methods 67 Veterans were admitted to a VA subacute rehabilitation unit following hospital discharge between March and August 2022. Veterans were asked to complete a brief evaluation within 7 days of admission, including the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), and Epworth Sleepiness Scale (ESS). Sleep disorder diagnoses were obtained through chart reviews. Descriptive statistics were used to evaluate the prevalence of sleep disorders, insomnia severity, sleep need, and daytime sleepiness. Results 48 of 67 (71.6%) Veterans (Mage=72.8±12.0;97.9%male;79.2%white) completed evaluations within 7 days of admission. 52.1% of Veterans reported at least subthreshold insomnia (ISI≥8) with 22.9% reporting moderately severe clinical insomnia (ISI≥15). 50% reported not meeting their sleep need (SNQ≥13) and 33.3% reported at least mild levels of daytime sleepiness (ESS≥11). Chart reviews indicated only 25% of Veterans had a formal sleep disorder diagnosis in their chart and only 4.2% Veterans had a formal diagnosis of insomnia disorder. Conclusion The results of this preliminary analysis highlighted the discrepancy between national outpatient statistics and local inpatient statistics on the prevalence of insomnia symptoms and disorder. While the Veterans admitted to the CLC may be experiencing additional factors influencing their sleep (e.g., environmental disruptors), this does not wholly explain the discrepancy between the local and national ­samples. Future evaluations should include multiple VA sites to obtain a more representative sample of Veterans. Clinically, these findings suggest that insomnia disorder should be considered a standalone diagnosis and added to Veterans’ charts when clinically elevated symptomology is endorsed. Support (if any)

0694 Sleep Disorders and Serious Mental Illnesses: Comorbidity, Treatment, & Demographic Factors in VA Health Record Data

Abstract Introduction People 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. Methods We 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. Results In 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. Conclusion Our 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).

0823 Social Determinants of Sleep Disorders Among Multiethnic Americans in the NIH All of Us Research Program

Abstract Introduction Studies show that social characteristics associated with good health, such as a high level of education, being married, and being employed, are associated with healthier sleep health. Accordingly, we leveraged All of Us (AOU), an NIH research, to analyze sleep disorders prevalence and sociodemographic covariates. Methods Phecodes for diagnoses were derived from the ICD-9/10 billing codes in participants’ electronic health records (EHRs). We used 0 phecodes of the parent category of sleep disorders (insomnia and sleep apnea) (phecode 327) in a person’s EHR to classify individuals as not having a diagnosis and 2+ phecodes as having a diagnosis (those with only one instance in their EHR were dropped). Logistic regression analysis was conducted to assess associations between sleep disorders and race/ethnicity, sex, age, and education level using the R statistical framework. Results A total of 214, 206 participants were available for analysis; of whom 61.3% were female (mean [SD] age, 51.7 [16.6] years). Women were 1.27xmore likely to have a diagnosed sleeping problem (95% CI: 1.31,1.23; p=1.31×10-61). We observed higher rates of sleep disorders in older individuals; compared to persons between 18-30 years old, those aged 65 years or older were 4.74 times more likely to have a diagnosable sleep disorder (95% CI: 3.83, 4.33; p< 10-300). We also observed a trend of greater education attainment corresponding to an increased likelihood of sleep problems; this was most extreme when comparing individuals with some college versus those who did not complete high school (OR=1.38; 95% CI: 1.30, 1.46; p=3.65×10-29). Individuals with reported income < 25K/year were 1.44x more likely to be diagnosed than those earning >100K (95% CI:1.51, 1.37; p=1.05×10-51). Individuals identified as Black were least likely to have a diagnosis (OR=0.52; 95% CI: 0.50, 0.54; p=2.2that 2×10-208). Conclusion Among All Of Us populations, self-identified Blacks, men, younger adults, higher-income, and non-college-educated patients are less likely to have recorded insomnia or sleep apnea diagnoses. Some of these unexpected within-group differences could be due to self-reported versus clinically recorded diagnoses and access to healthcare. Planned analyses aim to explore further social determinants of health by incorporating geospatial and available self-report data on exposures Support (if any) 1HL152453, R01MD007716, R01HL142066

Nonorganic sleep disorders and sleep quality among the general population of Mongolia

The aim of this study was to determine the prevalence of non-organic sleep disorders and sleep quality, using a structured psychiatric interview following screening through the Pittsburgh Sleep Quality Index (PSQI) among the general population. This nationwide population-based cross-sectional study was carried out between August and October 2020 and involved 964 participants (74% women, mean age: 40.72±14.34) who were randomly selected from 64 clusters in 10 sites of Mongolia. 27.9% of the study participants were evaluated as having non-organic sleep disorders based on the diagnostic guidelines of the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10). The prevalence of non-organic sleep disorders differed in age (p<0.001). Non-organic sleep disorders were related to age, employment, diastolic blood pressure, sleep quality, and quality of life. The prevalence of non-organic sleep disorders in the general population of Mongolia was calculated as 27.9%, while the prevalence rate of the poor sleep quality was 42.2%.

Prevalence of Sleep Disorders and the Effect of Sleep Health Education on Sleep Quality in Pregnant Women With Sleep Disorders.

Sleep quality affects pregnant women's health and quality of life. The aims of the study were to investigate the prevalence of sleep disorders and the effect of sleep health education on sleep quality in pregnant women with sleep disorders. To examine the frequency of sleep disorders among pregnant women, a cross-sectional study was conducted with an initial enrollment of 370 participants. Subsequently, 162 pregnant women were recruited for a pretest-posttest quasi-experimental design study. The intervention group (n = 82) performed sleep health education for four weeks and the control group (n = 80) received standard care. Sleep quality was assessed with Pittsburgh Sleep Quality. The prevalence of sleep disorder was 61.9 percent (CI 95% 56.85-66.69). It was determined that health education improved some sleep quality subscales including subjective sleep quality, sleep latency, sleep duration and habitual sleep efficiency, and sleep disturbances, daytime dysfunction, and global sleep quality. The difference was still significant after adjusting for the PSQI baseline (η2 = .311, P < .001). These findings provide evidence of a relatively high prevalence of sleep disorders in pregnancy. Therefore, screening for sleep disorders and providing supportive programs and models to improve sleep quality during pregnancy should be considered as part of prenatal care.

Sleep pattern and sleep disorders in school-going children aged 6-12 years and its association with screen time: a cross-sectional study from South Kerala during the COVID-19 pandemic

Background: Poor sleep quality in school children can negatively impact their neurocognitive abilities and academic achievement. Increased screen time was shown to interfere with children’s sleep habits and disrupts their sleep pattern. This study aimed to understand the sleep patterns and sleep disorders in school children and the influence of screen time on sleep in children during the COVID-19 pandemic. Methods: This cross-sectional observational school-based study was done on 443 children aged 6-12 years. Data was collected through parent filled online questionnaire having a proforma and child sleep habit questionnaire (CSHQ), a validated questionnaire to assess sleep disorders in children Results: Out of 443 children studied, the average sleep duration of the study population was 9:06 hours ±42:18 min and, 34.3% of the children slept less than 9 hours per day. The prevalence of sleep disorders was found to be 76.52%. Significant screen time after 8 PM was observed in 65.9% and 62.2 % of children had a total screen time of more than 2 hours. Increased screen time after 8 PM, delayed bedtime and wake-up time in children and also contributed to sleep disorders. Bedtime resistance and daytime sleepiness were more commonly observed in children with increased screen time. Conclusions: Sleep disorders in children are more predominant than sleep deprivation. Increased screen time before bed was found to alter sleep patterns in children and increases bedtime resistance, daytime sleepiness, and sleep disorders.

Prevalence and pattern of sleep disorders in childhood

Background: Sleep disorders are very common in the population of children, with prevalence rates ranging from 25-40%, and they are often persistent. The aetiology of sleep problems is very complicated and depend on many varied factors. Psychological factors concerning family life and general state of health have a significant impact on children. Methods: A hospital based descriptive study was carried out among 1024 children visiting the paediatric outpatient departments of Madras medical college, Chennai and Al-Ameen medical college and hospital, Vijayapura over a period of 1 year from March 2022 to March 2023. An appropriate questionnaire was formulated that had to be filled by parents and those children with sleep problems interviewed and assessed using appropriate statistical methods. Results: Out of 1164 questionnaires, 1024 (88.97%) were filled completely and returned. The 497 (48.54%) boys and 527 (51.46%) girls were included in this study. Of the 1024 children, 621 (60.64%) had no sleep related problems. The 403 (39.36%) had one or more sleep related problem, which included 211 (52.36%) boys and 192 (47.64%) girls. Male children were more commonly affected with sleep disorders and there is statistically significant difference at 5% level among males and females in having sleep disorders (p&lt;0.05). Conclusions: Most of the children studied had only 1 of sleep disorders of which males outnumbered females. Sleep disorders were predominantly found in the age group of 7-10 years among which most common sleep related disorder was nocturnal enuresis. The study also showed that sleep walking is usually associated with another sleep disorder.

Sleep quality and sleep disorders in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Sleep disorders have been considered risk factors for cardiovascular diseases, and poor sleep quality has become a common complaint in patients with coronary artery disease. Despite being a very common problem in these patients, it is not yet routinary studied and reflected in the clinical practice guidelines. Purpose To study the prevalence and type of sleep disorders in patients with acute coronary syndrome (ACS). Methods This study was a quantitative, descriptive, cross-sectional investigation. We included patients admitted for ACS (unstable angina, STEMI, NSTEMI, MINOCA,...) during the period from June to October 2022. The patients were interviewed, collecting the following information: Demographic variables (age, sex, marital status), classic cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia), presence or absence of a diagnosis of Obstructive Sleep Apnoea (OSA), as well as treatment or not with CPAP, toxic habits (tobacco, alcohol, other drugs), need for sleep medication and sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which is a validated self-rated questionnaire that assesses sleep quality and sleeps disturbance over the past month. Results We included 46 patients in our study. The mean age was 68,85 years (SD 11,88), 69,56% were male and 60,87% were married. The main reason for admission was NSTEMI. The distribution of risk factors was: High blood pressure 78,26%, Diabetes Mellitus 36,96%, dyslipidemia 63,04%, smoking 21,74%, drinking alcohol habitually 19,57%, and other drugs abuse 4,35%. The prevalence of OSA was 17,39%. Overall, the mean PSQI score of all participants was 8,98 (SD 4,73). The most affected sleep component was ‘Sleep disturbance’ (mean score 1,76/3), followed by ‘Sleep latency’ (1,5/3) and ‘Sleep duration’ (1,48/3). 34,78 % referred use of sleep medication and 41,30% had daytime dysfunction. Table 1 shows the results in PSQI related to the reason for hospitalization. Conclusions Sleep disorders and poor sleep quality are remarkably prevalent in our cohort of ACS patients, which could be considered as a possible added cardiovascular risk factor or risk modifier. We consider the proactive investigation of sleep disorders useful in clinical practice as we can develop strategies to improve sleep and reduce residual cardiovascular risk and quality of life.

Insomnia during coronavirus disease 2019 pandemic in Korea: a National sleep survey.

Coronavirus disease 2019 (COVID-19) pandemic has caused widespread increase in stress and affected sleep quality and quantity, with up to 30% prevalence of sleep disorders being reported after the declaration of the pandemic. This study aimed to assess perceived changes due to the pandemic in the prevalence of insomnia and excessive daytime sleepiness (EDS) in Korea, and identify the associated factors. An online survey was conducted among 4000 participants (2035 men and 1965 women) aged 20-69years enrolled using stratified multistage random sampling according to age, sex, and residential area, between January, 2021 and February, 2022. The questionnaire included various items, such as socio-demographics, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS). Insomnia was defined as difficulty falling asleep and difficulty maintaining sleep more than twice a week. EDS was classified as an ESS score ≥ 11. Insomnia was reported by 32.9% (n = 1316) of the participants (37.3% among women and 28.6% among men). Multivariate logistic regression revealed that insomnia was associated with female sex [odds ratio (OR) = 1.526, 95% confidence interval (CI) = 1.297-1.796], night workers (OR 1.561, 95% CI 1.160-2.101), and being unmarried (OR 1.256, 95% CI 1.007-1.566). EDS was reported by 12.8% (n = 510) of the participants (14.7% among men and 10.7% among women). EDS was associated with male sex (OR 1.333, 95% CI 1.062-1.674), and being employed (OR 1.292, 95% CI 1.017-1.641). During the COVID-19 pandemic, the prevalence of insomnia increased in Korea, while there was no significant change in EDS compared with pre-pandemic evidence.

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.

Evaluation of Sleep Quality and Fatigue in Patients with Usher Syndrome Type 2a

To study the prevalence, level, and nature of sleep problems and fatigue experienced by Usher syndrome type 2a (USH2a) patients. Cross-sectional study. Fifty-six genetically confirmed Dutch patients with syndromic USH2a and 120 healthy controls. Sleep quality, prevalence, and type of sleep disorders, chronotype, fatigue, and daytime sleepiness were assessed using 5 questionnaires: (1) Pittsburgh Sleep Quality Index, (2) Holland Sleep Disorders Questionnaire, (3) Morningness-Eveningness Questionnaire, (4) Checklist Individual Strength, and (5) Epworth Sleepiness Scale. For a subset of patients, recent data on visual function were used to study the potential correlation between the outcomes of the questionnaires and disease progression. Results of all questionnaires were compared between USH2a and control cohorts, and the scores of the patients were compared with disease progression defined by age, visual field size, and visual acuity. Compared with the control population, patients with USH2a experienced a poorer quality of sleep, a higher incidence of sleep disorders, and higher levels of fatigue and daytime sleepiness. Intriguingly, the sleep disturbances and high levels of fatigue were not correlated with the level of visual impairment. These results are in accordance with the patients' experiences that their sleep problems already existed before the onset of vision loss. This study demonstrates a high prevalence of fatigue and poor sleep quality experienced by patients with USH2a. Recognition of sleep problems as a comorbidity of Usher syndrome would be a first step toward improved patient care. The absence of a relationship between the level of visual impairment and the severity of reported sleep problems is suggestive of an extraretinal origin of the sleep disturbances. Proprietary or commercial disclosure may be found after the references.

Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data.

This study aimed to estimate the 12-month prevalence of diagnosed sleep disorders among veterans with and without serious mental illnesses (SMI) in Veterans Affairs health record data in 2019. We also examined diagnosed sleep disorders across a 9-year period and explored associations with demographic and health factors. This study used health record data from VISN 4 of the Veterans Health Administration from 2011 to 2019. SMI diagnoses included schizophrenia and bipolar spectrum diagnoses as well as major depression with psychosis. Sleep diagnoses included insomnias, hypersomnias, sleep-related breathing disorders, circadian rhythm sleep-wake disorders, and sleep-related movement disorders. Demographic and health-related factors were also collected from the record. In 2019, 21.8% of veterans with SMI were diagnosed with a sleep disorder. This is a significantly higher proportion than for veterans without SMI, 15.1% of whom were diagnosed with a sleep disorder. Sleep disorder rates were highest in veterans with a chart diagnosis of major depression with psychosis. From 2011 to 2019, the overall prevalence of sleep disorders in veterans with SMI more than doubled (10.2%-21.8%), suggesting improvements in the detection and diagnosis of sleep concerns for this group. Our findings suggest that identification and diagnosis of sleep disorders for veterans with SMI has improved over the past decade, though diagnoses still likely underrepresent actual prevalence of clinically relevant sleep concerns. Sleep concerns may be at particularly high risk of going untreated in veterans with schizophrenia-spectrum disorders. Bonfils KA, Longenecker JM, Soreca I, etal. Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data. J Clin Sleep Med. 2023;19(9):1651-1660.

Use of Daridorexant among Patients with Chronic Insomnia: A Retrospective Observational Analysis.

Insomnia is the most prevalent sleep disorder, affecting millions worldwide and taking a heavy toll on patient health with significant social and economic impact. Even though there are multiple different types of insomnia medications and behavioral therapies, there are still many individuals for whom treatment remains ineffective. The objective of this retrospective study was to analyze the effectiveness of daridorexant in a cohort of chronic insomnia patients largely transitioned from GABA-A positive allosteric modulators (benzodiazepines, zolpidem or eszopiclone) or other frequently prescribed insomnia medications (including trazodone, atypical antipsychotics or tricyclic antidepressants). A total of 86 patients were treated in the course of ordinary practice and the primary analytic endpoint was the change in Insomnia Severity Index (ISI) score following ≥ 30 nights of treatment with daridorexant. Results from 80 of the 86 patients with full data (65% female, mean age 53.5 years, 18.8% with comorbid obstructive sleep apnea, 91.3% transitioned from a different medication) showed a mean improvement in ISI score of 7.0 ± 0.54 points (SEM) (p < 0.0001) from 18.0 to 11.0. Overall, 78% of the cohort demonstrated a clinically meaningful improvement as defined by at least a six-point drop in ISI. Total sleep time increased by 54 ± 1.0 min (SEM) (p < 0.0001) from 6.0 h to 6.9 h. Mean sleep latency decreased by 23.9 ± 2.4 min (SEM) (p < 0.0001) from 58.8 min to 34.9 min. Wake after sleep onset decreased by 31.6 ± 3.2 min (SEM) (p < 0.001) from 42.8 min to 11.3 min. Sleep efficiency improved by 10.5 ± 1.1% (SEM) (p < 0.0001) from 79.3% to 89.8%. No significant adverse events were noted during the study duration. Keeping in mind this study's limitations, these data suggest that for insomnia patients with an incomplete response to current therapy, switching to daridorexant is safe and may be an effective alternative treatment.

0533 Healthcare Utilization by Patients with Obstructive Sleep Apnea and Excessive Daytime Sleepiness After Airway Therapy in the UK

Abstract Introduction Obstructive Sleep Apnea (OSA) is a chronic condition characterized by repetitive episodes of upper airway collapse during sleep. Despite standard treatment with continuous positive airway pressure (CPAP), some patients continue to experience residual excessive daytime sleepiness (rEDS). Pharmacotherapy use for rEDS is low in Europe and some wake-promoting agents are no longer allowed as treatments by the European Medicines Agency. The objective of this study was to characterize the patient demographics, comorbidities, medications, and healthcare resource utilization (HCRU) in a population of OSA patients with and without rEDS after CPAP initiation. Methods The retrospective observational cohort study used the Clinical Practice Research Datalink (CPRD) AURUM, a primary care database, linked at the patient level to the Hospital Episode Statistics (HES) database, which covers secondary care for all of England. The population included 10,746 adult OSA patients with a first record of CPAP treatment during the eligibility period (Jan 1, 2009-Mar 21, 2018). rEDS patients were identified 6 months after initiating CPAP treatment. Results Among all eligible OSA patients in the AURUM database, 596 (5.6%) had rEDS; 80.5% of rEDS patients were identified using recorded diagnosis code of daytime fatigue, and 21.7% using ESS score ≥11 (13 patients had both measures). A greater percentage of patients had a history of psychiatric (21.5%; p&amp;lt; 0.0001), gastrointestinal (7.7%; p&amp;lt; 0.0001), and neurodegenerative (13.6%; p=0.003) disorders in the rEDS group, compared with the non-rEDS group, while the prevalence of obesity, cardiovascular, and sleep disorders did not significantly differ between groups. Across all patients, rates of prescription for stimulants or modafinil were low during the 12 months prior to CPAP initiation. Patients with rEDS had significantly higher HCRU compared to non-rEDS patients in the first and second years after CPAP initiation. Conclusion Despite low rates of rEDS identified in this study, the clinical needs of patients with rEDS are significant, as evidenced by the volume of HCRU, low use of pharmacotherapy, and high comorbidity rates, highlighting the need to improve patient care in rEDS. Support (if any) Axsome Therapeutics and Jazz Pharmaceuticals

Fibroadipogenic progenitor-derived Gdf10 regulates neuromuscular junction and fat content in tongue muscles

Obstructive sleep apnea (OSA) is the most prevalent sleep disorder globally 4.5% in men and 2.5% in women. OSA increases the risk of more severe diseases such as heart attack, high blood pressure, type 2 diabetes, obesity, mild cognitive impairment, and depression. The known craniofacial anatomical changes leading to OSA are relaxed muscles and/or enlarged soft tissues by fat infiltration in the soft palate, pharynx, and particularly tongue, which blocks the upper airway during sleep. Although obesity is one of the main causes to induce OSA, the underlying mechanism of those changes has not been researched. The objective of our study is to understand the mechanism leading to those craniofacial changes that generate foundations to develop potential therapeutics for OSA. We hypothesize that high-fat diet-induced obesity regulates the fibroadipogenic progenitors, which are critical for neuromuscular interaction and is mainly responsible for increased fat content in skeletal muscles. To test this hypothesis, we used a mouse model fed with a high-fat diet to induce obesity or a normal diet (control group) for 6 months. Then we isolated tongue muscles for histology analysis, such as muscle size, neuromuscular junction integrity, and adipocyte content.We found that a high-fat diet leaded adipocyte hypertrophy and reduced intact neuromuscular junction in tongue muscles. To investigate the role of fibroadipogenic progenitors for tongue phenotypes by a high-fat diet, we isolated fibroadipogenic progenitor cells to measure transcript levels of Gdf10, also known as Bmp3b, since fibroadipogenic progenitor-derived Gdf10 has been known to stabilize Schwann cells for neuromuscular integrity in muscles. The role of Gdf10 has been suggested to protect from obesity by limiting adipocyte hypertrophy. Using single-cell RNA sequencing analysis, Gdf10 is specifically expressed in fibroadipogenic progenitors but not adipocyte or Schwann cells. We found that Gdf10 transcript levels are significantly reduced by a high-fat diet in tongue fibroadipose progenitors. Taken together, the reduced Gdf10 of fibroadipogenic progenitors by a high-fat diet reduces neuromuscular integrity but induces fat infiltration in tongue muscles in a paracrine manner. Therefore, targeting to increase Gdf10 expression is a potential therapeutic to reduce OSA by maintaining healthy tongue muscle. NIH R01AR071397 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Do Sleep Disorders Influence the Prognosis and the Response to the Therapy in Enuretic Children?

The current study describes the prevalence of sleep disorders in enuretic children, playing as influencing factors in the response to treatment and risk of relapse. Data were collected from September 2020 to February 2021 in 114 children aged between 5 and 14 years, with a diagnosis of nocturnal enuresis and concomitant sleep disorders, referred to the Pediatric Unit, Campus BioMedico University, Rome. Enuretic children were subjected to an anamnestic and clinical assessment. Sleep disorders investigated were sleep apnea, sleep talking, snoring, bruxism, restless sleep, and somnambulism. Each patient was subjected both to pharmacological and to non-pharmacological treatments and monitored for 3 months to identify the presence of relapse. Patients were divided into 2 groups according to therapy response, and statistical analysis was performed to evaluate possible variables involved in enuresis relapse. A high prevalence of sleep disorders was documented: 8/114 children (7%) had sleep apnea, 47/114 (41.2%) had bruxism, 66/114 (57.8%) had snoring, 54/114 (47.3%) had sleep talking, 18/114 (15.7%) had restless sleep. Forty-three of 114 children (37.7%) had relapses: 21/43 (49%) relapses occurred in children with only 1 sleep disorder, while 22/43 (51%) relapses occurred in children with 2 or more sleep disorders. Lower risk of relapses was reported in children subjected to dual therapy. Sleep disorders were widely associated with nocturnal enuresis, acting as comorbidities in the clinical course of nocturnal enuresis. Combined therapy seems to be associated with a lower rate of relapse of enuresis in a 3-month follow-up. A multidisciplinary approach is required to improve patients' management.

Sleep hygiene and sleep quality in Iranian adolescents during the COVID-19 pandemic

ObjectivesSleep is one of the issues that attracted the attention of researchers during the COVID-19 pandemic. Researchers focused their studies on the prevalence of sleep disorders, sleep quality, and sleep duration. Sleep hygiene is a set of guidelines that play an important role in the sleep quality, the present study sought to evaluate the amount of sleep hygiene and sleep quality in Iranian adolescents and their relationship during the COVID-19 pandemic.MethodsThe present study was conducted using a cross-sectional design. The research population consisted of all adolescents living in Kermanshah (western Iran) in 2021. The participants were a sample of 610 adolescents. They completed the Pittsburgh Sleep Quality Inventory and Adolescent Sleep Hygiene Scale.ResultsThe mean sleep quality score for the participants was 7.14 ± 2.47, indicating the high frequency of sleep problems affecting the participants. There were significant correlations between all components of sleep hygiene and sleep quality. There was also a significant correlation (r = − 0.46 between sleep hygiene and sleep quality (p < 0.001). No significant difference was observed in sleep hygiene and sleep quality between the male and female adolescents. The results showed that sleep hygiene subscales can predict sleep quality (R = 0.53, F = 39.20, p < .01).ConclusionsThe data in this study confirmed the poor observance of sleep hygiene in adolescents during the COVID-19 pandemic and reported frequent sleep problems among the participants. The results also indicated a moderate relationship between sleep hygiene and sleep quality in adolescents. Thus, sleep hygiene components can be related to sleep quality.

Sleep disorders and fatigue among truck and bus drivers in Mexico.

Fatigue and sleep disturbances are among the most common disorders suffered by transport drivers. To identify and analyze working conditions for Mexican federal transportation truck and bus drivers, and their connection with sleep disorders and fatigue. A cross-sectional, quantitative study was performed with a convenience sample of 172 drivers (84 truck and 88 bus) by applying the Survey Evaluation and Monitoring of Workers Health (PROESSAT in Spanish) and the Yoshitake Fatigue questionnaire. Night work and performing hazardous work increased the prevalence of sleep disorders (PR = 3.9 and PR = 6.9, respectively). Poor lighting and being paid per trip increased the prevalence of fatigue (PR = 2.8 and PR = 2.5, respectively). Several conditions were found to impact health, including long work shifts, strenuous physical effort, night work, little social support, being paid by distance, strict quality controls, and risk of crimes such as extortion, robbery, attacks, and kidnapping.