Sleep History Research Articles

Resilience of adolescents and teenagers with self-limited and genetic-generalized epilepsy during the COVID-19 pandemic.

The study-objective was to determine the emotional impact of the COVID-19 pandemic on children with self-limited and genetic-generalized epilepsy. Patients completed the Children's Depression Inventory-2 (CDI-2) and Multidimensional Anxiety Scale for Children 2nd Edition (MASC-2) questionnaires before and during the pandemic. Via tele-visits, a pandemic-lifestyle survey and Obsession with COVID-19 Scale (OCS) was administered. Fifty subjects with a mean (SD) age of 14.44 (2.97) years and 4.85 (2.97) years of epilepsy were included. Overall, mood (62%), anxiety (61%), sleep (68%) and seizure frequency (88%) were unchanged/improved during the pandemic. There was no significant difference in pre-COVID-19 and during COVID-19 CDI-2 and MASC-2 total T-scores. In 24% with a worsening CDI-2 total T-score, associations included higher total OCS score (p=0.001), poor sleep (p=0.013) and pre-existing psychiatric history (p=0.0450). In 28% with a worsening MASC-2 total T-score, associations included less exercise during the pandemic (p=0.028) and lower maternal education history (p=0.022). On OCS, 6% were in the dysfunctional range. This cohort demonstrated emotional resilience during the COVID-19 pandemic. However, screening is important, as a subgroup experienced disruptive changes, possibly related to modifiable factors, such as sleep and exercise. To determine the impact of the COVID-19 pandemic on children with epilepsy (CWE), 50 CWE completed a pandemic-lifestyle survey. Questionnaires for anxiety and depression completed before and during the COVID-19 pandemic were also compared. Overall, there was no worsening of seizures, anxiety, or depression during the pandemic. During the pandemic, 24% had more depressive symptoms (associations: poor sleep and psychiatric history) and 28% had more anxiety (associations: less exercise and lower maternal education).This cohort showed emotional resilience during the COVID-19 pandemic. Regular screening is important, as some CWE experienced disruptive changes, related to modifiable-factors, such as sleep and exercise.

Many faces of sleep regulation: beyond the time of day and prior wake time.

The two-process model of sleep regulation posits two main processes regulating sleep: the circadian process controlled by the circadian clock and the homeostatic process that depends on the history of sleep and wakefulness. The model has provided a dominant conceptual framework for sleep research since its publication ~ 40 years ago. The time of day and prior wake time are the primary factors affecting the circadian and homeostatic processes, respectively. However, it is critical to consider other factors influencing sleep. Since sleep is incompatible with other behaviors, it is affected by the need for essential behaviors such as eating, foraging, mating, caring for offspring, and avoiding predators. Sleep is also affected by sensory inputs, sickness, increased need for memory consolidation after learning, and other factors. Here, we review multiple factors influencing sleep and discuss recent insights into the mechanisms balancing competing needs.

Predictors of interindividual differences in vulnerability to neurobehavioral consequences of chronic partial sleep restriction.

Interindividual differences in the neurobehavioral response to sleep loss are largely unexplained and phenotypic in nature. Numerous factors have been examined as predictors of differential response to sleep loss, but none have yielded a comprehensive view of the phenomenon. The present study examines the impact of baseline factors, habitual sleep-wake patterns, and homeostatic response to sleep loss on accrued deficits in psychomotor vigilance during chronic partial sleep restriction (SR), in a total of 306 healthy adults that participated in one of three independent laboratory studies. Findings indicate no significant impact of personality, academic intelligence, subjective reports of chronotype, sleepiness and fatigue, performance on working memory, and demographic factors such as sex, ethnicity, and body mass index, on neurobehavioral vulnerability to the negative effects of sleep loss. Only superior baseline performance on the psychomotor vigilance test and ability to sustain wakefulness on the maintenance of wakefulness test were associated with relative resilience to decrements in vigilant attention during SR. Interindividual differences in vulnerability to the effects of sleep loss were not accounted for by prior sleep history, habitual sleep patterns outside of the laboratory, baseline sleep architecture, or homeostatic sleep response during chronic partial SR. A recent theoretical model proposed that sleep-wake modulation may be influenced by competing internal and external demands which may promote wakefulness despite homeostatic and circadian signals for sleep under the right circumstances. Further research is warranted to examine the possibility of interindividual differences in the ability to prioritize external demands for wakefulness in the face of mounting pressure to sleep.

Effectiveness of Titratable Oral Appliance in Management of Moderate to Severe Obstructive Sleep Apnea-A Prospective Clinical Study with Acoustic Pharyngometry.

To assess effectiveness of titratable Oral Appliance (OA) in management of moderate to severe cases of Obstructive Sleep Apnea (OSA). Thirty Polysomnography (PSG) diagnosed cases of moderate to severe OSA were subjected to a thorough cranio-facial-dental evaluation, a detailed sleep history and three dimensional assessment of upper airway geometry utilising Acoustic Pharyngometry (AP) (Eccovision, sleep group solutions). A titratable OA was delivered to all patients for mandibular advancement. Apnea Hypopnea Index (AHI), Oxygen Saturation (SPO2), Epworth's Sleepiness Scale (ESS), Mean area and volume of upper airway were recorded at Baseline (T0) and after 08weeks of appliance delivery (T1). The mean AHI & ESS scores were significantly lower and SPO2 was significantly higher at T1 compared to T0 (P-value < 0.05 for all). The mean area and volume of upper airway at T1 were significantly higher compared to values at T0 (P-value < 0.05 for both). The mean area showed 19.51% increase at T1 whereas mean volume increased by 18.55%. OA therapy is highly efficacious in cases with moderate to severe OSA, especially, in those with retrognathic mandible. This modality should be considered as an effective alternate to Continuous Positive Airway Pressure (CPAP) therapy in non-compliant patients rather than no treatment. AP is an effective modality to predict airway changes after advancement with OA, to ascertain follow up changes and is highly recommended in routine clinical practice. Large scale, multicenter studies are recommended to elaborate the findings of the present study and to add better quality evidence in this regard.

Towards Validating the Effectiveness of Obstructive Sleep Apnea Classification from Electronic Health Records Using Machine Learning.

Obstructive sleep apnea (OSA) is a common, chronic, sleep-related breathing disorder characterized by partial or complete airway obstruction in sleep. The gold standard diagnosis method is polysomnography, which estimates disease severity through the Apnea-Hypopnea Index (AHI). However, this is expensive and not widely accessible to the public. For effective screening, this work implements machine learning algorithms for classification of OSA. The model is trained with routinely acquired clinical data of 1479 records from the Wisconsin Sleep Cohort dataset. Extracted features from the electronic health records include patient demographics, laboratory blood reports, physical measurements, habitual sleep history, comorbidities, and general health questionnaire scores. For distinguishing between OSA and non-OSA patients, feature selection methods reveal the primary important predictors as waist-to-height ratio, waist circumference, neck circumference, body-mass index, lipid accumulation product, excessive daytime sleepiness, daily snoring frequency and snoring volume. Optimal hyperparameters were selected using a hybrid tuning method consisting of Bayesian Optimization and Genetic Algorithms through a five-fold cross-validation strategy. Support vector machines achieved the highest evaluation scores with accuracy: 68.06%, sensitivity: 88.76%, specificity: 40.74%, F1-score: 75.96%, PPV: 66.36% and NPV: 73.33%. We conclude that routine clinical data can be useful in prioritization of patient referral for further sleep studies.

Early objective adherence to hypoglossal nerve stimulation therapy.

To assess early adherence to therapy with hypoglossal nerve stimulation therapy. This is a prospective study of consecutive patients with moderate to severe obstructive sleep apnea who underwent implantation of hypoglossal nerve stimulation therapy within a single academic practice and attended a follow-up appointment after greater than 30 days of therapy use. Objective adherence data were extracted from an objective monitoring database and compared to patient characteristics. The study population was 79 participants who were 29.1% female with a mean age of 58.7 ± 12.8 years old, body mass index of 28.9 ± 3.4 kg/m2, and baseline apnea-hypopnea index of 33.8 ± 17.6 events/h. In the first 7 days after device activation, average use was 7.8 h/night, with 91.9% of nights with greater than 4 hours of therapy use and an average of 0.2 pauses in therapy per night. These figures remained stable after 30 days of use: 7.7 h/night, 91.0% of nights longer than 4 hours, and 0.3 pauses per night. Objective evidence of difficulty with acclimatization was associated with age less than 60 years (odds ratio 2.8, 95% confidence interval 1.1-7.1, P = .03) and a history of prior upper airway surgery (3.9, 1.2-11.9, P = .015). Insomnia was present in 31 patients and was not associated with objective evidence of difficulty tolerating therapy. Early adherence to hypoglossal nerve stimulation is excellent (92.4% >4 hours on >70% of nights), suggesting that the acclimatization period is straightforward in most. Younger age and a history of prior upper airway surgery appear to be associated with an increased risk of difficulty with acclimatization. Huyett P. Early objective adherence to hypoglossal nerve stimulation therapy. J Clin Sleep Med. 2022;18(2):631-636.

Brain tumours result in sleep disorders in children and adolescents

Background and objectivesSleep disturbances are frequently reported in children with brain tumours. The objective of our cross-sectional study was to systematically examine sleep in these children. We hypothesised that children with tumours involving the sleep-wake-regulatory areas have an altered sleep-wake-regulation. MethodsSixty-one patients aged 0–18 years and with a diagnosis of a primary brain or cervical medullary tumour were included. They were categorised based upon tumour location into two groups – those affecting the sleep-wake regulatory regions, i.e. brain stem, basal forebrain, hypothalamus, thalamus, and posterior fossa compressing the brain stem and those that did not. Sleep history, questionnaire surveys, polysomnography, and multiple sleep latency test were used, as indicated clinically. Surveys included Pediatric Daytime Sleepiness Scale, Children's Sleep Habits Questionnaire, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale. ResultsPatients with tumours involving the sleep-wake regulatory areas were sleepier/more fatigued (p = 0.03). Sleep apnoea was observed in 86% of all the patients and comorbid narcolepsy in 8%, without group differences (p ≥ 0.12). Patients with tumours involving the sleep-wake-regulatory areas had more emotional problems (p = 0.04), were more affected by mental health problems (p < 0.001), and had poorer quality of life (p ≤ 0.03). ConclusionsMany children with brain tumours suffer from disturbed sleep, poor mental health, and low quality of life. We recommend that systematic sleep evaluation is included in their routine care along with psychological and social support.

Dim light in the evening causes coordinated realignment of circadian rhythms, sleep, and short-term memory

Light provides the primary signal for entraining circadian rhythms to the day/night cycle. In addition to rods and cones, the retina contains a small population of photosensitive retinal ganglion cells (pRGCs) expressing the photopigment melanopsin (OPN4). Concerns have been raised that exposure to dim artificial lighting in the evening (DLE) may perturb circadian rhythms and sleep patterns, and OPN4 is presumed to mediate these effects. Here, we examine the effects of 4-h, 20-lux DLE on circadian physiology and behavior in mice and the role of OPN4 in these responses. We show that 2 wk of DLE induces a phase delay of ∼2 to 3 h in mice, comparable to that reported in humans. DLE-induced phase shifts are unaffected in Opn4-/- mice, indicating that rods and cones are capable of driving these responses in the absence of melanopsin. DLE delays molecular clock rhythms in the heart, liver, adrenal gland, and dorsal hippocampus. It also reverses short-term recognition memory performance, which is associated with changes in preceding sleep history. In addition, DLE modifies patterns of hypothalamic and cortical cFos signals, a molecular correlate of recent neuronal activity. Together, our data show that DLE causes coordinated realignment of circadian rhythms, sleep patterns, and short-term memory process in mice. These effects are particularly relevant as DLE conditions-due to artificial light exposure-are experienced by the majority of the populace on a daily basis.

Cortical thinning and sleep slow wave activity reductions mediate age-related improvements in cognition during mid-late adolescence

Study ObjectivesGains in cognitive test performance that occur during adolescence are associated with brain maturation. Cortical thinning and reduced sleep slow wave activity (SWA) are markers of such developmental changes. Here we investigate whether they mediate age-related improvements in cognition.Methods109 adolescents aged 15–19 years (49 males) underwent magnetic resonance imaging, polysomnography (PSG), and a battery of cognitive tasks within a 2-month time window. Cognitive tasks assessed nonverbal intelligence, sustained attention, speed of processing and working memory and executive function. To minimize the effect of sleep history on SWA and cognitive performance, PSG and test batteries were administered only after at least 8 nights of 9-h time-in-bed (TIB) sleep opportunity.ResultsAge-related improvements in speed of processing (r = 0.33, p = 0.001) and nonverbal intelligence (r = 0.24, p = 0.01) domains were observed. These cognitive changes were associated with reduced cortical thickness, particularly in bilateral temporoparietal regions (rs = −0.21 to −0.45, ps < 0.05), as well as SWA (r = −0.35, p < 0.001). Serial mediation models found that ROIs in the middle/superior temporal cortices, together with SWA mediated the age-related improvement observed on cognition.ConclusionsDuring adolescence, age-related improvements in cognition are mediated by reductions in cortical thickness and sleep SWA.

Effects of hospitalization on children's sleep pattern irrespective of sleep problems history.

El sueño es un proceso neurofisiológico necesario para el desarrollo cerebral cuyos patrones varían con la edad. El objetivo de este estudio fue comparar el comportamiento del patrón del sueño en niños con y sin problemas previos del sueño (PPS) durante las primeras 48 horas de hospitalización, y analizar los factores influyentes en la interrupción del sueño. Se realizó un estudio de cohorte prospectivo. Con el consentimiento informado, se siguieron dos grupos de pacientes < 17 años ingresados al área de hospitalización por diversas enfermedades agudas. El antecedente de PPS se determinó con el Cuestionario breve del sueño. El patrón del sueño se observó por 48 horas y se registraron las horas totales de sueño diario, los minutos para conciliar el sueño nocturno, los minutos de despertares nocturnos y las siestas diurnas. Se registraron las acciones médicas asociadas con el tiempo de sueño. En promedio, la duración total de las horas de sueño por día aumentó una hora en los pacientes con PPS, mejorando la higiene de sueño en este grupo. En el grupo de niños sin PPS se observó una disminución transitoria de las horas totales de sueño y un incremento en el tiempo para dormirse, los minutos de siestas diurnas y las vigilias nocturnas. El sonido de las alarmas, la colocación de venoclisis y de sondas de drenaje, así como la entrada y salida del personal de salud a las habitaciones, fueron identificados como factores de interrupción del sueño. La hospitalización altera los patrones del sueño, sobre todo en niños sin problemas previos del sueño. Se recomienda explorar los patrones del sueño en los niños hospitalizados y reducir, en lo posible, los factores externos asociados a su perturbación. Sleep is a neurophysiologic process necessary for brain development. However, sleep patterns change with aging. This study aimed to compare the sleep pattern in pediatric patients with and with no previous sleep problems (PSP) during the first 48 hours of hospitalization and analyze the factors influencing sleep disruption. We conducted a prospective cohort study. Under informed consent, two groups of patients < 17 years admitted to a hospital for acute illnesses were followed. The history of PSP was determined with the Brief sleep questionnaire. For 48 hours, the sleep pattern was observed in terms of total hours of daily sleep, daytime naps, night awakenings, and time to fall asleep. We recorded actions of attention associated with sleep time. Patients with PSP showed an increased total duration of sleep hours per day by an average of one hour, improving the sleep pattern. In patients with no PSP, the total hours of sleep diminished transitorily and the time elapsed to initiate sleep, the number of daytime naps, and night awakenings increased. Alarms sound, the presence of vein catheters and tubes, and the entry and exit of healthcare personnel to the rooms were identified as critical factors of sleep interruptions. Hospitalization alters sleep patterns, especially in children without previous sleep problems. We recommend exploring sleep patterns in all hospitalized children and reducing external factors associated with their disturbance as much as possible.

Sport Specialization and Quality of Life among Middle- and High-School Long-Distance Runners of Different Injury Status: A Retrospective Study

ABSTRACT Running-related injuries are prevalent in adolescent long-distance runners. The aim of our retrospective study was to compare differences in sport specialization, running habits,quality of life, and sleep habits among middle-and high-school long-distance runners of different injury statuses. Middle- and high-school long-distance runners across the United States were recruited via cross-country coaches and athletic directors between January and May 2020. Participants completed an online survey with questions related to demographics, sport specialization, running habits, quality of life, sleep, and self-reported injury history. Overall, 306 participants completed the survey (male = 107, female = 176, unspecified = 23; age = 15.7 ± 1.1 years). Of the participants, 178 (58.2%) reported no history of injury, 101 (33.0%) reported a previous injury, and 27 (8.8%) reported a current injury. Middle- and high-school runners with a current injury reported significantly lower overall health (p= .01) and average distance per run (p = .05) than uninjured runners. No significant differences were found among injury status and sport specialization level, quality of life, sleep habits, or running volume (p> .05). Runners with a self-reported previous or current injury do not appear to be classified as high-specialized runners more frequently than uninjured runners.

P-SP003. Idiopathic central sleep apnea with periodicity presenting as cheyne-stokes breathing

Introduction . Cheyne-Stokes breathing (CSB) is described by a cyclic variation in breathing with periods of central apneas or hypopneas alternating with periods of hyperpneas in a gradual waxing and waning manner. We describe this rare case of idiopathic central sleep apnea coming in a periodic fashion presenting as CSB pattern without specific causes. Results . A 72-year-old male (body mass index: 21.9 kg/m 2 ) with the complaints of excessive daytime sleepiness and fatigue for about 2 years. On detailed sleep history patient denied snoring, cataplexy, hypnogogic hallucination, sleep paralysis and sleep attack. No neurological deficit was seen in clinical evaluation. ENT evaluation was normal. Cardiac evaluation showed artrial fibrillation with no cardiac failure. An overnight Polysomnography (PSG) test showed total sleep time of 443 minutes, sleep latency of 19.0 min, and sleep efficiency of 70.0%. Sleep architecture for stage 1 sleep was 31.7%, stage 2 sleep was 52.4%, slow wave sleep was 12.9%, REM sleep was 3.1%. Total arousal index was 21.8/hr. Mean SaO2 was 96.4%, the lowest SaO2 was 82.8%, and SaO2 below 90% was 0.1%. Snoring was not observed and periodic limb movement index was 8.8/hr. PSG also showed cyclic fluctuation in breathing with periods of central apneas; alternating with periods of hyperpneas in a gradual waxing and waning fashion; but cardiac evaluation and magnetic resonance imaging of the brain could not find any cause of this sleep-disordered breathing. Conclusion . The pathogenesis and etiology of CSA is still vague. We think that further studies and follow up will be required to determine whether idiopathic central sleep apnea presenting as CSB pattern is the initial indication of certain diseases. So we concluded that this case was an idiopathic central sleep apnea with periodicity; presenting as CSB pattern.

Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to "Brain Fog".

Study ObjectivesPANS (pediatric acute onset neuropsychiatric syndrome) is thought to be the result of several mechanisms and multiple etiologies, ranging from endocrine/metabolic causes to postinfectious autoimmune and neuroinflammatory disorders. Sleep disorders represent one of the most frequent manifestations of PANS, involving around 80% of patients. The present study describes the clinical and polysomnographic features in a group of PANS children identifying the relationships between sleep disorders and other PANS symptoms.MethodsAll participants underwent a clinical evaluation including comprehensive sleep history, polysomnography, cognitive assessment and blood chemistry examination. A data mining approach with fourth-generation artificial neural networks has been used in order to discover subtle trends and associations among variables.ResultsPolysomnography showed abnormality in 17 out of 23 recruited subjects (73.9%). In particular, 8/17 children (47%) had ineffective sleep, 10/17 (58.8%) fragmented sleep, 8/17 (47.1%) periodic limb movement disorder (PLMD) and 11/17 (64.7%) REM-sleep without atonia (RSWA). Most subjects presented more than one sleep disturbances. Notably, among the 19/23 patients diagnosed with Tic/Tourette disorder, 8/19 (42.1%) show PLMD and 10/19 (52.6%) RSWA. Artificial neural network methodology and the auto-contractive map exploited the links among the full spectrum of variables revealing the simultaneous connections among them, facing the complexity of PANS phenotype.ConclusionDisordered sleep represents, for prevalence and impact on quality of life, a cardinal symptom in patients with PANS. Thus, considering the weight of sleep disturbances on diagnosis and prognosis of PANS, we could consider the possibility of including them among the major diagnostic criteria.

Age Related Effects of Sleep Apnea in Adults: A Polysomnographic Study

Background: Age is a risk factor of obstructive sleep apnea (OSA). It has been shown that OSA progresses over time, full-night polysomnographic sleep study is considered to be the gold standard method for the diagnosis of obstructive sleep apnea syndrome (OSAS). Objective: This study aims to determine the effect of age on sleep apnea patients. Patients and Methods: A cross sectional study that included 95 patients conducted at a sleep laboratory in the ENT Department, Sohag University Hospital and in the Clinical Neurophysiology Unit, Cairo University. The study population age range was (20-60). All participants were subjected to personal history taking, detailed sleep history, medical history, general examination, ENT examination, Epworth sleepiness score (ESS), and polysomnography. Results: Mean age was (43.99 ± 10.96). The male-to-female ratio was 1.7/1.3. Mean BMI was 35.27 ± 7.19. Mallampati score of grade II and III represented the majority of the patients (83.1%). The range of oropharyngeal collapse (tonsil collapse) was ranging from (no collapse-100%), with a mean of (62.31±25.50). The mean value of the Epworth sleep scale score in all patients was 8.09 ± 4.26. The mean of apnea hypopnea index (AHI) was 24.08 ± 28.33. Average O2 was 82.73 ± 31.61. A statistically significant linear correlation was observed between age and BMI, the circumference of the waist and neck, duration of complaints, and collapse of the tonsils (p <0.05). Conclusion: Prevalence estimates of OSA increased continuously with age. Obesity could play an important role in elderly patients with OSAS and BMI could be a significant variable in determining the severity of OSAS in elderly patients.

The Different Faces of Insomnia.

Objectives: The identification of clinically relevant subtypes of insomnia is important. Including a comprehensive literature review, this study also introduces new phenotypical relevant parameters by describing a specific insomnia cohort.Methods: Patients visiting the sleep center and indicating self-reported signs of insomnia were examined by a sleep specialist who confirmed an insomnia diagnosis. A 14-item insomnia questionnaire on symptoms, progression, sleep history and treatment, was part of the clinical routine.Results: A cohort of 456 insomnia patients was described (56% women, mean age 52 ± 16 years). They had suffered from symptoms for about 12 ± 11 years before seeing a sleep specialist. About 40–50% mentioned a trigger (most frequently psychological triggers), a history of being bad sleepers to begin with, a family history of sleep problems, and a negative progression of insomnia. Over one third were not able to fall asleep during the day. SMI (sleep maintenance insomnia) symptoms were most frequent, but only prevalence of EMA (early morning awakening) symptoms significantly increased from 40 to 45% over time. Alternative non-medical treatments were effective in fewer than 10% of cases.Conclusion: Our specific cohort displayed a long history of suffering and the sleep specialist is usually not the first point of contact. We aimed to describe specific characteristics of insomnia with a simple questionnaire, containing questions (e.g., ability to fall asleep during the day, effects of non-medical therapy methods, symptom stability) not yet commonly asked and of unknown clinical relevance as yet. We suggest adding them to anamnesis to help differentiate the severity of insomnia and initiate further research, leading to a better understanding of the severity of insomnia and individualized therapy. This study is part of a specific Research Topic introduced by Frontiers on the heterogeneity of insomnia and its comorbidity and will hopefully inspire more research in this area.

Incidence and predictors of comorbid insomnia in a sleep surgery clinic.

The objective was to determine the prevalence and predictors of comorbid insomnia in patients presenting for sleep surgery evaluation. The insomnia severity index (ISI) was utilized to evaluate patients' insomnia severity. A retrospective chart review was performed in patients presenting to an otolaryngology sleep surgery clinic; patients also completed a sleep history questionnaire. Patients were divided between those with and without clinically significant insomnia defined as ISI ≥ 15. A total of 119 patients were included in the study: 50 (42%) with an ISI ≥ 15 and 69 (58%) with an ISI < 15. Clinically significant insomnia was associated with respiratory disturbance index (P = .028) but not apnea-hypopnea index or SaO2 nadir (P > .05). Clinically significant insomnia was associated with frequency of wake ups (P = .008), time to fall back asleep (P = .049), history of continuous positive airway pressure device use (P = .012), Epworth Sleepiness Scale (P = .008), and Sino-nasal Outcome Test (SNOT-22) (P < .001). Patients reporting to a sleep surgery clinic are at an elevated risk for comorbid insomnia. The relationship between increased respiratory event-related arousals and nonsleep SNOT-22 scores to related sleep-maintenance insomnia supports the connection between insomnia, nasal obstruction, and continuous positive airway pressure intolerance. Sagheer SH, Scott ER, Ananth A, Boon M, Huntley C. Incidence and predictors of comorbid insomnia in a sleep surgery clinic. J Clin Sleep Med. 2021;17(11):2165-2169.

Sleep and interrogation: does losing sleep impact criminal history disclosure?

Study ObjectivesDespite centuries of using sleep deprivation to interrogate, there is virtually no scientific evidence on how sleep shapes behavior within interrogation settings. To evaluate the impact of sleeplessness on participants’ behavior during investigative interviews, an experimental study examined the impact of sleep restriction on disclosure of past illegal behavior.MethodsHealthy participants from a university community (N = 143) either maintained or curbed their sleep (up to 4 h a night) across 2 days with sleep monitored via actigraphy. They were then asked to disclose past illegal acts and interviewed about them. Next, they were reinterviewed following an example of a detailed memory account (model statement). Disclosures were blindly coded for quantity and quality by two independent raters.ResultsSleep-restricted individuals reported similar offenses, but less information during their disclosure with slightly less precision. Model statement increased disclosure but did not reduce the inhibiting impact of sleep loss. Mediation analysis confirmed the causal role of sleep as responsible for experimental differences in amount of information, and participants’ reports suggested impaired motivation to recall information played a role.ConclusionsThe findings suggest that even moderate sleep loss can inhibit criminal disclosure during interviews, point to motivational factors as responsible, and suggest investigators should be cautious when interrogating sleepy participants.

847 Rapid Improvement of Pulmonary Hypertension with Adequate Ventilatory Support in Patient with Prader-Willi Syndrome

Abstract Introduction Prader-Willi syndrome (PWS) is a genetic multi-system disorder characterized by developmental delay, hyperphagia, and often morbid obesity. Patients can have impairments in ventilatory control and are at risk for sleep disordered breathing due to craniofacial abnormalities, obesity, hypothalamic dysfunction, hypotonia and respiratory muscle weakness. This places them at higher risk for obstructive sleep apnea (OSA), hypoventilation and, if left untreated, may lead to cardiovascular complications. We present a patient with pulmonary hypertension (PH) in the setting of PWS and under supported OSA. Report of case(s) A 17-year-old female with PWS, obesity, type II diabetes mellitus, developmental delay and severe OSA, non-adherent to positive airway pressure (PAP) therapy, presented with 6 months of pedal edema, weight gain with acute shortness of breath, fatigue, and decreased appetite. Upon arrival she developed hypoxemic, hypercapnic respiratory failure requiring intubation. Echocardiogram two months prior to admission showed normal right ventricular size and function with normal septal configuration. Echocardiogram after intubation showed signs of PH with dilated and hypokinetic ventricles compared to prior exam, worsening tricuspid valve regurgitation, and septal bowing. Sleep history was notable for severe OSA in 2017 with obstructive apnea-hypopnea index (oAHI) of 22.6, oxygen nadir of 74%, peak transcutaneous pCO2 of 51 mmHg. Patient was lost to follow-up and as per our history, was non-adherent to PAP therapy. On admission she was started on aggressive diuresis and tadalafil. After successful extubation to BPAP and wean to room air while awake, a BPAP titration PSG was performed. It demonstrated low baseline oxygen saturations (93%), an oxygen nadir of 70%, transcutaneous CO2 peak of 57mmHg with obstructive events eliminated with BPAP of 24/14 cmH20 and hypoxemia treated with 4L supplemental oxygen. With adequate respiratory support with sleep combined with PH monotherapy, repeat echocardiogram prior to discharge showed improved systolic function and only mild septal flattening. Conclusion It is unclear the prevalence of PH in patients with PWS independent of OSA, however it is likely increased overall secondary to the increased prevalence of OSA. As a result, patients with PWS may benefit from routine interval echocardiogram to monitor for signs of PH. Support (if any):

154 Cortical thickness and sleep slow wave activity mediates age-related improvements in cognition during late adolescence

Abstract Introduction Adolescence is a period of rapid brain maturation, and studies have independently documented reductions in cortical thickness, reduced sleep slow wave activity (0.5-4Hz), and improved cognition as a child transitions into adulthood. In the present work, we investigate whether these factors interact in late adolescence. Methods 114 adolescents aged 15-19y (52 males) underwent a structural MRI scan, polysomnography (PSG) and a series of cognitive tests assessing fluid intelligence, sustained attention, speed of processing and working memory. As sleep history has been known to affect EEG measures of slow wave activity, actigraphic recordings ensured that participants received 9h of night the week prior to the PSG session. Cognitive scores were combined to obtain a single measure of global cognition. For assessment of cortical thickness, the Freesurfer (v5.3) pipeline was used to obtain measures for all regions of interest from the Desikan-Killiany cortical atlas. Pearson correlations were conducted to independently confirm associations between aging and reductions in cortical thickness, slow wave activity and improved global cognition, controlling for sex. Finally, a serial mediation model (SPSS PROCESS Model 6) was performed to test the mediating role of cortical thickness and slow wave activity between aging and global cognition. Results Reductions in EEG sleep slow wave activity, cortical thickness and improved global cognition was observed with increasing age, likely representing synaptic pruning and a decrease in waking metabolic activity that contributes to increased overall neural efficiency. Regions in the temporal and parietal areas showed the steepest age-related reductions. In addition, the age-related improvement in cognition was found to be mediated by both cortical thinning as well as reduced SWA activity, particularly in the middle temporal cortex. Conclusion The adolescent brain undergoes rapid growth in preparation for adulthood. Cortical restructuring through pruning of neural circuits during this period is associated with reduced slow wave activity, mediating the age-related improvement in cognition. Future work should investigate whether insults to the brain during this critical period alters this trajectory. Support (if any) This work was supported by grants awarded to Michael Chee (NMRC/STaR/015/2013, NRF2016-SOL002-001 and the Far East Organization).

689 Objective Assessment of Inpatient Sleep Patterns and Quality: A Pilot Study

Abstract Introduction Sleep disruption is common among hospitalized patients due to psychological, physiological, and environmental reasons including illness, pain, anxiety, invasive interventions, frequent monitoring, and stimuli, especially noise and light. The AASM has published guidelines for the use of actigraphy in the outpatient setting, but there is a paucity of literature evaluating the validity of actigraphy in inpatients. The aim of this study is to evaluate sleep in hospitalized general medicine patients undergoing sleep medicine consultation using actigraphy and qualitative surveys. Methods A single-site prospective study in hospitalized medicine patients. Patients were observed with a Fitbit® Charge3 wrist actigraphy device overnight, then administered 7 surveys: Richards-Campbell Sleep Questionnaire (RCSQ), qualitative questionnaires assessing sleep history, sleep hygiene, barriers to sleep, STOP-BANG, Epworth Sleepiness Scale (ESS), and Patient-Health Questionniare-2 (PHQ-2). Actigraphy data including total sleep time, slow wave sleep time, and number of awakenings was compared with patient-reported data. Results In preliminary analysis, six patients met inclusion criteria and underwent sleep medicine consultation, overnight actigraphy, and completed 7 surveys. Based on subjective sleep history questionnaires, average total sleep time was 437 + 215 minutes. Actigraphy revealed average total sleep time was 228 + 80 minutes with an average of 3.6 nocturnal awakenings. Increased number of awakenings on actigraphy was not correlated with increased number of awakenings by survey. The most frequently reported barriers to sleep on patient surveys were pain and being woken up for labs or vital signs. The average STOP-BANG score was 6 out of 8 and average ESS was 14 out of 24. Conclusion Restorative sleep warrants consideration alongside complex medical care during hospitalization. Patients experience decreased total sleep time and increased number of awakenings while in the hospital compared with their subjective estimates of sleep at home. Actigraphy provides a non-invasive and reliable way to monitor some sleep parameters in the inpatient setting. An elevated STOP-BANG score could represent sleep disordered breathing and impact perceptions of sleep quality. Patient-identified barriers to sleep are targets for quality improvement. Future studies should compare inpatient actigraphy data to polysomnographic data and the effect of sleep-directed interventions on sleep quality in the hospital. Support (if any):