Primary Sleep Research Articles

Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies

IntroductionNocturnal hypoxemia is associated with increased cardiovascular mortality. Here, we assess whether positive airway pressure by adaptive servo-ventilation (ASV) reduces nocturnal hypoxemic burden in patients with primary central sleep apnea (primary CSA), or heart failure related central sleep apnea (CSA-HF) and treatment emergent central sleep apnea (TECSA). MethodsOvernight oximetry data from 328 consecutive patients who underwent ASV initiation between March 2010 and May 2018 were retrospectively analyzed. Patients were stratified into three groups: primary CSA (n = 14), CSA-HF (n = 31), TECSA (n = 129). Apnea hypopnea index (AHI) and time spent below 90% SpO2 (T90) was measured. Additionally, T90 due to acute episodic desaturations (T90Desaturation) and due to non-specific and non-cyclic drifts of SpO2 (T90Non-specific) were assessed. ResultsASV reduced the AHI below 15/h in all groups. ASV treatment significantly shortened T90 in all three etiologies to a similar extent. T90Desaturation, but not T90Non-specific, was reduced by ASV across all three patient groups. AHI was identified as an independent modulator for ΔT90Desaturation upon ASV treatment (B (95% CI: −1.32 (−1.73; −0.91), p < 0.001), but not for ΔT90 or ΔT90Non-specific. Body mass index was one independent predictor of T90. ConclusionsAcross different central sleep apnea etiologies, ASV reduced AHI, but nocturnal hypoxemic burden remained high due to a non-specific component of T90 not related to episodic desaturation. Whether adjunct risk factor management such as weight-loss can further reduce T90 warrants further study.

Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions

BackgroundCognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment. Insomnia is a prevalent and debilitating public health concern. Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care.MethodsSemi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques.ResultsFindings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders.ConclusionsThese findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics.

Pharmacotherapies for sleep disturbances in dementia.

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Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers.

Difficulties in providing timely access to care have prompted interest in primary care delivery models for obstructive sleep apnea (OSA). Sustainable implementation of such models requires codesign with input from key stakeholders. The purpose of this study was to identify patient and provider perspectives on barriers and facilitators to optimal, patient-centered management of OSA in a primary care setting. This study was conducted in Alberta, Canada. Data from key stakeholders were collected through an online survey of primary care providers (n = 119), focus groups and interviews with patients living with OSA (n = 28), and workshops with primary care and sleep providers (n = 36). Quantitative survey data were reported using descriptive statistics, and qualitative data were analyzed using an inductive thematic approach. Several barriers were identified, including poor specialist access, variable primary care providers knowledge of OSA, and lack of clarity about provider roles for OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding trust in the system. Suggestions for improvement included integration of care providers in a comprehensive model of care, facilitated by improved system navigation and more effective use of technology. Themes were consistent across data collection methods and between stakeholder groups. Although primary care delivery models may improve access to OSA management, stakeholders identified important challenges in the current system. Innovative models of care, developed with input from patients and providers, may mitigate barriers and support optimal primary care management of OSA.

Sleep Dysfunction in Huntington's Disease: Perspectives from Patients.

Despite the abundance of clinical tools, sleep disorders are still not routinely evaluated in patients with Huntington's disease (HD). Sleep disturbances can exacerbate cognitive impairment and mood disorders and seriously affect the life of the patients and their families. The current study was designed to investigate sleep quality and its association with clinical symptoms in HD. As an exploratory aim, we also evaluated sleep quality in caregivers of patients with HD. Twenty-nine patients with HD and 22 caregivers completed a series of self-reported questionnaires about sleep quality and pattern, cognitive function, and depression and anxiety symptoms. Spearman correlation analyses were performed to ascertain the association between sleep quality and severity of self-perceived clinical symptoms. The primary sleep complaints reported by the patients were related to waking up in the middle of the night or early in the morning; and increased sleep latency. Seventeen of 29 HD patients (59%) and 12 of 22 caregivers (55%) were classified as "poor" sleepers. Worse sleep quality among HD patients was associated with greater severity of anxiety and depression symptoms. Importantly, a decline in sleep quality was associated with decreased self-perceived cognitive function for both HD patients and caregivers. Increasing awareness and improving our understanding of sleep dysfunction in HD is imperative for individuals with HD and indirectly, their caregivers. Regularly incorporating sleep assessments when evaluating HD patients should be considered to address this troublesome nonmotor symptom.

Survey of the Sleep Quality of Medical Staff in a Grade A Tertiary Hospital during the Novel Coronavirus Pneumonia Outbreak

This study aimed to investigate the sleep quality of medical staff in China who are combatting novel coronavirus pneumonia (COVID-19). To perform this, a survey of 127 medical staff from three separate wards (the general ward, isolation ward, and fever clinic) of a Grade A tertiary hospital in China was conducted. The survey questionnaire measured general characteristics and included the Pittsburgh Sleep Quality Index (PSQI). We consequently found that global PSQI scores differed significantly between the different wards (?2 = 44.561, P&lt;0.001). Whilst the medical staff in the general ward did not report any sleep disturbances, those in the isolation ward and the fever clinic both exhibited various degrees of sleep disturbance (global PSQI score &gt; 7). Medical staff in the isolation ward had the worst sleep quality (mean rank = 91.74), followed by those in the fever clinic (mean rank = 70.52) and the general ward (mean rank = 39.10), respectively. The primary sleep disturbances reported by the medical staff from the isolation ward included difficulty falling asleep (24 cases, 71.42%), waking early or at night (28 cases, 80%), and nightmares (18 cases, 51.42%). In addition, 31.42% (11 cases) of the medical staff from the isolation ward had less than six hours of sleep a night, and 65.71% (23 cases) felt that their sleep quality was poor; meanwhile, for the staff from the fever clinic these ratios were 16.67% (seven cases) and 33.33% (14 cases), respectively. In contrast, among medical staff in the general ward, 98% (49 cases) reported sleeping for more than six hours a night, and 96% felt that their sleep quality was good. In conclusion, of the medical staff providing treatment for COVID-19, those in isolation wards and fever clinics are more likely to experience sleep disturbances.

Gene polymorphisms (rs324957, rs324981) in NPSR1 are associated with increased risk of primary insomnia: A cross-sectional study.

Neuropeptide S and neuropeptide S receptor (NPSR1) are associated with sleep regulation. Herein, the possible contribution of 6 polymorphisms in NPSR1 on the chromosome to primary insomnia (PI) and objective sleep phenotypes was investigated.The study included 157 patients with PI and 133 age- and sex-matched controls. All subjects were investigated by polysomnography for 3 consecutive nights. The genotyping of 6 polymorphisms was carried out by polymerase chain reaction-restriction fragment length polymorphism method.A significant difference was detected for rs324957 and rs324981 between PI and controls. The PI patients had a higher frequency of AA than controls in rs324957 (P = .02) and rs324981 (P = .04). However, for other single nucleotide polymorphisms (rs323922, rs324377, rs324396, and rs324987), no significant differences were observed between PI patients and controls. There were 2 different allelic combinations that were associated with PI susceptibility (CATGTC, GCCAAT) and its risk factor. A significant difference in sleep latency was observed among 3 genotype carriers of NPSR1 gene polymorphism rs324957 in PI group (P = .04), with carriers of the A/A genotype having the longest sleep latency (mean ± SD: 114.80 ± 58.27), followed by the A/G genotype (112.77 ± 46.54) and the G/G genotype (92.12 ± 42.72).This study provided the evidence that the NPSR1 gene polymorphisms (rs324957, rs324981) might be susceptibility loci for PI. Further studies are needed to explore the role of NPSR1 gene polymorphisms in molecular mechanisms of PI in a larger sample size.

Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome?

IntroductionObstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. ObjectiveTo evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. MethodsTwenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. ResultsThe respiratory event index corresponded to 8.1 ± 4.0 in group 1 and 47.5 ± 19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ± 0.4; CSA 2 = 2.1 ± 0.9; CSA 3 = 3.5 ± 1.8 and, in group 2: CSA 1 = 1.2 ± 0.3, CSA 2 = 2.0 ± 0.5; CSA 3 = 2.8 ± 0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ± 1.0; V2 = 9.3 ± 5.0; V3 = 40.2 ± 21.5 and in group 2 a: V1 = 3.6 ± 0.5; V2 = 7.6 ± 1.5; V3 = 31.5 ± 6.7. Cross-sectional area and volume ​​did not differ between groups. ConclusionThere were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.

Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study.

The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range. Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline. Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001). SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.

Evaluation of the Impact of Body Position on Primary Central Sleep Apnea Syndrome

ObjectiveTo evaluate the impact of the body position on primary central sleep apnea syndrome. MethodsFifty-five subjects diagnosed with central sleep apnea (CSA) through polysomnographic examinations were prospectively enrolled in the study. All patients underwent cardiologic and neurologic examinations. Primary positional central sleep apnea (PCSA) was determined when the supine Apnea–Hypopnea Index (AHI) was greater than two times the non-supine AHI. The primary PCSA and non-PCSA groups were compared in terms of demographic characteristics, sleep parameters, and treatment approaches. ResultsOverall, 39 subjects diagnosed with primary CSA were included in the study; 61.5% of the subjects had primary PCSA. There were no differences between the primary PCSA and non-PCSA groups regarding age, sex, body mass index (BMI), co-morbidities, and history of septoplasty. In terms of polysomnography parameters, AHI (P=.001), oxygen desaturation index (P=.002), the time spent under 88% saturation during sleep (P=.003), number of obstructive apnea (P=.011), mixed apnea (P=.009), and central apnea (P=.007) was lower in the primary PCSA group than in the non-PCSA group. Twenty-nine percent of the patients in the primary PCSA group were recommended position treatment and 71% were recommended positive airway pressure (PAP) therapy; all patients in the non-PCSA group were recommended PAP therapy. ConclusionsOur results demonstrated that the rate of primary PCSA was high (61.5%) and primary PCSA was associated with milder disease severity compared with non-PCSA. The classification of patients with primary CSA regarding positional dependency may be helpful in terms of developing clinical approaches and treatment recommendations.

0389 Prevalent Insomnia Symptoms and Need for an Intervention Among Oncology Nurses

Abstract Introduction Insomnia is prevalent in the working population. Nurses may be particularly vulnerable to insomnia due to demands with shift work, limited recovery between shifts, lack of control over their work, and stress associated with proximity to life-threatening health conditions. Insomnia in nurses is a significant public health burden, because it can lead to degraded quality of patient care. This study examined the prevalence of insomnia symptoms among oncology nurses and the need for an intervention to improve insomnia symptoms. Methods Participants were 62 nurses working full-time at a cancer hospital (Mage=35.26±11.69). Participants were asked about their (1) main sleep-related complaint, (2) willingness to participate in a sleep-focused intervention, (3) preferred delivery forms of the intervention (i.e., group-based, online, and/or one-on-one), and (4) preference for content to include in the intervention (e.g., sleep hygiene education, mindfulness, cognitive-behavioral therapy). We used content analysis to analyze open-ended responses as well as descriptive statistics to summarize data. Results Most (74%) reported difficulty falling or staying asleep or not feeling rested upon awakening as their primary or secondary sleep concerns. Nearly all nurses (95%) expressed interest in participating in a future sleep-focused intervention. In terms of preferred delivery forms of the intervention, an online intervention was most preferred (56%), followed by group meetings at the workplace (50%), and one-on-one meetings at the clinic (29%). Mindfulness strategies were preferred by most nurses (73%), followed by cognitive-behavioral therapy (48%), and sleep hygiene education (34%). Conclusion Most oncology nurses report insomnia symptoms and the majority are interested in participating in an intervention to improve their insomnia symptoms either online or in group sessions at the workplace. The information obtained from this pilot study will serve as the basis for developing a future intervention to improve insomnia and overall sleep health in oncology nurses. Support This work was supported, in part, by the University of South Florida College of Behavioral &amp; Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).

0955 Does Primary Caregiver Influence Sleep in Preschoolers? Evidence from a Large-Scale Longitudinal Study in China

Abstract Introduction The aim of the study is to characterize sleep disturbances and sleep patterns in preschoolers, and to examine the potential role of primary caregivers and particularly its transition on children’s sleep in a large-scale cohort study in China. Methods A representative sample of 20324 newly enrolled preschoolers(age 3-4 years) were recruited in Shanghai,China at 2016.11. Sleep disturbances were examined at 3 timepoints from age 3-4 years to 5-6 years by the Children’s Sleep Habits Questionnaire(CSHQ). Data on bedtime, onset time and offset time were included, along with primary caregivers derived from each follow-up. Prevalence and trend estimates of sleep disturbances and sleep patterns were presented. Multivariable logistic regression and propensity score-adjusted models for sleep disturbances at wave3 on different caregiving models were analysed adjusting for demographics, socioeconomic status, family characteristics, maternal mental health and CSHQ total score at baseline. Results Prevalence of global sleep disturbances (CSHQ total score&amp;gt;41) steadily fell from 84.2% to 73.8%. Specifically, behavioral sleep problem domains of “Bedtime besistance”and “Sleep anxiety” decreased from 66.4% to 47.3% and 53.4% to 37.8%, respectively. Meanwhile, Bedtime gradually delayed from 21:04(SD=0:37) to 21:20(SD=0:33) while offset time changed slightly from 7:13(SD=0:29) to 7:17(SD=0:27). Compared with counterparts in western countries, children slept for a shorter nocturnal sleep duration (NSD) with 9.51(SD=0.57) hours at wave1, 9.42(SD=0.57) hours at wave2 and 9.42(SD=0.52) hours at wave3. Different caregiving models were independently associated with sleep disturbances at wave3. Taking “Predominant parental care” as reference, “Predominant grandparental care” and “Transition from parental to grandparental care” were associated with higher odds of sleep disturbances (OR=1.32, 95% CI [1.17, 1.48], p&amp;lt;0.001 and OR=1.25, 95% CI [1.03, 1.52], p=0.020, respectively). While “Transition from grandparental to parental care” has no significant effect(OR=1.04, 95%CI [0.94, 1.15], p=0.436). Conclusion Grandparental care is associated with increased risk of sleep disturbances among preschoolers in China. Parenting and Grandparenting factors should be considered when assessing and treating sleep disturbances and optimizeing sleep health in preschoolers. Support Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81728017); Ministry of Science and Technology (2016YFC1305203); Shanghai Science and Technology Commission (17XD1402800, 18695840200, 2018SHZDZX05, 18JC1420305);

1049 Sleep Fragmentation And Sleep Restriction Are Associated With Increased Energy Intake Among Individuals Who Have Involuntarily Lost Their Jobs

Abstract Introduction Obesity is a major public health concern disproportionately affecting people of lower socioeconomic status. Involuntary job loss is a predictor of economic hardship and unemployment has been associated with poor sleep quality. Little is known about daily sleep and energy intake in this high-risk population. We hypothesized that disrupted, short sleep would be associated with increased energy intake among individuals who experienced involuntary job loss within the last 90 days. Methods Complete baseline data were analyzed from the ongoing Assessing Daily Activity Patterns through occupational Transitions (ADAPT) study. Over the same two-week period, participants (n = 191; 117 female; 63 Hispanic) were instructed to complete 14 days of daily sleep diaries and up to three 24-hour dietary recalls, conducted by trained interviewers using the Nutrition Data System for Research. The primary sleep variable was a composite score summarizing standardized number of awakenings and reversed-scored total sleep time; higher scores represented worse sleep. Energy intake was estimated as average 24 hour reported kcals/day. Linear regression was employed with age, gender, and body mass index as covariates. Results Higher sleep composite scores were associated with higher self-reported intake in kilocalories (kcal), B = 84.83, SE = 38.01, t = 2.23, &amp;lt;i&amp;gt; p &amp;lt;/i&amp;gt; &amp;lt; .05. Wake time after sleep onset, sleep onset latency, and sleep efficiency were not associated with energy intake. Interestingly, higher subjective sleep quality was associated with consumption of more average daily kcals. Conclusion In a sample population of adults experiencing stress and economic hardship related to job loss, sleep continuity and quantity were associated with higher energy intake. With further prospective support, these findings suggest that public health interventions for obesity may benefit from behavioral sleep intervention components targeting both sleep fragmentation and sleep restriction. Support #1R01HL117995-01A1

0221 Late Meals, Sleep Duration, and Sleep Fragmentation: Findings From the American Time Use Survey

Abstract Introduction Sleep hygiene recommendations discourage eating close to bedtime, though published data on the impact are not consistent. Associations between eating or drinking, within 1-hour prior to bedtime, sleep duration and sleep fragmentation were examined in a nationally-representative sample. Methods Data from the American Time Use Survey (ATUS), administered to a nationally representative sample of n=201,151 US residents aged ≥15 years were utilized. In an annual phone interview, ATUS participants were asked to record their activities during a 24-hour period (04:00am to 04:00am on the interview day) and were randomly selected to report weekdays or weekend activities. The present analysis included data from 2003–2018 and restricted to weekday respondents (n=124,242). Reporting of eating/drinking activities within 1-hour prior to bedtime was considered as a dichotomous variable (yes/no). Sleep fragmentation was defined as any awakening during the primary sleep episode (yes/no). Linear and logistic regression models, adjusted for age, sex, cohabitation, education and employment, were used to examine associations between eating/drinking and sleep duration or sleep fragmentation. Results In this ATUS sample, 56% of respondents were female and the mean age was 45 years. Mean sleep duration was 8.02 (0.007) hours, and 6% of survey participants ate/drank within 1-hour prior to bedtime. Overall, eating/drinking within 1-hour prior to bedtime was associated with longer sleep duration (p&amp;lt;0.01). Women and men who ate/drank within 1-hour prior to bedtime, in comparison to those who did not, had 35 minutes and 26 minutes longer sleep duration (p- value&amp;lt;0.0001) Eating/drinking activities within 1-hour prior to bedtime were associated with 1.8 higher odds of fragmented sleep (p&amp;lt;0.001). Conclusion In this large population-based survey, weekday eating or drinking within 1-hour prior to bedtime was associated with sleep fragmentation and longer sleep duration. Causal pathways would be difficult to discern, though sleep fragmentation could lead to compensatory increases in sleep duration. Support None

0545 Bi-Layer Melatonin Tablet Provides Immediate and Extended Absorption to Address Primary Sleep Issues

Abstract Introduction Melatonin is a naturally-occurring hormone that functions in the regulation of the sleep-wake cycle. Exogenous melatonin has demonstrated utility for the induction and maintenance of sleep. Modulation of tablet dissolution rates can be achieved by strategically using binding agents in two layers to rapidly raise melatonin levels and sustain elevated levels over time to better emulate normal nocturnal melatonin secretion. Methods A randomized, double-blind, controlled cross-over study was conducted in healthy adults (n=18) to investigate the pharmacokinetics of a 4.5 mg melatonin bi-layer tablet with either prolonged-release (PR) or immediate-release (IR) characteristics. Blood samples were collected at 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 6, 8 and 10 h post-ingestion and melatonin concentrations were quantified. Results The PR formulation had a lower maximum concentration (Cmax, p&amp;lt;0.002), but a longer time to reach maximum concentration (Tmax, p&amp;lt;0.001). Absorption rate constant (Ka) and terminal disposition rate constant (λ) were both lower in PR melatonin than the IR formulation (p&amp;lt;0.001), indicating slower absorption and elimination rates. These measures were consistent with significantly greater absorption (ta1/2, p&amp;lt;0.002) and elimination half-lives (t1/2, p&amp;lt;0.001) in the IR formulation compared to the PR formulation. Additionally, plasma melatonin concentrations reached pre-ingestion values by 8 h post-administration of the PR formulation, indicating that individuals sleeping for a recommended 7-9 hours will wake with normal melatonin levels, when taken an hour before bedtime. Conclusion Prolonged-release bi-layer melatonin tablet safely and effectively extends the absorption of exogenous melatonin compared to an immediate-release formulation. Support Pharmavite, LLC

0648 Impact of Positive Airway Pressure (PAP) Troubleshooting Clinic Visits on Patient Satisfaction, PAP Use, Mask Leak, and Prolonged Use

Abstract Introduction Patients with sleep apnea are often prescribed positive airway pressure (PAP) treatment. Some patients have difficulty consistently using a PAP machine due to problems such as air leak, mask discomfort, and dry mouth. The purpose of this project is to evaluate the satisfaction and efficacy of a PAP Troubleshooting Clinic lead by a RN and a respiratory technician (RT). This clinic seeks to improve PAP compliance, increase PAP tolerability and increase PAP treatment efficacy Methods The PAP Troubleshooting Clinic consists of a RN and RT with specialized knowledge about sleep apnea and PAP treatment. During a 30 or 60-minute clinic visit, these providers review the patient’s experience with PAP, assess mask fit, review PAP data and PAP settings, and recommend treatment adjustments for the primary Sleep Clinic provider’s consideration. Outcomes assessment includes satisfaction (a telephone survey one week after the visit) and efficacy (30-day data on overall use, mask leak, and days with ≥ 4 hours of use downloaded from PAP machines). Results To date, 58 patients have received care in the clinic and 56 (96.5%) patients reported they were satisfied/highly satisfied with the PAP Troubleshooting Clinic. From the sample, forty-three (74.1%) patients were compliant with mask use over 30 days. Twenty-four (55.81%) showed a greater than 10% reduction in mask leak after intervention. Ten patients (23.3%) achieved an improvement with a 10% increase in number of days with &amp;gt; than 4 hours of PAP use. Conclusion Patients and Sleep Clinic providers are very satisfied with the PAP Troubleshooting Clinic. Patients are referred to this clinic because they have significant issues with PAP usage and are at high risk of discontinuing use. Patients find the clinic helpful and encouraging, while sleep medicine physicians and APPs appreciate the assistance in helping patients succeed with PAP, especially during the 30-day time period where PAP compliance receives scrutiny from clinics and payers. Support A PAP Troubleshooting Clinic is an effective way to improve patient PAP Use, Mask Leak, Prolonged Use and Patient Satisfaction. Importantly, this new clinical model offers a valuable alternative to provide patients with the appropriate level of care.

Who Is Seeking Help for Sleep? A Clinical Profile of Patients in a Sleep Psychology Clinic.

The present study outlines a clinical profile of an ecologically valid population consulting for sleep difficulties at the Sleep Psychology Clinic of the Consultation service of the School of Psychology of Université Laval . Patients self-report to the sleep clinic. Following a phone screening interview, patients present to the clinic for a semi-structured clinical interview for sleep and psychopathology, which is conducted by psychologists and doctorate psychology students. A chart review of adult patients (56% female, Mage = 43.6years) was conducted (between 2015 and 2018) to record diagnosed sleep, psychiatric, and medical conditions. There was a high level of comorbidity with an average of 2.85 diagnoses (any diagnosis combined) per patient (SD = 1.76), with 27% of the patients having at least four diagnoses. Reviewing specific types of disorders, 58.5% of patients presented with at least one comorbid psychiatric disorder, 27.5% with one medical comorbidity, or 39.5% with another sleep disorder alongside their primary sleep concern. Insomnia was the main sleep disorder (76%). Anxiety (77.8%) and depression (53.8%) were the predominant psychiatric disorders, while fibromyalgia (10.9%), hypertension (10.9%), and head trauma (9.1%) were the main medical conditions. Of patients with five diagnoses and more, 77.8% were taking on average 3.2 different types of medications. The number of diagnoses predicted the use of prescribed hypnotics and the use of any type of medications. This clinical profile emphasizes the reality of multiple morbidities, which may have implications for clinical decisions. Future research is required to evaluate transdiagnostic approaches for the sleep disorder patient with multiple morbidities.

Cellular damage, including wounding, drives C. elegans stress-induced sleep

Across animal phyla, sleep is associated with increased cellular repair, suggesting that cellular damage may be a core component of sleep pressure. In support of this notion, sleep in the nematode Caenorhabditis elegans can be triggered by damaging conditions, including noxious heat, high salt, and ultraviolet light exposure. It is not clear, however, whether this stress-induced sleep (SIS) is a direct consequence of cellular damage, or of a resulting energy deficit, or whether it is triggered simply by the sensation of noxious conditions. Here, we show that thermosensation is dispensable for heat-induced sleep, that osmosensation is dispensable for salt-induced sleep, and that wounding is also a sleep trigger, together indicating that SIS is not triggered by sensation of noxious environments. We present evidence that genetic variation in cellular repair pathways impacts sleep amount, and that SIS involves systemic monitoring of cellular damage. We show that the low-energy sensor AMP-activated protein kinase (AMPK) is not required for SIS, suggesting that energy deficit is not the primary sleep trigger. Instead, AMPK-deficient animals display enhanced SIS responses, and pharmacological activation of AMPK reduces SIS, suggesting that ATP-dependent repair of cellular damage mitigates sleep pressure.

Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain.

Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists. This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test. A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients. Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care. Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.

Primary Headaches and Sleep Disturbances: A Cause or a Consequence?

Primary Headaches and Sleep Disturbances: A Cause or a Consequence?