Sleep Arousal Research Articles

The therapeutic potential of attentional bias modification training for insomnia: study protocol for a randomised controlled trial

BackgroundThe efficacy of attentional bias modification (ABM) as a treatment for anxiety and depression has been extensively studied with promising results. Despite some evidence of sleep-related attentional biases in insomnia, only a small number of studies, yielding mixed results, have examined the application of ABM in insomnia. This study specifically aims to determine whether ABM can reduce (i) the presence of an attentional bias for sleep-related threatening words; (ii) insomnia symptom severity; (iii) sleep onset latency; and (iv) pre-sleep cognitive arousal amongst individuals with insomnia compared to a non-treatment control group of individuals with insomnia.Methods/designWe propose a randomised controlled trial of 90 individuals from the general population who meet the criteria for Insomnia Disorder. Following an initial examination for the presence of a sleep-related attentional bias using the dot-probe paradigm, participants will be randomised to an online attentional bias modification training condition, or to a standard attentional bias task (non-treatment) control condition. Both conditions will be delivered online by a web platform. All participants allocated to the non-treatment control group will be offered ABM training once the study is complete. The primary outcome will be the attentional bias indices of vigilance and disengagement and self-reported insomnia symptoms, sleep onset latency and pre-sleep cognitive arousal. Attentional bias and insomnia symptoms will be assessed at baseline (day 1) and post-treatment (2 days after the final training session: day 9). Insomnia symptoms will be again assessed at follow-up (day 16). Secondary outcomes include examining whether sleep associated monitoring and worry are related to a sleep-related attentional bias in insomnia, and whether such reports reduce following ABM. All main analyses will be carried out on completion of follow-up assessments. The trial is supported by the Department of Psychology, Sociology and Politics at Sheffield Hallam University.DiscussionThis study will extend the research base examining the efficacy of attentional bias modification for insomnia.Trial registrationISRCTN (ISRCTN11643569, registered on 5 June 2018).

High-intensity interval exercise induces greater acute changes in sleep, appetite-related hormones, and free-living energy intake than does moderate-intensity continuous exercise.

The aim of this study was to compare the effect of high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) on sleep characteristics, appetite-related hormones, and eating behaviour. Eleven overweight, inactive men completed 2 consecutive nights of sleep assessments to determine baseline (BASE) sleep stages and arousals recorded by polysomnography (PSG). On separate afternoons (1400-1600 h), participants completed a 30-min exercise bout: either (i) MICE (60% peak oxygen consumption) or (ii) HIIE (60 s of work at 100% peak oxygen consumption: 240 s of rest at 50% peak oxygen consumption), in a randomised order. Measures included appetite-related hormones (acylated ghrelin, leptin, and peptide tyrosine tyrosine) and glucose before exercise, 30 min after exercise, and the next morning after exercise; PSG sleep stages; and actigraphy (sleep quantity and quality); in addition, self-reported sleep and food diaries were recorded until 48 h after exercise. There were no between-trial differences for time in bed (p = 0.19) or total sleep time (p = 0.99). After HIIE, stage N3 sleep was greater (21% ± 7%) compared with BASE (18% ± 7%; p = 0.02). In addition, the number of arousals during rapid eye movement sleep were lower after HIIE (7 ± 5) compared with BASE (11 ± 7; p = 0.05). Wake after sleep onset was lower following MICE (41 min) compared with BASE (56 min; p = 0.02). Acylated ghrelin was lower and glucose was higher at 30 min after HIIE when compared with MICE (p ≤ 0.05). There were no significant differences between conditions in terms of total energy intake (p ≥ 0.05). HIIE appears to be more beneficial than MICE for improving sleep quality and inducing favourable transient changes in appetite-related hormones in overweight, inactive men. However, energy intake was not altered regardless of exercise intensity.

Apparent diffusion coefficient changes in human brain during sleep – Does it inform on the existence of a glymphatic system?

The role of sleep in brain physiology is poorly understood. Recently rodent studies have shown that the glymphatic system clears waste products from brain more efficiently during sleep compared to wakefulness due to the expansion of the interstitial fluid space facilitating entry of cerebrospinal fluid (CSF) into the brain. Here, we studied water diffusivity in the brain during sleep and awake conditions, hypothesizing that an increase in water diffusivity during sleep would occur concomitantly with an expansion of CSF volume - an effect that we predicted based on preclinical findings would be most prominent in cerebellum. We used MRI to measure slow and fast components of the apparent diffusion coefficient (ADC) of water in the brain in 50 healthy participants, in 30 of whom we compared awake versus sleep conditions and in 20 of whom we compared rested-wakefulness versus wakefulness following one night of sleep-deprivation. Sleep compared to wakefulness was associated with increases in slow-ADC in cerebellum and left temporal pole and with decreases in fast-ADC in thalamus, insula, parahippocampus and striatal regions, and the density of sleep arousals was inversely associated with ADC changes. The CSF volume was also increased during sleep and was associated with sleep-induced changes in ADCs in cerebellum. There were no differences in ADCs with wakefulness following sleep deprivation compared to rested-wakefulness. Although we hypothesized increases in ADC with sleep, our findings uncovered both increases in slow ADC (mostly in cerebellum) as well as decreases in fast ADC, which could reflect the distinct biological significance of fast- and slow-ADC values in relation to sleep. While preliminary, our findings suggest a more complex sleep-related glymphatic function in the human brain compared to rodents. On the other hand, our findings of sleep-induced changes in CSF volume provide preliminary evidence that is consistent with a glymphatic transport process in the human brain.

A Circadian Output Circuit Controls Sleep-Wake Arousal in Drosophila

The Drosophila core circadian circuit contains distinct groups of interacting neurons that give rise to diurnal sleep-wake patterns. Previous work showed that a subset of dorsal neurons 1 (DN1s) are sleep-promoting through their inhibition of activity-promoting circadian pacemakers. Here we show that these anterior-projecting DNs (APDNs) also "exit" the circadian circuitry and communicate with the homeostatic sleep center in higher brain regions to regulate sleep and sleep-wake arousal. These APDNs connect to a small, discrete subset of tubercular-bulbar neurons, which are connected in turn to specific sleep-centric ellipsoid body (EB)-ring neurons of the central complex. Remarkably, activation of the APDNs produces sleep-like oscillations in the EB and affects arousal. The data indicate that this APDN-TuBusup-EB circuit temporally regulates sleep-wake arousal in addition to the previously defined role of the TuBu-EB circuit in vision, navigation, and attention.

Respiratory-Related Leg Movements of Sleep Are Associated With Serotonergic Antidepressants But Not Bupropion.

Respiratory-related leg movements (RRLMs) may contribute to the cardiovascular risk associated with obstructive sleep apnea (OSA). Selective serotonin reuptake inhibitors (SSRIs), but not bupropion, increase periodic leg movements in sleep. This study examines whether patients with OSA using SSRIs have more RRLMs than those taking bupropion or no antidepressant. Patients with an apnea-hypopnea index (AHI) of at least 10 events/h during a full-night diagnostic study or split-night study, who were taking bupropion (n = 32), an SSRI (n = 31), or no antidepressant (n = 31), were selected from a database of prestudy questionnaires. RRLMs were scored according to World Association of Sleep Medicine 2016 standards. Patients using SSRIs had significantly greater overall RRLM% (defined as the percentage of respiratory events associated with a leg movement, including apneas, hypopneas, and respiratory effort-related arousals), RRLM index, and periodic limb movement index relative to patients using bupropion and control patients. The difference between the RRLM% in the SSRI and bupropion groups was limited to patients undergoing split-night studies, and that of the SSRI and control groups was limited to patients undergoing full-night diagnostic studies. The greater number of RRLMs and PLMs in the SSRI group may contribute to treatment-emergent insomnia often seen with SSRI use. Fragmented sleep and elevated autonomic nervous system activation associated with increased RRLMs in patients with OSA taking SSRIs might also limit the tolerability of antidepressant treatment, as well as increase the risk for cardiovascular disease.

Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients

Background: Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. Methods: In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. Results: Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04–3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36–9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12–9.57]) and multiple cardiovascular risk factors. Conclusions: Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.

Sleep hygiene-related conditions in patients with mild to moderate obstructive sleep apnea

ObjectiveSleep hygiene-related conditions are factors that affect the symptoms experienced by patients with obstructive sleep apnea (OSA). However, very few studies have investigated the association between sleep hygiene and sleep symptoms, especially in patients with mild or moderate OSA. This study evaluated the relationship between factors related to sleep hygiene and clinical symptoms in patients with mild to moderate OSA. MethodsOne hundred and seventy-four patients who visited the Sleep Breathing Disorder Center at a tertiary academic center to evaluate suspected OSA were included. All patients underwent standard polysomnography (PSG) and the Epworth sleepiness scale (ESS) and questionnaires related to daytime and nighttime symptoms and sleep hygiene. Medical records were reviewed for demographic, clinical, and PSG parameters. Correlation analysis between sleep hygiene-related conditions and clinical symptoms in patients with mild to moderate OSA was performed. ResultsThe correlation analysis between the nine categories of sleep hygiene and the three categories of clinical symptoms showed that, in the case of inadequate temperature and humidity conditions, the three categories of clinical symptoms were more severe (daytime symptoms r=0.382, nighttime symptoms r=0.568, ESS score r=0.321). Drinking alcohol before sleep (daytime symptoms r=0.457, nighttime symptoms r=0.649, ESS score r=0.301) and emotional excitement or arousal (daytime symptoms r=0.378, nighttime symptoms r=0.545, ESS score r=0.341) were correlated with greater severity of each of the clinical symptoms (p<0.05). ConclusionAmong the factors of sleep hygiene-related conditions, inadequate temperature and humidity, drinking alcohol before sleep, and emotional excitement or arousal were associated with symptoms of mild to moderate OSA. This study supports the hypothesis that patients with mild to moderate OSA can experience symptom relief if they are trained to correct lifestyle habits to maintain adequate sleep hygiene-related conditions.

Obstructive Sleep Apnea and Sleep Architecture in Adolescents With Severe Obesity: Effects of a 9-Month Lifestyle Modification Program Based on Regular Exercise and a Balanced Diet.

Physical exercise and lifestyle modification are recognized as adjunct therapy for obstructive sleep apnea (OSA) in overweight adults. The objectives of this study were to investigate the effects of long-term physical exercise combined with a balanced diet on sleep architecture, sleep duration, and OSA in adolescents with severe obesity. This interventional study was conducted in a nursing institution. Participants were aged 14.6 ± 1.2 years with obesity (body mass index (BMI) = 40.2 ± 6.5 kg/m2). At admission and at 9 months, participants underwent ambulatory polysomnography and incremental maximal exercise testing to determine cardiorespiratory fitness. Twenty-four subjects completed the study. Analyses were performed on the whole population and on a subgroup of subjects with OSA (OSA-subgroup). OSA, defined as obstructive apnea-hypopnea index (OAHI) ≥ 2 events/h, was diagnosed in 58.3% of the population. OAHI was only associated with fat mass in males (r = .75, P < .05). At 9 months postintervention, weight loss (-11.1 kg, P < .0001) and improved cardiorespiratory fitness (VO2peak: +4.9 mL/min/kg, P < .001) were found in the whole population. Sleep duration was increased (+34 minutes, P < .05) and sleep architecture was changed with an increase of rapid eye movement sleep (+2.5%, P < .05) and a decrease of stage N3 sleep (-3.1%, P < .001). Similar results were found in the OSA subgroup. However, OAHI remained unchanged (P = .18). A combination of supervised aerobic exercise and a balanced diet led to weight loss, improved aerobic capacity, and modified sleep architecture without changes in OSA. A commentary on this article appears in this issue on page 907. Registry: ClinicalTrials.gov, Title: Exercise and Venous Compression on Upper Airway Resistance in Obese Teenagers With OSA (OBESOMAC), URL: https://clinicaltrials.gov/ct2/show/NCT02588469, Identifier: NCT02588469.

Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder.

Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls.Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires.Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients.Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

Sleep architecture and epileptic characteristics of drug naïve patients in childhood absence epilepsy spectrum. A prospective study

PurposeChildhood absence epilepsy (CAE) is an epileptic syndrome presenting between 2nd–10th years. The spells are elicited with hyperventilation (HV) while sleep seems to exacerbate the electrical activity. Our aim is to describe sleep architecture and its relationship with epileptic discharges (EDs) in patients with CAE, before treatment and one year later. MethodsTwenty-eight, drug-naive children were recruited (21 girls), mean age 90.1 ± 32.6 months. Routine-EEG and overnight EEG-polygraphy were conducted upon diagnosis and one year later. Patients were separated in two groups of similar mean age, according to their clinical response at the second recording: group A: children with absolute control of absences and group B: children with partial control. Sleep parameters, EDs and arousals were measured. The effect of medication on sleep parameters was examined, according to 2 groups: valproic-treated and non valproic-treated. ResultsGroup A showed significant improvement in total sleep time, REM-sleep latency, REM-sleep, arousals-number/hour and arousals-duration/hour between the two recordings. Comparing the two groups for each recording separately, group A initially demonstrated greater epileptic activity and worse sleep parameters, whereas in the second recording exhibited total elimination of the EDs and significantly less arousals. Group B demonstrated persisting EDs and slight deterioration in some sleep parameters during the second recording, despite the lower epileptic load initially. No significant difference was identified between valproic and non-valproic treated patients, regarding the effect on sleep parameters. ConclusionAbsolute control of absences and normalization of the electroencephalogram are accompanied by more continuous, stable and efficacious sleep in children with CAE.

0142 Automatic Detection of Cortical Arousals in Sleep using Bi-direction LSTM Networks

0142 Automatic Detection of Cortical Arousals in Sleep using Bi-direction LSTM Networks

Neuronal noise as an origin of sleep arousals and its role in sudden infant death syndrome.

In addition to regular sleep/wake cycles, humans and animals exhibit brief arousals from sleep. Although much is known about consolidated sleep and wakefulness, the mechanism that triggers arousals remains enigmatic. Here, we argue that arousals are caused by the intrinsic neuronal noise of wake-promoting neurons. We propose a model that simulates the superposition of the noise from a group of neurons, and show that, occasionally, the superposed noise exceeds the excitability threshold and provokes an arousal. Because neuronal noise decreases with increasing temperature, our model predicts arousal frequency to decrease as well. To test this prediction, we perform experiments on the sleep/wake behavior of zebrafish larvae and find that increasing water temperatures lead to fewer and shorter arousals, as predicted by our analytic derivations and model simulations. Our findings indicate a previously unrecognized neurophysiological mechanism that links sleep arousals with temperature regulation, and may explain the origin of the clinically observed higher risk for sudden infant death syndrome with increased ambient temperature.

VaPER: The Development of Spaceflight Associated Neuro‐ocular Syndrome (SANS) During Hypercapnic 6° Head‐Down Tilt Bed Rest; sans Sufficient Sleep?

OBJECTIVETo determine whether the combination of a cephalad fluid shift induced by headdown tilt (HDT) bed rest and chronic exposure to mild hypercapnia for 30 days will alter sleep architecture and circadian rhythm, contributing to characteristics of Spaceflight Associated Neuro‐ocular Syndrome (SANS).METHODSAfter 14 days of ambulatory normocapnic familiarization with the facility and baseline data collection (BDC), eleven subjects (5 female) breathed mild, ambient hypercapnia (0.5% CO2) throughout 30 days of 6° HDT at the German Aerospace Center (DLR): envihab facility. Following HDT, subjects were monitored for an additional 14 days of ambulatory, normocapnic recovery (R). Overnight polysomnography (PSG) was measured using a type‐2 sleep monitoring system, and the PSG was scored by a Polysomnographic Technologist to assess sleep duration, staging, latency, and arousals. Circadian rhythm was assessed by monitoring 24‐hour core body temperature with rectal temperature probes. Arterial PCO2 levels were estimated from transcutaneous PCO2 monitoring throughout sleep. Retinal thickness was measured via optical coherence tomography (OCT); those with increased thickness &gt;50μ in the nasal quadrant were classified as RET+, those &lt;50μ were classified as RET‐. After one night of familiarization with the instrumentation, measurements were collected at six different time points (one BDC, three HDT, and two R).RESULTSWhen comparing RET+ to RET‐, subjects had: significantly less total sleep time (TST) in BDC (345 ± 25 min vs 401 ± 23 min, p &lt; 0.05), HDT4 (303 ± 64 min vs 375 ± 20 min, p &lt; 0.05), HDT28 (344 ± 59 min vs 407 ± 32 min, p &lt; 0.05), and R+4 (344 ± 68 min vs 421 ± 21 min, p &lt; 0.05); significantly less stage 2 (N2) sleep in HDT4 (157 ± 43 min vs 220 ± 9 min, p &lt; 0.05), HDT28 (198 ± 32 min vs 256 ± 21 min, p &lt; 0.05), and R+4 (187 ± 74 min vs 271 ± 32, p &lt; 0.05); significantly more wake after sleep onset (WASO) in HDT4 (147 ± 85 min vs 57 ± 27 min, p &lt; 0.05) and R+4 (134 ± 106 min vs 41 ± 12 min, p &lt; 0.05); and a significantly reduced core body temperature amplitude at BDC (0.3 ± 0.1 deg vs 0.5 ± 0.1 deg, p &lt; 0.05), HDT4 (0.2 ± 0.1 deg vs 0.4 ± 0.1 deg, p &lt; 0.05), HDT28 (0.3 ± 0.1 deg vs 0.4 ± 0.1 deg, p &lt; 0.05), and R+10 (0.3 ± 0.0 deg vs 0.4 ± 0.1 deg, p &lt; 0.05).CONCLUSIONSPrior to and throughout the experimental conditions, when compared to RET‐, RET+ subjects were “short” sleepers and in general had less N2 sleep, greater WASO, and had a lower amplitude of core body temperature. We conclude that insufficient sleep may predispose certain individuals to the development of retinal thickening, a finding of SANS. Objective PSG may be a potential variable to consider when determining astronaut spaceflight duration.Support or Funding InformationNASA Human Research Program NNJ14ZSA001NThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Sleep-Related Bruxism

This study aimed to review the current knowledge on sleep-related bruxism, highlight the most recent findings, and discuss future research perspectives. Sleep-related bruxism etiology appeared to follow a genetic-environmental model, whereas comorbidity with other sleep disorders, obstructive sleep apnea, and gastroesophageal reflux has been recently described and deserves further investigations. Sleep-related bruxism is an involuntary motor activity characterized by episodic and rhythmic masticatory muscle contractions of tooth grinding or jaw clenching during sleep. It predominantly occurs during light sleep stages and in association with sleep arousal. Although the gold standard diagnostic tool is a polysomnography recording, most of the time diagnosis is based on the medical and dental history and the clinical examination. A conservative therapeutic approach is generally recommended, using dental guards, and it aims to manage and prevent the eventual consequences on the masticatory system, including tooth wear, prosthetic biomechanical complications, implant failure, muscle pain, and headaches.

Automatic, electrocardiographic-based detection of autonomic arousals and their association with cortical arousals, leg movements, and respiratory events in sleep.

The current definition of sleep arousals neglects to address the diversity of arousals and their systemic cohesion. Autonomic arousals (AA) are autonomic activations often associated with cortical arousals (CA), but they may also occur in relation to a respiratory event, a leg movement event or spontaneously, without any other physiological associations. AA should be acknowledged as essential events to understand and explore the systemic implications of arousals. We developed an automatic AA detection algorithm based on intelligent feature selection and advanced machine learning using the electrocardiogram. The model was trained and tested with respect to CA systematically scored in 258 (181 training size/77 test size) polysomnographic recordings from the Wisconsin Sleep Cohort. A precision value of 0.72 and a sensitivity of 0.63 were achieved when evaluated with respect to CA. Further analysis indicated that 81% of the non-CA-associated AAs were associated with leg movement (38%) or respiratory (43%) events. The presented algorithm shows good performance when considering that more than 80% of the false positives (FP) found by the detection algorithm appeared in relation to either leg movement or respiratory events. This indicates that most FP constitute autonomic activations that are indistinguishable from those with cortical cohesion. The proposed algorithm provides an automatic system trained in a clinical environment, which can be utilized to analyze the systemic and clinical impacts of arousals.

Sleep Architecture and Hypothalamic-Pituitary-Adrenal Activity in Paradoxical and Psychophysiological Insomnia.

Introduction:There are controversial reports about association between sleep and Hypothalamic-Pituitary-Adrenal (HPA) activity. Studies have reported the influence of insomnia on HPA hormones. However, they usually ignored the heterogeneity of insomnia symptoms, so subtypes of the disorder have not been considered in the reports. The present study aimed to investigate the final and intermediate products of HPA system among a group of psychophysiological and paradoxical insomniac patients in comparison to a group of normal sleepers.Methods:We investigated the awakening serum level of Adrenocorticotropic Hormone (ACTH) and cortisol after one night Polysomnography (PSG) in 17 subjects with psychophysiological insomnia, 19 subjects with paradoxical insomnia and 17 subjects with normal sleep profile. Groups were matched for age and Body Mass Index (BMI). Serum levels of ACTH and cortisol were measured by Enzyme-Linked Immunosorbent Assay (ELISA) method.Results:Although, a tendency toward elevation of both ACTH and cortisol was observed among patients with paradoxical insomnia compared to both control and psychophysiological insomnia, the differences were not significant comparing three groups. According to regression analysis, higher Non-Rapid Eye Movement sleep (NREM) arousal and Pulse Transit Time (PTT) significantly predicted higher level of ACTH.Conclusion:These findings could suggest the personality traits hypothesis for paradoxical insomnia. Both cortical and subcortical arousal could lead to more HPA activity and higher ACTH level. Further studies are recommended to confirm the hypothesis.

Emotion, emotion regulation and sleep: An intimate relationship.

In recent years, research has witnessed an increasing interest in the bidirectional relationship between emotion and sleep. Sleep seems important for restoring daily functioning, whereas deprivation of sleep makes us more emotionally aroused and sensitive to stressful stimuli and events. Sleep appears to be essential to our ability to cope with emotional stress in everyday life. However, when daily stress is insufficiently regulated, it may result in mental health problems and sleep disturbances too. Not only does emotion impact sleep, but there is also evidence that sleep plays a key role in regulating emotion. Emotional events during waking hours affect sleep, and the quality and amount of sleep influences the way we react to these events impacting our general well-being. Although we know that daytime emotional stress affects sleep by influencing sleep physiology, dream patterns, dream content and the emotion within a dream, its exact role is still unclear. Other effects that have been found are the exaggeration of the startle response, decrease in dream recall and elevation of awakening thresholds from rapid eye movement (REM), REM-sleep, increased or decreased latency to REM-sleep, increase in percentage of REM-density, REM-sleep duration, as well as the occurrence of arousals in sleep as a marker of sleep disruption. Equally, the way an individual copes with emotional stress, or the way in which an individual regulates emotion may modulate the effects of emotional stress on sleep. The research presented here supports the idea that adaptive emotion regulation benefits our follow-up sleep. We thus conclude the current review with a call for future research in order to clarify further the precise relationship between sleep, emotion and emotion regulation, as well as to explain further how sleep dissolves our emotional stress.

Correlation of Mallampatti Score With Severity of OSA

SESSION TITLE: Sleep 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: 1.To assess the presence and severity of OSA in relation to different class severity of modified Mallampatti(MPT) score from 1-4. 2. To see if we can confidently predict a positive yield on PSG beforehand as PSG is an expensive procedure and patients themselves are the payer’s in vast majority of patients in India. METHODS: Data was accessed for 681 patients who presented from Sept 2011 to Sep 2016 with symptoms of sleep disordered breathing (SDB). MPT score of all selected subjects was measured along with Epworth Sleepiness Scale (ESS) before polysomnography. MPT was measured by same physician. All subjects had undergone level-1 Overnight Polysomnography study with Split night protocol. The PSG records were scored manually and revalidated by a single senior sleep specialist. Modified MPT score was used with grading of I-IV.OSA was defined as an AHI of 5 or greater. AHI of 5-15 being labelled as Mild OSA, with AHI of 16-30 being Moderate and AHI of more than 30 labelled as Severe OSA. RESULTS: In our study a total of 681 patients were studied. OSA was present in majority of patients (97.9%). The mean age of patients was 50.83 (±17.95) years.Five hundred and fifty eight (558) i.e 81.9% patients in our study were male who presented to us. Mean BMI was 31.60±6.04. Mean Epworth sleep score was 10.91 ±5.14. Mean MPT score was 3.10±0.84. Patients had MPT class I in 29 (4.3%), class II in 124(18.2%), class III in 281 (41.3%), class IV in 247 (36.3%). OSA was present in 667 (97.9%) patients. It was mild in 83 (12.4%), moderate in 163(24.4%) and severe in 421 (63.1%). Class I MPT patients were 27 in total who had mild OSA in 9(33%), moderate OSA in 11(40.7%) and severe OSA in 7 (25.9%). Class II MPT patients were 120 in total who had mild OSA in 29 (24.2%), moderate OSA in 34 (28.3%) and Severe OSA in 57 (47.5). Class III MPT patients were 276 in total who had mild OSA in 27 (9.8%), moderate OSA in 71(25.7%) and severe OSA in 178 (64.5%). Class IV MPT patients were 244 in total and who had mild OSA in 18(7.4%), moderate OSA in 47(19.3%) and severe OSA in 179 (73.4%). CONCLUSIONS: Presence and severity of OSA is directly related to MPT score. The higher the MPT score the greater is the probability of more severe disease. Patients with class III and IV MPT have a high probability of falling in severe OSA category. MPT class of IV and even III predicted severe OSA in 73.4 % and 64.5 respectively. CLINICAL IMPLICATIONS: The purpose of this study is not to replace PSG which is the gold standard in establishing variables of cardinal importance like fluctuation in oxygen saturation, sleep arousals, the percentages of various sleep stages especially slow wave and REM sleep, other variables like cardiac rhythm disturbances, blood pressure fluctuations and abnormal limb movements etc. However, a good clinical history and physical coupled with MPT score helps us predict the presence and severity of OSA before the patient is even subjected to PSG. DISCLOSURE: The following authors have nothing to disclose: Manjit Kanwar, Dixit Thakur, Girish Raheja, Priyadarshi Kumar, Ameet Kishore No Product/Research Disclosure Information

P365 Automated chin EMG analysis for quantification of REM sleep without atonia

Objectives REM sleep without atonia (RSWA) is a key feature of REM sleep behavior disorder (RBD). However, detailed visual scoring of EMG on 30 and 3 s intervals is highly time demanding. A computer program with automated scoring algorithm would thus be a valuable asset for sleep professionals scoring RBD. Methods Criteria’s for tonic (2xRMS baseline for >15 s per 30 s epoch), phasic (max amplitude >4 × RMS baseline (or 2 × Tonic), 3 s epochs) and any (tonic and/or phasic) chin EMG activity were implemented in a software algorithm. Sleep stages, respiratory-, arousal- and artifact events were visually scored and imported into the software. Visual scoring of EMG activity done by a blinded board-certified sleep professional was compared to the software algorithm by regression analysis and Kappa statistics. A total of 31989 3 s epochs in 19 patients with Parkinson’s disease (PD) were evaluated (mean age 65.2 ± 9.7, 10 RBD+, 9 RBD−). Results Total percentages of tonic, phasic and any muscle activity correlated strongly between the software algorithm and visual scoring ( R 2 > 0.97 for all activities). Cohen’s Kappa indicated very high agreement on individual events (0.73 for tonic, 0.80 for phasic, 0.83 for any activity). A cut-off value of 10% of any activity separated both groups correctly. Bouts of phasic activity were longer in patients with RBD compared non-RBD (375.4 ± 61.1 versus 478.3 ± 88.9, p = 0.014). Conclusion/significance Our software reliably detects altered chin muscle activity in PD patients when excluding artifact corrupted epochs, providing a fast tool for detecting RBD patients and metrics for correlation analysis with clinical variables.

PERFORMANCE ANXIETY AND SLEEP PROBLEMS AS PREDICTORS OF ACADEMIC ACHIEVEMENT

The present study investigated performance anxiety and sleep problems as predictors of academic achievement among a convenience sample of 100 university students (Male = 43, Female = 57).&#x0D; Method: The participants, aged 18 to 25 years, were selected from three different departments of University of Gujrat. Hamilton Anxiety Scale (Hamilton, 1959) and Pre Sleep Arousal Scale (Nicassio, Mendlowitz, Fussell, &amp; Petras, 1989) were individually administered to the participants in their respective departments. Academic achievement was measured in terms of GPA of previous semester of each respondent.&#x0D; Results: The Cronbach Alphas for both the scales for the present sample fell in acceptable range (α = 0 .84 - 0.87). Linear regression analyses indicated that performance anxiety significantly predicted (p &lt;.01, p&lt;.001) of low academic achievement among university students. It was also identified that the higher level of performance anxiety was also a strong predictor (p &lt; .0.001) of sleep problems among students.&#x0D; Conclusions: Discussion includes implications for future research and practices with reference to Pakistani culture.